Background: Patient satisfaction is an attitude resulting from a person’s general orientation to an experience. Most of studies tried to measure overall satisfaction with holistic services given to patients and confined only to outpatient services.

Objective: This study was aimed at comparing the satisfaction level of patients among inpatients with outpatients on nursing care in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2018.

Methods: A comparative cross sectional study design was used to compare the satisfaction level of patients in outpatient versus inpatient departments of Yekatit 12 Hospital Medical College, from June to July 2018. A total of 80 inpatients and 80 outpatient participants were sampled on the basis of convenience sampling. Data was collected with a pre-tested interviewer administered structured questionnaire. Analysis was carried out with SPSS version 21 software. Independent t-test was used to make comparison between the two groups, considering p<0.05 as a level of significance.

Results: Fifty-seven percent of inpatient participants and 42% of outpatient participants were females. Sixty-two percent of inpatients and 67% of outpatient participants reported to have a monthly income of 1500 birr and more. Fifty-three percent’s of outpatients and 38% of inpatients were satisfied. There was a statistically significant difference in level of satisfaction between the two groups on nursing care at p<0.05. Participants in outpatient department had a higher level (mean+SD, 20+7.16) of satisfaction than participants in the inpatient departments (mean+SD, 17+5.66) at p<0.05.

Conclusion: Findings of this study revealed that there was a significant difference in level of client satisfaction between inpatient versus outpatient. Satisfaction was higher among outpatient than inpatient groups, at p<0.05. Large scale studies are recommended to evaluate what actually happened to other areas of health sector.

Keywords: comparative, questionnaire, patients, participants, outpatient, inpatient

Problem or issue

1. Nursing professionals were majorities in most hospitals, and there was almost a constant attachment with patient in most of their cares (6, 11) hence level of satisfaction of patients (inpatients and outpatients) on nursing care was not well studied.

What is already known?

1. Studies conducted in Ethiopia, on level of patient satisfaction emphasized more patient satisfaction on health care professionals; to whole profession.
2. Though, few studies conducted on patient satisfaction toward nursing care were confined to whole services delivered by nurses than comparing the inpatient and outpatient.

What the paper adds

1. To the knowledge of researchers, this study was the only comparative study in the particular area of nursing care that depicted variation in level of satisfaction among patients in outpatients and inpatient department.
2. Findings from this study will help as a reference for researchers aiming to conduct study on the particular topic.
3. Policy makers can utilize on the way to make decision, planning and monitoring situations on the particular topic.

Satisfaction is a pleasant feeling that a person gets when receiving desired service or when a person has done something in need to do. Client satisfaction was linked to nursing care in most occasions. Patient satisfaction has emerged as a central focus of health care delivery during the last decades, of which nursing care became one significant component of patient satisfaction.^1-3

Nurses were from the very important group, which are largest single technical group engaged in hospitals. Hospitals may be soundly organized, beautifully situated and well equipped, but if nursing care is not up to the standard required, the hospital will fail in providing satisfying services. Nursing practice is a direct service, goal oriented and acceptable to the needs of individuals, family and community during health and illness. The nurses’ primary responsibility is to those people in need of nursing care.^4,5

Patient satisfaction with nursing care is considered the most important factor in the overall patient satisfaction with hospital services,⁶ and it varies from place to place, and time to time. A study on satisfaction of patients on nursing care at medical ward of Philippine general hospital showed that, 57.8% of patients were satisfied with nursing care.⁷ A study examining patients satisfaction with nursing care in Saudi Arabia comprising of 100 patients in a study, revealed that patients had a high(86%) level of satisfaction with provided nursing care.¹

Lower level of patient satisfaction on nursing care was observed in a study at National Health Service (NHS) hospital in England, while the service was delivered by non-UK educated nurses.⁸

In a study on outpatient and inpatient services satisfaction in Iranian Military Hospital, 91.9% of respondents were satisfied of routine nursing services.⁹ A study on impact of regular nursing round on patient satisfaction with nursing care, a controlled clinical trial comprised of 100 hospitalized patients in medical surgical ward, and allocation to experimental and control group was made by convenience sampling. For the first day; every 1-2 hours round was given for the experimental group, while routine service was for the control group. On the second day following intervention, the groups had no significance difference in their level of satisfaction.¹⁰

The other study on level of patient satisfaction revealed that the overall satisfaction with nursing care was 45%, with the care provided while 55% were partly dissatisfied.⁴

Patient satisfaction with nursing care is particularly important as nursing staff comprised majority of the health professionals and is constantly by the patient side in order to satisfy their needs, unquestionably overbearing component in maintaining and restoring their health. Now a day’s patient satisfaction is becoming an important criterion for hospital accreditation,¹¹ and whilst majority of health professionals in hospitals were nurses,⁶ studying level of patient satisfaction with nursing care has paramount significance to the success of the health sector in addressing their objectives.

