Basic research skills by lawjuris

TTLE: PATIENT'S EXPECTATION REGARDING NURSING CARE.

Problem statement: The study of patient's expectation regarding nursing care will be conducted at Comilla Medical College Hospital Comilla.

INTRODUCATION: This study acts as an important tool for providing direction to ensure that nursing provides a service to meet society’s expectations. Different nursing scholar's / expertise's view .nursing in various ways peplau (In Roberts, and Taylor, 1998, P7) states that "Nursing is a significant, Therapeutic, interpersonal process" and Henderson (1995) states that nursing is assisting-individual (sick or well) in the performance of those activities contributing to heath or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. Basic nursing care is concerned with helping a patient to .meet his/her basic human needs. These needs vary according to age. general health condition, culture and his/her physical and intellectual capacities or the particular pathologic state with which he\she is suffering the main goals of nursing care and helping the health seekers nurses must understand is individual clients conception of health and his\her health beliefs and practices .A nurse should be able to identify the factors influencing the clients behavior and impact of illness both the clients and his family .Successful nursing care depends on nurses awareness .The issue of patient's expectation about nursing care has been getting increased attention from policy makers .Administrators, physicians, nurses and evaluator of health care. Now a day’s health is considered as basic human rights. Peoples are less willing tolerates ill health and are insisting on radically improved health services. The public wants accountability for the quality of care they are receiving as society’s health needs and expectation rise, so does in cost of supplying health services.

In Bangladesh, health care is designed in four levels: •

Primary level

• Secondary level •

Tertiary level

•

Super specialized level

All health service institutions aim to maintain a high quality of services without evaluation they can not be sure that they are providing high quality services among the different measures available to evaluate services, consumers opinion is one of the most powerful indicators measuring the quality of services.

The average nurse-patients ratio in Bangladesh is 1:13 (in 3 shifts). International standard is 1:4 for general care and 1:1 for intensive care. How ever all blame for poor nursing care can not be attributed to the shortage of staff. It is fact the very often patients are not getting nursing care due to nurses disinterest, negative attitude and negligence of nurses. Public is gradually losing faith and trust in the nursing profession leading to a deterioration in the image of nursing, patient or client satisfaction is measured by every major health care organization that requires hospitals to routine measure and evaluate clients satisfaction with health care delivery. Despite of tremendous advanced information and technology in medical science and nursing science throughout the world the health status of the majority people in our country is very low. In the context of our country, patient's expectation is also very limited. Their demands are easy accessibility, affordability and availability of health services. They also expect human behavior and attitude of doctors, nurses and other health care providers. The purposes of all training research and education should be to ensure the best possible care is provided patient as member of society. Society is dynamic and changing continuously. These changes occur in the social, cultural, economical and religious, with such changes people’s needs and expectations also changes. Knowledge of patient's expectation with care is essential to the provision of high quality care to the patient.

This study examining patient's expectation with nursing care was designed to explore and describe the level of patient's satisfaction with the nursing care offered by a major hospital in Dhaka. This study provided information, which may used to improve nursing practice and thus increase, patient's satisfaction with the nursing care provided. LITERATURE REVIEW

This chapter includes of a review of the literature after the study of patient's expectation regarding nursing care in different setting in different countries. The purpose of reviewing this literature was to find out the context in which the studies were undertaken, the methods and tools used, the problem faced by previous researchers and how these were overcome. Measuring and improving the quality of medical care are important aspect of health program to make it effective. Patient's expectation is the principal factor for the measurement of quality care. The measurement of satisfaction is therefore important for quality assurance.

Assessment of patient's expectation is an indirect approach to measure the quality of care. Health care in addition to curative care should also involve prevention and promotion of peopleâ&#x20AC;&#x2122;s status of health as well as nurses has an important contribution to make in the promotion of health. The study is concerned with patient's expectation regarding nursing care in tertiary level. Review of available literature related to this subject matter was made to acquire knowledge to conduct this research. Relevant literature is mentioned in the following paragraph. The causes summarized as a failure to meet the expectations of the population, an ability of the health services to deliver a level of national coverage adequate to meet the stated demands and changing needs of different societies. In 1981, a study was conducted by Srilenwati et al to identify the quality of nursing service and behavior in giving care to the patient of nursing personnel in Ramati bodi Hospital.

Data was collected from 406 hospitalized patient's result shown that, most patient were ultimately satisfied with nurses technical skills, personnel manner and responsibility for routine care of the patient. Moderate satisfaction was shown in relation to activities reflected appropriately use of professional knowledge through personal judgment and skills in verbal communication. The nurse satisfied the patients moderately in critical aspects, except that of love and care for individual patient's problem which was positively low. The patient themselves satisfied mostly with the over all nursing care.

According to study done by Daisy, on "The nurse from the patient point of view" she expressed that patient's expect good care from nurses and at the same time, patient expressed that there are few nurses who have positive attitude and good knowledge towards patient care.

John E. Bair'd in his study expressed that hospital reputation for providing good patient care depends on a sufficient number of nurse patient ratio and good knowledge of nurses. If it is not maintained the situation clearly reflected in dissatisfaction of patient towards nursing care. A

study

was

conducted

cholleas

hospital

nursing

and

medicine

where he expressed that nurses are for giving nursing care to the patient. But the study gave a clear picture that nursing care needed by the patient does not depend on nurses only. It involved certain other factors, which are mainly hospital administration, management and other required resources. The review literature on the basis of the study stressed on the views of importance of patient's expectation of nursing care and its management. It helps to describe the extent of expectation and satisfaction to meet the basic health needs during hospitalization. It also helps to understand the standard of nursing care aimed by the patient in different countries. 1997 Lauri, Lepisto and Kappli (In Bean land, et a! 1999) conducted and exploratory study to observe whether there was any difference between the needs of hospitalized patient's as

perceived by the nurses compared with the patient's perception, the aim of the study was to provide data for future nursing interventions. The authors reported that in many areas, the nurseâ&#x20AC;&#x2122;s perception of patient's needs and patient's own perception differed. 1990 Begum H. conducted " A study on patient's expectation" of nursing care in the context of hospital management in Dhaka Medical College Hospital and Institute of postgraduate medicine and research (IPGMR).

