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Table of contents
1. Patients Satisfaction with Nursing Care in a Maternity Unit in South-Western Nigeria: Relationship with
Self Esteem.....................................................................................................................................................

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Document 1 of 1

Patients Satisfaction with Nursing Care in a Maternity Unit in South-Western Nigeria: Relationship
with Self Esteem
Author: Eegunranti, Adekunle B; Ibigbami, Olanrewaju I; Akinsulore, Adesanmi; Olowookere, Samuel A;
Ibigbami, Adebukola
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Abstract:
The purpose of health care institution is to satisfy the health care needs of their patients. Measuring patient
satisfaction has improved services provided by health care institutions. Among factors that influence patient
satisfaction, self-esteem of the clients has not received much attention in research. The aim of this study was to
assess patient satisfaction with nursing care in a maternity unit and its relationship with self-esteem. A
descriptive cross-sectional study in which 100 women were interviewed at the immunization clinic of the Wesley
Guild Hospital within six weeks post-delivery was used. Respondents completed socio-demographic
questionnaire, the modified La Monica-Oberst Patient Satisfaction Scale (LAOPSS) and the Rosenberg Self
Esteem Scale. The mean age of respondents was 29.9 years while mean satisfaction score was 97.98 (SD15.3; Range-79) with mean self-esteem being 30.15 (SD-6.59; Range-38). Factors associated with higher levels
of patient satisfaction were having tertiary education, having 1-3 children, being employed, higher income,
higher levels of self-esteem and longer duration of hospital stay. Predictors of patient satisfaction were selfesteem and duration of hospital stay. Self-esteem of women has a strong influence on their satisfaction with
nursing care in maternity units. Measures towards enhancing their understanding of the care given to them and
promoting their self-esteem are strong components of improving their satisfaction with nursing care
Full text:
Headnote
The purpose of health care institution is to satisfy the health care needs of their patients. Measuring patient
satisfaction has improved services provided by health care institutions. Among factors that influence patient
satisfaction, self-esteem of the clients has not received much attention in research. The aim of this study was to
assess patient satisfaction with nursing care in a maternity unit and its relationship with self-esteem. A
descriptive cross-sectional study in which 100 women were interviewed at the immunization clinic of the Wesley
Guild Hospital within six weeks post-delivery was used. Respondents completed socio-demographic
questionnaire, the modified La Monica-Oberst Patient Satisfaction Scale (LAOPSS) and the Rosenberg Self
Esteem Scale. The mean age of respondents was 29.9 years while mean satisfaction score was 97.98 (SD15.3; Range-79) with mean self-esteem being 30.15 (SD-6.59; Range-38). Factors associated with higher levels
of patient satisfaction were having tertiary education, having 1-3 children, being employed, higher income,
higher levels of self-esteem and longer duration of hospital stay. Predictors of patient satisfaction were selfesteem and duration of hospital stay. Self-esteem of women has a strong influence on their satisfaction with
nursing care in maternity units. Measures towards enhancing their understanding of the care given to them and
promoting their self-esteem are strong components of improving their satisfaction with nursing care
Key words: Patient satisfaction, Self-esteem, Nursing care, Maternity
Patient satisfaction with services provided in health care institutions has been widely accepted as a measure of
the quality of service provided(Weissman et al., 2008). It is regarded as the extent of agreement between what
a patient expects or obtain from the healthcare experience and the perception of care they actually receive (La
Monica, Oberst, Madea, &Wolf, 1986). Nursing staff provide support for all categories of patients within the
hospital setting hence, the results of their intervention is captured succinctly in the concept of patient
satisfaction. More importantly within the maternity unit, their duties include periodic assessment and constant
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review of patients who are in labour. They provide these clients with much needed psychological support. It is
important to ensure that their services are being periodically reviewed to foster progressive improvement in the
quality of care as frequent patient satisfaction surveys within a population are important in changing practices
(Davies et al., 2008). When patients are satisfied with the services they have received from their health care
provider it has been reported that they are more likely to return to such services (Dzomeku, 2011) and also
recommend the use of the service to others (Al-Mailam, 2005).
