Satisfaction with Nursing Care Quality of Post-operative Home-visiting Program at Palestinian Medical Relief Society


Master's Thesis, 2019

97 Pages, Grade: 81.2%


Excerpt

Table of Contents

Declaration

Abstract

Dedication

Acknowledgement

Table of Contents

List of Tables

List of Figures

List of Appendices

Chapter 1
Introduction
1.1 Introduction
1.2 Significance of the study
1.3 General objective
1.4 Specific objectives
1.5 Research questions
1.6 Study variables
1.7 Context of the study
1.7.1 Sociodemographic context
1.7.2 Economic context
1.7.3 Health care system
1.7.4 Palestinian Medical Relief Society
1.7.4.1 PMRS Main Programs
1.8 Definition of terms

Conceptual framework & literature review
2.1 Conceptual framework
2.2 Literature Review
2.2.1 Background
2.2.2 The concept of satisfaction with healthcare services
2.2.3 Factors affecting patients’ satisfaction
2.2.4 Importance of patients’ satisfaction
2.2.5 Perception of quality of nursing care
2.2.6 Previous studies
2.2.6.1 Palestinian studies
2.2.6.2 Regional studies
2.2.6.3 International studies
2.7 Summary

Chapter 3
Materials and Methods
3.1 Study design
3.2 Setting of the study
3.3 Period of the study
3.4 Population of the study
3.6 Inclusion criteria
3.7 Instrument of the study
3.8 Pilot study
3.8.1 Validity
3.8.1.1 Expertise validity
3.8.1.2 Internal consistency
3.8.2 Reliability
3.8.2.1 Cronbache alpha
3.8.2.2 Split half
3.9 Data collection
3.10 Data entry and analysis
3.11 Ethical and administrative considerations
3.12 Limitations of the study

Chapter 4
Results and Discussion
4.1 Descriptive results
4.1.1 Socio-demographic characteristics of the study participants
4.1.2 Level of satisfaction with nursing care
4.1.3 Perception about quality of nursing care
4.2 Inferential results
4.3 Summary

Chapter 5
Conclusion and Recommendations
5.1 Conclusion
5.3 Suggestions for further studies

The References List

Appendices

Abstract

Great March of Return is a new term in the Palestinian community, when huge numbers of Palestinian in Gaza Strip decided to go back for their original historical land. Aim of study: The aim of the study was to assess the level of satisfaction with nursing care provided through post-operative home-visits program launched by Palestinian Medical Relief Society during Great March of Return. Methods: The researcher used descriptive, analytical, cross-sectional design. The study sample was proportional stratified sample, consisted of294 participants from the five governorates of Gaza Strip, North of Gaza, Gaza city, the Middle area, Khanyounis and Rafah. The Patients’ Satisfaction with Nursing Care Quality Questionnaire-Arabic version (17-items) was used to collect data. A pilot study on 30 participants conducted to examine the validity and reliability of the questionnaire, and Cronbache alpha coefficient was 0.960. For data analysis, the researcher used SPSS program (version 25), and statistical analysis included frequencies, means, percentage, (t) test, and one-way ANOVA. Results: The mean age of study participants was 25.65 years, 97.3% were males, 40.5% were married, 46.3% had primary school education, 42.5 were unemployed, 32.3% received more than 30 home visits, and 75.9% sustained one injury. The study participants expressed high satisfaction with provided information (m= 4.28) with weighted percentage 85.6%, high satisfaction with provided care (m= 4.31) with weighted percentage 86.2%, and high overall satisfaction (m= 4.30) with weighted percentage 86%. The study participants showed high positive perception about the quality of care they received (m= 4.21) with weighted percentage 84.2%. In addition, the results showed that the study participants from Gaza city expressed significant higher overall satisfaction with nursing care (P= 0.000), and significant higher perception about quality of nursing care (P= 0.000). Participants who were single had significant higher satisfaction (P= 0.025) compared to married participants. Participants who have primary school education had significantly higher overall satisfaction (P= 0.000) and significant higher perception (P= 0.000) compared to those with higher level of education. Participants who received more than 30 home visits expressed significant higher satisfaction (P= 0.000) and significant higher perception (0.000) compared to those who received less frequent visits. The results indicated that the following factors did not have significant effect on patients’ satisfaction; age (P= 0.725), gender (P= 0.915), work (P= 0.452), and number of injuries (P= 0.905). Conclusion and recommendations: The study highlighted the valuable benefits of the home-based visits program launched by PMRS, and the need for expansion of this program to reach higher number of injured individuals.

Dedication

To my parents, lovely family and whom I love.

