Nurses communication should not be removed, but rather simplified, introducing only a limited number of nursing staff to the

patient. Also, this study demonstrates that incorporating communication issues into the measurement of service quality provides a more valid and reliable measure. The results show that the number of nurses which patients have talked to was inversely correlated with satisfaction and perceived quality. Specifically, patients who had talked to more nurses had significantly lower satisfaction rates. MANOVA analysis also showed the relation between high/low complexity and satisfaction, perceived quality, and behavioral intention. Also, Cronbachs Alpha coefficient scores showed that the survey was reliable and its reliability was actually improved after adding communication questions. Finally, the communication dimension was found to be correlated with satisfaction, perceived quality, and behavioral z
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Although effective communication with patients is increasingly understood as a key to effective, patient-centered care in all health care settings, the quantity and quality of training that nurses get in ways to promote and enhance effective nurse:patient communication is sadly lacking. This is true in the context of the pre-service training of nurses, and it is even more true with regard to the in-service training and continuing education of nurses. There are, fortunately, some rare exceptions. This annotated bibliography is intended to provide information about, and connections with, the relatively few publications that contain practical information and ideas about how to do a better job of helping nurses learn to jointly establish meaning (i.e., truly communicate) with patients with the wide variety of communication vulnerabilities and communication challenges that patients bring with them, or develop in the course of their treatment. What is needed now is energetic action by health care decision-makers to move forward more quickly in adopting and adapting some of the ideas contained in the list of publications below.

Shafer discusses various programs that train physicians, nurses, and social workers to relay difficult messages to patients, enhancing their necessary communication skills. She advocates the importance of provider-patient communication throughout the diagnosis, treatment, and recovery processes in order for health care professionals to provide quality care. She examines the position of Dr. Walter Baile (a MD and professor of behavioral science and psychiatry at MD Anderson Cancer Center in Texas) that it is essential for doctors to understand their patients emotions, as well as their own, when discussing diagnoses and treatment options.

The authors suggest that a communication skills module should be included in all final years of undergraduate nursing programs. With an array of clinical experiences to draw from, final year nursing students are better positioned to apply the skills of effective communication in practice if they also receive communication training.

. The lack of communication systems in hospital settings increased the amount of time and effort spent on communication, leading to considerable frustration for nurses and patients.

. The Implications for Staff Development section suggests that nurse educators facilitate an open discussion during training sessions to help the preceptors reflect back on what active listening skills they used during their nurse-patient interactions to engage the patient as an equal participant. Nurses progress in empowering patients and practicing active listening should be monitored over time. Recommendations for Further Studies Based on the findings, the following areas for further research are suggested: 1. A study of patient satisfaction with services provided by nurses in the childrens ward and Thai patients ward should be conducted as they are also an important source of hospitals revenue. The service evaluation completed by Thai patients is recommended in order to gain in-depth information for service improvement. Without evaluating service quality, the hospital may not be able to satisfy patients because they do not know what the patients think about their services. 40 2. Further studies should include out-patient satisfaction with the quality of nursing services at Samitivej Srinakarin Hospital. Out- patients are also an important source of hospital revenue. Understanding out-patient satisfaction will benefit hospital management for improving the level of patient satisfaction. 3. A study of improving nurses English communication ability would also be of value. The findings in this study revealed that the satisfaction of nurses English communication ability scored low. Further research should explore the correlation between improving the English ability of nurses, experience working on the international ward, and patients satisfaction ). Low patient satisfaction may result in poor compliance, potential waste of resources and suboptimal clinical outcomes. As pointed out by McKinley et al. (1997), satisfaction of the patients legitimate demands should be the