The fact that nursing professionals were majorities in most hospitals, there was almost a constant attachment with patient in most of their cares (6, 11) studying level of patient satisfaction with nursing care was of great importance to the success of health sectors in addressing community problem.

To date, available studies were confined to patient satisfaction with respect to the whole service within the hospitals. There were few studies measuring patient satisfaction level on nursing in Ethiopia, but they lacked comparing inpatient and outpatient satisfaction on nursing care and this study tried to fill this gap.

To the knowledge of researchers, this study was the only comparative study in the particular area of nursing care that depicted variation in level of satisfaction among patients in outpatients and inpatient department, and would hopefully fill the gap in literature in the study area and topic.

Participants and study design

The study received an ethical approval from universal medical College Research Review ethics committee and was conducted at Yekatit 12 Hospital Medical College from June-July 2018. All participants were provided written informed consent. Study area was Yekatit 12 Medical College Hospital, which was one of the hospitals in Addis Ababa, which is the capital of Ethiopia. Source population was all people within the catchment area for Yekatit 12 Hospital Medical College. The Study population included 80 inpatients and 80 outpatients. Participants were selected by convenience sampling in both cases, while both groups almost had similar characteristics other than criterion under investigation which was being inpatient and outpatient. In this study, participants were included in to inpatient group, those who stayed at least for 24 hours and more in ward during data collection period at Yekatit 12 Hospital Medical College and for those of outpatient group, patients who were treated, and or had follow up in outpatient department during data collection period in Yekatit 12 Hospital Medical College from June-July 2018.

Data was collected with pre-tested interviewer administered structured questionnaire. Pre-test was done on 5 patients from each group among patients at Menelik II Referral Hospital on May 2018.

Measuring tools

The questionnaire measuring the outcome variable consisted of likert scale ranging from:-strongly agree=5, agree=4, neither agree nor disagree=3, disagree=2, strongly disagree=1.

Dependent variable was satisfaction of clients with nursing care, of which computation for variables forming satisfaction was made to measure the magnitude of satisfaction in each department. For this study a patient is said to be satisfied with nursing care if more than mean positive answers were scored and not satisfied for those who responded less than mean score from six questions directly measuring satisfaction in both groups. Independent variables were common socio-demographic characteristics and some patient characteristics.

Reliability

To assure the quality of data, validity and reliability of the tool was done. The questionnaire was adopted and evaluated by two Senior Lecturers then modification was made as per their suggestions. Inter-item reliability was done for scales measuring inpatient and outpatient client satisfaction regarding nursing care. Cronbachs Alpha coefficient was 0.901 for the inpatient and was 0.980 for the outpatient department. This indicates that in both cases every construct measured satisfaction and all items were retained (Table 1).

Statistical analysis

All statistical analyses were carried out using SPSS 21.0 statistical software. Variables between the two groups were compared using the student t-test. The level of significance was set at p<0.05.

A total of 160 patients were included in this study, and were classified in to inpatients,(n=80) those who admitted to any of departments within the hospital and outpatient (n=80) if treated in outpatient (OPD) within the hospital.

The characteristics of both groups were presented in Table 2. Fifty-seven percent of inpatient participants and 42% of outpatient participants were females. Sixty-two percent’s of inpatients and 67% of outpatient participants reported to have a monthly income of about 1500 birr and more. Fifty percent’s of inpatients and 53.8% of outpatients responded to be orthodox religion followers. Most (97%) of inpatient participants and 71% of outpatient participants responded to resided in urban residence.

Satisfaction level of participants

In outpatient departments 53.8% (41) of participants were satisfied with nursing care, while 38.8%(31) of participants in inpatient departments were satisfied. In contrary, 46.2% of outpatients and 61.2% of inpatients were dissatisfied with nursing care (Figure 1).

Figure 1 evel of patient satisfaction on nursing care among participants at Yekatit 12 hospital medical college, Addis Ababa, Ethiopia, and July 2018.

Comparisons of satisfaction level

As shown in Table 3, Comparison of satisfaction was made between inpatients and outpatients on nursing care. Selected features; sex, educational level, religion, marital status, residency and satisfaction of patients in both groups were compared against presence of statistically significance differences. Accordingly, no statistically significant difference was observed between inpatients and outpatients whilst statistically significance difference was evidenced between inpatients and outpatients with respect to satisfaction level and residence at p<0.05.

