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PROJECT TOPIC- A PSYCHOLOGICAL ASSESSMENT OF PATIENT SATISFACTION IN OBSTETRIC ULTRASONOGRAPHY IN EBONYI STATE

PROJECT TOPIC- A PSYCHOLOGICAL ASSESSMENT OF PATIENT SATISFACTION IN OBSTETRIC ULTRASONOGRAPHY IN EBONYI STATE

CHAPTER ONE

INTRODUCTION

Patients are people who seek medical attention in hospitals. Patient’s satisfaction rating of obstetric ultrasonography cannot be understood without defining what obstetric ultrasonography is. This is the application of medical ultrasonography in obstetrics (pregnancy), in which ultrasound is used to visualize the embryo or fetus in its mother’s uterus (womb) (Wikipedia, 2005).

The procedure is often a standard part of prenatal care, as it yields a variety of information regarding the health of the mother and the fetus, as well as regarding the process of pregnancy. The satisfaction of a patient undergoing this procedure is very important, because it is the key component of motivation, (Keller ARCS, 1988). Residents of areas that lack hospitals or obstetric services have lower levels of satisfaction. (Wilcock, 1990).

Studies considering satisfaction of obstetric scanning by sonography, have typically gone beyond investigating pains, though pregnant women may suffer pains that is related to the pregnancy, but the procedure itself is rather painless, to consider situational factors (Ann Poulos and Gwyneth Wewellyn, 2005). These factors include the perception of the centre.

The standardized centre, with a serene environment is observed to increase patient’s satisfaction. Studies reveal that though these centres or hospitals are usually expensive (the serene environment) they tend to have the most trained sonographers. (Blose Lit. 1999). Another factor is privacy. This is regarded as the one of the most important factors (Ann Poulos, 2005).

The explanation given by the sonographer to the patient matters a lot. In some cases, women (pregnant mothers) always like to receive explanation of the state of their unborn child. Though at risk mother is not always disclosed to her rather the professional. This also ranges through series of complications to the child at risk. In this case the explanation is limited and positive.

The couch to which the patient lies for the examination must be conformable as this will increase stability and best patient experience. (Shackel B. Chidsey, Shipley 1969). The process from arrival through departure is very important to be taken care of. The time patients wait contributes to the motivation which will cause them to be satisfied, or increase their level of satisfaction.

That is to say the environmental serenity contributes much to patient’s satisfaction. For instance, music playing, air conditioned room, comfortable waiting room. The presence of a support person is also important. Murray I. 1980). This person(s) include the spouse or a close relative. Patient satisfaction is an important part or aspect of treatment in the medical profession, generally, this is the act or feeling of achievement or having gotten what was desired.

Dissatisfaction can stop women from or deter them from attending the scanning. Satisfaction has been considered most in three research domains: medical, nursing and ergonomics. The medical literature regards comfort more in its absence, for instance, in the rating of discomfort in ultrasonography, with dissatisfaction or discomfort regarded as painless part of a pain.

This brings us to the medical definition of dissatisfaction; which is the subjective unpleasant non-satisfactory feeling that the patient does not interpret as pain. (J. Cox 2005). Enhancement of patient satisfaction is one of the primary goals of the sonographer and the medical doctor as regards explanation. (J. Cox, A. Davidson, 2005). As earlier said that satisfaction is considered most in three research areas, namely; medical, nursing, ergonomics.

The medical literature considers satisfaction more in its absence, for instance, in the assessment of satisfaction or dissatisfaction in obstetric ultrasonography. The nursing domain considers it to be a multi-dimensional construct covering the physical, social, psychospiritual and environmental dimensions. Ergonomics tend to view satisfaction and dissatisfaction mostly in the physical domain, whether they are assessing the comfort of posture, feelings of the

environment generally (Odoh et al, 1989). Current evidence indicates that diagnostic ultrasound is safe for the fetus (unborn child), unlike radiographs, which employs ionizing radiation. However no randomized controlled trails have been undertaken to test for safety of this technology, (Wikipedia 2005).

PROJECT TOPIC- A PSYCHOLOGICAL ASSESSMENT OF PATIENT SATISFACTION IN OBSTETRIC ULTRASONOGRAPHY IN EBONYI STATE

1.2    PURPOSE AND BACKGROUND OF STUDY

Obstetric ultrasonography dissatisfaction rather has the ability to deter women from going for the scanning procedure. Thus recent studies have to focus on satisfaction of the ultrasound procedure.

