CHAPTER II REVIEW OF RELATED LITERATURE and STUDIES

This chapter presents a discussion on the concepts and principles drawn from different sources, both local and foreign presented in accordance to the questions dealt with in the study.

Nursing, in general, is the process of caring for, or nurturing, another individual. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. Professional nurses combine many different disciplines, including aspects of biology and psychology, to promote the restoration and maintenance of health in their clients. Registered nurses (RNs), regardless of specialty or work setting, perform basic duties that include treating patients, educating patients and the public about various medical conditions, and providing advice and emotional support to patients family members. RNs record patients medical histories and symptoms, help to perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

RNs teach patients and their families how to manage their illness or injury, including post-treatment home care needs, diet and exercise programs, and selfadministration of medication and physical therapy. Some RNs also are trained to provide grief counseling to family members of critically ill patients. RNs work to promote general health by educating the public on various warning signs and symptoms of disease and where to go for help. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses. They also require leadership, negotiation skills, and good judgment. Patient care is part of a nurse's role in implementing a care plan. Usually, nurses will perform patient assessment and evaluation of care while doing their patient care. Nurses must observe the principles of cleanliness at all times to prevent the spread of sickness. They wash their hands thoroughly with soap and warm running water before and after caring for patients, after handling any wastes, before and after eating and drinking, after smoking, coughing or touching clothes,

and after wearing gloves. For hands that aren't visibly soiled, alcohol gel has come into common use to sanitize the hands in place of washing; although, per infection control regulations, washing hands with soap and water must be done after the third instance of using hand sanitizer. Gloves are worn when exposure to body fluids may occur, as well as any time other than "casual" patient contact. Nurses keep accurate records of all care and observations for many purposes. In a hospital, the patient's record (often referred to as a "chart") is the main means by which different members of the health care team communicate with each other. The chart is usually a legal document that serves as evidence of care provided. Since the maintenance of records is a legal responsibility, the charts often have to meet certain standards, e.g. records must be permanent, accurate, complete, and kept for years after the care was given. Nursing Care Nursing care is based on forged experiential knowledge that has been refined through ones practice geared towards the provision of human service. It is also based on dynamic theoretical foundations that are constantly being evaluated to further understand human nature and the environment of care. The emotional intelligence and critical thinking of a nurse is crucial in nursing process and the best practice of care. Elements of human caring, compassion, devotion and commitment is crucial to the profession and is reciprocated by client

satisfaction

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what

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top

quality

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(http://www.bellaonline.com/articles/art40329.asp) From its earliest inception nursing has had a nurturing quality, and this quality is best evidenced in the care aspects of the nurses role. In caring for the patient, the nurse assists him in carrying out those activities which he would normally do for himself. Caring for the patient involves ministering to his needs and wants, providing comfort and support, protecting him from harm and assisting him to regain his independence as rapidly as possible. Much of the nursing action is concerned with the daily living of the patient. In providing comfort and support, the nurse is concerned not only in his physical comfort but also in assisting him to cope with his illness and the stress and anxiety that accompany ill health. The nurse protects the patients and sees that his safety is not endangered. In caring for the patient, the nurse also cares about him. To many patients, these are seen as on and the same; that is, the person who cares for him is perceived as the person who cares about him. Nursing care must be adjusted to suit each individual patients needs, for no two individuals are alike. Carrying out nursing activities with compassion, with empathetic understanding and with respect for the patient as an individual of worth and dignity are caring about the patient.

The value of nursing should be humane, people-focused, knowledgebased, innovative and creative. These values comprise a mixture of humanitarianism and cost effectiveness. In their everyday work caring for patients, nursing merge these values using sophisticated knowledge-gathering techniques and the unique models of decision, planning and evaluation (Parker 2000). Values are needed in our everyday life. Caring is one of the most common value. To give effective nursing care, the nurse should not be able to evaluate the individual need critically, but also to have these skills to meet these needs. From giving comfort measures and using communication and self effectively as therapeutic agents (Kelly 1987). Interaction with the patient, in the delivery of nursing care and interaction to the other members of the health team needs to be order to give the most effective care to patient. Based on the study conducted by McColl, Thomas and Bond entitled a study to determine patient satisfaction with nursing care, patients particularly appreciated an informal and open atmosphere in the ward manifested in terms of nurses sense of humor, the happy atmosphere they created in the ward and a perception of nurses being friends with patients. For these aspects of care, there was a high degree of consensus across wards. Patient also felt nurses were excelled at providing privacy when needed. In general, they have good

