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Chapter I THE PROBLEM AND ITS SETTING INTRODUCTION Nursing care through the years has become a distinct

and autonomous service in the hospital. Nursing practice is grounded on evolving theories that explore the individual who is in need of care, and the nature of caring itself. The first research endeavor was to study the impact of hospital restructuring on the nursing workforce and patient outcomes. More than 43,000 nurses in 700 hospitals in the US, Canada, England, Scotland, and Germany were surveyed. They found extensive problems in the organization and design of work in North America and Europe, confirming reports that stress, burnout, and job dissatisfaction was not unique to US hospital nurses. In each case, more than half the nurse respondents reported there were not enough nurses to provide high quality care. With the exception of Germany, at least 1 of 3 nurses had high levels of burnout. In those nurses under the age of 30, at least 25% planned to leave their job within a year; in England more than 50% intended to leave. Nurses were in agreement that working relationships with physicians were good, however across the board nurses reported that their hospitals did not provide the support services needed to get their job done, and less than half felt that administration listened and responded to their concerns. At least 1 in 3 nurses were routinely performing non-nursing tasks, such as delivering and retrieving food trays, transporting patients, coordinating and even performing ancillary services. At the same time, nursing tasks were not being attended to, such as oral and skin care,

teaching patients and families in preparation for discharge, and talking with or comforting their patients.( Aiken LH 2008) In a three year analysis survey of patients satisfaction carried out in Germany, Sweden, Switzerland, the United Kingdom and United States, it was found that patient satisfaction surveys could assist in local quality improvement efforts and facilitate the identification of poor quality care for further investigation and interventions among others. It was clear from the survey that in all the five countries, patients were

commonly concerned (or dissatisfied) with information and education, coordination of care, respect for patients preferences, emotional support, physical comfort, involvement of family and friends, and continuity and transition of care. Fitzpatrick also noted similar concerns from patients/Patient assessment of the hygiene of maternity facilities and health service providers were favorably rated. More than 90% of respondents rated hygiene in the admission room and health service providers as good or very good. A lower percentage of the respondents, less than 20%, rated hygiene in the toilets and showers of the antenatal and postnatal rooms as being either poor or very poor. 99.1% of respondents found their relationship/interaction with the health care provider either good or very good. And 97.3% of the women interviewed were either satisfied or very satisfied with the care that they received. When asked what they liked most about Chatinkha Maternity Unit, 65% of the participants responded that they liked the reviews done by doctors and nurses. Less than 3% of the participants disliked Chatinkha Maternity Unit because of either delayed attendance or infrequent doctors/nurses reviews or unnecessary prolonged stay. The highest percentage of the participants disliked Chatinkha Maternity

Unit for reasons other than the ones specified in the questionnaire.( Josephine Changole 2010) The main aim of this study was to determine patient satisfaction with nursing care (PSNC) in the medical wards of the UP-Philippine General Hospital (UP-PGH) using a valid and reliable locally developed UP-PGH PSNC questionnaire. Methods. The survey utilized a cross-sectional study design and was conducted in the medical wards of the UPPGH in 2006. A total of 237 patients were included in the survey. Results. Over a third or 34.3% (95% CI 28%, 40%) and 35% (95% CI 26%, 44%) were highly satisfied with their experience regarding the nurses caring attitude and the nurses skill/competence respectively. Fewer respondents were highly satisfied with the nurses as information providers, with only 17.2% (95% CI 12%, 22%) saying they were highly satisfied. A little over half or 57.8% (95% CI 52%, 64%) were highly satisfied in the overall evaluation of care. Conclusion. The patients were satisfied with the nursing care provided in two dimensions: The nurse as a caring person and the nurse as a skilled and competent health care provider, although only about a third indicated that they were highly satisfied. Nevertheless, 57.8% were highly satisfied in the overall evaluation of care, but these patients may have considered other hospital services and cost. Other factors that might affect patient satisfaction need to be explored and the use of other evaluation tools to augment these findings is recommended.(Maurice, edsel T. 2012) In the Philippine setting, the recent exodus of skilled nurses and the reported inadequacy of health care staff in the hospitals have also significantly affected quality of care. This might pose a problem on staffing of nurses. For example, in one of the tertiary

hospitals of the Philippines with a bed capacity of 1500; one thousand beds are intended for charity patients, and the remainder are for pay patients and special units. In this institution, wards are understaffed, with a typical nurse- patient ratio of 1:15, whereas the ideal nurse-patient ratio is 1:4 as stated by (Simbulan 2008). In addition, the understaffing problem is even greater in the charity wards than in the pay wards, with typical ratios of 1:15 in the charity wards and 1:8 in the pay wards per shift. This ultimately restricts the time of nurses to attend to patients and perform independent nursing functions. The insufficient time limits the nurses performance to those that are routine-based physiologic interventions and simple obedience to the doctors orders. Interventions that are responsive to the expressed need of the patient and that are holistic and critical are rather stepped aside in the course of the nurses care. (Simbulan 2008) Competent, volunteer nurses working for free and new nursing graduates undergoing training to enter the profession are two separate issues that should be treated separately, an official of a government hospital here said. Dr. Leopoldo Vega, head of the Southern Philippines Medical Center (SPMC), however said the government hospital does not tolerate exploitation of competent, professional nurses doing voluntary work but insisted that nurses fresh out of school need a year or two of training before entering the profession to reduce medical errors. Training is very important because after the nurses college years and the board exams, there is a wide gap between academe and practice. In order to minimize medical errors from dosages, administration, execution of clinical plans, the nurse has to undergo training, he said. He said new nursing graduates need to pay for the training, which includes training on IV, ICU, and other ward systems.

