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Original Article
Assessment of Patients’ Satisfaction with Nursing Care in
a Tertiary Hospital, South West Nigeria
Onianwa Patricia Obiajulu, RNM, Ph.D Nursing, FWACN, MCIPM
Department of Clinical Nursing, University College Hospital, Ibadan, Oyo, State, Nigeria
Ike Elizabeth Urenna, RNM, RPHN, BNSc, MSc
Nursing Department of Clinical Nursing, University College Hospital, Ibadan, Oyo, State, Nigeria
Kuforiji Bibian, RN, RM, BSc Nursing, MPH
Department of Clinical Nursing, University College Hospital, Ibadan, Oyo, State, Nigeria
Correspondence: Onianwa Patricia Obiajulu RNM, Ph.D Nursing, FWACN, MCIPM email:
patoboni@yahoo.com
Abstract
Introduction: Nursing care is generally observed as an important determinant of overall patient satisfaction during
hospital admission. As such it is a meaningful source of information for identifying gaps and developing an effective
action plan for quality improvement in healthcare organizations.
Aim of the study: To assess patients’ satisfaction with nursing care provided during hospital stay in a tertiary Hospital
in Nigeria.
Methods: A descriptive cross sectional study design was utilized involving patients admitted to the wards for a
minimum of two days and capable of independent communication. A semi-structured self and interviewer
administered questionnaire developed by the researchers was used for data collection. One trained Research Assistant
together with the researchers participated in the data collection. A simple random sampling technique was used to
select a sample of 371 patients from various wards in the hospital.
Data was analysed using both descriptive and inferential statistics. Fisher’s exact was used to test the association
between patients’ satisfaction and socio-.demographic variables.
Results: The majority of the respondents were female (76.6%) and the mean age was 38.7±15.9.
Overall, approximately 62% of the patients were satisfied with the overall nursing care they received at the Hospital.
Most particularly, patients were satisfied with overall nurse-patient interaction (76.9%); nurse’s admission and
provision of information (61.3%) and nurse’s attitude and performance of duty (61.6%). An overall 48% level of
dissatisfaction with the services was observed. There was a statistically significant positive association between
educational status (p<0.001) with level of patients satisfaction.
Conclusion: Patients were satisfied with the overall nursing care they received at the Hospital. There is need for nurses
to learn to treat patients politely. Hospital Management should employ more nurses to meet the standard nurse-patient
ratio and improve on water supply and toileting system.
Keywords: Assessment, Patient Satisfaction, Nursing Care, Quality improvement
Introduction
The concern for quality care has become
increasingly important in health care facilities and
patient satisfaction is generally observed as an
important indicator for quality care. Patients now
recognize quality care and services as their
fundamental human right (McSherry, MSherry and
Watson, 2012). In the light of this, healthcare
facilities are concerned in maintaining high levels
of patient satisfaction in order to stay competitive in
the healthcare industry (Wai MunTang, Chi-Yang
Soong and Wen Chieh Lim, 2013).
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Nurses are involved in almost every aspect of
patient’s care and interact with patients more often
than any other healthcare professional in the
hospital (Attallah, Hamdan-Mansour, Al-Sayed and
Aboshaiqah, 2013). Hence, nursing care is an
essential aspect of patient’s satisfaction. Quality
nursing care is desired by patients and promised by
nurses (Koy, Yunibhand and Angsurroc, 2015). The
American Nurses Association (2000) defines
‘patient satisfaction with nursing care’ as patients’
opinion of care received from nursing staff during
their hospitalisation (Wai MunTang, Chi-Yang
Soong and Wen Chieh Lim, 2013). Patient
satisfaction from the patient’s point of view is the
patient’s expectation of care compared with the
realities of the care received. In addition, patients’
satisfaction reflects the expression of patient’s
overall judgment on the quality of care received
particularly in the aspect of interpersonal process.
Furthermore, patient satisfaction from the
organization perspective is viewed as the goal of
health care delivery. Care assessed to be high in
quality according to clinical, economic, or other
provider-defined criteria can be far from ideal if as
a result of that care the patient is unhappy or
dissatisfied (Eyasu, Adane, Amdie, Getahun and
Biwota, 2016).Thus, measuring patient satisfaction
is a vital source of information for identifying gaps
and developing an effective action plan for quality
improvement in healthcare organizations (Al-Abri
and Al-Balusi, 2014).
Nurses are in the frontline that patients most likely
meet with, spend the highest amount of time with
and rely upon for recovery during their
hospitalization. Since majority of health
service providers are nurses, care provided by them
plays an important role in the satisfaction of patients
(Motaghed, Mahboobi-Ardakan and Meskarpour-
Amiri, 2016). In other words, nursing care plays a
prominent role in determining patient’s satisfaction.
