A Comparison of Patient and Nurse Expectations Regarding Nursing Care in the Emergency Department

doi:10.1016/j.jen.2013.02.010

Journal of Emergency Nursing

Volume 40, Issue 4, July 2014, Pages 317-322

https://doi.org/10.1016/j.jen.2013.02.010 Get rights and content

Introduction

Patient satisfaction, an important measurable outcome, allows nurses to assess what can be improved in nursing practice. The purpose of this study is to compare expectations of patients and nurses using 3 nursing care attributes: 1) friendliness, courtesy, and respectfulness; 2) comfort measures; and 3) degree of information sharing.

Methods

This is an Institutional Review Board-exempt survey of paired patients’ and nurses’ perceptions of nursing care in a 50-bed emergency department of a level 1 trauma center.

The survey consists of questions that addressed 3 performance attributes of nursing care. The respondent circled their responses in a Likert scale of 5 choices from 1: “way below expectation” to 5: “way above expectation.” An open-ended comment section followed each question; the last survey item asked for recommendations on how to make nursing care extraordinary.

Results

Nineteen males and 30 female patients, ages 18-89 participated. Of the nurse participants, 20% had <5 years ED experience, 22% had 5-10 years, and 52% had >10 years.

The patients rated the care they received consistently higher than nurses. The difference in the average patient ratings vs. the average nurse’s rating was significant. (P = < 0.002, paired T test and Sign test).

Patient ratings were also consistently higher when patients either knew their nurse’s name or were able to identify them by sight. The higher average rating was significant in all 3 attributes (P = 0.02, Wilcoxon Rank-sum test).

Discussion

The unexpected highly positive patient rating did not identify specific areas for practice improvement; it did provide positive feedback for excellent care, reinforcing good nursing practice.

Section snippets

Background and Significance

The term “expectations” is defined in the service quality literature as what the consumers believe a service provider should offer.¹ In the emergency department, our consumers are patients and family members whereas service providers are the ED staff. For the purpose of this article, the relevant service provider is the emergency nurse and the pertinent service is our nursing care. So, what do patients actually believe that nurses should provide? In other words, what are their expectations?

Purpose and Specific Aims

The purpose of this study is to compare expectations of patients and nurses by use of 3 service performance attributes relevant to nursing care: (1) friendliness, courtesy, and respectfulness; (2) comfort measures; and (3) degree of information sharing.

The specific aims were as follows:

•
To evaluate the degree of patient and nurse satisfaction with the nursing care provided
•
To identify satisfiers or dissatisfiers of the nursing care provided
•
To obtain patient and nurse recommendations on how to

Study Design

The study is an institutional review board–exempt, prospective, cross-sectional, paired survey of patients’ and nurses’ perceptions of nursing care provided in the emergency department.

Subjects

All nurses working in the emergency department were invited to voluntarily participate in this study. Staff members who were part of the research team were excluded from participating in this research. Patients aged 18 years or older who were able to complete a survey were also invited to voluntarily participate

Results and Data Analysis

Patients ranged in age from 18 to 89 years. There were 19 men, with a mean age of 48 years, and 30 women, with a mean age of 54 years. Nurses from all 3 shifts participated; years of ED experience were categorized as less than 5 years (20%), 5 to 10 years (22%), and more than 10 years (52%).

The average rating for each of the 3 attributes showed that patients rated their experience consistently higher than nurses’ ratings of the same attribute; that is, patients perceived their nursing care as

Discussion

Our hospital’s current patient satisfaction survey was geared toward the entire patient experience and lacked data specific to the ED experience. The study team thought that there was a need to focus simply on factors that emergency nurses can influence. Hence the nurse investigators decided to develop and administer a locally tailored survey. The study team expected differences in the perception of the level of nursing care between the patients and the nurses. On the basis of the study team’s

Limitations

The study has several limitations: (1) The survey instrument is not a validated instrument. Experienced emergency nurses who are experts in their field, but not in research, created it. (2) The study was performed in a single clinical setting, which reduces the generalizability of the results. (3) The environment of the emergency department is not conducive to thoughtful, considered assessments; the nurse intern who administered the survey attempted to give the patients as much time as they

Implications for Emergency Nurses

The caveat that patient satisfaction is transaction specific and that only repeated highly satisfactory experiences lead to an enduring global perception of quality is very important. The translation for nursing practice is that we, as nurses, have to continually strive to provide quality care not just some of the time but most of the time. It is not sufficient to deliver great care 1 day and then “relax” and deliver mediocre care the following day. It also means that because we are a team, we

Conclusion

The bar that nurses hold for what constitutes good nursing care appears to be higher than what patients’ expectations are, and these differences are significant. In general, the results speak well of the group of nurses surveyed. The findings speak to the success of their efforts to maintain professionalism despite the roadblocks.

