Mothers' Satisfaction Rate from Hospital Cares in Hematology- Oncology Ward.

BACKGROUND: Satisfaction evaluation is a good way to assess hospital conditions. In Health Care System, parentscan be also as children's main supporters, thus they may act as patient's viewpoints' representatives.This study aimed to evaluate mother's satisfaction of hospital care in hematology - oncology ward in Dr Sheikh hospital.
MATERIALS AND METHODS: A Cross-sectional descriptive analytic study was conducted using Pediatric Family Satisfaction (PFS) questionnaire and interviewing with 164 mothers duringMarchto February2013. The obtained data were analyzed using SPSS -16 software and descriptive statistics.
RESULTS: The mean age of mothers and children was31.2±5.8, and 7.95 4/66 years.The children were 64 % male and 36 % femael. A large number of mothers (%56 (describedtheir satisfaction about medical care as moderate,(%70.7) reported their satisfaction about nursing care at very high level and(36.5 %) reported satisfaction about welfare services at high level(59%)and describe overall satisfaction at very high level . The totals mean of mothers' satisfaction ratewas 121.8 ± 10.8. The mean of medical care, nursing care, welfare services was 2.9±34.1,4.6±50 and4.8± 32.9 respectively.
CONCLUSION: Overall satisfaction with medical, nursing and welfare staff was acceptable. For more satisfaction, it is widely recommended to improve veinipuncture by nurses, Physicians should inform parents about the tests results, and finally disturbance in ward with noise should be controled.

Introduction

New movement in health industries have been initiated towards continuous quality improvement and this phenomenhas gained momentum since 1990 .According to Donabedian's declaration for incorporating patient perception into quality assessment, healthcare managers incorporate patient centered care as a major component in the healthcare mission(1). The healthcare managers who endeavor to achieve excellence take patient perception into account when designing the strategies forquality improvement of care. Recently, the healthcare regulators shifted towards a market -driven approach of turning patient satisfaction surveys into a quality improvement tool for overall organizational performance (2). In 1996, evaluation of patient satisfaction was mandatory for all French hospitals (3). Since 2005, measuring satisfaction has been considered as an obligatory element of quality management reports in Germany(4).Since 2002, the Department of Health (DOH) has launched a national survey program in which all NHS trusts in England have to seek patient satisfaction on an annual basis and report the obtained results to their regulators(5). Therefore, measurement of patient satisfaction is a legitimate indicator for improving the services and strategic goals for all healthcare organizations (6).The most important outcome of pediatric care is the improvement of the child’s health or reduction of symptoms. However, parents’ satisfaction is associated with such central outcomes, including adherence to the therapeutic regimen and understanding of medical information, parents’ satisfaction with care can be considered a good proxy variable for some important aspects of quality care (7). Unfortunately, until now, parental experience with pediatric inpatient care has not been carefully explored. (8).In general, satisfaction is consideredas as a key measure in care quality; however, different attitudes toward the prominence of various issues are not commonly included in the studies. (9).Satisfaction evaluation is a good way to assess hospital conditions. In Health Care System, parents considered as children's main supporters, thus they may act as the patient's viewpoints' representatives.Thisstudy aimed to evaluate mother’s satisfaction of hospital care in hematology – oncology ward in Dr Sheikh hospital.

Materials and Methods

A Cross-sectional descriptive analytic study was conducted using Pediatric Family Satisfaction (PFS) questionnaire and interviewing with 164 mothers during 2013. The interview was done after discharging from the hospital.

Questionnaire: The questions reflected 3 dimensions: medical care (9 items), nursing care (11 items), and welfare services (8 items). For each item, the parents were asked to assess what they found most important on a 5-point Likert scale, from excellent to not applicable. The questionnaire also included items on mother characteristics: age and education. The pilot studywasdone and had a pretest of questionnaire in 15 parents.For reliability we use internal consistency. The Cronbach α score for 3 dimensions was 0.9. The distribution ofthe responses were normal.

To describe Motherssatisfaction Rate from hospital cares, the mean score of each item was calculated using scores from 1 to 5 on the rating scale. Statistical analysis was carried out using SPSS 16 statistical software (SPSS Inc, Chicago, Ill). Statistical significance was set at P<.05.We also used Anova and t- test.

