patient satisfaction with nursing care in the context of health care: a literature study

REV I EW ART ICLE

Patient satisfaction with nursing care in the context of healthcare: a literature study

Peter Johansson1,2RN, MNSc (Student), Magnus Ol�eeni1,3

RN, MNSc (Student)

and Bengt Fridlund1,4RN, RNT, PhD (Professor)

1School of Social and Health Sciences, Halmstad University, Halmstad, Sweden, Departments of 2Internal Medicine and 3Child Psychiatry,

Central Hospital, Halmstad, Sweden, and 4Department of Medicine and Care, Link€ooping University, Link€ooping, Sweden

Scand J Caring Sci; 2002; 16; 337–344

Patient satisfaction with nursing care in the context

of health care: a literature study

To evaluate and improve the quality of care provided, it is

of vital importance to investigate the quality of care in the

context of health care. Patient satisfaction is a significant

indicator of the quality of care. Consequently, quality work

includes investigations that map out patient satisfaction

with nursing care. To improve the quality of nursing care,

the nurse needs to know what factors influence patient

satisfaction. The aim of this literature study was to describe

the influences on patient satisfaction with regard to nur-

sing care in the context of health care. In the description of

nursing care, we have used Henderson’s nursing care

model. The results describe eight domains that have an

influence on patient satisfaction with nursing care: the

socio-demographic background of the patients, patients’

expectations regarding nursing care, the physical envi-

ronment, communication and information, participation

and involvement, interpersonal relations between nurse

and patient, nurses’ medical–technical competence, and

the influence of the health care organization on both

patients and nurses. The bulk of the literature included in

the study came from the UK, Sweden and the USA. This

means that the results should be applicable to health care

in the western world. An important implication for future

research is to continue to elucidate the factors that influ-

ence satisfaction with nursing care, as seen from the

patient’s perspective.

Keywords: patient satisfaction, quality of nursing care,

nursing, health care, literature review.

Submitted 20 April 2001, Accepted 30 May 2002

Introduction

Over the last two decades there has been an increasing

interest in how patients experience health care (1). It is of

utmost importance to be able to define, measure and

evaluate the quality of the health care provided, in order to

maintain and increase patient satisfaction. This area has

attracted worldwide attention in recent years; in Sweden,

too, its importance has increased significantly over the last

decade.

The reformation currently taking place in the Swedish

health care system has made it difficult to maintain a high

level of the quality of care (2). As a result of the recession

in the early 1990s, fewer resources were allocated to the

Swedish health care system (3, 4). With escalating costs

for treatment and nursing and with health care being

subjected to competition, new attention is being focused

on achieving patient satisfaction (5). This has resulted in

greater emphasis on improved quality (6). Today, nursing

care is recognized as an area subjected to competition,

where the patient is seen both as a client and as a con-

sumer of health care (7).

High-quality technical care is most often regarded as a

matter of course (8). For this reason, the patient places

high value on the interpersonal care provided by the

nursing staff. Here, our definition of nursing care is ‘to

promote health and to help, support, educate and develop

the patient by liberating his or her own resources. Nursing

care is based on interaction and participation for the pur-

pose of satisfying universal and personal needs in relation

to daily life, needs that have become disrupted because of

ill health. Professional nursing care is based on theoretical

knowledge and systematic scientific methods’ (9, p. 173).

The ability to provide satisfactory nursing care has been

circumscribed concurrently with staff cuts. Thus, demands

are now being raised to extend the duration of nursing care

(2, 10). Otherwise there is a risk that the patient’s per-

ception of care will be negatively affected, which in turn

Correspondence to:

Peter Johansson, Hertig Knutsgatan 7, S-302 50 Halmstad, Sweden.

E-mail: [email protected]

� 2002 Nordic College of Caring Sciences, Scand J Caring Sci 337

may exert a negative influence on the nurse’s perception

and possibility of providing high-quality nursing care.

There is a strong correlation between the patients’ per-

ception of nursing care and their perception of the quality

of care (2).