These are people accredited by Association of Nursing Service Administrators (ANSA) so theres a certain payment for the honorarium of instructors, and fees for lectures, Vega said.(Germelina Lacorte 2011) In pursuit of nursing excellence, DDH sets standards of nursing practice, defining conditions and performance considered essential in ensuring the quality of nursing care. True to its tag line "We Care for Life", the Nursing Service Department aims to satisfy the needs of external and internal clients for whom each personnel perform his or her own unique functions. To strengthen the nursing service, DDH organizes a General Orientation Program (GOP) training of new nurses. The GOP Training us a 45-day training program, composed of a 5-day didactic phase followed by a 6-week clinical exposure. This aims to provide basic orientation on hospital policies and procedures with emphasis on the specific aspects of the Nursing Care Delivery System. After the

program, nurse trainees are expected to: 1) gain in-depth understanding of the nurse's role through exposure to everyday practice; 2) perform nursing duties with increased competence and confidence in the practice setting; and 3) have a feeling of satisfaction as a result of professional nurturance. Meanwhile, the nurse mentor is expected to: 1) gain new learning in the process of training the nurse trainee; 2) identify strengths and weakness of the preceptorship program and will recommend areas for improvement; and 3) gain confidence in her role as nurse preceptor.

THEORETICAL FRAMEWORK Multidimensional Systems for Evaluating the Performance of Health Organizations 1. The patient role Usually, words as patient, user and consumer are indistinctly used as synonyms, even though they differ for the nature of relationships between health professionals and citizens. While the patient is a person who has an illness and comes to doctors and nurses asking for advice and treatment, the user may identify people who used, use or could use health care services. Instead, the consumer reminds us of a person who purchases goods and services for his needs or a person who consumes something (Herxheimer and Goodare, 1999). According to McIver (1992) in 1980s a general shift towards consumerism, evident in UK National Health System, increased the promotion of a customer service-oriented culture. Thus, even though the use of consumer concept in health care mainly received a wide opposition from the medical establishment (Wassersug, 1986) because of its strong commercial connotation (Blaxter, 1995; Leavy et al 1989, Normand, 1991), the consumerism movement introduced in health systems the issue of the protection of the consumers interests. Patient becomes a consumer when he looks for health services after having collected all information helpful to make the best choice (Shackley and Ryan, 1994). In this regard, researchers questioned: Can patient fulfill the role of consumer? And more, does patient wish to fulfill it? (Owens and Batchelor, 1996). In 2002 a study conducted in eight European countries (Germany, Italy, Poland, Slovenia, Spain, Sweden, Switzerland and UK) highlighted that patients ask for a more autonomous role in the health care decision-making process and, then, for more

information, 14 equitable access, freedom of choice, prompt attention, respect and quality of amenities (Coulter and Jenkinson, 2005). Nonetheless, consumers of health care still are often not well and sufficiently informed. This information asymmetry causes an imbalance in the relationship between who asks for health services and who provides them. Even though much effort has been put into these issues, the Health Care Systems still have to work in order to move away from the idea of patient as a passive and dependent stakeholder. 2. Patient satisfaction: a complex concept In 1990s researchers, health policy-makers and managers gave more attention to the patient perception of the quality of health services (Behm et al., 2000). In these years, the patient satisfaction studies have increased as shown by a PubMed search for patient satisfaction or customer satisfaction Despite its large use, the patient satisfaction was initially considered as a difficult concept to be measured and interpreted (Fitzpatrick & Hopkins, 1983; Williams, 1994). An unanimous consensus on the definition of

satisfaction with healthcare is not already fully achieved (Avis et al, 1996; Baker, 1997) due to the multidimensional and subjective nature of this concept, which is affected by individuals expectations, needs or desires. For example, when users have limited knowledge of opportunities and low expectations of service quality, high satisfaction scores may be recorded even though poor standards of care have been ensured. Factors influencing dissatisfaction could be somewhat different from factors generating satisfaction. While on one side an adequate or acceptable standard of 15 qualities might be considered as necessary, on the other, a feeling of satisfaction might result from an

high quality service. Moreover, when something negative happens consumers might be satisfied or not; for instance, this depends on whether the negative event is caused by the health professionals or it is not due to their behavior (Williams et al, 1998). Thus, it is possible that what makes one person satisfied might make another one dissatisfied (Avis et al, 1996; Greeneich, 1993). These ambiguities related to the patient satisfaction concept enhance the debate among researchers, health professionals and managers. In recent years, new approaches have also been evaluated and adopted in order to introduce more objective measures of the services quality. For instance, researchers ask people to report in detail their experience with health service using reporting and rating scales. The obtained results could be considered more helpful in order to identify weaknesses in the delivery and organization of the health services (Jenkinson et al, 2002). Sometimes, also patients willingness to use again and/or recommend services (e.g., hospital, general practitioner, etc.) is investigated as a reliable proxy of overall evaluation both in not for profit and in market-based health systems. 3. Patient satisfaction measurement A critical aspect in the patient satisfactions measurement is that models and instruments sometimes reflect the providers perspective rather than the patients one (Calnan, 1988). For example, the patient capability to evaluate health services and professionals skills is frequently questioned (Ben-Sira, 1976; Rao et al, 2006), even when these items receive high satisfaction rates. According to Hopkins et al. (1994) patients are less capable of judging technical competence because of a real informative asymmetry and in any case they are more reserved in expressing critical comments with

