The Relationship between Parents' Personal Characteristics and Personality Traits and Their

Satisfaction with the Quality of Nursing Care for Hospitalized Children in the Pediatric Department

1,2,3 Marin Mamić

1,3 Ivana Mamić

2,3,6 Ivana Jelinčić

3 Štefica Mikšić

1,2,3 Božica Lovrić

1,2,7 Ivan Vukoja

1 Ivanka Zirdum

2,3,5 Tihomir Jovanović

3,8 Zrinka Puharić

9 Slavka Galić

3 Robert Lovrić

1 General County Hospital Požega, Požega, Croatia

2 Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

3 Faculty of Dental Medicine and Health Osijek,

Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

4 Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

5 General Hospital Pakrac and Hospital of Croatian Veterans, Pakrac, Croatia

6 University Hospital Centre Osijek, Osijek, Croatia

7 Faculty of Medicine, University of Rijeka, Rijeka, Croatia

8 Department of Nursing, University of Applied Sciences Bjelovar, Bjelovar, Croatia

9 The Department of Social Sciences and Humanities, University of Slavonski Brod, Slavonski Brod, Croatia

Article received: 08.09.2024.

Article accepted: 14.11.2024.

https://doi.org/10.24141/2/8/2/6

Author for correspondence:

Marin Mamić

Tome Matica 20

34000 Požega, Croatia

E-mail: mmamic@fdmz.com

Keywords: hospitalized children, parents, pediatrics satisfaction with nursing care

Abstract

Introduction. Patients’ satisfaction with nursing care reflects the perception of care in relation to the level of care they expected before they were hospi- talized in the department. However, satisfaction can be influenced by various factors that can change the actual image of the care provided.

Aim. To examine the relationship between parents’ satisfaction with the nursing care provided to hos- pitalized children and the parents’ personality traits.

Methods. The research was conducted at the Gen- eral County Hospital Požega between 2022 and 2023, with 101 participants, parents of hospitalized children. The study employed a demographic ques- tionnaire, the Croatian version of Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ – Cro), and the Big Five Inventory (BFI 44).

Results. The results show that parents’ satisfac- tion with the quality of nursing care provided is negatively associated with the personality trait of neuroticism and the level of parents’ education, and positively associated with the personality trait of extraversion and parents’ age. The personality traits of neuroticism and extraversion, as well as age and level of education, were also found to be significant predictors of parents’ satisfaction with the quality of care.

Conclusion. The results indicate that personality traits and certain demographic characteristics can play an important role in parents’ satisfaction with the quality of nursing care, highlighting the impor- tance of considering individual psychological factors of parents in the assessment and improvement of nursing care.

Introduction

Patients’ satisfaction with certain care, including the quality of nursing care, reflects the perception of care in relation to the level of care they expected before they were hospitalized in the department (1). Therefore, it can be concluded from the above that satisfaction with care is not an objective assessment, and it can depend on many factors that can influence the expectations of the recipient of the same service before hospitalization (2). Different studies dealt with this issue in order to better understand satis- faction with the quality of nursing care, and thus it was shown that satisfaction with nursing care can be influenced by various demographic factors such as age, level of education and gender of the patient (3-5). However, not all stated results are consistent with research regarding the relationship between de- mographic aspects and satisfaction with the nursing care provided (3). Understanding satisfaction with the quality of nursing care is important because it is one of the indicators of the quality of nursing care

(6). Nursing care quality indicators play a key role, not only in evaluating the quality of care provided, but also in achieving and evaluating organizational goals set for improving nursing care. They also provide evi- dence of the effectiveness and financial profitability of certain medical processes. They also provide a bet- ter possibility of measuring and analyzing the quality of the nursing care provided (6). So, although the pa- tient’s subjective assessment, satisfaction with the quality of care is very important in the overall pic- ture of the provided nursing care. However, precisely because this assessment is subjective and plays an important role in further organizational procedures, it is necessary to better understand it and determine which factors can influence it.