The investigator interviewed 164 patients from 10 medical and surgical ward. Interviewing every alternate patients from each ward. The investigator conducted that according to the responses of literate patients, the nursing care was inadequate and according to the illiterate respondents nursing care was adequate.

The investigator recommended strengthening the supervision of service. Thus difference may have occurred because satisfaction is related to the expectations that the patients had of the care provided. The literate people may be more aware of their rights relating to hospital care than the illiterate. Therefore their expectations regarding care may be higher. Nursing service is the most important aspect of caring for the sick. Nursing meets the needs of each patient's individually by treating the patient as a whole person and not a presentation of the clinical sign and symptoms of a disease. The situation analysis is nursing services in Bangladesh, 1986. Conducted by the director is nursing services in Bangladesh. (DNS) with World Health Organization (WHO) technical and material assistance is a base line assessment on the strength and weakness of nursing service in Bangladesh. This study was carried out between August and November in a sample of 59 specialty, Medical College and district hospital and Upazila health complex through out the country. Administrators, matrons and doctors interviewed were asked to describe-nurses attitude towards patient's and their care of the 210 description given 35(17%) were positive. The most frequently given positive description of nurses attitudes towards patients are that nurses are sympathetic to patients. Description of Nurses negative attitudes towards patient and their care most frequently given are:

Nurses are unsympathetic to patients needs. Nurses do not care about patient Nurses lack of dedication to nursing Nurses lack a sense of responsibility for patient. Nurses are care less not interested. A self responding cross sectional study on 205 nurses of 4 specialized hospitals of Comilla city showed that "attitude" scored relatively lower marks than "practice" and that higher education improved the level of both altitude and practice towards bed side patient care. It was observed that 57.07% of the responding nurses. Showed positive attitude towards their patient, against 22.08% showing in different attitude and 16.59% showing a negative attitude, 79% of the respondents was observed to have practiced fully against 18.05% practicing fairly and 2.44% rarely. Attitude and practice on patient care were found to have significant association with each other. A study entitled on patients expectation of nursing care in aspect of hospital nursing care was conducted in COMCH. A sample of 164 respondents was interviewed of which 111 were males and 53 were females. The respondents were categories in 6 groups. Result shows that 58.5% of the total respondents were not satisfied as they expected and 38.41% respondents were satisfied as per level of education. The finding of the study reveals that expectation of hospitalized patient has direct relation ship with level of education. Summary: - This chapter included review of literatures on patientâ&#x20AC;&#x2122;s expectation regarding nursing care in different setting in Bangladesh and other countries, this review helped in development of the data collection tool, analysis of data and provided the basis for comparison of the result with their studies conducted previously in different hospital of Bangladesh. It helps to describe the extant of expectation and satisfaction to meet the basic health needs during hospitalization. It also helps to understand the standard of nursing care aimed by the patients in different countries. METHODOLOGY

Type of study: Descriptive study Study area: The study was conducted at (Comilla Medical College Hospital Comilla.

Study population: The respondents of the study were indoor patients of medical and surgical unit of Comilla Medical College Hospital Comilla. Study period: The duration of study extended from June to Nov. Sampling technique: Sampling technique was adopted on any patient who fulfill the selected criteria and agreed for an interview (Technique and application of the systemic sampling every alternate bed under-8.) Sample size: 52 admitted patients in medicine and surgery unit of Comilla Medical College Hospital Comilla. Male and female both sex. Data Collection instrument: A Close structured questionnaire was prepared for collecting date about nursing care providers and the patient expectation regarding the patient's management in hospital. Selection criteria: # only hospitalized patient were selected for the study, # Respondent age was more than 14 years. # Duration of patient's staying in hospital for at least 3-5 days were include male and female (Both sexes were included in the study). Data Collection: The patient's were informed about the purpose of study and then they were interviewed directly on the basis of interview schedule our questionnaire was used for each respondents. Data processing and analysis: Collected data were checked to exclude error if any Data were processed and tabulated manually. Tally Sheets were prepared 'against each variable for preparing of different table. Finding (Result With Tables) Table-01 Distribution of respondents by age

Number (N) -52 Age in Years 14-34 35-55 56-76 Total

No of Respondents 29 18 05 52

Percentage 55.77 34.62 9.62 100

Standard Deviation (SD) =+ 473 years. Table shows that out of 52 respondents 29 (55.77%) ware in the age group of 14 - 34 years, 18 (34.62%) ware in the age group of 35 - 55 years and 05 {,9.62%) were in the age group of 56 - 76 years. The mean age of the respondents was 35.30 years with the SD of_+ 4.73 years. Graph-01

160 140 120 100 80 60 40 20 0

Percentage No of Respondents

14-34

35-55

56-76

Total

Graph-1 Shows the age pattern of studied patient's. It was found that highest no of 29 patient's were in the age group 14-34 years followed by 18 in the age group 35 - 55 years and 05 in the age group of 56 - 76 years. Table No-02 Distribution of Respondents by sex Respondents Male Female Total

