PERCEIVED QUALITY OF CARE AND PATIENT SATISFACTION WITH NURSING SERVICES AMONG ELDERLY PATIENTS IN THE MEDICAL WARDS OF UNTH

1.1 Background of the Study Today’s nurses play multiple roles including caregiver, advocate, educator, communicator, critical thinker, manager, researcher, and rehabilitation specialist. Among these responsibilities, ensuring patient satisfaction with nursing care is vital. This is benched marked by The World Health Organization (WHO, 2019) and the International Council of Nurses (ICN, 2006) who emphasize that the ultimate goal in healthcare is for every individual to achieve optimal health, and one of the key ways to reach this goal is by providing high-quality care. Similarly, the Norwegian Ministry of Health and Care Services (2021), in its national action plan on health and social care, highlights the necessity of patient-centered care and the development of systems that allow patients to regularly participate in evaluating the quality of care they receive. The concept of "quality of care" is multifaceted and varies depending on cultural contexts, individual or societal viewpoints, and whether the focus is on process, structure, or outcome. Additionally, its meaning can differ depending on whether it is defined by patients, relatives, healthcare workers, administrators, or policymakers, and even by the time period in which it is being considered (Donabedian, 2021). Scholars generally agree that "quality of care" is a complex term (Crow et al., 2025). Florence Nightingale, in the mid-1800s, was the first to systematically organize and structure nursing care. Though her observations should be viewed within the context of her time, her contributions remain relevant in modern hospitals around the world. In her book Notes on Nursing (2021), she shared her insights on what defines excellent nursing care. For her, nursing was about placing the patient in the best possible condition for nature to heal. She placed a strong emphasis on individualized patient attention, meticulously documenting both the care provided and the patients’ reactions during her time with wounded soldiers in the Crimean War. While she may not have explicitly used the term "quality," her writings clearly aim to advocate for superior patient care, especially from the nurse’s perspective. Patient satisfaction, a concept that gained prominence during the consumer movement of the 1960s, has both practical and political relevance in contemporary healthcare. It is frequently used as a tool to examine patient experiences within the healthcare system (Danielsen, Garratt, Bjertnes, & Pettersen, 2017). However, there is still no universally agreed-upon definition of the term (Merkouris, Ifantopoulos, Lanara, & Lemonidou, 2019). Several theoretical perspectives offer differing interpretations of satisfaction, such as the discrepancy theory, fulfillment theory, equity theory (Lawler, 2019), and the value-expectancy model (Linder-Pelz, 2020). Larsson, Wilde, and Starrin (2021) proposed an alternative framework that views patient satisfaction as an emotional response. This model was further developed by Larsson and Wilde-Larsson (2021). Lawler (2019) also categorized satisfaction studies based on their underlying theoretical assumptions. Essentially, satisfaction during hospitalization reflects a balance between the patient’s expectations and their actual experiences with nursing care. It is widely accepted that patient satisfaction is not only a core measure of patient-centered care but also an important metric for evaluating the overall quality of healthcare. Research consistently shows a strong link between satisfaction with nursing care and overall patient satisfaction. According to Erickson (2019), this satisfaction is largely based on how patients cognitively and emotionally assess the gap between their expectations and the actual behavior and characteristics displayed by nurses during care delivery. 1.2 Statement of the Problem As people age, they often face physical limitations that prevent them from carrying out basic self-care tasks like bathing, eating, exercising, enjoying leisure, or grooming. These difficulties typically arise due to illness or injury, creating a need for assistance in their day-to-day activities. When individuals are no longer able to meet their own care needs, a "self-care deficit" occurs. According to Johansson (2025), this is precisely where the nursing profession steps in to provide support. Older adults are often unmotivated to make lifestyle changes due to a sense of helplessness. Over time, many come to believe that their efforts are unlikely to change their circumstances, leading them to feel powerless. This feeling intensifies when they become bedridden or incapacitated due to serious illnesses or accidents. In such situations, the patient may have little control or say in the care being delivered, placing a greater responsibility on nurses to ensure that the services provided meet acceptable standards (Laschinger, 2020). Because nurses are the healthcare professionals who interact most closely and frequently with patients, they carry a unique and significant responsibility to deliver safe, high-quality, and compassionate care—especially to elderly individuals who are often more vulnerable. Thus, this study aims to explore how elderly patients in the medical wards of the University of Nigeria Teaching Hospital (UNTH), Ituku, perceive the quality of care they receive and how satisfied they are with nursing care in that setting. 1.3 Objective of the study The general objective of the study is to Perceived Quality of Care and Patient Satisfaction with Nursing Services Among Elderly Patients in the Medical Wards of UNTH Ituku. The specific objective are as follows: 1. To access the quality of care given to the elderly patients by the nurses in UNTH 2, To ascertain the level of satisfaction with nursing care among elderly patients in the medical wards. 3, To determine the hindrances experienced by nurses in rendering quality care to elderly patients. 4, To determine the response of the elderly patients about the care given to them. 1.4 Research hypotheses The following hypothesis have been formulated for the study. HO: There are no hindrances experienced by nurses in rendering quality care to elderly patients. HA: There are hindrances experienced by nurses in rendering quality care to elderly patients. HO: The quality of care given to the elderly patients by the nurses in UNTH is not satisfactory. HA: The quality of care given to the elderly patients by the nurses in UNTH is satisfactory. H0: The response of the elderly patients about the care given to them is negative HA: The response of the elderly patients about the care given to them is positive H0: The level of satisfaction with nursing care among elderly patients in the medical wards is low. HA: The level of satisfaction with nursing care among elderly patients in the medical wards is high. 1.5 Significance of the study This study will examine perceived quality of care and satisfaction with nursing care among elderly patients in medical wards of UNTH Ituku. Hence the study will be significant in the following ways. Health care management board: this study will be significant to the health care management board as it will expose them to the need of improving quality of nursing care, nurses need to know what factors influence patient satisfaction. Nursing care plays the key role in providing satisfaction in this arena. Academia: this study will be significant to the academic community as it will contribute to the existing literature on quality of care and satisfaction with nursing care among elderly patients in medical wards. 1.6 Scope of the study This study will access the quality of care given to the elderly patients by the nurses in UNTH. The study will also ascertain the level of satisfaction with nursing care among elderly patients in the medical wards. The study will further determine the hindrances experienced by nurses in rendering quality care to elderly patients. Lastly, the study will determine the response of the elderly patients about the care given to them. Hence this study will be delimited to UNTH Ituku, 30 elderly patients in UNTH will be the respondent for the study in Enugu state. 1.7 Definition of terms Quality: the standard of something as measured against other things of a similar kind; the degree of excellence of something Care: the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something. Nursing care; assistance provided for the health care needs of sick or disabled individuals, by or under the direction of licensed nursing personnel Medical wards: a hospital ward in which patients are being treated by drugs rather than surgery.