Assessment of Patients Satisfaction Regarding Nursing Care Provided at General Hospitals in Al-Najaf City ضر مييقتا ىضرملا ةيانعلل

Background: Patients are considered to be the best source of information about a hospital system's communication, education, and pain-management processes. Patients' satisfaction has become an important indicator in measuring the quality of care rendered to the patients while in hospitals.
Objectives: 1. To assess level of satisfaction of the patients with different dimensions of nursing care provided in selected general units i.e. (medical, surgical). 2. To determine the relationship between the satisfaction level of patients with their demographic variables.
Methodology: A Non Probability "purposive" sample of (150) patients are included in the present study. The data is collected in Jan. 10th, 2015 to March 10th, 2015 through the utilization of a developed questionnaire (Arabic version) and by means of interview with each patient who is included in the present study the study instrument rated as (strongly agree, agree, undecided, disagree, and strongly disagree). The final copy of the questionnaire consists of the following parts: the first part is composed of patient's demographic data sheet. Second part includes the Patient's Satisfaction form. Validity of the study instrument was determined through the panel of (14) experts, and the reliability of the study questionnaire through the pilot study. Descriptive and inferential statistical analysis procedures were used to data analysis.
Results: The results showed that there was an accepted satisfaction (54%) among the nurses-patient's communication, also more than half of the study sample (56.7%) were satisfied with nursing care domain. In addition, the study subjects (56%) were satisfied with overall satisfaction with nursing care domains.
Conclusions: The study concludes that majority of the study sample were satisfied with nursing care provided in medical and surgical wards.
Recommendations: The study recommended that the nursing administrators and nurses can utilize the findings of the present study to recognize the strengths and weaknesses of nursing care services and adopt necessary measures in enhancing quality of nursing care to increase patient satisfaction. Moreover emphasis to be put on importance of patients satisfaction especially with nursing care in the curriculum of medical and nursing colleges as well as health institutes and nursing schools


INTRODUCTION
Quality of health care services refers to patient's decision about particular service.These services can be indicated through the difference between the patient's expectation and what they received from the qualified services.If the expected service and the perceived service levels are equals, it indicates an Excellency of the health care.If the patients reported that the care is qualified, it indicates a better service quality.In addition, if the perceived service level is less than what they hope, it means a worse service quality (1).Quality of care is an approach to health services, which obviously defines technical competence and the interpersonal dimension of health care giving process.Patients perceiving the health care services refer to an important issue for qualified the health care services.Moreover, it may refers to the preference of the patients for such services, and the patients judgment is the most important thing and is needed for qualifying health care services (2).Patient satisfaction is an important strategy that makes the decision clear and concise about the practices of the care providers.And it's a useful method that might be used to assess and evaluate the quality of the nursing management of all the nurses (3) .
Nursing services is a major component of hospital services, it has two major aims; nursing care for the sick patient, and prevention of disease and promotion of health (4) .
Patient satisfaction if beneficial as an indicator of care values provided by care providers.The patient's prediction of overall fulfillment with provided services in hospitalsis related to their agreement with health services (5) .Through awareness the value regarding patient gratification and defining its actual issue, the service of the care providers it's be more appropriate to the needs of health care consumers.Another support came from reviewing a relevant literature, which stated that assessment of clients gratification level is a method to evaluating the health care providers, and its refers to an available measure to improve their work.Furthermore, these gratifications give the ability to qualify the health workers practices and to evaluate the general health policies (6) .

OBJECTIVES
1. To assess level of satisfaction of the patients with different dimensions of nursing care provided in selected general units i.e. (medical, surgical).2. To determine the relationship between the satisfaction level of patients with their demographic variables.

METHODOLOGY
A descriptive Cross-Sectional study design is carried throughout the present study to assess medical and surgical wards adults' patients' satisfaction regarding nursing care provided at general hospitals in Al-Najaf City.This study started from November 11th, 2014 to July 2nd 2015 in order to achieve the early stated objectives.The data collection started from Jan. 10 th .2015 to March, 10 th .2015.Non Probability "purposive" sample of (150) patients are included in the present study.They were representative from previously mentioned settings, An Interviewing Patients' Satisfaction Questionnaire is prepared and modified by the researcher after reviewing of relevant literatures and studies and were based on Newcastle Satisfaction with Nursing Scale (NSNS).for the purpose of assessment of patients satisfaction regarding nursing care provided in both hospitals in Al Najaf city (Al-Sadr Medical City, and Al-Hakeem general hospital).The final study instrument is composed of two main parts as the following, The first part is composed of patient's demographic data sheet which is consisted of (11) items, that include hospital, ward, residency, age, gender, marital status, level of education, occupation, monthly income, length of stay in the hospital and number of admissions in the hospital.The second part of the questionnaire consists of (32) items regarding nursing care provided through assessing nurses' communication with the patients, The study instrument is rated on 5 Points Likert Rating Scale Whereas (strongly agree, agree, undecided, disagree, and strongly disagree), and all statements were scored as 5,4,3,2, and 1 respectively, based on this rating the researcher make decision according to the mean of scores that equal to (3) according to the following formula (sum of scores / number of scores) and this mean of score used for judgment about the patients satisfaction (if the mean of score more than 3 that mean the patients are satisfied with the nursing care otherwise the patients dissatisfied with the nursing care.The data of the present study are analyzed through the use of Statistical Package of Social Sciences (SPSS) version 16, performed through the use of descriptive statistical data analysis approach; such as(Frequencies, percentages), and inferential statistical data analysis (Chi-Square).Table (1) shows that the (65.3%) from the study subjects are from urban residential area.In regarding to the age group, the study results show that the (30%) from the study subjects are within the age group (33-47) years old.While in regarding to the subjects' gender, the (51.3%) from the study subjects are female, in regarding to the study subjects occupation, the study results show that (36%) are housewife.Table 2 shows that in light of mean of scores (3), the (54%) of the study subjects are satisfied with the communication domain.Table (3) shows that (56.7%) of the study subjects are satisfied with the nursing care domain.Table (4) shows that (56%) of the study subjects are satisfied with the nursing care provided at medical and surgical wards.(5) shows that there is a non-significant relationship between the patients' satisfaction with nursing care and the patients' residency and age.While there is a significant and highly significant relationship between the patients' satisfaction and their gender, and occupation respectively.

