Patients' Satisfaction Concerning Hospital Care Post-acute Myocardial Infarction at Maysan Governorate Hospitals

Objective: To identify the satisfaction of patients concerning hospital care post-acute myocardial infarction. Methodology: Quantitative design (connective a descriptive study) was carried out to identify the patients' satisfaction concerning hospitals care post-acute myocardial infarction at Maysan governorate hospitals. Starting from December 30th 2014 up to May 28th 2015. To achieve the objectives of the study, a non-probability sample (a purposive sample) consisted of (100) patients were acute myocardial infarction. Data were collected through the use of questionnaire which is related to acute myocardial infarction patients’ The questionnaire was interview with acute myocardial infarction patients who were attended coronary care unit at Al-Sadder Teaching Hospital, and Maysan Center of Cardiac Disease after obtaining agreement from the patients throughout using Arabic version of questionnaire. The researcher conducted private meeting with each patient who spends about 25-30 minute to respond to the interview which were developed for the purpose of the study. Instrument validity was determined by a panel of experts. Reliability of the instrument was determined through the use of Cronbach Alfa which was (0.85) which are strong acceptable for acute myocardial infarction patients'. Analysis of data was performed through the application of descriptive statistics (frequency, percentage), mean of score and Standard Deviation. RESULT: .high patients' satisfaction was in item (4) with mean score (5.59) and stander deviation (0.494) and anther items with less mean score CONCLUSION: The results indicated that there is a high satisfaction for patients when little of the items of satisfaction and little satisfaction in most of the other items RECOMENDATION: increased the medical staff to provide the important health care for patient that led to increased patient satisfaction concerning hospital care.


Abstract:
Objective: To identify the satisfaction of patients concerning hospital care post-acute myocardial infarction.Methodology: Quantitative design (connective a descriptive study) was carried out to identify the patients' satisfaction concerning hospitals care post-acute myocardial infarction at Maysan governorate hospitals.Starting from December 30th 2014 up to May 28th 2015.To achieve the objectives of the study, a non-probability sample (a purposive sample) consisted of (100) patients were acute myocardial infarction.Data were collected through the use of questionnaire which is related to acute myocardial infarction patients' The questionnaire was interview with acute myocardial infarction patients who were attended coronary care unit at Al-Sadder Teaching Hospital, and Maysan Center of Cardiac Disease after obtaining agreement from the patients throughout using Arabic version of questionnaire.The researcher conducted private meeting with each patient who spends about 25-30 minute to respond to the interview which were developed for the purpose of the study.Instrument validity was determined by a panel of experts.Reliability of the instrument was determined through the use of Cronbach Alfa which was (0.85) which are strong acceptable for acute myocardial infarction patients'.Analysis of data was performed through the application of descriptive statistics (frequency, percentage), mean of score and Standard Deviation.RESULT: .highpatients' satisfaction was in item (4) with mean score (5.59) and stander deviation (0.494) and anther items with less mean score CONCLUSION: The results indicated that there is a high satisfaction for patients when little of the items of satisfaction and little satisfaction in most of the other items RECOMENDATION: increased the medical staff to provide the important health care for patient that led to increased patient satisfaction concerning hospital care.Keywords: Patients' satisfaction, hospital care, Myocardial infarction.

INTRODUCTION:
Myocardial Infarction (MI) focuses on the myocardium (the heart muscle) and the changes that occur in it due to the sudden deprivation of circulating blood, hence limited oxygen supply.The main change is necrosis (death) of myocardial tissue.The incidence of Acute Myocardial Infarction (AMI) is high, and it is the leading cause of death in the elderly (1) .AMI has a mortality of 30% with half of deaths occurring before hospital arrival.Recent data from Quebec has shown that providing STEMI care in hospitalized patients that is both appropriate and timely (according to guideline-based practice) reduces 30-day mortality rates by half.The reduction in mortality is true whether the chosen method of reperfusion is fibrinolysis or primary percutaneous coronary intervention (PCI) (2) .The incidence of AMI is high and it is the leading cause of death in the elderly also.According to World Health Organization (WHO) in the world 14 million people die annually (3) .
. In the year 2003, it was estimated that heart attacks are the leading cause of death among both men and women all over the world (4) .In the year 2007, WHO estimated that globally (29 %) of deaths were due to CVD and among them, (25-28 %) of deaths were due to MI (5) .Patient satisfaction is one of the establishes yardsticks to measure success of the services being provided in the health facilitate.But it is difficult to measure the satisfaction and gauze responsiveness of the health system as not only the clinical but also the non-clinical outcomes of care do influence the patient satisfaction (6) .Patient satisfaction depends upon many factors such as; clinical services provided, availability of medicine, behavior of doctors and other health staff, cost of services, hospital infrastructure, physical comfort, emotional support and respect for patient preferences (7) .

