Inpatient Satisfaction Of Informal Nursing Care In Public Tertiary Hospitals In China

Objectives Based on the inpatient survey results of the 2019 Third-party evaluation of the National Healthcare Improvement Initiative,to investigate the inpatient satisfaction and influencing factors of the informal nursing care in the public tertiary hospitals in China,and to provide evidence for optimizing the management of informal nursing care,and meeting the patients’needs.Methods Conducted inpatient satisfaction survey to informal nursing care in 144 public tertiary hospitals(93 local hospitals,44 National Health Commission affiliated and 7 Traditional Chinese Medicine Administration affiliated hospitals)across 31 provinces of China.The survey adopted the uniformed inpatient questionnaire,targeted the inpatients discharged on the day or to be discharged on the next day of the survey.A Likert 5-point scale was used to formulate the questionnaires.The study conducted descriptive analysis,defined the selection of "very satisfied" and "satisfied" as "satisfied"=1,and "Not satisfied and not dis-satisfied","dis-satisfied" and "very dis-satisfied" as "dis-satisfied"=0.The study measured the patient satisfaction as the proportion of the frequency of the selections of "very satisfied" and"satisfied".The study conducted univariate analysis to measure the differences of inpatient satisfaction to informal nursing care in hospitals among patients with different demographic and social characteristics,from different regions,different types and affiliations of hospitals,and received different types of informal nursing care.The study also performed multivariate analysis of the influence factors of inpatient satisfaction to informal nursing care in hospitals with binary Logistic regression model.The statistically significant level was set as P<0.05.Among the survey hospitals,we selected 2-3 hospitals from the eastern,western and the central regions of China with the stratified sampling method.We further selected about 50 inpatients who received the informal nursing care services among the responded inpatients in the selected hospitals with"snowball" sampling method,and conducted face-to-face in-depth interviews with a semi-structured interview outline,to learn the influence factors of the patient satisfaction to informal nursing care in hospital.The "grounded theory" analysis method was used to analyze the interview results.Results A total of 23,033 inpatients responded the inpatient survey.Among which,6.211(26.97%)received different types of informal nursing care in hospitals and responded the questions about informal nursing care in hospitals.The overall satisfaction to informal nursing care of the 6.211 inpatients was 96.09%.There was statistically significant differences(P<0.05)of the distributions of inpatient satisfactions among inpatients in different ages,education levels,occupations,annual family income,inpatient departments,surgical status,length of stay,type of admission and discharge of inpatients,hospitals from different regions,different types and affiliations,and different types of informal nursing care services.With controlling of other variables,the likelihood of inpatient satisfied to paid informal nursing care provided by either commercial companies or individual givers were much lower than free informal nursing care provided by hospitals(OR=0.19/0.57,P≤0.01).The likelihood of inpatient in central and western regions satisfied with informal nursing care were much lower than inpatients in eastern region(OR=0.70/0.32,P<0.05).The likelihood of inpatient with annual family income ranged between CNY 20 000-40 000 higher central and western regions satisfied with informal nursing care was much higher than those with less than CNY 20 000(OR=1.87,P=0.03).The likelihood of inpatient underwent surgery satisfied with informal nursing care was lower than the non-surgery inpatients(OR=0.59,P<0.01).And The likelihoody of inpatient hospitalized 6～10 days,11～15 days and 16-20 days was lower than those with 1～5 days of length of hospital stay(OR=0.50/0.55/0.62,P<0.05).Important factors that influenced the inpatient satisfaction to informal nursing care in hospital include the quality,attitude and value of individual caregivers.It was also associated with the management model of caregivers and the market environment as well as the social recognition.Conclusion The informal nursing care in Chinese hospitals experienced full-care in the past,evolved to individual informal nursing care givers and givers managed by commercial companies,and experiencing a stage of caregivers managed by commercial company and supervised by hospitals,towards a future development direction of full-care model.To increase the inpatient satisfaction to informal nursing care in hospitals,meeting the special needs of the senior inpatients and relieving the financial burden of individuals were the key strategies.The individual characteristics of informal nursing caregiver,hospital and the commercial company,as well as the society environment,all have a great impact on patient satisfaction,which are complementary and associated with each other.China should take a reference of the developed countries,defining the role and function of informal nursing care in hospitals,improving the education and training system,as well as the hospital nursing care system.These are the critical factors to secure the professional quality and the overall quality of nursing care.