Fidela S.J. Blank, Member, ENA Pioneer Valley Chapter, is Research Coordinator IV, Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, and Assistant Professor, Emergency Medicine, Tufts University, School of Medicine, Boston, MA.

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In emergency health care services, patient satisfaction is one of the fundamental indicators of quality emergency care, making it essential to identify factors that can impact this component of care. This study aimed to determine emergency service patients’ attitudes toward using patient rights, their satisfaction levels with emergency service, and related factors.
The cross-sectional study was conducted with 382 patients who presented to the emergency department between November 2022 and March 2023. Data were collected using the Patient Description Form, the Emergency Department Patient Satisfaction Scale, and the Scale of Patient Rights Using Attitude. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting.
The mean score of the Emergency Department Patient Satisfaction Scale was 53.88 ± 6.88 (minimum score, 30; maximum score, 68), and the mean score of the Scale of Patient Rights Using Attitude was 108.89 ± 11.90 (minimum score, 73; maximum score, 135). As a result of the regression analysis, it was found that the Scale of Patient Rights Using Attitude scores and frequency of ED visits significantly contributed to the Emergency Department Patient Satisfaction Scale scores. Younger patients who had higher educational status presented to the emergency department more frequently and had chronic diseases were associated with positive attitudes about using patient rights and had higher levels of ED patient satisfaction (P < .001).
The study has provided valuable information for assessing the attitudes of ED patients toward exercising their patient rights and their satisfaction levels. Respect for patient rights and their effective utilization by patients can enhance the quality of ED services and increase patient satisfaction.
The attitudes of emergency department nurses towards patient safety
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This study aimed to identify the attitudes of emergency department nurses towards patient safety, and found that the nurses generally had a positive attitude towards patient safety. According to Göransson et al. [18] and Blank et al. [21], the average duration of working in an emergency department was 1–5 years. These results are consistent with the results of the present study.
This research was planned to identify the attitudes of emergency department nurses towards patient safety.
The study was performed as descriptive. The universe of the research the universe comprised hospitals defined as 3rd level according to Turkish health care classification, which provides service to all health disciplines in Istanbul. The sample consisted of emergency department (ED) nurses who work in those hospitals. The data was collected by using tools such as the “Information Questionnaire” and the “Patient Safety Attitudes Scale”.
In this study, the attitudes of ED nurses towards patient safety were found to be average and was not related to age, gender, education level, nursing experience, ED experience, ED certification, patient safety training, nurse’s self sufficiency perception of patient safety, hospital’s quality certification or ED quality certification.
The attitudes of nurses towards patient safety were compared by age, gender, marital status, education level, ED experience and there was no meaningful difference. However, a meaningful difference was found between the age groups and the “defining stress” sub-dimension of the Patient Safety Attitudes Scale. ED nurses’ status of certification for emergency care, patient safety training, training of quality, hospitals’ or ED’s quality certification status had no significant statistical difference.
Patient and caregiver expectations of emergency department care: A scoping literature review
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There were a variety of outcome variables of interest described in the literature (Table 3). Several articles (n = 8) explored patients’ and caregivers’ ED expectations and the impact this had on their satisfaction with care (Blank et al., 2014; Enarson et al., 2012; Issa, 2007; Karras et al., 2003; Mohamed et al., 2014; Spahr et al., 2006; Toma et al., 2009; Whiteley and Goodacre, 2014). The majority of research was conducted on overall ED expectations of care; however, a few papers described expectations of specific complaints from patients who present to the ED.
Communication between health care providers (HCPs) and patients and/or their caregivers in the chaotic emergency department (ED) context can be challenging and potentially impact health outcomes and patient satisfaction. Studies examining strategies to improve communication of patient and caregivers expectations of care in an ED are widely dispersed.
We conducted a scoping review of the published and grey literature to examine the extent, range and nature of existing research evidence regarding strategies to enhance communication of patient and caregiver expectations of care in an ED.
Of the 599 articles retrieved, 24 met the inclusion criteria. Most of the studies identified included patients (n = 9) or caregivers (n = 8) as the population of interest, while the remainder examined the expectations of a mix of patients, parents/caregivers, and/or HCPs (n = 7). The majority (n = 21) of the studies did not communicate patient/caregiver expectations to HCPs.
This scoping review highlights the paucity of available research literature evaluating strategies to communicate patient and caregiver ED expectations. Our findings identify the need for experimental designs in future studies to evaluate implementation strategies for ED expectation tools with a particular emphasis on measuring the impact of sharing patient expectations with HCPs.
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They are able to instill trust and confidence in vulnerable clients that they know what they are doing as reflected in the following: this is a doctor I would trust with my life (Medical Interview Satisfaction Scale). Feedback on service quality often reflects patients' desire for improvements in courtesy, friendliness, and respect.51,52 One of the studies in this review included a patient experience measure asking about the friendliness of the therapist,25 3 studies asked about courtesy (Picker Patient Experience Questionnaire,39 Monnin and Perneger,36 Knight et al study25), and 9 studies asked about respect (Client-Centered Rehabilitation Questionnaire,32 Consumer Quality Hip Knee Questionnaire,43 MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care,14 Picker Patient Experience Questionnaire,39 QUality Of care Through the patient's Eyes,30 Rehabilitation Patient Experiences Questionnaire,21 Satisfaction with Stroke Care,41 Patient Satisfaction Questionnaire,29 SAPHORA33).
To identify key dimensions of patients' experience across the rehabilitative care system and to recommend a framework to develop survey items that measure the rehabilitative care experience.
Data were sourced from a literature review that searched MEDLINE (PubMed), CINAHL (Ebsco), and PsycINFO (APA PsycNET) databases from 2004 to 2014, the reference lists of the final accepted articles, and hand searches of relevant journals.
Four reviewers performed the screening process on 2472 articles; 33 were included for analysis. Interrater reliability was confirmed through 2 rounds of title review and 1 round of abstract review, with an average κ score of .69.
The final sample of 33 accepted articles was imported into a qualitative data analysis software application. Multiple levels of coding and a constant comparative methodology generated 6 themes. There were 502 discreet survey questions measuring patient experience that were categorized using the following dimensions: rehabilitative care ecosystem, client and informal caregiver engagement, patient and health care provider relation, pain and functional status, group and individual identity, and open ended.
The most common survey questions examine the care delivery ecosystem (37%), the engagement of clients and their informal caregivers (24.9%), and the quality of relations between providers and patients (21.7%). Examination of patient's functional status and management of pain yielded (15.3%) of the instruments' questions.
Currently available instruments and questions that measure patients' experience in rehabilitative care are unable to assess the performance of rehabilitative delivery systems that aspire to integrate care across the continuum. However, question panels derived from our 6 key themes may measure the key concepts that define rehabilitative care and facilitate measurement of patient experience at the system level.
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Judith Tobin is Level IV Staff Nurse, Department of Emergency Medicine, Baystate Medical Center, Springfield, MA.

