Assessment of Satisfaction with the Quality of Conventional Treatment in Patients with Diagnosed Civilisation Diseases in the Contex of Professional Nurse Competences

Introduction. Satisfaction with the quality of conventional treatment, including nursing care, in the opinion of patients directly translates into levels of satisfaction, whose quantifiable indicators provide information on quality within the healthcare system. Medical team is required to perform their professional duties with best possible results, which becomes particularly meaningful with respect to patients who suffer from cardiovascular diseases, as they have become an increasingly pressing health issue among the senior population.
Aim. Assessment of competences and evaluation of quality of conventional care among the patients treated for cardiovascular diseases.
Material and methods. Research covered a group of 100 patients hospitalized due to ischemic heart disease and arterial hypertension. Author`s questionnaire was used as research tool with the support of anonymous Questionnaire of Patient Satisfaction (QPS).
Results. The patients taking part in the evaluation and assessing the level of medical care as high accounted for 74%. A significant group (77%) expressed satisfaction with treatment or care procedures they underwent. Similarly, a large group of participants (76%) underlined the fact of receiving the information related to their functioning with the disease. Just as highly patients evaluated the level of cooperation (66%) with the medical team and their promptness in bringing help (60%). A statistically significant correlation between the age of the patients and the level of satisfaction with medical care was noted. 
Conclusion. In the opinion of evaluated patients, the general assessment of the quality of care was highly positive. Men and persons from the age group of 66-85 gave a higher assessment of quality of performed medical services. General nursing competences in the educational scope were assessed as being average. Patients with higher education and persons from the age group of 26-45 years of age were harsher critics, more demanding with respect to nurses’ competences.


INTRODUCTION
Currently the '(...) quality of health care measures as a level to which the services for people and for the whole populations elevate the likelihood of obtaining demanded health effects, and which comply with current professional knowledge (...)' [1, p. 162].Nurses play a major role in these activities, and, according to legislation, their presence streamlines the activities thereby increasing the quality of offered services [2,3], defined by Piątek [2005] as: '(...) a degree to which such care, in compliance with current knowledge, increases the probability of obtaining required effects in the health condition of persons/populations, raising their independence and ability for self-care, all the while being complaint with the latest professional knowledge and accepted standards (...)' [1, p. 172].
Patients` satisfaction with received services is fundamental for evaluation of the quality of received care.Satisfaction transpires from meeting the needs and expectations, recognizing subjective feelings and emotions in given circumstances.Assessment of the nurse-patient relation is composed of these elements: fulfilment of expectations and a positive or negative feeling that arises out of the quality of received care in relation to its recipient [4,5,6].Assessment of patients` satisfaction constitutes an important criterion as the nurse is the first person to build a relationship with the patient and it is her attitude that influences the patient`s opinion, which -subsequentlyprovides a valuable and measurable source of information [5,7].Nurse`s tasks arising out of performance of her professional capacity such as providing emotional support, professional approach, precision of performed instrumental procedures, education, level of knowledge, expertise [3,4,5,6,8], are all subject to assessment as well.
A survey on satisfaction with conventional care in patients diagnosed with chronic diseases, such as ischemic heart disease or arterial hypertension, is exceptionally pivotal due to the nature of these disorders as well as due to the fact that a complete recovery from such diseases is impossible.

AIM
The goal of this research is an assessment of satisfaction with health care (including nurse care) in the context of professional competences of a nurse by patients with diagnosed selected civilisation diseases.

MATERIAL AND METHODS
The research was conducted in a group of 100 participants hospitalized at the Department of Internal Diseases with Cardiology and Geriatrics Unit at the Independent Public Health Care Centre in Brzesko and was conducted between 20 April 2015 and 31 May 2015, with the consent of the hospital`s management board, having obtained the consent of the Bioethics Committee of the Jagiellonian University College of Medicine.Forty-nine per cent of the subjects were women and 51% men, from the 28-85 age group (median age being 59.44).The most representative group was composed of subjects from 46 to 65 years of age (53%).The largest group -50 % of the participants -had basic vocational education, with 25% having secondary education and 11% with higher education, thus being the smallest group.Majority of the subjects (56%) were married and a relatively large group consisted of widowed persons (33%), with 11% claiming the single status.A definite majority of the respondents (77%) came from rural areas.In order to assess the patients` satisfaction with the quality of nurse care, a diagnostic survey was used, accompanied by authors` questionnaire and a standardized Questionnaire of Patient Satisfaction (QPS) [9], after obtaining the author`s consent.

