Preventive Care in Nursing and Midwifery Journal
Volume 16, Issue 1 (1-2026)
Prev Care Nurs Midwifery J 2026, 16(1): 45-55 |
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Ethics code: NIPSOM/IRB/2023/06
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Akter S, Akhtar K, Faizha Shama F, Jahan S. Patient Satisfaction With Inpatient Nursing Care at a Secondary-Level Hospital in Bangladesh: A Cross-Sectional Study. Prev Care Nurs Midwifery J 2026; 16 (1) :45-55
URL: http://nmcjournal.zums.ac.ir/article-1-1007-en.html
URL: http://nmcjournal.zums.ac.ir/article-1-1007-en.html
National Institute of Preventive and Social Medicine, Mohakhali, Dhaka, Bangladesh , fahmidafaizha72@gmail.com
Keywords: Patient Satisfaction, Nursing Care, Patient- Centered Care, Healthcare Quality, Inpatient Experience, Bangladesh.
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Note. Mean scores range from 1 (high satisfaction) to 5 (high dissatisfaction).
As shown in Table 2, satisfaction varied across the three care quality domains. The interpersonal trusting domain showed the strongest satisfaction, with 96.1% of patients satisfied with discussing problems freely.
The technical professional domain also demonstrated favorable ratings, particularly for nurses' skills and advice.
In contrast, the interpersonal educational domain was the weakest.
More than half of the patients were dissatisfied with nurses failing to follow up on queries (62.5%), explain test results (50.9%), or provide excessive medical explanations (58.9%). Mean scores for each domain are reported in Table 2.
Table 2. Mean Satisfaction Scores for Quality of Nursing Care Domains (N = 387)
Note. Mean scores range from 1 (high satisfaction) to 5 (high dissatisfaction).
Table 3 presents the correlations between patient characteristics and satisfaction levels. Older age showed the strongest negative correlation with satisfaction (r = –0.277, p < 0.001), followed by longer hospital stay (r = –0.150, p = 0.002) and number of admissions (r = –0.099, p = 0.026).
Table 4 summarizes the relationships between various factors and patient satisfaction.
Table 3. Correlations Between Age, Duration of Hospital Stay, Number of Admissions and Level of Patient Satisfaction (N = 387)
Note. Higher satisfaction scores indicate greater dissatisfaction (range 48–240).
Satisfaction was significantly higher among literate patients (p = 0.002), those placed on beds versus the floor (p = 0.001), and those without comorbidities (p = 0.001). Regarding the hospital environment, adequate cleanliness, good food quality, and a reliable water supply were each significantly associated with higher satisfaction (all p-values < 0.001). Urban versus rural residence showed borderline significance (p = 0.059).
Table 4. Relationship between Different Variables and Level of Patient Satisfaction (N = 387)
Note. Higher mean scores indicate greater dissatisfaction (range 48–240).
Discussion
This study provides a comprehensive evaluation of patient satisfaction with inpatient nursing care at a secondary-level hospital in Bangladesh. The findings reveal a nuanced picture of satisfaction across multiple dimensions of nursing care, highlighting both strengths and areas for improvement. The study employed convenience sampling, which limits the representativeness of the sample and the generalizability of the findings to broader populations. Conducted in a single secondary care hospital, the results may not reflect patient satisfaction across other healthcare settings in Bangladesh. Self-reported measures of satisfaction may also be subject to recall bias. Low Cronbach's alpha in the technical-professional and technical-educational domains indicates weak internal consistency, which reduces confidence in the conclusions. The questionnaire needs refinement through item revision, removal, or revalidation to improve reliability.
The findings regarding patient satisfaction with basic nursing care [Table 1] reveal a generally positive outlook, particularly in areas such as communication, personal cleanliness, mobility support, assistance in managing body temperature, and respect for care decisions. However, there are notable areas requiring improvement, especially in respiratory care, with about one-third of patients pleased with breathing assistance and monitoring. Previous studies indicate that a significant majority of patients are satisfied with nursing care, with approval ratings often exceeding 2/3 across various dimensions, including communication and personal cleanliness [16, 17]. Despite high satisfaction, we highlighted respiratory care and the provision of treatment and medication information as areas needing enhancement. For instance, researchers noted dissatisfaction with breathing assistance and monitoring [16, 18]. These findings highlight both strengths in compassionate, hands-on care and responsiveness that warrant attention.
The study revealed that in the technical professional domain [Table 2], over two-thirds of patients expressed satisfaction with nurses' proficiency in assisting physicians, conveying accurate Information, and providing beneficial advice. However, patients expressed dissatisfaction with the clarity of medical instructions and the organization of work. Prior studies have shown that patients reported high satisfaction with nurses' technical skills in supporting doctors, indicating effective collaboration in care delivery [19, 20].
A significant majority appreciated the quality of communication between nurses and doctors, which correlated positively with overall patient satisfaction [20, 21]. Patients felt that nurses did not adequately explain medical instructions, leading to confusion and dissatisfaction [22].