Several studies have demonstrated an association
between nursing and patient satisfaction,
identifying nursing care as the only hospital service
having a direct and strong relationship with overall
patient satisfaction (Joolaee, Givari, Taavoni and
Bahrani, 2008; You, Aikenl Sloane, Liu, 2013;
Papastavrou, Andreou, Tsangari and Merkouris,
2014). A practice that consistently and continuously
measures patient perceptions will be more efficient
and effective in its daily operations (Riskind, Fossey
and Brill, 2011). Nurses will not know the quality
of care they render unless it is investigated.
Interestingly, the benefit of achieving patient
satisfaction with nursing care include, compliance
with healthcare regimens, health services utilization
and general attitudes towards the health care system
and better health outcomes. Apart from being an
important indicator of quality nursing care, patient
satisfaction has a reciprocal effect, that is, it can be
used to improve nursing care that will in turn
increase satisfaction (Wagner, Bear, 2009;
Papastvrou, Andreou, Tsangari and Merkouris,
2014; Motaghed, Mahboobi-Ardakan and
Meskarpour-Amiri, 2016). Measuring patient
satisfaction is a prove that a system is interested in
quality and in doing things better (Riskind, Fossey
and Brill, 2011). To improve the quality of nursing
care, the nurses need to know what factors influence
patient satisfaction. In literature, patient satisfaction
is linked with a variety of nursing factors, such as
nurse staffing levels, higher proportions of
registered nurse (RN) skill-mix, nurses’ work
environment, and RN-physician collaboration
(Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn,
Neff and Aiken, 2009). Several environmental
factors have been reported as hindering the nursing
profession in its ability to achieve improved health
outcomes through the provision of competent,
culturally sensitive, evidence-based care. These
factors among others include poor working
conditions, heavy workloads, lack of participation
in decision making, and limited opportunities for
career mobility (Papastvrou, Andreou, Tsangari and
Merkouris, 2014).
The healthcare managers that endeavour to achieve
excellence take patient perception into account
when designing the strategies for quality
improvement of care (Al-Abri and Al-Balusi,
2014). In the study setting, the quality and
effectiveness of care is constantly examined and
monitored so as to maintain standards and ensure
that patients receive quality care and are satisfied.
The aim of this study therefore is to assess patients'
satisfaction with quality of nursing care provided
during hospitalization.
Objective
To assess patients’ satisfaction with quality of
nursing care provided during hospital admission in
Tertiary Hospital, South West Nigeria. The
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questions expected to be answered in this research
are as follows.
Research Questions
1. What is the level of patients’ satisfaction
with the ward environment during admission in
UCH, Ibadan?
2. What is the level of patients’ satisfaction
with the nurse-patient relationship during
hospitalization in UCH, Ibadan?
3. What is the level of patients’ satisfaction
with the information provided by the nurses about
their care/ management during admission in UCH,
Ibadan?
4. What is the level of patients’ satisfaction
with nurses attitude and their performance of duty
during hospitalization in UCH?
5. What is the overall patients’ satisfaction of
quality of nursing care provided in relation to
selected demographic characteristics during
hospitalization in UCH, Ibadan.?
6. What are the areas of dissatisfaction with
nursing care provided that need to be improved
upon.
Research Hypothesis
There is no significant difference between patients’
level of satisfaction with nursing care and selected
demographic characteristics (age, gender, religion
and educational status).
Research Methods
Study design: This study utilized a cross-sectional
descriptive survey design to determine the level of
patients satisfaction with nursing care provided
during hospital admission.
Study setting: It was conducted in the University
College Hospital Ibadan (UCH) in Oyo State, South
West Nigeria. The Hospital is a flagship tertiary
health care institution in West Africa Sub-region,
located along Queen Elizabeth road, Orita-Mefa, in
Ibadan North Local Government Area of Oyo State,
Nigeria. UCH is a research, training and service
centre for all health professionals and health care
needs for all age groups. The bed capacity of the
hospital is Nine hundred and seventy (970) and Nine
hundred and twenty nine (929) for in-patients beds
only in the following Units: Intensive Care Unit,
Labour Ward Complex, Obstetric and
Gynaecological Unit, Paediatric Unit, Surgical
Unit, Medical Unit, Neuro Science Unit,
Nephrology Unit, Radio Oncology Unit and
Specialist Clinics. The department of Clinical
Nursing is an arm of nursing that provides direct
nursing care to patients. It is also involved in
teaching, administration and research through its
Quality Improvement Unit.