regard to the abilities of doctors. As a consequence, the high satisfaction scores observed may depend on the confidence in doctors capabilities. Instead, Coulter (2006) argued that well designed questionnaires allow to assess both the technical competence and interpersonal skills of health professionals. The patient satisfaction measurements have been generally used in order to provide researchers, health managers and professionals with valuable information for understanding patients experience, promoting patients compliance with treatment, identifying the weaknesses in services and evaluating health service performance (Fitzpatrick, 1984; Sitzia and Wood, 1997). 16 Although the debate on the use of patient satisfaction as an outcome measure is still open (Reker et al, 2002; Norquist, 2009), it has been observed that satisfied patients are more compliant and more likely to participate in their treatment (Stewart, 1989; Guldvog, 1999). In fact, a satisfied patient is more aware of his care pathway and more willing to follow the physician prescriptions. As said before, the level of satisfaction depends on several and different elements. For instance, healthy people tend to be more satisfied when they receive general information on health services and on their quality; on the contrary, people with a chronic condition may be more satisfied if involved in the decision-making process (Cleary, 1997). Thus, the improvement of patient compliance requires adopting different actions depending on the patients profile. The assessment of patient satisfaction with the process of care is an important measure of the care quality and it allows to identify the phases of the process to be improved. Questionnaires using report style questions allow to observe how the care is delivered (Wensing et al, 2003; Leeper et al, 2003). Some studies have highlighted that satisfaction strongly increases when care is provided in accordance


with the clinical standard procedures (Lantz et al, 2005; Marchisio et al, 2006). Furthermore, the patients point of view may help managers to evaluate activities such as the purchase of new technologies or the test of new medical treatments (Hopkins et al, 1994; Goulrey and Duncan, 1998; Dunlop et al, 2003; Ahmad et al, 2008; Van Koulil et al, 2009). 4. Patient experience; A new perspective for performance evaluation systems in health sector. A famous statement on the performancequalitymanagement relationship argues: The ultimate goal is to manage quality. But you cannot manage it until you have a way to measure it, and you cannot measure it until you can monitor it (Eagle et al., 1993). Thus, a question is: how to measure the quality in health care? In most cases, managers and policy-makers who have approached performance measurement agreed with Donabedians (1988) definition of health quality as a comprehensive concept including both service characteristics (structure, organization, care process) and patient satisfaction. In the last years, several health care services have adopted multidimensional evaluation systems in order to monitor the outcome of health programs (Katesa et al., 2001) as well as the performance of organizations (Arah et al., 2003).


A Thesis Presented to the Faculty of Nursing Department Holy Child College Davao Davao City

In Partial Fulfillment Of the Course Requirement in Nursing Research 2 For the Degree in Bachelor Science in Nursing





Patients role

Patients satisfaction

Patients Satisfaction Measurement

Patients Experience

In the conceptual framework of this study that follows, the illustration shows that the dependent variable is Care Rendered by Nurses, and dependent variable is Level of patient satisfaction. CONCEPTUAL FRAMEWORK INDEPENDENT VARIABLE Level of patients satisfaction DEPENDENT VARIABLE Care rendered by nurses


STATEMENT OF THE PROBLEM This study sought to determine the relationship between quality of patient care given by nurses and patients satisfaction. Specifically, it aimed to answer the following questions: 1. What is the demographic profile of patient in terms of: Age

2. What is the level of quality on patient care delivered by nurses? a. as a caring person b. as a skilled person c. as a competent health care providers 3. What is the level of patient satisfaction on the care given by nurses?

SCOPE AND DELIMITATION The subjects of the study was the patients admitted in the Southern Philippines Medical Center OB ward; a set of inclusion criteria were considered in choosing the participants of the study, which consisted of (1) being a OB patient; (2) at age 16 24 years old; (3) having the ability to understand and speak Filipino; (4) and having no mental illness, this study would last up to 6 months (June to November), and with a minimum of 41 respondents.


SIGNIFICANCE OF THE STUDY The study is believed to be relevant in nursing profession and for the community in establishing a link between the nurses and caring for a patient. That the result of the research will be useful for both the non nursing profession and nurses to help provide a tender loving and efficient care to their patients. And also to determine or to discover other barriers that may affect quality nursing care by nurses in satisfying patients, thus it will be useful to develop or improve the ways on how these nurses will deliver care. Findings of this study were deemed significant to the following: Nursing Administration. The study aimed to provide significant contributions toward improvement of the overall health care delivery system in carrying out nursing care for hospitalized patients. In the long run, this would be beneficial to the entire health institution, for the patients trust and satisfaction in the capabilities of the care service would be improved. Nursing practice. Through this study the nurses were made aware of their nursing care rendered to different patients in different institutions by means of nursing interventions to help in patients recovery. Patient. Given that the researchers valued patients satisfaction, this study was focused on the ways to promote good health service given by nurse to satisfy patients. Nurse. Determining the patients satisfaction on the care rendered by nurse could push and strive harder in rendering quality care to patients. And also this will be significant by knowing their weakness and strengths so that they could work or change it in order to provide much effective nursing care.