Frequency 24 28 52

Percentage 46.2% 53.8% 100%

Table shows that out of 52 respondents 46.2% were males and 53.8% were female

Graph-02

Female 54%

Male 46%

Male Female

Graph-2 shows that most of respondents were female 53.8% and male 46.2% Table No-3 Distribution of respondents by marital status N-52 Respondents Married Unmarried Total

Frequency 38 14 52

Percentage 73.1% 26.9% 100%

Unmarried 27%

Married 73%

Table No-04

Distribution of respondents by level of education N:-52 Level of Education Illiterate Primary Secondary Above Secondary Total

Frequency 6 13 25 8 52

Percentage 11.53% 25% 48.07% 15.38% 100%

Table-4 shows that out of 52 respondents 11.53% were illiterate, 25% were primary level, 48.07% were secondary level 15.38% were above secondary level. Graph-04

Above Secondary

Secondary

Primary

Illiterate

50.00% 40.00% 30.00% 20.00% 10.00% 0.00%

Graph-4 sows that most of the respondents were educational level up to SSC and lowest respondents were illiterate group. Table-05 Distribution of respondents by occupation N:-52 Occupation Service Business Farmer House Wife Day Labor Students Total

Frequency 18 05 03 16 03 07 52

Percentage 34.61 9.61 5.77 30.77 5.77 13.47 100%

Table-5 shows that out of 52 respondents 18 (34.61%) service, 05 (9.61%) Business, 03 (5.77%) Farmer, 16 (30.77%) House Wife, Day labor 03 (5.77%) and students. Graph-5

Students Day Labor 13% 6% House Wife 31%

Service Service 34% FarmerBusiness 10% 6%

Business Farmer House Wife Day Labor Students

Table No-06 Distribution of Respondents by Monthly Income N:- 52 Monthly Income <2000 2000-5000 >5000 Total

Frequency 9 28 15 52

Percentage 17.30% 53.85% 28.85% 100%

This table shows that out of 52 respondents income/ moth <2000/- 17.30% 2000-5000/53.85% and >5000/- 28.85% majority of respondents 28 (53.85%) were in the income group of Taka 2000-5000/- and lower 9 (17.30%) were in the income group of Taka. <2000/Graph-06

Income per Month

>5000 29%

<2000 17%

<2000 2000-5000

2000-5000 54%

>5000

Table No-7 Distribution of Respondents by residence N:-52 Residence Rural Urban Sub Rural Total

Frequency 29 16 07 52

Percentage 55.76% 30.76% 13.46% 100%

Table-7 shows that out of 52 respondents 29 (55.76%) were rural, 16 (30.76%) were urban and 07 (13.46%) were sub rural.

Graph-07

Residence Sub Rural 13% Rural 56%

Urban 31%

Graph-7 shows that out of the 52 respondents 55.76% rural 30.76% were urban and 13.46% respondents were sub Rural.

Table No-8 Distribution of Respondents by Duration in the Hospital Staying. NL-52 Duration <30 days <30 days Total

Frequency 50 02 52

Percentage 96.15% 3.85% 100%

Table-8 shows that out of 52 respondents 50 (96.15%) were <30 days in hospital and 02 (3.85%) were >30 days in hospital. Majority of respondents 50 (96.15%) stayed in the hospital <30 days and lower 2 (3.85%) stayed in the hospital >30 days. Mean +SD is not significant. Graph-8

Hospital Staying <30 days 4%

<30 days 96%

Table-9 (Q-1) Distribution of respondents by level of education Expectation about Nurses role in providing care in the hospital. Responses Level of No Education Illiterate Up

A of No

respondents 6 to 13

B No

C No

D No %

16.6

7 38.4

7 7.69

primary

Total %

66.67 100

0 53.84 100 7

level Up to S.S.C Above

25 8

14 3

56 37.5

11 05

44 62.5

S.S.C level Total

44.3

3.87

51.92

100 100

3 Note: A. To instruct the ward boy / Aya only to look after the articles? B. To assist the patient in treatment. C. Only to carry out the doctor's instruction, D. To look after the patient regarding their needs. The above Table shows that 04 (6G.G7%)respondents of illiterate group,. 07(53.84%) respondents up to primary level of education, 05(62.5%) respondents of above S.S.C level expect up to S.S C level respectively, expected "D'" (to look after this patient regarding their needs). While 14(56%) respondents of up to S.S.C level expected "B"(to assist the patient in treatment)

Table10 (Q-1) Distribution of respondents by monthly family income and Expectation about nurseâ&#x20AC;&#x2122;s role in providing care in the hospital. Responses Monthly

A Number of No

family

respondents

income <2000/-

2000-5000/>5000/Total

28 15 52

B No

C No

D No %

33.3

11.1

55.56 100

14 06 23

3 50 40 44.2

01 02

1 6.67 03.8

14 08 27

50 100 53.33 100 51.92

Total %

Note: A) To instruct the ward boy / on y to look after the articles. B) To assist the patient in treatment. C) Only to carryout the doctor's instruction. D) To look after the patient regarding their needs. Above table shows that 05 (55.56%) respondents of <2QOO/- earning group, 14(50%) respondents of 2000-5000/- earning group and 08(53,33%) respondents of >5000/earning group respectively expected "D" (to look after the patient regarding their needs).

