Predictors Of Dissatisfaction Research Articles

How Back Pain Affects Patient Satisfaction After Primary Total Knee Arthroplasty

BackgroundAlthough back pain (BP) has been shown to be a predictor of dissatisfaction after total knee arthroplasty (TKA) in some reports, these studies did not use a scale to quantify the degree of pain. The purpose of this study was to quantify the effect of BP intensity on patient satisfaction reported at 1 year after TKA. MethodsA multicenter prospective cohort was taken in which 9,057 patients undergoing primary unilateral TKA were enrolled in FORCE-TJR and demographic and clinical data were collected. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire. Patients were classified into 4 categories based on the severity of BP. Patient-reported outcomes (PROs) were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). We used a validated 5-point Likert satisfaction scale. Univariate analyses of the difference between the satisfied and dissatisfied patients’ groups was performed. Multivariate logistic regression models with 95% confidence interval (CI) were used to quantify the effect of BP intensity on patient dissatisfaction at 1 year. Receiver operating characteristic (ROC) analyses were performed with measurement of area under curve (AUC). ResultsAt 1 year, a total of 1,657 TKA patients (18.3%) were dissatisfied. A total of 4,765 patients (52.6%) reported back pain at the time of surgery, including mild BP in 2,264 patients (24.9%), moderate BP in 1,844 patients (20.3%), and severe BP in 657 patients (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA (P = .0006). The multivariate regressions showed that patients who had severe BP were 1.6 times more likely to be dissatisfied when compared to patients who had no BP [odds ratio (OR) 1.63; 95% confidence interval (CI) (1.23-2.16), P = .0006]. While patients who had mild BP [OR 0.98; 95% CI (0.82-1.17), P = .87] or moderate BP [OR 0.97; 95% CI (0.80-1.18), P = .78] were not associated with an increased likelihood of dissatisfaction. Other predictive variables for dissatisfaction, include age [OR for younger patients <65 years versus older patients ≥65 years, 0.74; 95% CI (0.59-0.92)], educational level [OR for post high school versus less, 0.83; 95% CI (0.71, 0.97)], smoking [OR for nonsmoker versus current smoker, 0.63; 95% CI (0.45, 0.87)], and Charlson comorbidity index [OR for CCI ≥2 versus 0, 1.25; 95% CI (1.05, 1.49)]. ConclusionIncreased BP intensity was associated with increased risk of dissatisfaction 1 year after TKA. Only patients who had severe BP were 1.6 times more likely to be dissatisfied. The data presented here can help to improve shared decision-making and patient counseling before surgery. Surgeons should consider a spine evaluation in patients who have severe BP prior to TKA.

Patient satisfaction with medication in rheumatoid arthritis: an unmet need.

Shared decision-making between rheumatologists and patients has become an overarching principle in current treatment recommendations in rheumatoid arthritis (RA). Therefore, in the present study, we aimed to assess the satisfaction of patients with RA with their treatment and to investigate the associated factors. A cross-sectional study was carried out in the Rheumatology Department of Mongi Slim Hospital. We included adults with RA receiving their current disease-modifying anti-rheumatic drugs for at least 12 months.Satisfaction among patients was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM) and it was defined by a score ≥ 80%. The factors indirectly influencing patient satisfaction that were assessed were: satisfaction with medical care management, disease activity, functional impact, professional impact, and the impact of RA. Multivariable regression analysis was applied to determine the predictors of satisfaction. We included 70 patients (63 female/7 male) with a mean age of 57.8 ±10.6 years. The mean disease duration was 13.71 ±7.2 years.Mean TSQM scores were 65.42 ±14.77 for convenience, 68.71 ±18 for effectiveness, 70.60 ±24.5 for side effects, and 67.95 ±17.10 for global satisfaction. Satisfaction rates were: 20% for convenience, 39% for effectiveness, 46% for side effects and 30% for global satisfaction.In multivariable analysis, the predictors of global dissatisfaction were Rheumatoid Arthritis Impact of Disease (RAID) overall score (p = 0.003) and the degree of physical difficulties (p = 0.001). Satisfaction with the physician was correlated with better global satisfaction (p = 0.029). Difficulties in adapting to RA (p = 0.043) and current treatment with biologics (p = 0.027) were predictors of dissatisfaction with convenience. Predictors of dissatisfaction with efficiency were the RAID overall score (p = 0.032) and the difficulties of adapting to RA (p = 0.013). The predictors of satisfaction with side effects were a lower degree of interference with domestic work (p = 0.02) and better involvement of the patient in the treatment decision (p = 0.014). The satisfaction with the attending physician, the participation in the treatment decision, and the impact of RA seem to influence treatment satisfaction the most. These data suggest that a better understanding of patients' medical needs and preferences would improve satisfaction outcomes.

