Effect Of Nurse Caring Behavior And Communication On Inpatients Satisfaction

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Effect Of Nurse Caring Behavior And Communication On Inpatients Satisfaction

Liza Afriliana ^a,1*, Chriswardani Suryawati ^a, Luky Dwiantoro ^b

a Public health faculty, Diponegoro University, Central Java, ^bMedical faculty, Diponegoro University, Central Java

* corresponding author

I. Introduction

Patient satisfaction is very important in health services in the hospital. A decrease in patient satisfaction will have an impact on a decrease in the number of patients in the hospital. Patients stated that the thing that makes them most dissatisfied is when they receive unprofessional service [1] Patient satisfaction with overall health services in hospitals is largely determined by patient satisfaction with the nursing care provided by nurses [2][3] [4]. Nurses are at the forefront of patient care and as health workers who interact the longest with patients during treatment [5].

Nurse caring behavior is needed by patients during treatment [6]. Caring is the basic core of nursing services which provides a reference for nurses in providing services to patients [7]. Nurses as health workers must demonstrate caring behavior in providing services to patients [8]. Nurses have a major role in providing emotional and psychological support to patients and their families in all healthcare units by providing optimal nursing care [9].

Communication is something that nurses cannot avoid when interacting with patients during the process of providing care [10]. Patient centered communication in nursing care plays an important role during patient care [11]. Communication between nurses and inpatients takes place every day while the patient is being treated which is integrated with the nurse's activities and influences the outcome of the health services provided [12].

The Previous study has explained that the poor behavior and communication of health workers when providing health services will harm the patient's emotional well-being which will have an impact on patient dissatisfaction [1], [13]. A study in Saudi Arabia found that 77.6% of patients stated that nurses in the surgical ward treated them politely and respectfully, listened to them, and gave good explanations [14]. Another study explained tha.t 44.6% of patients with chronic diseases in Ethiopia were satisfied during their treatment [3]. The patient satisfaction is still far from what was expected.

ARTICLE INFO A B S T R A C T

Article history:

Received 31 Ags 2022 Revised 6 Sept 2022 Accepted 13 Okt 2022

Patient satisfaction is very important in health services in hospitals. A decrease in patient satisfaction will have an impact on a decrease in the number of patients in the hospital. Caring and communication behavior are examples of attitudes that must be considered in nursing care for patients. This study aimed to evaluate the effect of caring behavior and nurse communication on inpatient satisfaction. This cross-sectional study involved 125 inpatients at Puri Asih Hospital Salatiga, Indonesia. Patients who fit the inclusion and exclusion criteria were taken by purposive sampling method. The caring behavior questionnaire used the Caring Dimension Inventory (CDI) instrument, nurse communication was assessed by the Nurse Quality of Communication with Patient Questionnaire (NQCPQ), and patient satisfaction by the La Monica Oberst patient satisfaction scale (LOPSS) in the Indonesian version. The Chi- square test and logistic regression were used in this study. Caring behavior and nurse communication significantly affect patient satisfaction (p < 0.001).

Caring behavior and good nurse communication can protect against low patient satisfaction by 69% each (OR = 0.31, 95% CI: 0.134-0.721). Good caring behavior and communication can prevent patient dissatisfaction. Caring behavior and nurse communication must be continuously improved to increase patient satisfaction..

Keywords:

Patient Satisfactory, Nursing,

CDI

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Recent research on nurse caring behavior, nurse communication, and inpatient satisfaction is still limited. This study will evaluate the effect of caring behavior and nurse communication on inpatient satisfaction.

II. Methods

This study used an analytic descriptive design with a cross-sectional approach. The study was conducted at Puri Asih Hospital Salatiga, Indonesia. The study subjects were 125 inpatients. The inclusion criteria in this study were adult inpatients, aged > 17 years, fully conscious, able to read and write, as well as fluent in communication. Patients in emergency conditions were excluded from the study. Purposive sampling was used for sample selection. Patients who were respondents were patients who met the inclusion criteria, were willing to become respondents, and had signed informed consent selected by the researchers as respondents sequentially until the number of samples was fulfilled.