Various factors have been found by previous researchers to significantly influence patients' satisfaction with
nursing care. These include the outcome of the healthcare service experience (Amyx, Mwen, &Hamm, 2000),
individual patient socio-demographic factors like, gender (Rafii, Hajinezhad, &Haghani, 2009), age, ethnicity,
culture and health status (Johansson, Oleni, &Fridlund, 2002). Other factors include levels of anxiety,
depression and hostility (Carruth, Tate, Moffat, &Hill, 1997; La Monica, et al., 1986). Other factors include, the
type of nursing care (Wan, Hu, Thobaben, Hou, &Yin, 2011; Zeidan, Idris, &Bhairy, 2011), management of
labour pain, length of labour, complications, level of participation in the decision making process, information
received on the process of pregnancy (Seguin, Themen, Champagne, &Larouche, 1989) and the type of postpartum nursing care (Cottrell &Grubbs, 1994). Self-esteem can be simply described as one's attitude towards
oneself (Colman, 2003) which may be positive (favorable or high), neutral or negative (unfavorable or low). It
has been shown to be significantly correlated with life satisfaction in a previous study (An, An, O'Connor,
&Wexler, 2008). In spite of the proposal that more research needs to be conducted in exploring the relationship
between self-esteem and patient satisfaction (Decker, 1999), the role of selfesteem in patient satisfaction with
nursing care has not been given much attention in previous research. In Nigeria, the selfesteem of mothers who
were delivered by caesarean section (CS) was found to be significantly lower than their counterparts who had
normal spontaneous vagina delivery (Loto et al., 2010; Loto et al., 2009).
Generally, there has been an increase in research on the concept of patient satisfaction in Nigeria. Researchers
have looked at patients satisfaction in helpless patients (Ehiemere, Nwaneri, Iheanacho, &Akpati, 2011), Some
studies have looked at factors that influence maternal satisfaction with cesarean section (Enabudoso &Isara,
2011). No study has explored the relationship between self-esteem of mothers who have received care in a
maternity unit and their satisfaction with the care they have received at the unit. The aim of this study was to
explore patient satisfaction with nursing care among the study population with the specific objective of
describing the relationship between their self-esteem and satisfaction with nursing care they have received
during their last confinement.
We hypothesized that there will be no relationship between self-esteem and patient satisfaction in the study
population.
Methods
The study was a descriptive, cross-sectional survey. The target population was women who were cared for at
the maternity department of the Wesley Guild Hospital (WGH) Unit, Obafemi Awolowo University Teaching
Hospital Complex in Ilesa, Southwestern Nigeria. The WGH unit serves as a tertiary care centre for residents of
Ilesa town and other smaller towns and villages in Ijesa-land in Southwestern Nigeria. Ethical approval for the
study was obtained from the Ethical and Research Committee of the hospital. The women in labour presenting
at the maternity unit were first assessed by the nursing staff on duty after which they are reviewed by the
medical doctor on duty. The role of the nursing staff at this point is to admit them into the first stage room and to
continue labour monitoring. During this period, the nursing staff provides their clients much needed emotional
and psychological support. If the labour progress normally and is uncomplicated until the delivery of the baby,
the client is subsequently transferred into the post natal ward. The nursing staff continues to provide care for
her, teaching her how to care for herself and her baby even after they are discharged from the hospital. The
mothers are required to present their babies at the immunization clinic and are usually given an appointment for
post natal checkup within 6 weeks postdelivery. Women who had booked and received perinatal care at the
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maternity department of WGH were all considered to be prospective subjects. Exclusion criteria included being
less than 18 years of age, having any psychological impairment that could possibly interfere with competence,
post-delivery major complications that warranted additional gynecological or obstetric intervention including
hysterectomy or admission to the intensive care unit and adverse outcomes of the delivery which includes
hospitalization or loss of the baby after the delivery. All women recruited over a month of period were included
in the study. The data of 100 consenting women were analyzed. The mothers were interviewed by one of the
authors with a questionnaire containing questions on socio-demographic characteristics, patient satisfaction
using the modified La Monica-Oberst Patient Satisfaction Scale (LAOPSS) and the Rosenberg
Self Esteem Scale
The LAOPSS (La Monica, et al., 1986) is a 28 item instrument that are further categorized into three sub-scales
that measure interpersonal support (nine questions), good impression (five questions) and dissatisfaction (14
questions) with nursing care. A 5-point Likert scale, ranging from strongly agree (1), to neutral, to strongly
disagree (5), was used to obtain closed-ended responses. This instrument has been used both in patient and
out patient population. The original instrument which was in English was thoroughly reviewed by the
researchers. Face and content validity was done to determine the suitability of the items amongst the Nigerian
population. The instrument was pretested among a sample of clients who were not included in this study
population. The LAOPSS has good internal consistency, with a reported Cronbach alpha coefficient of 0.97
(Munro, Jacobsen, &Brooten, 1994). In the current study the Cronbach alpha coefficient was 0.87. The
associations between patient satisfaction and the sociodemographic variables were determined with the
satisfaction scores categorized into two with reference to the median score. Those whose scores were below
the median score and those whose scores were greater than or equal to the median score
The Rosenberg self-esteem scale (RSES) is a widely used scale for the assessment of self-esteem. It has 10
items which are rated on 4 points (Likert) from strongly agree to disagree. It has been previously adapted for
use among a study population of women after delivery within the same setting in a previous study (Loto, et al.,
2009). The scores of each of the participants were summated to determine the self-esteem of each of them and
utilized in analysis as a continuous variable. The data obtained from the respondent hospital records include
duration of stay in the hospital and the sex of the baby. The data were analyzed using Statistical Package for
the Social Sciences Software (Version 16). Descriptive and inferential statistics was used for the analysis. The p
value of less than 0.05 was accepted as significant.
