ALAN REY D.

ANTOQUIA, RN, RPT

MAN-NSA THESIS WRITING 1.

PATIENTS’ SATISFACTION ON HEALTH CARE DELIVERY SYSTEM AT CARAGA

REGIONAL: NURSING SERVICE FOCUS

- Based on your background you’re shifting the focus of your study

now to simply measuring patient satisfaction and finding the
effect cause by patient’s profile.

POINTS TO PONDER UPON:

- It seems that your study is only trying to identify how the
profile of the patient is affecting the patient satisfaction?
My point is why identify the patient then seek their
satisfaction? Is this worthy enough to be studied and do you
believe this is uncommon or no study such as this exists? This
is to avoid duplication and provide interest to your study to
convince the panel to grant you the topic.
- Upon viewing the paradigm it seems that way profile of the
patient as the CAUSE then the patient satisfaction as the EFFECT.
- If the study will push through your result will only seek
a. What are different Age group, Sex: whether more are male
or more female, Marital Status: more are single than
married, their Highest Educational Attainment, Monthly
Income, Health Insurance and Room Accommodation.
b. Are the patient in Caraga regional hospital satisfied on
the following nursing services/factors; Admission,
Medication, Grooming and Competence Attitudes?
c. Do age and other factors affect patients’ satisfaction?
Example Age: do the older patient are more satisfied
compared to the younger patient, Civil Status: are married
couple more satisfied compared to single patients.
- If such study’s direction will push through will you have a hard
time providing your intervention since your result will probably
focus only how nurses will deal with the different age range or
how nurses will deal with single patient compared to married,
widow, single parent or how will nurses will deal with educated
versus not educated patient during admission, medication related
intervention, the type of grooming needed by nurses to project
when caring for each type of patient when group according to
profile,
- or you will device recommendation or interventions to train
nurses what type of grooming or competence needed to project for
philhealth patient versus not philhealth
- Or what type of grooming or competence should be projected by
nurses in caring for patient in the ward compared to private
rooms? (huge risk for discrimination)
- MY SUGGESTED SOLUTION TO IMROVE THE STUDY IS IN THE NEW SUGGESTED
PARADIGM KINDLY STUDY IT TO PROVIDE YOU A CLEARER PRESPECTIVE.
Chapter 1
 THE PROBLEM AND REVIEW OF LITERATURE

Background of the Study

Patient satisfaction is essential in evaluating the

quality of health care delivered (Larrabee, J.H., 2001). It

implies that patient satisfaction describes how patients

value and regard their care; it is a process as much as an

attitude, so it must be, monitored continually, and

frequently measured.

In today’s competitive health care environment,

measuring quality has become a requirement; therefore, health

care organizations or hospitals should focus on patient

satisfaction as a way to improve and maintain market share.

It has been observed that satisfied patients are more obedient

and more likely to participate in their treatment (Guldvog,

B., 1999). Patients’ satisfaction became a vital component of

health care services quality monitoring and improvement

processes (Jenkinson, C. et. al., 2002).

The results of these studies are increasingly being used

by health care providers and regulators to locate and solve

problems that can improve the quality of care (Naidu, A.,

2009). Some experts have suggested that waiting time is

critical in determining overall patient satisfaction (Bursch,

B., et. al., 1993). While others have shown that interpersonal

skills, humanitarian qualities of the staff, the amount of

information given to a patient about his or her condition are

paramount (Yarnold, P.R. et. al, 1998) and behaviors of

physician and nursing staff are most influential in

determining patient satisfaction.

Many studies specify that customers in different

countries evaluate good service in different ways. Therefore,

measures applicable in one culture may be incompatible with

others cultures as patient expectations and priorities vary

worldwide (Kueh, K. and Ho Voon, B., 2007). Data gathered

through measuring patient satisfaction reflect care delivered

by staff and can serve as a tool in decision making. Moreover,

patient satisfaction surveys can be tools for learning by

highlighting areas of weakness in order to overcome these

obstacles through appropriate management decisions. Data can

also serve as means of holding physicians and nurses

accountable; and it can show that they have acceptable level

of patient’s satisfaction. Furthermore, these data are

becoming obligatory to be used in health care quality

documentation by accrediting organizations and consumer

(Entwistleet al, 1996).