Study population: The population consist of all
patients admitted into UCH. The average number of
admissions in all the wards per month is 850.
Respondents were proportionally drawn from the
wards of each unit.
Sample size determination: The Slovin’s formula
was used to calculate the sample size;
n = N 1+N(e
2
)
Where: n= the desired sample size N= the estimated
population e= the level of precision or relative error
of estimation (0.05).
Using the above formula: n = 2033
1+(2033)(0.05)(0.05)
n= 2033 1+ (2033)(0.0025) = 2033
6.0825 = 334 Sample size = 334
Adjusting for 10% Non- response rate =
Non- response rate = Total population 1- Non-
response rate = 334
1-10% = 37 Sample size = 334+37=371
Sampling technique: Firstly, the researchers listed
all the wards under each unit of the Clinical Nursing
Department where patients are admitted. Two wards
were selected from each unit using simple random
sampling technique by balloting.
Secondly, patients who met the inclusion criteria
and agreed to participate in the study were
purposively selected from each ward. The number
of patients who participated from each ward was
proportionally calculated.
Instrument development: Questionnaire was used
for data collection. The tool was designed after
thorough literature review to assess patients’
satisfaction with the quality of nursing care
provided in UCH, Ibadan. It consists of forty two
(42) items and three sections. Section A consist of
ten (10) items which captured the socio-
demographic information, Section B was structured
to answer the research questions on patients
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satisfaction in relation to quality of nursing care
provided. Patients will identify their satisfactions
through a 5- point Likert scale type items
(Very dissatisfied, Dissatisfied, Neutral, Satisfied
and Very satisfied). It contains 32 items divided into
five domains as indicated below.
A. Therapeutic Ward Environment: This domain
consists of four items, in which patient will identify
their satisfaction with the ward environment.
B. Interpersonal Relationship: This domain
consists of 5 items, in which patient will identify
their satisfaction with nurses interpersonal
relationship.
C. The nurse as an information provider: This
domain consists of eleven items. Patient will
identify their satisfaction as regards nurses as
information providers through a 5-point Likert scale
type items.
D. Nurses attitude and performance of duty: This
domain consists of ten (10) items. Patient will
identify their satisfaction in relation to nurses’
attitude as caring, competent and skilled healthcare
provider through a 5-point Likert scale type items.
The score assessment will be conducted by
aggregating the points of all items and converting
them to percentage values. A total score of
‘satisfied’ and ‘dissatisfied’ was calculated and
documented.
Finally, Section C consist of two open ended
questions aimed at soliciting information on
patients areas of dissatisfaction with care and
recommendations to improve nursing care.
Validity of instrument: The face and content
validity of the instrument was ensured by reviewing
and critiquing by the researchers. A pilot study was
carried out in the orthopaedic wards of the same
setting to ascertain feasibility of the study before the
final study was carried out.
Method of Data Collection: Data was collected by
a self and interviewer administered semi-structured
questionnaires from literate and non-literate patients
respectively on the wards of the UCH. The
researchers; members of Staff of Continuing
Education and Training Unit and Nursing Audit of
the Department of Clinical Nursing, UCH, Ibadan,
and one trained research assistant participated in
data collection. At each ward, the nurse in charge
(Ward Manager) was approached; the purpose of
the study explained and a copy of ethical approval
given. The ward leader assisted in introducing the
researchers to the patients and explanation was
given on the study, purpose, benefits and criteria for
selection of participants.
Data Analysis: The Statistical Package for Social
Science (SPSS 20) software was used for data entry,
storage and analysis. Descriptive statistical analysis
such as frequency count, percentage, mean and
standard deviation was employed to describe the
variables of interest. Inferential statistics fisher’s
exacts was used to describe the association between
variables. Statistical significance was set at p<0.05.
Ethical consideration: Approval to carry out the
study was obtained from UI/UCH Ethical
Committee (NHREC/05/01/2008a). The project
was implemented with the authorization and
support of the Chairman Medical Advisory
Committee UCH, Ibadan and Director Clinical
Services, Research and Training and the Director of
Nursing and Head, Department of Clinical Nursing.
The investigators also met with the Deputy Director
of Nursing in charge of each unit and Ward leaders
for their informed consent and their maximum
cooperation during the process of data collection.
Administration of the questionnaire observed all
ethical principles on patient information, anonymity
and privacy. Respondents were made to know that
their participation in the study was voluntarily and
that their decision is of their own choice without any
direct or indirect influence.