The concept of patient satisfaction

Patient satisfaction is defined as the patients’ subjective

evaluation of their cognitive and emotional reaction as a

result of the interaction between their expectations

regarding ideal nursing care and their perceptions of the

actual nursing care (11, 12). No consensus can be found in

the literature regarding the factors that constitute patient

satisfaction (13, 14). Yet, the concept is used as an important

indicator of care quality (6, 7, 10, 15–17). Moreover, it is

frequently included as a variable of interest in health care

planning and evaluation, i.e. in measurements of the

quality of care (11). It is also regarded as a marker, which is

described and evaluated from a professional perspective (6).

In measurements, this indicator has to be used together with

other indicators relevant to the area of the quality of care

(18). Patient satisfaction has become important because of

the increasing practice of applying a consumer policy

viewpoint to health care while also safeguarding patients’

rights and taking their views into account (17). Another

contributory factor is the knowledge that a patient who is

satisfied complies, to a greater extent, with the treatment

and advice he or she receives from health care professionals

(16). A satisfied patient also tends to return more frequently

when in need of health care. Moreover, a satisfied patient is

more willing to recommend the hospital that provided his or

her care to others (19).

It is the patient’s subjective perception of what consti-

tutes patient satisfaction that counts (18). No one other

than the patient can tell the health care professionals what

is important. For this reason, the concept should be

regarded as an adequate indicator of nursing care quality.

Patients can expect and demand satisfaction from nursing

care and be allowed to take an active part in decision-

making regarding their care (7). This contributes to making

nursing care both patient- and result-orientated. Different

health care professionals exert different influences on the

patient’s perception of satisfaction (19). The nursing care

provided by nurses is regarded as the most important factor

in patient assessments of their satisfaction with health care.

In this respect, the nurse is at the forefront of the hospital.

If the nurse is unable to fulfil this role, a high level of

patient satisfaction will not be achieved. It is therefore of

crucial importance that all health care professionals

co-operate to improve care quality, in consultation with

the care-receivers (20).

The factors that influence the concept of patient satis-

faction, as seen from the patient’s perspective, are of

primary importance. Other perspectives, such as those of

the health care professionals, are of lesser value (21). If the

patient is satisfied with the nursing care received, this is

positive not only for the individual but also for the nurse

and the entire health care organization. Although it is an

indisputable fact that the nurse’s care is important for

patient satisfaction, an interesting point is how the nurse

can improve it. Accordingly, the focus of nursing care must

be on factors that influence patient satisfaction. By bearing

this focus in mind, the nurse can enhance the quality of

nursing care. The aim of this literature study was to

describe what influences patient satisfaction regarding

nursing care in the context of health care, based on the

following questions:

• In what way do patients’ social background variables

influence patient satisfaction?

• In what way do patients’ subjective evaluations of health

care influence patient satisfaction?

• In what way does nurses’ care influence patient satis-

faction?

• In what way does the organization of health care

influence patient satisfaction?

The theoretical framework of nursing care based

on Henderson’s nursing model

Henderson’s nursing model has been used for the analysis

of and reflection on the literature (22). This model des-

cribes how nursing care should primarily be individual-

orientated. Important factors for achieving good health

are knowledge, ability and will-power (22, p. 22). The

surrounding physical environment in the form of air,

light, sound and hygiene also impacts on the patient’s

physical and mental health (22, p. 42). Nursing care

should be based on a dynamic relation between patient

and nurse. Furthermore, nursing care should be aimed at

instruction and be built on professional research findings

(22, p. 84).

All human beings have the same basic needs but each

individual has his or her own unique needs as well (22, p.

27). These needs vary from individual to individual and

during different periods in life (22, p. 27). As the patient

knows his or her own needs best and often has distinct

wishes and expectations regarding the performance of the

nursing care (22, p. 23), the patient should be regarded as

an active and responsible participant in nursing care (22, p.

