Journal of Psychosocial Nursing and Mental Health Services

Original Article 

Patient Satisfaction With Psychiatric Nursing Care: A Survey in Calabar, Nigeria

Faith Raneh Omoronyia, MSc, PGDE, BNSc, RN, RM, RPN; Joseph Oyeniyi Aina, PhD, RN; Olufunmilayo Oluyemi Ogungbesan, MSc, BNSc, RN, RM

Abstract

Nurses have the most contact with patients and therefore play vital roles in their satisfaction with health care services. The current study aimed to assess patient satisfaction with nursing care in Calabar, Nigeria using the Newcastle Satisfaction with Nursing Scale. One hundred eighty-five patients were surveyed, with a mean age of 33.5 (SD = 9.4 years). Mean percentage satisfaction score was 60.4% (SD = 19.2%). Eighty-two (44.3%) patients were dissatisfied with nursing care. Common areas of dissatisfaction were type of information nurses provided (54.6%), privacy nurses provided (52.4%), time spent with patient (51.4%), and nurses' helpfulness to patient (51.4%). Prevalence of dissatisfaction was more common among respondents who were 40 or younger, as well as among males (p < 0.05). There was a high prevalence of dissatisfaction with psychiatric nursing care in the current study setting. Areas of dissatisfaction and their implications for improvement in nursing care in developing countries are discussed. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

Abstract

Nurses have the most contact with patients and therefore play vital roles in their satisfaction with health care services. The current study aimed to assess patient satisfaction with nursing care in Calabar, Nigeria using the Newcastle Satisfaction with Nursing Scale. One hundred eighty-five patients were surveyed, with a mean age of 33.5 (SD = 9.4 years). Mean percentage satisfaction score was 60.4% (SD = 19.2%). Eighty-two (44.3%) patients were dissatisfied with nursing care. Common areas of dissatisfaction were type of information nurses provided (54.6%), privacy nurses provided (52.4%), time spent with patient (51.4%), and nurses' helpfulness to patient (51.4%). Prevalence of dissatisfaction was more common among respondents who were 40 or younger, as well as among males (p < 0.05). There was a high prevalence of dissatisfaction with psychiatric nursing care in the current study setting. Areas of dissatisfaction and their implications for improvement in nursing care in developing countries are discussed. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

Every patient who comes to a health care facility has many expectations, including nursing care that is empathetic, compassionate, and culturally acceptable. Expectations also include prompt understanding and response to patients' needs, health information dissemination, and efficient and individualized provision of quality nursing care. In developing countries, due to worsening shortages in personnel mostly attributable to brain drain (i.e., the emigration of skilled professionals from one country to another, usually due to a search for better living conditions or remuneration [Darkwa, 2018]), there is high risk of occupational burnout and fatigue in psychiatric nursing practice (O'Connor et al., 2018). Consequently, there is increased risk for errors, poor disease prognosis, prolonged hospitalization, and increasing cost of health care, all of which may contribute to patients' dissatisfaction with care (Shan et al., 2016).

A descriptive study among patients in Malaysia found that patients were moderately satisfied with nursing care (Tang et al., 2013). High satisfaction was reported for the affective domain, which included respect, smiling, and caring. However, patients were not satisfied with aspects of decision making and family involvement in their care. A significant correlation was also found between patient satisfaction and ethnicity, with Malay patients being more satisfied than non-Malay patients (p < 0.001), perhaps due to sociocultural differences in mode of interpersonal relationship and threshold for expression of gratitude or displeasure with care (Tang et al., 2013). In a cross-sectional survey study among 66,348 patients and 2,963 nurses in England, negative perceptions about care were influenced by lack of confidence in nurses (Aiken et al., 2018). Other factors that decreased satisfaction were increased nurse–patient ratios, poor work environment, and insufficient time with patients (Aiken et al., 2018).

Nurse–patient collaboration plays a key role in caring. The physical and emotional assistance patients receive from nurses defines patient satisfaction to a large extent (Evans, 2016). Educational status of patients has been shown to influence their satisfaction. In a facility-based cross-sectional study among 252 patients in medical, surgical, and pediatric wards in Ethiopia (Sharew et al., 2018), patients with higher educational levels were 80% less satisfied with care compared with those with no formal education.

