Analysis of Nurse Services Quality on Patient Satisfaction Class II Hospital

ABSTRACT


INTRODUCTION
Medical services, medical rehabilitation, and care services are among the health services provided to patients in hospitals (Manzoor et al., 2019;Fatima et al., 2018).These services are provided through emergency departments, outpatient departments, and inpatient departments.The function of nurses in hospital patient care cannot be separated.Nurses play an essential role in the implementation of nursing care, as well as overseeing or managing the condition and progress of patients undergoing treatment.A nurse is someone who cares for and looks after other individuals who have patient health problems for 24 hours a day, seven days a week, or who provides the longest service to patients than other health workers (Kim et al., 2020).Given the critical importance of nursing personnel, it is crucial to consider nurses' demands as professional human resources in carrying out their primary responsibilities and activities, namely delivering optimal nursing services.Despite the fact that many patients complain, the quality of health care in a service must always be able to please patients (Ladds et al., 2020;Karaca & Durna, 2019).The ability of a hospital to provide services that are in accordance with health professional standards and acceptable to patients is usually referred to as the quality of health services.The level of patient satisfaction after receiving health services is indicated by the quality of health services; if the quality of health services is good, the patient is satisfied; if the quality of health services is poor, the patient is dissatisfied with health services, particularly nursing services (Usak et al., 2020).
Nursing services are primarily concerned with patient happiness.Customers who are pleased are incredibly precious assets since they will continue to utilize the service of their choice, but patients who are dissatisfied will tell twice as many people about their unpleasant experience.
Customer satisfaction has emerged as a key idea in corporate and healthcare management discourse.Patient happiness is a key consideration when it comes to delivering health care in hospitals (Amporfro et al., 2021;Asamrew et al., 2020).Patients anticipate pleasant, courteous, friendly, and comfortable encounters with nurses, hence nurse services (providers) in hospitals must have competence, credentials, and a positive attitude.According to Supranto that service quality in hospitals is centred on efforts to meet customer needs and desires, as well as delivery accuracy to balance customer expectations (Will et al., 2019).
Recent worldwide study on the degree of patient satisfaction with nursing care is uncommon.Nursing services in the United Kingdom (UK) were analysed through a National Health Service (NHS) survey of inpatients, which revealed that patients were dissatisfied with nursing services because they did not have time to complete pain management (7%), missed treatments and procedures (11%), less time to educate patients and families (52%), and comfort when talking to patients (65%).More than a quarter of nurses (27%) do not have enough time to finish three or four types of patient care.According to Robertson the level of patient satisfaction with inpatient services is 55% (down by 5% in 2016), emergency services are 52%, dental services are 57%, and social care is 23%, based on the results of the National Health Service (NHS) survey in England, Scotland, and Wales from 1983 to 2017.According to Persolia research of inpatients at the Italian Slovenian Hospital, the degree of patient satisfaction regarding nurses spending time in nursing services to patients with the lowest proportion of 7.3% and the maximum proportion of 54.2%, and the highest non-care services 59%.
A similar study in Africa, one of which was conducted by Nkwinda, concluded that the highest level of patient satisfaction was found in the dimension of trust (90.6%), and the lowest level of patient satisfaction was found in the dimension of health education delivered to patients due to busy work (37.4%;M=1.87; SD=1.710) in African Malawi Hospital.Mahlich did a study in ASIA in Japan, and 89% of 500 rheumatoid arthritis patients reported being happy with healthcare services, with 72% coming from the statement of suffering feeling severe sadness.Shan Discovered that around 24% of patients expressed dissatisfaction with inpatient care at the Heilongjiang Provincial Hospital in a study of 1,200 patients (27 units from the health sector and 35 from the non-health sector).A large proportion of satisfaction utilizing patient subjects with emergency health situations might lead the emergence of disparities in satisfaction levels amongst individuals (Martinez et al., 2018;Trumello et al., 2020).Furthermore, socioeconomic variations might result in dramatically differing levels of pleasure.
Hospitals, as change agents, are supposed to deliver exceptional patient care (Davies et al., 2019;Patel et al., 2022).As a result, it is critical to assess patient satisfaction.The rules for measuring patient satisfaction can be guided by the Minister of Administrative Reform's Decree No. KEP/25/M.PAN/2/2004 concerning General Guidelines for Compiling the Community Satisfaction Index, the Service Unit of Government Agencies, which is useful for understanding the weaknesses or shortcomings of each element in public administration, knowing the performance of service delivery, as a material for determining policies and efforts needs to be done, knowing Public Health Sciences (IKM) as a whole and spurring positive competition between implementing units.