Nursing Education. In clinical education, assessment of students in clinical practice was imperative in order to ensure that those who become registered nurses are safe and competent practitioners. The study could contribute to the improvement of the way nursing students deliver care thus contributing to the development of nursing education and enrichment of nursing research pertinent in patients satisfaction. A significant relationship between the clinical performance of nursing students and patient satisfaction would provide another dimension by which the nursing students clinical performance would be evaluated. Nursing Research. The study could supplement and support the previous research study and could be used in correlation with other studies and reviews like that of about the effects of profile variables on patient satisfaction, so that the researchers would be able to have comprehensive reviews reevaluation. It could also be used as a framework or basis for the establishment of future studies for those who wish to pursue the research study.


DEFINITION OF TERMS Quality of Patient Care


involves assessing the appropriateness of medical tests and treatments and measures to continually improve personal health care in all fields of

medicine(Source: http://www.kaiseredu.org)

In this study, quality of care is the ability of the student nurse to deliver effective nursing care based on individual needs wherein patients can experience Quality Scale Tool with the

satisfaction. This is measured using Nursing

following scores: 5-point Likert scale (5-strongly agree, 4-agree, 3-Neutral, 2disagree and 1-strongly disagree) .

Patients Satisfaction is the degree of congruency between a patients expectations of ideal nursing care and his perception of the real nursing care that he receives (SOURCE: www.hrsdc.gc.ca). In this study, patient satisfaction is measured using the following domains:

(i) Responsiveness is conceptually defined as the degree to which the nurse demonstrates that she or he is able to meet patient needs in caring and attentive manner. (ii) Individualization is the degree to which the nurse personalizes care according to the patient's feelings, preferences, and desired level of involvement in care. (iii) Coordination is the degree of communication among other nurses and the patient. (iv) Proficiency is the degree to which the nurse provides knowledgeable, skillful

nursing care.


The mean of the satisfaction rating were assigned according to the four domains. The total mean for each domain of patient satisfaction was used to derive the general average of patient satisfaction. Mean was used to identify the average of the patient satisfaction from the respondents. As a caring person Skilled nursing care is health care given when a person needs skilled nursing staff (registered (RN) or licensed practical nurse (LPN)) to manage, observe, and evaluate care. Skilled nursing care requires the involvement of skilled nursing staff in order to be given by non professional staff is not considered skilled nursing care. The goal of skilled nursing care is to help improve the patients condition and prevent it from getting worse. (nursing-Care.com) Nurse as a competent health care provider Competence encompasses knowledge, skills, abilities and traits. It is gained in the health care professions through pre service education, in-service training, and work experience. Competence is a major determinant or provider performance as represented by conformance with various clinical, non-clinical, and interpersonal standards (www.scribd.com) Nurses Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health


policy and in patient and health systems management, and education are also key nursing roles. Southern Philippines Medical Center Is a Government hospital under the Department of Health of the Republic of the Philippines. It is located at the JP Laurel Ave, Bajada,Davao City Its former name was the Davao Medical Center which was changed on November 19, 2009 by Republic Act 09792. And in Obstetrical Ward they have 100 bed capacity.


ACKNOWLEDGEMENT The researchers wish to express their sincere and profound gratitude to the following persons and institutions who, in one way or another, have generously contributed to the successful completion of the study. The researcher would like also to thank their adviser Prof. Elvira Grace Ponce De Leon to whom they owe so much debt of gratitude for their thoughtful criticism and valued suggestions that helped shaping this study into its form. Also, for the encouragement that keeps them motivated to work hard on this research. Mr. Darwin Poledo, MaEd-Math, Mr. Virgion Mamonong, MaEd- English, Ms. Carolyn Arado, MaEM, Ms. Charmie Lou Pea,RN,MAN their panelists, for their valuable suggestions and for providing constructive criticism for the improvement of this study. To their parents thank you for the moral and financial support to this study. The researcher would also like to express their sincere thanks to all the respondents who extended their immense help by giving unstintingly their time and efforts. And above all, to their Heavenly Father, who gave His undying blessings, strengths, determination and guidance to pursuit this study. Jeffrey Costan Jaquiline Saren Amina Mokalid

CHAPTER 2 REVIEW OF RELATED LITERATURE In this chapter, the researcher presents readings taken from journal, books including those materials obtained from internet. A. Patient Satisfaction Generally, patient satisfaction has been defined as the patients subjective perception of care, which is usually an indicator of the degree of congruency between a patient's expectations of ideal care and his or her perception of the real care he or she receives (Ganova-Ioloska, et al., 2008). Most research has tried to correlate these with socio-demographic variables, such as age, sex, the level of education, employment, income, or marital status. Patients are consumers, and what they purchase in a medical institution are both products and services that are rendered primarily to keep them healthy and free of harm. As consumers, one of the patients priorities is satisfaction with the purchase. Among the services that patients evaluate is nursing care. B. Nursing Care Once, nursing mainly focused on keeping the body in a near homeostatic state during illness. As innovation ushers more discoveries on the various aspects of health, what was once the humanitarian act of nursing is now being transformed to a humane profession. The idea that a purely physiologic nursing care is enough for a patient is now replaced with the view that nursing care should be holistic, sensitive, and meaningful.