Results
Table 1.1 reveals that the age of the respondents
ranges between 19 and 93 with slightly above half
(54.5%) of the respondents within the age group of
20 to 39 years with mean±SD 38.7±15.9. Three-
quarter (76.6%) are female with sex ratio of 0.3
indicating that for every one male there will be three
female. Seventy four percent (74.0%) were married.
Apart from Yoruba tribe with the highest number
(82.1%), Igbo tribe was high among other tribes,
and about two-third (64.9%) of the respondents
were Christians. Slightly above two-fifth (41.8%) of
the respondents had tertiary education certificate
and nearly one-third (29.1%) engaged in trading as
occupation.
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On the aspect of satisfaction with therapeutic ward
environment, 94.3% were satisfied with the
cleanliness of the ward environment, 56.1% were
satisfied with functioning toilet and bathroom,
95.6% were satisfied with ventilation and lightning
and 90.1% were satisfied with visitors and noise
under control (table 2.1). The overall cleanliness of
the ward environmental satisfaction mean score was
11.9±2.8. Figure 1 reveals that 88.8% of the patients
were satisfied with overall cleanliness of the ward
environment.
The patients’ satisfaction about interpersonal
relationship (nurse-patient interaction), table 2.2
reveals that 88.8% of the patients were satisfied
with nurses’ being very friendly and courteous
manner of treatment, 89.3% were satisfied with
nurses’ ‘listening carefully’ and 81.7% were
satisfied with nurses spending enough time to
explain and interact in an easy manner to understand
the procedure. Figure 2 shows that 76.9% of the
patients were satisfied with overall satisfaction on
nurse-patient interaction.
Table 2.3 reveals that 96.9% of the patients were
satisfied with nurses’ admission, 70.6% were
satisfied with nurses’ pre-admission, only 21.3%
were satisfied with nurses’ introduction to the ward
and other patients, 77.7% were satisfied with
nurses’ provision of information on patient’s
investigation, 75.1% were satisfied with nurses’
provision of information on patient’s meal policy,
93.5% were satisfied with nurses’ provision of
information on patient’s purchase, 93.5% were
satisfied with nurses’ provision of information on
patients’ visiting time and 57.1% were satisfied with
nurses’ provision of information on patient’s need.
The overall nurses’ admission and information
satisfaction mean score was 20.7±4.9. Figure 3
reveals that 61.3% of the patients were satisfied
with overall nurses’ admission and information
provision for patients.
It was detected (table 2.4) that 56.9% of the patients
were satisfied with nurses’ introduction of herself to
patients, 82.6% were satisfied with nurses’ seek
permission before performing nursing procedures,
81.8% were satisfied with nurses’ explanation of
nursing procedure, 82.1% were satisfied with
nurses’ provision of nursing care without delay and
93.5% nurses’ provision and assurance of privacy.
The overall nurses’ attitude and performance of
duty satisfaction mean score was 20.9±4.5. Figure 4
reveals that 61.6% of the patients were satisfied
with overall nurses’ attitude and performance of
duty.
Figure 5 reveals that 61.6% of the patients were
satisfied with overall nursing services. The overall
satisfaction mean score was 43.6±6.7.
Data analysis (table 3.1) reveals that out of 48
patients who signified their areas of dissatisfaction,
25.0% were dissatisfied with heavy workload on
nurses as it affects quick response to patients, 20.8%
reported impolite attitude of nurses, 14.6%
complained of water shortage, 10.4% reported on
toileting system and other complained such as
infestation of rats, mosquitoes bite, malfunctioning
of socket and unpleasant food served.
On the areas of improving nursing care (table 3.2) It
was revealed that only one hundred and thirty three
(133) patients responded out of which 43.6%
reported on employment of more nurses to reduce
the workload, 17.3% implored on training and
retraining of nurses on skilful discharge of duty,
14.2% challenges on time to time supervision of
nurses on duty, 9.0% urged that all cadre of nursing
should be involved in nursing care not only the
junior ones, 10.6% urged management to work on
ward lighting, water and toilet system, functional
electrical equipment and ward environmental
sanitation, 5.3% encouraged the management of the
hospital on computerization of the services to ease
paper work especially on investigation results.
Inferentially, test of association shows that only
educational status was significantly (p<0.001)
associated with level of satisfaction while age
(p=0.658), gender (p=0.921) and occupation
(p=0.103) were not significantly associated with
patient’s level of satisfaction with nursing services
(table 4.1).