experiences with respect to nurses explaining their actions. Patients perceived nurses to be knowledgeable and felt that they were available in terms of making time for them. Nursing functions can be described in broad or specific terms. For instance, classically, the common elements have included maintaining or restoring normal life function, .observing and reporting signs of actual or a potential change in a patients status, assessing his/her physical and emotional state and immediate environment, formulating and carrying out a plan for the provision of nursing care based on medical regimen including administration of medications and treatments and interpretation of treatment and rehabilitative regimens, counseling families in relation to other health related services and teaching. The nurse practitioner role adds diagnosing and treating common illnesses. Of course, some nurses still see the nurse more as a manager of a nursing care that a face to face clinical practitioner- In other words, responsible for nursing care, supervising and coordinating the work of others, but not personally giving care. However, in recent years, there has been a return to a clinical emphasis. Nursing services Nursing service is the part of the total health organization which aims at satisfying the nursing needs of the patients/community. In nursing services, the

nurse works with the members of allied disciples such as dietetics, medical social service, pharmacy etc. in supplying a comprehensive program of patient care in the hospital. (All India Institute of Medical Sciences) World Health Organization expert committee on nursing defines the nursing services as the part of the total health organization which aims to satisfy major objective of the nursing services is to provide prevention of disease and promotion of health.

(http://www.aiims.edu/aiims/nursingservices/NURSING%20SERVICES.htm) Today, the Nursing Services faces the ever-increasing challenges of the times: intensive and specialized care, rapid technological advancement, migration of nurses, etc. It faces problems that resulted from changes outside and within the PGH. Cognizant of the fact that the strength of any organization lies on its people, the Nursing Services believed that it will be able to hurdle these challenges. (http://www.pgh.gov.ph/nursing) Nursing Actions Nurses have both dependent and independent functions. The former are those that must be carried out under the orders of a licensed physician or dentist, including such duties as administering medications and changing dressings on wounds. Independent functions are those that nurses carry out based on their own professional judgment. Such duties include bathing patients, positioning

them to prevent joint contractures, teaching people how best to care for themselves, and providing nutritional counseling. (Andres, et al, 2008) Top 10 Qualities of a Great Nurse o Communication Skills- A great nurse has excellent communication skills, especially when it comes to speaking and listening. They are able to follow directions without a problem and can easily communicate with patients and families. o Emotional Stability- Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial o Empathy- Great nurses have empathy for the pain and suffering of patients. They are able to feel compassion and provide comfort. But be prepared for the occasional bout of compassion fatigue; it happens to the greatest of nurses. Learn how to recognize the symptoms and deal with it efficiently. o Flexibility- Being flexible and rolling with the punches is a staple of any career, but its especially important for nurses. A great nurse is flexible with regards to working hours and responsibilities. o Attention to Detail- A great nurse pays excellent attention to detail and is careful not to skip steps or make errors.

o Interpersonal Skills- Nurses are the link between doctors and patients. A great nurse has excellent interpersonal skills and works well in a variety of situations with different people. They work well with other nurses, doctors, and other members of the staff. o Physical Endurance- Always on the go, a great nurse maintains her energy throughout her shift; frequent physical tasks, standing for long periods of time, lifting heavy objects (or people), and performing a number of taxing maneuvers on a daily basis are staples of nursing life. Staying strong, eating right, and having a healthy lifestyle outside of nursing is important too! o Problem Solving Skills- A great nurse can think quickly and address problems as - or before- they arise. With sick patients, trauma cases, and emergencies, nurses always need to be on hand to solve a tricky

situation. Whether its handling the family, soothing a patient, dealing with a doctor, or managing the staff, having good problem solving skills is a top quality of a great nurse. o Quick Response- Nurses need to be ready to respond quickly to emergencies and other situations that arise. Quite often, health care work is simply the response to sudden incidences, and nurses must always be prepared for the unexpected. Staying on their feet, keeping their head cool in a crisis, and a calm attitude are great qualities in a nurse.

o Respect. Respect goes a long way. Great nurses respect people and rules. They remain impartial at all times and are mindful of confidentiality requirements and different cultures and traditions. Above all, they respect the wishes of the patient himor herself.

