Sygeplejevidenskab . Omvardnadsforskning - - - - - - - - - - - - ,

Patient Satisfaction as an Indicator of the Quality of Nursing Care By Helena Leino-Kilpi and Jaana Vuorenheimo

Biography Helena Leino-Kilpi, PhD., R.N., Assistant professor, University of Turku, Department of Nursing. Jaana Vuorenheimo, MNSc., R.N., Senior lecturer, University of Turku, Department of Nursing, Turku, Finland Abstract This paper deals with the patientsatisfaction, as an indicatorof the qualityof nursingcare. Theliterature review and a Finnish empirical illustra-

Introduction An important priority on the health policy agenda of the 1990s, both in Finland and elsewhere, is the definition, evaluation and assurance of the quality of nursing care. Although the history of quality evaluations goes as far back as nursing care itself, it is only in recent decades that we have seen a more systematic effort both in evaluation and in the use of its results (1, 2, 3, 4). The traditional method employed in research to find out what patients think about the quality of nursing care has been one of indirect inference in the context of some other issue or topic. In recent years, however, there has been an increasing tendency to use the patient perspective for definition and evaluation purposes (1, 5, 6, 7, 8, 9, 10). Patient evaluations have usually been based on the patient's level of satisfaction. Vuori (11) identifies three possible functions for patient satisfaction: it can serve as an attribute of good quality care; as an indicator of good quality care, reflecting the patients' views on different aspects of care; and, third, as a precondition for quality care, the assumption being that satisfied patients are more inclined to follow the instructions given and to come back


tion, using patient interviews, are included inthe article. The results indicate a high level of satisfaction. However, there is no basis to use the measurement of patient satisfaction as a soleindicator of the quality of care, becausethe satisfied patients expressed also reasons for dissatisfaction. Key words Patient satisfaction, quality indicator, quality assurance.

for care later (see also 12). All of these functions can be identified in previous studies on patient satisfaction. In nursing research, patient satisfaction is used most frequently to evaluate the effects of particular interventions (10). This article looks at patient satisfaction, its content and meaning as an indicator of the quality of nursing care. Our purpose is to discuss the use of satisfaction measures in the evaluation of the quality of care, using an empirical example from our own research project as a case in point (8, 13, 14).

Review of the literature Patient satisfaction has been measured in many different ways with the aim of describing the quantity and quality of satisfaction. We analysed 41 scientific study reports published between 1974 and 1991 in Finland, Scandinavia, UK and USA (Table 1). Most of the reports dealt with both hospital patients and outpatients. The mean sample size was 335 patients, ranging from 20 to 2117 patients. In most cases (N = 33) the data were collected by means of a questionnaire; seven used interviews and one patient letters. We also examined some metaanalyses and summaries of patient

satisfaction studies (10, 12, 15, 16, 17,18,19,20,21). Most of the studies were based on instruments that had been developed earlier and that were now being tested. The most popular scale in our sample (N = 56) was Risser's Patient Satisfaction Instrument (PSI) and its modifications (22,23,24,25, 26, 27, 28). PSI (22) evaluates the patients' attitudes towards nurses and nursing. The instrument consists of 25 items, with a five-level likert-type scale for each item. It is divided into three content areas: 1) technical-professional, 2) educational relationship and 3) trusting relationship. The first content area includes items referring to technical skills, knowledge base and carefulness. The items related to educational relationship measure patient satisfaction with the nurses' teaching and supervision skills and their informativeness. The items in the third content area measure the patient-nurse relationship and the humanity of the nurse. Most PSI modifications have changed the number of items and their content (23, 24, 28). Lucas et al. (27) added one new item to PSI, i.e. overall satisfaction. Another common instrument used in the measurement of patient satisfaction is the Ware Satisfaction