While 03(33.33%) respondents of <2QOO/-, 14(50%) respondent of 2000-5000/- and 06(40%) respondent of >5000/- earning group respectively expected "B" [to assist the patient in treatment) Table-11 (Q.2) Distribution of respondents by the level of education and expectation regarding nurse patient relationship. Responses A Level of Number of -

B No

C No

D No %

education Illiterate

respondents No 6 -

Total %

37.33 100

to 13

15.3

66.6

7.7

53.8

100

Primary Up to 25

8 32

7 23.0

100

1.92

40.38

Secondary Above

S.S.C Level Total 52

37.5

1 28

32.6 9

Note : A. Friendly B. As a relative C. Familiar D. Courteous Above table shows those 07 (53.8%) respondents of up to primary level of education and 10 (40%) respondents of up to secondary level of education respectively expected ‘D’ (Courteous). Multiple response given by the respondents. While 04 (66.67%) resp0ondents of illiterate group and 03 (37.5%) respondents of above S.S.C level receptivity ‘B’ (as a relative). Table-12 (Q-2) Distribution of respondents by monthly family income and expectation about the relationship between the nurse and patients: Responses Monthly

A Number of -

family

respondents No

income <2000/-

2000-

B No

C No

D No %

Total %

11.11

33.3

55.5

100

% 28.57

3 39.2

5 28.5

100

7 53.3

100

1.92

3 40.3

5000/>5000/-

33.33

8 13.3

Total

26.92

3 30.7

3.57

Note: E. Friendly F. As a relative G. Familiar H. Courteous Above the table illustrates that 5 (55.55%) respondents of <2000/- earning group and 8 (53.33%) respondents of >5000/- earning group respectively expected ‘D’ (Courteously). Multiple responses given by the respondents. While only 11 (39.28%) respondents of 2000-5000/- earning group expected ‘B’ (as a relative) Table-13 (Q-3) Distribution of respondents by the level of education and expectation regarding kinds of service from nurses just after admission. Responses A Level of Number of education Illiterate

respondents No 6 03

B No

C No

D No %

Total %

33.3

16.6

100

to 13

38.46

3 30.7

7 30.7

100

Primary Up to 25

7 36

7 16

100

Secondary Above

37.5

12.5

100

42.30

36.5

19.2

1.92

S.S.C Level Total

3 Note: A. Necessary action to relive immediate problems

B. To extend all possible helps and assistance. C. To tell the scope and opportunities of hospital D. To manage special aya / Boy to help Above table shows that 03 (50%) respondents of illiterate group, 05 (38.46%) respondents of up to primary level and 11 (44%) respondents of up to secondary respectively expected ‘A’. On the other hand only 04 (50%) respondents of above S.S.C level expected ‘B’. Table-14 (Q-3) Distribution of respondents by monthly family income and expectation about the kind of service from the nurses just after admission. Responses Monthly

A Number of No

family

respondents

income <2000/-

B No

C No

66.66

D No %

Total %

22.2

100

25-

100 100

2000-

28.57

2 46.4

5000/>5000/-

3 26.6

25 13.3

Total

4423

7 36.5

3 19.2

Note: A. Necessary action to relieve immediate problems. B. To extend all possible helps and assistance. C. To tell the scope and opportunities of hospital D. To manage special Aya / Boy to help. Above table shows that 6(66.66%) respondents of <2QQO/- earning group. and 9 (60%) respondents of >5GOO/- earning group respectively expected "A". On the other hand, only 13 (46, 43%) respondents of 2000/--5000/-earning group expected "B".

Table-15 (Q-04) Distribution of respondents by level of education and expectation about kind of services from nurses during hospitalization. Responses A Level of Number of No education respondents Illiterate 6 04 Up to Primary level Up to Secondary level Above S.S.C Level Total

B No

C No

66.67

D No %

Total %

33.3 3 23.0 8

100

76.92

100

23.0 7

1.92

Note: A. According to patient's needs. B. According to nurses willingness C. Same service for ail Patient. D. According to patient's willingness. Above table shows 04 (6667%) respondents of illiterate , 10(76.92%) respondents of up to primary level 17(68%) respondents of up to secondary level and 08(100%) respondents of above S.S C level respectively expected "A" It is clear that majority of respondents expected â&#x20AC;&#x2DC;Aâ&#x20AC;&#x2122; Table-16 (Q-4) Distribution of respondents by monthly family income and expectation about the kind of service from Nurses during Hospitalization. Responses Monthly

A Number of No

B No

C No

D No %

Total %

family

respondents

income <2000

2000-

77.78 78.57

22.2

100

2 21.4

100

6.67

100

1.92

5000/>5000/-

3 33.3

Total

73.07

3 25

Note: A. According to patient’s Need. B. According to Nurses willingness C. Same service for all patients D. According to patient’s willingness Above table shows 07 (77.78) respondents of <2000/- earning group 22 (78.57) respondents of 2000-5000/- earning group and 09 (60%) respondents of >5000/- earning group respectively expected ‘A’ It is observed that majority of respondents expected ‘A’ Table-17 (Q-5) Distribution of respondents by level of education and expectation about the role of nurses while feeding in the hospital.

Responses Level of education

A Number of No

Illiterate

respondents 6 02

B No

C No

Total %

33.33

16.6

100

53.8

100

17 04

4 68 50

100 100

Up to primary level

7.69

7 38.4

Up to S.S.C level Above S.S.C level

25 8

02 01

8 12.50

06 03

7 24 37.5 0

Total

11.53

28.8

59.6 0

Note: A. Ask the patient to take diet. B. Help the patient to take diet. C. Observe the quality and quantity of diet served. Above table illustrated that 03 (50%) respondents of illiterate, 07 (53.84%) respondents of up to primary level, 17 (68%) respondent of up to secondary (S.S.C) and 04 (50%) respondents of above S.S.C respectively expected ‘C’. It is shown that majority of respondents from different education level expected ‘C’. Table-18 (Q-5) Distribution of respondents by monthly family income and expectation above the role of nurses while feeding in the hospital. Responses Monthly

A family Number of No

B No

C No

Total %

income <2000/-

respondents 09 02

22.22

11.1

66.6

100

2000-5000/-

10.71

1 35.7

7 53.5

100

>5000/-

13.33

1 26.6

8 60

100

7 28.8

57.6

Total

13.46

5 Note: A. Ask the patient to take diet B. Help the patient to take diet C. Observe the quality and quantity of diet served

Above table shows that 06 (66.67%) respondents of <2000/- earning group 15(53.58%) respondents of 2000-5000/- earning group and 09 (60%) respondents of >5000/- earning group respectively expected ‘C’ It is shown that majority of respondents from different earning group expected ‘C’.