Results
A total of 100 women were interviewed. Table 1 shows the socio-demographic characteristics of the
respondents. The age of the respondents ranged between 18 and 47 with a mean of 29.9 years (SD5.3).
Majority were married (84%) and in monogamous family settings. Most were Christians (87%), had formal
education (98%) and Yoruba (69%) while about 30% were unemployed. The number of children they have
previously ranged between 1 and 9 with a greater portion (70%) between 1 and 3 children. The sex of the baby
at last delivery was evenly distributed between both sexes. Duration of hospital stay vary from 1-10 days with
majority (69%) between 1-3 days.
The respondents were required to subjectively rate the level of support they get from their family on a scale of 110. Majority (59%) rated their family support highly (8-10). The mean satisfaction score as measured by the
LOPSS for the entire sample was 97.98 (SD-15.31), with a median of 99 ranging between 60 and 139. The
mean self-esteem score on the Rosenberg scale was 30.15 (SD-6.59) with a median of 31 ranging between 2
and 40.
The factors that were found to significantly influence satisfaction scores included education, with a greater
number of those with tertiary education having scores equal to or greater than the median satisfaction score
(Table 2). The mothers with less than 4 children were found to have better satisfaction than mothers with 4 or
more children (p=0.029). Also, higher level of satisfaction was seen in respondents that were either employed or
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were earning higher income. Similarly, respondents whose partners were either employed or earn higher
income reported higher satisfaction.
The satisfaction scores were also correlated with self-esteem scores and the duration of hospital stay (Table 3).
A significantly large correlation (r=0.536, p=<0.001) was found between patient satisfaction and self-esteem
with high levels of self-esteem associated with higher levels of patient satisfaction. The correlation between
patient satisfaction and the number of days spent on admission was small but significant (r=0.207, p=0.039)
with longer duration of hospital stay associated with higher levels of patient satisfaction,
To test our null hypothesis linear regression was carried out. The result of the multivariate linear regression is
presented in table 4. The prediction model was statistically significant, F(7, 92) = 7.563, p <.001, and accounted
for approximately 36% of the variance of self-esteem (R2 = ..365, Adjusted R2 = .317). Patient satisfaction was
primarily predicted by higher levels of self-esteem and longer duration of hospital stay. The raw and
standardized regression (Beta) coefficients of the predictors together with their significant levels are shown. Our
hypothesis was hereby rejected and the alternative accepted.
Discussion
This study explored the relationship between self-esteem and patient satisfaction. Self-esteem was found to be
significantly positively influenced patients satisfaction. Some other findings are also worthy of note. For instance
formal education was found to be associated with a higher level of patient satisfaction among this study
population. This finding has also been reported by previous researchers (Liu &Wang, 2007). This could be
because educated patients are more likely to communicate more effectively with the nursing staff. They are
more likely to express themselves (needs and expectations) and understand the process of care which could
possibly account for their higher level of satisfaction with nursing care.
Mothers whose last confinement was their 1st -3rd, were also more satisfied with nursing care than their
counterparts whose children were their 4th or more. This might be because currently in Nigeria, the idea of
family planning is being widely encouraged. Part of the strategy is to encourage the family to limit the number of
their children to a maximum of 4. When a mother has four or more children, there is a possibility of their not
being as excited or enthusiastic as their counterparts who are just having their 1st - 3rd child. Also, being
employed or having a higher level of income was also associated with a higher level of satisfaction. These two
variables see to be interrelated as economic security for the participants. Mothers who have enough means to
cater for their needs will ultimately be able to meet the requirements of the hospital for their care. They will be
able to meet the demands and financial obligation associated with procurement of all that is needed for a safe
delivery and care. Same explanation could also be given for the higher level of satisfaction that was found
among those whose partners had higher level of income or were gainfully employed.
