The impact of communication on patients' satisfaction with quality of nursing care: A study of hospitalized patients in Uttar Pradesh, India

Introduction

One way to evaluate medical treatment is to examine whether or not patients are content with it. Patient satisfaction is the only metric by which the quality of treatment can be assessed,1 even though it is fluid and ill-defined. Most people who use health care services do so while hospitalized and who helped the hospital and its reputation flourish in the community. Having happy patients also helps healthcare staff do their jobs well.2 The medical wards have seen an influx of patients. Patients move across these areas due to environmental and vector factors.3 It was found that patients were less satisfied with their care on medical wards than they were on surgical wards because of the greater emphasis placed on contact and technical nursing interventions in the latter.4 Although inpatients often remain in the hospital for longer, outpatient services were better able to meet their fundamental requirements. Thus, improving hospitalized patients' sense of well-being is crucial in ensuring high-quality treatment.5 Evaluating patients' satisfaction with nurse-quality care provides insight into what needs improvement, where nurse interventions are lacking, and how to improve overall care quality.

Nurses are the backbone of the healthcare team since they are the ones that look after patients around the clock in the hospital and help those who are hospitalized get used to their unfamiliar setting.6 Hence, nurses need to be aware of patient expectations to exceed those expectations and boost Patient satisfaction.7 Good bedside manners, complete patient participation, care provider communication, and clear, concise instructions all contribute to satisfied patients. First, high-quality patient care relies on executives who can communicate effectively and who can run their departments efficiently. Patients have various needs in the hospital, from basic nursing care to information, psychological, religious, and support and help from nurses.8 The nurses' ability to keep patients updated on their treatment status during delays in the emergency room had a favourable impact on Patient satisfaction overall.9 In India, the clinical, surgery, orthopaedic, and maternity departments also saw an increase in Patient satisfaction due to the nurses' ability to communicate effectively, as well as their performance and emotional support.10, 11 Patient satisfaction was also impacted favourably by nurses' ability to clearly communicate with them, provide them with explanations before performing nursing operations, and update them on their health status. Patients in North Ethiopia were pleased with the level of independence they were allowed at the hospital, the warmth of the nurses' demeanour, the attention they received tailored to their specific requirements, and the competence with which they were tasked. Patients wanted better nurses' communication skills and discharge instructions.12 Patients' perceptions of the hospital's educational offerings and informational resources were found to be more positive than those of coordinated care, psychological support, continuity and transmission, and physical comfort in a study of public hospitals in Chennai. Similarly, the report advised that private sector organizations measure patient satisfaction. So, this research aimed to assess the level of contentment felt by patients admitted to Chennai's private medical wards.13

Materials and Methods

Data were analyzed using SPSS software 2012 software, Stat-kingdom and excel sheet analysis. Further mean, standard deviation, F-test, Kolmogorov–Smirnov, and ANOVA tests were performed to check the hypothesis.

Results

P-value testing for patient satisfaction survey between NABH accreditation and non-NABH accreditation hospitals across India:

The p-value equals 0.0206, with limit value of 0.9897, which indicates that the chance of error is less within the value of 0.0206 (2.06%). If the p-value is small then hypothesis H₁ is accepted.

The statistic test F-value equals 1.1984, which is not present in the 95% acceptance region: with limit values 0.8549 and 1.1656. The variance ratio is =1.09, which is not in the 95% acceptance region with values in the limit of 0.9246 and 1.0796. The 95% confidence interval values for standard deviation results are 1.0281 and 1.4017. The 95% confidence interval for standard deviation value is within the limits of 1.0281 and 1.4017.

Table 1

Patient characteristics demographic variables used in this statistical study (N = 499) (Original data with the analysis of the demographic variables by the authors with no conflict of interest).

