Satisfaction of Breast Cancer Patients about Nursing Care in Rizgari Teaching Hospital in Erbil City يدثلا ناطرسب نوباصملا ىضرملا دنع ىضرلا ىوتسم مييقتلوح عرلاةيا يضيرمتلاة يف ليبرا هنيدم يراكزر ىفشتسم

Background: Patients’ satisfaction has become an established outcome indicator of the quality and efficiency of the health care system. Objective The aim of this study was to assess the level of Breast cancer patients’ satisfaction toward nursing care in selected hospital of Erbil city in Iraqi Kurdistan Region. Materials and Methods: A descriptive study was designed at oncology ward of Rizgari Teaching Hospital. Participants were interviewed and questions were asked. It started from 1 st June to 20 th September 2014.The questionnaire included demographical data: gender, educational qualification, history of cancer in the family, family income, type of hospital room and duration of stay in hospital, and type of treatment and frequency of hospitalization were analyzed by using Rating Scale. Results: 60 patients participated in this study. Likert scale was used to assess the levels of satisfaction. Chi-square analysis was computed to find the associations between the levels of satisfaction and demographic variables. 30 patients had a scored between 60-80 and considered to have a good level of satisfaction toward nursing care. However, 30 participants had scoring between 38-59 and are considered to have average level of satisfaction. Conclusion: The study concluded breast cancer patients had positive attitude toward nursing care. be conducted to assess the level of breast cancer patients’ satisfaction toward nursing care Recommendations: Further research including further oncology hospitals.


INTRODUCTION:
Cancer has become a major health problem in world.Recently, nearly 14.1 million cancer cases have been diagnosed breast cancer both in developed and less developed countries (1) .The incidence rate is almost 25% higher in men than in women (2) .However, among women the most frequently diagnosed cancer is breast cancer, and now it is considered one in four of all cancer in women (3,4).
Patients' satisfaction has become an established outcome indicator of the quality and efficiency of the health care system.This may because assessing health care effectiveness is essential in order to evaluate the available resources (5) .Satisfaction can be defined as patients' experience, and his or her expectation that related to the general health needs (6) .
Nurse plays an important role at the hospital to meet the patients' need, in particular for patients who have been diagnosed with breast cancer and their families in all settings simultaneously (7) .
All these are based on their qualification, professional knowledge; skills and attitudes nurses can deliver care to breast cancer patients that will enable this population to understand the process of their disease and symptoms that may arise during their treatments.To provide a high quality care and satisfy breast cancer patients and their families, the assessment of needs for breast cancer care is required and it is a critical step.points out that attributing patients" satisfaction is a totally separate dimension, In other words, states that the final quality confirmation is not only defined by the effectiveness of medical care, but from the satisfaction as well, which consists an indicator of the quality of health care provided (8) .
However, breast cancer patients may have some difficulties to express their concern regarding services, and this may effect on the quality of care (9,10) .Thus, patients' satisfaction among breast cancer patients has become an important subject.
The first effort to evaluate patients' satisfaction with the nursing services began in 1956 in the United States of America (11) .Today, in developed countries such as the USA and UK, its measurement is legally safeguarding, and in many cases, license as a prerequisite for hospital list required (12) .
Literatures have shown that nurses can play a significant role in forming patients' satisfaction with nursing services (13,14) .However, most of the studies have assessed the patients' satisfaction about cares that are delivered by physician (15) .Meanwhile, there is no a descriptive evidence regarding the breast cancer patients satisfaction toward nursing services in Kurdistan region -Iraq, in particular among cancer patients.
Therefore, the aim of this study was to examine the breast cancer patients' satisfaction about care which are delivered by nurses in term of information given by the nurses, the interpersonal relationship between the nurse and patient, the technical skills of the nurse and the physical environment.The findings could be used for program planning as well as for monitoring and improving the nursing care services in a selected hospital of Erbil city in Kurdistan region of Iraq.

