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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 3  |  Page : 141-146

Nursing staff perception about the quality of health-care system in primary health-care centers in Beni Suef Governorate


1 Master Student at Faculty of Nursing, Cairo University, Egypt
2 Assistant Prof. of Nursing Administration, Faculty of Nursing, Cairo University, Egypt
3 Assistant Prof. of Nursing Administration, Faculty of Nursing, Beni-Suef University, Egypt

Date of Submission02-Mar-2020
Date of Decision15-Mar-2020
Date of Acceptance17-Mar-2020
Date of Web Publication20-Aug-2020

Correspondence Address:
Fatma N Fahim
Nurse Specialist at Beni-Suef Health Directorate, Beni-Suef, 62511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_4_20

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  Abstract 


Introduction Quality of health care is an important component of long-term socioeconomic development. Health-care systems are thus encountering an increased demand for high quality care while the resources they can command from society are decreasing. Primary health care (PHC) aims to prevent disease or injury before it ever occurs.
Aim This study aimed to assess nurses’ perception about the quality of health-care system in PHC centers in Beni Suef Governorate.
Research design Descriptive cross-sectional design was used.
Participants and methods The study was conducted at PHC centers in Beni Suef Governorate. Randomly selected65 (PHC) centers excluding maternal child health centers. The total sample size was 455 nurses of different categories of nursing staff working in the selected 65 PHC centers in Beni Suef Governorate. A self-administered questionnaire for nurses’ perception about the quality of health-care system in PHC centers was adopted from Hassan (2013).
Results The highest mean score of nurses’ perception (37.92±6.26) was teamwork formation and its type. The lowest mean score (12.06±2.51) was elements of quality. More than half (51.9%) of the participants had a high perception level of quality health-care system, Also, more than one-quarter (35.8%) of them had moderate perception level while a minority (12.3%) of them had low perception level.
Conclusion There was high and moderate perception among most nursing staff in PHC centers.
Recommendations Reinforce nurses’ perception toward the quality of health-care system by applying Egyptian guidelines and standards for PHC centers.

Keywords: Keywords, nursing staff, perception, primary health care, quality of care


How to cite this article:
Fahim FN, Abd Elwahab EA, El-Guindy HA. Nursing staff perception about the quality of health-care system in primary health-care centers in Beni Suef Governorate. Egypt Nurs J 2019;16:141-6

How to cite this URL:
Fahim FN, Abd Elwahab EA, El-Guindy HA. Nursing staff perception about the quality of health-care system in primary health-care centers in Beni Suef Governorate. Egypt Nurs J [serial online] 2019 [cited 2020 Oct 20];16:141-6. Available from: http://www.enj.eg.net/text.asp?2019/16/3/141/292494




  Introduction Top


Quality of care is the responsibility of everyone involved in health care. It is defined as the degree of patient-care services which increases the probability of the desired outcomes, and reduces the probability of undesired outcomes; also quality is described in nursing as the process for the attainment of the highest degree of excellence in the delivery of patient care (Potter and Perry, 2018).

Several professional organizations further define the standards of nursing practice as an authoritative statement that describes a level of care or performance that are common to the profession of nursing against which actual performance can be compared. They provide a guide to the knowledge, skills, judgment, and attitude that are needed to practice safely (American Association of Critical Care Nurses, Clinical Practice Standard, 2016; Finkelman, 2018).

As standards vary among institutions, employees must know the standard expected of them in their organization. Employees must be aware that their performance will be measured in terms of their ability to meet established standards. A nurse’s performance can be measured only when it can be compared with a pre-existing standard. Identifying information relevant to the criteria is the second step in a quality control process. Such information is determined by reviewing the current research or existing evidence (Clark, 2017).

Health-care systems are thus encountering an increased demand for high-quality care while the resources they can command from the society are decreasing. This factor has led to increasing health-care costs and cost containment pressures ‘Health care systems must deliver more with less, amidst profound changes in the populations that need to be served, and changing health care priorities.’ At the same time, there is increasing evidence that health-care systems in the United States as well as in Europe suffer from poor quality and safety. Several studies in the US indicate that as many as 100 000 patients die every year due to poor safety and bad execution in the American System (IOM, 2000). More recently, using a literature review of four studies in the USA, where the Global Trigger Tool 1 was used to identify the patient (Mohrman et al., 2014). According to the Central Agency for Public Mobilization and Egyptian Statistics, 56 300 persons per 950 000 persons (population) die every year. Moreover, according to Beni-Suef Health-Care Directorate Statistical Report,790 patients per 98 748 patients die every year due to poor safety and bad execution (Beni-Suef Health Care Directorate Statistical Report, 2020).