Great nurses respect the hospital staff and each other, understanding that the patient comes first. And nurses who respect others are highly respected in return. (http://nursinglink.monster.com/benefits/articles/5019top-10-qualities-of-a-great-nurse?page=1) Roles and Responsibilities of the Nurse o Nursing roles. A role is a set of expected behaviors associated with an individuals status or position. Role includes behaviors, rights and responsibilities. Nurses function in a variety of roles everyday. o Caregiver. The caregiver is the role most commonly associated with nursing by the general public. In the role of caregiver, the nurse provides direct care when clients are unable to meet their own needs. When individuals are ill, they are more likely to be dependent upon others for assistance in meeting their basic needs. Such dependency may result in the person experiencing a perceived loss of control and feelings of helplessness. Effective nurses understand the importance of helping clients maintain control as much as possible.

o Counselor. When acting as a counselor, the nurse assists clients with problem identification and resolution. The counselor facilitates client action by helping clients to make their own decisions. Counseling is done to help clients increase their coping skills. Effective counseling is holistic in that it addresses the individuals, emotional, psychological, spiritual and cognitive dimensions. o Teacher. Teaching is an intrinsic part of nursing. The nurse views each interaction as an opportunity for education, both client and nurse can learn something from every encounter with each other. Client education focuses on client empowerment, that is empowering clients to do as much as possible for themselves. o Client advocate. A client advocate is a person who speaks up for or acts a behalf of the client. Advocacy empowers clients to be partners in the therapeutic process rather than passive recipients of care. The relationship that encourages client empowerment is one of the mutual participation by client and nurse. Clients and families are actively involved in establishing goals. o Change agent. Nurses who function in the role of change agent recognize the chance is a complex process. The change agent is proactive (takes the initiative to makes things happen) rather than reactive (responding to things after they have happened). Change should not be than in a random

manner. Its should be planned carefully and implemented in a deliberate way to facilitate the clients progress. o Team member. A vital of the nurse is that of team member. The nurse does not function in isolation but rather works with other members if health care system. Collaboration requires the nurse to use effective

interpersonal skills and promotes continuity of care. o Resource person. The nurse functions as a resource person by providing skilled intervention and information. Identifying resources and making referrals as needed also fall under the auspices of this role. Nurses must consider the client strength as well as availability of resources, including physical, intellectual, economic, social and environmental factors.

Preoperative Care Preoperative patient assessments also enable holding area nurses to make judgments about patients' responses to illness or changes in life processes. Nurses should recognize that patients are interpreting their impending surgical procedures and intervene if necessary. Nurses also should demonstrate effective communication, patient education, and stress reduction skills. Effective communication. The security that patients feel from caring nurses is irreplaceable. This can be demonstrated by using effective

communication skills. Interpersonal skills and empathy are necessary for holding area nurses to interact effectively with the diverse patient population being provided care. Nurses must be empathetic, manage activities in the holding area, make rapid accurate assessments, and modify their approaches as needed. Empathy -- the ability to perceive a person's feelings -- is crucial for every nurse. Nurses must develop the ability to imagine and understand die lives of other people to accurately perceive their feelings and meanings without tempering them with their own beliefs and feelings, and they must subsequently convey this understanding. Studies have shown that a patient's health will improve in direct relation to the amount of empathy he or she receives. Preparing for surgery causes patients to experience high anxiety levels because they are dealing with their own illnesses, along with the unexpected outcomes associated with surgical procedures. A main focus for holding area nurses is to decrease anxiety experienced by either patients and/or their accompanying support people by providing honest, realistic, factual information. The nurse, for instance, should explain procedures, including placement of monitoring leads (eg, ECG leads), placement and tightness of the BP cuff, and positioning (eg, lateral, fetal, sitting) for spinal anesthetic catheter insertion. The patient is reminded that the room may be cold but wet blankets will be provided. Preoperative

teaching, such as postoperative deep breathing after administration of general anesthesia and the need to request pain medication as needed, should be reinforced. If the procedure will be performed with local anesthesia along with conscious sedation, the nurse should explain that the local injection may sting initially, but the intent is to numb the area. If a Bier block is used, the nurse will need to explain the feeling that the patient will experience with the rubber wrap and pneumatic tourniquet cuff. Explaining activities before they occur can reduce apprehension and the preoperative nurse can solicit the most assistance from the patient. Verbal and nonverbal communication are important skills to be used when gathering patient information. Nonverbal communication includes

observing the patient's facial expressions, body language, voice inflection, and eye contact. These behaviors account for 93% of the communication process. Nurses also should be aware of their own nonverbal communication, including the use of space and touch and the effect it has on patients. Patient education. Sharing information with patients to increase their awareness and understanding of procedures will alleviate their anxiety. Patients sometimes state that they do not want to know what is going to happen. In this situation, the nurse should accurately prioritize information that would benefit the patient and identify nonthreatening methods of