Table-19 (Q-6) Distribution of respondents by level of education and expectation regarding information about the scope and opportunities of hospital from Nurse. Responses Level of education Illiterate Up to primary level up to S.S.C level Above S.S.C level Total

A No 06 13 25 7 51

Number of respondents 6 13 25 08 52

% 100 100 100 87.50 98.08

B No 01 01

% 1.92

Total % 100 100 100 100

Note: A. Yes B. No Above table illustrated that 06 (100%) respondents of illiterate, 13 (100%) respondents of up to primary level, 25 (100%) respondents of up to S.S.C level and 07 (87.50%) respondents of above S.S.C level respectively expected ‘A’ (yes) It is shown that majority respondents of different educational level expected ‘A’ Table-20 (Q-6) Distribution of respondents by monthly family income and expectation regarding information about the scope and opportunities of Hospital from Nurses. Responses Monthly family income

Number

A of No

B No

Total %

respondents 9 28 15 52

<2000/2000-5000/>5000 Total

09 27 15 51

100 96.42 100 98.08

01 01

1.92

10 100 100

Note: A. Yes B. No Above table shows that 09 (100%) respondents of <2000/- earning group %) respondents of 2000-5000/- earning group and 15 (100%) respondents of >5000/- earning group respectively expected ‘A’ (yes)

It is shown that most of the respondents from different earning group expected ‘A’. Table-21 (Q-7) Distribution of respondents by the level of education and expectation regarding care while they become very sick during Hospitalization. Responses A Level of Number of No education Illiterate Up

respondents 6 05

to 13

B No

83.33

53.85

C No

D No %

Total %

16.6

100

7 46.1

100

primary level up

5 to 25

S.S.C level Above 8 S.S.C level Total 52

100

62.50

12.5

100

0 1.92

26.7

71.15

Note: A. Nurse B. Doctor C. Ward boy D. Relatives Above table shows those 05 (83.33%) respondents of illiterate, 07 (53.85%) respondents of up to Primary, 20(80%) respondents of up to S.S.C level and 05 (62.50%) respondents of above S.S.C level respectively expected â&#x20AC;&#x2DC;Aâ&#x20AC;&#x2122; (Nurse) multiple responses given by different respondents. Table-22 (Q-7) Distribution of respondents by monthly family income and expectation regarding care while they become very sick during Hospitalization.

Responses Monthly

A Number of No

family

respondents

income <2000/-

B No

77.78

C No

D No %

Total %

22.2

100 100 100

2000-

2 25

5000/>5000/-

6.67

33.3

Total

71.15

1.92

3 26.9 2

Note: A. Nurses B. Doctors C. Ward Boy D. Relatives

Above table shows that 07(77.78%) respondents of <2000/- earning group, 21(75%) respondents of 2000-5000/- earning group and 09 (60%) respondents of >5000/- earning group respectively expected ‘A’ (Nurses). It is observed that majority respondents from different earning group expected ‘A’ (Nurse). Multiple responses given by the respondents. Table-23 (Q-8) Distribution of respondents by the level of education and expectation regarding administration of drugs by a nurse. Responses A Level of Number of No %

B No

C No

D No %

Total %

education Illiterate

16.6

100

7 46.1

7 -

100

respondents 6 01 to 13

16.67 7.69

Primary

46.1 5

level Up to S.S.C 25

100

Level Above

12.50

37.5

100

S.S.C Level Total

5.77

0 38.4

5.77

6 Note: A. Give drugs in patient’s hand B. Give drugs in the hand of patient’s attendance C. Administer drugs by the nurse him/ herself. D. Observe the patient whether the drugs taken/ not Above table shows that 06 (46.15%) respondents of up to primary level, 15 (60%) respondents of up to S.S.C level and 04 (50%) respondents of above S.S.C level respectively expected ‘B’

On the other hand 03 (50%) respondents of illiterate, 06 (46.15%) respondents of up to primary level, 08 (32%) respondents of up to S.S.C level and 03 (37.05%) respondents of above S.S.C level respectively expected ‘C’. Table-24 Distribution of respondents by monthly family income and expectation regarding administration of drugs by a nurse. Responses Monthly

A Number of No

family

respondents

income <2000/-

2000-5000/-

B No

C No

D No %

Total %

55.5

33.3

11.1

100

5 53.5

3 35.7

1 3.57

100

1 46.6

6.67

100

6 38.4

5.77

7.14

>5000/-

6.67

7 40

Total

5.77

6 Note: A. Give drugs patient’s hand B. Give drugs in the hand of patient’s attendance C. Administer drugs by the nurse him/ herself. D. Observe the patient whether the drugs taken/ not Above table shows that 05 (55.55%) respondents of <2000/- earning group. 15 (53.57%) respondents of 2000-5000/- earning group and 06 (40%) respondents >5000/- earning group respectively expected ‘B’. On the other hand 03 (33.33%) respondents of <2000/- earning group. 10 (35.71%) respondents of 2000-5000/- earning group and 07 (46.66%) respondents >5000/- earning group respectively expected ‘C’.