Objectives:
The aim of this study was to assess the level of breast cancer patients' satisfaction towards nursing care in a selected hospital of Erbil city in Iraqi Kurdistan Region.

METHODOLOGY:
This study was analytical study conducted to gain new insights, discover new ideas or increase the knowledge of phenomenon.In present study, from 27 th June 2014 to 1 st December 2014, the investigators have described the correlation between selected demographic variables with the level of satisfaction of patients with breast cancer towards nursing care in selected hospitals of Erbil city Kurdistan Region-Iraq including Rzgari Teaching Hospital.
Participated were who had been diagnosed with breast cancer and between age group of (21-60) years, and admitted to medical ward.Non-probability convenient sampling technique was used.Convenience sampling is also known accidental sampling.
Convenience sampling is an inexpensive method.The samples are accessible and usually require less time to acquire.The sample consisted of 60 cancer patients who are not critically ill.A self-structured rating scale was developed for assessing the level of satisfaction of patients with cancer towards nursing care in selected hospitals of Erbil city.Suggestions of experts in the field were considered regarding the questionnaire.
The investigators have prepared the 5 points Likert Scale which included completely satisfied, very satisfied, quite satisfied, fairly satisfied and not satisfied.By giving numerical values to these five possible responses (5,4,3,2,1 etc) the investigators could generate both a score for each individual patient and a summary score for each item for included participants.
Patient's satisfaction scale focuses on the following six domains of nursing:1.Reception and admission, 2. Privacy and freedom, 3. Personal and environmental hygiene, 4. Nutrition and medication, 5. Daily activity and comfort, 6. Communication and education This study was approved by College of Nursing/Hawler Medical University.Participants were informed that they had right to refuse if they would not to participate, In addition, they assured that the information is not anonymous to anyone.
Characteristics of samples were statistically described in terms of frequencies and percentages.The total score for each patient was calculated to assess the levels of satisfaction.Besides, Chisquare test was used to calculate and determine the association between satisfaction and demographic data.In addition, Mean for satisfaction scores was calculated to each question.This table shows description of the demographic variables of samples by frequency and percentage.It shows that most of the samples were between the age group of 51-60 year (n=37, p=61%).In other words, majority of the samples were male (n=33, p=55%) and were married (n=50, p=83%).Regarding the educational background, it has appeared the study revealed that (n=19, p=32%) were illiterate.Business qualification lead the group with (n=22, p=37%).Most of the samples had a family income ranging from Below 500000 ID (n=32, p=53).Majority of the samples were from urban (n=41, p=68%).With respect to family history of breast cancer, most of the participants did not have breast cancer among their family members (n=41, p=68%).With regard to treatments, the study have showed that most of the patients were undergoing chemotherapy (n=42, p=70%).Participants were also visiting hospitals (n=39, p=65%).However, half of them stayed at the hospital which was between 1 to 5 days (n=51, p=85%).Table 1 shows scores level of breast cancer patient's satisfaction toward nursing care.Fortunately, out of 60 participants, 30 patients had good level of satisfaction (60-80) toward nursing care, while 30 of them had average level of satisfaction (38-59).On the other hand, and none of them had poor level of satisfaction (16-37).Table 3 shows that the (gender, educational qualification, type of treatment and frequency of hospitalization, family income, history of cancer in the family, type of hospital room and duration of stay in hospital) are related with the H0.ie.They have no significant difference in the level of satisfaction because P value > chi square, we accept H0.But others like (age) are also related with the H0.They have significant difference in the level of satisfaction because P value < chi square.We reject H0.

Table 4: Level of cancer patients' satisfaction regarding the items of satisfaction scale
Question No.
Mean for each question 1.The nurse receives you with respect and courtesy on Your arrival.3.6 2. Feel satisfied with the information provided to you and your family members regarding ward routine on admission.