23, 84). The nurse should create a natural and constructive

relationship with the patient for the purpose of achieving

the goal of nursing care, which is to satisfy the patient’s

needs and to help the patient attain the greatest possible

degree of self-efficacy (22, p. 28). In order to do this, the

nurse needs to be responsive, empathetic, provide emo-

tional support, and be able to observe and understand the

patient’s nonverbal expressions (22, p. 28). The patient’s

needs should be satisfied in the way to which the patient is

accustomed, unless this conflicts with the treatment and

� 2002 Nordic College of Caring Sciences, Scand J Caring Sci

338 P. Johansson et al.

nursing plan (22, p. 23). The nurse should also help the

patient carry out medical prescriptions initiated by the

physician (22, p. 22).

Method

The literature search was carried out using Medline and

CINAHL databases. The search was not restricted with

respect to dates. The following search words were used

separately and in combination with each other: client

satisfaction, customer satisfaction, patient satisfaction,

quality of care, quality indicators and quality of nursing

care. The names of authors from the reference lists in the

scientific articles identified through the data search were

also used in the extended search. To get a comprehensive

outlook, the following inclusion criteria were used: the

articles had to have been peer reviewed and published in

English, Swedish, Danish or Norwegian, and to have a

caring science perspective. The data material was proc-

essed, analysed and reflected through a step-wise proce-

dure, using a theoretical framework based on Henderson’s

model. The first step consisted of reading through the

material to reach an overall impression of the content.

Then attributes included in the aim and the issues raised

therein were searched for. The attributes were grouped

systematically and categorized into so-called domains

according to the content of the subject.

Results

Thirty studies, published between 1987 and 1999, were

found. The majority of the articles were statistically ana-

lysed observation studies, which were carried out in the

UK, Sweden and the USA. From the data material, eight

domains, describing factors that influence patient satis-

faction with nursing care in the context of health care,

were developed.

Socio-demographic background of the patients

The care-receiver’s age was important for his or her per-

ception of satisfaction with the nursing care provided (14,

23–26). The older care-receiver tended to be more satisfied.

Quality measurements focusing on the patient’s perspective

demonstrated that older people rated the quality of care

higher (27). Further, the patient’s gender also influenced

the perception of satisfaction (8, 23–26). Men reported a

higher level of satisfaction compared with women. Patients

with a higher level of education reported less satisfaction

compared with those with less education (27).

Expectations of nursing care

Patients’ satisfaction was determined by their expectations

regarding the health care they were about to receive and

by their perception of health care previously received (17).

These two subjective factors were crucial for the patient’s

perception of being satisfied or dissatisfied. Dissatisfaction

arose when their expectations were not fulfilled (28).

Care-receivers who perceived the quality of service and

care to be better than expected reported greater satisfaction

with their hospital stay (19). The patients’ different

expectations fluctuated during the course of the hospital

stay (29). Some expectations were relatively stable and did

not change over time, while others were influenced by the

information given by the nursing staff. Patients had

expectations that the nurse would play a central role in

their care (29) as well as expectations regarding the care to

be provided by the nurse (30). These expectations were not

only related to the nurse’s knowledge and competence but

also to ‘personal’ care. There were also expectations that

the nurse would act as a companion and adviser. Other

expectations were that the nurse would possess an empa-

thetic ability and good communication skills as well as

being able to provide necessary information, while guiding

the patient both emotionally and physically during the

hospital stay. Patients’ expectations regarding nursing care

were important for the outcome of the care provided and

for their perception of satisfaction or dissatisfaction. There

were also expectations that the nurse and the doctor would

co-operate in giving care (29).

Physical environment

The surrounding physical environment had an influence

on patient satisfaction (31). The physical environment

included cleanliness, food, sound level, fellow patients,

and the comfort and aesthetics of the premises. The patient

made suggestions for improvements, such as more single

bedrooms, a maximum of two patients per room and a

special room for postoperative care (14). Clean clothes, a

clean bed and tasty food were considered to be tokens of

good nursing care (32, 33). Further cutbacks in areas not

related to the immediate care, such as cleaning routines,

also had an influence on the patient’s satisfaction with the

hospital stay (19).