Results

The mean age of mothers and children were 31.2±5.8 and 7.95 4.66 years, respectively. The children were 64 % male and 36 % female. A large number of mothers(%56 (described their satisfaction as follow:about medical care as moderate,(%70.7) about nursing care at very high level, and(36.5 %) about welfare services at high level(59%)and very high level about all aspect. The total mean of Mothers’ Satisfaction Rate was 121.8 ± 10.8 .The mean of medical care, nursing care, and welfare services were2.9 ± 34.1 406±50and4.8± 2.9, respectively.Regarding medical care The main points, evaluated weakly, in order of importance included as follows: to inform parents about the tests results (29.9 %), regarding nursing care :doing veinipuncture (4.9%) and in regard to welfare services: disturbance in ward with noise(1.8%). There is a negative relationship between mother's education and mother's satisfaction (ANOVA, p=0.007).

Discussion

Hosseinian and et al in their research about Mothers satisfaction of hospital care in the pediatric ward of Kashan reported mothers were dissatisfied with doctors for not being available on time and their failure to notify the results of their chidern’stests. They were also dissatisfied with nurses for the lack of education about their chidern’streatment and also the lack of post-discharge care. The mothers were also dissatisfied with welfare services (e.g. providing an appropriate play room for children (71.4%) Average satisfaction scores for the medical, nursing,and welfare staff were 22.25±6.19, 29.05±6.88,:and 26.68±6.93,respectively. A significant relationship was observed between child's disease and mothers satisfaction (P<0.0001) (9).

Pourmovahed and etal in their research titled as Mothers satisfaction Rate of Hospital Cares in the Pediatric Ward at Sadoqi Hospital of Yazd reported the main points, regarding medical care, evaluated weakly, in order of importance included as follows: to inform parents about the tests results and the medical managements (9%), regarding nursing care: to aware parents about medical care and post-charge care (10.5%) and then in regard to welfare services: availability of playing conditions for children in the ward (56.5%). Overall mean score for welfare, nursing,and medical care were 32.01±4.58, 47.32±7.43and 38.36±6.13respectively (10).

Failure to notify the results of their chidern’stests by doctors was one of the finding reported in this study which is in line with other studies such as Hosseinian and Pourmovahed.

The results of tests are very vital in oncology ward and doctors should report the results of tests to parents.

The main points, regarding nursing care and welfare services were doing veinipuncture (4.9%) and disturbance in ward with noise(1.8%). veinipuncturein oncology ward is a important role of nurses and it should be done by expert nurses because most of the children havedamaged vein caused by chemotherapy.

Noise disrupts the peace of mothers and their children and since psychological state of them is not stable, the noise can make bad Situation for them. ; therefore, noise control is essential in the ward. In this study, overall satisfaction in children with mother's education with bachelor's degree was lower (ANOVA, p=0.002).The obtained findings revealed that

There is a negative relationship between mother's education and mother's satisfaction.Pourmovahed and etal in their researchshowed the same) (10).

Conclusion

Overall satisfaction reported excellent in oncologic ward of this hospital.To satisfy mothers and improve their satisfactionit is necessaryto inform parents about the tests results, veinipuncture should be done by expert nurses and thenoiseshould be control in ward. There is a growing interest in mother's satisfaction as an outcome of care and as an indicator of the quality of care. Interest in mother's satisfaction with pediatric care is not new, but research in this field is limited.

TableI

Frequency of number of children in family

number of children	%	number	%
one	31.1	51	31.1
two	43.3	71	43.3
tree or more	25.6	42	25.6
Total	100	164	100

TableII

Frequency of ratingbirth

Ratingof birth	number	%
one	77	47.0
two	65	39.6
tree or more	22	13.4
Total	164	100

TableIII

Frequency of Residence

Residence	number	%
city	109	66.5
Rural	55	33.5
Tatal	164	100

TableIV

Frequency type of malignancy

Type of malignancy	%	number	%
Leukemia	53	86	53
Lymphoma	15	25	15
Nephroblastoma	10	17	10
Neuroblastoma	8	13	8
Others	14	23	14
Total	100	164	100