Table -25 (Q-9) Distribution of respondents by level of education and expectation regarding information about the disease treatment procedure from a Nurse. R responses Level of Education

illiterate Up to Primary level Up to S.S.C level Above S.S.C level Total

respondents 6 13 25 8 52

A of No 06 13 24 07 50

(%)

B No

(%)

(100%) (100%) (96%) (4%) (96.15%)

01 01 02

(4%) (12.50%) 3.85%)

Total % 100 100 100 100

Note: A) Yes B) No Above table illustrated that 06 (100%) respondents of illiterate 13(100%) respondents of up to primary level, 24 (96%) respondents of up to S. S. C level and 07 (87.50%) respondents respectively expected "A". Table-26 ( Q-9) Distribution of respondents by monthly family income and expectation

regarding

information about the diseased and treatment procedure from a nurse . R responses Monthly

family No

A of No

(%)

B No

Total (%)

income <2000/2000-5000/>5000/-

respondents 9 28 15

09 26 15

(100%) (92.86%) (100%)

02 -

(7.14%) -

Total

(96.15%)

(03.85%)

Note: A) Yes B) No

100 100 100

Above table shows that 09 (100%) respondents of <2000/- earning group . 26 (92.86 %) respondents of 2000-5000/- earning group and 15(100%) respondents of >5000/- earning group respectively expected "A".

Table-27(Q-10) Distribution of Respondents by level of education and expectation about nurses visit without their schedule duty . R responses Level of Education

Illiterate Up to Primary level Up to S.S.C level Above S.S.C level Total

respondents 6 13 25 8 52

A of No 06 13 24 07 50

(%)

B No

(%)

(100%) (84.62%) (96%) (100%) (94.23%)

02 01 03

(15.38%) (4%) 5.77%)

Total % 100 100 100 100

Note: A) Yes B) No Above table show that 06(100%) respondents of illiterate , 11 (84.62) respondents of up primary level, 24(96%) respondents of up to S.S.C. level and 8(100%) respondents of educational respondents respectively expected ‘A’. It is shown that majority respondents from different educational level expected ‘A’. Table-28 (Q-11) Distribution of respondents by monthly family income and expectation about nurses visit without their schedule duty . R responses Monthly income <2000/2000-5000/>5000/-

family No respondents 9 28 15

A of No 08 25 15

(%)

B No

Total (%)

(88.88%) (89.28%) (100%)

01 03 -

(11.72%) (10.72%) -

100 100 100

Total

(92.31%)

(7.69%)

Note: A) Yes B) No Above table shows that 08 (88.88) respondents of <2000/- earning group, 25 (89.28) respondents of 2000- 5000/- earning group and 15 (100%) respondents of <5000/earning group respectively expected ‘A’. It is shown that majority respondents from deferent earning group expected ‘A’.

Table-29 (Q-11) Distribution of respondents by level of education and expectation about giving of discharge certificate by a Nurse. Responses Level of education

A Number of No

B No

C No

Total %

Illiterate Up to primary level

respondents 6 13 01

7.69

06 12

100 92.3

100 100

up to S.S.C level Above S.S.C level Total

25 8 52

1.92

25 08 51

1 100 100 98.0

100 100

8 Note: A. To handover the discharge certificate to the patients B. To handover the discharge certificate to the relatives C. To explain the contents of the certificate

Above table shows that 06 (100%) respondents of illiterate, 12 (92.31%) respondents of up to primary level, 25 (100%) respondents of up to S.S.C level and 08 (100%) respondents above S.S.C level respectively expected ‘C’, Table-30 (Q-11) Distribution of respondents by monthly family income and expectation about giving of discharge certificate by a Nurse. Responses Monthly

A family Number of No

income <2000/2000/>5000/Total

respondents 9 28 15 52

B No

01 01

C No

Total %

6.67 7.92

09 28 14 51

100 100 100 93.3

100 100 100 100

3 Note: a. To handover the discharge certificate to the patients b.

To handover the discharge certificate to the relatives

c. To explain the contents of the certificate

Above table shows that 9 (100%) respondents of <2000/- earning group. 28 (100%) respondents of 2000-5000/- earning group and 14 (93.33%) respondents of <5000/- earning group respectively expected ‘C’. Table=31 (Q-12) Distribution of respondents by level of education and expectation regarding the causes of deterioration of nursing services in hospital. Responses level Education Illiterate

A of Number of No respondents 6 04

Up to primary 13

B No

C No

66.67 38.46

D No %

Total %

33.3

100

15.3

3 38.4

7.69

100

level Up to

S.S.C 25

Level Above

S.S.C 8

37.50

level Total

28.84

8 12

6 48

100

12.5

100

0 11.5

40.3

19.2

Note: a. Shortage of manpower b. Lack of necessary instruments c. Lack of willingness d. Incompetence

Above table shows those 05 (38.46%) respondents of up to primary level and 12 (48%) respondents of up to S.S.C level respectively expected â&#x20AC;&#x2DC;Câ&#x20AC;&#x2122; Table-32 (Q-12) Distribution of respondents by Monthly family income and expectation regarding the causes of deterioration of Nursing service in hospital. Responses A Monthly Family Number of No income <2000/2000-5000/>5000/Total