Quality improvement in health care is made up of diverse models and methods, aiming to improve health care, making care more effective and efficient, and to increase safety for those being served can have a positive impact on patients, health-care providers, and organizations. (American Association of Critical Care Nurses, Clinical Practice Standard, 2016).

Primary health care (PHC) aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease, altering unhealthy or unsafe behaviors that can lead to disease and increasing resistance to disease or injury should an exposure occur. Primary prevention of bronchial asthma requires reduction or avoidance of people exposure to common risk factors. The PHC seeks to increase equity in the health sector, reducing public spending, increasing universal coverage of health services, reducing deficiencies in health status, and, above all, involving people in the field of health promotion and delivery of care (Le Mone and Burke, 2017).

Nurses play a vital role in the delivery of PHC services. They require specific knowledge and skills to function effectively in PHC centers, focusing on preventive measures such as immunizations or screenings, promotive, curative as well as rehabilitative care planning with a clinical team, administering medications, providing patient education and initial evaluation of new symptoms, ongoing care for chronic diseases, conducting delegated nursing visits, providing care, understanding orders of a licensed independent practitioner, and providing telephone advice and triage and also coordinating the referral process (Finkelman, 2018).


  Significance of the study Top


Since 2004 when the quality system was introduced in PHC centers in Beni Suef city, it was observed by the Ministry of Health supervisors that at the beginning of the quality system, there was high resistance among nurses toward this system as it increases their work load and consumes much of their time without much benefit from their point of views.

According to a study conducted in Egypt by Hassan et al. (2013), it has been concluded that health-care providers’ level of awareness about a quality health-care system in accredited centers was higher than their peers in the nonaccredited centers and these differences were statistically significant as no studies examined the nurse’s perception about the quality of health-care system in all PHC centers in Beni Suef Governorate. Therefore, the present study will investigate that issue in order to improve the negative perception about quality system and enhance the positive one, as a proceeding effort to introduce quality system in all PHC centers.


  Aim Top


The aim of the study was to assess nurse’s perception about the quality of health-care system in PHC centers in Beni Suef Governorate.

Research question

What are the nurses’ perceptions about quality of health-care system in PHC centers in Beni Suef Governorate?

Research design

Descriptive cross-sectional design was utilized to achieve the aim of the current study.

Setting

The study was conducted in PHC centers in Beni Suef Governorate. These centers composed of 185 centers in rural and urban regions, including seven maternal child health centers. A randomly selected 65 centers were recruited excluding (maternal child health) centers which represent 35% of the total centers.

The services provided by all these centers include free, paid medical care and health insurance services, first aid in emergency rooms, ongoing care for chronic diseases, and preventive services.

Participants

The total sample size included 455 nurses of different categories of nursing staff working in the selected 65 PHC centers in Beni Suef Governorate, who had at least 5 years of experience in PHC centers, and who complied with the inclusion criteria, which are available at the time of the study in the selected centers.

Data collection tools

Self-administered questionnaire for nursing staff to assess their perception about the quality of health-care system in PHC centers. This tool is adopted from Hassan et al. (2013); it was developed and used at Benha PHC centers. The tool consists of two parts:

The first part was concerned with nurses’ personal data.

The second part composed of questions to assess nurses’ perception about the quality of health-care system in PHC centers. It included 63 items. To evaluate the participants’ responses, the five-point Likert scale ranged from strongly disagree, disagree, not sure, agree, and strongly agree, 1, 2, 3, 4, and 5, respectively.

Validity

Tool validity was performed by Hassan et al. (2013).

Reliability

Reliability was calculated as follows: hospital policies=0.935, administrative supervision=0.923, nursing performance evaluation system=0.787, staff development=0.658, work environment=0.648, and motivation=0.533.

Pilot study

A pilot study was carried out on 10% of the study sample in order to test the feasibility of the tool used, clarity of questions and time consumed for filling the questionnaire sheet. The researcher handed over the questionnaire sheet to 45 nurses. The time of filling the questionnaire sheet was about 20 min. No modification was done after the pilot study; the pilot sample was included in the study sample.