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. . . - - - - - - - - - - - - - Helena Leino-Kilpi, Jaana Vuorenheimo - - - - - - - - - - - , Scale, which was originally developed in the 1970s (12, 29, 30, 31). Ware et al. (12) created a taxonomy with eight dimensions that form the main source of satisfaction: 1) art of care, 2) technical quality of care, 3) accessibility/convenience, 4) finances, 5) physical environment, 6) availability, 7) continuity and 8) efficacy/outcomes of care. According to Ware et al. (12, see also 32), patients tended to be more satisfied when providers gave more information (33, 37), when they were counselled by a physician, when payment plans were explained, when providers were happier and had more favourable attitudes towards patients, and when providers showed a personal interest. Patients are also more satisfied when the provider has time for them and when the continuity of care is assured. Franklin & McLemore (34), Zyzanski et al. (35) and Hulka et al. (36) used the Thurstone Scale, which was developed in the 1950s. Consisting of 42 items and using the Likert scale, this instrument measures patient satisfaction in three areas: 1) the professional competence of the physician, 2) the personal qualities of the physician and 3) cost/convenience. The results of the satisfaction studies vary depending on the purpose and interests of the study; this is why a comparison of the results is difficult (10, 12, 15, 16). In Finland, the study made by Sarvimaki (37) is especially comparable with this study. She describes (37) the level of satisfaction of Finnish surgical patients (N = 99). As a general rule it seems that most patients are satisfied with the quality of nursing care, as is the case also in the study of Sarvimaki (37, also 43, 44). The level of satisfaction is highest among hospital patients, who also form the biggest target group (1,16). Nonetheless there are also patient groups who are not fully satisfied with the care they receive (15). In the literature, there is a lack of international comparison of this topic. However, Sarvimaki (37) has started the comparison between Finland and Sweden by using the same questionnaire (SPRI).

There are numerous studies that have explored the impact on satisfaction of various socio-demographic factors, such as age, sex, socio-economic status, level of education, marital status, race or ethnic group and family size (12, 38, 39). The role of patient confidence in the health care system and his or her feelings of internal control have also been used as explanatory factors (40). Ware et al. (12) have presented a summary of the results that show an association between certain socio-demographic factors and patient satisfaction. Older patients seem to be more satisfied with the behaviour of health care workers than younger patients, although they are less satisfied with access to health care services and with the outcomes of care (cf. 41). Dissatisfaction with medical care in general and with the behaviour of the providers tend to be more common among those with a lower level of education (see also 42). Family size also seems to be a relevant factor, as patients from bigger families appear to be more dissatisfied with access to care. Further, people in the low income bracket are less satisfied with access and the outcomes of care. Those in higher occupational positions (e.g. 41) and women (e.g. 36) tend to be more satisfied. According to the findings of Ware et al. (12), patient satisfaction is not associated with marital status, race or social class. Hall & Dornan (39) conclude that socio-demographic factors in general have only limited influence on the general level of patient satisfaction.

An empirical illustration Patient satisfaction is also a central concern in our ongoing research project (8, 14), where satisfaction is defined as a key indicator of the quality of nursing care. The project addresses two main questions: 1) What is the level of satisfaction among surgical hospital patients? and 2) What are the reasons for dissatisfaction?

charge from two hospitals in autumn 1990. The background variables used for explaining experiences of satisfaction were sex, age, place of residence, occupation, marital status, payment category, reason for hospitalization, type of anaesthesia, earlier hospitalizations, self-perceived health and restrictions in functional ability at the time of discharge. Men outnumbered women in the sample (54% vs. 46%). The mean age of the patients was 50 years, ranging from 18 to 88 years. One quarter lived in rural areas and three quarters in urban areas. Over half of the patients (58%) represented blue-collar and lower white-collar positions; one quarter (24%) were in upper white-collar positions and 16 % were pensioners. Most of the patients (66%) were married; 25 % were divorced or widowed; and 10 % were not married. Almost one fifth (18%) were private patients. All of the patients in the sample had previous hospitalizations (mean 3-4 times). A wide range of surgical problems were represented: the largest single categories were backoperated (30%) and abdominal surgery patients (24%). Almost all of the patients (94%) had had some operation, usually under general anaesthesia (71 %). Only six patients were in hospital for three days or less: the majority spent 4-7 days in hospital. Three percent of the patients described their condition as excellent; 76% as good; 20% as satisfactory; and two patients as poor. Two thirds (64%) of the patients suffered from some restrictions in functional ability related to the operation; in most cases (52%) these were restrictions in moving.