Also, apart from being an indicator of nursing care, satisfaction with nursing care has been shown to be one of the main predictors of satisfaction with the overall care provided in a health facility (3, 7). As nurses spend the most time with the patient (3), the above results are not surprising, but they give added importance to monitoring and understanding satisfaction with nursing care, because in today’s in- creasingly market-oriented health care system in the countries of Western Europe, ensuring the patient’s arrival is very important for financial reasons. Satis-

fied patients will return to an institution where they feel that they received adequate care, they will rec- ommend it to others, etc. (3). There is also an eco- nomic factor in patient satisfaction, because a satis- fied patient will comply with the instructions given in the hospital and outpatient environment, and the path to their recovery will be faster and more suc- cessful, and the number of returns and repeated treatments caused by non-compliance with the in- structions can be reduced (3,8-10).

Parents’ satisfaction with nursing care provided to hospitalized children

However, when we talk about parents and their sat- isfaction, there is not much research on this subject. In addition to all the above that can affect the pa- tient’s satisfaction, parental expectations of nurs- ing care can be conditioned by the clinical diagnosis, the health status of the child, but also by subjective factors on the part of the parents, the length of the child’s stay and the final outcomes of treatment (11- 15). It has also been shown that parents of hospi- talized children require a high level of support from nurses during hospitalization, and if this is achieved, parents feel less anxious, less stressed, and it facili- tates their adaptation to new parental roles, in the case of a newborn, and also encourages healthy in- teraction between the parent and the child (16-18). If pediatric nurses are supportive of parents and they are more satisfied with the service, this will have a positive effect because such parents will be more open to learning, care, better communication and will achieve healthier mutual relationships (16-18).

Personality traits and their relationship with satisfaction with nursing care

Examination of personal factors, such as parents’ per- sonality traits, was not conducted in relation to sat- isfaction with the quality of nursing care provided to their children. Personality traits are very important in interpersonal relationships because they can influ- ence parents’ experience and their evaluation of vari- ous services received, including nursing care. Different parental traits, such as openness, neuroticism or ex- traversion, can shape their expectations and reactions to the nursing care received. Therefore, personality traits could be a very important factor in modulating this subjective experience, because certain personal- ity traits, such as neuroticism, can negatively affect

the very experience of interpersonal relationships, but people with more pronounced personality traits can actually create worse interpersonal relationships (3). On the other hand, a person with a more pronounced personality trait of agreeableness is characterized by cooperation, morality, sympathy, low self-confidence, a high level of trust in others, and they tend to be happy and satisfied because of their close mutual re- lationships (20), while extraversion is characterized by a higher level of self-confidence, positive emotions, enthusiasm, energy, seeking excitement and social interactions, openness, creativity, imagination, intel- lectual curiosity and originality (19).

Based on all of the above, it can be assumed that personality traits will also modulate parents’ satis- faction with care, and a better understanding of this relationship will lead to the possibility to adapt the approach to parents, taking into account their per- sonal characteristics and specific needs.

Aim

To examine the relationship between parents’ satis- faction with the nursing care provided to hospital- ized children and the parents’ personality traits

Methods

In this study, a cross-sectional design was used. The research took place at the General County Hospital Požega in 2022 and 2023 at the Department of Pediatrics. To qualify for the study, the parents had to be with the hospitalized child in the hospital the entire time. The parents filled in the questionnaires when the child was discharged from the hospital.

The criteria for inclusion in the research were: stay in the hospital and the time of hospitalization, possibil- ity to fill out the questionnaire independently, con- sent to the research and over 18 years of age.

Exclusion criteria were: parents not being with the child in the ward the whole time, refusal to partici- pate in the research, under 18 years of age.

Participants

A total of 110 parents of hospitalized children par- ticipated, out of which 101 individuals completed the questionnaires and were included in the analysis.