 The researcher sought to explore factors of patient

satisfaction in Caraga Regional Hospital that could impact

the patient’s perception of the care provided throughout an

inpatient care.

- Remember: The Introduction will serve as your proof that

the chosen topic needs to be studied in full a scale thesis,
this should convince the panel as well as future readers
that your topic it feasible enough to be studied.
- Introduction should contain;
a. Problems that are existing to prove why of all the
research topic you chose this study
b. Actual observation and experience of the researcher
that lead to the adaptation of the research topic.
c. Role of the nurses why such topic is chosen, how the
nursing profession is affected by the problem chosen.
- You may cite definition of the role of nurses
for example in the health care delivery system
or declaration of any trusted author that state
that the problem is affecting the nurses in their
delivery of the health care. (avoid over
discussion just provide one paragraph for this)
d. Statistics to prove that such problems does exist,
stats could be from the
- Local
- Regional
- National
- Worldwide
e. Desire of what the study wants to achieved (make
projections not conclusions to avoid being biased with
a premature conclusion)

Review of Literature

The profession of nursing started way back to 1853 with

Florence Nightingale’s contribution and participation with

caring for the Crimean War wounded. Cleaning the hospital,

general sanitation, and providing basic hygiene to patients

are specific role of the nurse in the 1800’s. Nicknamed “Lady

of the Lamp,” this early nursing pioneer is remembered for

her implementation of organizational and administrative

expertise which resulted in a 40% reduction in mortality rates

among the Crimean War wounded (Nightingale, 1860).

Nightingale established the first school of nursing in

1860. In her work, Notes onNursing: What it is, what it is

not (1860); Nightingale described the knowledge of nursing as

having a major focus on sanitation and hygiene. She point out

topics such as ventilation, temperature, noise, nutrition,

bedding, and personal hygiene as instrumental to the nursing

role (Nightingale, 1860).

Modern nursing and nursing education have

grownsignificantly since Nightingale’s era. The nursing

profession has undergone a longstanding struggle to gain

formal recognition as a professional discipline. Numerous

theorists and nursing scholars have contributed to uplift the

nursing discipline to recognition as a distinct and separate

profession within the healthcare realm. Today’s nurse has

evolved from Nightingale’s role emphasis on hygiene and

sanitation to that of the professional clinician, capable of

combining technical theoretical knowledge, expert clinical

skill, empathy, and compassion for the delivery of competent

patient care. Such a contemporary focus within the healthcare

arena represents and embodies the unique and individual

expression of the art and science of nursing.

Patient satisfaction with care received is an essential

criterion by which patientsassess quality of medical care

received. Satisfaction is broadly defined as the

humanexperience of being filled and enriched by an experience

(Merriam Webster OnlineDictionary, 2005). Additionally,

Williams (1994) defines patient satisfaction as theclient’s

personal and subjective evaluation of expectation

fulfillment.Patient satisfaction is viewed as a significant

and valid measure of efficiency inhealth care delivery.

Patients are often active and discerning consumers capable

ofrendering opinions regarding care received. Positive

satisfaction with health care isfurther viewed as a

determinant of patient compliance and subsequent health

statusoutcome. For the provider satisfaction with health care

is viewed as instrumental toattracting and maintaining

patients within the competitive health care arena.

Theyconclude that a health care provider’s ability to

provide clear explanations and to displayempathy and concern

contributes positively to enhanced patient

satisfaction.Furthermore, improving health care

practitioners’ interpersonal skills can effect

patientsatisfaction more positively. Additional findings of

the study included higherdocumented satisfaction by men,

those with higher education, higher severity of disease,and

enhanced quality of life.In a descriptive study of patient

satisfaction with advanced practice nurses, Bryantand Graham

(2002) found that affective support, health information

received, decisionalcontrol, and technical competence all

positively influenced client satisfaction with care.