Association between patient characteristics and dissatisfaction after cranial neurosurgery: A prospective observational study.

Patient satisfaction is an indicator of the quality of healthcare. It can improve treatment adherence and health outcomes. This study aimed to determine the incidence, predictive factors, and impact of post-operative patient dissatisfaction with perioperative care after cranial neurosurgery. This was a prospective observational study conducted in a tertiary care academic university hospital. Adult patients undergoing cranial neurosurgery were assessed for satisfaction 24 h after surgery using a five-point scale. The data regarding patient characteristics that may predict dissatisfaction after surgery were collected along with ambulation time and hospital stay. Shapiro-Wilk test was used to assess normality of data. Univariate analysis was performed using Mann-Whitney U-test and significant factors were entered into binary logistic regression model for identifying predictors. The level of significance was set at P < 0.05. Four hundred and ninety-six adult patients undergoing cranial neurosurgery were recruited into the study from September 2021 to June 2022. Data of 390 were analyzed. The incidence of patient dissatisfaction was 20.5%. On univariate analysis, literacy, economic status, pre-operative pain, and anxiety were associated with post-operative patient dissatisfaction. On logistic regression analysis, illiteracy, higher economic status, and no pre-operative anxiety were predictors of dissatisfaction. The patient dissatisfaction did not impact ambulation time or duration of hospital stay after the surgery. One in five patients reported dissatisfaction after cranial neurosurgery. Illiteracy, higher economic status, and no pre-operative anxiety were predictors of patient dissatisfaction. Dissatisfaction was not associated with delayed ambulation or hospital discharge.

Building Construction Clients’ Design Consultant and Contractor Selection Criteria Versus Post-Occupancy Satisfaction Levels

In today’s competitive building construction markets, achieving clients’ satisfaction is of utmost importance. The choice of a design consultant and a contractor for a building project has a crucial influence on the post-occupancy satisfaction of the client. Hence, this study provides insights into private building construction clients’ perceptions of a set of criteria contributing to their selections of design consultant and contractor together with the resulting post-occupancy overall client satisfaction levels eventually reached, by presenting survey findings of 330 clients in North Cyprus construction market. Unlike previous studies, the current study combined all the interrelated and vital stages of design consultant and contractor selection with post-occupancy client satisfaction levels. A further contribution is differentiating among various types of client groups’ behaviors in each of the three specified stages. Clients in different categories had distinct approach differences in selection stages, and different post-occupancy satisfaction values indicating that firms may benefit from market segmentation. “Residential” and “&lt;120,000£” type building clients were the least satisfied groups, while “project execution stage” and “functionality” emerged as major features creating dissatisfaction. The findings revealed the importance attached by the clients to “references about the firm” in the selection stages and low client satisfaction with the completed projects. Regression analysis findings revealed different design consultant and contractor selection factors predicting overall clients’ satisfaction while assigning high importance to the “cost-effectiveness approach of the firm” emerged as the only strong predictor of dissatisfaction. This study provides a guide for building construction clients to attain higher post-occupancy satisfaction and assists design consultants and contractors in adopting specific customer-focused strategies.

Predictors of dissatisfaction with day care chemotherapy services among patients with cancer: A single center retrospective study

Predictors of dissatisfaction with day care chemotherapy services among patients with cancer: A single center retrospective study

How Principals’ Perceived Resource Needs and Job Demands Are Related to Their Dissatisfaction and Intention to Leave Their Schools During the COVID-19 Pandemic

School principals are facing greater challenges during the COVID-19 pandemic than they have ever faced, which has implications for whether they can conduct their work productively and remain in their jobs over the long term. This article draws on a unique, nationally representative, longitudinal panel of K–12 public school principals across the United States to examine principals’ self-reported resource needs and job demands during the COVID-19 pandemic as well as how those resource needs and demands are related to principals’ dissatisfaction and their intention to leave their job. Although principals’ reported resource needs (which increased over time) and teacher shortages were consistently related to dissatisfaction and intention to leave, various other job demands were predictors of dissatisfaction but not the intention to leave. These results have several implications for supporting and retaining principals as well as the teachers they serve.

Undergraduate nursing student satisfaction with the nursing program at a university campus in Namibia

BackgroundStudent satisfaction is increasingly becoming a policy driver for evaluating the quality of education and the accreditation of academic programmes. Although student satisfaction is viewed as a yardstick of academic success, it remains understudied in Namibia. ObjectiveTo determine undergraduate students’ satisfaction with the nursing programme at a university campus in Namibia. Methods and materialsA cross-sectional descriptive survey, with use of a non-proportional quota sampling strategy was used to recruit 147 undergraduate nursing students. Data were analysed using SPSSv27, using mean score and logistic regression as inferential statistics to predict the relationship between variables. ResultsThe study found a mean satisfaction of 3.27 ± 0.91 among the 147 respondents. The majority of the respondents (70.6%) were generally satisfied, whereas 29.4% were dissatisfied with the nursing programme. The frequent areas of satisfaction were in-class teaching (90.5%), simulation-based teaching (76.9%) and staff conduct (62.6%), whereas dissatisfaction was associated with access to school services (52.4%). A significant prevalence of satisfaction was found among the second and third year students (55.8%, 60.9%, p = 0.00). The predictors for dissatisfaction were being male vs. female (54.1% vs 45.3%) and having retired parents (70.5%, p < 0.05). ConclusionThe study identified important areas of dissatisfaction in a nursing programme. A high level of dissatisfaction was linked to a lack of access to the building’s emergency exit plans (62.5%) and teaching facilities, i.e., the computer and clinical laboratories (55.8%). It is vital for nursing training schools to take cognisance of these areas, toward optimising quality nursing education.

Development and internal validation of machine learning algorithms to predict patient satisfaction after total hip arthroplasty

BackgroundPatient satisfaction is a unique and important measure of success after total hip arthroplasty (THA). Our study aimed to evaluate the use of machine learning (ML) algorithms to predict patient satisfaction after THA.MethodsProspectively collected data of 1508 primary THAs performed between 2006 and 2018 were extracted from our joint replacement registry and split into training (80%) and test (20%) sets. Supervised ML algorithms (Random Forest, Extreme Gradient Boosting, Support Vector Machines, Logistic LASSO) were developed with the training set, using patient demographics, comorbidities and preoperative patient reported outcome measures (PROMs) (Short Form-36 [SF-36], physical component summary [PCS] and mental component summary [MCS], Western Ontario and McMaster’s Universities Osteoarthritis Index [WOMAC] and Oxford Hip Score [OHS]) to predict patient satisfaction at 2 years postoperatively. Predictive performance was evaluated using the independent test set.ResultsPreoperative models demonstrated fair discriminative ability in predicting patient satisfaction, with the LASSO model achieving a maximum AUC of 0.76. Permutation importance revealed that the most important predictors of dissatisfaction were (1) patient’s age, (2) preoperative WOMAC, (3) number of comorbidities, (4) preoperative MCS, (5) previous lumbar spine surgery, and (6) low BMI (< 18.5).ConclusionMachine learning algorithms demonstrated fair discriminative ability in predicting patient satisfaction after THA. We have identified modifiable and non-modifiable predictors of postoperative satisfaction which could enhance preoperative counselling and improve health optimization prior to THA.

Predicting dissatisfaction following total hip arthroplasty using a Bayesian model averaging approach: Results from the Australian Arthroplasty Clinical Outcomes Registry National (ACORN).

Total hip arthroplasty (THA) provides excellent pain relief and improved function in patients with painful arthritis. The aim of this study was to identify rates and predictors of dissatisfaction following THA. Data were collected prospectively from the Australian Arthroplasty Clinical Outcomes Registry National (ACORN) database between 2014 and 2016 from 2096 patients who underwent THA. Data included baseline demographics, patient-reported outcome measures (PROMs) and postoperative clinical outcomes. Patients were dichotomized into two groups based on their 6-month response to the satisfaction question answered on a Likert scale. Eighteen predefined variables were analyzed. PROMs included full Oxford Hip Score, EQ-5D, and patient satisfaction. A Bayesian model averaging approach was used to build the best predictive model for dissatisfaction. Multiple logistic regression techniques were applied to quantify the effect size of the best model. At 6 months following THA, 95.4% of patients (n=2000) were satisfied with surgical outcome and 4.6% (n=96) were dissatisfied. The only variable that was significantly associated with dissatisfaction after THA was "complications after discharge." This result was consistent for both the complete and imputed dataset (odds ratio 4.78, 95% confidence interval 2.60-8.80, P < 0.001 and odds ratio 3.8, 95% confidence interval 2.60-5.60, P < 0.001, respectively). Our study confirms the high rates of patient satisfaction following THA, with postoperative complications being the only determinant of dissatisfaction. Optimization of patients prior to surgery, reducing postoperative complications, may further improve satisfaction rates after THA.