Customer satisfaction can provide several benefits (Sitio & Ali, 2019), including: the consumer-company relationship becomes harmonious, which serves as the foundation for repurchasing services and creating customer loyalty, as well as forming word-of-mouth recommendations, which are, of course, profitable company.Therefore, patient satisfaction is very important in evaluating service quality by measuring the extent to which the patient's response after receiving the service (Javed & Ilyas, 2018).Many factors can influence hospital in patient satisfaction (Hussain et al., 2019).The major variables that determine service quality are dependability, responsiveness, assurance, empathy, and actual proof.Patient character (background) tend to determine several aspects of various aspects of health services that are acceptable/experienced as the basis for determining the size of satisfaction after receiving services.On the characteristic dimensions of hospital patients, it can be developed, among others, diagnosis of disease/type of disease, length of treatment, and treatment class (Reis et al., 2018).
Anggraina's research concludes that the factors of reliability, confidence, assurance, empathy and physical evidence as dimensions of paramedical service quality affect patient satisfaction at the dr.Abdul Rivai Berau District (p0.000<0.05).Based on the research above, it shows that the factors that can affect patient satisfaction include: diagnosis of disease/type of disease, length of treatment, and treatment class, reliability, confidence, assurance, empathy and physical evidence.ICU nurses can spend an average of 469.50 minutes (7.8 hours) every working day providing direct nursing care to patients.The time utilized by nurses to deliver direct nursing services is still within normal limits (6-8 hours), and it requires 13 implementing nurses, 1 head of room, and 4 team leaders per day.The cost of nurses each day in the hospital is related to the time of treatment.Anjarsari's research, explains that the length of time a patient is treated is viewed from two approaches: 1) The illness that the patient is suffering from takes a long time (maybe more than a week); and 2) Patients feel comfortable in undergoing treatment.Patient dissatisfaction due to length of service can occur because it is psychological or administrative (Hofmeyer & Taylor, 2021;Flores-Mir et al., 2018).
One of the private hospitals in Binjai City is the Latersia Binjai Hospital with type C located at Jalan Soekarni Hatta Km 18 No.451-453 Binjai has been established since 2006.Latersia Binjai Hospital has collaborated with the Health Insurance Administration Agency (BPJS) in providing health services to the community.The hospital has provided health services in the form of emergency services serving 24 hours, outpatient services consisting of 12 polyclinic units, inpatient services consisting of Very Important Person (VIP), Intensive Care Unit (ICU), Class one, Class two, Class three, medical support services, medical diagnostics and testing, operating room services (operations), intensive care unit services and general services (one ambulance unit).It is assisted by 10 general practitioners, 10 specialist physicians, 43 nurses, 12 midwives, 8 pharmacists (analysis), 18 nutrition workers, and 8 receptionists to provide health services to patients.The hospital has given numerous services and inpatient programs to aid the patient's healing process (Eldal et al., 2019;Bearnot et al., 2019).
Another thing that is drawn as a research problem is that the Latersia Binjai Hospital is a private hospital that accepts referral patients (BPJS) in Binjai City in fast and quality health services.In accordance with the hospital's slogan, it is stated that they immediately serve quickly and precisely, becoming a "Trauma Centre" that works quickly and is responsive and precise.The results of the performance report of the Latersia Binjai Hospital are based on the Bed Occupancy Ratio (BOR) figure, which is 61% in 2019 in accordance with the Minimum Service Standard, which is 60-80%) with a total of 99 beds.The results of the 2019 nursing committee survey report explained that of the 3,000 medical record files studied, it turned out that 1011 files (33.7%) were filled in completely by health workers, the rest 66.3% incomplete medical records.
Patient satisfaction with nursing services at the Latersia Binjai Hospital can refer to the number of complaints from health service users taken in March 2020.The number of complaints entered in the suggestion box always increases annually in 2019 from 45 people to 52 people in 2020 (15%) specifically about the ability of nurses in providing nursing services.After being investigated through interviews on April 25, 2020 with ten (10) patients who are currently undergoing inpatient treatment, both suffering from acute and chronic infections, the results explain that nurses provide services that are less responsive or slow because there are nurses who are pregnant while working and the workload is not yet available.proportional to the number of patients (the number of nurses is limited).Nurses are less able to spend time providing health education to patients/patients' families, perhaps because nurses have multiple jobs so they are in a hurry to provide services (Hemadeh et al., 2019).Nurses are not friendly in providing health services.There are nurses who are less skilled at doing infusions and take too long to provide information that is too short and incomplete, and when needed or called to the inpatient room, they seem less alert or slow.This is thought to be causing a decrease in hospital inpatient service consumption, particularly in 2018, when there were 1,269 patients (an average of 105 persons per month),