Multiple factors and aspects of carewithin the health

care arena ultimately determine an individual client’s

opinion regardingsatisfaction with services rendered. Of

these factors interpersonal communication isoften the most

important determinant of satisfaction, demonstrating the

importance ofpatient education, communication, and feedback

in the delivery of health care.The amount of time required by

patients to wait before seeing a health care providerwas found

to be inversely correlated with overall satisfaction. In a

study involvingsubjects who were randomly assigned to groups

either receiving or not receiving healtheducation in the

waiting room, Oermann et al. (2002) foundthat patient

education delivered in the waiting room had no effect on

overall satisfaction,but did result in increased satisfaction

regarding health education received.

Beach et al.(2004) stipulate that satisfaction varies by

health care specialty. Self-disclosure byprimary care

physicians was demonstrated to have a negative effect on

patientsatisfaction, while self-disclosure by surgeons

resulted in increased satisfaction. Safran et al. (1998)

examined the relationship between primary care performanceand

clinical care outcomes of physicians. The study examined the

relationships betweenclinical care accessibility,

continuity, comprehensiveness, integration, clinical

interaction,interpersonal treatment, trust with outcomes such

as adherence to physician’s advice,patient satisfaction, and

improved health status. Results demonstrated that trust was

thevariable most strongly associated with patient

satisfaction. Additional positivelycorrelated variables to

patient satisfaction included communication and

personalknowledge of the patient.

Green(2002) conversely determined that patients aged 18

– 25 years were less satisfied withnurse delivered

healthcare. Similarly, Pinkerton (1998) found no

statisticallydifferences in health outcome or patient

satisfaction between nurse andphysician managed groups.

Clients were determined to be more satisfied with

nurseinterpersonal manner, time spent in collaboration,

accessibility, andconvenience. Likewise, Wilson (1999) found

no statistically significant differences insatisfaction based

on client gender, age, employment status, educational level,

andmarital or family status.In a retrospective observational

study over a four-year time period, Roblin, et al. (2004)

reviewed over 41,209 responses from patientsregarding level

of satisfaction with care received. The researchers measured

satisfactionat three levels; practitioner interaction, care

access, and overall experience and concludedthat patients in

an outpatient health maintenance organization were

significantly moresatisfied with practitioner interaction

during care delivery by physician assistants andnurse than by

physicians. Hooker, et al. (1997)alsofound no difference by

provider type, age, gender, and length of employment in a

KaiserPermanente study of physician assistants, nurse, and

physicians, concludingthat patient satisfaction depended on

communication style and not on provider.

In relations to influence of demographic determinants

towards patients satisfaction, most of the past studies

highlighted as age increased, the level of patient

satisfaction was higher (Milutinovic et al, 2012).In

relations to comparing gender with level of satisfaction with

nursing care, previous studies revealed that female patients

were more satisfied with the nursing care provided than male

patients (Alasad, J. A., & Ahmad, M. A. 2003). In regards to

level of education, previous studies showed patients with

higher level of education experienced less satisfaction with

nursing service (Alasad, J. A., & Ahmad, M. A. 2003). In

general, no association was found between marital status and

patient satisfaction with nursing care (Alasad, J. A., &

Ahmad, M. A. 2003). Similarly, past studies also revealed no

association between past healthcare experience and patient

satisfaction(Milutinovic et al, 2012). Interestingly, a

recent study found that patients who were hospitalized for a

longer period (more than 22 days) are more satisfied that

patients who had shorter stay in hospital(i.e., 10 days or

less) (Findik et al, 2010).

GENERAL IMPRESSION: your review of related literature is compose

of cluttered, not organized and unarranged studies.