Data collection procedure

Formal approval was obtained through official letters from health affair and the manager of nursing administration at Beni Suef Governorate. Also, official permission was granted from the general medical manager and head nurse of each of the selected PHC centers was sought before start of the study. Meeting with the head nurse of each unit was held to explain the aim, nature, and the significance of the study for guidance of the suitable time of meeting the nurses. However aim of the study and its significance was explained to each nurse to obtain her acceptance to participate in the study, assured complete confidentiality of the obtained information, and the study would not affect in any way of the quality of the work or jeopardize patient care.

Data were collected through individual interview with each nurse during their work and explain the aim of the study to accept their participation as well as organizing and arranging the nurses’ participation according to unit needs and activates the investigator to hand over the questionnaire sheets individually to participant nurses in their unit. The average number of nurses per unit was seven; the number of interviewed nurses was between three and four nurses per unit, two units per day, three rounds per week. The time spent to fill the questionnaires was 30 min. The rate of return was 100%. The data collection lasted for 10 months from June 2015 to March 2016.

Ethical considerations

Initial approval was granted from the Research Ethics Committee at the Faculty of Nursing Cairo University to conduct the study. A written consent was obtained from all nurses who agree to be participating in this study and the purpose and nature of the study and its importance was explained to them. Final approval was granted from the Research Ethics Committee of the Faculty of Nursing Cairo University after the end of data collection.


  Results Top


Frequency distribution of the sample according to the personal data showed that more than one-third (37.4%) of participant’s ages were between 31 and 40 years. More than one-third of the participants (38.7%) had more than 20 years of experience. The majority of the participants (93.6%) had a bachelor’s degree in nursing. The majority of the participants (87%) were married. More than half of the participants (51.2%) were not attending training courses. More than half of participants (54.1%) had past experiences related to the source of information about quality health-care systems ([Table 1]).
Table 1 Frequency distribution of the sample according to personal data (n=455)

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Frequency distribution of the nurses according to their perception levels showed that more than half (51.9%) of the participants had a high perception level of quality health-care system, Also, more than one-quarter (12.3%) of them had moderate perception level while a minority (35.8%) of them had low perception level ([Table 2]).
Table 2 Frequency distribution of the nurses, according to their perception levels (n=455)

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Mean scores and mean percent of nurse’s perception about the quality of health-care system in PHC centers showed that the highest mean score (37.92±6.26) about quality health care systems was regarding the team work formation and its types. The lowest mean (12.06±2.51) score was elements of quality; the total mean percent was 79.11% ([Table 3]).
Table 3 Mean scores and mean percent of nurse’s perception about the quality of health-care system in primary health care centers (n=455)

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The correlation between nurses’ perception regarding quality of the health-care system subscales and total scores has shown that there is a highly positive statistically significant relationship between nurses’ perception of quality of health-care system subscales and total scores ([Table 4]).
Table 4 Correlation matrix of nurses’ perception regarding the quality of health-care system subscales and total scores

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  Discussion Top


Of the nurses who participated in the present study more than one-third were between 31 and 40 years of age and had more than 20 years of experience. Long years of experience could be due to their interest to work in PHC centers as there is no long shift and no critical cases; however, the work required them to help each other; also all of them were living in the same setting of work so it is suitable for their social life. In the same line, this result is in agreement with Afifi et al. (2016) who in their text Quality Caring in Nursing and Health Systems: Implications for Clinicians, Educators, and Leaders observed that the majority of the participants’ ages ranged from 25 to 40 years.

The majority of the participants were married and had a bachelor’s degree in nursing. More than half of the participants were not attending training courses and their source of information was the past experiences. This might be due to the inadequate number of training courses about quality health care from the Directorate of Health, even training done is held in the Directorate of Health which is far, time-consuming and money-consuming. Congruent with a study by Mohammed et al. (2017) who studied awareness from A Nurse’s Perspective: an Insight from Upper Egypt: finding reveled that that more than two thirds of the participants have not attended any training program and work depending on their personal abilities from the past experience.

On the other hand, Hassan et al. (2013) conducted a study entitled ‘Health care providers awareness about quality system and its relation to quality of their performance at maternal and child health centers at Benha Governorate,’ that all health-care providers attended training about quality health care.