Variables	N	%
Male	142	28.45
Female	244	48.89
Education :
No formal education	45	9.01
Primary	145	29.05
Secondary	123	24.64
Graduation/Post Graduation	32	6.41
Occupation:
Management position	112	22.44
Skilled persons	45	9.01
Trained professional job persons	56	11.22
Office clerks	67	13.42
Shop keepers	43	8.61
Agriculture and Fishery	10	2.00
Industrial workers	5	1.00
Lack of skill workers	3	0.60
Unemployed workers	2	0.40
Type of Family:
Joint family members	134	26.85
Nuclear family members	44	8.81
Single parent family members.	36	7.21
Place of residence:
Rural	45	9.01
Urban	76	15.23
Semi-urban	90	18.03
Monthly family income (Rs) :
≤10,0000	35	7.01
10,000-40,000	60	12.02
≥40,000	50	10.02
No. of previous admission in the hospital :
0 times	Nil	0
1-2 times	56	11.22
3-4 times	34	6.81
≥5 times	23	4.60
Length of stay in hospital :
≤3 days	54	10.82
4-6 days	32	6.41
>7 days	24	4.80
Type of admission ;
Direct entry in hospital	78	15.63
Admission in an emergency department	67	13.42
Transfer of Patient from one ward to another	56	11.22
Method of payment :
Insurance facility	77	15.43
Special insurance schemes	45	9.01
Straight entry patient treatment facility	32	6.41
Patient’s relative association	25	5.01
No financial dependency	35	7.01
Partial financial dependency	28	5.61
Totally financial dependency	15	3.00
Type of discharge
Discharge after treatment	89	17.83
After medical advice from a doctor	56	11.22

Table 2

Patient characteristics demographic variables (N = 899) (Original data with the analysis of the demographic variables by the authors with no conflict of interest).

Variables	N	%
Male	342	38.04
Female	244	27.14
Education:
No formal education	345	38.37
Primary	156	17.35
Secondary	86	9.56
Graduation/Post Graduation	256	28.47
Occupation:
Management position	345	38.37
Skilled persons	278	30.92
Trained professional job persons	145	16.12
Office clerks	56	6.22
Shop keepers	45	5.00
Agriculture and Fishery	45	5.00
Industrial workers	23	2.55
Lack of skill workers	11	1.22
Unemployed workers	15	1.66
Type of Family:
Joint family members	345	38.37
Nuclear family members	245	27.25
Single parent family members.	167	18.57
Place of residence:
Rural	235	26.14
Urban	145	16.12
Semi-urban	75	8.34
Monthly family income (Rs):
≤10,0000	245	27.25
10,000-40,000	322	35.81
≥40,000	156	17.35
No. of the previous admission in the hospital :
0 times	Nil	Nil
1-2 times	357	39.48
3-4 times	212	23.58
≥5 times	245	27.25
Length of stay in hospital:
≤3 days	145	16.12
4-6 days	128	14.23
>7 days	123	13.68
Type of admission;
Direct entry in the hospital	389	43.27
Admission in the emergency department	134	14.90
Transfer of Patient from one ward to another	126	14.01
Method of payment:
Insurance facility	457	50.83
Special insurance schemes	234	27.02
Straight entry patient treatment facility	53	6.12
Patient’s relative association	33	3.81
No financial dependency	24	2.77
Partial financial dependency	23	2.55
Totally financial dependency	21	2.33
Type of discharge:
Discharge after treatment	145	16.12
After medical advice from a doctor	243	27.03

Table 3

The questionnaire analysis of the mental health quality score of the patients according to the mean and standard deviation values.

Questionnaire analysis questions
1.	Whether the nurses obtain all the necessary information from the nurse regarding treatment?
2.	Do nurses have the necessary skill and expertise to treat patients?
3.	Whether the nurses communicate and coordinate with the patients properly?
4.	Do the nurses maintain proper healthcare facilities while caring for the patients?
5.	Whether the patients are monitored properly in the hospital ward room?
6.	Did the nurses show courtesy and friendly behaviour while caring for the patients?
7.	Do the nurses follow a flexible schedule of caring for the patients admitted in the hospital ward?
8.	Do the nurses perform the daily work of providing medicines on time?
9.	Whether the nurses provide all the instructions to the patients on time?
10	Do nurses work with genuineness, trustworthiness and honest behaviour while caring for the patients admitted in a hospital?

