The degree of satisfaction of in-hospital medical patients with nursing care and predictors of dissatisfaction: findings from a secondary analysis

Background Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. Aims To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. Design and methods A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012–2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale (PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 – very dissatisfied to 44 – very satisfied). Patients were defined as ‘satisfied with NC’ when the score was ≥33, whereas they were considered as ‘dissatisfied with NC’ when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. Results There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients (RR 1.883, 95% CI 1.359–2.609), in those who developed pressure sores during the in-hospital stay (RR 1.555, 95% CI 1.021–2.368), who received NC with high skill mix (RR 1.072, 95% CI 1.034–1.111) and those who were admitted to a large hospital (RR 1.001, 95% CI 1.001–1.002). In contrast, increased age (RR 0.987, 95% CI 0.975–0.998), increased amount of care offered by Registered Nurses (RR 0.984, 95% CI 0.974–0.994), a higher proportion of baccalaureate nurses on staff (RR 0.975, 95% CI 0.958–0.993) and being admitted to a teaching hospital (RR 0.497, 95% CI 0.130–0.910) all decreased the likelihood of being dissatisfied with NC. Conclusions Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction.