Abstract
Although prior research has suggested that satisfaction with nursing care is affected by multilevel factors (e.g., patient characteristics, episode-of-care, the institution providing care), these studies typically focused only on a single level of analysis. The present study examines three levels of influence simultaneously to assess the relative effect each has on satisfaction. Results suggest that satisfaction is determined primarily by the patient and the episode of care; organization-level factors explained almost no additional variance.
Previous research has found that patient satisfaction with nursing care in an inpatient setting is strongly associated with a patient's overall satisfaction with the hospital experience,1,2 suggesting its importance in quality improvement initiatives. However, published research on factors influencing patient satisfaction with nursing has typically failed to assess the extent to which individual (patient specific), patient-provider, and departmental (provider-specific) influences interrelate in affecting patient satisfaction.3 Individual influences shown to affect satisfaction include patient sociodemographic characteristics, patient expectations, and psychosocial factors.4-9 Departmental (care unit) influences (e.g., provider characteristics, structural characteristics, process characteristics) have also been shown to affect satisfaction, albeit in separate studies.4,9,10 In addition to these two levels of analysis, a third level-the specific hospital admission or "episode of care"-may also influence patient satisfaction in unique ways. In other words, the same patient may have somewhat different experiences each time he or she visits the hospital-for example, because of changes in staff or how busy the care unit may be.
Understanding the degree to which each of these influences affect patient satisfaction with nursing care should help hospitals ensure that service improvement initiatives are focused at the appropriate levels. For example, it may be that hospitals focus on process or structural improvements in an effort to improve patient satisfaction when satisfaction may be more directly influenced by patient/patient-provider interactions. In this situation it may be more cost-effective for the hospital to focus resources on improving patient-provider interactions (episodes of care) than on structural or process improvements.
The purpose of the present study is to examine the extent to which satisfaction with nursing care in a specific academic medical center is affected by influences at multiple levels. To accomplish this, patient surveys from this organization were analyzed to determine the extent to which the following three levels of analysis contribute to satisfaction scores: episode of care (level one), individual patient influences (level two), and care unit (departmental) influences (level three).