Ethics

The research received approval from the Ethics Com- mittee of the General County Hospital Požega (Reg. number: 02-7/2-2/1-4-2022), and all participants pro- vided informed consent for their participation in the study. The research is fully compliant with the pre- scribed ethical standards for scientific research in medi- cine, including the fundamentals of good clinical prac- tice, the Helsinki Declaration, the Health Care Act of the Republic of Croatia (NN 150/08, 71/10, 139/10, 22/11, 84/11, 154/11, 12/12, 35/12, 70/12, 144/12, 82/13,

159/13, 22/14, 154/14), and the Patient Rights Act of the Republic of Croatia (NN 169/04, 37/08).

All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all the patients for them to be able to be included in the study.

Instruments

In this study, three instruments were employed: a de- mographic questionnaire, PSNCQQ - Cro, and the BFI 44 questionnaire.

The demographic questionnaire was divided into two sections. The first part inquired about the gender, age and professional education of the parents.

The PSNCQQ - Cro (Patient Satisfaction with Nurs- ing Care Quality Questionnaire - Croatian version) consists of 19 items that measure patient satisfac- tion with the quality of nursing care (3, 7). Partici- pants respond by assessing their level of agreement with each statement on a Likert-type scale from 1 – “Excellent” to 5 – “Poor” (3, 7). The overall result of satisfaction with the quality of nursing care is the sum of all the items. The reliability level expressed by the Cronbach’s Alpha coefficient of the Croatian version of the questionnaire was 0.97 (3), while in

this research it was α=0.91, thus indicating a very high internal consistency of the questionnaire and confirming that the questions are largely aligned and measure the same construct.

Big Five Inventory (BFI 44) – BFI aimed to evaluate the personality dimensions through 44 items, struc- tured by simple sentences, and rated in the Likert scale of 5 points, ranging from 1 – “ Totally disagree” to 5 – “Totally agree”. The questionnaire consists of five subscales, where 8 items refer to extraversion (possible score range from 8 to 40), nine items to agreeableness (possible score range from 9 to 45), nine items to conscientiousness (possible score range from 9 to 45), eight items to neuroticism (pos- sible score range from 8 to 40) and ten items on ex- traversion (possible score range from 10 to 50) (21). The total score of each subscale is the sum of all items that refer to a particular subscale. In this study, the level of reliability of the BFI subscales, expressed by the Cronbach’s Alpha coefficient, showed high in- ternal consistency for the subscales of neuroticism (α=0.83) and conscientiousness (α=0.89), indicat- ing a strong relationship between questions within these personality dimensions. On the other hand, the scales of agreeableness (α=0.64), extraversion (α=0.65) and openness (α=0.69) have a moderate level of reliability, which suggests some variability among questions within these dimensions, but it is still acceptable for research purposes.

Statistics

Descriptive statistical methods were employed to present the frequency distribution of the investigat- ed variables. Mean values are presented as arithmetic mean, minimum and maximum values, and standard deviation. The results of the Kolmogorov-Smirnov test of all numerical variables (parents’ satisfaction with the quality of health care, age, and personality traits) were shown to deviate from the normal distri- bution (p>0.05), and non-parametric Spearman cor- relations were used. Linear regression analysis (en- ter method) was conducted to identify predictors of parents’ satisfaction with the quality of nursing care. The prerequisites for regression analysis were met, with VIF values ranging from 1.032 to 1.400. Since VIF values below 5 are generally considered accepta- ble, this indicates the absence of significant multicol- linearity. The normality of residuals is confirmed by the Kolmogorov-Smirnov test, where the p-value for unstandardized and standardized residuals is 0.159,

suggesting that deviations from normality were not statistically significant. The Durbin-Watson value is 1.669, which indicates a slight positive autocorrela- tion, but it remains within the generally acceptable range of 1.5 to 2.5, suggesting that autocorrelation is not a significant issue. A scatterplot of residuals for the overall regression shows randomly distribut- ed residuals around the zero axis, with no discernible patterns, supporting the assumption of homoscedas- ticity. The dispersion is uniform, which suggests that the assumptions of linearity and homoscedasticity were met, with one deviation that may represent an outlier. A significance level of p<0.05 was adopted.