Nursing is inherently therapeutic and is differentiated from other medical care by the personalization or individualization of care. One of the oft-quoted nurse-theorists, Watson (1988), developed her own checklist of nursing care components. These are: (1) Humanistic-altruistic system of values; (2) Faith-hope; (3) Sensitivity to self and others; (4) Helping-trusting, human care relationship; (5) Expressing positive and negative feelings; (6) Creative problem-solving caring process; (7) Transpersonal teaching-learning; (8) Supportive, protective, and/or corrective mental, physical, societal and spiritual environment; (9) Human needs assistance; and (10) Existential-phenomenological-spiritual forces. Watson (2003) concluded that what should define the nursing practice is the act of caring itself. Caring can save the life of a patient, offer a death with dignity, and convey trust and commitment to patients, families, and staff (Vance, 2003). On the Philippine front, the UP-PGH has provided a list of actual duties and responsibilities of the nurse in terms of patient care, teaching, and research. These items are as follows: a) Accurately assess the nursing needs of patient through establishing rapport and trust with the patients and significant others. b) Obtain nursing history c) Conduct a physical health exam d) Be able to recognize the normal and abnormal findings from laboratory or diagnostic exams. e) Monitor and interpret vital signs.


f) Provide support measures like physical and psychosocial needs including dietary regimen, comfort, hygiene, safety, and health teaching. g) Maintain therapeutic environment. h) Carry out doctors orders. i) Formulate a nursing care plan through prioritization of health needs. j) Evaluate the nursing care given and be able to make necessary revisions through appropriate documentation of information relevant to patient are. In addition, Laurente (1996) has defined, in her study of the effect of nursing care in anxiety reduction, the following components of nursing care: presence (proximity, active listening, therapeutic touch, verbal communication), concern (respectful attitude, gentleness in handling, patience, various helping acts), and stimulation (encouragement, guidance, smiling, compliment or praise). C. Quality of Care Azam, et al. (2008) have defined quality of care as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. the totality of features and characteristics of a service that bear on its ability to satisfy a given need. Likewise, Leino-Kilsi (1989) has defined quality of care as comprehensive, based on patients needs, oriented to the patient as an individual, conducive to a sense of security in the patient, forms a complex process, involves self- care on the part of the patient, is based on certain philosophical foundations and contains certain situational factors (Collado, 1993).


More specifically, the perceptions of hospitalized adult medical-surgical patients (n = 268) have been explored (Larson & Ferketich, 1993). Using the Care Satisfaction Questionnaire, these researchers defined caring as intentional actions conveying physical care and emotional concern and promoting a sense of safety and security. The

CARE/SAT instrument combined the CARE-Q scale (developed previously by Larson) items with visual analogue scales and 21 new items to measure overall satisfaction with nurse caring behaviors. Instrument reliability and validity were established. This phase of instrument development was necessary to focus on the quality care issue of patient satisfaction which could ultimately assist nurses to assess whether hospitalized patients experience nurse caring. Larson and Ferketich correlated the CARE/SAT with the modified Risser Patient Questionnaire (Hinshaw & Atwood, 1981) establishing construct validity. This established that the instrument measured the theoretical construct. D. Measuring Patient Satisfaction with Nursing Care In the past, quality of care was measured based on practice standards. But in recent years, there has been renewed emphasis on the involvement of patients in the evaluation of health care as manifested by the measurement of their satisfaction. Various methods and tools have been utilized to measure patient satisfaction. They have explored components such as the art of care/ interpersonal manner, technical quality of care, inaccessibility/ convenience, finances of how the service is paid for, physical environment, availability of providers, and continuity and efficacy/ outcomes (Buban, et al., 2003). When exactly should these studies be conducted? There are those more concerned


with specific interventions, and, as such, they assess satisfaction immediately after an intervention is performed. There are others concerned with the degree of satisfaction upon discharge. Sulit (2007) found it convenient in the Philippine setting to conduct the interviews right before discharge, while papers and bills were still being addressed by watchers. Several examples of tools include: (1) the Care Satisfaction Questionnaire developed by Larson & Ferketich (1993) that combines questions with visual analogue scales; (2) the Quality of Nursing Care Scale by Mabel Wandett that measures patient satisfaction with art of care, technical quality of care, safety and protection, communication; (3) the Patient Satisfaction Scale by Risser (1995); and (4) the SERVQUAL tool by Azam, et.al. (2008) which measures reliability, responsiveness, assurance, empathy, and tangibility. E. Factors Affecting Patient Satisfaction with Nursing Care The factors that affect patient satisfaction with nursing care can be categorized as follows: 1.Quality of interpersonal relationship (i.e., communication, courtesy and consideration, nurses' willingness to listen to patients' explanations of problems, nurses' advice, smiles, humor, reassurance, kindness, compassion, gentle touch, the ability to anticipate needs, etc.) (Lange, 1999; Haqq et al. 1999; Meade, et al., ?; Stutts, 2001; Dipaula, et al., 2002; Ambrose, 1998); 2. Skills and competence (Stutts, 2001); 3. Patient expectations and perception of fulfillment of these (Meade, et al., 2006;


