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| Suzanne McNamee is a Clinical Nurse Specialist on the Cardiothoracic ward at St. Vincent's Hospital Sydney. |
A patient satisfaction survey was conducted on the Cardiothoracic surgical ward (CW 16) between June and October 1993. The survey was designed to assess the level of satisfaction patients had with their hospitalisation on CW 16 both preoperatively and postoperatively and also with their visit to the preadmission clinic (if applicable).
Questionnaires were used for data collection. These questionnaires were distributed to patients either the day before their anticipated discharge from CW 16 or the morning of the day of discharge. Patients were informed that their responses would remain anonymous.
The survey results proved most informative. Significantly, the responses to the preadmission clinic were overwhelmingly positive with many patients stating that attendance at the clinic dispelled their fears and worries. Two particular areas of nursing care were shown to need improvement. These were patient education on the topic of warfarin therapy and the promotion of patient/family attendance at the ward-based discharge education sessions. A frequent complaint from patients was the unacceptable level of noise on the ward.
Based on the results of the survey, efforts will be made to extend patient/family attendance at both the preadmission clinic and ward-based discharge education sessions, and to improve the education of patients on the ward with respect to the warfarin regimen. Interventions aimed at reducing the level of noise on CW 16, particularly at night and during the rest period from 1.00 - 3.00 pm, will also be instigated.
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CW 16 accommodates patients with high nursing dependency rates who are commonly transferred to the ward less than 24 hours post openheart surgery. The turnover of patients is high with total inpatient activity on the ward averaging approximately 35 to 40 patients on a weekday. The average inpatient hospital length-of-stay is now only seven to eight days. During this time, the nurse endeavours to meet the patient's physical, psychosocial and educational needs.
The potential exists for the nursing staff to 'streamline' or 'standardise' the nursing care they provide. The individual needs of patients may be inadequately identified and/or attended to. Furthermore, holistic nursing care may also be hindered if nursing interventions aimed at meeting a patient's physical needs are given priority over his/her psychosocial and educational needs. Sometimes the latter are only dealt with if time permits.
The perception of the nursing staff on CW 16 is that the time constraints are barriers to the provision of optimal nursing care. This patient satisfaction survey was undertaken to determine whether patients on CW 16 were satisfied with their hospital stay and in particular, the nursing care they received.
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One hundred questionnaires were distributed randomly to patients on the ward. The questionnaire consisted of a total of twenty-four questions with the majority being closed questions. To increase the reliability of the questionnaire, the sample group was restricted to Cardiothoracic surgical patients, excluding patients undergoing transplantation operation.
The questionnaires were distributed to patients by the nursing staff the day prior to their anticipated discharge or the day of discharge. Generally, at this time, pain, confusion, and nausea that the patient may have experienced earlier in the postoperative period, have resolved. Distribution of questionnaires at the time of discharge was thought to be more conducive to accurate responding than the early postoperative period.
The patients were informed that the responses would remain anonymous. No identifying features or personal details were obtained from the patients. Respondent age, sex, or length of hospital stay, for example, is not known. Anonymity was chosen in an effort to encourage the patients to respond accurately and honestly without fear of repercussions if their responses were not favourable. Also, the patients were instructed not to return their completed questionnaires until the actual time of their discharge, so that their responses would not be read prior to their discharge. A response rate of 65% was obtained.
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Significantly, 43 patients (66%) said they found the preadmission clinic helpful. Only two respondents said the clinic was not helpful. An example of a positive response was 'It (the preadmission clinic) dispelled some of the fear of the unknown'.
Some very encouraging results for the nursing staff were obtained from the survey. Seventy-five per cent of the patients said that they were 'very satisfied' with the nursing staff's attention to their pain relief and additionally 18% were 'satisfied'; a total positive response of 93%. Also, 93% of patients were 'satisfied' or 'very satisfied' with the nursing staff's attention to patient concerns and problems during their stay. Only one patient was dissatisfied with the information/education given by ward nursing staff about discharge medications, care at home following discharge, and followup appointments.