Table V

Frequency of Mothers’ satisfaction in Relation to Medical Care

satisfaction Question	Excellent	Good	Fair	Poor		not applicable	Total
1- were caring and concerned	128(78 )	29( 17.7)	7( 4.3)		-	-	164(100 )
2- were familiar with the medical history	116(70.7)	38( 23.2 )	9(5.5)		1( 0.6 )	-	164(100 )
3-were available when needed or called	101(61.6)	53( 32.3)	7( 4.3)		3(1.8 )	-	164(100 )
4- responded promptly to changes in the patient's condition.	105( 64)	47(2807 )	10( 6.1)		2( 1.2)	-	164(100 )
5- had clear, honest communication with us	120( 73.1)	34( 20.7 )	9( 5.4 )		1( 0.6 )	-	164 (100)
6- gave us information about treatments and tests before they were done	75( 45.7)	35(21.3 )	11(6.7 )		18(11)	25(.15.2 )	164(100 )
7- kept us informed of test results an of changes In the patient's condition	49(29.9)	16(9.8 )	21(12.8 )		29(17.7 )	49(29.9 )	164(100 )
8- gave us complete explanations	103(62.8)	38(23.2)	20(12.2)		1(0.6 )	2(1.2)	164(100 )
9- answered our questions clearly	108(65.9 )	45(27.4)	9(5.5)		2(1.2)	-	164(100 )

Table VI

Frequency of Mothers’ satisfaction in Relation to Nursing Care

satisfaction Question	Excellent	Good	Fair	Poor	not applicable	Total
1- were caring and concerned	131( 79.9)	29(17.7 )	4(2.4 )	-	-	164(100 )
2- were gentle with the patient	129(78.7 )	29( 17.7)	5(3 )	1( 0.6)	-	164(100 )
3- Checked the patient's condition closely	113( 68.9)	46( 28)	3( 1.8)	2( 1.2)	-	164(100 )
4- notified the doctor when necessary	138(84.1 )	24(14.6 )	2( 1.2)	-	-	164(100 )
5- Gave treatment and medication on time	119(72.6 )	40( 24.4)	3( 1.8)	2( 1.2)	-	164(100 )
6- kept us informed	83( 50.6)	65( 39.6)	11( 6.7)	5(3 )	-	164(100 )
7- Answered our questions clearly	93(56.7 )	59( 36)	10( 6.1)	2(1.2 )	-	164(100 )
8- explained the patient's condition and care in terms we understood	80(48.8 )	55(33.5 )	22( 13.4)	7(4.3 )	-	164(100 )
9- themethod ofvenipuncture is suitable	66( 40.2)	71(43.3 )	19( 11.6)	8(4.9 )	-	164(100 )
10- reducepainwhen required	94(57.3 )	56(34.1 )	10(6.1 )	4(2.4 )	-	164(100 )
11- reducefeverwhen required	105(64 )	46(28 )	11(6.7 )	2(1.2 )	-	164(100 )

Table VII

Frequency of Mothers’ satisfaction in Relation to welfare services

satisfaction Question	Excellent	Good	Fair	Poor	not applicable	Total
1. The admission procedure went smoothly.	93(56.7 (	51)31.1 (	16)9.8 (	4(2.4 (	-	164(100 )
2- The unit and patient rooms were clean	98)59.8 (	40)24.4(	24)14.6 (	2)1.2 (	-	164(100 )
3- The decor and furnistiings were suitable.	79)48.2 (	46)28 (	27)16.5 (	11)6.7 (	1(0.6 )	164(100 )
4- The patient was not disturbed by noise.	51)31.1 (	51)31.1 (	39)23.8 (	20)12.2 (	3(1.8 )	164(100 )
5- provided age-appropriate toys, games, play- rooms, and activities	82)50 (	42)25.6 (	25[)15.2 (	13)7.9 (	2(1.2 )	164(100 )
6- The hospital staff worked together as a team.	100(61 (	45)27.4 (	17)10.4 (	2)1.2 (	-	164(100 )
7-Availabilityphonesneeded	50)30.5 (	59)36 (	30)18.3 (	24)14.6 (	1(0.6 )	164(100 )
8- The qualityof food	58)35.4 (	44(26.8 (	19)11.6 (	43)26.2 (	-	164(100 )

Table VIII

Frequency of Mothers’ satisfaction in Relation to mean of medical care,nursing care and welfare services

Satisfaction Type of care	Mean	SD	Min	Max
medical care	34.1	2.9	26	40
nursing care	50	4.6	35	55
welfare services	32.9	4.8	20	40
Total	121.8	10.8	95	140

Table IX

Frequency of Mothers’ satisfactionrate

Satisfaction Type of care	Excellent	Good	Fair	Poor	not applicable	Total
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
medical care	-	62(38)	92(56)	10( 6 )	-	164 ( 100)
nursing care	116(70.7)	37(22.5)	11(6.7)	-	-	164 ( 100)
welfare services	59 (36)	60(36.5)	25(15.3)	18(11)	2(1.2)	164 ( 100)
Total	97(59)	52(32)	15(9)	-	-	164 ( 100)