Communication and information

Clear communication and information was a prerequisite

for the patient’s perception of satisfaction with the nursing

care (23, 34–36). The patients emphasized the importance

of receiving adequate information and that there was a

need for the information they received to be improved for

their satisfaction to increase (7, 14, 31, 37). It was

important that the nurses’ explanations were clear and

straightforward, so that the patient could understand what

they were talking about (38). The time aspect also had an

influence on patient satisfaction. Patients who had

received information about ward routines at an early stage

Patient satisfaction with nursing care 339


rated the quality of care higher (27). It was also considered

important that care-receivers were given information in

such a way that their integrity was not violated (31). The

key factor in involving patients in their own care was the

information and education provided by the nurse (7, 38).

Participation and involvement

The patients’ ability to participate and be actively involved

had an influence on their perception of satisfaction (23,

39). They wished to be able to influence and take

responsibility for the care they received and had expecta-

tions in this respect (29). Thus, they needed to be given the

opportunity to take part in decisions concerning their own

nursing care (7, 23, 32, 34).

Interpersonal relationship

A good relationship between care-receiver and nurse was

found to be important for patient satisfaction (40). The

characteristics of a good relationship were: mutual

understanding, respect, trust, honesty, co-operation (33)

and humour (37). The patient perceived being treated as a

specific individual and being given personal nursing care as

positive (31). Patients who reported a high level of satis-

faction had been influenced, to a significant degree, by

how much attention the nurse paid to them and to what

extent she had shown empathy and patience (41). Care-

receivers regarded consideration and attentiveness on the

part of the nurse as a necessary condition for satisfaction

with nursing care (42). This, in turn, enabled nurses to use

their intuition to understand the patient’s unexpressed

questions and needs.

Patient satisfaction was rated high in an organization

where the nurse was allowed to give more personalized

nursing care (35). Personalized nursing care resulted in

improved communication, increased patient involvement

and a better outcome. There was a positive relationship

between the nurse’s care and patient satisfaction (10). The

more attention the nurse paid to the patient, the greater

the perception of satisfaction. In addition, patient satis-

faction was influenced by the nurse’s behaviour and nur-

sing qualities (31, 38). These should be characterized by a

pleasant and positive interaction between patient and

nurse, which demanded that the nurse was responsive,

kind, attentive, calm and encouraging. Other important

factors were that the nurse took time to listen to the

patient as well as demonstrating an interest and a com-

mitment in contacts with the patient (32, 39). The initial

contact was especially important for the development of

future relations and patients’ level of confidence in the

nursing care, in turn influencing their perception of sat-

isfaction with nursing care. A holistic view of nursing care

was a significant factor in achieving patient satisfaction (2).

Nursing care based on feelings was the best predictor of the

patient’s perception of satisfaction. Nursing care based on

feelings means to be responsive to patients’ feelings and to

care about their needs.

Medical–technical competence

Important factors for patient satisfaction were the advice

the nurse gave and that she performed her work in a

technically correct way (38). Patients felt that nurses

should skilfully assist the doctor in examinations and

treatments and that they should support and show patients

how to carry out the doctor’s orders. Patients expected the

nurse to have a command of specific knowledge about

each patient and his or her treatment (31). Adequate pain

relief influenced patient satisfaction (41). Absence of

physical pain resulted in a higher level of patient satisfac-

tion with nursing care (43). Pain relief was considered

by the patient to be the equivalent of good nursing care

(32).