B No

respondents 9 03

33.33

15 52

07 05 15

33.33 28.84

C No

11.1

1 14.2

01 06

8 6.67 11.5 3

Note: a. Shortage of manpower b. Lack of necessary instruments

D No %

Total %

44.4

11.1

100

4 39.2

1 21.4

100

06 21

9 40 40.3

03 10

3 20 19.2

100

c. Lack of willingness d. Incompetence

Above table shows that 04 (44.44%) respondents of <2000/- earning group. 11 (39.29%) respondents of 2000-5000/- earning group and 06 (40%) respondents of >5000/- earning group respectively expected ‘C’ Multiple responses given by the different respondents. Table-33 (Q-13) Distribution of respondents by level of education and satisfaction according to level of expectation regarding Nursing care in hospital. Responses level of Education Illiterate Up to primary level Up to S.S.C Level Above S.S.C level Total

Number of respondents 6 13 25 8 52

A No 05 07 05 17

% 83.33 53.85 20 32.70

B No 01

% 16.6

Total % 100

7 46.1

100

20 08 35

5 80 100 67.3

100 100

0 Note: A. Yes B. No Above table shows that 06 (46.15%) respondents of up to primary level, 20 (80%) respondents of up to S.S.C level and 08 (100%) respondents above S.S.C level respectively expected ‘B’ On the other hand only 05 (83.33%) respondents of illiterate group expected ‘A’ Table-34 (Q-13) Distribution of respondents by monthly family income & satisfaction according to level of expectation regarding existing Nursing care in Hospital.

Responses Monthly

family Number of respondents

income <2000/2000-5000/>5000/Total

9 28 15 52

A No

B No

Total %

33.33

66.6

100

7 71.4

100

09 35

3 60 67.3

100 100

08 06 17

28.57 40 32.70

0 Note: A. yes B. No Above table shows that 06 (66.67%) respondents of <2000/- earning group 20 (71.43%) respondents of 2000-5000/- earning group and 09 (66%) respondents >5000/- earning group respectively expected â&#x20AC;&#x2DC;Bâ&#x20AC;&#x2122; Out of 52, 09 respondents were in low economic group (<2000/-) Discussion

Educational level and monthly income group is one of the hypothesis which is associated with the patient's expectation regarding nursing care. To investigate the hypothesis educational level monthly income of respondents were considered to find out the variation of patient's expectation which were dependent. According to this variable respondent were classified into four groups and income were categorized into three groups. Table no 4,6. Total study population is 52 in number of 14 years and above. The majority of them were in age group 14-34 years. Mean age was 35 30 years. With the SD of + 4.73 years table no-1. This age group is quite masseur in making constructive criticism. In accordance with economical status out of 52 respondents 28(53.84%) were in the income group of taka-20005000/-per month table no-6.

Table No-9+10

This study status that 04(66.67%) respondents from illiterate group 07(53.84%) respondents from up to primary level and 05(62.5%) respondents of above S.S C level expected to look after the patient regarding their needs. Out of 52 respondents 27 expected about the nurses role look after patient regarding their needs. While 23 expected to assist the patient in treatment and rest of 02 expected only to carry out the doctor's order. Table-11+12 This table shows that 10 (40%) respondents from S.S.C level 07(53.8%) from primary level expected courteous relationship between nurse and patient. While 04 (66.67%) respondents of illiterate group and 03(37.5%) respondents of above S.S.C level respectively expected as a relative relationship.

Relationship means understanding co-operation, communications and exchange of views and ideas between two persons. If relationship is good and desirable people can work much more despite of the work load. Specially courteous relation makes people psychologically related and socially acceptable. According to the total number of respondents 21 expected courteous relationship between nurse and patient 17 expected as a relative relationship and 13 expected as friendly.

Table-13+14 This table shows that 03(50%) respondents from illiterate group 05(38.46%) respondents of up to primary level and 11(44%) respondents up to secondary respectively expected about necessary action to relieve immediate problems from nurses just after admission. On the other hand only 04 (50%) respondents from above S.S.C level expected extending all possible helps and assistance from a nurse just after admission. From total number of respondents 22 expected about necessary action to relieve immediate problems from nurses. Then 19 expected extending all possible helps and assistance then 10 expected information about the scope and opportunities of the hospital from nurses.

Table-15+16 Respondents from illiterate to above S.S.C the maximum percentage expected nursing care according to individual needs of the patient's. Most of the respondents of 22 are from income group 2000 - 5000/- expected nursing care according to the patient needs. According to respondents from all income group 38 are expected nursing care according to individual needs of the patients. Then 13 are expected same services for all patients,

Table-17+18 This study shows about the patient's expectation of nursesâ&#x20AC;&#x2122; role in feeding. That the majority of respondents from ail categories of educational level and income group were expected that a nurse should observed the quality and quantity of diet served. It is important that proper nourishment is essential to maintain good health. All patientsâ&#x20AC;&#x2122; need food and fluid, according to their condition. Observation on appropriate amounts and quality of food is important for the maintenance of patient's good health.

Table-19+20 The maximum percentage of respondents from all categories of education level and income group expected that nurse should inform about the scope and opportunities of hospital Table-21+22 This study reveals that majority of respondents (37) from different categories of educational level and income group were expected "Nurse" regarding patients care while they become very sick during hospitalization. On the other hands minimum number of respondents (14) from different categories of education and income group were expected "relatives'' 1 regarding care, while they become very sick during hospitalization.

Table-23+24 Out of 52 majority of respondents (26) from different categories of educational level and income group expected that nurse should give drugs in the hand of patient's attendance.

On the other hand 20 number of respondents expected that nurse should give drugs by herself Rest of G respondents from different categories of educational level and income group

expected that nurse should give drugs in patient's hands and observe the patient's whether the drugs are taken or not respectively

Table-25+26 Out of 52, maximum number of respondents (50) from different categories of educational level and income group expected that nurses should inform about the disease and treatment procedures While vary negligible number of respondents (2) from different categorize of educations level and income group expected that nurses need not inform to the patient's about the disease and treatment procedures Table 27+28 Out of 52, most of the respondents from different categorize of educational level and income group expected that nurses should visit the patients in addition to their schedule duty While very minimum respondents of different categories of educations level and income group expected that nurses need not visit the patients despite of their schedule duty.