Buban, et al., 2003); 4. Previous experiences (Buban, et al., 2003); 5. Waiting time (Haqq, et.al., 1999); 6. Staffing and continuity (Azam, et.al., 2008; Stutts, 2001; Ambrose, 1998); 7. Socio-demographic factors such as age and sex (DiPaula et.al., 2002); 8. Health status (DiPaula et.al., 2002); and 9. Direct care time (DiPaula et.al., 2002; Macdonald, 2007). Greeneich developed a theoretical model inclusive of all these and further categorized into three dimensions: (1) the nurse (inherent personality characteristics, nursing care characteristics and nursing proficiency); (2) the patient (expectations); and (3) the environment (nursing milieu) (Buban, et al., 2003). Haqq, et.al. (1999) found that, in terms of courtesy and consideration, as educational level increased, percentage of satisfied patients declined. In terms of skills 25 and competence, willingness to listen, nurses' advice, waiting time, satisfaction increased with age. In terms of waiting time, satisfaction decreased with longer waiting time. Interestingly, there have also been studies that differentiate patient satisfaction by gender. Ottoson (1997) on patient satisfaction in the surgical setting, noted that men receive more information spontaneously from nurses compared with women, indicating that there are also gender differences in satisfaction with men rating more positively. While some studies, men tend to score higher than women, other studies showed an opposite conclusion. Ambrose (1998) on the other hand found the following as most significant to


female patients: (1) listening; (2) responding to the patient's uniqueness; (3) being perceptive and supportive of the patient's concerns; (4) being physically present; (5) having attitudes and displaying behaviors that made the patient feel valued as a human being not as an inanimate object or a thing on display; (6) returning to the patient voluntarily without being asked; (7) showing concern that is comforting and relaxing; (8) using a soft gentle voice and mannerisms; (9) invoking feelings of security; and (10) evoking patient feelings of wanting to reciprocate. For male patients, being physically present so the patient felt concern as a valued person, returning voluntarily without solicitation, making the patient feel comfortable, relaxed, and secure, attending to the comfort and needs of the patient before doing tasks, and, using a kind, soft, pleasant, gentle voice and attitude were important. Very appropriate to the Philippine setting and an area as yet unexplored is the association between the experience of the surrogate (or watcher) and the level of satisfaction. Sagert (1991) explored surrogates perceptions of their experience as well as reactions/attitudes, and responded to six satisfaction questions on: RN Care, RN Communication, Doctor Management, Doctor Communication, Waiting Room, and Treatment as a Relative. The greatest degree of satisfaction was with RN Care (92%) and the least was with Doctor Communication (59%). There was no association between extent of patient recovery (full, partial, very limited) and surrogate satisfaction. Ever the vigilant standard-bearer, the WHO (2000) warned that client satisfaction with treatment processes may both influence, and be influenced by, treatment outcomes. Clients who are not satisfied with a service may have worse outcomes than

26 25

others because they miss more appointments, leave against advice or fail to follow through on treatment plans. On the other hand, clients who do not do well after treatment may have less than favorable attitudes towards a treatment service, even if it was of high quality by other criteria. F. Limitations/Issues in Measuring Patient Satisfaction The WHO (2000) advised, Your strategy for selecting clients for a satisfaction survey can influence the kinds of results you obtain. If the surveys are limited to clients who complete treatment, the results will probably differ from those obtained in surveys that include people who have dropped out of the program. If the objective is to learn about client satisfaction among those who complete treatment then there will be no need to involve treatment dropouts. However, if the aim is to find how, in general, clients feel about the programme, a representative sample of all clients completing the intake process would be more appropriate. Other issues can be summed as follows: 1. First impressions or the carry-over effect among staff and units, i.e. a bad encounter with one nurse may influence the perception of nursing care in general (DiPaula, et.al., 2002); 2. Unrealistic expectations of patients (WHO, 2000); 3. The problem with constructs or the "chameleon effect", in which the exact meaning and interpretation of satisfaction differs for each situation (L&Cote, 2000); 4. That satisfaction in and of itself does not necessarily result in improved health


status (Ervin, 2006); and 5. That surveys conducted at the end of care do not allow for individualization, i.e. satisfaction should be measured before care is completed in order to tailor to the needs of the patient instead of generalizing results for future patients (Ervin, 2006). G. Patient Satisfaction with Nursing Care in the Philippines Several Patient satisfaction studies have been conducted locally. A local study on the assessment of patient satisfaction at the OPD of Far Eastern University Nicanor Reyes Medical Foundation Hospital used a patient satisfaction questionnaire patterned from the Patient Satisfaction Questionnaire III by Ware et al. and translated into Filipino. This study however, was more concerned with the satisfaction of patients with care provided by doctors than by nurses. Pedres (2002) explored the effect of modular nursing on patient and staff satisfaction at the Davao Doctors Hospital. However, patient satisfaction was measured by using an instrument adapted from a foreign source. In the Philippine General Hospital, several departments have attempted to measure or rather evaluate nursing care and measure patient satisfaction. The Philippine General Hospitals Nursing Service has been developing its own evaluation system for nursing care. They measure performance of nurses through a performance evaluation report that is accomplished through self-assessment and assessment by other nursing colleagues and the head nurse. The PGH Department of Pay Patient Services on the other hand has come up with a survey form to measure pay patients satisfaction with hospital services. No local tool has been made in the past to measure patient satisfaction until in her


masters thesis, Sulit (2007) constructed a tool to measure the satisfaction of Filipino patients at the Philippine General Hospital (PGH). In Phase One, she conducted a qualitative review of nine patients and their respective watchers to find themes in patient satisfaction. She pre-tested with 186 patients in phase two and then conducted the actual survey with 236 patients in phase three. She found the four following roles of the nurse as influential to patient satisfaction: (1) the nurse as a member of the health care team; (2) the nurse as a caring person; (3) the nurse as a competent and skilled health care provider; and (4) the nurse as an information provider. Patient satisfaction is considered as an important measure of quality care services. It is influenced by the different internal and external needs of the patient these include the socio-demographic factors such as age, gender, economic status and educational attainment. Other than these, environmental factors and expected outcomes are also taken into consideration in assessing and evaluating the nursing care received. Nurses comprising majority healthcare team are considered as the best determinants in patient satisfaction since they are often at the patients side to render care. Their professional skills, technical knowledge, interpersonal capabilities are viewed as the basis of evaluation of the care from patient to patient.

