Evaluating Patient Satisfaction With Nurse-Led Wound Care Services

Introduction

Chronic non-healing wounds can affect quality of life, cause serious events such as limb amputations or even premature deaths [1], and present a substantial economic burden on society and the healthcare system [2,3]. An evaluation of the clinical and economic burden associated with wound care in the tropics revealed a significant rise between 2013 and 2017, with a healthcare cost per patient ranging from $15,789 to $17,761 across the wound categories [4]. Similarly, a study conducted in Saudi Arabia revealed that hospitalisations and surgical treatments significantly raise the entire cost of healthcare when treating diabetic foot ulcers, with high direct medical expenditures [5]. Wound healing is affected by a complex interaction of factors, including physiological, psychosocial, and wound characteristics, and this emphasises the need for a multifactorial approach to detecting and intervening with ulcers [6]. Despite the recommendations of clinical practice standards, there exist deviations in surgical wound care practices, which vary from one clinical setting to another [7]. There remains a gap between implementing an effective referral system and the actual practice, despite paramount literature on the importance of wound care services and multidisciplinary team care [8]. Studies indicate that patients’ knowledge, attitudes, and habits regarding wound care are not up to par, and that awareness is essential to bridge the gap between educational level and knowledge and beliefs [9,10]. As well as comprehensive pain assessment and cost-effective care, nurse-led wound care clinics can provide improved education and better social support to maximise the level of care for people with chronic wounds [11]. Wound care clinics support general practitioners in treating wounds [12], have high patient satisfaction scores, and result in decreased ED visits [13]. International studies have demonstrated positive perceptions of nurse-practitioner-led wound care [14-16]. Specialist wound clinics with trained wound care nurses (WCN) provide appropriate care and referral based on the wound care system [17], while the WCNs themselves benefit from a demanding but

rewarding role influenced by the environment and challenges presented by individuals with pressure ulcers [18]. Furthermore, studies indicate that clinicians in wound care clinics face practical difficulties and challenges [19,20], and one study recommended testing and evaluating the efficacy of services in nurse-led clinics [21]. The literature emphasises the importance of evaluating services and client satisfaction as a way of measuring the efficacy of any health service, and to develop awareness of where improvements can be made [22]. It should also be remembered that patients’ perceptions and views may differ according to their medical complexity and the specific type of wound; it is thus necessary to understand the level of satisfaction of a particular cohort of beneficiaries with the specific services they receive[23]. The importance of in-hospital wound care clinics in responding to patient needs is well established in the literature. The concept of nurse-led wound care clinics arose from the increasing incidence of chronic wounds, with a significant proportion of patients being treated in the tertiary healthcare setting, and the economic implication of such services. In order to enhance the services of these wound care clinics, it is essential to understand the beneficiaries’ perception of such services. Thus, this study aims to examine the satisfaction of patients with nurse-led wound care clinics.

Methodology

Study design

This study utilised a cross-sectional, descriptive design and was carried out from September 2022 until October 2023.

Setting and participants

Participants were recruited from King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. This is a 1000-bed facility, incorporating multiple hospitals and centres, and providing healthcare services, including wound care, to the majority of Riyadh’s population. Wound care and management in the facility is overseen by a nurse-led service utilising a multidisciplinary approach. The service is guided by policies and procedures, based on evidence-based practice, which are regularly updated to ensure the highest standards of care. A dedicated team of nine nurses, each with a specific job description and scope of practice, carries out this specialised service. The team’s expertise and collaborative efforts ensure that patients receive

comprehensive and tailored wound care management, promoting optimal healing outcomes and patient well-being. The study’s target population comprised patients of the clinic who received wound care treatment. Of these, 160 participants were selected using the convenience sampling method. Participation was voluntary, and both inpatient and outpatient recipients of the service were invited to participate. Participants were considered eligible if they were beneficiaries of the wound care services, were willing to participate in the survey, and were fluent in Arabic. Patients who were very sick and unable to respond to the survey were excluded from the study.

