Development of an Instrument to Measure Patient Perception of the Quality of Nursing Care and Related Hospital Services at the National Hospital of Sri Lanka

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      This study aimed to develop and validate an instrument to measure patient perception of quality of nursing care and related hospital services in a tertiary care setting.


      We compiled an instrument with 72 items that patients may perceive as quality of nursing care and related hospital services, following an extensive literature search, discussions with patients and care pro-I viders and a brainstorming session with an expert panel. A cross-sectional study was conducted at the National Hospital of Sri Lanka. A sample (n = 120) of patients stayed in general surgical or medical units responded to the interviewer administered instrument upon discharge. Item analysis and principal component factor analysis were performed to assess validity, and internal consistency was calculated to measure reliability.


      Of the 72 items, 18 had greater than 20% of responses as ‘not relevant’. A further 11 items were eliminated since item-total correlations were less than .2. Factor analysis was performed on remaining 43 items which resulted in 36 items classifying into eight factors accounting for 71% of the variation. Factor loadings in the final solution after Varimax rotation were interpersonal aspects (.68–.85), efficiency (.62–.79), competency (.66–.68), comfort (.60–.84), physical environment (.65–.82), cleanliness (.81–.85), personalized information (.76–.83), and general instructions (.61–.78). The instrument had high Internal consistency (Cronbach's alpha = .91).


      We developed a comprehensive, reliable and valid, 36-item instrument that may be used to measure patient perception of quality of nursing care in tertiary care settings.

      Key Words


        • Bacon C.T.
        • Mark B.
        Organizational effects on patient satisfaction in hospital medical-surgical units.
        The Journal of Nursing Administration. 2009; 39: 220-227
        • Bryant F.B.
        • Yarnold P.R.
        Principal components analysis and exploratory and confirmatory factor analysis.
        in: Grimm L.G. Yarnold R.R. Reading and understanding multivariale statistics. American Psychological Association, Washington, DC1995: 99-136
        • Davis B.
        • Kiesel C.K.
        • McFarland I.
        • Collard A.
        • Costón K.
        • Keeton A.
        Evaluating instruments for quality: testing convergent validity of the consumer emergency care satisfaction scale.
        Journal of Nursing Care Quality. 2005; 20: 364-368
        • de Silva K.S.
        • Dharmage S.C.
        Assessment of client satisfaction in a paediatric ward.
        The Ceylon Medical Journal. 1996; 41: 148-150
        • Donabedian A.
        The quality of care. How can it be assessed?.
        The Journal of the American Medical Association. 1988; 260: 1743-1748
        • Dozier A.M.
        • Kitzman H.I.
        • Ingersoll G.L.
        • Holmberg S.
        • Schultz A.W.
        Development of an instrument to measure patient perception of the quality of nursing care.
        Research in Nursing & Health. 2001; 24: 506-517
        • Gonzalez-Valentin A.
        • Padin-Lopez S.
        • de Ramon-Garrido E.
        Patient satisfaction with nursing care in a regional university hospital in southern Spain.
        Journal of Nursing Care Quality. 2005; 20: 63-72
        • Gunathunga M.W.
        Measuring mental health: a new tool and its usefulness.
        Journal of College of Community Physicians of Sri Lanka. 2010; 15: 13-23
        • Han C.H.
        • Connolly P.M.
        • Canham D.
        Measuring patient satisfaction as an outcome of nursing care at a teaching hospital of southern Taiwan.
        Journal of Nursing Care Quality. 2003; 18: 143-150
        • Larrabee J.H.
        • Bolden L.
        Defining patient perceived quality of nursing care.
        Journal of Nursing Care Quality. 2001; 16: 34-60
        • Laschinger H.
        • Hall L.
        • Pedersen C.
        • Almost J.
        A psychometric analysis of the patient satisfaction with nursing care quality questionnaire: an actionable approach to measuring patient satisfaction.
        Journal of Nursing Care Quality. 2005; 20: 220-230
        • Lynn M.
        • McMillen B.
        • Sidani S.
        Understanding and measuring patients' assessment of the quality of nursing care.
        Nursing Research. 2007; 56: 159-166
        • Parasuraman A.
        • Zeithaml V.
        • Berry L.
        A conceptual model of service quality and its implications for future research.
        Journal of Marketing. 1988; 49: 41-49
        • Ross C.
        • Steward C.
        • Sinacore J.
        The importance of patient preferences in the measurement of health care satisfaction.
        Medical Care. 1993; 31: 1138-1149
        • Sandin Bojo A.K.E.
        • Hall-Lord M.L.
        • Axelsson O.
        • Uden G.
        • Wilde Larsson B.
        Midwifery care: development of an instrument to measure quality based on the World Health Organization's classification of care in normal birth.
        Journal of Clinical Nursing. 2004; 13: 75-83
        • Senarath U.
        • Fernando D.N.
        • Rodrigo I.
        Factors determining client satisfaction with hospital-based perinatal care in Sri Lanka.
        Tropical Medicine & International Health. 2006; 11: 1442-1451
        • Siztia J.
        • Wood N.
        Patient satisfaction: a review of issues and concepts.
        Social Science & Medicine. 1997; 45: 1829-1843
        • Uzun O.
        Patient satisfaction with nursing care at a university hospital in Turkey.
        Journal of Nursing Care Quality. 2001; 16: 24-33
        • Ware J.E.
        • Snyder M.K.
        • Wright R.
        • Davies A.R.
        Defining and measuring patient satisfaction with medical care.
        Evaluation & Programme Planning. 1983; 6: 247-263
        • Yildiz Z.
        • Erdoğmuş S.
        Measuring patient satisfaction of the quality of health care: a study of hospitals in Turkey.
        Journal of Medical Systems. 2004; 28: 581-589
        • Young G.
        • Meterko M.
        • Desai K.
        Patient satisfaction with hospital care: effects of demographic and institutional characteristics.
        Medical Care. 2000; 38: 325-334