Patient satisfaction was measured using the La Monica Oberst patient satisfaction scale (LOPSS) instrument in which each assessment item has four responses with a Likert form. This LOPSS instrument has 3 domains namely dissatisfaction, interpersonal support, and good impression. Caring behavior was measured using the Caring Dimensions Inventory (CDI) instrument. Each dimension is assessed using a 4-point Likert. The Communication was measured using the Nurse Quality of Communication with Patient Questionnaire (NQCPQ) questionnaire. Each assessment item has an answer range of 1-4 Likert scale. All questionnaires were made in Indonesian and validity and reliability tests were carried out, where the Cronbach alpha values obtained for the instrument, caring behavior, nurse communication, and patient satisfaction were 0.883; 0.939; 0967. Caring behavior was assessed with 24 question items, communication with 24 question items, and patient satisfaction with 38 question items. Patient demographic data such as age, gender, education level, and occupation were also identified in this study. Data were collected in September and October 2022. Demographic data, caring behavior, nurse communication, and patient satisfaction were collected at the same time the patient was leaving the hospital.

SPSS version 23 was used in this study to analyze data. Data is reported in frequency and percentage. The median value is used as the cut of point for categorizing caring behavior, communication, and patient satisfaction because the data are not normally distributed. The Kolmogorov-Smirnov test was used to confirm the data distribution. Chi-square test and logistic regression were used to determine the effect of caring behavior and nurse communication on patient satisfaction. Variables with p values <0.25 on the Chi-square test were included in the logistic regression multivariate test. A significance level of 0.05 was used in this study.

The proposal has been approved by the ethics committee at the Faculty of Public Health, Diponegoro University with number 322/EA/KEPK-FKM/2022, and has followed the principles of the Helsinki declassification. All subjects had received an explanation and signed informed consent before participating in the study.

III. Result and Discussion

A total of 125 inpatients were included in the study. Table 1 shows respondent characteristics. The majority of patients were in adulthood (76%), female (56%), high school education level (52.8%), and actively working (64%). The majority of patients rated the nurse's caring behavior as good (52%) and the nurse's communication as good (52%). As many as 52% inpatients were satisfied

As many as 52% of patients stated that they were satisfied with the nursing services provided during hospitalization. This is in line with previous research that patient satisfaction is still far from what was expected, namely below 95%. Satisfaction assessment was carried out on inpatients, both internal medicine, surgery, neurology, heart, skin, and genitalia who met the inclusion criteria. In contrast to previous studies, individual characteristics can affect patient satisfaction. Previous research stated that most of the high satisfaction levels were given by patients who were married, had higher education, surgical patients, and obstetrics and gynecology units [9].

Patient satisfaction is the result of the patient's assessment of health services by comparing what is expected following the reality of health services received in a hospital health setting. Patients’

expectations have been defined as the anticipation that given events are likely to occur during, or as an outcome of, healthcare [15]. Thus, what people expect to receive from their healthcare, compared

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with their observations of what they received in practice, are potentially important in influencing patients’ evaluations of their care. However, expectations have at least two elements, such as what they would expect in ideal circumstances, in other words what they feel should be capable of being provided in a rich industrialized country and what we might term realistic expectations, or what they actually expected to happen, which will be shaped by, among other factors, their understanding of the financial pressures on the health service and media coverage of its performance [15].

Patient satisfaction is something that must be fulfilled and can be an indicator of the quality of a hospital. The patient's satisfaction will also be the reason for the patient to regain service at the hospital and of course, it will provide benefits for the hospital. Low patient satisfaction will reduce public trust in the hospital, reduce the number of visits and ultimately reduce the income of the hospital. This of course will be very detrimental to hospitals, especially the increasing number of hospitals so that patients have more choices to determine which hospital to go to. Patient satisfaction is important to maintain patient behavior or loyalty in the long term. Although the definition of customer-oriented satisfaction, in this case, the patient, does not mean that in determining the quality of service, the service provider must comply with all the wishes of the consumer or patient, the service provider must also consider other related matters that can be fulfilled in fulfilling the wishes of the patient.