METHODS
This is a quantitative study, therefore an analytical survey using a cross-sectional study technique was used to analyse the variables of nurse service on patient satisfaction in Class III inpatients at Latersia Binjai Hospital in 2021.This study will take place in a Class III inpatient room.Jalan Soekarni Hatta Km 18 No.451-453 Binjai is the address of III Binjai Latersia Hospital.The rationale for selecting the research location is because the first survey findings show that the level of patient satisfaction with nursing services is 75.6%, which falls short of the minimum service standard aim of 90% at Latersia Binjai Hospital.The research was conducted from January to February of 2021.This study's group consisted of 101 patients who were hospitalized Class III in 2021.The sample size was calculated to be as much as 80 class III participants based on the preceding estimates.The researchers utilized a purposive sampling approach after determining the sample size.In this study, questionnaires and checklists were employed as research techniques or instruments.Multiple linear regression analysis was done to examine the factors that impact Multiple linear regression analysis is used to examine the influence of the independent variable on the dependent variable and to forecast the value of the dependent variable based on the independent variable.

Characteristics of the Respondents
The study included 101 participants, who were patients in the second-class inpatient room at Latersia Binjai Hospital in 2021 and had the following characteristics: Guarantees in nursing services in Class III Inpatients of Laterisa Binjai Hospital as it is known that more nurses' guarantees are not good (55.0%) and the rest are good (45.0%).Empathy in nursing services at Class III Inpatients at Laterisa Binjai Hospital as it is known that more nurses' empathy is not good (58.8%) and the rest are good (41.2%).Physical evidence in nursing services at Class III Inpatients at Laterisa Binjai Hospital as it is known that more physical evidence of nurses is not good (66.3%) and the rest are good (33.8%).Patient satisfaction with nurse services in Class III Inpatient Hospital Laterisa Binjai as it is known that more respondents said they were not satisfied (51.2%), the rest said they were satisfied (48.8%).
Table 2 According to table 2, the reliability of nurses and patient satisfaction in the Latersia Binjai Hospital's Class III Inpatient Room shows that of 37 respondents (100%) who stated that the reliability of nurses was not good, the majority felt less satisfied 25 people (67.6%) and the rest are satisfied 12 people (32.4%).The majority of respondents who answered that the nurse's dependability was good were satisfied 27 individuals (62.8%), whereas the remainder were less satisfied 16 people (37.2%).In the Class III Inpatient Room at Latersia Binjai Hospital, the relationship between nurse responsiveness and patient satisfaction revealed that of the 42 respondents (100%) who stated that the nurse's responsiveness was not good, the majority felt less satisfied 28 people (66.7%) and the rest were satisfied 14 people (33.3%).The majority of respondents who reported that the nurse's response was good were satisfied 25 individuals (65.8%), whereas the remainder were less satisfied 13 people (34.2%).
Nurse guarantees and patient satisfaction in the Latersia Binjai Hospital's Class III Inpatient Room revealed that of 44 respondents (100%) who claimed that the nurse's guarantee was not good, the majority felt less content 30 people (68.2%) and the remainder were satisfied 14 people (31.8%).The majority of respondents who thought that the nurse's promise was good were happy 25 individuals (69.4%), while the rest were less content 11 people (30.6%).Nurses' empathy and patient satisfaction in the Latersia Binjai Hospital's Class III Inpatient Room revealed that of 47 respondents (100%) who claimed that nurses' empathy was not excellent, the majority were unhappy 33 individuals (70.2%) and the remainder were satisfied 14 people (31.8%).Physical evidence with patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital revealed that of the 53 respondents (100%) who stated that the physical evidence was not good, the majority felt less satisfied 32 people (60.4%) and the rest were satisfied 21 people (39.6%).The majority of respondents who thought that the fiscal evidence was good were satisfied (18 persons (66.7%)), whereas the remainder were less happy (9 people (33.3%)).