Table 4

Represents the mean, standard deviation and the questionnaire analysis of the mental healthcare of the Patient based on the 5-point Likert scale consisting of the below points– (1) Strongly Disagree; (2) Disagree; (3) Neither Agree nor Disagree; (4) Agree; (5) Strongly Agree (Source: SPSS, Stat kingdom software)

Questionnaire-based on the Likert Scale analysis	Mean	Standard deviation	Variance	Margin of error
	3.5	1.61	1.269	0.401

Table 5

for the Likert analysis scores for the different groups with the frequency of the occurrence about satisfaction in receiving the desired healthcare standards in NABH accreditation hospitals:

Value	Frequency
1	1 (10%)
2	1 (10%)
3	2 (20%)
4	4 (40%)
5	2 (20%)

Figure 1

The graph depicting the F-test standard deviation variancevalues for group 1 (N=499) and group 2 (N=899) (Source: Excel sheet software, Stat-kingdom software applications, SPSS)

Table 6

Shows the F-value distribution between the different variables used in this demographic study like income, insurance policies and the mental healthcare quality received by the patient.

Source	DF	Sum of Square	Mean Square	F Statistic	P-value
Groups (between groups)	2	5.6	2.8	2.0599	0.147
Error (within groups)	27	36.7	1.3593
Total	29	42.3	1.4586

The Table 6 F-statistics score reveals the following results:

One Way ANOVA test (Table 6), using F distribution df (2,27) (right-tailed) tests are shown as given below. The p-value equals 0.147027 which is high. Thus there are few dependencies of income and insurance policies on mental health.

The statistics (Table 6)

The test statistic F equals 2.059945, which is present in the 95% acceptance region with values in the range of -∞ and 3.3541.

Effect size (Table 6)

The observed effect size f is high, with a value equal to 0.39. That indicates that the value of the difference between the averages is large. The η² value, according to the statistical results, is 0.13. It means that there is 13.2% variance of the group.

Kolmogorov–Smirnov Test Table Result is Given Below as Follows:

Mean: 3.7

Median: 4

Standard Deviation: 1.207734

Skewness: -0.505858

Kurtosis: -0.845648

The Kolmogorov–Smirnov test indicates a D-value of 0.199 for the test.

Discussion

An important goal of high-quality medical treatment is high-quality nursing care. Customers who get excellent service are more likely to return for future consideration, refer their friends, and positively affect the company's reputation. It's assumed that any hospital would provide high-quality care. Patient satisfaction is correlated with demographic factors such as age, sex, level of education, marital status, income, and more. Intriguingly, the current investigation found no statistically significant link between patients' satisfaction with the quality of nursing care and the confounding factors. Comparable research by Alsaqri in Hail, Saudi Arabia, across three tertiary care settings with a total of 87 patients and 90 head nurses using convenience sampling found no association between nurses' caring behaviour and patients' satisfaction.14 Patient satisfaction was shown to be unrelated to demographic characteristics such as age, gender, and admission method, duration of stay, previous admission, or pre-admission health state in a research of 140 patients done in Northern India, similar to the results observed in the current study.15 Similar findings were found in research done in Thiruvananthapuram, Kerala, which revealed that demographic factors such as patients' sex, marital status, education, income, duration of hospital stay, and the number of prior admissions did not influence their level of satisfaction.16 The second research came to the same conclusion: there was no link between Patient satisfaction and nurses' effectiveness.3 Few patients were even somewhat satisfied with the nurse's communication skills; however, this may be remedied by having nurses engage in basic, comforting conversations with patients in their native tongue while doctors explain medical procedures and diagnoses to family members.

Conclusion

Medical ward patients were the most pleased with the quality of their nursing care. Nurses' ability to provide necessary information to patients before procedures, at discharge, and after the Patient has left the hospital needs improvement.

Ethical Consideration

All the statistical analysis was conducted in the laboratory with no conflict of interest. The samples were collected across different regions of Uttar Pradesh including Gorakhpur. There is no racial conflict, bias and discrimination amongst the participants who volunteered to answer the set of questionnaire present in this survey with consent of non-disclosure of the personal information of the volunteers. Further the authors have no conflict of interest and all the authors contributed equally in developing the statistical results.

Source of Funding

None.

Conflict of Interest

None.