Data The data were collected by interviewing a random sample of 132 surgical hospital patients upon dis-


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Table 1. Summary of instruments and dimensions measuring patient satisfaction with nursing care


Scaling method

Aday & Andersen (1975)

Faktor Analytic/ Likert

Abramovitz et al. (1987)

Faktor Analytic/ Likert




Satisfaction Instrument (PSI) Likert

Brody et al. (1989)

ware Satisfaction Scale (modified) Likert

Carey & Posavac (1982)

Printed survey Factor Analytic

Chew (1989)

Semistructured interviews Content Analysis

Dimensions 1) AccessNinances 2) Art ofcare/ technical Quality


Sample size


Scaling method





Courts (1988)

Combined Likert, Patient and family 9 satisfaction with care open-ended, "checklist" inrehabilitation hospital

1) Admission 35 2) Attending physicians 3) House staff 4) Nurses 5) Nurse's aides 6) Housekeeping 7) Food services 8) Escort 9)Other staff 10) Miscellaneous services


Dayton (1988)

Yes/no-checklist, Satisfaction with open-ended, outpatient care multiple choice Questionnaire

1) Technicalprofessional area 2) Patient education area 3) Trusting area



1) Examination 10 2) Tests 3) Medications 4) Nondrug treatments 5) Education 6) Stress counseling 7) Negotiation


1) Admissions 2) Nursing care 3) Housekeeping 4) Food services 5) Hospital services as a whole



1) Food 2) Toilet/washing facilities 3) Cleanliness ofthe ward 4) Bed 5) ward routines 6) Nurse response to request 7) Rapport with staff 8) Provision of information 9) Discussion ofcare being provided 10) Physical care 11) Technical care 12) Discharge arrangements 13) Overall satisfaction

Cleary & LeRoy (1989)

Combined Likert, Overall satisfaction with care in hospital open-ended, "checklist"

Collins (1975)



DiMatteo et al. Structured (1980) interwiev

1) Communication skills 2) Techn ical skills 3) Art of care



DiMatteo et al. Visit-spesific (1986) Satisfaction Scale/ Likert

1) Communication skills 2) Affectiv care 3) Technical care



Doering (1983)

Structured Questionnaire

1) Hospital 11 environment 2) Food services 3) Information 4) Treating 5) Needs 6) Willingness to return 7) Overall satisfaction


Engstrom (1984)


Satisfaction with information


Eriksen (1987)

1) The plan of 49 136 The Patient nursing care Satisfaction with 2) Attending physical Nursing care needs Check list 3) Attending non-physical Check list needs 4) Evaluation of achievement ofnursing care objectives 5) Protection ofall patients by following the unit procedures 6) Administration and managerial services

Feletti et al. (1986)

6-step Likert

Ferguson (1983)

Yes/no-checklist, Patient concerns with hospital care comments

Ferrans (1987)

Structured interview/ Likert Faktor Analytic

Franklin & McLemore (1970)

Thurstone Scale I General satisfaction Likert



Satisfaction with 20 nursing care in hospital

Sample size


1) Ideal physician 10 503 2) Latest consultation with primary care physician 26

27 Overall and spesific satisfaction with hospital care of haemodialysis patients 20


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Helena Leino-Kilpi, Jaana Vuorenheimo Investigators

Scaling method



Gamotis et al. Patient (1988) Satisfaction Instrument (PSI)

1) Technical25 professional relationship 2) Education relationship 3) Trusting relationship

Guzman (1988)

Patient Satisfaction Questionnaire (PSQ)

Satisfaction with services and personal interactions in hospital

Structured questionnaire

Hospital services: 1) technical quality 2) functional quality 3) organizational image

Harju (1991)


Patient Satisfaction Instrument (PSI)

Hulka et al. (1975)

Thurstone Scale 1) Physicians 42 Likert professional competence 2) Physicians personal qualities in relationship with the pa tient 3) Accessibility to care (cost, convenience)


Structured questionnaire


Kovner (1989)

Scaling method

Like & Zyzanski (1987)

Patients' 1) Request for Perspective services Interview, 2) Received services Patient Request for Services Schedule, Patient Services Received Schedule


Linn (1975)

Structured questionnaire

Satisfaction with medical and nursing care inan outpatient clinic


Littlefield & Questionnaire! Adams (1987) Likert

Satisfaction with birthing experience and postpartum hospital stay


Lucas et al. (1988)

1) Technicalprofessional 2) Educational 3) Trusting area 4) Overall satisfaction



MacKeigan & ware Larson Satisfaction (1989) Scale! Likert

1) Explanation 44 2) Consideration 3) Technical competence 4) Financial aspects 5) Accessibility 6) Drug efficacy 7) Product availability 8) Quality of the drug product


Mangen & Griffith (1982)

Sructured interview and questionnaire

Satisfaction with the perceived therapeutic relationship and overall satisfaction with care