Marcia Jaouen, Member, Berkshire County Chapter, is Level IV Staff Nurse, Department of Emergency Medicine, Baystate Medical Center, Springfield, MA.

Ellen Smithline, Member, ENA Pioneer Valley Chapter, is Clinical Nurse Educator, Department of Emergency Medicine, Baystate Medical Center, Springfield, MA.

Heather Tierney is Staff Nurse, Holyoke Medical Center, Holyoke, MA, and Student, Masters Nursing Program, Northeastern University, Boston, MA.

Paul Visintainer is Director of Epidemiology and Biostatistics, Division of Academic Affairs Baystate Health System, Springfield, MA.

View full text

ResearchA Comparison of Patient and Nurse Expectations Regarding Nursing Care in the Emergency Department

Introduction

Methods

Results

Discussion

Section snippets

Background and Significance

Purpose and Specific Aims

Study Design

Subjects

Results and Data Analysis

Discussion

Limitations

Implications for Emergency Nurses

Conclusion

Servqual: a multiple-item scale for measuring consumer perceptions of service quality

J Retail

A conceptual model towards the productivity of complex services: identifying factors of influence

A conceptual model of service quality and its implications for future research

J Marketing

Research
A Comparison of Patient and Nurse Expectations Regarding Nursing Care in the Emergency Department