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

BackgroundDespite the continued improvement in the surgical techniques during primary total knee arthroplasty (TKA), literatures indicate that up to 10 to 20% patients are not satisfied with their outcomes. Psychological factors in this dissatisfaction are yet to be clearly identified. The aim of this study is to develop a method to assess whether the patient’s current mental state is suitable enough to accept a TKA surgery.MethodsPreoperative demographic and clinical data of 532 patients who underwent TKA were prospectively obtained from January 2012 until December 2016. We recorded the scores evaluated by SF-36 questionnaire and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperatively and 1 year postoperatively. Preoperative Life Satisfaction Rating (LSR) is emphatically evaluated.ResultsPoor preoperative score of LSR was a significant predictor of dissatisfaction after TKA. Patients with low LSR reported significant pain and stiffness, although there was no remarkable effect on functionality of the replaced joint. The results also showed that age and BMI were not strong predictors of satisfaction in TKA.ConclusionOur outcomes can help clinicians evaluate whether a patient’s current mental status is favorable for TKA. If patients have extreme low scores of LSR (less than 10), a psychological intervention should be recommended for better satisfaction following a TKA surgery. This would also allow surgeons to individually assess the risks and benefits of surgery.

Sociocultural attitudes toward appearance and body shape dissatisfaction in adolescent Egyptian females: association and moderators.

Body image dissatisfaction is considered a predicting and maintaining factor of a variety of prevalent health problems. This study aimed to assess the influences of sociocultural factors and body mass index (BMI) on body dissatisfaction among university female students. This is a cross-sectional study. It included 1408 adolescent Egyptian females chosen randomly from Minia University students who answered the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-4), Body Shape Questionnaire (BSQ) and The Rosenberg Self-Esteem Questionnaire in the period from June to July, 2018. In addition, their BMI was measured. Around one third of the students had major concerns about their body shape. BMI was the strongest predictor for dissatisfaction with body image (Standardized β = 0.31; p-value: <0.00018). Both total and pressure subscales scores of SATAQ-4 were also significant explanatory variables. Pressures from the family were a strong predictor among urban students, peer pressures among rural students, and both family and peer pressures among students with low self-esteem. This study supported the associations of BMI and sociocultural influences with body image. Residence and self-esteem modified the level of sociocultural influences. Family literacy training and social support for students with low self-esteem are suggested preventive tools of eating and body image disturbances.

Dissatisfaction with life and associated factors in older community-dwelling adults

Abstract Objective: To analyze the prevalence of dissatisfaction with life and associated sociodemographic factors. Method: A cross-sectional, population-based study was carried out. Data collection was performed using the Brazil Old Age Schedule (BOAS) questionnaire. A total of 573 older adults from the urban area were interviewed, selected through cluster sampling, stratified by sex. Bivariate analysis was performed using the chi-square and prevalence ratio with a 95% confidence interval (CI). For multivariate analysis, the Poisson Robust regression model was applied. Variables were entered into the model using the backward method. Results: The prevalence of dissatisfaction with life was 15.53%. Dissatisfaction with life was associated with women (PR=1.54; 95% CI: 1.02; 2.32), being illiterate (PR=2.57; 95% CI: 1.44; 4.60), having up to four years of schooling (PR=1.79; 95% CI: 1.01; 318) and having an income of less than two minimum wages (PR=3.29; 95% CI: 1.29; 8.42). In the multivariate analysis, being female (PR=1.50; 95% CI: 1.01; 2.25), being illiterate (PR=2.54; 95% CI: 1.42; 4.54) and having up to four years of schooling (PR=1.77; 95% CI: 0.99; 3.14) remained associated with dissatisfaction with life Conclusion: the prevalence of dissatisfaction is low. Dissatisfaction with life was associated with sex, education and income, in a bivariate manner. Sex and education were predictors of dissatisfaction with life. These findings reinforce the need for actions to promote social equality between men and women and to facilitate the access of older adults to education.