The Effect of Reliability on Patient Satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital
The findings revealed a link between nurse dependability and patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital.This can be seen based on the distribution of patient answers, the majority of which stated that the nurse's reliability was good.The majority of patients stated good for the statement that the nurse who took care of you was able to handle your case properly, the regularity of the nurse's service every day (check pulse, body temperature, administering medication according to time, etc.) patients about the care suggestions, and the patients claimed that they were fairly good for the assertions of nurses' serving skills (injecting, taking blood pressure, etc.).Multivariate analysis also proved that reliability had an effect on satisfaction of class III inpatients (p 0.035 < 0.05).Results This research is in accordance with the theory which explains that the capacity of a corporation to deliver on its promises accurately and consistently is referred to as dependability.Customer expectations must be met, which involves prompt performance, error-free service, a compassionate attitude, and high accuracy.
service quality is as follows: Allowing customers to wait for no obvious cause results in bad evaluations of service quality.According to the author's assumption that reliability affects patient satisfaction because patients feel that the ability and skills of nurses in providing are good enough, but from the aspect of attention they feel that they are still lacking, especially in terms of giving warnings, greetings and smiles that have not been applied.The patient feels that the patient rarely gives touch to the wound or the location area that can cause a sense of pleasure and comfort to reduce the patient's illness (Stöckig et al., 2019).

The Influence of Responsiveness on Patient Satisfaction in Latersia Binjai Hospital's Class III Inpatient Room
Reliability refers to a company's ability to deliver on its promises accurately and consistently.To meet client expectations, you must provide fast service, without errors, with a compassionate attitude, and with high accuracy.One facet of service quality is speed and precision, which entails making customers wait for no apparent reason, which leads to bad judgments of service quality.Multivariate analysis also proved that responsiveness had an effect on satisfaction of class III inpatients (p0.015<0.05).The findings of this study support Parasuraman, Zeithaml, and Berry's assertion that responsiveness is one of the five characteristics of service quality (SERVQUAL).The factor of the quality of nurse services in the inpatient room is particularly important in this study.
Responsiveness is a characteristic that demonstrates the company's ability to respond quickly to consumer requests (Norcross & Wampold, 2018).In a nutshell, it denotes a willingness to assist consumers by offering good and timely service.As for the attributes in the Responsiveness dimension, namely nurses provide fast service, nurses are always ready to provide help the patient, and the nurse can take the time to answer the patient's questions (O'Brien et al., 2019).According to the author's assumption that responsiveness affects patient satisfaction because the patient feels that the nurse's response to complaints of illness is less responsive.If asked about the disease, the nurse only explains the therapy that will be given, but regarding the diagnosis of the disease, it is recommended to ask the doctor who handles it directly.

The Impact of Guarantee on Patient Satisfaction in Latersia Binjai Hospital's Class III Inpatient Room
Multivariate analysis also proves that insurance has an effect on satisfaction of class III inpatients (p 0.032<0.05).In accordance with the theory that explains that assurance Knowledge, civility, and the capacity of firm staff to promote client faith in the organization are examples of certainty.Communication (Communication), credibility (Credibility), security (Security), competence (Competence), and politeness are the components (Courtesy).Acceptance, attentiveness, and accountability are fundamental characteristics of nursing service quality.communication and cooperation as well as aspects of ease of transaction, obtaining information and easy contacting/accessing officers/staff.According to the author's assumption that assurance affects patient satisfaction because the patient is not satisfied with caring for the patient, where when asked the nurse tends to answer briefly without having to ask again whether the patient has understood what was conveyed.This situation makes the patient feel less satisfied with the empathy aspect given by the nurse (Hermann et al., 2019).