McGivern (1972)

Questionnaire! Likert

1) Patient-nurse relationship 2) Patient-physician relationship 3) Information 4) Education 5) Overall satisfaction with received care


Satisfaction with received care




1) Length of the 5 consultation 2) Ability to communicate with the physician


Patient Satisfaction Instrument (PSI)

1) Technicalprofessional 2) Educational 3) Trusting area


laMonica et al. Patient (1986) Satisfaction Instrument (PSI)

1) Technicalprofessional 2) Educational 3) Trusting area



Larsson & Starrin (1990)

"Face Scale"

Interaction between patient and nurse



Leonard (1975)

Affect Expression Checklist

Patient attitudes toward direct and indirect nursing interventions


Ley et al. (1976)

6 questionnares

1) Overall satisfaction inhospital 2) Communication

Patient Satisfaction Instrument (PSI)! Likert


Moore & Structured Cook-Hubbard questionnaire (1975) and interview



Sample size



Hinshaw & Atwood (1981)

Hull & Hull (1984)

1) Technicalprofessional area 2) Educational area 3) Trusting area

Sample size




103 Morgan (1986)

Yes!No-checklist, Satisfaction with nursing activities in comments hospital emergency department

Nelson (1989)

Questionnaire! Likert


63 Satisfaction with care and hospital services



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Scaling method

Niemela & Structured Makinen (1982) interview

Noon & Davero Questionnaire! (1987) open ended! Likert



1) Access to care, 109 reception, discharge 2) Information 3) Services and treatment 1) Preoperative contact with nurse 2) Service departments 3) Day surgery unit 4) Nursing care 5) Postoperative teaching 6) Overall satisfaction with care

Questionnaire! 1) Services 5-step Likert 2) Request for information and Spielberger's 3) Received Anxiety Inventory information 4) Fears 5) Quality of care


Ostrowski & Routhier (1972)


Satisfaction with direct and indirect patient care in hospital


Pankratz (1981)

Questionnaire! Rating scale

Satisfaction with conditions, and treatmen!, trust, confidence, skill, competence, and interest of nurses and physicians

Oberst (1984)

Pienschke (1973)

Pope (1978)

Putterman (1990)

Sample size 600




Satisfaction with 28 nurses and physicians giving cancer patients information about their diagnosis and prognosis 15 Two question1) Technical quality naires openand competence ended! structured! 2) Access to the system for routine care rating scales 3) Access to the system in acute need 4) Cost in relation with benefits 5) The physicianpatient relationship 6) Patient corve nience and comfort 1) Surgical care 17 Questionnaire! 2) Nursing care rating scales 3) Anesthesia 4) Medications 5) Outcomes of care 6) The treatment as awhole Structured questionnaire! open ended! rating scales

1) Expectations Rempusheski Patient letters! et al. (1988) Grounded theory 2) Received care


Scaling method


Risser (1975)

Patient Satisfaction Instrument (PSI) Factor Analytic! Likert

1) Technicalprofessional 2) Educational 3) Trusting area General satisfaction with care





Sarvimaki (1990)

Structured questionnaire (SPRI)

1) Information 2) Nursing care 3) Services 4) Environment 5) Term of adress



Shukla & Turner (1984)

Questionnaire! Checklist of Patients

1) Satisfaction with care 2) Perceived omissions in care



Sinkkonen et al. (1988)

Structured questionnaire

1) Physical care 2) Psychological care 3) Social care 4) Spiritual care 5) Interaction, communication, social support 6) General satisfaction


Sutherland et al. (1989)

Two questionnaires Rating scales

1) Staff attitudes 2) Control over treatment decisions 3) Continuity of medical supervision


Tessler & Mechanic (1975)

Two homeinterviews! Factor Analytic

Satisfaction with medical care received by patient and family


Volicer (1974)

Interview! rating scales

Stress-producing events during hospitalization

Rojek et al. (1975)

Ware &Snyder Ware Satisfaction 1) Availability 2) Accessibility (1975) Scale!Likertl Faktor Analytic 3) Continuity 4) Finances 5) Art of care 6) Technical quality White (1972)



Sample size


Questionnaire! Likert

Zyzanski et al. Thurstone (1974) Scale! Likert

Satisfaction with nursing activities






42 1) Professional competence 2) Personal qualities 3) Accesslfinances 4) General satisfaction