Health care organization

Organizational changes influence the patient’s perception

of satisfaction with nursing care (23, 44). It has been

shown that the introduction of care provided by staff

members working in teams of two, individual care

planning, nursing documentation and quality assurance

within important nursing areas contributed to increased

patient satisfaction in several nursing areas. Continuity

of the health care organization exerted an influence on

patient satisfaction (31) as did accessibility (39). There

was also a wish to be cared for by as few nurses as

possible (31). Patients considered that this, among other

things, facilitated and improved the communication

between the nurses with respect to their situation,

resulting in fewer misunderstandings when a new shift

took over. Accessibility meant that it should be easy to

get the attention of the nurse (39). The nurse’s job

satisfaction influenced patient satisfaction with nursing

care (45). A nurse who is over-worked or who expresses

dissatisfaction with the workplace has a negative influ-

ence on the patient’s perception of satisfaction. The

nursing staff’s work environment was a factor of

importance for how the patient perceived the quality of

care (25).

Discussion

The results of this literature study are based on peer-

reviewed articles published in scientific journals, the

majority of them having quantitative observation designs.

It would have been desirable however, if more of the

identified articles had had an experimental design, as such

a design is considered to be of greater scientific value (46).

On the other hand, explorative qualitative studies are



needed to study patients’ views. We chose to describe

patient satisfaction with nursing care from the perspective

of the nurse but other health care professionals may, of

course, also benefit from the results.

In the present study it was found that patients’ expec-

tations of nursing care are of crucial importance for how

they perceive satisfaction in the context of health care. In

addition to age, gender and education, previous experience

of nursing care had a primary influence on expectations.

This previous experience is based on how the patients

perceived communication and information, participation

and involvement, the health care organization, interper-

sonal relation, medical–technical competence and the

physical environment during their last stay in hospital. The

finding of the present study that older patients rated their

satisfaction higher than younger patients can perhaps be

explained by the fact that they grew up in a society where

institutions had great power and were seldom questioned,

which may mean that they are not inclined to criticize

nursing care (47). Despite the fact that the need for nur-

sing care tends to increase with age, elderly people are the

group most satisfied with their care. A likely explanation is

that people place greater value on nursing care when their

own need of care is at its greatest.

Differences in satisfaction ratings between men and

women may be caused by the man–woman relationship or

to behavioural differences between the sexes. It has been

shown that men receive information more spontaneously

from the nursing staff compared with women (23).

Patients’ educational level also influences their level of

satisfaction. Patients with higher levels of education

probably make greater demands on nursing care, which

may lead to expectations of more information and educa-

tion. These patients rated their satisfaction lower if they

perceived that the information and education they had

received was insufficient. A social network of relatives and

friends who support the patient by being the patient’s

spokesperson may increase patient satisfaction. People

from different cultures may have different expectations

regarding nursing care, which means that, as patients, they

perceive satisfaction differently. In line with Henderson,

the need for nursing care can vary during the course of a

person’s life and from individual to individual (22, p. 27).

Further, norms and mores prevailing in different cultures

and social environments may influence this need. This

could explain the influence of age, education and gender

on the degree of satisfaction.

The physical environment has an impact on the patient’s

physical and mental health (22, p. 42). In today’s modern

hospitals, the overall control of many physical aspects,

such as the air, is in the hands of technology, while pro-

fessional groups are responsible for the hospital food.

However, the nurse still has some measure of influence on

factors in the physical environment (31) by, for example,

considering the patient’s need of warmth or quiet (14).

Consequently, nurses should take part in the planning

of new care units, thus allowing them to influence the

patient’s physical environment at an early stage.

The literature underlines the importance of providing

adequate communication and information to the patient,

which leads to increased patient satisfaction. Nursing care

should be aimed at instructing patients to increase their

knowledge, thereby helping them to attain good health

(22, p. 85). Despite this, insufficient information has been

shown to be perhaps the most common cause of dissatis-

faction (14, 18). Many factors may contribute to the

patient’s experience of not receiving sufficient information.