In the United States, female patients reported less satisfaction for all hospital consumers' assessment of health care provider system measures (Lake et al., 2016). In contrast, gender was not reported to have an influence on satisfaction scores in German hospitals (Kraska et al., 2017). A cross-sectional study in Ethiopia using the Newcastle Satisfaction with Nursing Scale (NSNS) found 67.1% prevalence of satisfaction with nursing care (Negash et al., 2014). Another cross-sectional study in Nnewi, Southeast Nigeria found 76.8% prevalence of satisfaction with nurses' attitudes toward patients (Modebe et al., 2014). However, there is a paucity of literature on patient satisfaction with psychiatric nursing care in southern Nigeria. Therefore, the current study aimed to assess patients' satisfaction with nursing care in a neuropsychiatric hospital in Calabar, Nigeria.

Method

Study Design, Setting, and Sample

The current cross-sectional study was conducted in Federal Neuropsychiatric Hospital (FNPH), Calabar, Cross River State, Southern Nigeria. The FNPH has an estimated 150 beds, with an average of 80 patients with psychiatric illness receiving care weekly. Sample size of 185 was estimated using the Leslie Kish (1965) formula, with p being the estimated proportion of patients satisfied with nursing care services = 31.7% (Mohammed & Odetola, 2014). A purposive sampling method was used to recruit patients.

Eligibility

Only patients who had regained insight on the ward (evidenced by awareness of their mental illness status and need for psychiatric care) were included in the study. Patients with previous admissions but still receiving care at the outpatient clinic were also included. Patients who were younger than 18, had never been admitted to FNPH, and unable to provide coherent responses were excluded.

Instrument

The study instrument had two sections. Section A comprised 13 questions regarding respondents' sociodemographic data. Section B assessed patient satisfaction with nursing care using the NSNS (Thomas et al., 1996). The instrument in the current study was an adaptation of the validated tool comprising 19 items and a 5-point Likert scale. Higher scores indicate better satisfaction with care. To ensure reliability of the instrument, it was pre-tested among patients with similar sociodemographic characteristics in Aro Neuropsychiatric Hospital Abeokuta, Ogun State, Nigeria, and yielded a Cronbach's alpha of 0.93.

Data Analysis

Data were entered and analyzed using SPSS version 21.0. Degree of patient satisfaction for each item on the NSNS was computed as satisfied for scale responses 4 (very satisfied) and 5 (completely satisfied), and dissatisfied for scale responses 1, 2, and 3 (not satisfied, barely satisfied, and quite satisfied, respectively). Prevalence of satisfaction for each item was computed and compared between dissatisfied/satisfied groups using chi-square test of proportions and presented as cross-tabulations. In addition, satisfaction scores were computed for each respondent for the purpose of assessing overall satisfaction. Overall satisfaction score for each respondent was computed by summing and transforming the score for all 19 items to yield a percentage score ranging from 0 to 100. Patients were coded as satisfied if they scored 60%. Frequency of overall satisfaction was presented using tables. Significance was set at p = 0.05. Ethical clearance (similar to Institutional Review Board approval) was obtained from FNPH Calabar, and consent from participants was obtained before commencement of data collection.

Results

One hundred eighty-five respondents with a mean age of 33.5 (SD = 9.4 years, range = 18 to 56 years) were surveyed. Most respondents were age 21 to 40 (67.6%), male (63.2%), single (73.5%), had tertiary education (51.4%), and employed (62.2%) (Table 1). Common psychiatric diagnoses were depression (23.8%), bipolar affective disorder (22.7%), and schizophrenia (22.2%). Approximately one half of respondents (51.9%) had duration of illness within 3 years. Mean number of admissions was 2.9 (SD = 3.2, range = 1 to 21).

Sociodemographic and Clinical Characteristics of the Study Sample (N = 185)

Table 1:

Sociodemographic and Clinical Characteristics of the Study Sample (N = 185)

Mean satisfaction score was 3.4 (SD = 0.77, range = 1.7 to 5), whereas mean percentage satisfaction score was 60.4% (SD = 19.2%, range = 17.1% to 100%). Eighty-two (44.3%) respondents were generally dissatisfied with nursing care services provided. Common areas of dissatisfaction were type of information nurses provided (54.6%), privacy nurses provided (52.4%), time spent with patient (51.4%), and nurses' helpfulness to patient (51.4%) (Table 2). Common areas of satisfaction were nurses' knowledge of patient care (65.4%), nurses' capability at their job (63.2%), and nurses' ability to put relatives' minds at rest (63.2%).

Patient Satisfaction using the Newcastle Satisfaction with Nursing Scale (N = 185)

Table 2:

Patient Satisfaction using the Newcastle Satisfaction with Nursing Scale (N = 185)

Prevalence of dissatisfaction was significantly more common among young adults (i.e., those age 21 to 40) compared with those who were older (48.9% vs. 31.3%, p < 0.05) (Table 3). Males had significantly higher prevalence of dissatisfaction compared with females (52.1% vs. 30.9%, p < 0.01). Compared with other diagnoses, respondents with substance use disorders and depression had significantly higher prevalence of dissatisfaction (p < 0.05). However, prevalence of dissatisfaction was not significantly different when other sociodemographic and clinical characteristics were compared (p > 0.05).