METHODOLOGY:
Design of the Study: Quantitative design (connective a descriptive study) was carried out to identify the patients' satisfaction concerning hospitals care and its effect on general self-efficacy post-acute myocardial infarction at Maysan governorate hospitals.Starting from 30 th Dec. 2014 up to the 28 th May 2015.

The Setting of the Study:
The study was conducted at Al-Sadder Teaching Hospital and Maysan Center of Cardiac Disease in Al-Amarah City.These hospitals provide caring for patients with acute myocardial infarction.

The Sample of the Study:
The sample of the study non-probability (a purposive sample) consisted of (100) patients with acute myocardial infarction after admitted to hospital and were selected according to the following criteria:-1.Patients which admitted to hospital and medically diagnosed as acute myocardial infarction.2. Both sexes of acute myocardial infarction patients.

Patients different level of education.
Instrument Construction: After extensive review of relevant literature and studies the researcher constructed the questionnaire and was used as mean of data collection.The questionnaire consisted of (61) items which include four parts.

Part I: Patients' demographic characteristics
The first part of instrument concerning with determination the demographic characteristics of patients which include seven items (age, gender, marital status, level of education, occupational status, change occupation after disease, and monthly income).

Part II: Medical Information Concerning Sample of Study
The second part of instrument concerning with medical information for sample of study which include four items (Risk factor that causes disease, Time of treatment the heart attack in hospital, Have you been making the necessary first aid at the moment of a heart attack?, and Methods of treatment).

Part III: Items Related to Patients' Satisfaction Concerning Hospital Care Post-Acute Myocardial Infarction
This part focused on medical and nurse staff care which provided for patients with acute myocardial infarction which consisted of (38) items.These items were measured, scored to express about satisfaction of patient by rated on 6 levels type Likert scale: (6) for very satisfactory, (5) for satisfactory, (4) for satisfactory to some extent, (3) for unsatisfactory, (2) for not very satisfactory, and (1) for I don't know.

Part IV: General patient satisfaction about health care
This part include comprehensive patient satisfaction to the medical and nursing care which provided for patients during stay in hospital which expressed by line ranging with satisfaction from one (low satisfaction) to five (high satisfaction).

Validity of the Instrument:
The validity of the instrument was established through a panel of ( 12) experts.

Reliability of the Instrument:
The aims of reliability was to ensure that the items of the questionnaire were clear, suitable, and understandable.The reliability of the present study instrument was determined through Cronbach's alpha.Pilot study was carried out from February .24 th of 2015 up to March 24 th of 2015 on (10) patients with acute myocardial infarction at Al-Sadder Teaching Hospital , and Center of Maysan for Cardiac Disease.The result of reliability coefficients by Cronbach's alpha was (0.85) .This result of the reliability for the pilot study indicated that the items of the questionnaire were clear, relevant, and understandable, and this indicated that the questionnaires are strong acceptable Data collection: After permission were obtained from all institutions, the data was collected from 25 th March of 2015 up to 10 th May of 2015.Data was collected through the use of designed questionnaire format by interview techniques.The questionnaire was interview with acute myocardial infarction patients who were attended coronary care unit at Al-Sadder Teaching Hospital, and Maysan Center of Cardiac Diseases after obtaining agreement from the patients throughout using Arabic version of questionnaire for all subjects who were included in study sample during discharge from hospital for all items of questionnaire and after one month for items of general self-efficacy.The investigator conducted private meeting with each patient who spends about 25-30 minute to respond to the interview.Data analysis: Analysis of data was performed through the application of descriptive statistics (frequency, percentage), mean of score and Standard Deviation.Table (1) shows that the highest percentage (38%) of the patients' age group (60 years and above) old.Most of them (64 %) were male.All of them (100%) were married.Most of them (94%) have children.The level of education represents that most of them (40%) were illiterate.(29 %) of them were Housewife.(18%) from Retirees say the current health status (AMI) isn't reason for being retired.Majority of them (79%) don't change their jobs after the disease.The monthly income for most of patients (52%) was enough to some extent.Table (2) indicates that the majority risk factor (70%) of the disease for sample of study was chronic disease.(5) shows that the majority sample of study (65%) have method of disease treatment by medication in the intensive care unit.Table (6) indicates that the item (4) came in ranked first with mean of score (5.59) and standard deviation (0.494), item (2) came in ranked second with mean of score (5.51) and standard deviation (0.502) , while item (1) came in third place with mean of score (5.29) and standard deviation (0.640)   2) reveals that the majority level of patients, satisfied about nurses care provided by the nurse during the period of residence in the hospital was excellent for (52%) of study sample.