Sample size

Another study was used as a reference to estimate the required sample size [21]; assuming that 67.9% of patients were satisfied with the interprofessional approach to wound care among a patient population of 750 in a year, a sample size of 160 produces a two- sided 95% confidence interval with a width equal to 0.15 when the sample proportion is 0.679.

Data collection

Data were collected using a client satisfaction questionnaire (CSQ-8) [25] with good psychometric properties. This tool has excellent internal reliability, with Cronbach’s alpha ranging from 0.83 to 0.93 [26] and a validity factor of 0.8 on average ― a significant correlation with other instruments measuring satisfaction [27]. It includes questions about the causes of wounds, referral sources, and sociodemographic details such as age, gender, marital status, nature of patient service (inpatient/outpatient), educational level, and work status. Participants received detailed instructions on completing the CSQ-8 questionnaire, consent was obtained, and the data were collected by a research assistant. Permission was obtained to use the questionnaire for this study. This research was approved by the Institutional Review Board (IRB), log number 22-452.

Data analysis

Data were cleaned and verified prior to analysis, to guarantee a legitimate dataset. Thereafter, descriptive labels were assigned to the numbered response options for each of the CSQ8 questions, to facilitate interpretation of the results. For instance, the response options for the first question, which asks participants to assess the level of service, were

as follows: 1-Poor, 2-Fair, 3-Good, and 4-Excellent. This procedure was repeated for each question, ensuring that the rank order was upheld. For instance, the four possible answers to question 8 on the CSQ-8 are 1-No, absolutely not; 2-No, I don’t think so; 3-Yes, I think so; 4-Definitely, yes. Thus, all questions have the same rank order, with response option 1 being the least favourable, and response option 4 being the most favourable, despite differences in verbal descriptors. The authors utilised percentages to portray the CSQ-8 results according to the four degrees of satisfaction, since they could not find such uniformity in any other data presentation techniques. Data were analysed using the Statistical Package for the Social Sciences (IBM SPSS Statistics 20). Descriptive statistics (means, standard deviation, and

frequencies) were used to summarise the participants’ sociodemographic characteristics as well as their responses to the eight questions measuring their satisfaction with the wound care services. A 0.05 significance threshold was used to determine whether mean differences between subgroups were significant for each CSQ-8 question.

Results

Sociodemographic characteristics

Of the 160 participants, 25% were older than 60 years and 16% were younger than 30 years, as illustrated in Table 1. Females represented 52%, the majority of respondents were married (68%), 31% had a college or university degree, and 52% were unemployed. 80% of participants received inpatient wound care services.

Satisfaction with Wound Care Services Characteristic Description N (%) How would you rate the quality of service you received?

Poor 6 (3.8) Fair 8 (5.0) Good 51 (31.9) Excellent 95 (59.4) Did you get the kind of service you wanted?

No, I did not 7 (4.4) No, not really 16 (10.0) Yes, generally 56 (35.0) Yes, definitely 81 (50.6) To what extent have our services met your needs?

None of my needs have been met 6 (3.8) Only a few of my needs have been met 23 (14.4) Most of my needs have been met 46 (28.8) Almost all of my needs have been met 85 (53.1) If a friend were in need of similar help, would you recommend our services to him or her?

No, definitely not 6 (3.8) No, I don’t think so 9 (5.6) Yes, I think so 34 (21.3) Yes, definitely 111 (69.4) How satisfied are you with the amount of help you received?

Quite dissatisfied 5 (3.1) Indifferent or mildly dissatisfied 10 (6.3) Mostly satisfied 49 (30.6) Very satisfied 96 (60.0) Have the services you received helped you to deal more effectively with your problem?

No, they really didn’t help 9 (5.6) No, they seemed to make things worse 3 (1.9) Yes, they helped somewhat 45 (28.1) Yes, they helped a great deal 103 (64.4) Overall, how satisfied are you with the service you received?