DISCUSSION
Quality of health care services refers to patient's decision about particular service.These services can be indicated through the difference between the patient's expectation and what they received from the qualified services.If the expected service and the perceived service levels are equals, it indicates an Excellency of the health care.If the patients reported that the care is qualified, it indicates a better service quality.In addition, if the perceived service level is less than what they hope, it means a worse service quality.The current study aimed to measure patient's satisfaction regarding nursing care provided in Al Sadr Teaching Hospital and Al Hakeem Hospital in Al Najaf city.Regarding the socio demographic characteristics of patients under this study, the results showed that most of the study samples (65.3%) were from urban residential area.This may be related to the diseases may occur among individuals from urban residential area more than those from rural, because the risk factors and the disease contributing factors may focused in most moderns and more industrial areas, and this reason might increase the admission numbers for those persons from urban areas.In regard to the age group, the study results show that the highest percentages of the study sample (30%) were within (33-46) years old.This result is supported by Qadri, et, al, in that they found that most of the study sample are within the age group of (33-42) years old and those with age group more than 60 years old (7) .
While in regard to the subjects' gender, the study results indicate that more than half of the study sample (51.3%) was female.This result comes along with another study that they found that the majority of the study sample was female (8) .In addition the mentioned to the patients' gender as the female patients present with a higher percentage more than male patients, in regard to the study subjects occupation, the study results showed that most of the study subjects were housewife (9) .With respect to the study sample age groups and their gender (female) the researcher can concludes that those female patients have less opportunity to work.Also this result is supported by Javed, in that they stated the majority of the study sample was not working (10)   .Also AL-Biaty, found that the majority of the study sample were housewives (11) .On assessing patients satisfaction regarding communication of nurses with patients, the results of the current study revealed that more than half of study subjects (54%) were satisfied with nurses communication and the patients were satisfied with all items related to communication domains, On investigating patients' satisfaction toward meeting their needs the results of the present study revealed that nearly more than patients were satisfied with all the studied items by meeting their needs and expectations,This result is supported by Soliman, et, al,they find that the majority of the study sample are satisfied with nursing care domains (12) .Also relative to the final patients satisfaction with nursing care provided at medical and surgical wards, the study results indicate that the majority of the study sample were satisfied with nursing care provided in medical and surgical wards.This result might come because there is a good relationship with the health care delivery system members, and the majority of the services provided are not costly.Regarding the relationship between the patients satisfaction with nursing care, the study results indicate that there is a significant relationship between the patient's satisfaction and their gender and occupation, and there is a non-significant relationship with their age and residency.These results come along with Halaet al., they find that there is a significant relationship between the patients satisfaction toward nursing care and their gender, while there is a non-significant relationship with the other demographic data (1) .Also Giannakopoulou, et al., found that there is a significant relationship between the patient's satisfaction and their gender, occupation (13) .

CONCULSION
The patients' satisfaction with nursing care is affected by their gender, and occupation.Also, the study concluded that there was an accepted satisfaction among the nurses-patient's communication, also with nursing care domains, Majority of the study sample were satisfied with nursing care provided in medical and surgical wards at studied hospitals.

RECOMMENDATIONS:
1. Nursing administrators and nurses can utilize the findings of the present study to recognize the strengths and weaknesses of nursing care services and adopt necessary measures in enhancing quality of nursing care to increase patient satisfaction, 2.More emphasis to be put on importance of patients satisfaction especially with nursing care in the curriculum of medical and nursing colleges as well as health institutes and nursing schools,

REFERENCES :
of the Study Subjects by their Overall Responses to the Communication Domain.Satisfied (mean of scores < 3), dissatisfied (mean of scores >= 3)

Figure ( 1 )
Figure (1): Distribution of the Study Subjects by their overall responses to the communication domain items.

Figure ( 2 )
Figure (2): Distribution of the Study Subjects by their responses to the nursing care domain items.

Figure ( 3 )
Figure (3): Distribution of the Study Subjects by their overall satisfaction.