The current study shows that in the interpersonal educational domain [Table 2], almost all patients were highly satisfied with nurses' speed in giving directions and simple language explanations and found them easy to understand. At the same time, more than half were dissatisfied with nurses asking questions but not acting, test results explanations, and excessive medical explanations. According to one established study, the vast majority of patients report satisfaction with nursing interactions, particularly with clear explanations of care and procedures [23]. Another study found that using simple language and active listening is crucial, as it enhances understanding and reduces anxiety, thereby improving treatment adherence [24]. On the other hand, a significant number of patients feel frustrated when nurses ask questions but do not act on the responses, indicating a gap in effective communication [22]. Patients often report confusion due to excessive medical terminology, which detracts from their understanding of their health condition [25].
Regarding interpersonal trust [Table 2], more than two-thirds of patients were satisfied discussing problems with nurses, felt free to ask questions, and were satisfied with nurses being pleasant. However, dissatisfaction was expressed with nurses spending time at their desks and talking down to patients. Past studies reveal that patients value a friendly approach, as evidenced by patients finding nurses attentive and not perceiving them as pleasant [26]. Patients express frustration when nurses are frequently absent from their bedsides, which impacts the quality of care and communication [27]. Negative interactions, such as talking down to patients, lead to feelings of disrespect and dissatisfaction, undermining trust [23].
In this study, older age, longer stays, and more admissions are all significantly linked to lower satisfaction—with age being the strongest factor [Table 3]. Age has the strongest negative correlation with satisfaction, while Karaca & Durna found younger patients (18–35) were more satisfied than older ones [12].
This aligns with the findings. Due to their greater expectations, complex medical needs, and frequent encounters with the healthcare system, older individuals may be less satisfied and more critical of the quality of the services they receive. Thus, age appears not only as a demographic factor but also as a marker of varying care needs, underscoring the importance of tailoring nursing care for older populations.
Education, cleanliness, food, water, and patient position all significantly impact satisfaction [Table 4]. In comparison, a study by Papastavrou et al. emphasized the role of organizational factors, such as care rationing and nurse workload, in shaping satisfaction [28]. At the same time, Karaca & Durna noted dissatisfaction with information delivery and emphasized the importance of communication and the environment [12]. These results strongly echo the current findings, especially regarding cleanliness and basic amenities, which are often overlooked but crucial; they also reinforce this trend and highlight occupational disparities in healthcare perception.
This study has several limitations. First, convenience sampling and the single‑hospital setting limit the generalizability of findings to other healthcare facilities in Bangladesh. Second, self‑reported satisfaction measures are subject to recall and social desirability biases. Third, two subscales showed very low internal consistency (technical‑professional: α = 0.231; interpersonal-educational: α = 0.231), which reduces confidence in conclusions drawn from those domains and indicates a need for questionnaire revision or revalidation. Despite these limitations, the overall scale demonstrated acceptable reliability (α = 0.715), and the normal distribution of satisfaction scores supported the use of parametric tests.
Conclusion
This study evaluated patient satisfaction with inpatient nursing care at a secondary-level hospital in Bangladesh, highlighting both strengths and opportunities for improvement. Patients reported significant satisfaction with fundamental nursing care, including hygiene, nutrition, mobilization, rest, and medication administration, as well as nurses' communication and interpersonal support. Nonetheless, dissatisfaction was observed with the dissemination of Information about treatment, test results, and hospital conditions. In light of these findings, hospital administrators ought to enforce regular and audited sanitation protocols for wards and restrooms to maintain consistent hygiene standards, develop systematic communication training programs to enhance nurses' ability to articulate tests and treatment plans, and initiate regular patient feedback sessions facilitated by nurse leaders to identify concerns and reinforce patient-centered care promptly. Future studies should encompass multi-center studies to enhance generalizability and qualitative investigations to examine the factors contributing to reduced satisfaction among elderly patients and those with prolonged hospital stays.
Ethical Considerations
This study is approved by the Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM) with IRB Memo No. "NIPSOM/IRB/2023/06". The Declaration of Helsinki was followed, and written permission was also obtained from the hospital authority of the 250-bed Bongomata Sheikh Fazilatunnesa Mujib General Hospital, Sirajgong. All participants provided written informed consent before participation.
Acknowledgements
We acknowledge all the participants included in the study.
Conflict of Interest
The authors declare no conflicts of interest.
Funding
This study was funded by the Bangladesh Medical Research Council (BMRC), which was received only by the Principal Investigator. This was a student grant (ref: BMRC/Revenu/Student Grant/2025/164(1-140) to conduct the research project. Otherwise, no author received any other type of funding regarding this research project. The funder had no role in the conceptualization, design, data collection, analysis, or preparation of the manuscript.
Authors' Contributions
Conceptualization: S. Akter, K. Akhtar
Methodology: S. Akter, K. Akhtar
Investigation: S. Akter
Formal Analysis: S. Akter, K. Akhtar
Validation: K. Akhtar
Visualization: S. Akter, K. Akhtar, F.F. Shama, S. Jahan
Writing – Original Draft: S. Akter, K. Akhtar, F.F. Shama
Writing – Review & Editing: S. Akter, K. Akhtar, F.F. Shama, S. Jahan
All authors read and approved the final manuscript.
Artificial Intelligence Utilization for Article Writing
The authors used Copilot and Quillbot during the preparation of this work to enhance the language and readability of the manuscript, as the authors are not native English speakers. After using the tool, the authors thoroughly reviewed and edited the content as necessary and assume full responsibility for the manuscript.
Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to participant privacy concerns and institutional restrictions. However, the data that support the findings are available from the corresponding author upon reasonable request.
Knowledge Translation Statement
Audience: Nursing managers and hospital administrators
Patients reported high satisfaction with basic nursing care yet significant dissatisfaction with informational aspects, as over 50% were dissatisfied with nurses failing to follow up on queries and explain test results. Older age, longer stays, and poor hospital hygiene, food, and water supply correlated with lower satisfaction. Nursing managers should implement structured communication training, regular environmental audits, and targeted elderly care interventions to bridge the information gap and improve patient experience.
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Introduction
Satisfaction refers to the extent to which an individual feels content after comparing actual performance or outcomes with prior expectations. The difference between perceived performance and expectations determines it. Improving patient satisfaction strengthens loyalty and encourages return visits, as service and satisfaction are closely linked [1]. Patient-centered care is a prerequisite of high-quality healthcare delivery [2].
According to the World Health Organization (WHO), hospitals are vital parts of the social and healthcare system, providing inpatient, outpatient, and emergency services. These services must meet five key quality dimensions: tangibility, reliability, responsiveness, assurance, and empathy. Hence, continuous evaluation of service quality is vital for preserving patient trust. Nursing care is a core element of hospital service quality and shapes the institution's image within the community [1]. As healthcare systems globally evolve, improving service quality has become a major concern for meeting rising patient expectations [3, 4]. Measuring patient satisfaction is an effective tool for assessing service performance and ensuring the fulfillment of patient needs [3].
Patient satisfaction is a multifaceted and complex concept [5]. Health authorities now believe that patients are the best judges of healthcare quality. Their feedback helps identify problems in the system and suggest ways to improve it [4]. Nursing care plays a central role in achieving high service quality, as enhancing nursing performance improves efficiency, reduces costs, and increases patient satisfaction [6]. As a major indicator of healthcare standards, patient satisfaction reflects both service quality and institutional performance [1]. High satisfaction is associated with improved treatment adherence, reduced readmission and mortality rates, and shorter hospital stays [7]. It requires effective and timely service delivery, cost control, and management strategies within health structures [8]. However, one study revealed that only 46.2% (95% CI: 41.2%–51.1%) of patients were satisfied with hospital services [4]. Patient-centered care is essential for achieving high-quality healthcare, whereas poor satisfaction can negatively affect outcomes [2]. Evidence has suggested that patients' psychological state can affect their healing process [9]. The quality of nursing care depends on nurses' skill, speed, and accuracy, which may vary by patient characteristics such as age, sex, and residence [6, 9].
Recently, many countries have emphasized patient satisfaction as a key measure of healthcare quality. The United Kingdom's NHS inquiry in 1983 encouraged the evaluation of services based on patient experience [8]. In the USA, hospitals are required to report satisfaction scores, while China has increasingly adopted patient-centered care models [7].
Measuring the quality and happiness of healthcare is a crucial component of effective resource management. It also enables a focus on users' preferences, allowing them to create a personalized health service that better meets their needs and expectations. Therefore, patient happiness and the caliber of medical care are essential components of health institutions' long-term viability [3]. Establishing solid institutions and bolstering the social state depend on providing suitable and high-quality healthcare [8]. In Saudi Arabia's healthcare system, 77.6% and 93% of patients reported that nurses and doctors, respectively, treated them with respect, listened attentively, and provided clear explanations. Additionally, 90.3% of patients expressed satisfaction with hospital sanitation, while 64.1% reported receiving written discharge instructions [2]. Studies in Iran have shown that the highest satisfaction levels were related to nurses' professional performance (mean = 3.98), while the lowest were associated with routine nursing tasks (mean = 2.69). 13.6%, 50.5%, and 35.9% of patients reported low, moderate, and high levels of satisfaction, respectively [5]. From two studies of Bangladesh, we can see that the mean score of patient satisfaction regarding nursing care was 2.74 (SD = 0.68) out of a maximum of 4 points, indicating a moderate level [10], and regarding attitude, 52.6% were satisfied, 33.4% were highly satisfied, and 14.0% were dissatisfied; regarding nurses' behavior, 53.8% were satisfied, 32.5% were highly satisfied, and 13.7% were dissatisfied; and regarding nurses' interpersonal relationships, 44.4% were highly satisfied, 40.4% were satisfied, and 15.2% were dissatisfied [11].
Objectives
The study aims to identify patient satisfaction with inpatient nursing services at a secondary care hospital in Bangladesh. Research in this area remains limited, particularly regarding how nurses' training, behavior, and attitudes align with patient expectations. The study also allows comparison with national satisfaction levels and addresses contextual challenges such as resource limitations, high patient loads, and a shortage of graduate nursing programs.
Methods
Study Design
This descriptive cross-sectional study was conducted to assess patients' satisfaction with inpatient nursing care at a secondary-level hospital. To achieve this objective, the study was carried out systematically.
Participants
The study was conducted at the 250-bed Bongumata Sheikh Fazilatunnessa Mujib General Hospital in Sirajganj from January 1st to December 31st, 2023. The study involved patients admitted to the Medical, Surgical, Orthopedic, and Gynecology & Obstetrics departments, including those aged 18 years or older, willing to participate in interviews, and those staying for less than 3 days. Patients with severe mental or psychological issues were excluded from the study.
