Taiwan Nurse Practitioner Care Model (TNPCM) is the nurse practitioners in collaboration with the auxiliary physician-in-charge to provide continuity and integration of the patient's medical care. Many hospitals apply this care model to replace the shortage of resident physician. However, at present, we don’t know whether the quality of medical service of the nurse practitioners meets the expectation of the patients and how the patients feel about the care model. Therefore, the purposes of this study were to investigate the patients’ expectations, the perceptions of the actual care provided and measure the gap between patients’ expectations and perceptions in the TNPCM.
Methods:
This study adopted a cross-sectional, descriptive correlational design. The PZB service quality model was used to develop the modified Service Quality (SERVQUAL) scale. The structured questionnaire included patients’ demographic and disease-related characteristics of patients. The survey was conducted from 1st June to 30th November 2016. Finally, 200 patients were included in this study. The construct validity was examined and the data was analyzed by descriptive analysis, independent t-test, paired t-test, one-way ANOVA and Pearson’s correlation.
Results:
The modified SERVQUAL scale had a good construct validity with 5 factors which could explain 66.76% variances and the Cronbach's Alpha value was 0.96. Major patients were male(56.5%) with a mean age of 57 years old. The frequency of nurse practitioners visit was more than twice a day, about 70%. The most of patients’ admission type was from the emergency department(59.5%). In addition, we also recorded the average score of patients’ Symptom Severity Scale(40.70), Length of Stay(11.79 days), Charlson Comorbidity Index(4.32) and Karnofsky Performance Status(78.23).
The results of the study showed that patients had an overall high expectation (M=6.46) on the quality of medical service in the TNPCM, and the average scores of the patients’ perceptions (M=5.77) were above the middle level of the scale. Comparing the five medical service quality dimensions, patients had the highest expectation of reliability, and the lowest perception in responsiveness. Differences between expectations and perceptions among the most of the dimensions were significant (p < 0.001). The largest gap between expectations and perceptions was reliability (M=1.99) and the smallest was tangible (M=0.08).
The results revealed that there was a significant association between patients’ symptom severity with mean gap of the responsiveness and assurance dimensions (p < 0.01), indicating those patients with higher symptom severity had higher level of gaps in domains of responsiveness and assurance.
Conclusion:
There is still a gap in quality of medical care perceived by the patients, especially in the dimension of reliability. Overall, the results of the study suggest the service quality dimensions of reliability, responsiveness and assurance in the nurse practitioners care model should be firstly improved by performing following suggestions: (1). Nurse practitioners should enhance the abilities in assessment and management for major diseases’ sign and symptoms, particularly in fatigue, pain, fever and comorbidities. (2). Nurse practitioners need to explain the details of the disease progression, medical procedure and precautions to the patient or his families before the examination or treatment to reduce the patient's fear and anxiety. (3). Nurse practitioners should cultivate the patient-centered with evidence-based healthcare so that the patients will be more trust on nurse practitioners. Then, that will help nurse practitioners to build trust and credibility with patients and improve the continuity and integrated quality of medical care.