Harbingers of unrest in Baltimore: racial and spatial cleavages in satisfaction with quality of life before the 2015 Uprising

ABSTRACT The 2015 Baltimore Riots, which occurred following clashes between residents and police during anti-police brutality protests, were the most widespread acts of civil unrest to grip the city since 1968. The civil unrest raised questions about whether policymakers had misdiagnosed the intensity of resident dissatisfaction with neighborhood conditions or the ease at which the death of a black resident in police custody would ignite outrage. I use data from the 2014 Baltimore Citizen Survey, a city-commissioned satisfaction survey, to examine resident perceptions of police a year before the unrest and to examine which individual and contextual factors shaped dissatisfaction with quality of life in the city. Results from one-way ANOVA, factor analysis, and multivariate regressions show that race and economic distress were significant predictors of dissatisfaction. Furthermore, blacks, Millennials, and residents of certain planning districts were highly dissatisfied with police and with the availability of resources. High levels of dissatisfaction were reported by areas which would become flashpoints of the 2015 unrest. I discuss the implications of racial, spatial, and social cleavages in satisfaction for city governance, including how citizen surveys, as policy feedback devises, can attune policymakers to the attitudinal, demographic, and experiential profiles typically correlated with civil unrest.

Outcomes and Patient Satisfaction With Arthroscopic Partial Meniscectomy for Degenerative and Traumatic Tears in Middle-Aged Patients With No or Mild Osteoarthritis

Background: There is controversy about the benefit of arthroscopic partial meniscectomy (APM) for degenerative lesions in middle-aged patients. Purpose: To compare satisfaction with APM between middle-aged patients with no or mild knee osteoarthritis (OA) and a degenerative meniscal tear and those with a traumatic tear. Study Design: Cohort study; Level of evidence, 2. Methods: A comparative prospective study at 5 years of middle-aged patients (45-60 years old) with no or mild OA undergoing APM for degenerative (n = 115) or traumatic (n = 143) tears was conducted. Patient satisfaction was measured by a 5-point Likert scale and functional outcomes by the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Univariate and multivariate regression analyses were used to identify factors correlating with patient-reported satisfaction at 5 years postoperatively. Results: Baseline patient characteristics were not different between groups. At the 5-year evaluation, the satisfaction rate in the traumatic and degenerative groups was 68.5% versus 71.3%, respectively (P = .365). Patient satisfaction was significantly associated with functional outcomes (r = 0.69; P = .024). In the degenerative group, 43 patients (37.4%) had OA progression to Kellgren-Lawrence (K-L) grade 2 or 3, but only 24 patients (20.8%) had a symptomatic knee at final follow-up. Multivariate regression analysis for patient dissatisfaction at 5-year follow-up showed the following significant independent factors: female sex (odds ratio [OR], 1.6 [95% CI, 1.1-2.3]; P = .018), body mass index >30 kg/m2 (OR, 2.6 [95% CI, 1.7-4.9]; P = .035), lateral meniscal tears (OR, 0.6 [95% CI, 0.1-0.9]; P = .039), and OA progression to K-L grade ≥2 at final follow-up (OR, 1.4 [95% CI, 1.2-2.6]; P = .014). At the final evaluation, there were no significant differences between groups in pain scores (P = .648), WOMAC scores (P = .083), or KOOS-4 scores (P = .187). Likewise, there were no significant differences in the KOOS subscores for Pain (P = .144), Symptoms (P = .097), or Sports/Recreation (P = .150). Although the degenerative group had significantly higher subscores for Activities of Daily Living (P = .001) and Quality of Life (P = .004), the differences were considered not clinically meaningful. Conclusion: There were no meaningful differences in patient satisfaction or clinical outcomes between patients with traumatic and degenerative tears and no or mild OA. Predictors of dissatisfaction with APM were female sex, obesity, and lateral meniscal tears. Our findings suggested that APM was an effective medium-term option to relieve pain and recover function in middle-aged patients with degenerative meniscal tears, without obvious OA, and with failed prior physical therapy.