The G*Power program determined that a minimum sample size of 85 subjects with 4 predictors, with a test power of 0.8, was required for linear regression analysis.

The statistical package JASP, version 0.17.2.1 (De- partment of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands) was used for data processing.

A total of 99 (98%) women and 2 (2%) men partici- pated in the research, most of them (45 respondents, 44.6%) completed secondary education, and the mean age was M=32.405 years (SD=5.634) (Table 1).

Results

Gender of parents

Parents’ level of education

male 2 (2)

female 99 (98)

primary school 1 (1)

high school 45 (44.6)

college education 28 (27.7)

university education 27 (26.7) M (range) SD

The results showed that the mean value of parents’ satisfaction with the quality of nursing care was M=78.881 (SD=11.905), which can be considered a very high satisfaction of parents with the quality of health care provided to children (Table 2).

n (%)

Table 1. Sociodemographic data of parents of hospitalized children

The results indicated that parents’ satisfaction with the quality of nursing care has a low positive correla- tion with the age of the parents (ρ=0.356; p<0.001) and their level of extraversion (ρ=0.358; p<0.001). Additionally, there is a moderate negative correla- tion between parents’ satisfaction and their level of education (ρ=-0.431; p<0.001), while the correla- tion with neuroticism is low and negative (ρ=-0.222; p=0.026), that is, the older the parents are and the more pronounced the personality trait of extraver- sion, the more satisfied they are with the health care provided to their children, while the higher their level

Parents’ age 32.405 (18 – 46) 5.634

of education and the more pronounced the person-

Note: n - Number of respondents, % - Percentage, M - Mean, SD - Standard deviation

ality trait of neuroticism, the less the satisfaction (Table 3).

Linear regression analysis was used to determine which personality traits of parents of hospitalized children serve as predictors of parental satisfaction with the quality of nursing care of hospitalized chil- dren. Only variables that proved to be significant in the correlation were included in the regression analy-

Table 3. Correlation of parents’ satisfaction with the quality of nursing care with demographic variables and personality traits of parents

1. 2. 3. 4. 5. 6. 7.

1. Satisfaction with the quality of nursing care

   
   

2. Age

   
   

3. Parents’ level of education

   
   

4. Extraversion

   
   

5. Conscientiousness

   
   

6. Agreeableness

   
   

7. Neuroticism

   
   

8. Openness

ρ

p*

ρ 0.356

p* <0.001

ρ -0.431 -0.013

p* <0.001 0.895

ρ 0.358 0.049 -0.302

p* <0.001 0.629 0.002

ρ 0.048 -0.162 -0.053 0.376

p* 0.634 0.105 0.596 <0.001

ρ 0.079 -0.189 0.011 0.397 0.449

p* 0.435 0.058 0.914 <0.001 <0.001

ρ -0.222 0.116 0.076 -0.448 -0.529 -0.412

p* 0.026 0.248 0.452 <0.001 <0.001 <0.001

ρ -0.126 0.083 0.073 -0.183 -0.550 -0.288 0.227

p* 0.208 0.412 0.469 0.067 <0.001 0.003 0.022

Table 4. Results of regression analysis - satisfaction with the quality of care as the dependent variable, demographic variables and personality traits as predictor variables

Note: ρ – Spearman correlation coefficient; p - statistical significance

sis. The variables included in the regression signifi- cantly explain 34% of the variance of parents’ sat- isfaction with the quality of health care provided to children (Adjusted R2=0.340; p<0.001). Parents’ age (p<0.001) and parents’ level of education (p=0.002) and parents’ neuroticism (p=0.009) and extraversion (p=0.021) proved to be significant variables. An in- sight into the β-coefficient shows that the level of education and neuroticism contribute negatively, while age and extraversion contribute positively to satisfaction with nursing care.

Discussion

The aim of this research was to examine the relation- ship between parents’ satisfaction with the nursing care provided to hospitalized children and the par- ents’ personality traits.

In terms of demographic variables, it was shown that age and level of parents’ education contribute to par- ents’ satisfaction with the quality of nursing care of

hospitalized children. The older age of parents con- tributes to greater satisfaction with the quality of care. This result is not consistent with previous re- search on this topic (15). However, possible reasons for the obtained results are that greater emotional stability comes with age, which consequently brings better stress regulation, and maintaining calmness and control in stressful situations that comes with hospitalization of a child (22). One of the reasons is also that older parents have more life experience and know what they can expect from the health system and nurses, which is important precisely in the con- text of satisfaction with care, which was previously defined as the range of expectations before admis- sion to the hospital and later services provided.

The level of education of the parents proved to be a significant predictor of parents’ satisfaction with the quality of health care provided to their children,

i.e. parents with lower levels of education expressed greater satisfaction with their children’s care. The re- sults are consistent with previous research (15, 23, 24, 25). Possible reasons for this result are that less educated parents are not familiar with their child’s and their rights in the hospital, they are also less fa- miliar with the standards of nursing care, and con- sequently have lower expectations from nurses, and lower expectations can lead to greater satisfaction with care (15). It is also possible that this result is due to low level of knowledge among less educat- ed patients, which may lead to low expectations of nurses and lack of judgment skills (2, 26).

Regarding parents’ personality traits and their rela- tionship with children’s nursing care satisfaction, it was shown that neuroticism negatively contributes to satisfaction of parents with the quality of nurs- ing care. Since there is no research on the men- tioned topic, the results cannot be compared with the previous research. However, it can be said that the obtained result was expected due to the fact that people with the mentioned personality trait are characterized by anxiety, anger, insecurity, im- pulsiveness and vulnerability (27). Such individuals have higher levels of negative affect, they are easily irritated, and more likely to turn to inappropriate cop- ing responses, such as hostility (28). More neurotic people tend to create interpersonal relationships, but also to perceive interpersonal relationships as worse than they really are (19). In such cases, bad interper- sonal relations are generated, and in fact neurotics themselves create a bad climate around themselves,

and later they are dissatisfied with the whole situa- tion, so they are probably also dissatisfied with the treatment of their children and the nursing care pro- vided to them. Such persons may have difficulties in interpreting interactions with health professionals, including nurses, positively, regardless of their true quality. Experiencing and creating negative relation- ships with nurses can result in frustration, increased levels of stress and tension in mutual relationships (19), and it is possible that this dynamic can worsen the experience of satisfaction with care, although in reality it may be adequate, and thus creates a circle of dissatisfaction and mistrust. They may also per- ceive greater threats in their interactions than they do, even in cases where they do not actually exist. This way of experiencing mutual relationships with others can lead parents to exaggerate difficulties and misunderstandings in communication with nurs- es. In such cases, neurotic persons could focus on the feeling of conflict with the nurses, and consequently on their feeling of insecurity, which can contribute to a negative perception of the entire treatment, includ- ing the nursing care segment (29).

Extraversion also proved to be a significant predictor of parents’ satisfaction with the quality of health care provided to children, however, unlike neuroticism, extraversion contributes positively to the aforemen- tioned construct. Research on this topic has not been carried out, therefore it is not possible to check and compare this relationship with previous research. Ex- troverts are normally characterized by a higher level of self-confidence, positive emotions, enthusiasm, energy, thrill-seeking and social interactions. Extra- verted people are creative, imaginative, intellectually curious, impulsive and original, open to new experi- ences and ideas (19). Extroverts start and maintain positive interactions with others more easily, while their sociability and openness in communication en- ables them to express their feelings, concerns and expectations so that there will generally not be any unresolved situations between interlocutors (30). It is possible that such communication enabled the parents of hospitalized children to get and partially achieve what they wanted for the child during hos- pitalization and were therefore more satisfied. Also, their tendency towards more positive emotions and optimism may have mitigated the potentially nega- tive aspects of care if they were provided, i.e. due to their characteristics, it is possible that they were more tolerant in certain situations in which other per-

sons with differently distributed personality traits were not (31).