3.6
3. Feel satisfied with the explanation given to you regarding policies and procedures existing in the ward. 3.8

4.
Satisfied with the privacy provided to you by the nurse.
3.9 5. Satisfied with the amount of freedom you had In the ward.
3.8 6. Satisfied with the cleanliness of your ward.
3.6 7. Satisfied were you with amount of care you received from the nurses in bed making, brushing and Bathing.3.6 11.The nurses make you comfortable while doing procedures.
3.5 12 You were satisfied with the assistance the nurse gave during daily activity.
3.5 13.Were you provided with peaceful environment for rest and sleep?
3.5 14.Satisfied with the amount of your involvement In the planning and discussion on your nursing care.

3.5
15. Satisfied with the nurses advise about your rest activity, dietary restrictions, medication and follow up at the time of discharge.

3.6
16.You were at ease to communicate your requirement with the nurse during your Stay.

3.7
Table (4) Satisfaction got the highest mean (3.9) which included satisfaction with the privacy provided to patients .In contrast, question No.9 got the lowest mean ( 3.4) which was satisfaction of the breast cancer patients toward treatments which were carried out by nurses.

DISCUSSION:
The findings from this study indicated that a vast majority (50%) of the respondents had good level of satisfaction toward nursing care that provided at the selected Hospitals.Similarly, a study by (16) .Indicated that level of patients' satisfaction in their study was higher.This study has also showed that 60 patients who received nursing care at the oncology wards in the Hospitals of Erbil city reported 50% of respondents were good level of satisfaction with the overall services.The finding reported in which 70% of cancer patients in Northern Ireland reported satisfaction with nursing care during hospitalization (17) .
In this study there was no relationship between genders regarding cancer patients' satisfaction toward nursing care.Similarly, in two studies at Hospital University Kebangsaan Malaysia (HUKM) in Malaysia and Hong Kong there were no relation between patient's satisfaction and gender (17,18) .In contrast, four studies have concluded that men were more satisfied with nursing caring process, daily care and environment of the hospital then women ( 14, 19, 20, 21) .
Regarding education, this study has shown between educational qualification and level of satisfaction there was relationship; however, this is contradicted with the result of a study that there was no relationship between cancer patients' satisfaction and educational level (23) .
Another finding of this study was that the patients who had high family income were more satisfied about nursing care.However, a study in England has concluded that cancer patients with low income had low level of satisfaction (18) .On the other hand, in Tehran Hospital among cancer patients has found that there was no significant relationship between patients' income and level of satisfaction (20) .
In other words, in this study has found that there was no relationship between types of rooms and patients satisfaction.In contrast, a study has shown patients who were in private room were more satisfied with nursing care (22) .Furthermore, this study has showed that there was a relationship between frequency of hospitalization and level of satisfaction has been observed among breast cancer patients (24) .On the other hand, patients who stayed for a short period of time at hospital may contribute to change in cancer patients' satisfaction toward nursing care (24) .

CONCLUSION:
This study has concluded that satisfaction among women who have been diagnosed breast cancer is a subjective feeling.Besides, demographic variables do not have positive or negative effect on this population.In addition, it can be said that high mean scores of breast cancer patient's satisfaction has indicated that nurses were successfully treated this population.On the other hand, there was low mean score of breast cancer patients in terms of their involvement in education, nutrition, and planning their procedure that were provided by nurses.Therefore, this shows that patients were not satisfied about those aspects of nursing care.Hence, for further developing of breast cancer patients toward nursing care, there should be an educational training course for nurses in oncology wards.

RECOMMENDATIONS:
1. Further research with large sample size should be conducted.

2.
A quasi experimental study can be conducted before and after implementing in service education.

3.
Studies can be conducted to assess the satisfaction in post operative patients.4. Studies can be conducted to assess the job satisfaction of nurses in oncology centre.5.A comparative study can be conducted on satisfaction of patients between three or more hospitals.

3 . 7 8..5 9 . 4 10.
The nurses help you in taking the food and fluids in time satisfactorily.3Satisfied with the way the nurse carried out your Treatment.Example: oral medications and injections for relieving pain immediately.3.The nurse explains to you before Commencing any procedure.