Sampling Methods
Convenience sampling was used for data collection. A cross-sectional study design was employed. The minimum required sample size was calculated a priori using the single-population proportion formula: n = (Z² p q) / d², where Z = 1.96 (95% confidence level), p = 0.639 (estimated proportion of patient satisfaction based on prior literature) [12], q = 1-p, and d = 0.05 (desired margin of error). This yielded a minimum sample of 358. Accounting for an estimated 10% non-response rate, the final target sample size was set at 394 participants. However, within the defined data collection period, data could be collected from 387 respondents. Due to feasibility constraints inherent to the clinical setting, a non-probability convenience sampling technique was utilized to recruit participants from the medicine, surgery, orthopedic, and gynecology & obstetrics wards during the study period. All consecutive eligible patients who provided informed consent were enrolled until the target sample size was met.
Data Collection Procedures
A pretested, semi-structured questionnaire was used for data collection after obtaining IRB approval and permission from the hospital superintendent. The 87-item questionnaire included 10 socio-demographic questions and 23 questions on basic nursing care [13]. 25 questions on nursing care quality (Risser satisfaction scale) [14] and 29 questions on associated factors [15]. The complete questionnaire is presented in Appendix A. The questions used a 5-point Likert scale ranging from 1 (highly satisfied), 2 (satisfied), 3 (neutral), 4 (dissatisfied), and 5 (highly dissatisfied). To assess patients' satisfaction level, the total score is calculated by summing all 48 question scores, with a minimum score of 48 indicating high satisfaction and a maximum score of 240 indicating high dissatisfaction. Before data collection, pretesting was done among 20 patients. Pretesting was conducted with 20 patients at the 300 Bedded Hospital in Narayanganj and 20 patients at Manikgonj Sadar Hospital to assess the questionnaire's accuracy and reliability. The questionnaire was finalized after a necessary modification based on pretest findings. After obtaining informed consent, face-to-face interviews lasting 15–20 minutes were conducted to ensure privacy and confidentiality.
Variables
The main outcome variable of this study was patient satisfaction with inpatient nursing care. Satisfaction was measured through two dimensions: (i) Basic nursing care and (ii) Quality nursing care, which covered technical-professional behaviors, interpersonal-educational attitudes, and interpersonal-trusting relationships.
Measurement Tool
A five-point Likert scale was used to calculate patient satisfaction levels [Appendix A] for the complete instrument, where higher scores denoted greater discontent with the structured questionnaire. The aggregated score was used to divide satisfaction levels into five groups: highly satisfied, satisfied, neutral, dissatisfied, and highly dissatisfied. To ensure reliability and validity of the study results, we used several techniques: (i) conducted pretesting; (ii) collected the data by a trained data collector; (iii) checked the data and fixed errors by observing descriptive statistics; (iv) Test of the normality score of the scale shows an approximate normal distribution, with a mean of 106.91, a median of 107.00, a mode of 109, a standard deviation of 7.946, a skewness of 0.058, and a kurtosis of 0.503. The Kolmogorov-Smirnov and Shapiro-Wilk tests are used to assess normality. For both tests here, the p-values are > 0.05; (v) employed Cronbach's alpha, the reliability coefficient. Reliability statistics for Basic nursing care: Cronbach's Alpha = 0.569; total number of items = 23. Quality of nursing care (Technical-Professional): Cronbach's alpha 0.231, total number of 7 items; Technical-Educational Cronbach's alpha 0.231, total number of 7 items; Interpersonal-Trusting Cronbach's alpha 0.521, total number of 11 items. The overall scale has a Cronbach's alpha of 0.715, based on 48 items. Satisfaction scores ranged from 48 to 240.
Statistical Methods
The data were analyzed using SPSS (Statistical Package for the Social Sciences; version 26). Descriptive statistics, including frequency, mean, and standard deviation, were calculated. Descriptive data were analyzed by frequency, mean, standard deviation, and percentage. Normality testing showed normal data distribution, so t-tests were done to compare socio-demographic and associated factors with satisfaction levels. The ANOVA test was conducted on respondents' occupations to analyze their satisfaction scores. Pearson correlation assessed the association between different variables and satisfaction. Data were presented in tables, bar diagrams, and pie charts, and the analysis aimed to assess patient satisfaction with inpatient nursing care at the hospital.
Result
Patients reported high satisfaction with most domains of basic nursing care [Table 1]. Mean satisfaction scores were 1.94 (0.53) for pain and psychological support, 2.10 (0.39) for privacy and respect, 2.46 (0.64) for respiratory care, and 2.34 (0.84) for medication safety and Information.
Table 1. Mean Satisfaction Scores for Basic Nursing Care Domains (N = 387)
Satisfaction refers to the extent to which an individual feels content after comparing actual performance or outcomes with prior expectations. The difference between perceived performance and expectations determines it. Improving patient satisfaction strengthens loyalty and encourages return visits, as service and satisfaction are closely linked [1]. Patient-centered care is a prerequisite of high-quality healthcare delivery [2].