All of the above indicates that personality traits can play an important role in parents’ satisfaction with the quality of nursing care, and together with the contribution of parents’ demographic variables to children’s satisfaction with care, this only confirms the fact that satisfaction with care is subjective but also complex, and that further research is needed in order to gain a deeper understanding of the said construct.

All the above results emphasize the importance of taking into account both individual and psychological factors in the assessment of parents of hospitalized children. Further research is needed in order to be able to improve the experiences of parents, regard- less of their psychological characteristics, but also to be able to improve the interpersonal relationships of parents and health professionals, which can improve the overall care provided to children. The results are also important in understanding the whole construct of satisfaction with care, which, as one of the indi- cators of the quality of nursing care, can influence the overall evaluation of the care provided, as well as further procedures to improve it, and understand- ing the fact that parents’ satisfaction with care does not necessarily have to be based on facts and to the care provided, but it can really depend on their per- sonality, so that parents’ assessments of the nursing care provided to their children should be taken with understanding, taking into account all the previously mentioned results, and they should be interpreted with caution.

Also, in future research, it would be good to examine how much the psychological and personal character- istics of the other party, the nurses, affect parents and their assessment, because nursing care is an interpersonal relationship, and psychological charac- teristics can affect both the service provider and the other side, the recipients of these same services, as can be seen in this paper.

Thus, it can be concluded that this research showed that significant predictors of satisfaction with the quality of parental health care from the demographic variables are the age and level of education of the parents, while neuroticism was the only predictor of the personality traits of the parents.

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POVEZANOST OSOBNIH KARAKTERISTIKA I CRTA LIČNOSTI RODITELJA SA ZADOVOLJSTVOM KVALITETOM ZDRAVSTVENE NJEGE PRUŽENE HOSPITALIZIRANOJ DJECI NA ODJELU PEDIJATRIJE

Sažetak

Uvod. Zadovoljstvo pacijenata zdravstvenom nje- gom odražava percepciju skrbi u odnosu na razinu skrbi koju su očekivali prije hospitalizacije na odjelu, no na zadovoljstvo mogu utjecati različiti čimbenici koji mogu promijeniti stvarnu sliku pružene skrbi.

Cilj. Ispitati povezanost zadovoljstva roditelja pruže- nom njegom hospitaliziranoj djeci s osobnim karakte- ristikama i crtama ličnosti roditelja.

Metode. Istraživanje je provedeno u Općoj županij- skoj bolnici Požega od 2022. do 2023., a ispitan je 101 roditelj hospitalizirane djece. U istraživanju je primijenjen demografski upitnik, hrvatska verzija Upitnika o zadovoljstvu pacijenata kvalitetom zdrav- stvene skrbi (PSNCQQ) i Big Five Inventory (BFI 44).

Rezultati. Rezultati su pokazali kako je zadovolj- stvo roditelja kvalitetom pružene zdravstvene njege negativno povezano s crtom ličnosti neuroticizma i stupnjem obrazovanja roditelja te pozitivno s crtom ličnosti ekstraverzije i dobi roditelja. Crte ličnosti neuroticizma i ekstraverzije te dob i stupanj obrazo- vanja također su se pokazali značajnim prediktorima zadovoljstva roditelja kvalitetom zdravstvene njege.

Zaključak. Rezultati pokazuju kako i osobine lično-

sti i osobne karakteristike mogu igrati važnu ulogu u       

zadovoljstvu roditelja kvalitetom zdravstvene njege te da ih je važno uzeti u obzir u procjeni i poboljšanju

Ključne riječi: hospitalizirana djeca, pedijatrija, roditelji, zadovoljstvo zdravstvenom njegom

zdravstvene njege.