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. - - - - - - - - - - - Helena Leino-Kilpi, Jaana Vuorenheimo - - - - - - - - - - - - , Results Overall satisfaction was measured with one structured question. Over half of the patients (53%) were very satisfied with the nursing care they received and 41% fairly satisfied (Table 2). These results are consistent with the findings of many previous studies of patient satisfaction (37, 43, 44). Table 2. Overall satisfaction with surgical nursing care (N = 132)

Satisfaction level


Very satisfied Satisfied Fairly satisfied Not at all satisfied

53 41 6


This general picture of patient satisfaction is supported by the finding that 50% of the patients spontaneously said that allthe nurses and 49% that part of them had been good/ professional/com petent. However, some of our interviewees also had complaints about the quality of nursing (Table 3). Almost one third of the patients (28%) said they had not received enough information during their stay in hospital. About one fifth complained that they had had problems getting into hospital, that they sensed an atmosphere of indifference on the part of the nursing and medical staff, and that they remained uninformed about the results of care. Lack of space and peace and quiet were also fairly common complaints. Table 3. Reasons for dissatisfaction (N=132)

Reason Lack of information during hospital stay Problems with access Indifferent staff attitudes Uncertainty about results of care Hospital environment Incompetent care Level of care in general Problems getting home


28 21 19 17 14 7 7 2

No statisticallysignificant correlations were found between the background variables analysed and experiences of satisfaction.

Discussion Patient satisfaction has here been

discussed and examined as an indicator of the quality of nursing care. In the light of this indicator and our empirical data, the quality of surgical nursing in Finnish hospitals is very good indeed: the vast majority of our patients were very satisfied with the care they received. The results are similar with other studies made in Finland (37, 43, 44). However, there are various problems involved in the use of patient satisfaction as a sole measure of the quality of nursing care (11, 15, 16, 45,46,47). One obvious indication of this is that many satisfied patients also had various complaints. Most of the studies have been done with hospital patients. Thus their fear of being punished may influence on their answers (10, 48, 49). Satisfaction itself involves two profoundly subjective elements: the patients' expectations with regard to nursing care and their evaluation of how it is actually implemented (11). Therefore a number of scholars and research teams have drawn serious attention to the reliability and validity of the various instruments used in the measurement of satisfaction, which, it is argued, have not been evaluated to the extent necessary (10,11,12,15,16,35). The commonest reason for dissatisfaction among our patients were lack of information during the hospital stay (33, 50), problems with access and treatment by the medical and nursing staff - all factors that have been included in previous satisfaction measurement tools (12, 22). On this basis it seems that Finnish evaluations of the quality of nursing care could make better use of these tools and their modifications. The meaning and role of satisfaction measurements in the effort to improve the quality of nursing care is not fully understood. Vuori (11), for instance, has criticized development programmes of nursing quality for their failure to make systematic satisfaction measurements. In the absence of systematic measurements, it is impossible to establish the true influence of these programmes on patient satisfaction or to identify the factors underlying patient satisfaction. Redfern & Norman (12) have also pointed out that the

quality of care is a broader concept than satisfaction and that satisfaction should therefore be seen as only one component of quality (see also 15,42,45). Most instruments used in the measurement of satisfaction are rigidly structured, and therefore they lend themselves to easy testing in different groups. At the same time, this rigidity has its negative side as well, for it imposes strict limits on the expression of satisfaction experiences (10). What is more, many of these instruments measure only the quantity of satisfaction rather than its content or the underlying cause of satisfaction (2,12). In any event, it is clear that patient satisfaction is fundamentally a matter of subjective views, and something that nursing staffs should take seriously (51). Whether the patient is right or wrong is really of no consequence; what matters is the patient's subjective experience. It is one indicator of the quality of nursing care. In future, there is a need for international and Scandinavian comparisons.