Not all responses, however, were positive. Sixteen per cent of patients said nursing staff did not discuss warfarin therapy with them and, even though 64% of families who attended the patient education session found it helpful, 23% of patients/families did not attend.
A 'yes' response was given by 29 of the 59 patients who answered the question 'Did noise affect your sleep at night?'. When asked 'What type of noise affected your sleep at night?', responses given included 'trolleys, high heels, staff talking, cleaners, general noises'. One patient even said that the rest period '...is noisy sometimes.'
Other responses that provided useful information include 'I thought the rest period from 1-3 pm was really needed' and 'Give patient and family updates on their condition/treatment some patients are reticent to ask.'
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Overall the results show that the nursing staff are providing patients with satisfactory explanations and education in most areas. There is, however, a need to ensure that every patient on warfarin therapy receives and comprehends the warfarin education, as this is overlooked at times. The warfarin tape/slide program should be routinely put on every Tuesday and Wednesday at 0930 hours, as indicated on the patient education timetable. Also, at the time of discharge the nurse discharging the patient must check to ensure that the patient's warfarin booklet is completed with the necessary details. The survey's results indicate the need to evaluate the effectiveness of the Warfarin Therapy Education session on a continuous basis.
The survey results also show that efforts must be made to increase patient/family attendance at the discharge education sessions. It must be determined why not all patients and their families are attending the education sessions. The method of information dissemination, the timing of the education sessions and the length of the sessions all need to be examined.
One of the most significant problems on the ward is the noise level. The large number of patient complaints obtained about the ward's noise level indicates the need for attention to this problem. The nursing staff need to make a concerted effort to reduce the noise level particularly at night and during the day time rest period. This must include a reduction in noise created by nursing staff; for example, by the wearing of rubber soled shoes and the lowering of voices. Also, nursing staff, as the coordinators of patient care, can restrict visitors during rest period, ask other health professionals to be quiet during this period, and ensure patient treatments such as ECG and physiotherapy are scheduled outside of the rest period. Other interventions aimed at noise level reduction include the fixing of noisy trolley wheels, informing the cleaners of the importance of adequate rest for patients, and the laying of carpet around the central, nurse's station.
Only one complaint was received about the nursing staff and this was in relation to poor communication between patient/family and staff and also between the nursing staff and the medical staff. To improve communication, a member of the nursing staff will endeavour to take part in every ward round and encourage patient involvement during the round. The medical staff will also be asked to inform the nursing staff when they are commencing a ward round.
Clearly, the preadmission clinic is considered beneficial by the patients; thus, the staff will endeavour to increase patient and family attendance. Improved communication between the hospital's booking clerk, the surgical team, and the nursing staff may facilitate increased utilisation of the clinic.
Few respondents answered the open-ended questions, such as 'Are there any comments you would like to make that may help us to improve the nursing care of patients on CW 16?'. Only 29% responded to this question. This was disappointing as it was hoped that these open-ended questions would prove a good means of data collection. It was thought that keeping the questionnaires both anonymous and short would prompt patients to answer these questions. To increase the return of questionnaires for followup surveys, it may be beneficial to remind patients to hand in their questionnaires when they are leaving the ward at the time of discharge. To encourage response to all questions, including unfavourable responses, the anonymity of the questionnaire will be reinforced.
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The results of the patient satisfaction survey highlighted the need to increase patient/family attendance at both the preadmission clinic and ward-based discharge education sessions and reduce the noise level on the ward both during the night and day. In addition, warfarin education needs to be more effective. Interventions to improve communication between all health care workers and the patients also require introduction. Consequently, changes outlined in the discussion relevant to these areas, have been or will be introduced.
A followup patient satisfaction survey will be conducted to ascertain whether the implemented changes have improved patient satisfaction with the nursing care received on CW 16. In addition to the Patient Satisfaction Survey, it may be beneficial to conduct a survey of nursing staff satisfaction to determine the nurses' level of job satisfaction. A comparison could then be made between the results of the two satisfaction surveys.
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