HOW TO ARRANGE LITERATURE: Use the variables in your paradigm

- All research cited on the review of related literature should
be categorized according to the variables stated in your
paradigm and statement of the problem.
- Example:
Profile of the Patient
Age. under this category are related studies that state that
age can affect patients satisfaction like during Admission,
Medication, Grooming and Competence Attitudes.
Marital Status. Studies that declares there are difference in
patient satisfaction between married, single, window.
Sex. related studies that states which are easily satisfied
male or female patient, which are not easily satisfied?
Highest Educational Attainment. Related studies on the type
of satisfaction felt by patient if they’re grouped according
to their Educational Attainment.
Monthly Income. Related studies on the type of satisfaction
felt by patient if they’re grouped according to their Monthly
Income
Health Insurance. Related studies on the type of satisfaction
felt by patient if they’re grouped according to patient with
Philhealth, paying or indigents.
Room Accommodation. Related studies on the type of
satisfaction felt by patient admitted in the ward, pay ward
or indigent ward or private rooms.
Patients’ Level of Satisfaction
 Admission. Related studies on the satisfaction of patient
when group according to their profile (age, sex, status, ect…)
during admission
Medication. Related studies on the satisfaction of patient
when group according to their profile (age, sex, status, ect…)
during giving of medication.
Grooming and Competence. Related studies on the satisfaction
of patient when group according to their profile (age, sex,
status, ect…) in terms of their perception of the nurses
Grooming and Competence.
Attitudes. Related studies on the satisfaction of patient
when group according to their profile (age, sex, status, ect…)
in terms of their perception of the nurses attitude during
the conduct of care.
- You may also add other categories that you feel necessary in
making your survey questionnaire later on.
- All the categories above are based on your paradigm but can be
change if you decide to use the suggested paradigm with more
specific variables based on your conceptual framework
“Interaction Model of Client Health Behavior”. (please refer
to the succeeding page after your original paradigm)
- Please use references that are 10 years or less.

Conceptual and Theoretical Framework

The concepts where the study anchor is the Interaction

Model of Client Health Behavior[1]. The Interaction Model of

Client Health Behavior comprises of three major elements

which are: client singularity, client- professional

interaction and health outcome[1]. –who is the author of this

theory?

Client SINGULARITY is meant by the background variables

of different patients which consist of background variables

which comprise of demographic profile, social influence,

previous health care experience and environmental resources.

Age, gender and educational level are examples of demographic

characteristics. Marital status is an example of social

influence. Previous hospitalization experience and length of

hospitalization are examples of previous healthcare

experience. Health insurance is an example of environmental

resources. As proposed in Interaction Model of Client Health

Behavior, CLIENT-PROFESSIONAL INTERACTION has four domains

which will influence patients’ health outcomes. HEALTH

OUTCOME in this study is referring to ‘patients’ satisfaction

with care [1].

The first domain of CLIENT-PROFESSIONAL INTERACTION is

affective support which refers to attending the emotion needs

of the clients. The second domain is health information which

refers to the knowledge that assists patients to further

understand about their health conditions which will impact

their lifestyle and alternatives in managing their health

conditions[4]. The third domain is decision control which

refers to patient’s expectations of participating in

decision-making about their healthcare. The fourth domain is

professional-technical competencies which refer to the skills

that are used by nurses (i.e., checking on vital signs,

initiating an intravenous infusion) to meet patients’ health

needs[1].
 Hence, the conceptualization of patient satisfaction of

four domains of client professional interaction proposed by

Interaction Model of Client Health Behaviorwas used in this

study. The satisfaction of patients are affected by affective

support, health information, decisional control and

professional-technical competencies[1]. – This best describes

your study

By using this model, the findings of this study would be

able to highlight the specific domains of client-professional

interaction that need to be further developed and enhanced

among the nurses. This would also assist the hospitals in

further developing appropriate training for nurses.

- You have a very good conceptual framework, use it properly in

your study and don’t waste the concept.
[1]., [4]. – This is not how the FSUU format which is based on
APA in citing authors.
- Why not use all variables in Interaction Model of Client Health
Behavior in making your paradigm, I will be much more concept
based, increasing your topic’s chance to be approved by the
panel.

Independent Variable Dependent Variables

Profile of Patients’
 Age Patients’ Level of
 Sex Satisfaction
 Highest Educational
Attainment  Admission
 Marital Status  Medication
 Monthly Income  Grooming and
 Health Insurance Competence
 Room Accommodation  Attitudes
 Figure 1. Research Paradigm

- Are those factors identified really encompasses everything there

is to measure about patient satisfaction?
- Kindly check your variable specially on patient satisfaction I
don’t see in relationship and significance of the variables like
admission is a process and grooming/competence are nurses
personality. Why not focus on assessing the nurse instead of the
process in the hospital like admission and medication. (kindly
refer to the suggested paradigm and statement of the problem in
the succeeding page)

Statement of the Problem

The study intended to determine the Patients’ Level of

Satisfaction of Caraga Regional Hospital, particularly the

nursing department.

