ICU
Construction of a parent satisfaction instrument: Perceptions of pediatric intensive care nurses and physicians

https://doi.org/10.1016/j.jcrc.2008.06.002Get rights and content

Abstract

Purpose

The aims of the study were (1) to identify parental satisfaction items through the opinions of pediatric intensive care unit (PICU) nurses and physicians, (2) to reach consensus on the identified items, and (3) to apply factor analysis to evaluate the items and domains toward a PICU parental satisfaction instrument.

Materials and Methods

Pediatric intensive care unit nurses and physicians working in 8 university hospitals in the Netherlands participated. A 2-round Delphi method was completed. Confirmatory factor analysis was performed on the satisfaction items and domains.

Results

Three hundred two nurses and 62 physicians participated in the Delphi study, and 269 (76%) completed 2 questionnaire rounds. In Delphi round 2, 14 of the 78 items had a mean of less than 8.0 (range, 1 [low importance] to 10 [high importance]). The interquartile range of all domains decreased by almost half, and only 10 satisfaction items had a heterogeneity of less than 70%. Structure determination revealed that 4 satisfaction items needed to be excluded. Out of 74 satisfaction items, 72 showed factor loadings greater than 0.50. The reliability estimates, Cronbach α, for the 6 domains varied from 0.74 to 0.92.

Conclusions

Priorities in parental satisfaction measures are identified. The findings are fundamental in the development of a PICU parental satisfaction instrument.

Introduction

Hospitals are increasingly pressured by patient organizations and health care authorities to document the delivered care. Demanding accountability for increasing health care costs, the public in general looks closely into efficiency and effectiveness of hospital care. In the past decades, quality of care received much attention in health care. However, the American Institute of Medicine identified 6 areas in today's health care system that are still below standard: safety, effectiveness, timeliness, patient-centeredness, efficiency, and equity [1]. The challenge is to place patients in the center of care and to empower them toward more autonomy. Most children in the pediatric intensive care unit (PICU) are unable to express their needs and experiences. In this perspective, the experiences of parents are recognized to be fundamental for quality of care [2], [3]. Principles of family-centered care mandate incorporation of parents in daily care [4]. Subsequently, measures of parent satisfaction may be a valuable tool in establishing a family-centered driven care model that would benefit quality of care.

Although the interest in patient satisfaction with care started a few decades ago, the current debate concerns methodological issues and the value of satisfaction data for quality improvement [5]. In addition, patient satisfaction data should enable us to identify core strategies improving care delivery [6], [7].

In pediatric critical care, the long-established and accepted evaluation measures refer to clinical parameters such as mortality, length of stay, and severity of illness. A measure like parental satisfaction is not yet widely recognized in medicine, but is gradually being accepted as a quality performance indicator [8], [9]. Yet, a satisfaction performance indicator requires profound development before the data are recognized and accepted as valid and reliable [10]. Despite the existence of many patient satisfaction surveys, only 1 validated parent satisfaction questionnaire is known specifically for PICU [10]. The current general satisfaction questionnaires may not be relevant to PICU because parents might experience difficulties in separating the specific PICU care within the general satisfaction items.

All 8 PICUs in the Netherlands identified parental satisfaction as an important quality performance indicator. A multiphase project was designed to establish a reliable and validated parent satisfaction instrument. The initial phase was directed toward the current available evidence and the perceptions of the health care professionals working in the PICUs. The findings of this phase will be used for further exploration of the parental perceptions on the satisfaction items in the next phase of this multicenter project. Both projects should eventually result in a validated parent satisfaction instrument for the Dutch PICUs.

The main objective of the multicenter study is to develop a parent satisfaction instrument for the PICUs in the Netherlands. Specifically, the objectives of this phase are (1) to assess parental satisfaction measures based on the perceptions of PICU health care professionals, (2) to reach consensus on the satisfaction items for further exploration among a large group of parents, and (3) to perform factor analysis to evaluate the satisfaction items and domains.

Section snippets

Material and methods

We used a multiphase design. The first phase concerned the identification and selection of satisfaction performance indicators to be included in a preliminary questionnaire. The second phase encompassed a 2-round Delphi method (Fig. 1; online electronic version). This method is a technique of systematically consulting a panel of experts and of collecting, evaluating, and tabulating their opinions without bringing them physically together [11], [12]. Its specific characteristics are anonymity,

Results

Of all 520 nurses and physicians invited to participate in the Delphi study, 364 (70%) returned the questionnaire, that is, 302 of 433 (70%) nurses and 62 of 87 (71%) physicians. As 9 questionnaires had been returned anonymously, the second Delphi round involved 355 eligible participants. The overall response was now 269 of 355 (76%), that is, 218 of 293 (74%) nurses and 46 of 62 (74%) physicians. Five were returned anonymously. The demographic characteristics of the health care workers for

Discussion

The objective of this study was to assess the perceptions of Dutch PICU nurses and physicians on satisfaction for the development of a national parent satisfaction instrument. The scores of the satisfaction items in both Delphi rounds were relatively high. To our knowledge, no similar study has been reported, making it difficult to compare the findings. However, from a methodological perspective, our developmental process of the parent satisfaction instrument has some similarities with the

Acknowledgments

The authors acknowledge the nurses and physicians of the PICUs in the Netherlands sharing their expertise and their commitment. Corry van den Hoed-Heerschop and Erwin Ista are gratefully thanked for reviewing the satisfaction items and identifying the domains for the questionnaire. The physicians and nurses of the focus group meetings and those piloting the questionnaire are also recognized for sharing their knowledge. Ko Hagoort is thanked for final editing the paper.

This study was partially

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    The authors have no financial interest or any other conflict of interest to declare.

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