However, this is no excuse for the patient’s perception, on

leaving the hospital, of not having received sufficient

information. Other reasons for insufficient information

reaching the patient could be weak pedagogical skills on the

part of the nurse or the nurse’s increased workload. This

could lead to information not being prioritized. Greater

emphasis should be placed on patient education during

nursing education. This would give the nurse increased

knowledge of how to give information, counselling, guid-

ance and support to the patient (48) and would no doubt

lead to increased patient satisfaction. Yet another way of

increasing patient satisfaction is to give the patient infor-

mation regarding ward procedures and what care and

treatment are planned as early as possible after arrival at the

hospital (14). Patients who receive information not only

show greater satisfaction but also take part and become

involved in their own care to a greater extent. The patient

should be regarded as a resource and as an active and

responsible actor with individual wishes and expectations

of nursing care (22, p. 23, 84). Participation and involve-

ment lead to greater patient satisfaction (14). In order to

actively involve patients in their care, its planning and

implementation should be carried out in consultation with

the patients(14, 22, p. 85). Nurse and patient should work

jointly towards an agreed common goal.

Patients have reported that nursing interventions based

on feelings are more important for patient satisfaction than

the medical–technical nursing interventions (38). In order

for nurses to satisfy the patient’s nursing care needs, they

must create a natural and constructive relationship with

the patient (22, p. 28). The nurse should not underesti-

mate the value of physical contact with the patient, espe-

cially if it has a comforting effect. The capacity to feel

kinship with the patient is characteristic of the best nurses.

Within the health care of today, nurses are faced with

great demands regarding their relationship with the care-

receiver, among other things. To ensure patient satisfac-

tion, nurses need to provide personalized care. They need

to be attentive, show empathy and respect as well as caring

about what they are doing. They need to exhibit patience,

consideration, dedication and honesty. In order to create a

pleasant and positive interaction with patients, nurses

need to be responsive, friendly, calm, encouraging, take



the time to listen, show an interest and be able to under-

stand patients’ unexpressed questions and needs. Nurses

are expected to meet these demands while, at the same

time, experiencing increasing time-related pressures and

demands for high quality. If they are unable to cope with

these demands, there is a risk that they will develop feel-

ings of insufficiency. This, in turn, can negatively influence

nursing care, resulting in decreased patient satisfaction.

Despite this, many studies have shown that patients are

very satisfied with nursing care (8, 18, 23, 37). The nurse

must be aware that the patient’s perception of satisfaction

or dissatisfaction is not always a reflection of the nursing

care provided (49). As the present results show, other

factors influence the care-receiver, over which the nurse

has little influence.

Few descriptions were found showing patient satisfaction

to be the result of the nurse’s technical competence. A

possible explanation for this is that patients in general lack

the necessary knowledge to evaluate the technical care (50,

51). What patients can assess, however, is the quality of the

nursing care they receive. This means that the patient is the

optimal judge of the care provided in areas not related to

technology (16, 51). However, the importance of technical

competence should not be underestimated. Nurses need to

feel confident in their technical competence in order to

provide satisfactory nursing care at all levels. The nurse has

a responsibility to assist the patient in performing the

medical actions necessitated by the disease (22, p. 22).

There is a clear relationship between patient satisfaction

and compliance with prescriptions, advice and directions

(52, 53). A patient who is dissatisfied seldom complies with

directions and often does not turn up for revisits. This

indicates that a prerequisite for patient participation in

medical care is that the patient is satisfied with nursing

care. In other words, quality nursing care is a prerequisite

for quality medical care. The increasing costs of health care

in the western world (3–5) will force relatives and friends to

assume greater responsibility for nursing care in the future.

Escalating health care expenditure also increases the pres-

sure on politicians to deliver a more efficient health care

system. Research can establish what good quality nursing

is, thereby making it possible to optimize nursing care

resources. The politicians can then make clear to the

general public the demands and expectations that can be

placed upon the nursing profession, in turn increasing the

possibilities of achieving patient satisfaction.