Chapter 3 METHODOLOGY Presented in this chapter are the methods used in the study, the research locale and research procedure, selection of respondents, data gathering instrument and statistical treatment. RESEARCH METHOD This study followed a descriptive correlation design, utilizing both qualitative and quantitative data to validate the assumption that the frequency of nursing care activities determines patient satisfaction. It is, in effect, an outcomes research as it is concerned with examining nursing care dimensions vis--vis patient outcomes, specifically, satisfaction. This research design allowed the researchers to observe, describe and document the aspects of patient satisfaction with overall nursing care while its correlation component allowed description of relationships between variables. The major disadvantage though is the designs inability to reveal causal relationships (Polit and Beck, 2006). RESEARCH LOCALE This was conducted in Southern Philippine Medical Center; the center was established in 1917 as the Davao Public hospital. It has a 25 bed capacity hospital in San Pedro St., Davao City. In 1946, The hospital was named as the Davao General Hospital increasing its capacity to about 200 beds. In 1957, the hospital transferred to its current location at JP Laurel ave., Bajada Davao City. It was renamed Davao Regional Medical and Training Center by virtue of the Republic Act. 1859. Davao Medical Center which


was changed on November 19, 2009 by Republic Act 09792 and it was named Southern Philippine Medical Center is a Government hospital under the Department of Health of the Republic of the Philippines. RESPONDENTS The subjects of the study was admitted in the Southern Philippines Medical Center OB ward; a set of inclusion criteria were considered in choosing the participants of the study, which consisted of (1) being a OB patient; (2) at age 16 24 years old; (3) having the ability to understand and speak Filipino; (4) and having no mental illness, and with a minimum of 41 respondents. Data Gathering Instrument The questionnaire used in this study consisted of a variety of questions related to level of patients satisfaction on the care rendered by nurses. This is a self made questionnaire. Validation of Instrument To have the questionnaire validated the researcher test the questionnaire to 3 patients in admitted in OB ward. Research Procedure 1.) Informed the head nurse of OB ward that we are conducting a survey regarding patients satisfaction. 2.) Gathered the total census in OB ward. 3.) Introduce ourselves to the patient and the objective was discussed to them


4.) Distributed the survey questionnaires. 5.) Gathered the questionnaires. 6.) Responses were tallied and interpreted. Statistical Treatment Frequency. The ratio of the actual number of favorable events to the total possible number of events; often taken as an estimate of probability. The proportion of the range of a random variable taking a given value or lying in a given interval. http://www.thefreedictionary.com/Frequency+(statistics)) Percentage. A fraction or ratio with 100 understood as the denominator; for example, 0.98 equals a percentage of 98. The result obtained by multiplying a quantity by a percent. http://www.thefreedictionary.com/percentage

Chapter 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA Discussed in this chapter is the level of satisfaction of patients in OB ward on the care rendered by the nurses in the Southern Philippines Medical Center. Discussion follows the given outline:
a.) Profile of patient in terms of age.

b.) The level of quality profile on patient care delivered by the nurses in terms of: As a caring person As a skilled person As a competent

c.) The profile of patient in terms of level of satisfaction on the care given by the nurses.


Table 1 Profile of patient in terms of age.

AGE 16 17 18 19 20 21 22 23 24 TOTAL

FREQUENCY 1 2 5 8 7 6 5 4 3 41

PERCENTAGE 2.44% 4.88% 12.20% 19.51 17.07% 14.63% 12.20% 9.76% 7.31% 100%

In examining the profile of the patient in term of age, the largest percentage of respondent were 19 years old consisted of 19.51 percent while the lowest age were 16 years old consisted of 2.44 percent.


Table 2 Level of quality on patient care delivered by nurses.

Statements As a Caring Person 1. Does the nurse put me into a comfortable position. 2. Does the nurse show empathy in rendering care. 3. Does the nurse provide personal hygiene postpartum. As a Skilled Person 1. Is the nurse taking vital signs on time. 2. Does the nurse explains the effect of their drugs appropriate. 3. Does the nurse gives their ordered medication on time. 20 13 12 Satisfactory Poor Unsatisfactory 17 16 19 Poor Poor Poor Mean Descriptive Equivalent

4. Does the nurse provides information regarding the ideal dietary regimen 5. Does the nurse provides home discharge instructions. As a Competent Health Care Provider 1. Does the nurse perform intravenous insertion successfully. 2. Does the nurse perform urinary catheterization successfully. 3. Does the nurse dress the post incision site in an efficient manner.







5 4

Excellent Excellent


In this table 2 shows, as a caring person the highest descriptive equivalent were poor, and as a skilled person the highest descriptive equivalent were satisfactory, and as a competent health care provider the highest descriptive equivalent were excellent. Table 3 Patients Level of Satisfaction on the Care Rendered by Nurses. Statements 1. Does the nurse responded to my complains immediately. 2. The nurse communicates well to me and to my family regarding my illness 3. Does the nurse spend extra time in responding to my queries. 4. Does the nurse provides information regarding the doctors prescription before giving it to me. 5. Are you satisfied with the nursing care activities rendered by the nurse. Mean 13 17 18 13 Descriptive Equivalent Poor Poor Poor Poor



In this table shows that most of descriptive equivalent were poor, because of the nursepatient ratio of 1:50 thats why nurse-patient relationship cannot be established by nurses because of overloading of task every shift.