Table 1. Respondent Characteristics

Characteristics n (%)

Age

- Teenager - Adult - Elderly Gender

- Male - Female Education Level

- Elementary school - Junior high school - High school - College Working

- No - Yes Nurse Caring

- Not good - Good Nurses Communication

- Not good - Good Patient satisfaction

- Not satisfied - Satisfied

13 (10.4) 95 (10.4) 17 (13.6)

55 (44.0) 70 (56.0)

4 (3.2) 27 (21.6) 66 (52.8) 28 (22.4)

45 (36) 80 (64.0)

60 (48.0) 65 (52.0)

60 (48,0) 65 (52.0)

60 (48.0) 65 (52.0)

Table 2 shows that patient satisfaction was not related to patient demographic characteristics. High patient satisfaction was found more in patients who received good caring behavior significantly compared to patients who received poor caring behavior (p <0.001). High patient satisfaction was also found more in patients who received good nurse communication compared to patients who received poor communication (p <0.001), Table 3 shows that caring behavior and good nurse communication could protect against low patient satisfaction by 69% each (OR=0.31, 95% CI: 0.134-0.721).

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Table 2. Bivariate Analysis

Patient satisfaction OR 95%CI P Dissatisfied Satisfied

Age

- Teenager - Adult - Elderly Gender

- Male - Female Education Level

- Elementary school - Junior high school - High school - College Working

- No - Yes Nurse Caring - Poor - Good Nurses Communication

- Poor - Good

8 (61.50) 43 (45.30)

9 (52.90)

28 (50.90) 32 (45.70)

3 (75.00) 12 (44.40) 34 (31.70) 11 (39.30)

22 (48.90) 38 (47.50

41 (28.80) 19 (31.20)

5 (38.50) 52 (54.70)

8 (47.10)

27 (28.60) 38 (54.30)

1 (25.00) 15 (55.60) 32 (48.50) 17 (60.7)

23 (51.10) 42 (52.50)

19 (31.20) 46 (33.80)

1 1.935 1.422

1.231 1

1 3.750 2.824 4.636

1.057 1

1 0.191

0.590-6.348 0.328-6174 0.607-2.499

0.345-40.806 0.279-28.562 0.426-50.441 0.509-2.196

0.089-0.410

0.089-0.410 0.270 0.638 0.564

0.333 0.616 0.295 0.891

0.000

Table 3. Multivariate Analysis

OR 95%CI P

Good Caring 0.31 0

0.134-0.721 0.006 Good

Communication

0.31 0

0.134-0.721 0.006

Patient satisfaction is influenced by various factors, both factors originating from the patients themselves as well as factors originating from the hospital and components within the hospital.

Respondents in this study were patients treated in inpatient rooms. Patients had different demographic characteristics, where the majority of respondents were in the category of adult age, female, had the highest high school education and were actively working. In line with previous study that demographic characteristics of the patient didn’t corelate with patient satisfaction. The study has shown that patient satisfaction is more influenced by medical staff service attitude, followed by medical staff technology and hospital convenience [16]. The medical staff that play an important role in patient satisfaction include the presence of nurses. The results showed that caring behavior and nurse communication could prevent patient dissatisfaction.

The study showed that caring behavior was related to patient satisfaction. In line with previous research that the better the nurse's caring behavior, the more patient satisfaction will increase. Regular reviews of nurses’ caring behavior and actions, and patient satisfaction may help nursing administration to plan necessary improvement in practice [17]. Previous study has explained that the habits and behavior, and poor communication of health workers when providing health services will be detrimental to the emotional well-being of patients which will have an impact on patient dissatisfaction [13]. So, the nurse's caring behavior will prevent patient dissatisfaction at the hospital.