To the ambiguous sense in myself that lead me to discover the knowledge.

With Love and Respect

Acknowledgement

I would like thank Dr. Aed Yaghi for his great support to accomplish this study.

I am so proud to complete this study under the guidance and supervision of Prof. Dr. Yousef Aljeesh who gave me confidence for myself.

I would like thank Palestinian Medical Relief Society(PMRS) teams who also provided a great effort in facilitating accomplishing this study.

To my friends, and to all those who contributed to the completion of this study, especially Dr. Hassan Zainelldin and Mrs. Lorina Trazi and Mr. Azzam Alshawa, thank you very much.

Ahamd M. Alraee August 2019

List of Tables

Table (3.1): Distribution of population and sample subjects by province of residency

Table (3.2): Correlation between each item and the total score of its domain

Table (3.3): Correlation between each domain and the total score of the scale

Table (3.4): Correlation between each item and the total score of perception domain

Table (3.5): Reliability of questionnaire (Cronbache alpha coefficient)

Table (4.1): Distribution of study participants according to sociodemographic characteristics

Table (4.2): Distribution of the study participants according to number of visits and frequency of injuries

Table (4.3): Satisfaction of the study participants with nursing care

Table (4.4): Perception of the study participants about quality of nursing care

Table (4.5): Differences in satisfaction with nursing care and perception about quality of care related to place of residency

Table (4.6): Differences in satisfaction with nursing care and perception about quality of care related to age

Table (4.7): Differences in satisfaction with nursing care and perception about quality of care related to gender

Table (4.8): Differences in satisfaction with nursing care and perception about quality of care related to marital status

Table (4.9): Differences in satisfaction with nursing care and perception about quality of care related to level of education

Table (4.10): Differences in satisfaction with nursing care and perception about quality of care related to work

Table (4.11): Differences in satisfaction with nursing care and perception about quality of care related to number of home visits

Table (4.12): Differences in satisfaction with nursing care and perception about quality of care related to number of injuries

List of Figures

Figure (2.1): Diagram of conceptual framework (self-developed)

Figure (4.1): Distribution of study participants according to gender

List of Appendices

Appendix (1): Map of Palestine

Appendix (2): Map of Gaza Strip

Appendix (3): Patient Satisfaction with Nursing Care Quality Questionnaire (Arabic version)

Appendix (4): Patient Satisfaction with Nursing Care Quality Questionnaire (English version)

Appendix (5): Approval letter from PMRS

Appendix (6): Protocol of PMRS Nurses

List of Abbreviations

Abbildung in dieser Leseprobe nicht enthalten

Chapter 1

Introduction

1.1 Introduction

The Great March of Return (GMR) began on 30th of March 2018, organized as a series of demonstrations near the eastern borders of Gaza Strip (GS). These demonstrations are held in protest of the nearly 13 years of blockade imposed on the GS and in recognition of the Nakba, when many of Gaza’s current inhabitants were forcibly displaced from their homes. The Israeli military forces met the peaceful demonstrations with aggressive use of force, leaving hundreds of martyrs and tens of thousands injured, many of whom are facing permanent disabilities (Palestinian Medical Relief Society - PMRS, 2019).

According to Palestinian Ministry of Health (MOH), between the period 30.3.2018 to 31.12.2018, huge number of individuals sustained injuries at different parts of their bodies, with 239 martyrs, 25,702 injured, and 53.0% of injured persons attended the hospital, while 47.0% were treated at field medical points and primary health care centers. Moreover, 10,034 of injured persons admitted to MOH hospitals. There were three martyrs and 461 wounded among medical staff, who were injured by gunfire and tear gas inhalation, while 84 ambulances were partially damaged as the result of attacks (MOH, 2019).

The weakened health sector in GS is struggling to respond to this sudden, extreme and significant need for emergency medical services, having already been unable to operate at the capacity required before the GMR started, with shortage in electricity and a chronic shortage of essential medication and supplies. Due to mass overcrowding, individuals requiring follow-up medical care have been prematurely discharged from hospitals. The PMRS plays an active role in providing necessary health services (HS) through volunteers who offer lifesaving first aid assistance at the demonstrations scene, and through multidisciplinary health teams who reach the injured individuals at their homes. HCS at home include wound care (WC), physiotherapy (PT), assistive devices (ADs) and medications. PMRS established mobile health teams to provide home-based HCS to victims in any part of GS.

Since the beginning of the GMR, 1083 people received comprehensive rehabilitation services including WC, PT, occupational therapy, psychosocial services, medications, consultations by PMRS physicians, and ADs (PMRS, 2019).