According to the World Health Organization (WHO), hospitals are vital parts of the social and healthcare system, providing inpatient, outpatient, and emergency services. These services must meet five key quality dimensions: tangibility, reliability, responsiveness, assurance, and empathy. Hence, continuous evaluation of service quality is vital for preserving patient trust. Nursing care is a core element of hospital service quality and shapes the institution's image within the community [1]. As healthcare systems globally evolve, improving service quality has become a major concern for meeting rising patient expectations [3, 4]. Measuring patient satisfaction is an effective tool for assessing service performance and ensuring the fulfillment of patient needs [3].
Patient satisfaction is a multifaceted and complex concept [5]. Health authorities now believe that patients are the best judges of healthcare quality. Their feedback helps identify problems in the system and suggest ways to improve it [4]. Nursing care plays a central role in achieving high service quality, as enhancing nursing performance improves efficiency, reduces costs, and increases patient satisfaction [6]. As a major indicator of healthcare standards, patient satisfaction reflects both service quality and institutional performance [1]. High satisfaction is associated with improved treatment adherence, reduced readmission and mortality rates, and shorter hospital stays [7]. It requires effective and timely service delivery, cost control, and management strategies within health structures [8]. However, one study revealed that only 46.2% (95% CI: 41.2%–51.1%) of patients were satisfied with hospital services [4]. Patient-centered care is essential for achieving high-quality healthcare, whereas poor satisfaction can negatively affect outcomes [2]. Evidence has suggested that patients' psychological state can affect their healing process [9]. The quality of nursing care depends on nurses' skill, speed, and accuracy, which may vary by patient characteristics such as age, sex, and residence [6, 9].
Recently, many countries have emphasized patient satisfaction as a key measure of healthcare quality. The United Kingdom's NHS inquiry in 1983 encouraged the evaluation of services based on patient experience [8]. In the USA, hospitals are required to report satisfaction scores, while China has increasingly adopted patient-centered care models [7].
Measuring the quality and happiness of healthcare is a crucial component of effective resource management. It also enables a focus on users' preferences, allowing them to create a personalized health service that better meets their needs and expectations. Therefore, patient happiness and the caliber of medical care are essential components of health institutions' long-term viability [3]. Establishing solid institutions and bolstering the social state depend on providing suitable and high-quality healthcare [8]. In Saudi Arabia's healthcare system, 77.6% and 93% of patients reported that nurses and doctors, respectively, treated them with respect, listened attentively, and provided clear explanations. Additionally, 90.3% of patients expressed satisfaction with hospital sanitation, while 64.1% reported receiving written discharge instructions [2]. Studies in Iran have shown that the highest satisfaction levels were related to nurses' professional performance (mean = 3.98), while the lowest were associated with routine nursing tasks (mean = 2.69). 13.6%, 50.5%, and 35.9% of patients reported low, moderate, and high levels of satisfaction, respectively [5]. From two studies of Bangladesh, we can see that the mean score of patient satisfaction regarding nursing care was 2.74 (SD = 0.68) out of a maximum of 4 points, indicating a moderate level [10], and regarding attitude, 52.6% were satisfied, 33.4% were highly satisfied, and 14.0% were dissatisfied; regarding nurses' behavior, 53.8% were satisfied, 32.5% were highly satisfied, and 13.7% were dissatisfied; and regarding nurses' interpersonal relationships, 44.4% were highly satisfied, 40.4% were satisfied, and 15.2% were dissatisfied [11].
Objectives
The study aims to identify patient satisfaction with inpatient nursing services at a secondary care hospital in Bangladesh. Research in this area remains limited, particularly regarding how nurses' training, behavior, and attitudes align with patient expectations. The study also allows comparison with national satisfaction levels and addresses contextual challenges such as resource limitations, high patient loads, and a shortage of graduate nursing programs.
Methods
Study Design
This descriptive cross-sectional study was conducted to assess patients' satisfaction with inpatient nursing care at a secondary-level hospital. To achieve this objective, the study was carried out systematically.
Participants
The study was conducted at the 250-bed Bongumata Sheikh Fazilatunnessa Mujib General Hospital in Sirajganj from January 1st to December 31st, 2023. The study involved patients admitted to the Medical, Surgical, Orthopedic, and Gynecology & Obstetrics departments, including those aged 18 years or older, willing to participate in interviews, and those staying for less than 3 days. Patients with severe mental or psychological issues were excluded from the study.
Sampling Methods
Convenience sampling was used for data collection. A cross-sectional study design was employed. The minimum required sample size was calculated a priori using the single-population proportion formula: n = (Z² p q) / d², where Z = 1.96 (95% confidence level), p = 0.639 (estimated proportion of patient satisfaction based on prior literature) [12], q = 1-p, and d = 0.05 (desired margin of error). This yielded a minimum sample of 358. Accounting for an estimated 10% non-response rate, the final target sample size was set at 394 participants. However, within the defined data collection period, data could be collected from 387 respondents. Due to feasibility constraints inherent to the clinical setting, a non-probability convenience sampling technique was utilized to recruit participants from the medicine, surgery, orthopedic, and gynecology & obstetrics wards during the study period. All consecutive eligible patients who provided informed consent were enrolled until the target sample size was met.