References 1. LeesG, Richman J, Salauroo M & Warden S. Quality Assurance: is it professional insurance? Journal of Advanced Nursing 1987, Vol. 12, P 719-727. 2. Redfern S & Norman I. Measuring the quality of nursing care: a consideration of different approaches. Journal of Advanced Nursing 1990, Vol. 15, P 1260-1271. 3. Leino-Kilpi H. Katsaus hoidon ja hoitotyon laadun arviointiin. Ylihoitajalehti 1991, No.3, P 4-8. 4. Meisenheimer C. Improving Quality. A guide to effective programs. Aspen Publishers, Gaithersburg, Maryland 1992. 5. Donabedian A. Commentary on some studies of the quality of care. Health Care Financing Review (annual supplement) 1987, p 75-85. 6. Morris B. Customer Satisfaction and Resource Productivity in Health Care. International Journal of Health Care Quality Assurance 1989, Vol. 2, No.3, P 23-30. 7. Newcomb K.. & Kleiner B. Managing for excellence in hospital institutions. International Journal of


VARD I NORDEN 3/4/1992 Downloaded from njn.sagepub.com at Bobst Library, New York University on April 2, 2016

Health Care Quality Assurance 1989, Vol. 2, No.3, p 14-16. 8. Leino-Kilpi H. & Vuorenheimo J. Potilas hoidon laadun arvioijana. Unpublished report. University of Turku. Department of Nursing 1991. 9. Taylor A, Hudson K & Keeling A. Quality nursing care: The consumers' perspective revisited. Journal of Nursing Quality Assurance 1991, Vol. 5, No.2, P 23-31. 10. Bond S & Thomas L. Measuring patients' satisfaction with nursing care. Journal of Advanced Nursing, Vol. 171992, P 52-63. 11. Vuori H. Patient satisfaction Does it matter? Quality Assurance in Health Care 1991, Vol. 3, No.3, P 183-189. 12. Ware J, Davies-Avery, A & Stewart A. The Measurement and Meaning of Patient Satisfaction. Health & Medical Care Services Review 1978, Vol. 1, No.1, P 1-15. 13. Leino-Kilpi H & Vuorenheimo J. The Quality of Perioperative Nursing Care: The Patient's Point of View. Manuscript of the article, accepted for publication in AORN Journal, USA, in 1992. 14. Leino-Kilpi H & Vuorenheimo J. Good Surgical Nursing Care - The Perspective of the Patient. Manuscript of the article, accepted for publication in the Annual Review Book of Pro Nursing Association 1991, Finland, in 1992. 15. Locker D. & Dunt D. Theoretical and Methodological issues in Sociological Studies of Consumer Satisfaction with Medical Care. Social Science and Medicine1978, Vol. 12, p 283-292. 16. French K. Methodological Considerations in Hospital Patient Opinion Surveys. International Journal of Nursing Studies 1981, Vol. 18, No.1, P 7-32. 17. Zastowny T, Roghmann K. & Hengst A. Satisfaction with Medical Care: Replications and Theoretic Reevaluation. Medical Care 1983, Vol. XXI, No.3, P 294-322. 18. Hall J & Dornan M. Meta-analysis of Satisfaction with Medical Care: Description of Research Domain and Analysis of overall Satisfaction Levels. Social Science and Medicine 1988, Vol. 27, No.6, P 637-644. 19. Hall J. & Dornan M. What Pa-

tients Like about their Medical Care and How Often they are Asked: A Meta-analysis of the Satisfaction Literature. Social Science and Medicine 1988, Vol. 27, No.9, P 935939. 20. McDaniel C. & Nash J. Compendium of Instruments Measuring Patient Satisfaction with Nursing Care. Quality Review Bulletin 1990, May, p. 182-188. 21. Rubin H. Can patients evaluate the quality of hospital care? Medical Care Review 1990, Vol. 47, No.3, P 267-326. 22. Risser N. Development of an instrument to Measure Patient Satisfaction with Nurses and Nursing Care in Primary Care Settings. Nursing Research 1975, Vol. 24, No.1, P 45-52. 23. Hinshaw A. & Atwood J. A Patient Satisfaction Instrument: Precision by Replication. Nursing Research 1981, Vol. 31, No.3, P 170175. 24. LaMonica E., Oberst M., Madea A. & Wolf R. Development of Patient Satisfaction Scale. Research in Nursing & Health 1986, Vol. 9, No.1, P 43-50. 25. Bader M. Nursing Care Behaviors that Predict Patient Satisfaction. Journal of Nursing Quality Assurance 1988, Vol. 23, No.2, P 11-17. 26. Gamotis P., Dearmon V., Doolittle N. & Price, S. Inpatient vs Outpatient Satisfaction: A Research Study. AORN Journai1988, Vol. 47, No.6) P 1421-1425. 27. Lucas M., Morris C. & Alexander J. Exercise of Self-Care Agency and Patient Satisfaction with Nursing Care. Nursing Administration Quarterly 1988, Vol. 12, No.3, P 23-30. 28. Kovner C. Nurse-Patient Agreement and Outcomes After Surgery. Western Journal of Nursing Research 1989, Vol. 11, No.1, P 7-19. 29. Ware J. & Snyder M. Dimensions of patient attitudes regarding doctors and medical care services. Medical Care 1975, \101. 13, P 669682. 30. Brody D., Miller S., Lerman C., Smith D. G., Lazaro C.G. & Blum M. The Relationship Between Patients' Satisfaction with their Physicians and Perceptions about Interventions they Desired and Received.