Over the last twenty years, more focus has been directed towards improving the quality of care (QOC). Therefore, measuring quality of nursing care (QONC) became a priority for healthcare providers (HCPs) and policymakers. Moreover, nurses are the largest body in healthcare settings, and therefore, measuring QONC is vital in determining the success any healthcare systems. In addition, patient satisfaction (PS) is an important factor that plays a major role in the success of health care facility. Thus, measuring PS is an important step in the process of assessing the QOC of health care systems (Joshi et al., 2013).

Patient satisfaction with nursing care (PSNC) is an indicator of QOC; therefore, nurses’ contribution influences the level of PS with the overall healthcare services provided (Albashayreh et al., 2019).

Moreover, PSNC is usually associated with nursing care which revealed patients’ point of view about the care they received (Alsaqri, 2016).

It is obvious that HCS works towards improving the health status of people. HS vary from one region to another, and affected by general local health problems, needs, and availability of resources. In addition, HS should be comprehensive, and meet the needs of individuals and community. Moreover, the success of any HCS depends on availability, affordability, efficiency, and feasibility of its services, taking in consideration PS with HS is important indicator of QOC (Joshi et al., 2013).

1.2 Significance of the study

Since the start of GMR at end of March 2018, there is a continuous ongoing cumulative increase of injured individuals, many of them with temporary or permanent disability. The health sector was under severe pressure to treat many complicated injuries and by end of December 2018, more than ten thousands of casualties have been admitted to MOH hospitals in GS. Many of those casualties are in need for further health care and follow up after discharge from hospitals. To decrease the pressure from MOH hospitals, PMRS established home visits program to reach the casualties and provide the needed care at their homes. As part of its mission, PMRS emphasize QOC to all the beneficiaries. The QOC could be attained by outcomes and PSNC. Therefore, this study assessed the level of PS with post­operative home-visits program, and in the light of the obtained results, PMRS decision makers can gain insight about the QOC provided and plan modifications as needed to improve its HCS to higher levels.

1.3 General objective

To assess the level of satisfaction of injured individuals with nursing care of post­operative home-visits provided by Palestinian Medical Relief Society during Great March of Return in Gaza Strip.

1.4 Specific objectives

- To identify the level of satisfaction of injured individuals with the information provided by PMRS team during their home visits.
- To determine the level of satisfaction of injured individuals with the nursing care provided by PMRS team during their home visits.
- To assess the perception of injured individuals about the quality of nursing care provided by PMRS team during their home visits.
- To examine the association between socio-demographic characteristics of injured individuals and their level of satisfaction with the nursing care provided by PMRS team during their home visits.
- To provide recommendations to the stakeholders that could improve the quality of post-operative home-visits care.

1.5 Research questions

- What is the level of satisfaction of injured individuals with the information provided by PMRS team during their home visits?
- What is the level of satisfaction of injured individuals with the nursing care provided by PMRS team during their home visits?
- How the injured individuals perceive the quality of nursing care provided by PMRS team during their home visits?
- Is there an association between socio-demographic characteristics of injured individuals and their level of satisfaction with the nursing care provided by PMRS team during their home visits?
- What are the suggested recommendations to the stakeholders that could improve the quality of post-operative home-visits care?

1.6 Study variables

Dependent variables: level of satisfaction of injured individuals from the nursing care provided by PMRS.

Independent variables: Independent variables that affect level of satisfaction of injured individuals include: gender, age, marital status, level of education, work, place of residency, number of home visits, and number of injuries.

1.7 Context of the study

1.7.1 Sociodemographic context

Palestine lies in an area bordered by Lebanon, Jordan, Egypt, and the Mediterranean Sea with a total land of 27,000 square kilometers (Km2) (annex 1). The GS borders the Mediterranean Sea to the west, Egypt to the south, and Israeli occupation to the north and east (Annex 2). GS consists of five provinces: North of Gaza, Gaza, Mid­zone, Khanyounis, and Rafah (Palestinian Central Bureau of Statistics - PCBS, 2018).

Based on reports of the (PCBS) in July 2019, the estimated total Palestinian population is 13 million, of them about 5 million live in Palestine (about 2.99 million in WB and 1.99 million in GS). Data revealed that the population of Palestine is a young population as 38.0% of Palestinian people are from the age group 0-14 years (36% in WB and 42% in GS), while ages over 65 years constituted only 3.0% (PCBS, 2019).

1.7.2 Economic context

Gaza Strip suffers from long-term siege imposed by Israeli occupation, resulted in negative impact on the economic status in GS became very weak, resulted in elevation of inflation and poverty rates increased to about 53% (United Nations Office for the Coordination of Humanitarian Affairs - UNOCHA, 2018). In addition, unemployment rate in GS increased to 61.2% (PCBS, 2018).

