Patient Satisfaction and Management

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diagnoses, pain is a common complaint among inpatients. In the U.S. alone, approximately 100 million patients experience chronic pain (Alaloul et al., 2015). Pain negatively affects numerous aspects of an individual's life, such as sleep, quality of life, and physical functioning. Pain is also associated with negative psychological outcomes like depression, extended hospitalization, and a huge economic burden. In the U.S., for instance, pain imposes an estimated cost of $635 billion on patients and the healthcare system as a whole (Alaloul et al., 2015). Ineffective management of pain can have a negative impact on patient satisfaction, underscoring the need for more effective interventions.

Effective pain management is particularly important in postpartum care, where the experience of pain is common (Eshkevari, Trout & Damore, 2013). However, the management of pain in postpartum care remains quite ineffective, with up to 20% of postpartum patients reporting dissatisfaction with pain management (Niemi-Murola et al., 2007; Espenshade & Hreniuk, 2017). The dissatisfaction stems from, among other factors, poor midwifery care, little or individualized care, poor communication between providers and patients, and lack of involvement in decision making (Mohammed, 2016). For mothers, such experiences may lead to negative childbirth experiences. Accordingly, it is crucial for nurses in postpartum care to use more effective pain management interventions so as to increase maternal satisfaction with pain management.

Generally, structured nurse rounding is one of the ways through which patient satisfaction in nursing practice can be improved (Mitchell et al., 2014; Brosey & March, 2015; Alaloul et al., 2015). This intervention essentially involves monitoring the patient on a regular basis. For instance, the patient can be assessed every one hour during the day and every two hours during the night. The assessment focuses on a number of patient aspects such as pain, temperature, safety hazards, positioning, and need for toileting (Brosey & March, 2015). Patient satisfaction can also be increased by improving provider-patient communication (Singh et al., 2011; Tan et al., 2013; Alaloul et al., 2015). Can these techniques improve patient satisfaction in postpartum care? Based on this premise, the following PICOT question is formulated: In postpartum, women undergoing either vaginal or caesarean delivery (P), does hourly rounding and use of whiteboard (I), compared to no rounding and no use of whiteboard (C), increase patient satisfaction with pain management (O) in a 3-month trial period (T)? The following section provides a critique of five quantitative research articles relating to the PICOT question.

Critique

Brosey, L., & March, K. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159.

Research Purpose

The purpose of the study was to monitor the impact of structured hourly nurse rounding on patient falls, hospital acquired pressure ulcers (HAPU), and patient satisfaction. The nursing intervention was implemented at a 24-bed medical-surgical unit within a large community hospital.

Research Design

The study took the form of a descriptive study. The descriptive design is one of the major forms of quantitative research designs. Essentially, a descriptive study aims to describe the characteristics of a given phenomenon, meaning that the researcher does not formulate a hypothesis at the beginning of the study (Creswell, 2014). Also, a descriptive study usually does not involve randomization, blinding, or a control group. The chosen design ideally fits the nature of the study, which was aimed at examining the effectiveness of structured hourly nurse rounding on patient satisfaction. As such, the analysis of data focused on describing patient satisfaction, patient fall, and HAPU rates at the beginning and end of the study period. With respect to the time of data collection, the study was prospective in nature. A prospective study involves studying outcomes during the study period with the aim of establishing the impact of a given intervention (Maltby et al., 2015). In this case, satisfaction scores as well as fall and HAPU rates were measured before, during, and after the implementation of the nurse rounding intervention.

Though descriptive research provides information about the attributes of a given research phenomenon, it provides little or no knowledge about cause-and-effect relationships (Bryman, 2008). In this case, for instance, it may not be said with certainty that hourly nurse rounding actually increased patient satisfaction as patient satisfaction may be influenced by other factors within the care environment. Further, lack of randomization and a control group may present generalization difficulties.

Sampling

As mentioned earlier, the study was carried out in a 24-bed medical-surgical unit in a large hospital.

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In total, 582 eligible patients were discharged during the study period. However, only 81 patient surveys were returned. Given the nature of the study, the recruitment of the sample involved non-random techniques. In other words, outcomes were observed in all patients that got admitted to the unit during the study period. Lack of random sampling presents a threat to internal and external validity due to the possibility of researcher bias (Maltby et al., 2015). Furthermore, the final sample (n = 81) is fairly small in view of the larger population under investigation, making it not sufficiently representative of the population.

Measurement Methods

Data collection is one of the most important elements of the research process. Accordingly, data collection procedures must be undertaken with a great deal of caution. One of the ways of ensuring effective data collection is ensuring data collectors have extensive knowledge of what data they are supposed to collect and how to collect it (Maltby et al., 2015). In Brosey & March's (2015) study, the data collection process was preceded by a 20-minute education session aimed at familiarizing the unit's staff (the nurse manager, registered nurses, patient care assistants, and secretaries) with related evidence, the intervention, historical, performance indicators, and goals of the intervention. Training was crucial since the unit's staff would be the data collectors.

Effective data collection also entails choosing an appropriate data measurement tool. When it comes to data collection, a researcher may choose between a researcher-designed tool and standardized tool (Creswell, 2014). Compared to a researcher-designed tool, a standardized tool tends to be more effective as it has been scientifically tested for validity and reliability (Maltby et al., 2015). In this case, patient satisfaction was measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey is a nationally applicable tool for measuring patient satisfaction with healthcare, thereby an appropriate tool for the study. This enhances validity and reliability.

Descriptive and Inferential Statistics

The analysis of the data mainly involved descriptive statistics. This was primarily informed by the descriptive nature of the study. Descriptive statistics basically involves describing the attributes of data using techniques such as frequencies, tables, and graphs (Martin & Bridgmon, 2012). Being a descriptive study, inferential statistics were not employed. For instance, elements such as effect sizes and confidence intervals were not used. Also, as the study did not involve hypotheses, type I and type II errors are not relevant. Nonetheless, a Cox-Stuart trend analysis was performed on data collected 12 months before the implementation of the intervention. The analysis was conducted to determine the statistical significance of reduction in patient falls in the 12-month period preceding the intervention.

Data Management

Data management is an important aspect of the data analysis process (Broeck et al., 2005). It involves processes such as cleaning and coding data, checking for outliers and nature of data distribution, handling missing data, as well as inter-rater reliability. In Brosey & March's (2015) article, it has not been mentioned whether any procedures were undertaken to clean the collected data prior to analysis, to deal with incomplete responses in the HCAHPS questionnaires, or to determine the distribution of the data. Inter-rater judgment was also not done. The only aspect reported is attrition: out of the 582 eligible patients, only 81 returned their HCAHPS surveys. The absence of most data management aspects can be viewed as one of the major weaknesses of the data analysis process in this study.

Mitchell, M., Lavenberg, J., Trotta, R., & Umscheid, C. (2014). Hourly rounding to improve nursing responsiveness. A systematic review. The Journal of Nursing Administration, 44(9), 462-472.

Research Purpose

This is a systematic review aimed at synthesizing empirical evidence on the impact of hourly nurse rounding on patient satisfaction. As this was not a primary study, no hypothesis was formulated.

Research Design

A systematic review is a type of research method aimed at summarizing and critically analyzing the available evidence on a given research topic (Garg, Hackam & Tonelli, 2008). This way conclusions or inferences are drawn from numerous studies as opposed to a single study. For studies within the field of healthcare, systematic reviews are valuable as readers can readily establish the effectiveness of a given intervention. Indeed, systematic reviews are often described as the most robust form of medical evidence (Maltby et al., 2015). This is one of the major advantages of a systematic.....

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