Medical Care 1989, Vol. 27, No. 11, P 1027-1035. 31. MacKeigan L. & Larson L. Development and Validation of an instrument to Measure Patient Satisfaction with Pharmacy Services. Medical Care 1989, Vol. 27, No.5, p 522-536. 32. Morgan M., Calnan M. & Manning N. Sociological approaches to health and medicine. Croom Helm, London 1985. 33. Engstrom B. A study of changes in the information routines in a neurological ward. International Journal of Nursing Studies 1986, Vo1.23, No. 3, P 231-245. 34. Franklin B. & McLemore S. Factors affecting the choice of medical care among university students. Journal of Health and Social Behavior 1970, Vol. 11, P 311-319. 35. Zyzanski S., Hulka B. & Cassel M. Scale for the Measurement of Satisfaction with Medical Care: Modifications in Content, Format and Scoring. Medical Care 1974, Vol. XII, No.7, P 611-620. 36. Hulka B., Kupper L., Daly M., Cassel J. & Schoen F. Correlates of Satisfaction and Dissatisfaction with Medical Care: A Community Perspective. Medical Care 1975, Vol. 8, No.8, P 648-658. 37. Sarvimaki A. Patienternas syn pa kirurgisk sjukvard, Vard i Norden 1990, Vol. 10, No. 18, P 10-14. 38. Fox J. & Storms, D. A Different Approach to Sociodemographic Predictors of Satisfaction with Health Care. Social Science and Medicine 1981, 15A, P 557-564. 39. Hall J. & Dornan M. Patient Sosiodemographic Characteristics as Predictors of Satisfaction with Medical Care: A Meta-analysis. Social Science and Medicine 1990, Vol. 30, No.7, P 811-818. 40. Weiss G. Patient Satisfaction with Primary Medical Care. Evaluation of Sociodemographic and Predispositional Factors. Medical Care 1988, Vol. 26, No.4, P 383-392. 41. Doering E. Factors influencing Inpatient Satisfaction with Care. Quarterly Review Bulletin 1983, Vol. 9, P 291-299. 42. Rinnevuori E. Vaeston nakemykset terveyskeskuspal-veiujen laadun indikaattorina. KansanterFortscettes side 62

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litetsikringsarbeidet og arbeider med a klargjrore egne verdier, holdninger, ledelsesprinsipper og rolle. Kvalitetssikring skal innebeere at sykepleiere utvikler ny kunnskap, sterre ansvarlighet og profesjonell praksis. Dette er grunnelementer for a sikre og bedre kvaliteten i sykepleien. Valg av frernqanqsrnate er imidlertid helt avgjrorende for hvorvidt kvalitetssikringsarbeidet vii fere til bedre kvalitet. Skal rnalet vrere a forbedre omsorgen for pasientene, kan dette neppe skje gjennom direktiver fra ledelsen. Det ma vokse frem gjennom aktiv deltakelse og faglig stimulering av pleiepersonalet i deres daglige arbeid. Dette stiller nye krav til ledere: Det betyr en omstilling fra tradisjonelle lederroller og organisasjonsstrukturer til nyere former for ledelse med vekt pa delt ansvar og beslutningsmyndighet blant de ansatte. Det forutsetter videre en ledelsesfilosofi som er rotfestet i det samme verdi- og tenkningsgrunnlaget som den sykepleiepraksis ledelsen skal administrere, og organisasjonsformer som er i samsvar med dette. Dette er ikke bare viktig i forhold til kvaliteten i sykepleien. Det er ogsa vesentlig for a mete de utfordringer som sykepleietjenesten i dag star overfor og for a kunne tydeliggjrore viktigheten av sykepleiens bid rag i et sam let helsetilbud. Hvis sykepleietjenesten i fremtiden skal hevde seg som selvstendig profesjon og sykepleieledere skal utvikle en sykepleietjeneste av hey profesjonell kvalitet basert pa et eget sykepleiefaglig fundament, ma kunnskap om fag og verdier integreres med kunnskap om ledelse og organisasjon.