Regarding the level of nurses’ perception, the current study reported that the highest mean score was in the area of teamwork formation and its types. From the investigator’s point of view, this may be due to their long experience with each other; in addition, most of the participants had a bachelor’s degree in nursing, living in the same village, and have the same tradition. Besides, the nature of work in PHC centers require from them that they work with each other. In the same line, this result is in congruence with the study by Rosen et al. (2018), who studied teamwork in health care: Key discoveries: enabling safer, high-quality care and found that more than two-thirds of the participants reported that team formulation is the first and the most important task for health-care administrators that enable them to achieve hospital goals. On the contrary, Hassan et al. (2013) found in their study that half of the nurses were not aware about items and types of quality team.

The current study also showed that the lowest mean score was in elements of quality. In the same line, Hassan et al. (2013) found that one-third of the participants were not aware about elements of quality.

This result is in agreement with the study by Paddock et al., (2017), who reported that more than two-thirds of the participants agreed on information management and presence of quality improvement programs. Moreover, this result is supported by Shabbir et al. (2016) who studied measuring patients’ health-care service quality perceptions, satisfaction, and loyalty in public and private sector hospitals and indicated the importance of evaluation for improving the quality of health care.

Regarding the correlation between nurses’ perception regarding quality of the health-care system subscales and total scores, the this study showed that there is a highly positive, statistically significant relationship between nurses’ perception of the quality of the health-care system subscales and total scores. In the same line, this study is congruent with the study by Paddock et al. (2017) who studied the association between process-based quality indicators and mortality in patients with substance-use disorders and indicated the presence of significant correlation between quality subitems scores and total quality scores.


  Conclusion Top


The study arrived at the high perception among nursing staff about a quality health-care system in Beni Suef Governorate. There is a highly positive, statistically significant correlation between nurses’ perception of quality of the health-care system subscales and total scores.

Recommendations

In the light of the findings of this study arrived at the following recommendations:
  1. Reinforce nurses’ perception toward quality by applying Egyptian guidelines and standards for PHC centers.
  2. Develop a procedure manual based on quality nursing care standards for PHC centers and ensure close supervision for its implementation.
[14]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Afifi RM, Qulali A, El Raggal AA (2016). The healthcare safety environment: Egyptian health practitioners’ attitude to medical errors.  Back to cited text no. 1
    
2.
American Association of Critical Care Nurses, Clinical Practice Standard, 2016, October 13, 2018. Available at: http://www.aacn.org. [Accessed October 5, 2018].  Back to cited text no. 2
    
3.
Beni-Suef Health Care Directorate Statistical Report (2020). Beni-Suef health directorate, Egypt.  Back to cited text no. 3
    
4.
Clark C (2017). Creative nursing leaderships and management. Boston: Jones and Bartlett Publishers; pp. 385–387.  Back to cited text no. 4
    
5.
Finkelman A (2018). Leadership and Management for Nurses: Core Competencies for Quality Care. 2nd ed. XX: Pearson; 185.  Back to cited text no. 5
    
6.
Hassan M, Abo El Soud A, Abd El Wahab E, Abd El Aziz L (2013).Health care providers awareness about quality system nd its relation to quality of their performance at maternal and child helth centers [doctorate thesis]. Benha: Fculty of Nursing, Benha University.  Back to cited text no. 6
    
7.
Institute of Medicine (2000). Institute of medicine measures of quality improvement. Am J Prev Med 22:199–206.  Back to cited text no. 7
    
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Le Mone P, Burke K (2017). Medical Surgical Nursing; Critical Thinking in Client Care. 4th ed. NJ: Pearson, Prentice Hall. 11.  Back to cited text no. 8
    
9.
Mohammed ES, Seedhom AE, Ghazawy ER (2017). Awareness and practice of patient rights from a patient perspective: an insight from Upper Egypt. Int J Qual Health Care 30:145–151.  Back to cited text no. 9
    
10.
Mohrman B, Aagaard B, Nielsen K, Steen B (2014). Action research and interactive research, quality health care challenges. Maastricht: Shaker Publishing.  Back to cited text no. 10
    
11.
Paddock SM, Hepner KA, Hudson T, Ounpraseuth S, Schrader AM, Sullivan G, Watkins KE (2017). Association between process based quality indicators and mortality for patients with substance use disorders. J Stud Alcohol Drugs 78: 588–596.  Back to cited text no. 11
    
12.
Potter PA, Perry AG (2018). Fundamental of Nursing. 7th ed. Mosby: Elsevier; 293.  Back to cited text no. 12
    
13.
Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D et al. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol 73:433.  Back to cited text no. 13
    
14.
Shabbir A, Malik SA, Malik SA (2016). Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan. Int J Qual Reliab Manag 33:538–557.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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