Chapter 5 SUMMARY, CONCLUSION, AND RECOMMENDATION SUMMARY This study was conducted to determine the level of satisfaction of patients in OB ward on the care rendered by the nurses in the Southern Philippines Medical Center. Specifically the study sought answers to the ff. questions: 1. What is the demographic profile in terms of: Age 2. What is the level of quality on patient care delivered by nurses? a. As a caring person b. As a skilled person c. As a competent health care providers 3. What is the level of patient satisfaction on the care given by the nurses? FINDINGS
1. Most of the respondents in SPMC-OB ward were 19 years old. 2. Majority of the respondents rate the nurse as a caring person as poor, and as a

skilled person was satisfactory and as a health care provider was excellent.
3. Majority of respondents rate in level of satisfaction on the care rendered by

nurses were poor.


CONCLUSION: In the light of the findings of the study, the following conclusions are drawn: 1.) Nurses should have a caring ability to the patient so that patients satisfaction could be provided.
2.) Nurses must improve their skills so that they could be more efficient and effective

when rendering care to the patients.

3.) In, overall nurses should focus in giving care to the patient holistically so that

patients satisfaction can be meet and provided to them. RECOMMENDATIONS: The hospitals. Should strictly monitor their nurses and trained them properly on how to handle patient with care. The nursing schools. The Clinical instructor should strictly monitor their student nurses and
trained them properly on how to handle patient with care. And should train them also their student on how to be more sympathetic and be good and competitive nurses someday.

The nurses.

They should determine the patients satisfaction on the care that they

rendered so that they could push and strive harder in rendering quality care to the patients. And knowing their weakness and strengths so that they could work or change it in order to provide much effective nursing care.


http://www.scribd.com/doc/59107891/Final-Research READING, UNDERSTANDING, AND APPLYING NURSING RESEARCH 2ND EDITION byJames A. Fain Og NURSING RESEARCH PRINCIPLES AND METHODS 7TH EDITION by Polit, Denise, Beck Cheryl. INTRODUCTION TO NURSING RESEARCH QUEST FOR QUALITY NURSING CARE by Lydia Venson http://www.phdmanagement.sssup.it/documenti/awarded/murante_thesis.pdf images.groupbbb.multiply.multiplycontent.com www.freedictionaryonline.com images.groupbbb.multiply.multiplycontent.com/.../CHAPTER%202


Title Page Acknowledgement Abstract Table of Contents Chapter I The Problem and Its Setting a. Introduction b. Theoretical Framework c. Schematic Diagram d. Statement of the Problem e. Scope and Delimitation f. Significance of the Study g. Definition of Terms II III Review of Related Literature Methodology a. Research Method b. Research Locale c. Respondents of the study d. Data Gathering Procedures e. Validation of Instruments

Page ii iii iv

1-5 6-10 11 12

13-14 15-17 18-27

28 28-29 29

f. Research Procedure g. Statistical Treatment IV Presentation, Analysis, Interpretation of Data a. Table 1 b. Table 2 c. Table 3 V Summary, Conclusion, and Recommendation a. Summary Findings b. Conclusion c. Recommendation Bibliography Survey Questionnaire

29-30 30

32 33-34 34


36 36 37 38-39


ABSTRACT The primary objectives of this study is to explore and identify the level of patients satisfacion in OB ward on the care rendered by the nurses in the Southern Philippines Medical Center. The research was conducted at Southern Philippines Medical Center OB ward, Davao City. And the largest percentage of respondent was 19 years old consisted of 19.51 percent while the lowest age 16 has a percentage of 2.44 while the lowest age were 16 years old consisted of 2.44 percent. Majority of the respondents rate the nurse as a caring person as poor, and as a skilled person was satisfactory and as a health care provider was excellent.

Mostly of the respondents rate the level of satisfaction on the care rendered by nurses as poor.

QUESTIONNAIRE I. Profile Name (optional)_____________________________Age:________ Address:__________________________________Gender:______F_____M_____ EVALUATION CHECKLIST OF THE PATIENTS LEVEL OF SATISFACTION IN OB WARD ON THE CARE RENDERED BY NURSES OF THE SOUTHER PHILIPPINES MEDICAL CENTER SCALE DESCRIPTION 5 4 3 2 1 Excellent Good Satisfactory Unsatisfactory Poor

INSTRUCTION: Please check ( / ) appropriate box corresponds to your answer II. Quality of Nursing Care a.) As a care 1.) Does the nurse put me into a comportable Position? 2.) Does the nurse show empathy in rendering Care? 3.) Does the nurse provide personal hygiene postpartum? b.) As a Skilled Person 1.) Does the nurse is taking vital signs on time. 2.) Does the nurse explain the effect of their drugs appropriately. 3.) Does the nurse give their ordered medication on time. 4.) Does the nurse provides information regarding the ideal dietary regimen. 5.) Does the nurse provides home discharge 5 4 3 2 1

instructions. c.) As a Competent Health Care Provider 1.) Does the nurse perform intravenous insertion successfully. 2.) Does the nurse perform urinary catheterization successfully. 3.) Does the nurse dress the post incision site in an efficient manner. I. Patient Level of Satisfaction on the Care Rendered by Nurses 5 1. Does the nurse responded to my complains immediately. 2. The nurse communicates well to me and to my family regarding my illness. 3. Does the nurse spend extra time in responding to my queries. 4 3 2 1