Referanser 1. Porter-O-Grady 1. Creative Nursing Administration. Participative Management into the 21st Century. Rochville, Aspen Publications, 1986. 2. Stevens B. Applying Nursing Administration Theory in Nursing Administration, in Chaska, Norma: A Time to Speak. London, McGraw Hill,1983. 3. Rossvrer T. Organisasjonsteorier i sosiologisk belysning, Tano 1987. 4. Joiner C, van Sevellen GM. Job Enrichment in Nursing. A Guide to

Improving Morale, Productivity, and Retention. Rockville, An Aspen Publication, 1984. 5. Herzberg F. Work and Nature of Man. The World Publishing, New York,1966. 6. Lancester J. Creating a Climate for Excellence. The Journal of Nursing Administration 1985; 1:18-9. 7. Peterson M, Allen D. Shared Governance: A Strategy for Transforming Organizations. The Journal of Nursing Administration 1986; 2: 11-6. 8. Kramer M., Schmalenberg C. Magnet hospitals Part I. Institutions of Excellence I. The Journal of Nursing Administration 1988; 2:13-4. 9. Kramer M, Schmalenberg C. Magnet hospitals Part I. Institutions of Excellence II: The Journal of Nursing Administration 1988; 2:1-19. 10. Holter 1M. Critical Theory: An Introduction and an Exploration of its Usefulness as a Philosophical Foundation for Developing Nursing Theories and for Guiding Nursing Practice and Administration. Oslo, Institutt for Sykepleievitenskap, Publikasjonsserie 1987; 10. 11. Hegyvary S. The Nursing Administrator: Advocate or Adversary. Kap. 49 in Chaska N. A Time to Speak. London, McGraw - Hill, 1983. 12. Miller K. The Human Care Perspective in Nursing Administration. The Journal of Nursing Administration 1987; VoI.17/2. 13. Norsk sykepleierforbund.KiH Kvalitet i helsetjenesten - et brukerfokusert system for kontinuerlig forbedring av kvalitet i helsetjenesten. 1991.

Patient Satisfaction as an Indicator of the Quality of Nursing Care Fortsat fra side 28 veystieteen lisensiaatintutkimus, Kuopion yliopisto. Kuopio 1987. 43. Niemela P. & Makinen A. Miten HYKStoimii. Osa3: Potilaiden kokemukset ja tyytyvaisyys hoitoon ja palveluihin sairaalassa. HYKS - Tutkimusjulkaisuja 2/1982. Helsinki. 44. Sinkkonen S., Paunonen M., Kinnunen J. & Laitinen A. Hoitotyon laadun maarittely ja mittaaminen tarveteoriaun pohjalta. Sairaanhoidon vuosikirja XXIV, SHKS, Helsinki 1988, p 105-143. 45. Eriksen L. Patient Satisfaction: An Indicator of Nursing Care Quality? Nursing Management 1987, Vol. 8, No.7, P 31-35. 46. Richards D. & Lambert P. The nursing process: the effect on patients' satisfaction with nursing care. Journal of Advanced Nursing 1987, Vol. 12, P 559-562. 47. Vuori H. Patient Satisfaction - An Attribute or Indicator of the Quality of Care? Quality Review Bulletin 1987, Vol. 13, No.3, P 106-108. 48. Pearson A., Durand I. & Punton S. Determining quality in a unit where nursing is the primary intervention. Journal of Advanced Nursing 1989, Vol. 14, P 269-273. 49. Virtanen V. Laakarin ja potilaan hoitosuhde. Tutkimus perusterveydenhuollon laakarin ja potilaan vuorovaikutuksesta. Acta Universitatis Ouluensis 1991, Series D, Medica 218. University of Oulu. 50. Engstrom B. The patients' need for information during hospital stay. International Journal of Nursing Studies 1984, Vol. 21, No.2, P 115130. 51. Harper-Petersen M. Measuring Patient Satisfaction: Collecting Useful Data. Journal of Nursing Quality Assurance 1988, Vol. 2, No.3, P 25-35.


VARD I NORDEN 3/4/1992

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Patient satisfaction as an indicator of the quality of nursing care.

This paper deals with the patient satisfaction, as an indicator of the quality of nursing care. The literature review and a Finnish empirical illustra...
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