sharing. Priority information includes the activities that the patient must participate in before, during, or after the procedure. Presenting information in a calm, nonthreatening manner may elicit a positive response from a patient who is not interested in the information being shared. Perioperative nurses must demonstrate patience, answer all questions (or find the answer if needed), and be receptive to the patient's needs. Stress reduction strategies. Patients react to anxiety in different ways. Some patients may prefer to be left alone; others may become loquacious; and still others may become distant, upset, or even belligerent while mulling over ramifications of their impending surgical procedures and outcomes. Several strategies can be used to manage stress in the holding area. (http://findarticles.com/p/articles/mi_m0FSL/is_n5_v66/ai_20157983/pg_5/ ?tag=mantle_skin;content)

Postoperative Phase Begins with the admission of the patient to the PACU and ends with a followup evaluation in the clinical setting or at home. The scope of nursing care covers a wide range of activities during this period. In the immediate post-operative phase, the focus includes maintaining the patients air-way, monitoring vital signs, assessing the effects of the anesthetic agents, assessing the patient for

complications, and providing comfort and pain relief. Nursing activities then focus on promoting the patients recovery and initiating the teaching, follow-up care, and referrals essential for recovery and rehabilitation after discharge. Each phase is reviewed in more detail in the three chapters of this unit.

Patient satisfaction as a measure of quality of care Patients are the best source of information about a hospital systems communication, education, and pain-management processes, and they are the only source of information about whether they were treated with dignity and respect. Their experiences often reveal how well a hospital system is operating and can stimulate important insights into the kinds of changes that are needed to close the chasm between the care provided and the care that should be provide. Patients should be allowed to define their own priorities and evaluate their care accordingly, rather than having those criteria selected by professionals. Satisfaction studies can function to give providers of care some idea of how they would have to modify their provision of services in order to make their patients more satisfied. The extent to which consumer opinion can influence policy makers and health care personnel is not only dependent upon collecting the right kind of data, it also requires that policy makers and health personnel accept the value of the consumers point of view

There is general agreement that client satisfaction is an integral component of service quality and expanded definitions of health service quality typically make explicit mention of patient satisfaction. The argument has been offered that the effectiveness of health care is determined, in some degree, by consumers satisfaction with the services provided. Support for this view has been found in studies that have reported a satisfied patient is more likely to comply with the medical treatment prescribed more likely to provide medically relevant information to the provider, and more likely to continue using medical services. The logic has been extended to developing countries; patient satisfaction and perceived quality will influence utilization of services, as well as compliance with practitioner recommendations. But some still feel that patients cannot really be considered good judges of quality, dismissing their views as too subjective, Petersen (1988) challenges this view by suggesting that it is not important whether the patient is right or wrong, what is important is how the patient felt, even though the caregivers perception of reality may be quite different. At a minimum, their inputshowever subjective that may be should help providers understand and establish the acceptable standards of service that must be delivered to ameliorate patients suffering. Weitzman (1995) suggests that health care quality can be defined in relationship to 1- the technical aspects of care 2- the interpersonal relationship between

practitioner & patient and 3- the amenities of care. Organizations that focus on customer satisfaction are able to build loyal clients who then serve to promote the organization further through vitalword of-mouth advertising referral.

Nursing Care and patient satisfaction

Nursing care is one of the major components of Health Care Services. Thus, patients have the right to expect quality of nursing care. Nursing staff, which comprise the vast majority of hospital staff, have the greatest contact with patients. Abramowitz et al., (1987) noted that nurses act as goodwill ambassadors & frontline representatives for hospitals. Nurses, rather than physicians, are seen as responsible for the day-to-day activities on a unit. Nurses provide the main connection with patients, act as patient advocate with other care providers, give physical care to patients, and offer emotional support to both patients and families. In their teaching capacity, they also play a key role in posthospital adjustment. The importance of the nursing role is evidenced in a number of studies. Patient satisfaction with nursing care is considered an important factor in explaining patients' perceptions of service quality.