Data Collection Procedures
A pretested, semi-structured questionnaire was used for data collection after obtaining IRB approval and permission from the hospital superintendent. The 87-item questionnaire included 10 socio-demographic questions and 23 questions on basic nursing care [13]. 25 questions on nursing care quality (Risser satisfaction scale) [14] and 29 questions on associated factors [15]. The complete questionnaire is presented in Appendix A. The questions used a 5-point Likert scale ranging from 1 (highly satisfied), 2 (satisfied), 3 (neutral), 4 (dissatisfied), and 5 (highly dissatisfied). To assess patients' satisfaction level, the total score is calculated by summing all 48 question scores, with a minimum score of 48 indicating high satisfaction and a maximum score of 240 indicating high dissatisfaction. Before data collection, pretesting was done among 20 patients. Pretesting was conducted with 20 patients at the 300 Bedded Hospital in Narayanganj and 20 patients at Manikgonj Sadar Hospital to assess the questionnaire's accuracy and reliability. The questionnaire was finalized after a necessary modification based on pretest findings. After obtaining informed consent, face-to-face interviews lasting 15–20 minutes were conducted to ensure privacy and confidentiality.
Variables
The main outcome variable of this study was patient satisfaction with inpatient nursing care. Satisfaction was measured through two dimensions: (i) Basic nursing care and (ii) Quality nursing care, which covered technical-professional behaviors, interpersonal-educational attitudes, and interpersonal-trusting relationships.
Measurement Tool
A five-point Likert scale was used to calculate patient satisfaction levels [Appendix A] for the complete instrument, where higher scores denoted greater discontent with the structured questionnaire. The aggregated score was used to divide satisfaction levels into five groups: highly satisfied, satisfied, neutral, dissatisfied, and highly dissatisfied. To ensure reliability and validity of the study results, we used several techniques: (i) conducted pretesting; (ii) collected the data by a trained data collector; (iii) checked the data and fixed errors by observing descriptive statistics; (iv) Test of the normality score of the scale shows an approximate normal distribution, with a mean of 106.91, a median of 107.00, a mode of 109, a standard deviation of 7.946, a skewness of 0.058, and a kurtosis of 0.503. The Kolmogorov-Smirnov and Shapiro-Wilk tests are used to assess normality. For both tests here, the p-values are > 0.05; (v) employed Cronbach's alpha, the reliability coefficient. Reliability statistics for Basic nursing care: Cronbach's Alpha = 0.569; total number of items = 23. Quality of nursing care (Technical-Professional): Cronbach's alpha 0.231, total number of 7 items; Technical-Educational Cronbach's alpha 0.231, total number of 7 items; Interpersonal-Trusting Cronbach's alpha 0.521, total number of 11 items. The overall scale has a Cronbach's alpha of 0.715, based on 48 items. Satisfaction scores ranged from 48 to 240.
Statistical Methods
The data were analyzed using SPSS (Statistical Package for the Social Sciences; version 26). Descriptive statistics, including frequency, mean, and standard deviation, were calculated. Descriptive data were analyzed by frequency, mean, standard deviation, and percentage. Normality testing showed normal data distribution, so t-tests were done to compare socio-demographic and associated factors with satisfaction levels. The ANOVA test was conducted on respondents' occupations to analyze their satisfaction scores. Pearson correlation assessed the association between different variables and satisfaction. Data were presented in tables, bar diagrams, and pie charts, and the analysis aimed to assess patient satisfaction with inpatient nursing care at the hospital.
Result
Patients reported high satisfaction with most domains of basic nursing care [Table 1]. Mean satisfaction scores were 1.94 (0.53) for pain and psychological support, 2.10 (0.39) for privacy and respect, 2.46 (0.64) for respiratory care, and 2.34 (0.84) for medication safety and Information.
Table 1. Mean Satisfaction Scores for Basic Nursing Care Domains (N = 387)
| Domain | Items (n) | Mean (SD) |
| Communication & admission information | 4 | 2.13 (0.66) | |
| Personal hygiene & physical care | 6 | 2.25 (0.65) | |
| Respiratory care | 2 | 2.49 (4.55) | |
| Mobility, rest & comfort | 4 | 2.14 (0.46) | |
| Medication safety & Information | 3 | 2.34 (0.87) | |
| Privacy & respect | 2 | 2.10 (0.40) | |
| Pain & psychological support | 2 | 1.94 (0.54) | |
| Overall basic nursing care | 23 | 2.26 (0.74) |
As shown in Table 2, satisfaction varied across the three care quality domains. The interpersonal trusting domain showed the strongest satisfaction, with 96.1% of patients satisfied with discussing problems freely.
The technical professional domain also demonstrated favorable ratings, particularly for nurses' skills and advice.
In contrast, the interpersonal educational domain was the weakest.
More than half of the patients were dissatisfied with nurses failing to follow up on queries (62.5%), explain test results (50.9%), or provide excessive medical explanations (58.9%). Mean scores for each domain are reported in Table 2.