  1. Purpose of this study is to consider satisfaction from a holistic perspective of the obstetric ultrasonography experience, derived from pregnant women themselves.
  2. This research is also geared to evaluate satisfaction of situational factors like privacy, explanation given by the sonographer, time spent from arrival to departure at the centre, and assess its influence on satisfaction.

Due to technological advancement, obstetric ultrasound has played a significant role in the development of diagnostic ultrasound technology in general. Much technological advances in diagnostic ultrasound technologies are due to the drive to treat better obstetric ultrasound equipment, having well trained sonographers, and also primarily assessing satisfaction and comfort of the patient. (Keefe et al 1994).

  1. Based on safety issues, this research is also carried out to ascertain the number of times patients go for this procedure and to ascertain if this could increase their level of satisfaction.

1.3    IMPORTANCE OF STUDY

  1. This study is important as due to the present reform of the health sectors in Nigeria. It will help to see the areas to which achieving better health care system is lacking.
  2. The study is also important to improve policy on health sectors, and also to see where the practitioners are lacking in terms of better interaction with patients.

As treatment requires both psychological and physical aspect of the patient, satisfaction needs to be rated to guarantee patients’ confidence in the centres and also in the treatment procedure.

  • METHODOLOGY

Ebonyi State has had many ultrasound centres from 2000-2006. A self completion questionnaire was designed and sent to Ebonyi State University Teaching Hospital, Federal Medical Centre Abakaliki, being government institutions and two private establishments namely Jeomedics Ultrasound Centre and Life Scan Centres. Questionnaire was used for data collection due to geographical spread of these centres. It also elicited responses from pregnant women after routine obstetric ultrasonography.

Pilot Study

The questionnaire was piloted on women with previous experience of the procedure. 8 questionnaires sent for the pilot study were all returned. One of the respondents noted that some women may have preference. For either a male or female sonographer, and hence this question was included in the final questionnaire.

Questionnaire Design

The questionnaire was designed to elicit qualitative and quantitative data in order to gather facts and attitudinal information.

100 questionnaires containing 9 questions (both open ended and close ended) which were divided into two sections.

*        Demographic data – Completed by all patient respondents (Part A)

*        Feelings/Perception of factors – completed by all patient respondents (Part B)

Part B was the main research questions. Visual Analogue Scales (VAS) with numbers from 10-100 (in percentage) were used to assess the patients satisfaction rating, explanation provided, privacy and comfort ratings. High scores signify high level of satisfaction. The VAS score was used to characterize the level of satisfaction, privacy, explanation and comfort.

A verbal rating scale (VRS) was used to assess patients rating of centre, thus: High class was scored “1”, middle class “2”, and low class “3”. A 5 point likert scale was used to assess patients perception of time spent while waiting for the procedure. A period of one month was allowed before the data was analysed.

Exclusion Criteria

Criteria for exclusion include married pregnant women, married women who felt sad or excited after being told that they were carrying twins or more (multiple gestation) and women who underwent transvaginal sonography. Women who were told the sex of their babies after scan were excluded, as this affects satisfaction (Adewale 2002).

Data Analysis

Data was analysed by both descriptive and inferential statistics. Spearman rank order correlation was also adopted (Obasi 1999), Spearman’s rank order correlation was used to estimate correlation coefficient between satisfaction rating and other variables. (Comfort etc.). Relationships represented by correlation co-efficient were interpreted according to the guidelines suggested by Portey et al (2000), where an “r” between 0.00 and 0.24 indicates little or no degree of relationship, r between 0.25 and 0.49 indicate moderate relationship and r between 0.75 and 1.00

indicates good excellent degree of relationship. T-test was used to compare satisfaction scores of those that attended private and government owned centres and also to compare the satisfaction scores of those that attended once and more than once. The difference between situational factors that affect satisfaction (comfort, explanation, privacy, time spent and rating of centre), using one way analysed variance for multiple comparisons. Test was two tailed with P < 0.05 indicting statistical significance.

PROJECT TOPIC- A PSYCHOLOGICAL ASSESSMENT OF PATIENT SATISFACTION IN OBSTETRIC ULTRASONOGRAPHY IN EBONYI STATE

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