Democratic demand and supply: a spatial model approach to satisfaction with democracy

ABSTRACTSatisfaction with democracy (SWD) is a commonly used indicator, and its determinants have been analysed extensively. But what does dissatisfaction with democracy substantially mean? This paper tests if satisfaction is actually a coherent consequence of citizens considering democratic supply and demand. It starts from the simple idea that satisfaction can be explained by the distance between what “should be” and what “is”; between democratic expectations and reality. I capture this idea in a spatial model of democratic support, where size and direction of the gap between citizens’ expectations and evaluations of democracy determine levels of satisfaction. I use data for 26 countries from the European Social Survey. Taking into account both expectation-surplus and evaluations-surplus gaps, I find that satisfaction is affected by both the size and the direction of the distance between expectations and evaluations. The main finding is that liberal criteria of democratic quality are generally agreed upon amongst citizens, and that a perceived lack of their realization is the strongest predictor of dissatisfaction. Democratic input dimensions like direct participation and output criteria like social justice are more disputed, and create dissatisfaction amongst those wanting more of them as well as those wanting less.

Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late.

The primary aim of this study was to assess whether patient satisfaction one year after total knee arthroplasty (TKA) changed with longer follow-up. The secondary aims were to identify predictors of satisfaction at one year, persistence of patient dissatisfaction, and late onset dissatisfaction in patients that were originally satisfied at one year. A retrospective cohort consisting of 1369 patients undergoing a primary TKA for osteoarthritis that had not undergone revision were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire scores were collected preoperatively, and one and five years postoperatively. In addition, patient satisfaction was assessed at one and five years postoperatively. Logistic regression analysis was used to identify independent predictors of satisfaction at one and five years. The overall rate of satisfaction did not change from one (91.7%, n=1255) to five (90.1%, n=1234) years (p=0.16). Approximately half (n=53/114) of the patients who were dissatisfied at one year became satisfied with their TKA at five years, whereas 6% (n=74/1255) of those who were satisfied at one year became dissatisfied at five years. At one year, patients with lung disease (p=0.04), with depression (p=0.001), with back pain (p<0.001), undergoing unilateral TKA (p=0.001), or with a worse preoperative WOMAC pain score (p=0.04) were more likely to be dissatisfied. Patients with gastric ulceration (p=0.04) and a worse WOMAC stiffness score (p=0.047) were at increased risk of persistent dissatisfaction at five years. In contrast, a worse WOMAC pain score (p=0.01) at one year was a predictor of dissatisfaction in previously satisfied patients at five years. Three groups of dissatisfied patients exist after TKA: 'early' dissatisfaction at one year, 'persistent' dissatisfaction with longer follow-up, and 'late' dissatisfaction developing in previously satisfied patients at one year. All three groups have different independent predictors of satisfaction, and potentially addressing risk factors specific to these groups may improve patient outcome and their satisfaction. Cite this article: Bone Joint J 2018;100-B:161-9.

Factors Influencing Job Satisfaction and Turnover Intention among Coronary Care Unit Nurses in Bahrain

Background: At a time of worldwide nursing shortage, is raising questions about the issue of increasing nurses' turnover. The literatures have shown that stronger intention to leave as a consequence of job dissatisfaction may lead to actual turnover. Therefore, it may be a crucial to understand nurses' job satisfaction issue, as this is a key factor in nurses' intention to leave the working place and low job commitment. Aim and Objective: This study examined the factors that determine job satisfaction which are personal, environmental and organizational components and the relation of those factors on Coronary Care Unit nurses' intention to leave their working place. Methodology/ Design: Across sectional, quantitative and correlation design was selected at a fixed point in time. Method: Data was drawn from analysis of self reported questionnaire which included three sections of; demographic data, McClosky Mueller Satisfaction Scale and Anticipated Turnover Scale. The questionnaires were distributed to 60 accessible nurses in CCU. A total of 42 respondents completed the questionnaires with an70 percent response rate. Finding: Nationality and work scheduling were significantly influencing job satisfaction, but marital status and work experience were more influencing the turnover intention. The study finding showed an evidence of considerable highly negative relation between job satisfaction and turnover intention, which was manifested by 78.6% those nurses reporting to be dissatisfied or in neutral responds with their overall job. Moreover, 72.8% of nurses were more likely to hold an intention to leave working place. The most statistically significant predictor of dissatisfaction and lead to leave intention was external reward. Job satisfaction subscale connected to social support was identified as an important factor which may decrease leave intention. Conclusion: The study findings suggested increase nurses' satisfaction through improving benefit package such as health insurance, retirement profits and salary is a key for possible strategy to decrease turnover intention among Coronary Care Unit nurses in Bahrain. Implication for Practice: The study findings have ramifications for nurses' manages to develop strategies aimed at improving the job satisfaction in order to decrease turnover intention.