RESULTS
A subjective assessment of the quality of care was the subject of this research, which was evaluated by 74% of the respondents as high-level care.The care was evaluated as average by 24%, with only 2% of the participants branding the care 'low quality' .A prevailing group of the patients (over 75%) confirmed that the nurses respected the Patient`s Rights.As little as 4% reported that they felt they were treated like objects.None of the participants of the research reported disrespecting Patient`s Rights.Cooperation of nurses with other medical staff was also assessed as positive.A large group (66%) rated the level of care as high quality care, 31% rated the cooperation as average, with as little as 3% branding it low quality.The participants of the research highly rated the possibility of obtaining support with respect to individual solutions to their health problems (73%) or getting assistance in case of inability to perform a given action unaided (70%).With respect to performed professional procedures, the participants were Nr 4 (53)/2015 57 Beata Ogórek-Tęcza, Natalia Zachara asked about diligent and meticulous performance of care procedures.A high proportion of respondents (77%) gave a positive assessment.However, a large group (20%) underlined the fact that the procedures were performed under a time pressure.More than half of the research participants (57%) confirmed that provided information explaining the purpose of performed procedures was clear and comprehensive, with one third of respondents evaluating the level of provided information as basic.
An important area of professional nurse activities under assessment was providing health education with a view to supplying the patients with advice on how to proceed in case of ischemic heart disease and arterial hypertension.Sixty-four per cent of the respondents rated the provided education as clear, informative and comprehensive, with 31% stating that the advice was not always clear and comprehensive, leaving one respondent without any advice whatsoever.More than 75% of the participants of the research reported that the advice covered civilisation diseases with special focus on risk factors, long-term sequelae and their elimination, while 6% did not receive any information on how to live with the disease they were diagnosed with.In the opinion of 66% of the participants, the nurse involved used teaching materials during the educational process.A negative aspect of implementation of this particular professional function was continuity of education.As many as 81% of the respondents indicated that the nurse did not verify whether the information was understood by the patients and failed to supplement previously provided health education.
Analysis of the research results revealed a significant statistical dependency between the demographic variable and the assessment of the care quality.Respondents from the 66 -85 age group rated higher the received care (p=0.01),followed by those with lower educational background (p=0.05),married and widowed (p=0.01) with those residing in rural areas (p=0.00).
Statistical analysis of the anonymous QPS confirmed the positive results indicating that the quality of provided nurse care was high (high median values -4.00 in the results yielded by individual questions).When including the median into the interpretation, the best assessment was received in the area marked 'V.-General organisation and assessment of the ward' , which confirmed very good rapport between the nursing staff and the visitors (median -5.00).Area 'I.Stay in the Accident and Emergency' , with median value of 3.00 received the lowest evaluation on the scale.Detailed interpretation of the results received by way of QPS is presented in Table 1.
Poor results received in Area I may be related to the fact that the scope of nursing care realized in the accident and emergency zone is limited in time and focused on instrumental procedures.Results received in the remaining areas suggest a high level of satisfaction of the respondents with the provided nursing care.

DISCUSSION
From author`s own research, as well as from research conducted by other authors, a conclusion transpires that the quality of care -as seen by patients -is generally assessed highly.However, when individual tasks are split into specific areas of care that arise out of competences, the evaluation of quality slightly varies.
Many research studies reveal that the quality of nursing care unequivocally correlates with the index of patient`s satisfaction.To create the image of a nurse as a service provider, one needs to take into the account the general approach, values and skills in direct connections between therapeutic and treatment procedures, educational nursing and interpersonal activities consolidated in the areas of competences.
The conducted research reveals that the subjective assessment of the quality of nursing care is highly positive (74%), which is in line with the results achieved by other authors [9,10].Analysis of the results from conducted research confirms the statistical significance with respect to a higher degree of satisfaction with care in the group of 66 -85 years of age male subjects, as well as in the group of patients residing in rural areas, followed by those with lower education.The research studies by Glińska [4,5,10,11], Brodzińska et al. [12], Kózka et al. [13] and Ogórek-Tęcza [14] yielded similar results.
Despite the fact that almost half of the subjects assessed the health education provided by their nurse as clear, informative and comprehensive, it is alarming that a rather large group did not fully share this opinion and 81% of the patients pointed out that the education was not continuous and the scope of acquired knowledge was notin any manner -further verified.Other researchers also underline the existence of negative consequences of rush education and of educating with the use of a limited number of instructional aids, as well as entirely unprofessional approach to educational activities [4,15,16].
In the authors` research, the area of cooperation within the therapeutic team fluctuated around the average and good; (67% of the respondents named the fact that they were able to contact their family and 55% reported the family`s commitment in care and its further continuation after being released from hospital).Glińska`s research yielded similar results and confirmed that 46% of the patients name the cooperation between the nurse and their family, and 42% name the fact that they received advice on how to proceed after being released from the hospital [4].
In the summary of obtained results it must be noted that the assessment of rendered medical services is contingent upon the quality of their performance, as compared with the accepted standards, both in relation to individual social relations between the provider and the receiver of care, and also in the capacity of performed professional roles, and therefore, should result in a permanent and continuous perfection of professional competences.

CONCLUSIONS
General assessment of the quality of nursing care among the patients with diagnosed CVDs and arterial hypertension was positively high (74%).The quality of nursing care was better assessed by men, persons from rural areas and those from 66-85 age group.Tab. 1. Assessment of patient`s satisfaction with the quality of care according to QPS Beata Ogórek-Tęcza, Natalia Zachara A significant factor that influenced a high assessment of quality of care was the treatment of patients as subjects, not objects, which manifested itself in individual solutions to a patient`s problems (73%), assistance in satisfying their needs (70%) and in respect for Patient`s Rights (79%).
A general assessment of nurses` competences in the field of providing health education, according to patients with diagnosed CVDs and arterial hypertension, was at an average level, which created a basis for a continuous and systematic monitoring of provided educational activities.
Patients with higher education and persons from the age group of 26-45 years old were the harsher critics, more demanding with respect to nurses` competences.