Table- 29+30 Among 52, very high number of respondents (51) from different categories of educational level and income groups expected that nurse should explain the contents of discharge certificate, before handing over it (DC) to patients. On the other hand very negligible, only one respondent of similar educational level and income group expected that nurse only should hand over the discharge certificate to the patients. Table-31+32 Among 52. majority of the respondents (21) from different categories of educations level and income group mention that lack of willingness is the main cause of deterioration of nursing services in the hospital where as 15 respondents from different categories of educational level and income group expressed that shortage of manpower causes deterioration of nursing service.

On the other hand in the same educational evel and income group, 11 respondents said about in competency of nurse and G respondents said about lack of necessary instruments regarding deterioration of nursing services.

Table-33+34 Out of 52. Maximum 35 respondents from different categories of educational level and income group expressed that existing nursing care is not up to the level of their expectation and 11 respondents of above educational level and income group expressed just opposite opinion (They are satisfied with the existing nursing care).

Special note for table no-33+34 In those tables it is found that, total number of respondents from illiterate group is G of 52 respondents Among G illiterate 5 respondents expressed that they are satisfied with existing nursing care. From the above study it is proved that existing nursing care activity performed by the nurse are not up to the level of patient's expectation. The nurses performance is very poor in every area of patient's care in the medical and surgical ward of the hospital selected for study. Based on the suggestion of respondents and investigator's own observation during the study, shortage of nursing persona, poor supervision and guidance and lack of equipment and supplies are the main causes of deterioration of nursing care. Administrative guideline needs to be developed to clarify professional roles and duties in different unit of the hospital. Inadequate number of nursing personal lead to poor performance in providing care Supervision and monitoring of nurses performance are inadequate. This shortage is often riot only a matter of staff nurse; it is also a matter of the in competence of health personnel. In other wards, there is shortage of skilled and qualified nursing personnel. These situations would improve considerably if the nurses have sufficient training and job satisfaction. Job satisfaction is an importance element for improving interest and accountability of nurse.

Finding and Analysis Study populations interviews were recorded on the cross sectional/observational/descriptive checklist. Problems, suggestions expressed by them were recorded on the close ended questionnaire. The result of the study were lustrated in' the form of tables with the help of frequency distribution and percentage. The findings are sample of admitted patients who involved in this study. The mean age of the sample was 35.30 year. The age of sample range from 14-34 out of 52, respondents 29 were belongs to age group between 14-34 years. 18 were between 35-55 years and 05 were the age group 56-76 years. Majority of respondents expressed that the existing nursing care provided by the nurse was not up to label of their expectation. The finding, revealed that all the nurses performed activities related to patients care was not up to the label of patient's expectations.

Conclusion A descriptive study on study on patient's expectation regarding nursing care was conducted at (COMCH) Comilla Medical College Hospital Comilla From April 2007 to July 2007 A total study population was 52 Number of admitted patients under medical & surgical wards for a minimum duration of 5 days prior to data collection. Majority were not satisfied according to their expectation because most of them expected information about disease and treatment procedure and scope and opportunities of hospital from a nurse. Most of them desired nurse for care while sick in hospital. Many of them expected that nurse-patient relationship could be courteous and care should be according to their need. Majority expressed that existing nursing care was not up to the level of their expectation. Recommendation:

The following recommendations are put forth for improving nursing care situation in Bangladesh

1. Skilled and qualified nursing personnel may be required. 2. Increase the number of nursing personnel in providing nursing care situation in hospital. 3. Provide necessary resources and supplied by increasing the national Health Budget for assurance of quality care in hospital. 4. Arrange continuing adequate in service education and training for nursing personnel to promote their knowledge and skills regarding different special areas of nursing care. 5. Encourage operational research and effective monitoring of nursing care as the basis to reduce stressful condition for the nursing in Bangladesh. 6. Patient's allocation system may be established. 7. Arrange orientation training program on current information and modem instruments and technology used in nursing and medical science. Above mentioned recommendation may be adopted in the local & national Policy for farther improvement of nursing care. BIBLIOGRAPHY 1. Khanam ST. (1998) " Research Methodology Basic Concepatients" 2 nd Edition. Publisher By Author, 17/a Nakhalpara, Tejgoan, Dhaka, Bangladesh. 2. Samaddar S.S. (2004) “Handout of Basic Research Skills”, Instructor, College of Nursing Mohakhaii, Dhaka. 3. Begum H.A. (1990) “A Study on Patient’s Expectation of Nursing

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the

Context of Hospital Management", NIPSOM, Mohakhaii, Dhaka. 4. Begum T. (2002) “Patient’s Satisfaction Regarding Nursing Services in a Tertiary Level Health Facility" NIPSOM, Mohakhaii, Dhaka. 5. Park K. (2003) “Park’s Textbook of Preventive and Social Medicine" 17 th edition, Banarshl das Bhanot, India.

6. Bell J. (1997) â&#x20AC;&#x153;Doing Your Research Project" /2nd Edition, Open University Press, Buckingham, Philadelphia. 7. "Manual on Research Methodology for Nurses" Nursing Research Cell Directorate of Nursing Services and World Health Organization, 2002. 8. "Trends and Issues Related to Nursing in Bangladesh" Organized By - Research Cell College of Nursing, Mohakhaii, Dhaka, Bangladesh. 9. "Compendium of Nursing Research and Practice Development" The University of Adelaide, Department of Clinical Nursing, South Australia.