These numbers reflect the deteriorating economic situation in GS caused by the Israeli siege against the strip, which created extra pressure on the healthcare system and the ability to offer health services to the people in GS.

1.7.3 Health care system

The MOH is the main healthcare provider. Other providers include Non­governmental Organizations, United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA), the military medical services, and the private sector. There are 13 governmental hospitals in GS with 1664 beds. There are 2529 physicians and 3580 nurses working in governmental sector in GS (MOH, 2018).

Due to presence of different health service providers, there are many challenges facing the health system in providing a coordinated health service all the time and during military escalations by Israeli forces (WHO, 2018).

1.7.4 Palestinian Medical Relief Society

Palestinian Medical Relief Society is a community-based health organization established in 1979 aiming to supplement the decayed health infrastructure caused by long years of Israeli military occupation. It is non-profit, voluntary, and one of the largest health NGOs in Palestine. PMRS national health programs focus on prevention, education, community participation, and the empowerment of people. PMRS works towards improving the overall physical, mental, and social well-being of the Palestinians, regardless of racial, political, social, economic status, religion or gender. The quality health services provided by PMRS focus on the needs of the most vulnerable members of Palestinian society: women, children, disabled and the poor in rural villages, refugee camps, and urban centers (PMRS, 2008).

1.7.4.1 PMRS Main Programs Mobile Clinic

The emergency response program was largely bom out of the need to take action to serve unarmed Palestinians who were victims of the violent actions by Israeli military forces, though community based training in first aid. This training program resulted in 180,000 citizens trained in first aid just four years later, in 2000. Another branch to response to the emergency during the GMR, the post-operative home visits program began to act with the huge number of casualties. Within the first year of the GMR, the PMRS program carried out 12,229 WC, 8,558 PT sessions, 3,306 rehabilitation sessions, 2,793 psychological session, and 820 injured individuals received free of charge medication and helping devices (PMRS, 2019).

1.8 Definition of terms

Injury

Injury is defined as damage to the body caused by external force due to accidents, falls, hits, and weapons (National Institute of Health, 2015).

Injured individuals

The researcher defines injured individuals operationally as any individual who sustained injury during GMR from gunfire or gas weapons, and that injury required surgical intervention in the hospital and follow up after discharge.

Post-operative home-visiting program

The researcher defines the post-operative home-visits program operationally as the emergency home-based health services established by PMRS, in response to the high numbers of injured individuals who participate in GMR protests, and need follow up after discharge from the hospital.

Patients’ satisfaction

Patients' satisfaction is the degree to which an individual regards health care as useful, effective, and beneficial (Ahmad et al., 2012).

The researcher defines patients ’ satisfaction operationally as the extent to which the injured individuals value the health services they received at home, and it is measured by the total scores obtained on the Patient Satisfaction with Nursing Care Quality Questionnaire.

Nurses

The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country (International Council of Nurses, 2019).

The researcher defines nurses operationally as: any male or female nurse who is licensed by MOH, and work full-time with the PMRS health team.

Chapter 2

Conceptual framework & literature review

2.1 Conceptual framework

Abbildung in dieser Leseprobe nicht enthalten

Figure (2.1): Diagram of conceptual framework (self-developed)

The diagram presented the main domain under study "PSNC". The researcher will assess the level of PSNC provided at home visits for the injured individuals. PSNC became an important indicator of QONC, and many health facilities include PS in evaluation of HS.

The diagram showed that there are two factors associated with satisfaction; components of satisfaction and sociodemographic factors.

Components of satisfaction; include three factors; Satisfaction with provided information: Providing accurate, easy to understand information to patients about their health conditions and future expectations will put the patient at ease, and enhance their cooperation and compliance with treatment plan.

[...]

Excerpt out of 97 pages

Details

Title
Satisfaction with Nursing Care Quality of Post-operative Home-visiting Program at Palestinian Medical Relief Society
College
Islamic University of Gaza
Grade
81.2%
Author
Year
2019
Pages
97
Catalog Number
V505658
ISBN (eBook)
9783346068354
ISBN (Book)
9783346068361
Language
English
Tags
satisfaction, relief, medical, palestinian, program, home-visiting, post-operative, quality, care, nursing, society
Quote paper
Ahmad Alraee (Author), 2019, Satisfaction with Nursing Care Quality of Post-operative Home-visiting Program at Palestinian Medical Relief Society, Munich, GRIN Verlag, https://www.grin.com/document/505658

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