expected outcome of all medical care. Nurses play an important role in satisfying patients expectations as they are the primary point of contact between patients and the world of healthcare. Satisfaction occurs when a service or product meets their needs, wants and expectations of the custumer. It is considered one of the most important competitive factors, and is the best indicator of a companys profitability (Muffato & Panizzolo, 1995). It also indicates the quality of service at all levels of the company (Sermsri & Chompikul, 2007) and helps an organization achieve its objectives by retaining loyal customers who promote positive word of mouth (Soutar, 2001). Feedback from customers allows a company to measure customer satisfaction. Patients' satisfaction is an important indicator for quality of care. Measuring healthcare quality and improving patient satisfaction have become increasingly prevalent, especially among healthcare providers and purchasers of healthcare. This is mainly due to the fact that consumers are becoming increasingly more knowledgeable about healthcare. No studies of inpatients' V Relationship with staff and daily routine Univariate analysis showed that higher satisfaction in RS dimension was associated to male gender (P = 0.032), urban residence (P = 0.008), higher income (>180 euro/month) (P = 0.001), staying in double room (P = 0.001), better perceived health status compared to admission (P < 0.001), and satisfaction with life in general (P < 0.001). ], our study showed that in the univariate analysis men tended to be more satisfied than women particularly in RS dimension. These results might indicate that women expect more than men, or that women have different experiences than men do. Patient-related factors The literature appears mixed on the importance of patients' demographic and social factors in determining satisfaction. Some studies stated that patient demographics are a minor factor in patient satisfaction, 1 while others concluded that demographics represent 90 percent to 95 percent of the variance in rates of satisfaction.2 Nevertheless, the literature does shed some light on how particular demographic factors affect patient satisfaction. Age. The most consistent finding has been related to age: Older patients tend to be more satisfied with their health care.

Ethnicity. Studies that have looked at ethnicity have generally held that being a member of a minority group is associated with lower rates of satisfaction. In a ranking of degrees of satisfaction, non-Hispanic whites had the highest satisfaction, followed by African Americans, Asian/Pacific Islanders and Hispanics. The lowest degree of satisfaction was found in Indians/Alaskan natives.3 Gender. Studies on the effect of gender are contradictory, with some studies showing that women tend to be less satisfied and other studies showing the opposite. Communication. Doctor-patient communication can also affect rates of satisfaction. When patients who presented to their family physician for work-related, low-back pain felt that communication with the physician was positive (i.e., the physician took the problem seriously, explained the condition clearly, tried to understand the patient's job and gave advice to prevent reinjury), their rates of satisfaction were higher than could be explained by symptom relief.12 While the literature contains a number of contradictions on the subject of patient satisfaction, it also offers a number of compelling reasons for working to improve satisfaction among our patients. Studies support the idea that patients who get better are (not surprisingly) satisfied with their care. One study, in which researchers followed up with patients three weeks after they were seen, found that most were better, but those who were still symptomatic were still worried, had unmet expectations and had lower satisfaction. The assessment of satisfaction with care is considered as a major component of quality management and reflects healthcare professionals' ability to meet their patients' needs and expectations. Numerous studies on patient needs and expectations have been conducted and many patient satisfaction scales have been developed and validated. The effect of clinical characteristics and socio-demographic factors on satisfaction scores has been widely studied, but their impact on satisfaction is still unclear. Indeed, results are inconsistent and diverge from one study to another [1, 2]. According to the literature, gender, ethnic origin, educational, social, or marital status and conditions of admission, have all been found to be associated [36]. Subjective health status also seems to affect the satisfaction score: subjects who believe they were in poor health before hospitalization tend to be less satisfied, as do those who consider that their health has not improved by the end of hospitalization [4, 69]. However, the effect of subjective health status seems to be smaller after adjustment for all other co-variables [10]. In a meta-analysis carried out in 1988, Hall [11] concluded that socio-demographic characteristics are a minor predictor of satisfaction, at best. In conclusion, our results suggest that age is an important modifier of satisfaction and should be taken into account when interpreting these kinds of data. The patient age variable should be considered as a non-linear factor for adjusting patient satisfaction scores Implications Patients in both hospitals consider good doctor with the ability to cure' as the most important attribute of medical care in a hospital. Different attributes which matter most to patients are

almost same, but relative importance of these is a function of background (socio-economic status) and what is available in the hospital. But the most important thing is the doctor, who should be not only be competent i.e able to treat, but also have good communication skills and is empathetic