Empathy's Influence on Patient Satisfaction in a Class III Inpatient Room at Latersia Binjai Hospital
According to Yahya said one aspect of service quality is caring, how far the company pays attention to the emotions or feelings of consumers, aspects of service quality have a sense of respect and regard for customers in brief, it may be understood as an endeavour to recognize and comprehend unique consumer demands.The space gives enough time for all patients, according to the question qualities in the empathy dimension, nurses pay special attention to each patient, nurses pay attention to patient complaints and nurses understand the needs of each patient.Multivariate analysis also proved that empathy had an effect on satisfaction of class III inpatients (p 0.008<0.05).Relevant to Baharuddin research explains that ability, attitude, appearance, attention affect patient satisfaction, but actions and responsibilities have no effect.
Torry notes that patient satisfaction is determined by the actual waiting time experienced by the patient as well as the speed with which the patient receives care.According to the author's belief, empathy impacts patient satisfaction because the patient perceives nurses as being less serious in giving nursing services since nurses do not want to remain in the Class III inpatient room.When the nurse comes to visit, the nurse can sit and chat with the patient but after being examined, the nurse immediately leaves without explaining what action has just been taken to the patient (Van Belle et al., 2020).

The Influence of Physical Evidence on Patient Satisfaction at Latersia Binjai Hospital's Class III Inpatient Room
Multivariate analysis also proved that physical evidence had an effect on satisfaction of class III inpatients (p 0.031<0.05).The findings of this study support the premise that physical proof is a company's ability to demonstrate its existence to third parties.The look and capabilities of the company's physical buildings and infrastructure, as well as the quality of the surrounding environment, give concrete proof of the service provider's services.This comprises physical facilities (buildings, rooms, and so on), as well as technology (equipment used), One aspect of service quality is the physical environment, which is an aspect that shows the comfort of the environment that consumers will enjoy when they use the product, as well as the appearance of its employees.According to the author's assumption that physical evidence affects patient satisfaction because the existing health facilities available in the inpatient room have not been able to make patients feel satisfied.Where the room does not use Air Conditioner machine like in other classes room and the bathroom looks less clean without complete hand washing facilities.This condition makes patients feel less satisfied with the hospital's current appearance.

CONCLUSION
Based on the findings of the study, it is possible to conclude that there is an effect of reliability on patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital (p 0.0350<05) and that there is an effect of responsiveness on patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital (p 0.0350<05).(p 0.015<0.05),There is empathy for patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital (p 0.032<0.05),assurance has an effect on patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital (p 0.008<0.05),and physical evidence has an effect on patient satisfaction in the Class III Inpatient Room at Latersia Binjai Hospital (p 0.0310<05).

SUGGESTION
Based on the study's findings, the authors provide many recommendations for future improvements, including Hospital Management strengthening oversight of total health services, particularly nurse services in the Inpatient Room.Hospital Management fulfils patient comfort support facilities, especially in Class III rooms.Hospital management seeks to improve the information services desired by patients/patients' families.Future researchers should examine topics relevant to this research with different aspects and a broader discussion.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.Jurnal Perilaku Kesehatan Terpadu Vol 1 No 1 2022

Table 1 .
Shows the frequency distribution of patient characteristics treated in Laterisa Binjai Inpatient Class III Hospital in 2021.According to table 1, the characteristics of the respondents include patients treated in the Class III Inpatient Room at the Laterisa Binjai Hospital in 2021.The remainder were 16 persons aged >50 years (20.0%), and 15 people aged 20-30 years (7.5%).as many as 32 (42. 0%) persons Respondent characteristics based on education of the majority of 58 individuals (72.5%), the remainder of junior high school as many as 14 people (17.5%), and undergraduate as many as 8 people (10.0%).According to occupation, the majority of respondents (54 individuals, or 67.5%) are entrepreneurs, followed by homeowners (12 people, or 15.0%), private workers (11 people, or 13.8%), and government servants (3 people, or 3.8%).The category of reliability is recognized to have more good nurse reliability (53.8%) and less good (46.3%).Responsiveness in nursing services at Inpatient Class III Laterisa Binja Hospital as shown in table 4.4 it is known that more nurses' responsiveness is less good (52.5%) and the rest are good (47.5%).It is known that more guarantees for nurses are not good (55.0%) and the rest say they are good (45.0%).
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