Factors Associated with Patient Satisfaction (N = 185)

Table 3:

Factors Associated with Patient Satisfaction (N = 185)

Discussion

The current study explored the level of overall as well as various aspects of patient satisfaction with psychiatric nursing care in a Nigerian acute care hospital. With overall dissatisfaction of 44.3%, these findings imply generally suboptimal acceptability of mental health nursing services by patients in the study setting. A similar study in Ethiopia found lower dissatisfaction prevalence of 32.9% (Negash et al., 2014). In a multicenter survey in 11 countries, study centers in Nigeria had the highest proportion of psychiatric patients (83%) reporting low satisfaction with inpatient care (Krupchanka et al., 2017). In addition to differences in quality of health care services in these settings, the priorities and views of patients may vary significantly in regard to their sociocultural, demographic, and economic differences.

The current study identified common areas of dissatisfaction. At least one half of respondents were dissatisfied with the type of information nurses provided (54.6%), privacy nurses provided (52.4%), and time spent with patient (51.4%). These are areas essential for provision of patient-centered nursing care, which determines patient satisfaction. In addition to caring behaviors of nurses, the extent to which patients perceive the ward to be person-centered may have influenced their experience and perception of quality of nursing care (Edvardsson et al., 2017). In other words, nurses who spend time with patients and encourage their involvement in decision making may contribute to their overall satisfaction with nursing care.

Other clinically significant areas of dissatisfaction found in the current study were unavailability of nurses when needed (48.1%), lack of freedom given by nurses (46.5%), and not feeling at home (44.9%). These areas, which contribute to defining the degree of friendliness of the hospital environment, may be key age-old determinants of patient satisfaction with nursing care as posited by founders of the profession (Nightingale, 1969). From a theoretical perspective, a more caring hospital environment is central to the relationship between patients and facilitation of their healing or state of health and well-being. This finding suggests the potential health benefit of an inviting, patient-friendly hospital environment in the facilitation of the sense of wellness, especially among patients with psychiatric illness.

Common areas of satisfaction were also identified in the current study, including nurses' knowledge of patient care (65.4%) and nurses' capability at their job (63.2%). These aspects, which relate to patients' perceptions of receiving optimum care from highly skilled staff, contributes to overall satisfaction with nursing care. Skills acquisition, especially through years of practice experience, may therefore be one of the most important aspects to build upon to improve patient satisfaction (Manary et al., 2013).

Compared with older patients, a significantly higher proportion of younger patients was dissatisfied with nursing care in the current study. Differences in coping strategies may be responsible for the differences in proportions found. Older patients with years of life experience may use problem-centered coping strategies for initiating and sustaining the feeling of being in control of their circumstances. This strategy may help them express satisfaction despite the perception of unfavorable conditions of nursing care. In addition, a higher proportion of males compared with females was dissatisfied with nursing care provided. Women, especially in many patriarchal settings, may be less likely to express dissatisfaction with already scarce mental health services (Matud, 2004). Compared with women, men have been shown to be more likely to express dissatisfaction, especially with care provided by female nurses (Teunissen et al., 2016). These findings suggest that development and implementation of mental health nursing care may need to consider patient age and gender.

Dissatisfaction with nursing care was proportionately more common among patients with depression and substance use disorders compared with other psychiatric diagnoses. This finding is at variance with reports from a multicenter study, which found schizophrenia diagnoses to be associated with dissatisfaction with care (Krupchanka et al., 2017).

Limitations

The current study had several limitations. The use of a purposive sampling method and cross-sectional study design necessitate cautious interpretation of these findings of significant association. In addition, the current study may have been limited by non-assessment of other potential determinants of satisfaction with nursing care, including patients' perception and satisfaction with other aspects of care, such as medical care and access to rehabilitation and other social support services (Krupchanka et al., 2017).

Conclusion

Patients in the current setting were found to have suboptimal levels of satisfaction with mental health nursing care. Psychiatric nurses in developing countries need to do more to create enabling and friendly hospital environments in the few available acute care hospitals. The key areas of patient dissatisfaction and satisfaction in the current study provide direction to build nurses' capacity to care for these individuals, as well as provide more effective interactions and satisfying inpatient and outpatient experiences. Recognizing the uniqueness of each patient is key to successful patient satisfaction. Further research including qualitative studies on how age, gender, and other sociocultural factors may influence level of satisfaction with nursing care is needed.