Specifically, it sought to answers to the following

problems:

1. What is the profile of Patients’ in terms of:

1.1 Age;

1.2 Sex;
 1.3 Marital Status;

1.4 Highest Educational Attainment;

1.5 Monthly Income;

1.6 Health Insurance;

1.7 Room Accommodation;

2. What is the patients’ level of satisfaction in terms of:

2.1 Admission;

2.2 Medication;

2.3 Grooming and Competence;

2.4 Attitudes;

3. Is there a significant difference in the patients’ level

of satisfaction whengrouped according their profile?

Hypothesis

At 0.05 level of significance, it is hypothesized that:

Ho. There is no significant difference in the patients’

level of satisfaction when grouped according their profile.

 - MY SUGGESTION ON YOUR PARADIGM AND STATEMENT OF THE PROBLEM
USING “INTERACTION MODEL OF CLIENT HEALTH BEHAVIOR”

SINGULARITY
 Demographic profile
o Age
o Sex
o Marital Status
 Social influence
o Marital Status
 Previous health care
experience
o Previous
hospitalization
experience Patients’ Level
o length of of Satisfaction Proposed
hospitalization (HEALTH OUTCOME) Intervention
 Environmental Based on the
resources  Timeliness Result of
o Health Insurance
o Room Accommodation  Communication Patients’
 Respect Satisfaction
 Grooming Survey
 Demeanor
HEALTHCARE QUALITY
(CLIENT-PROFESSIONAL  Competence
INTERACTION)  Attitude

 Affective support

 Health information
 Figure 1. Research Paradigm

-NEW SUGGESTED STATEMEN OF THE PROBLEM

Statement of the Problem

The study intended to determine the Patients’ Level of

Satisfaction of Caraga Regional Hospital, particularly the

nursing department.

Specifically, it sought to answers to the following

problems:

1. What is the client’s singularity in terms of:

1.1 Demographic profile

1.1.1 Age

1.1.2 Sex

1.1.3 Marital Status

1.2 Social influence

1.2.1 Marital Status

 1.3 Previous health care experience

1.3.1 Previous hospitalization experience

1.3.2 Length of hospitalization

1.4 Environmental resources

1.4.1 Health Insurance

1.4.2 Room Accommodation

2. What is the level of healthcare quality given to the

patients in terms of:

2.1. Affective support

2.2. Health information

2.3. Decision control

2.4. Technical competencies

3. What is the patients’ level of satisfaction in terms of

the nurses:

3.1. Timeliness

3.2. Communication

3.3. Respect

3.4. Grooming

3.5. Demeanor

3.6. Competence

3.7. Attitude

4. Is there a significant relationship on the variables

stated in problem number 1 and 3?

5. Is there a significant relationship on the variables

stated in problem number 2 and 3?

6. Is there a significant difference in the patients’ level

of satisfaction when grouped according to their

singularity?

- NEW SUGGESTED HYPOTHESIS

Hypothesis

At 0.05 level of significance, it is hypothesized

that:

Ho1. There is no significant relationship between the

patients’ singularity and level their satisfaction.

Ho2. There is no significant relationship between the

level of healthcare quality given to the patients’

and level their satisfaction.

Ho3. There is no significant difference in the patients’

level of satisfaction when grouped according to

their singularity.

Significance of the Study

The findings of this study would be of great contribution

in the field of Nursing Education and Research. The output of

this study would also be useful in enhancing the

implementation of the services of Caraga Regional Hospital

nurses. Specifically, this will bring benefits to the

following group of individuals:

Nurse. The study would help in enhancing the quality of

service and skill the nurses currently have. It would also be

able to pinpoint the strengths and weaknesses of the nurses

in the health care profession.