The mean self esteem score of this sample was much higher than that which was reported by a previous study
sample from the same hospital (Loto, et al., 2010; Loto, et al., 2009). This might be as a result of the difference
in the methodology with regards to the time of recruitment of the sample. The sample for this study was
recruited 6 weeks after their discharge at the immunization clinic. The atmosphere of the immunization is
characterized by much rejoicing and entertainment in the hospital due to the fact that the mothers are generally
happy with their babies. This could possibly influence the mothers' perception of their self-worth.
The significant positive correlation between self-esteem and patient satisfaction indicate that the individual's
stable sense of self-worth or worthiness is related to patient satisfaction. There is a possibility that individuals
who are more secured financially and have things seemingly to be favourable for them will have a better or
higher perception of their self-worth. This is indicative of the need for the nursing staff to ensure that they
consider approaching their patients with the intent of boosting the self-esteem and confidence of these patients
in other to improve their satisfaction with nursing care. This has been previously recommended by a previous
study (Loto, et al., 2009). The significance of self-esteem was further emphasized by the linear regression which
revealed self-esteem of the respondents as a significant predictor of patient satisfaction within this study
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population. It could be inferred that all the other factors that were found to significantly influence patient
satisfaction within this population could also influence self-esteem. Hence one can reasonably opine that
measures tailored towards enhancing the self-esteem of clients within the population could possibly positively
influence their satisfaction with nursing care.
To the best of our knowledge, this is the first study in our environment to explore the relationship between
patient satisfaction and self-esteem. The limitations of our study includes the fact that the study was conducted
only in one center which suggests that the results might not be generalizable to all populations.
Conclusion
The self-esteem of women influences their satisfaction with the nursing care in the maternity unit during their
confinement. Focusing on the improvement of the patient's self-esteem will go a long way to ensure a positive
change in the satisfaction of patients with nursing care. More studies are still needed to further explore our
findings.
References
References
Al-Mailam, F. (2005). The effect of nursing care on overall patient satisfaction and its predictive value on
returnto-provider behavior: a survey study. . Quality and Management of Health Care, 14(2), 116-120.
Amyx, D., Mowen, J. C., &Hamm, R. (2000). Patient Satisfaction: A Matter of Choice. Journal of Services
Marketing, 14(7), 557-572.
An, J.-Y., An, K., O'Connor, L., &Wexler, S. (2008). Life Satisfaction, Self-Esteem, and Perceived Health Status
Among Elder Korean Women: Focus on Living Arrangements. Journal of Transcultural Nursing, 19(2), 151-160.
doi: 10.1177/1043659607313070
Carruth, A. K., Tate, U. S., Moffat, B. S., &Hill, K. (1997). Reciprocity, emotional well-being, and family
functioning as determinants of family satisfaction in caregivers of elderly patients. Nursing Research, 46(2), 93100.
Colman, A. M. (Ed.). (2003). Oxford Dictionary of Psychology. New York: Oxford University Press.
Cottrell, B. H., &Grubbs, L. M. (1994). Women's satisfaction with couplet care nursing compared to traditional
postpartum care with rooming-in. Res Nurs Health, 17(6), 401-409.
Davies, E., Shaller, D., Edgman-Levitan, S., Safran, D. G., Oftedahl, G., &Sakowski, J. (2008). Evaluating the
use of a modified CAHPS survey to support improvements in patient-centred care: lessons from a quality
improvement collaborative. Health Expectations, 11(2), 160-176.
Decker, P. J. (1999). The hidden competencies of healthcare: why self-esteem, accountability, and
professionalism may affect hospital customer satisfaction scores. Hosp Top, 77(1), 14-26. doi:
10.1080/00185869909596515
Dzomeku, M. V. (2011). Maternal satisfaction with care during labour: A case study of the Mampong-Ashanti
district hospital maternity unit in Ghana. International Journal of Nursing and Midwifery, 3(3), 30-34.
Ehiemere, I. O., Nwaneri, A., Iheanacho, P., &Akpati, V. (2011). Helpless patients' satisfaction with quality of
nursing care in Federal tertiary hospitals, Enugu, Southeast, Nigeria. International Journal of Nursing and
Midwifery, 3(1), 6-13.