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Table 1.1: Demographic Characteristics
Variable Frequency Percentage (%)
Age group (yrs)
Below 20
20 – 39
40 – 69
Above 69
(Mean±SD) = (38.7±15.9)
Max = 93, Min = 19
28
210
124
23
7.3
54.5
32.2
6.0
Gender
Male
Female
Sex ratio: 0.3
90
295
23.4
76.6
Marital Status
Single
Married
Divorced
Widow
Widower
71
285
12
3
14
18.4
74.0
3.1
0.8
3.6
Tribe
Yoruba
Igbo
Hausa
Others
316
33
8
28
82.1
8.6
2.1
7.3
Religion
Christianity
Islam
Traditional
Other
250
124
4
7
64.9
32.2
1.0
1.8
Educational Status
Primary
Secondary
Technical
Tertiary
Non-formal
57
142
10
161
15
14.8
36.9
2.6
41.8
3.9
Occupation
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Civil service
Trading
Teaching
Self-employed
Health worker
Others (student)
36
112
34
91
18
94
9.4
29.1
8.8
23.6
4.7
24.4
Table 2.1. Therapeutic Ward Environment
Frequency (%)
Variable Item Satisfied Dissatisfied
Therapeutic Ward
Environment
Cleanliness (ward environment)
Functioning toilet and bathroom
Ventilation and lightning
Visitors and noise under control
363(94.3)
216(56.1)
368(95.6)
347(90.1)
22(5.7)
169(43.9)
17(4.4)
38(9.9)
Mean score = 11.9±2.8 Cut off point = 12
Table 2.2. Interpersonal Relationship (Nurse-patient interaction)
Frequency (%)
Variable Item Satisfied Dissatisfied
Interpersonal
Relationship
Nurse’s very friendly and courteous
manner treatment
Nurse’s listen carefully
Nurse spends enough time to explain and
interact in an easy manner to understand
342(88.8)
344(89.3)
315(81.7)
43(11.2)
41(10.7)
70(18.3)
Mean score = 13.4±2.7 Cut off point = 13
Table 2.3 Nurses’ Admission and Information Provision for patient
Frequency (%)
Variable Item Satisfied Dissatisfied
Information
Provision
Nurses’ admission of patients
Nurse’s pre-admission instruction to patient
Nurses’ introduction to the ward and other patients
Nurses’ provision of information on patient’s
investigation
Nurses’ provision of information on patient’s meal
policy
373(96.9)
272(70.6)
82(21.3)
299(77.7)
289(75.1)
360(93.5)
12(3.1)
113(29.4)
303(78.7)
86(22.3)
96(24.9)
25(6.5)
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Nurses’ provision of information on patient’s drug
purchase
Nurses’ provision of information on patient’s
visiting times
Nurses’ provision of information on patient’s
health needs
360(93.5)
220(57.1)
25(6.5)
165(42.9)
Mean score =
20.7±4.9
Cut off point = 21
Table 2.4 Nurses’ Attitude and Performance of duty
Frequency (%)
Variable Item Satisfied Dissatisfied
Attitude and
Performance of duty
Nurses’ introduction of herself to
patients
Nurses’ seek permission before
performing nursing procedures
Nurses’ explanation of nursing
procedure
Nurses’ provision of nursing care
without delay
Nurses’ provision and assurance of
privacy
219(56.9)
318(82.6)
315(81.8)
316(82.1)
360(93.5)
166(43.1)
67(17.4)
70(18.2)
69(17.9)
25(6.5)
Mean score = 20.9±4.5 Cut off point = 21
Table 3.1: Areas of Dissatisfaction (n=48)
Dissatisfaction with: Frequency
Percentage (%)
Toileting system 5 10.4
Shortage of water 7 14.6
Delay in calling doctor 2 4.2
Heavy workload on nurses affects quick response to patients 12 25.0
Inadequate number of nurses especially at night 4 8.3
Impolite attitude of nurses 10 20.8
Environmental noise and poor ventilation 3 6.3
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Others (Infestation of rats, Malfunctioning of socket, food served
not delicious)
5 10.4
Total 48 100.0
Table 3.2: Areas of improving nursing care (n=133)
Improve on: Frequency
Percentage (%)
Employment of more nurses to reduce the workload 58 43.6
Training and retraining of nurses on skilful discharge of duty and
relationship with patients and relatives
23 17.3
All cadre of nursing should be involved in nursing care 12 9.0
Time to time supervision of nurses on duty 19 14.2
Management should provide ward light, water and toilet system,
functioning electrical equipment and environmental sanitation to keep out
rats and mosquitoes
14 10.6
Computerization of the hospital to ease paper work especially on
investigation results
7 5.3
Total 133 100.0
Table 4.1: Cross – tabulation of demographic characteristics and patients’ level of
satisfaction