The mean level of patient satisfaction among outpatients on nursing care was higher at 20+7.16 (mean+standard deviation) as compared to the mean level of patient satisfaction among inpatients on nursing care which was 17+5.66(mean+standard deviation) at p<0.05.

Patient satisfaction with nursing care is considered the most important factor in the overall patient satisfaction with hospital services⁶ and varies from place to place, time to time. A study on satisfaction of patients on nursing care at medical ward of Philippine General hospital showed that 57.8% of patients were satisfied with nursing care.⁷ which was higher than findings of this study. This difference might be due to variations in sample size.

The other study examining patient’s satisfaction with nursing care in Saudi Arabia revealed that patients had a high (86%) level of satisfaction with nursing care.¹ which was higher than findings of this study of which level of patient satisfaction was 53.8% in outpatients and 38.8% in inpatients. This difference might be due difference in study design.

The level of patient satisfaction in this study was lower than the finding in Iran, where 91.9% of respondents were satisfied of nursing routine services.⁹ This variation might be due to differences in characteristics of participants. The study on level of patient satisfaction revealed that the overall satisfaction with nursing care was 45%, with the care provided while 55% were partly dissatisfied.⁴ Which was slightly higher than in-patient satisfaction and lower than outpatient satisfaction level.

This study revealed that there was a statistically significant difference in level of patient satisfaction on nursing care among patients in Yekatit 12 Hospital Medical College at p<0.05. Outpatients had a higher level of satisfaction as compared to inpatient on nursing care; and hence lower level of patient’s satisfaction on nursing care was observed. Responsible bodies need to work over the low patient satisfaction level encountered in the study area. Large scale longitudinal studies should be needed to evaluate the situation for appropriate course of action.

Addisu Tadesse Sahile involved in designing of the study, data analysis, drafting and critically reviewing the manuscript. Whilst Sinetsehay Alemayehu Getahun, and Sinetsidk Getahun Bogale took part in designing of the study and data collection. All authors read and approved the final manuscript.

A finding of this study was generated from data collected and analyzed on the basis of stated methods and materials hence all data were already available in the manuscript.

Consent for publication of the manuscript was not applicable due to the fact that there were no participant’s individual data videos or images.

The study protocol was performed in accordance with the ethics principle. Ethical approval was obtained from ethics review board of Universal Medical College. The data collectors obtained written informed consent from all participants.

This study was funded by authors.

1. Atallah MA, Hamdan–Mansour AM, Al–Sayed MM, et al. Patients' satisfaction with the quality of nursing care provided: the Saudi experience. Int J Nurs Pract. 2013;19(6):584–590.
2. Aiken LH, Sloane DM, Ball J, et al. Patient satisfaction with hospital care and nurses in England: an observational study. BMJ open. 2018;8(1):e019189.
3. Özlü ZK, Özge Uzun. Evaluation of satisfaction with nursing care of patients hospitalaized in surgical clinics of different hospitals. International Journal of Caring Sciences. 2015;8(1):19–24.
4. Khan MH, Hassan R, Anwar S, et al. Patient satisfaction with nursing care. Rawal Medical Journal. 2007;32(1):27–30.
5. Rajeswari T. A study to assess patients satisfaction with quality of nursing care. 2011.
6. Merkouris A, Andreadou A, Athini E, et al. Assessment of patient satisfaction in public hospitals in Cyprus: a descriptive study. Health Science Journal. 2013;7(1):28–40.
7. Villarruz–Sulit MVC, Dans AL, Javelosa MAU. Measuring satisfaction with nursing care of patients admitted in the medical wards of the philippine general hospital. Acta Medica Philippina. 2009;43(4):52–56.
8. Germack HD, Griffiths P, Sloane DM, et al. Patient satisfaction and non–UK educated nurses: a cross–sectional observational study of English National Health Service Hospitals. BMJ Open. 2015;5(12):e009483.
9. Ameryoun A, Pourtaghi G, Yahaghi E, et al. Outpatient and Inpatient Services Satisfaction in Iranian Military Hospitals. Iran Red Crescent Med J. 2013;15(9):843–847.
10. Negarandeh R, Hooshmand Bahabadi A, Aliheydari Mamaghani J. Impact of Regular Nursing Rounds on Patient Satisfaction with Nursing Care. Asian Nurs Res (Korean Soc Nurs Sci). 2014;8(4):282–285.
11. Sack C, Scherag A, Lütkes P, et al. Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37,000 patients treated by 73 hospitals. Int J Qual Health Care. 2011;23(3):278–283