Interpersonal factors that play an important role in patient satisfaction include the presence of nurses.

Patients who come to the hospital hope to get treatment from a nurse because of their declining health condition. They hope that when providing nursing care, nurses will display caring behavior. They need the help of health workers, especially nurses to provide 24-hour care. When patients receive nursing care following their expectations, patient satisfaction will increase. Patients expect nurses to respect the uniqueness of patients and treat patients humanely. They also expect nurses to give them realistic expectations, be sensitive to the feelings of others, develop a trusting relationship between

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them, facilitate them to express their feelings, help solve their problems, provide health education, provide a supportive environment, and help meet their basic needs. and open to the phenomenological existence that occurs.

Watson in his theory has identified 10 carative factors which are indicators of a nurse who behaves caringly [18]. Nurses must understand all of these carative factors and practice them in their daily lives without exception if they want to make patients satisfied. Watson’s carative factors are seen as nurse-patient interactions and modalities that can be employed to support and enhance the experience of the actual caring occasion. These carative factors are described as consisting of: cultivating the practice of loving-kindness and equanimity toward self and others as foundational to caritas consciousness; being authentically present; enabling, sustaining and honoring the faith, hope and the deep belief system and the inner-subjective life world of the self and of the other; cultivating one’s own spiritual practices and transpersonal self, going beyond the ego-self; developing and sustaining a helping-trusting, caring relationship; being present to, and supportive of, the expression of positive and negative feelings; creatively use the self and all ways of knowing as part of the caring process;

engaging in the artistry of caritas nursing; engaging in genuine teaching-learning experiences that attend to the unity of being and subjective meaning; attempting to stay within the other’s frame of reference; creating a healing environment at all levels; administering sacred nursing acts of caring- healing by tending to basic human needs; opening and attending to spiritual or mysterious and existential unknowns of life and death [18].

Patient satisfaction with nurse caring behavior varies from country to country. In line with previous studies, nurse caring behavior is related to patient satisfaction. Patient satisfaction with the caring behavior of nurses in Turkey is 63.9% [9] and in Ethiopia 55.15 % [3]. Another study stated that around 51.6% of nurses in Ethiopia were assessed as having good caring behavior by patients [19].

Not much different from previous studies, this study found that 52% of nurses had caring behavior.

The nurse's caring behavior assessment is carried out by the patient. However, there are differences in the assessment of caring behavior between nurses and patients, where nurses tend to have a higher assessment of caring behavior [7], [20]. Research also shows that communication is related to patient satisfaction. In line with previous research that the better the nurse's communication behavior, the more patient satisfaction will increase. Previous research has explained that poor communication among health workers when providing health services will harm the emotional well-being of patients which will have an impact on patient dissatisfaction [1],[13]. So, nurse communication will prevent patient dissatisfaction in the hospital. Interpersonal factors that play an important role in patient satisfaction include the presence of nurses, including the nurse's communication skills

Communication is one of the skills that must be possessed by a nurse [10]. An important form of communication that must be created by a nurse is a form of therapeutic communication. Therapeutic communication allows the creation of a therapeutic nurse-patient relationship so that patient recovery can be created. Therapeutic communication is consciously planned communication, where the purpose of the planned communication is centered on the patient's recovery [21]. Communication is tied to all activities carried out by a nurse starting from the nurse meeting the patient for the first time, identifying the patient's problem, and helping the patient solve the patient's problem until the patient is declared cured and will go home [10]. The results of the study explained that the better the nurse's communication, the more patient satisfaction increases. This means that nurses need to continue to improve their communication skills, especially in therapeutic communication. If nurses do not continue to improve their communication skills, it will continue to have an impact on patient satisfaction

IV. Conclusion

Good nurse caring behavior and communication can prevent patient dissatisfaction. Nurses need to continuously evaluate their caring behavior and communication skills in order to maintain patient satisfaction.

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