Level of satisfaction Remark
Dissatisfied Satisfied d.f
X
2
-value
p-value
Age group
Below 20
20 – 39
40 – 69
Above 69
13 (8.8%)
83 (56.1%)
43 (29.1%)
9 (6.1%)
15 (6.3%)
127 (53.6%)
81 (34.2%)
14 (5.9%)
3
1.61
0.658
Insignificant
Gender
Male
Female
35 (23.6%)
113 (76.4%)
55 (23.2%)
182 (76.8%)
1 0.01
0.921
Insignificant
Educational
status
Non-formal
Primary
Secondary
Tertiary
Technical
4 (2.7%)
21 (14.2%)
37 (25.0%)
81 (54.7%)
5 (3.4%)
11 (4.6 %)
36 (15.2%)
105 (44.3%)
80 (33.8%)
5 (2.1%)
4
20.38
<0.001
Significant
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Occupation
Civil service
Trading
Teaching
Health worker
Self employed
Others
20 (13.5%)
40 (27.0%)
13 (8.8%)
9 (6.1%)
27 (18.2%)
39 (26.4%)
16 (6.8%)
72 (30.4%)
21 (8.9%)
9 (3.8%)
64 (27.0%)
55 (23.2%)
5
9.15
0.103
Insignificant
Note: Fisher’s exact result was recorded for small cell
Figure 1: Respondents’ level of satisfaction on Therapeutic Ward Environment
0
50
100
150
200
250
300
350
Dissatisfied Satisfied
43(11.2%)
342(88.8%)
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Figure 2:Respondents’ level of satisfaction on Nurse-patient interaction
Figure 3: Respondents’ level of satisfaction on Nurses’ Admission and Information Provision
for patient
0
50
100
150
200
250
300
Dissatisfied Satisfied
89(23.1%)
296(76.9%)
0
50
100
150
200
250
Dissatisfied Satisfied
149(38.7%)
236(61.3%)
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Figure 4: Respondents’ level of satisfaction on Nurses’ Attitude and Performance of duty
0
50
100
150
200
250
Dissatisfied Satisfied
Dissatisfied
148(38.4%)
Satisfied
237(61.6%)
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Figure 5: Respondent’s Overall level of satisfaction
Discussion of Findings
Nursing care is one of the major components of
health care services, hence patient satisfaction with
nursing care is an important indicator of health care
services. This study assessed the level of patients’
satisfaction with nursing care and its associated
factors.
The study revealed the mean age of the respondents
as 38.7±15.9 with three-quarter (76.6%) being
female and male to female ratio of 0.3 indicating
that for every one male patient there were three
females. This is in congruent with other studies
where more female were admitted than their male
counterparts (Omorogbe and Amiegheme, 2016;
Lawal, Agbla, Bola-Lawal, Afolabi and Ihaji,
2018). This could be due in part to the fact that the
life expectancy is higher among women than men as
reported by Crimmins, Shim, Zhang, Kim. (2019).
However this may not necessarily be generalized as
the high rate of female admission is exclusive to the
research under study. This study also found that
majority (41.8%) of the respondents had tertiary
education certificate. This is consistent with a
similar study in Abuja, Nigeria where University
graduates (47.9%) were majority among the
respondents (Lawal, Agbla, Bola-Lawal, Afolabi
and Ihaji, 2018). This could be due to the fact that
the University College Hospital (UCH) is located
within the heart of Ibadan city which would
invariably cause influx of more educated people to
access health care services and also most of the
locals erroneously believe UCH to be the ‘last bus
stop’ of any such individual and that such persons
may never recover. Nurses can also leverage on this
information and health educate the public against
the ills of believing such hearsays.
The mean score for the overall ward environmental
satisfaction was 11.9±2.8 which reveals that
88.8% of the patients were satisfied with the general
ward environment. This is in contrast to a
research carried out by other studies where patients
registered dissatisfaction with the ward
environment (Lawal, Agbla, Nkeiruka Bola-
Lawal,Afolabi and Ihaji,2019). Infection control
practices is an integral aspect of any health care
institution as it largely contributes to overall health
outcome of patients. Though more than three
quarter of the respondents were satisfied with UCH
Dissatisfied
148(38.4%)
Satisfied
237(61.6%)
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general ward environment, there is still room for
improvement to make it as close to home as
possible.
