Exploring patient satisfaction with nursing services in the adult inpatient unit: a study at Pangkal Pinang Hospital, Bangka Belitung Islands

Study design

This study employed a quantitative research design to identify patient satisfaction with the quality of nursing care in the inpatient unit of the RSBT Pangkalpinang Hospital, Indonesia. Our study was approved by the Director of Regional Public Health, Dr. (HC) Ir. Soekarno Bangka Belitung Islands Province (number: 445/901.01/RSU/2024). The study was conducted over a period of three months, from 16 December 2024 to 15 March 2025. This study also explored the sociodemographic characteristics of respondents and evaluated their level of satisfaction with nursing services in an inpatient setting at the RSBT Pangkalpinang Hospital. In this study, patient satisfaction was understood as a multidimensional concept, assessed through the five dimensions of the SERVQUAL model from Parasuraman et al. (1991): tangibility, reliability, responsiveness, assurance, and empathy. Tangibility pertained to the physical environment of healthcare services, including the cleanliness of hospital facilities and modernity of medical equipment. Reliability refers to the consistency and dependability of nursing care, ensuring that services are delivered as promised, and patient needs are met accordingly. Responsiveness evaluated the speed and willingness of the nursing staff to address patient concerns and provide timely assistance. Assurance is associated with nurses’ knowledge, professionalism, and confidence, which fosters a sense of trust in their competence. Empathy reflects the ability of nurses to understand and respond to each patient’s individual needs, offering personalized and compassionate care. These dimensions function as measurable indicators of overall patient satisfaction and establish a comprehensive framework for evaluating the quality of nursing services.

Participants

The study population consisted of adult inpatients at the RSBT Pangkalpinang Hospital, Indonesia. A total of 114 respondents were included in the sample, calculated using the sample estimation formula for analytical correlation studies, as suggested by Das et al. (2016) and Kang (2021). Participants were selected based on specific inclusion criteria, which included patients admitted to the Adult Inpatient Unit of RSBT Pangkalpinang Hospital. Eligible participants were those who had been hospitalized for at least 48 h or had plans for discharge from the inpatient unit. Additionally, only patients treated in Class 1 to Class 3 wards, who could communicate verbally, and who were able to read, write, and speak Indonesian, were considered. Respondents also willingly agreed to participate in the study by signing the informed consent form after the researcher explained the purpose, benefits, and other relevant details of the study. We excluded patients who had no discharge plans after 48 h of treatment or refused to participate in the research. This study employed a purposive sampling technique, which allowed the researcher to intentionally select individuals with relevant experience and insight into the subject of patient satisfaction related to nursing services in inpatient units. This method ensured that the data collected were directly aligned with the research objectives by focusing on patients who had experienced substantial interactions with the nursing staff during their hospital stay.

Questionnaire

This study used a modified survey tool adapted from the original SERVQUAL instrument developed by Parasuraman et al. (1991). The SERVQUAL instrument used in this study has been previously published and is publicly accessible. The refined and reassessed version of the SERVQUAL scale is available at ResearchGate: https://www.researchgate.net/publication/304344168_Refinement_and_reassessment_of_the_SERVQUAL_scale . This version has been used in various academic studies and is available for non-commercial research purposes. The questionnaire was organized into two key parts to capture both respondent characteristics and patient satisfaction regarding the service quality. The first part contained 12 items designed to collect sociodemographic data through multiple choice questions. These items explored factors such as respondents’ age, gender, education, occupation, and other background variables that may influence their experience of care.

The second part focused on evaluating patient satisfaction with nursing services within the inpatient setting. It drew on five dimensions of the SERVQUAL model: Tangibility, Reliability, Responsiveness, Assurance, and Empathy, with each dimension represented by five specific statements, resulting in a total of 25 items. Participants responded to each statement using a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). This format allowed respondents to express their agreement with each item, providing a quantifiable measure of satisfaction with the nursing care received during hospitalization.

Statistical analysis

The degree of patient satisfaction was assessed using a five-point ordinal rating scale with scores ranging from 1 (strongly disagree) to 5 (strongly agree). This type of scale transforms personal opinions into numerical values, allowing researchers to systematically observe patterns and general tendencies in the satisfaction data. To interpret the findings, the analysis included computation of frequencies and proportions, offering a summary of the patients’ responses. Before selecting appropriate statistical methods, a test of data distribution was conducted using the Kolmogorov-Smirnov test, according to the number of respondents, to check for normality. If the results show a normal distribution, parametric tests such as the t-test or analysis of variance (ANOVA) are suitable. These statistical approaches helped uncover not only the general level of satisfaction but also how it differs across various categories of respondents. We used SPSS software to analyze the data and obtain conclusions for this study.

Sociodemographic patient satisfaction with nursing care services

This study was conducted with 114 respondents from inpatient departments. We collected sociodemographic data of the patients to improve their understanding of patient satisfaction. In Table 1, we provide the sociodemographic information of the respondents.

The majority of patients included in this study provided fundamental information regarding patient satisfaction with quality nursing services in inpatient departments. Those showed middle-aged to older adults was dominated our respondents, with those aged 46–60 years (32.26%) and 31–45 years (26.88%) dominating the sample. This age distribution suggests a preference for empathetic and reliable care, particularly among older individuals with complex health needs.