Table 2. Mean Satisfaction Scores for Quality of Nursing Care Domains (N = 387)
| Domain | Items (n) | Mean (SD) |
| Technical-Professional | 7 | 2.06 (0.57) |
| Interpersonal-Educational | 7 | 2.64 (0.69) |
| Interpersonal-Trusting | 11 | 2.15 (0.59) |
| Overall quality of nursing care | 25 | 2.24 (0.65) |
Table 3 presents the correlations between patient characteristics and satisfaction levels. Older age showed the strongest negative correlation with satisfaction (r = –0.277, p < 0.001), followed by longer hospital stay (r = –0.150, p = 0.002) and number of admissions (r = –0.099, p = 0.026).
Table 4 summarizes the relationships between various factors and patient satisfaction.
Table 3. Correlations Between Age, Duration of Hospital Stay, Number of Admissions and Level of Patient Satisfaction (N = 387)
| Attribute | Pearson's r | 95% Confidence Interval | p (1-tailed) |
| Respondent age | –0.277 | [0.182, 0.366] | < 0.001 |
| Duration of hospital stay (days) | –0.150 | [0.051, 0.246] | 0.002 |
| Number of admissions | –0.099 | [0.001, 0.197] | 0.026 |
Satisfaction was significantly higher among literate patients (p = 0.002), those placed on beds versus the floor (p = 0.001), and those without comorbidities (p = 0.001). Regarding the hospital environment, adequate cleanliness, good food quality, and a reliable water supply were each significantly associated with higher satisfaction (all p-values < 0.001). Urban versus rural residence showed borderline significance (p = 0.059).
Table 4. Relationship between Different Variables and Level of Patient Satisfaction (N = 387)
| Variable | Category | n | Mean (SD) | t | p |
| Type of residence | Rural | 321 | 106.56 (7.88) | 1.894 | 0.059 |
| Urban | 66 | 108.59 (8.13) | |||
| Education | Up to primary | 196 | 105.70 (8.14) | 3.056 | 0.002 |
| Above primary | 191 | 108.15 (7.57) | |||
| Position of patient | Bed | 359 | 106.45 (7.69) | 4.173 | 0.001 |
| Floor | 28 | 112.82 (8.87) | |||
| Comorbidities | Yes | 109 | 104.47 (8.27) | –3.852 | 0.001 |
| No | 278 | 107.07 (7.62) | |||
| Cleanliness of hospital ward | Yes (clean) | 172 | 105.30 (7.70) | –3.628 | < 0.001 |
| No (not clean) | 215 | 108.20 (7.92) | |||
| Quality of hospital food | Yes (good) | 219 | 104.64 (7.54) | –3.292 | 0.001 |
| No (poor) | 168 | 107.73 (7.56) | |||
| Adequate water supply in bathrooms | Yes | 168 | 105.36 (9.00) | –3.292 | 0.001 |
| No | 219 | 108.10 (6.81) |
This study provides a comprehensive evaluation of patient satisfaction with inpatient nursing care at a secondary-level hospital in Bangladesh. The findings reveal a nuanced picture of satisfaction across multiple dimensions of nursing care, highlighting both strengths and areas for improvement. The study employed convenience sampling, which limits the representativeness of the sample and the generalizability of the findings to broader populations. Conducted in a single secondary care hospital, the results may not reflect patient satisfaction across other healthcare settings in Bangladesh. Self-reported measures of satisfaction may also be subject to recall bias. Low Cronbach's alpha in the technical-professional and technical-educational domains indicates weak internal consistency, which reduces confidence in the conclusions. The questionnaire needs refinement through item revision, removal, or revalidation to improve reliability.
The findings regarding patient satisfaction with basic nursing care [Table 1] reveal a generally positive outlook, particularly in areas such as communication, personal cleanliness, mobility support, assistance in managing body temperature, and respect for care decisions. However, there are notable areas requiring improvement, especially in respiratory care, with about one-third of patients pleased with breathing assistance and monitoring. Previous studies indicate that a significant majority of patients are satisfied with nursing care, with approval ratings often exceeding 2/3 across various dimensions, including communication and personal cleanliness [16, 17]. Despite high satisfaction, we highlighted respiratory care and the provision of treatment and medication information as areas needing enhancement. For instance, researchers noted dissatisfaction with breathing assistance and monitoring [16, 18]. These findings highlight both strengths in compassionate, hands-on care and responsiveness that warrant attention.
The study revealed that in the technical professional domain [Table 2], over two-thirds of patients expressed satisfaction with nurses' proficiency in assisting physicians, conveying accurate Information, and providing beneficial advice. However, patients expressed dissatisfaction with the clarity of medical instructions and the organization of work. Prior studies have shown that patients reported high satisfaction with nurses' technical skills in supporting doctors, indicating effective collaboration in care delivery [19, 20].
A significant majority appreciated the quality of communication between nurses and doctors, which correlated positively with overall patient satisfaction [20, 21]. Patients felt that nurses did not adequately explain medical instructions, leading to confusion and dissatisfaction [22].
The current study shows that in the interpersonal educational domain [Table 2], almost all patients were highly satisfied with nurses' speed in giving directions and simple language explanations and found them easy to understand. At the same time, more than half were dissatisfied with nurses asking questions but not acting, test results explanations, and excessive medical explanations. According to one established study, the vast majority of patients report satisfaction with nursing interactions, particularly with clear explanations of care and procedures [23]. Another study found that using simple language and active listening is crucial, as it enhances understanding and reduces anxiety, thereby improving treatment adherence [24]. On the other hand, a significant number of patients feel frustrated when nurses ask questions but do not act on the responses, indicating a gap in effective communication [22]. Patients often report confusion due to excessive medical terminology, which detracts from their understanding of their health condition [25].