The nurse is part of a health care team and is expected to

co-operate with the other health care professionals

involved in the care of the patient (22, p. 22). In their role

as supervisors, nurses have an important task to fulfil in

the organizational work of the field of health care. In this

work, the nurse should not only act in the patient’s best

interest but also in the interest of the nursing staff and

their work environment, as this influences patient

satisfaction (45). One way of increasing patient satisfaction

is to provide nursing staff with a positive work environ-

ment in order to prevent burnout. Neglect of the well-

being of the nursing staff results in disregard of patient

satisfaction as well as decreased quality of care in the long

term. By creating an organizational climate that is con-

ducive to further education, the staff is given the possibility

of enhancing their nursing competence, which, in the long

run, may improve patient satisfaction and possibly also the

nursing staff’s job satisfaction.

In investigations of patient satisfaction, care-receivers

with communication and speech difficulties as well as

confused or demented care-receivers are often excluded

(23, 44). However, these groups are the most important to

investigate when it comes to satisfaction with nursing care,

as they are the most dependent on the nurse’s care. It is of

utmost importance to develop measuring instruments that

make it possible to evaluate this patient group’s satisfaction

with the nursing care (24).

Conclusions

Patients’ expectations regarding health care are a key factor

when it comes to satisfaction with nursing care. Several

factors influence patient expectations both before and

during care. The background factors influencing expecta-

tions before the care begins are age, gender and education,

all of which belong to the socio-demographic domain, as

well as experiences from previous occasions on which the

patient received care. While in hospital, the patient has

expectations that can be found within the other domains,

such as the physical environment, communication and in-

formation, participation and involvement, interpersonal

relations between nurse and patient, the nurse’s medical–

technical competence, and influence of the health care or-

ganization on patient and nurse. These are domains where

nursing care may influence the care-receiver’s perception

of satisfaction. However, in some of these, such as physical

environment, medical–technical competence and the

health care organization, the nurse has less opportunity to

exert an influence. Accordingly, the nurse is dependent on

co-operation from other health care professionals to

achieve patient satisfaction. Nurses have a far greater pos-

sibility of influencing the domains of communication and

information, participation and involvement, and interper-

sonal relations, as these are the very foundations of their

profession. The patient makes a continuous subjective

evaluation of these domains, resulting in a perception of

nursing care. This perception is then reflected in new ex-

pectations within the different domains. As Fig. 1 shows, it

is the perception of satisfaction or dissatisfaction with nur-

sing care that forms the basis for the patient’s expectations

prior to the next hospitalization. This literature study pri-

marily illuminates patient satisfaction from a western world

perspective, as the scientific articles studied come from the

UK, Sweden and the USA. The health care in these coun-



tries can be said to be characterized by an equally high level

of technology. From this follows that the results can be

applied to the Swedish health care system as well as to the

rest of the western world.

Implications

In order to increase patient’s knowledge, greater emphasis

must be placed on patient education within nursing edu-

cation as well as within health care services as a whole.

The patient should expect to receive personal nursing care

based on scientific knowledge and utilization of the

patient’s own resources. Furthermore, in order to satisfy

his or her need of nursing care, the patient also expects the

nursing staff to have a joint strategy and common goals. It

is important to give patients information about what to

expect from nursing care, as it has been shown that their

expectations are of great importance for patient satisfac-

tion. The scientific community should inform hospital

administrators and politicians of what the general public

can expect from care and what demands they can place

upon it so that this can be made known to the public.

What is most important today is to clarify the concept of

patient satisfaction and to make clear what influences

patient satisfaction from the perspective of the patient, i.e.

to explore what it is that makes the patient perceive the

provided nursing care as of good quality.

It is therefore desirable to carry out further experimental

studies that illuminate patient satisfaction. In addition,

more explorative qualitative studies are needed, in order to

study the patient’s perspective. When this has been

achieved, the development of new and/or old instruments

can be continued. It is also important to develop an

observation instrument for measuring patient satisfaction

in patients who have communication difficulties or who

suffer from dementia, as no such instrument is available

today. There is also reason to focus further research on a

measurement of patient dissatisfaction, as this may be

another step forward in improving patient satisfaction and

thereby the quality of care.

References

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Figure 1 The diagram shows eight domains and their relations that have an influence on patient satisfaction with the nursing care provided by the

health services.



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