title: Nurses' Perspectives on Patient Satisfaction and Expectations: An International Cross-Sectional Multicenter Study With Implications for Evidence-Based Practice.
abstract: BACKGROUND
  Addressing patient expectations is necessary to achieve high satisfaction. However, few data are available on nurses' perceptions and performance with respect to patient expectations and satisfaction.
  
  
  OBJECTIVE
  This international multicenter study aimed to: (a) evaluate nurses' attitudes and performance with respect to patient satisfaction and expectations, and (b) identify predictors of nurses' inquiry of patients' satisfaction at the point of discharge.
  
  
  METHODS
  A questionnaire examining attitudes and performance toward patient satisfaction and expectations was developed and validated. Nurses at four academic hospitals in the United States, the United Kingdom, Israel, and Denmark were surveyed.
  
  
  RESULTS
  A total of 536 nurses participated in the study (response rate 85.3%). Nurses expressed positive attitudes toward activities related to patient satisfaction and expectations, endorsing the importance of talking with patients about their satisfaction status (91.6%) and their expectations (93.2%). More than half of the responders (51.8%) claimed to have responded to the status of patient satisfaction or dissatisfaction (Israel: 25%; United States: 54.9%; United Kingdom: 61.7%; Denmark: 69.9%; p < .001). However, only 12.1% stated that they routinely ask patients about their level of satisfaction, with nurses in the United States (18.3%) and Denmark (17.5%) more likely to ask compared to nurses in the United Kingdom (7.4%) and Israel (6.3%; p = .001). Adjusted logistic regression identified four significant predictors (p < .05) of nurses' inquiry about patients' satisfaction: "Responding to patient's satisfaction status" (OR: 3.1; 95% CI: 1.7-5.8); "Documenting patient's satisfaction status" (OR: 2.8; 95% CI: 1.6-5.1); "Asking routinely about expectations" (OR: 5.4; 95% CI: 3-9.7); and "Responded to expectations during the past month" (OR: 4.3; 95% CI: 1.9-9.4).
  
  
  CONCLUSIONS
  These findings warrant further investigation, potentially into the nurses' work environments or educational programs, to better understand why nurses' positive attitudes toward patient satisfaction and expectations do not result in actively asking patients about their satisfaction level and what should be done to improve nurses' performance. Healthcare organizations and policy makers should develop and support structured programs to address patient expectations and improve patient satisfaction during hospitalization.
authors: Postdoctoral Research Fellow, Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, and Postdoctoral Research Fellow, Harvard Medical School, Boston, MA.
authors: Maxim
authors: M
authors: Topaz
authors: Postdoctoral fellow, Faelles AKUT Afdeling & Center for Akutforskning, Aarhus University Hospital, Denmark.
authors: Marianne
authors: M
authors: Lisby
authors: Project Manager, Center for Patients and Families, Brigham and Women's Hospital, Boston, MA.
authors: Constance R C
authors: CR
authors: Morrison
authors: Director, Hadassah Medical Center, Jerusalem, Israel.
authors: Osnat
authors: O
authors: Levtzion-Korach
authors: Immunopharmacology Group, University Medicine and University Pathology, Southampton University, Southampton, UK.
authors: Peter M
authors: PM
authors: Hockey
authors: Research Fellow, Division General Internal Medicine, Johns Hopkins Bloomberg School of Medicine, Baltimore, MD.
authors: Claudia A
authors: CA
authors: Salzberg
authors: End of Life Care Coordinator, Unit of Palliative Care, Assaf Harofeh Medical Center, Zerifin, Israel.
authors: Nechama
authors: N
authors: Efrati
authors: Director, Biostatistical Services, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
authors: Stuart
authors: S
authors: Lipsitz
authors: Senior Vice President and Chief Innovation Officer, Brigham and Women's Hospital; Chief, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; and Professor of Medicine, Harvard Medical School, Boston, MA.
authors: David W
authors: DW
authors: Bates
authors: Director, Unit for Innovative Healthcare Practice & Technology, Division of General Internal Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, MA.
authors: Ronen
authors: R
authors: Rozenblum
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003718:Denmark; D055317:Evidence-Based Practice / Q000592:standards; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D017060:Patient Satisfaction; D010465:Perception; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014481:United States
keywords: care delivery system; communication; critical care; medical/surgical; nurse-patient relations; quality improvement/quality of care; quality of services; survey