Regarding interpersonal trust [Table 2], more than two-thirds of patients were satisfied discussing problems with nurses, felt free to ask questions, and were satisfied with nurses being pleasant. However, dissatisfaction was expressed with nurses spending time at their desks and talking down to patients. Past studies reveal that patients value a friendly approach, as evidenced by patients finding nurses attentive and not perceiving them as pleasant [26]. Patients express frustration when nurses are frequently absent from their bedsides, which impacts the quality of care and communication [27]. Negative interactions, such as talking down to patients, lead to feelings of disrespect and dissatisfaction, undermining trust [23].
In this study, older age, longer stays, and more admissions are all significantly linked to lower satisfaction—with age being the strongest factor [Table 3]. Age has the strongest negative correlation with satisfaction, while Karaca & Durna found younger patients (18–35) were more satisfied than older ones [12].
This aligns with the findings. Due to their greater expectations, complex medical needs, and frequent encounters with the healthcare system, older individuals may be less satisfied and more critical of the quality of the services they receive. Thus, age appears not only as a demographic factor but also as a marker of varying care needs, underscoring the importance of tailoring nursing care for older populations.
Education, cleanliness, food, water, and patient position all significantly impact satisfaction [Table 4]. In comparison, a study by Papastavrou et al. emphasized the role of organizational factors, such as care rationing and nurse workload, in shaping satisfaction [28]. At the same time, Karaca & Durna noted dissatisfaction with information delivery and emphasized the importance of communication and the environment [12]. These results strongly echo the current findings, especially regarding cleanliness and basic amenities, which are often overlooked but crucial; they also reinforce this trend and highlight occupational disparities in healthcare perception.
This study has several limitations. First, convenience sampling and the single‑hospital setting limit the generalizability of findings to other healthcare facilities in Bangladesh. Second, self‑reported satisfaction measures are subject to recall and social desirability biases. Third, two subscales showed very low internal consistency (technical‑professional: α = 0.231; interpersonal-educational: α = 0.231), which reduces confidence in conclusions drawn from those domains and indicates a need for questionnaire revision or revalidation. Despite these limitations, the overall scale demonstrated acceptable reliability (α = 0.715), and the normal distribution of satisfaction scores supported the use of parametric tests.
Conclusion
This study evaluated patient satisfaction with inpatient nursing care at a secondary-level hospital in Bangladesh, highlighting both strengths and opportunities for improvement. Patients reported significant satisfaction with fundamental nursing care, including hygiene, nutrition, mobilization, rest, and medication administration, as well as nurses' communication and interpersonal support. Nonetheless, dissatisfaction was observed with the dissemination of Information about treatment, test results, and hospital conditions. In light of these findings, hospital administrators ought to enforce regular and audited sanitation protocols for wards and restrooms to maintain consistent hygiene standards, develop systematic communication training programs to enhance nurses' ability to articulate tests and treatment plans, and initiate regular patient feedback sessions facilitated by nurse leaders to identify concerns and reinforce patient-centered care promptly. Future studies should encompass multi-center studies to enhance generalizability and qualitative investigations to examine the factors contributing to reduced satisfaction among elderly patients and those with prolonged hospital stays.
Ethical Considerations
This study is approved by the Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM) with IRB Memo No. "NIPSOM/IRB/2023/06". The Declaration of Helsinki was followed, and written permission was also obtained from the hospital authority of the 250-bed Bongomata Sheikh Fazilatunnesa Mujib General Hospital, Sirajgong. All participants provided written informed consent before participation.
Acknowledgements
We acknowledge all the participants included in the study.
Conflict of Interest
The authors declare no conflicts of interest.
Funding
This study was funded by the Bangladesh Medical Research Council (BMRC), which was received only by the Principal Investigator. This was a student grant (ref: BMRC/Revenu/Student Grant/2025/164(1-140) to conduct the research project. Otherwise, no author received any other type of funding regarding this research project. The funder had no role in the conceptualization, design, data collection, analysis, or preparation of the manuscript.
Authors' Contributions
Conceptualization: S. Akter, K. Akhtar
Methodology: S. Akter, K. Akhtar
Investigation: S. Akter
Formal Analysis: S. Akter, K. Akhtar
Validation: K. Akhtar
Visualization: S. Akter, K. Akhtar, F.F. Shama, S. Jahan
Writing – Original Draft: S. Akter, K. Akhtar, F.F. Shama
Writing – Review & Editing: S. Akter, K. Akhtar, F.F. Shama, S. Jahan
All authors read and approved the final manuscript.
Artificial Intelligence Utilization for Article Writing
The authors used Copilot and Quillbot during the preparation of this work to enhance the language and readability of the manuscript, as the authors are not native English speakers. After using the tool, the authors thoroughly reviewed and edited the content as necessary and assume full responsibility for the manuscript.
Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to participant privacy concerns and institutional restrictions. However, the data that support the findings are available from the corresponding author upon reasonable request.
Type of Study: Orginal research |
Subject:
Nursing
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