Quite dissatisfied 4 (2.5) Indifferent or mildly dissatisfied 8 (5.0) Mostly satisfied 47 (29.4) Very satisfied 101 (63.1) If you were to seek help again, would you make use of our services?

Discussion

This cross-sectional descriptive study examined patient satisfaction with wound care services in Riyadh’s tertiary healthcare setting, and found that most respondents rated the quality of service as

Table 2. Satisfaction with wound care services

No, definitely not 6 (3.8) No, I don’t think so 11 (6.9) Yes, I think so 41 (25.6) Yes, definitely 102 (63.8)

“excellent” and were very satisfied with the service they received overall. These findings are similar to those of many other studies measuring patient satisfaction with wound care services in different healthcare settings. For example, a study conducted

in Qatar [24] showed that patients were generally satisfied with wound care services delivered by an interprofessional team; as assessed by the CSQ-8, their results revealed favourable satisfaction ratings ranging from 67.9% to 90.1% [24]. Our findings are also consistent with a study in which most patients reported high satisfaction with wound care from a nurse-led clinic [13,23]. Most of the participants in our study reported receiving the kind of service they wanted and were very satisfied with the level of help they received in dealing with their problem; these responses indicate a positive experience with the clinic. This finding is in alignment with a study that explored the experiences and satisfaction of patients receiving wound care consultations for acute wounds, which found that participants were satisfied with the accessibility and comprehensiveness of the wound service delivery, and that they trusted the healthcare providers [28]. These results also support the findings of international studies, which showed a positive experience with NP-led wound care [14- 16]. Most of our respondents reported that the services they received helped them “a great deal” or “somewhat” in dealing with their problem, and would recommend these services to friends who needed help. This is similar to the findings of other studies [15] that reported improved wound healing and high levels of client satisfaction. Furthermore, it agrees with a study [29] that revealed a good level of patient satisfaction with health services in hospitals. Yet another study confirmed the quality of services provided by nurse-led clinics, finding that entrusting specialised nurses with chronic wound care produced better results than standard practice with regard to wound healing, repair and regeneration, duration of treatment, and readmission rates [30]. On the contrary, one study reported that, although the majority were satisfied, a few participants did not experience satisfactory wound healing and moved on to another service [31]. Furthermore, our results are similar to those of other studies assessing the patient and family experience of attending a nurse-led clinic for chronic wounds; the findings highlighted client satisfaction and physical accessibility as benefits of the clinic [11], as well as high-level patient satisfaction [13]. Other studies revealed positive experiences of nurse practitioner care [14] and nurse-led multidisciplinary team care [16].

Providing optimum patient outcomes (wound healing) and positive patient experiences is challenging [20]. Despite a positive patient experience with the nurse-led wound care clinic, nurses demonstrated in a study that wound care management involves decision-making that requires multidisciplinary and holistic approaches, tempered with knowledge about the patient and the expertise of others [32]. The potential expansion of the wound clinic model of care in general practices is centred around enhancing nurses’ readiness, confidence, and capability in managing wounds and improving patient outcomes [33,34]. Thus, wound care nurses must strive for improvement in their aseptic technique, hand hygiene, pain assessment, patient education, and documentation [35,36]. Given that this study was conducted in a hospital, the findings could not fully reflect the conditions at other facilities providing wound care services. Thus, these results cannot be immediately applied to other situations. Moreover, the researcher used a cross- sectional study design, which may be subject to recall bias, as well as a structured questionnaire to collect data, which limits participants to preset responses to given questions, without the option to explain further. As a result, further information could not be collected about why some patients felt their needs had not been met.

Conclusion

In conclusion, patient satisfaction with the wound care services was high, although there remains weakness in certain areas. This should be investigated in greater detail so that actions may be taken to improve the quality of healthcare services through appropriate policies and strategies. Further research is suggested in different settings to assess patient satisfaction on a larger scale.

Declaration of Interests

The authors have no conflicts of interest to disclose.