There was 76.9% overall satisfaction of patients on
nurse-patient interaction. This finding is a pointer to
the level of professionalism displayed by the nurses
on the respective wards. This implies that nurses
utilize Hildegard Peplaus’ theory of interpersonal
relations in their daily practice of nursing care. In
the theory of interpersonal relations, Peplau
emphasized patients’ experience and the effect that
nurse-patient interaction have on those experiences
(Hagerty, Samuels and Gigliotti, 2017). Cordial
relationship between nurses and patients is a strong
precursor of quality nursing care at all levels of
healthcare delivery system (Ojo, 2010). The finding
however, is not consistent with another study in
northern Nigeria where most of the patients were
dissatisfied with the poor interpersonal relationship
and unfriendliness of the nurses (Ajayi and
Olumodeji, 2016). Owing to the fact that patients
are becoming aware of their rights with the
increasing cost of healthcare services, it is essential
for nurses to improve on their communication skills.
As indicated in the report, 81.7% were satisfied with
nurses spending enough time to explain and interact
in an easy to understand way. This high level of
satisfaction could be due in part to UCH
determination as the centre of excellence to
maintain professionalism by employing highly
skilled and qualified nurses.
Slightly more than half (61.3%) of the patients were
satisfied with overall nurse’s admission and
provision of information. A study in two public
hospitals in Kenya showed similar findings
whereby most of the patients in both settings were
satisfied with the information received from the
nurses on admission (Githemo, Karani, Ogutu and
Gachoka, 2018). This is in contrast to other studies
in Nigeria and Turkey where the patients reported
dissatisfaction with the information given by nurses
(Ajayi and Oyedele, 2009; Karaca and Durna,
2019). Informations provided to patients during
admission play an important role in their
satisfaction; more importantly if nurses provide the
information in a clear and concise method (Ozsoy,
Ozgur and Durmaz, 2007). This calls for a far more
modern approach to providing information to
patients. It reveals the dire need to adopt the
advanced system of providing information to
patients or their relatives in which patients will have
all information in a handbill in the language they
understand better. This will further reduce the
workloads of nurses and other health care team as
the time spent providing information will be used
for other procedures.
In agreement with previous studies (Eyasu, Adane,
Amdie, Getahun and Biwota. 2016), this study
reveals that 61.6% of the patients were satisfied
with overall nurse’s attitude and performance of
duty. This result is not better than the study
conducted in two other tertiary institutions in south-
east and south-south state of Nigeria where a higher
proportion of the patients were satisfied with the
attitude of nurses, 76. 8% and 93.7% respectively
(Modebe, Azuike, Ucheagwa, Azuike, Obi,
Epundu, Chikezie, Ebulue and Aniagboso,2014;
Ekpe and Peter, 2016). It has been noted in literature
that nurses’ attitude; courtesy, respect, careful
listening and easy access of care have a great
influence on overall patients’ satisfaction (Ekpe and
Peter, 2016). Therefore, there is need for UCH
nurses to improve on their attitude and
responsiveness to patients.
Interestingly, the current study revealed that,
approximately 62% were satisfied with the overall
nursing care they received at UCH. This finding is
better than other studies in Ethiopia in which 52.5%
(Eyasu, Adane, Amdie, Getahun and Biwota, 2016)
and 49.2% (Sharew, Bizuneh and Habtewold, 2018)
of the respondents were satisfied with overall
nursing care they received respectively. However it
is not better than other studies in Nigeria (77%),
Kenya (87%), Malaysia (82.7%) and Turkey
(63.9%).
As regards area of dissatisfaction with services,
during admission at UCH, findings revealed that out
of 48 patients who signified their areas of
dissatisfaction, 25.0% were dissatisfied with heavy
workload on nurses as it affects their quick response
to patients. This confirms the assertion by Ajayi and
Olumodeji that heavy workloads and shortage of
nursing staff reduces patients’ satisfaction (Ajayi
and Olumodeji,2016). This could be linked to poor
staffing by the UCH management, brain drain
and/or improper construction of duty roster by the
nurse leaders. Nevertheless, the legally required
nurse-to-patient ratio is 1:2 or fewer in an intensive
International Journal of Caring Sciences May-August 2022 Volume 15 | Issue 2| Page 1429
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care unit and 1:4 or fewer in other specialties at all
times that patients are receiving treatment (Ford,
2013). A balanced nurse-to-patient ratio (good
staffing) leads to positive outcomes (Needleman,
Buerhaus, Pankraz, Leibson, Stevens and Harris,
2011; Aiken, Sloane, Ball, Bruyneel, Rafferty and
Griffiths, 2018). UCH as the centre of excellence
should strive to meet the standard nurse-to-patient
ratio.