The degree of satisfaction of in-hospital medical patients with nursing care and predictors of dissatisfaction: findings from a secondary analysis.

Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012-2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale (PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 - very dissatisfied to 44 - very satisfied). Patients were defined as 'satisfied with NC' when the score was ≥33, whereas they were considered as 'dissatisfied with NC' when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients (RR 1.883, 95% CI 1.359-2.609), in those who developed pressure sores during the in-hospital stay (RR 1.555, 95% CI 1.021-2.368), who received NC with high skill mix (RR 1.072, 95% CI 1.034-1.111) and those who were admitted to a large hospital (RR 1.001, 95% CI 1.001-1.002). In contrast, increased age (RR 0.987, 95% CI 0.975-0.998), increased amount of care offered by Registered Nurses (RR 0.984, 95% CI 0.974-0.994), a higher proportion of baccalaureate nurses on staff (RR 0.975, 95% CI 0.958-0.993) and being admitted to a teaching hospital (RR 0.497, 95% CI 0.130-0.910) all decreased the likelihood of being dissatisfied with NC. Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction.

Dissatisfaction after laparoscopic Heller myotomy: The truth is easy to swallow

BackgroundAlthough laparoscopic Heller myotomy has been shown to well palliate symptoms of achalasia, we have observed a small subset of patients who are “Dissatisfied”. This study was undertaken to identify the causes of their dissatisfaction. Study designPatients undergoing laparoscopic Heller myotomy from 1992 to 2015 were prospectively followed. Using a Likert scale, patients rated their symptom frequency/severity before and after the procedure. Patients graded their experience from “Very Satisfying” to “Very Unsatisfying.” Results647 patients underwent laparoscopic Heller myotomy. Fifty (8%) patients, median age 57 years and BMI 24 kg/m2 reported dissatisfaction at follow-up subsequent to myotomy. “Dissatisfied” patients were more likely to have undergone prior abdominal operations (p = 0.01) or previous myotomies (p = 0.02). “Dissatisfied” patients had a greater incidence of diverticulectomy (p = 0.03) and had longer postoperative LOS (p = 0.01). Symptom frequency/severity persisted after myotomy for dissatisfied patients (p > 0.05). ConclusionDissatisfaction after laparoscopic Heller myotomy is directly related to persistent/recurrent symptoms. Previous abdominal operations/myotomies, diverticulectomies, and longer LOS are predictors of dissatisfaction. With this understanding, we can identify patients who might be more prone to dissatisfaction.

Comparative Study of Nurse Managers’ Job Dissatisfaction in Public Hospitals and Health Clinics in Malaysia

Background: Nurse Managers in public hospitals and health clinics in Malaysia have added responsibilities as an administrative role and this work load place further pressure and affect the nurse managers’ job dissatisfaction. Incentives and concerted efforts have brought about better working environment for the nurse managers. The objective is to assess the improvement of the situation of job dissatisfaction among the nurse managers; exemplify the causes of job stress, and identify the skills required for the future training of nurses. Method: In 2002 questionnaires were mailed out to 998 nurse managers working in public sector which is then compared to 2014 extrapolated data sampling of 262 nurse manager respondents from Penang. Nurse Managers were asked to give their perceived job dissatisfaction working as a nurse manager in terms of factors and level of stress encountered. Data were then analysed between these two groups of respondents to determine if situation has improved and to identify the contributing factors of stress and problems encountered. Results: Though only 7.7% of the nurse managers in 2002 were job dissatisfied, 64.4% of them reported being overworked and 19.7% of them had frequent job stressed. The predictors for dissatisfaction among public sector nurse managers were stress, overworked and having a poor interpersonal relation with supervisors. Findings of 2014 however an increased level of job dissatisfaction to 14.1%; 61.1% complained of overworked and 7.3% subjected to frequent stress. Overworked and work stress were factors associated with job dissatisfaction among public healthcare nurse managers. The respondents in both the survey felt that too many responsibilities and the lack of managerial skills are the contributors to job dissatisfaction. Conclusion: Reforms in nursing practice and mitigation of work stress are needed. Comprehensive formal management training for nurse managers is needed to better prepare nurses to the demands of their job.