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Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met. / School of Nursing

Intensive care units (ICUs) emerged across Canada during the early 1960s, significantly contributing to the image of Western hospitals as places of scientific advancement that predominated over much of the twentieth century. ICUs rapidly became both a resource intensive and expensive type of care as the number and size of units increased to accommodate diverse patient populations and treatment options. Nurses enabled the formation and growth of ICUs through their constant presence and skilled care. There has been limited research, however, regarding the historical development of Canadian ICUs, the relationships between nurses and other personnel in such units, how they developed an identity as ICU nurses, or how ICU nursing became a specialty practice. Situated within the broader histories of hospitals, healthcare, and nursing, this study uses a social history approach to examine nurses’ experiences within Canadian ICUs between 1960 and 2002. Berger and Luckmann’s Social Construction of Reality provided a lens for analysis and interpretation of oral histories, photographs, professional literature of the time period under study, and both archival and organizational records. This thesis argues that ICU nurses’ relationships with one another, in the context of a technologically complex environment, socially constructed their knowledge and skill acquisition, their socialization as ICU nurses, and the development of a specialized body of knowledge that ultimately led to formal recognition of ICU nursing as a specialty in Canada.

The Intensive Care Unit (ICU) is a unit that manages the most critically ill, complex and unstable patients in the hospital. As a result, the ICU is characterised by a high degree of clinical and organisational unpredictability and uncertainty. In Western discourse, uncertainty is often portrayed as problematic, and as something to be controlled and reduced. This research challenges this discourse by examining the productive relationship between certainty and uncertainty in the work practices of ICU clinicians, and subsequently, how intensive care clinicians utilise uncertainty to construct order in a highly unpredictable work environment. To understand how order can coexist with ICU’s unremitting unpredictability, complexity theory is used to frame this investigation. This research engaged an emergent, interventionist methodology, deploying multiple methods. Using ethnography, video-ethnography, and video-reflexivity, this research relied on clinicians’ participation in the construction and analysis of video data of the ICU clinicians’ work practices. This resulted in clinician-led practice change in the ICU. This research suggests that methods need to be deployed adaptively in order to deal with the complexity of ICU, in addition to the moment-to-moment emergence of events that require the researcher’s own work plans to be revisited. Moreover, in order to gain traction with, and understand highly complex and changeable environments, the researcher needs to also enter and experience uncertainty herself. Using complexity theory as its analytical tool, this research shows an inseparability of uncertainty and certainty in the ICU which is labeled ‘un/certainty’. Three main conclusions emerge from this research. First, un/certainty predominates in intensive care, and due to this, ordering is a process rather than a final state. Un/certainty is at the heart of the adaptive practices that clinicians enact. These adaptive practices are highly interconnected to the changes that the ICU environment may require, and thus produce a dynamic order in the unit. Second, the researcher herself, in order to come to terms with the complexity and un/certainty of the ICU environment must also enter un/certainty in order to gain traction with the ICU environment: unpredictability and complexity cannot be studied from a neat and disengaged distance. Third, the presence of un/certainty in the ICU can be significant and enabling rather than disabling for clinicians in their ongoing pursuit of dynamically ordering practice. The contribution of un/certainty to frontline practice is as a central driver to managing change and complexity. Therefore it should be positively revalued by health services researchers, policy makers and clinicians alike.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser + 1 bil.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Växjö : Växjö universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.