A good number (20.8%) of patients reported
dissatisfaction with impolite attitude of nurses. The
impolite attitude of nurses reported in this study is
not acceptable for it violates the ethics of nursing
profession. However, it might be connected to
patient’s attitude, high workloads, staff shortages,
lack of equipment, lack of leaders support and
burnout (Haskin, Phakathi, Grant and Horwood,
2014). Overall, patients’ are the reason why nurses
are employed and for no reason or situation should
nurses act unethically.
Other areas of dissatisfaction include, Shortage of
water (14.6%), toileting system (10.4%), infestation
of rats, mosquitoes bite, malfunctioning of socket
and unpleasant food served. There was an overall
48% level of dissatisfaction with the services.
Though the percentage of dissatisfaction seemed
low compared with other studies, the areas pointed
out by the patients needs to be attended to as they
would impact on overall patients’ outcome. For
instance, patient complained of shortage of water,
poor toileting system, rat infestation and mosquito
bites which are sources of nosocomial infections
and thus requires urgent attention (Maina, Tosas-
Auguet and Mcknight, 2019).
On the areas of improving nursing care, 43.6%
suggested employment of more nurses to reduce the
workload. Consistent with literature, reduction of
nurses workload will greatly improve quality of
patient care (Needleman, Buerhaus, Pankraz,
Leibson, Stevens and Harris, 2011; Oetelaar, van
Stel and Van Rehen, 2016; Aiken, Sloane, Ball,
Bruyneel, Raffert and Griffiths, 2018). It is widely
recognized that most countries particularly Sub-
Saharan African countries have failed to meet the
WHO recommendation for nurse patient ratio which
greatly impacts on nursing care. Due to the
peculiarities of Nigerians, referral system has not
been effective, thus UCH had been saddled with
large outflow of patients which had invariably
placed strains on the rather fragile health system and
available resources. Hence the need to increase the
number of nurses cannot be overemphasized. Few
respondents (17.3%) implored on training and
retraining of nurses on skilful discharge of duty.
This is necessary because nursing continuing
education results in improvement of nursing activity
(Eslamian, Moeini and Soleimani, 2015).
Other areas of improving nursing care that worth
mentioning according to the respondents include;
supervision of nurses on duty, involvement of all
cadres of nurses in the nursing care of patients, ward
lighting, adequate water supply, toilet system, ward
environmental sanitation, functional electrical
equipment and computerization of the services to
ease paper work especially on investigation results.
The patient’s response is directly related to the poor
health system that has hitherto plaqued the Nigerian
health care system. Research has shown that
patients’ opinion are the best source of feedback that
can inform the hospital management and providers
of important things, that can be used in healthcare
planning and evaluation (Abdel Maqsood, Oweis
and Hansa, 2012; Merkouris et al., 2013).
This study showed that there is a statistically
significant positive association between educational
status (p<0.001) with level of patients satisfaction.
In other words patient satisfaction gets higher
commensurately with the level of education. This
corroborates other studies that reported more
satisfaction among patients with tertiary level of
education than those with high school level of
education (Ibigbami, Egunranti, Akinsulore and
Ibigbami, 2015; Karaca and Durna, 2019).
However, it is not consistent with previous research
where education level was not associated with
patient satisfaction with care (Ozlu and Uzun, 2015;
Sharew, Bizuneh and Habtewold, 2018; Lawal,
Agbla, Nkeiruka Bola-Lawal, Afolabi,and Ihaji,
2019). The possible explanation is that, majority of
the patients are graduates of tertiary institutions and
thus have a good grasp of their patients’ rights and
would demand they receive quality care.
In addition, age (p=0.658), gender (p=0.921) and
occupation (p=0.103) were not significantly
associated with patient’s level of satisfaction with
nursing services. This is not in consonance with
another study, where age, gender and occupation
were among the factors significantly associated with
International Journal of Caring Sciences May-August 2022 Volume 15 | Issue 2| Page 1430
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patient satisfaction with nursing care (Eyasu,
Adane, Amdie, Getahun and Biwota, 2016). The
discrepancy could be due to different sociocultural
background of the respondents.
Conclusion
The study showed that more than half of the patients
were satisfied with overall nursing care received on
admission. However, they were dissatisfied with
heavy workload on nurses as it affects their quick
response to patients. Other areas of dissatisfaction
as documented by the patients include; impolite
attitude of nurses, shortage of water, toileting
system, infestation of rats, mosquitoes bite,
malfunctioning of socket and unpleasant food
served.
There is need therefore to develop service
improvement strategies that will address the above
listed issues in the hospital.
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