Supervising Nurse. The study would be able to inform the

supervisor about the strengths and weaknesses of their nurses

in order them to give advice and commendation. This would

also use as the spring board on their management decisions.

Hospital Administrators. The study would provide the

administrators a current picture of the nurses’ services and

skills enabling them to monitor the quality of health care

services.

Patients. The study will enable them to understand

better the role and duty of nurses being the health care

provider anda direct benefactor of health care services. This

study will make them aware of the crucial role of nurses.

- Please add Nursing service director, DOH, department in-charge

with all the surveys at Caraga Regional Hospital and Future
Researchers.
- This is enough but it would be much better if all benefits are
realistic so that you won’t have a hard time later formulating
your recommendation in Chapter 4.

Scope and Limitation of the Study

The study focused on the patients’ satisfaction of

Caraga Regional Hospital particularly in the nursing service

department. The indicators use in the survey is based in the

quality assurance policy of nursing service department

specifically the patient care. The participants were the

admitted patients of the hospital who will experienced

nursing services. This study will be conduct by the researcher

on June 2016 onwards.

- Please provide in your scope all limitations like;

a. Time frame in which you plan to conduct the study from
start to end.
b. Inclusion criteria of the type of respondents you plan to
include in the study.
c. Reason why you only would like to focus your study at
Caraga Regional Hospital.
d. Also your limitation on which area in the nursing service
or how many nursing department you plan to include or plan
to get your respondents.
e. Limitations also on focus in the nursing department only
excluding the other department in the hospital.

REMEMBER: Scope and limitation is very important to prevent the

members of the panel from introducing more strenuous coverage of
your study.

Definition of Terms

- Define all variables in your study including the most

necessary operationally.
- Example:
Age. This term refers to the patients’ age range as
the respondents of the study.
Communication. This term refers to the strategy used
by the nurses when conveying a message to the
respondents during delivery of health care.
- Please observe the manner of highlighting the term and
ending with a period before the actual operational
definition.
- Arrange all terms alphabetically.

Nursing- This term refer to a profession within the health

care sector focused on the care of individuals, families,

and communities so they may attain, maintain, or recover

optimal health and quality of life.

Patient - This term referto any recipient of health

care services. The patient is most often ill or injured and

in need of treatment by a physician, registered nurse, or

other health care provider.

Patient Care - This term refer toproviding care that is

respectful of and responsive to individual patient

preferences, needs, and values, and ensuring

that patient values guide all clinical decisions.

Health Care - This term refer to the maintenance and

improvement of physical and mental health, especially through

the provision of medical services.

Health Care Delivery System - This term refer to the

organization of people, institutions, and resources

that deliver health care services to meet the health needs of

target populations.

Nursing Service Department - This term referto the part of

the total health organization which aims at satisfying

the nursing needs of the patients/community.

Patients’ Satisfaction - This term referto a measure of the

extent to which a patient is content with the health care

which they received from their health care provider.

Admission- This term refer to

theformalacceptancebyahospitalorotherinpatienthealthcarefac

ilityofapatientwhoistobe
providedwithroom,board,andcontinuousnursingserviceinanareao

fthehospitalorfacilitywherepatients

generallyresideatleastovernight.

Medication - This term refer to course of action intended to

achieve a result in the care of persons with health problems.

A medical procedure with the intention of determining,

measuring or diagnosing a patient condition or parameter is

also called a medical test.

Grooming- This term refer tothe things that you do to make

yourappearancecleanand neat, for examplebrushingyourhair.

Competence - this term refer to Sufficiency of knowledge and

skills that enable someone to act in a wide variety of

situations. Because each level ofresponsibilityhas its

ownrequirements, competence can occur in anyperiodof

aperson'slife or at anystageof his or hercareer.

Attitudes - This term refer to a predisposition or a tendency

to respond positively or negatively towards a certain

idea,object,person, or situation.

Attitudeinfluencesanindividual'schoiceofaction,

andresponsesto challenges,incentives,

andrewards(togethercalledstimuli).
- This should be in the Bibliography, please use the APA
format and categorize your references according to books,
journals, magazines, electronic references.

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