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Sociodemographic and Clinical Characteristics of the Study Sample (N = 185)

Variablen (%)
Age (years)
  ≤2012 (6.5)
  21 to 3079 (42.7)
  31 to 4046 (24.9)
  41 to 5037 (20)
  >5011 (5.9)
Gender
  Male117 (63.2)
  Female68 (36.8)
Marital status
  Single136 (73.5)
  Married41 (22.2)
  Widowed8 (4.3)
Highest level of education
  Primary/none17 (9.2)
  Secondary73 (39.5)
  Tertiary95 (51.4)
Occupation
  Unemployed70 (37.8)
  Business52 (28.1)
  Civil servant49 (26.5)
  Other14 (7.6)
Diagnosis
  Depression44 (23.8)
  Bipolar affective disorder42 (22.7)
  Schizophrenia41 (22.2)
  Substance use disorder28 (15.1)
  Other30 (16.2)
Duration of illness (years)
  ≤396 (51.9)
  >389 (48.1)

Patient Satisfaction using the Newcastle Satisfaction with Nursing Scale (N = 185)

Variablen (%)
DissatisfiedSatisfied
Overall degree of satisfaction82 (44.3)103 (55.7)
Privacy nurses gave patient97 (52.4)88 (47.6)
Nurses' awareness of patient needs75 (40.5)110 (59.5)
Nurses' willingness to respond to patient's needs75 (40.5)110 (59.5)
Nurses' individual treatment of patient81 (43.8)104 (56.2)
Nurses listened to patient's worries69 (37.3)116 (62.7)
Nurses' manner in doing their work85 (45.9)100 (54.1)
Type of information nurses gave patient101 (54.6)84 (45.4)
Time nurses spent with patient95 (51.4)90 (48.6)
Nurses' helpfulness to patient95 (51.4)90 (48.6)
Freedom nurses gave patient in the ward86 (46.5)99 (53.5)
Nurses put relatives' minds at rest68 (36.8)117 (63.2)
How capable nurses were at their job68 (36.8)117 (63.2)
Nurses' knowledge about patient care64 (34.60121 (65.4)
How nurses explained things to patient70 (37.8)115 (62.2)
How often nurses checked on patient84 (45.4)101 (54.6)
Amount of information nurses gave patient83 (44.9)102 (55.1)
How nurses made patient feel at home83 (44.9)102 (55.1)
Nurses are always available if needed89 (48.1)96 (51.9)
How quickly nurses responded to patient76 (41.1)109 (58.9)

Factors Associated with Patient Satisfaction (N = 185)

VariableDissatisfiedSatisfiedp Value
Age (years)0.03
  ≤4067 (48.9)70 (51.1)
  >4015 (31.3)33 (68.7)
Gender0.01
  Male61 (52.1)56 (47.9)
  Female21 (30.9)47 (69.1)
Marital status0.14
  Married14 (34.1)27 (65.9)
  Unmarried68 (47.2)76 (52.8)
Educational level0.43
  Primary or none6 (35.3)11 (64.7)
  Secondary or greater76 (45.2)92 (54.8)
Occupation0.07
  Employed57 (49.6)58 (50.4)
  Unemployed25 (35.7)45 (64.3)
Diagnosis0.01
  Depression25 (56.8)19 (43.2)
  Bipolar affective disorder16 (38.1)26 (61.9)
  Schizophrenia15 (36.6)26 (63.4)
  Substance use disorder18 (64.3)10 (35.7)
  Other8 (26.7)22 (73.7)
Duration of illness (years)0.29
  ≤339 (40.6)57 (59.4)
  >343 (48.3)46 (51.7)
Authors

Ms. Omoronyia is Lecturer, Federal School of Psychiatric and Mental Health Nursing, Calabar, Cross River State, Dr. Aina is Head, Department of Mental Health Nursing, Faculty of Nursing Science, Babcock University, Ogun State, and Ms. Ogungbesan is Senior Nursing Officer, Department of Nursing, Federal Medical Centre, Keffi, Nassarawa State, Nigeria.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Faith Raneh Omoronyia, MSc, PGDE, BNSc, RN, PM, RPN, Lecturer, Federal School of Psychiatric and Mental Health Nursing, Mary Slessor Avenue, Calabar, Cross River State, Nigeria; e-mail: fomoronyia@gmail.com.

Received: September 19, 2019
Accepted: November 19, 2019
Posted Online: March 10, 2020

10.3928/02793695-20200305-01

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