DISCUSSION:
Through the data analysis distribution of demographic variables table (1) reports that most of myocardial infarction patients are (60 year and more) years old and this account for (38%) of the study sample.This result is similar to the results obtained from studies done by (8) .These results indicate that the majority of myocardial infarction patients' ages are late adulthood.The researcher emphasizes that the people in this age group are less active and reproductive so they need most care and support to preventive from heart disease, Regarding gender of myocardial infarction patients majority of sample are male (64%).These results agree with study done by (9) .suggest that the female myocardium is more resistant to ischemia/reperfusion injury than the male myocardium.Concerning the marital status all members of sample study are married (100%).(94%) of them have children.These results agree with study done by (10) that indicates most of myocardial infarction patients are married and have children.Based on the findings the researcher suggests that the married persons are highly exposed to problems of heart such as AMI .With regard to the level of education of myocardial infarction patients, it is demonstrated that most of the patients are illiterates (40 %).This result is consistent with the study which indicate that the majority of myocardial infarction patients are low level of education (45%) (11) .In relation to occupation status the majority (29%) of myocardial infarction patients in the study are housewives.(18%) from Retirees say the current health status (AMI) isn't reason for being retired.This result is in agreement with study that the majority of myocardial infarction patients in this study have a wide spectrum of occupational factors, stress, noise and fine particulate dust (76%) (12) .(79%) of myocardial infarction patients in the study don't change their jobs after the disease.This result is in agreement with study that the majority of myocardial infarction patients don't change their jobs after the disease (97%) (13) .The monthly income for most of myocardial infarction patients 52 (52%) is enough to some extent The majority risk factor of acute myocardial infarction for sample of study table (2) was chronic disease that was accounted for (70 %).This result is disagree with study done by another study which indicate that the lifestyle occupation first rank for risk factor of acute myocardial infarction include smoking appears to be the cause of about (36%) and obesity the cause of (20%) of coronary artery disease. (14)Lack of exercise has been linked to (7-12%) of cases.Less common causes include stressrelated causes such as job stress, which accounts for about 3% of cases, and chronic high stress levels.The second rank chronic disease.
Table (3)Sample of study were treatment before the end of the (first 4 hours) of a heart attack that were accounted for (64 %) .This result is consistent with the study done by another study which indicates that the majority of patients with AMI treatment during the period between the first (2-4) hours of a heart attack. (15)Myocardial infarction patients have been making the necessary first aid at the moment of a heart attack that were accounted for (96 %) table (4).This means that myocardial infarction patients have prior knowledge about necessary first aid at the moment of a heart attack for expected AMI because most of sample of study have chronic diseases.Table (5) The majority of myocardial infarction patients have method of disease treatment by medication in the intensive care unit that was accounted for (65 %).This result is in agreement with the study done by another study Which indicates that most of myocardial infarction patients treatment by medication in the intensive care unit (80%) (16) .
Table (6) shows that the item (Respect for the rules and regulations (such as no smoking, calm, dates of visit) by others) came in ranked first with mean of score (5.84) and standard deviation (0.395), item (The instructions that are provided to you on how to get away from the stress and nervousness when you discharge the hospital) came in ranked second with mean of score (5.8) and standard deviation (0.426) , while item (The instructions that are provided to you on the daily activities and the extent of the amount of effort you can, and their level of physical comfort when you discharge the hospital) came in third place with mean of score (5.71) and standard deviation (0.478).This result is disagree with the study done by Al Faraj and others, 2009.This study indicates that patients estimate the satisfaction about skills and abilities of professional physicians with highest average (M=3.91,SD=1.07),While the lowest average was their appreciation for the quality of the information provided them by the physician (M=3.42,SD=1.12).Patients estimate the satisfaction about taking vital signs in an intensive care unit by nurses with highest average (M=3.90, SD=0.93) , while the lowest average was the availability of nurses for their time in order to hear patient (M=3.31 , SD= 1.12) (17) ..
Figure (1) reveals that the majority level of patients , satisfied about medical care provided by the physician during the period of residence in the hospital was excellent for (50%) of study sample.Also, figure (2) reveals that the majority level of patients , satisfied about nursing care provided by the nurses during the period of residence in the hospital was excellent for (52%) of study sample.This result is disagree with another study This study indicates the levels of patients , satisfied about medical care provided by the physician and levels of patients , satisfied about nursing care provided by the nurses during the period of residence in the hospital was good (83%) (18) .

CONCLUSION
The results indicated that there is a high satisfaction for patients when little of the items of satisfaction and little satisfaction in most of the other items.

RECOMMENDATION:
1-Increased the number of nurses staff graduate from college to provide the importance health care for patients with (AMI).
2-Acute myocardial infraction requires immediate medical attention.Treatment attempts to save as much viable heart muscle as possible and to prevent further complications.

Figure 1 .
Figure 1. level of patient satisfied about medical care provided by the physician during the period of residence in the hospital

Figure 2 .
Figure 2 .level of patients' satisfied about nursing care provided by the nurses during the period of residence in the hospital

Table 3 . Treatment time of a heart attack in hospital
F: frequencyTable(3)indicates that the majority sample of study (64%) were treated before the end of the (first 4 hours) of a heart attack.