According to O'Connor et al., It's the patient's perspective that increasingly is being viewed as a meaningful indicator of health services quality and may, in fact, represent the most important perspective. The majority of early studies on patient satisfaction have explored the impact of physician care (55%) rather than nursing care (6%) or both types of care provision (39%) Patient satisfaction is a popular way of evaluating nursing practice in developed countries. Patient satisfaction has a common-sense appeal as evidence in support of practice, and has frequently been used in past attempts to evaluate changes in nursing, such as the introduction of primary nursing. A number of studies have identified the aspects of nursing care thought to contribute to good quality. These include individualized patient care provided in an empathetic and caring way, nursing that is competent and consistent, and nurses who provide patients with information effectively and appropriately. Patients' satisfaction has been used as an indicator to measure the quality of health care provided by nurses. More specifically, the assessment of quality of health care from the patient's perspective has been operationalized as patient satisfaction. Patient satisfaction has been advocated as an outcome measure of quality nursing care Health Service Quality can be assessed from the provider perspective in which it is based on acceptable standards and from the consumer perspective in this case through examining patient satisfaction. Patient satisfaction has become popular way of assessing quality in health care facilities.

It has been used as an indicator to measure the quality of health care provided by nurses. Nursing that may be rated by the profession as of high quality may not be seen that way by the patient. Helping patients to regain independence by encouraging them to wash and dress themselves may be seen as poor care by patients who think the nurse should do the washing and dressing. There are seven main dimensions that have been addressed in the literature as crucial in the measurement of patients' satisfaction. These dimensions are: respect for patients' values, preference and expressed needs; coordination, integration and information flow; information and education; physical comfort; emotional support and alleviation of fear and anxiety; involvement of family and friends; and transition and continuity of care. Accordingly, patients' satisfaction measurement tools should consider the aforementioned dimensions. On this line, the Newcastle Satisfaction with Nursing Scale (NSNS) covers most of the dimensions of patient satisfaction suggested in the literature such as quality of care and patients views of the care.

The Newcastle Satisfaction with Nursing Care (NSNS)

The NSNS is designed principally to detect differences between wards (hospitals) and patient groups with respect to overall experience of and satisfaction with nursing. Therefore, the main focus of the analysis is an overall scale scores. The basis for the construction of the NSNS was:

Attentiveness. general awareness or anticipation of patients needs; regular patient checking of patient; making time for patients; willing to respond to requests.

Availability. Nurses available when needed and quick to respond to patient requests

Reassurance. Making patient feel at home, nurses aware when patient upset; comforting patient, allaying fears; showing empathy.

Individual treatment. Tailoring care to individual patients; remembering personal preferences; giving patient choice Openness / informality. patient allowed some freedom; nurses seem like friends; nurses care for patient with humor Information. Nurses keep patient informed about condition / care; nurses explain their actions; nurses keep relations informed

Professionalism. nurses do any job without complaining; nurses always maintain a pleasant manner; nurses treat all patients equally. Nurses knowledge. Nurses demonstrate sound nursing knowledge and have good knowledge of individual patients condition and treatment Ward organization / management. ward appears to be organized efficiently; between nurses provide continuity of care; there is good communication nurses; nurses work as a team.

Environment process. nurses give patients some control over their environment; privacy provided. Environment structure. comments on ward cleanliness, noise, layout, decoration, facilities and equipment. Comments on nursing staff levels; other patients; quality of food.

Findings from different articles Respect for patients needs and wishes is central to any humane health care system. Providers wishing to meet those needs more effectively have shown growing interest in the use of patient evaluation and reports as a complement to other methods of quality assessment and assurance.

Analysis of patient surveys carried out in Germany, Sweden, Switzerland, the United Kingdom, and the United States in 19982000 revealed high rates of problems during inpatient hospital stays. Problems with information and education, coordination of care, respect for patients preferences, emotional support, physical comfort, involvement of family and friends, and continuity and transition were prevalent in all five countries. These dimensions of patients experience appear to be salient and relevant in each of the five countries, but attempts to develop international rankings based on this type of evidence will have to overcome a number of methodological problems. (Angela Coulter and Paul D. Cleary,May/June 2001 Patients Experiences With Hospital Care In Five Countries

According to Walsh and Kowanko, the aspects with which patients were least satisfied (regardless of admitting ward) were the amount and type of information they receive regarding their condition and treatment. The top aspects that patients scored highest for their satisfaction with nursing care were the feeling of privacy, nurses capability at their job, and nurses helpfulness. It is generally believed that elements of privacy, respect, and advocacy that nurses consider through their practice enhance patients' satisfaction with the care.