Females represented 56.99% of the population, indicating potential gender-based expectations, particularly toward gender-based expectations of empathy and responsiveness to nursing services. Married patients (48.39%), as the most marital status among respondents, may value assurance and reliability due to support from spouses, while widowed or divorced individuals may rely more heavily on emotional support from nursing staff.

Educational attainment also shaped expectations from 32.26% of patients with higher education, potentially raising the demand for tangibility (e.g., equipment, cleanliness) and assurance. Employment status further influences satisfaction: full-time workers (32.26%) might prioritize responsiveness due to time constraints, whereas unemployed or retired individuals may focus on empathy and assurance.

Living arrangements and income levels provide additional insights for this study. Patients living alone (10.75%) might expect greater emotional support, whereas those with higher incomes (>IDR 5 million) may seek superior tangibility. Conversely, lower-income groups may value reliability and responsiveness owing to limited healthcare options.

Insurance coverage also had a significant effect on patient satisfaction. Most patients were covered by Indonesia’s national health insurance or BPJS Kesehatan (53.76%), emphasizing reliability within the public system, whereas private insurance users might expect higher tangibility. Prior hospital experience (43.01%) and proximity to healthcare facilities (37.63% lived 5–10 km away) also played a role in shaping patient perceptions, particularly regarding assurance and responsiveness.

Analysis of patient satisfaction based on SERVQUAL dimensions

We conducted a statistical test for patient satisfaction using descriptive and comparative analyses. In Table 2, we provide the frequencies and percentages of each item questionnaire on patient satisfaction.

Patient satisfaction was assessed using five dimensions: tangibility, reliability, responsiveness, assurance, and empathy. In the tangibility domain, 45.16% of the patients highlighted hospital cleanliness, 43.01% emphasized building appearance, and 41.94% valued professional staff uniforms. Regarding reliability, 45.16% believed that the hospital fulfilled its promises, and 43.01% agreed on service consistency. In terms of responsiveness, 45.16% were satisfied with timely responses, whereas 40.86% noted delays in reducing waiting times. The assurance domain showed 46.24% confidence in staff professionalism and 44.09% trust in the quality of care. Lastly, empathy was reflected in 45.16% feeling treated with kindness, although only 40.86% felt that they received truly personalized attention. These results highlight the strengths of cleanliness and professionalism, with improvements in response times and individualized care.

After we conducted the Kolmogorov-Smirnov test, our data were normally distributed with a p-value above.05, for all datasets. The ANOVA test results in Table 3 revealed significant variations in patient satisfaction across the five SERVQUAL dimensions. For tangibility, an F-value of 5.62 and a P-value of 0.052 indicate that physical aspects such as cleanliness and facilities influence satisfaction but show only moderate differences between patient groups. The between-group SS was 2.91, and the within-group SS was 12.35, reflecting diverse individual perceptions. For reliability, the F-value was 7.82, with a P-value of .043, suggesting greater variation in how consistently the services were delivered. A between-group SS of 3.45 and within-group SS of 10.89 indicate that some patients experienced reliable care while others faced inconsistencies. For responsiveness, the F-value reached 9.70 with a P-value of 0.038, indicating significant disparities in how quickly and effectively the staff responded to patient needs. The between-group SS was 3.89 and within-group SS was 9.95, reinforcing the variability in patient experiences.

Assurance yielded an F-value of 11.78 and a P-value of .029, with SS between groups at 4.23, and within groups at 9.15. This highlights considerable differences in how patients perceive the professionalism and competence of the healthcare staff. The highest variation was observed in empathy, with an F-value of 13.44 and a P-value of .025. The between-group SS was 4.85, while the within-group SS was 8.78, indicating substantial differences in how patients felt emotionally supported and personally cared for. Overall, responsiveness, assurance, and empathy showed the most significant disparities, suggesting that improvements in communication, emotional support, and reliability could enhance patient satisfaction in an inpatient setting.

Study limitation

This study had several limitations that should be acknowledged. First, the study was conducted in a single hospital, which limits the generalizability of the findings to other healthcare settings or regions within Indonesia. These results may not represent patient satisfaction in different hospitals with varying resources, management styles, or patient demographics. Second, the use of a purposive sampling method may have introduced selection bias, as participants were chosen based on specific inclusion criteria. This could lead to overrepresentation of certain patient groups, potentially skewing satisfaction results. Third, the cross-sectional design captures patient perceptions at a single point in time without accounting for changes over the course of hospitalization or after discharge. Longitudinal studies are required to better understand the evolution of patient satisfaction. Fourth, responses were collected using self-reported questionnaires, which may be subject to social desirability bias, where patients provide favorable answers due to perceived expectations or reluctance to criticize the healthcare staff. Finally, the study relied solely on quantitative measures using the SERVQUAL model. While this offers structured insights, it may not fully capture the deeper emotional or contextual factors that influence satisfaction. Integrating qualitative methods, such as interviews or open-ended questions, could enrich this analysis.