Enabudoso, E., &Isara, A. R. (2011). Determinants of Patient Satisfaction after Cesarean Delivery at a
University Teaching Hospital in Nigeria International Journal of Gynaecology and Obstetrics, 114(3), 251-254.
Johansson, P., Oleni, M., &Fridlund, B. (2002). Patient satisfaction with nursing care in the context of health
care: a literature study. Scand J Caring Sei, 16(4), 337-344.
La Monica, E. L., Oberst, M. T., Madea, A. R., &Wolf, R. M. (1986). Development of a Patient Satisfaction
Scale. Research in Nursing and Health, 9, 43-50.
Liu, Y., &Wang, G. (2007). Inpatient satisfaction with nursing care, and factors influencing satisfaction in a
teaching hospital in China. Journal of Nursing Care Quality 22(3), 266-271.
15 September 2016

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Loto, O. M., Adewuya, A. O., Ajenifuja, O. K., Orji, E. O., Ayandiran, E. O., Owolabi, A. T., &Ade-Ojo, I. P.
(2010). Cesarean section in relation to self-esteem and parenting among new mothers in southwestern Nigeria.
Acta Obsttrica Gynaecologica Scandinavica, 89(1), 35-38.
Loto, O. M., Adewuya, A. O., Ajenifuja, O. K., Orji, E. O., Owolabi, A. T., &Ogunniyi, S. O. (2009). The effect of
caesarean section on self-esteem amongst primiparous women in South-Western Nigeria: A case-control study.
The Journal of Maternal-Fetal and Neonatal Medicine, 22(9), 765-769.
Munro, B. H., Jacobsen, B. S., &Brooten, D. A. (1994). Re-examination of the Psychometric Characteristics of
the La Monica-Oberst Patient Satisfaction Scale. Research in Nursing and Health, 17, 119-125.
Rafii, F., Hajinezhad, M. E., &Haghani, H. (2009). Nurse caring in Iran and its relationship with patient
satisfaction. Australian Journal of Advanced Nursinq, 26(2).
Seguin, L., Themen, R., Champagne, F., &Larouche, D. (1989). The components of women's satisfaction with
maternity care. Birth, 16(3), 109-113.
Wan, H., Hu, S., Thobaben, M., Hou, Y., &Yin, T. (2011). Continuous primary nursing care increases
satisfaction with nursing care and reduces postpartum problems for hospitalized pregnant women. Contemp
Nurse, 37(2), 149-159. doi: 10.5172/conu.2011.37.2.149
Weissman, J. S., Schneider, E. C., Weingart, S. N., M., E. A., David-Kasdan, J., &Feibelmann, S. (2008).
Comparing Patient-Reported Hospital Adverse Events with Medical Record Review: Do Patients Know
Something That Hospitals Do Not? Annal of Internal Medicine, 149(2), 100-108.
Zeidan, Z. A., Idris, A. M., &Bhairy, N. M. (2011). Satisfaction among pregnant women towards antenatal care in
public and private care clinics in Khartoum. Khartoum Medical Journal, 4(2), 590-595.
AuthorAffiliation
Adekunle B. Eegunranti
Department of Psychiatry
Ladoke Akintola University of Technology
Teaching Hospital
Osogbo.
Olanrewaju I. Ibigbami
Department of Psychiatry
State Specialist Hospital, Asubiaro
Osogbo, Osun State, Nigeria
Corresponding Email: oibigbami@yahoo.com
Adesanmi Akinsulore
Department of Mental Health
College of Health Sciences
Obafemi Awolowo University, Ile-Ife, Nigeria
Samuel A. Olowookere
Department of Community Health
College of Health Sciences
Obafemi Awolowo University, Ile-Ife, Nigeria
Adebukola Ibigbami
Wesley Guild Hospital, Ilesa, Osun State, Nigeria
Subject: Patients; Studies; Patient satisfaction; Self esteem; Customer satisfaction;
Publication title: Ife Psychologia
Volume: 23

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Issue: 1
Pages: 176-183
Number of pages: 8
Publication year: 2015
Publication date: Mar 2015
Year: 2015
Publisher: IFE Centre for Psychological Studies
Place of publication: Ile-Ife
Country of publication: Nigeria
Publication subject: Psychology
ISSN: 11171421
Source type: Scholarly Journals
Language of publication: English
Document type: Feature
Document feature: References Tables
ProQuest document ID: 1726788580
Document URL: http://search.proquest.com/docview/1726788580?accountid=25704
Copyright: Copyright IFE Centre for Psychological Studies Mar 2015
Last updated: 2015-10-31
Database: Social Science Database

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