McGhee interviewed 400 patients recently discharged from hospital using an unstructured schedule. She did not obtain an overall satisfaction score but noted the comments made about nine aspects of hospital care. Food, medical and nursing care attracted the highest proportion of favorable comments. McGhee concluded that the greatest single defect in hospital care was the barrier to easy exchange of information. In Jeffery et al study, older patients are generally more satisfied than younger patients. Other demographic characteristics such as sex and race seem to be unimportant. Patients reporting their health as poor are less satisfied than those who describe themselves as healthy. Satisfaction may also be influenced by the patients mental state: psychological distress, depression and personality disorders have been associated with lower levels of satisfaction. Lower satisfaction has also been found among elderly, disabled Medicare beneficiaries. Unmet patient expectations may also affect satisfaction. The overall rating of patient satisfaction in Alasad and Ahemed, study was 77 percent, it was considered relatively low in comparison to other studies. In comparison between wards, the gynecological ward had a significantly higher percentage of patients satisfaction with nursing care than the surgical wards. The Netherlands by Kalkman and colleagues. They found an incidence of 25.8% of severe pain in surgical patients, measured within 1 h after surgery. In their study, Men are more satisfied than women with the care provided. Patients

who had major surgical procedures were more satisfied with the information supplied. As expected also specialty influences patient satisfaction. The way the health professional acted on these problems influenced their degree of satisfaction. From a patients perspective of healthcare, quality is not only determined by the outcome of treatment, but also by the extent to which patients are supported during their hospital stay. In this study, they found that better informed patients also ranked staffpatient relationship higher. Combining these observations, they concluded that information provision and staffpatient relationship are the major determinants for patient satisfaction with perioperative care. Kuprat and colleagues found that the discrepancy between patient and practitioner beliefs about care is an important determinant of trust and satisfaction. Involving patients in the decision-making process results in higher satisfaction with care. Integrating patients satisfaction in the decision-making process should be an integral part of continuous quality improvement in anaesthesia care. The study confirms that quality of anaesthesia care is not only composed of good information and communication skills but also how the health professional acts or behaves towards the patient. They believe that once the patient has good reason to assume that the best possible care is provided, that patient satisfaction is largely based on good patient information and the staff patient relationship. (M. A. A. Caljouw*, M. van Beuzekom and F. Boer, March

12, 2008, Patients satisfaction with perioperative care: development,validation, and application of a questionnaire

http://bja.oxfordjournals.org/content/100/5/637.full.pdf+html)

In David Locker and Dunt study, elderly patients consistently reported higher levels of satisfaction than younger age groups. The relationship between satisfaction and social class, however, was not consistent across studies. The communication of information about illness and treatment appeared to be the most frequent source of dissatisfaction. In one study, marked associations were found between satisfaction and gender, age and social class. Elderly patients were more likely to report themselves very satisfied, 85% of those over 65 giving this rating compared to 52% of those aged 15 39 years. Satisfaction was also related to social class, those from extremes (high social class) tending to be most satisfied than the intermediate groups. Older age was the strongest predictors of satisfaction and men tended to be more satisfied than women, By definition, a study can only have content validity if it measures the dimensions of care that constitute patient satisfaction. Satisfaction appears to be influenced by a number of factors, including patient characteristics, their previous experience of health care and their expectations. Among these factors, only age has been found to have a consistent effect on satisfaction, with older patients generally expressing higher levels of satisfaction.

A study was conducted in Jimma to determine patient perception of the care received. The investigators of Jimma study was utilized a tool with yes or no answers and the interview was conducted by nurses. Since the investigators utilized a tool only with yes or no answers and took a small sample (sample size = 60) that would be difficult for the purpose of comparison with this study. However, the most positive areas of patient satisfaction with nursing care in Jimma included: getting an immediate response from a call for help, positioning according to the nature of the disease, meals provided on time, appropriateness of meals in line with religious considerations, information regarding diets, greetings and politeness of nurses, and attention to the medication prescribed. Low satisfaction emerged relative to offering help during meal time, information regarding the disease condition, as well as hospital facilities and ward environment, maintaining privacy, the degree of instruction for self care, result explanation, involving patient in discussion, and patient teaching and instructions for self care. All the interviewed patients stated that they did not receive orientation about the hospital wards, the direction of toilet and bathrooms, or information regarding visiting hours and safety measures. In the areas of informing the patients about their medical diagnosis and medical treatment all respondents stated that the nursing staff did not do this. Besides, only half were given explanation about procedures before they were performed. However, patients were satisfied in areas of greetings and politeness of the nurses.

Patients' views have become an important element in the evaluation of health care, even though the concept of patient satisfaction has rarely been defined or examined theoretically. This is reflected in the diversity of definitions and measurement approaches in studies. In a meta-analysis of satisfaction literature, Hall and Dornan found it difficult to compare studies because of the variations in the dimensions of satisfaction measured.