Next Article in Journal
Xylo-Oligosaccharides in Prevention of Hepatic Steatosis and Adipose Tissue Inflammation: Associating Taxonomic and Metabolomic Patterns in Fecal Microbiomes with Biclustering
Next Article in Special Issue
Personality Traits and the Sense of Self-Efficacy among Nurse Anaesthetists. Multi-Centre Questionnaire Survey
Previous Article in Journal
How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?
Previous Article in Special Issue
Occurrence of Delirium during ECMO Therapy in a Critical Care Unit in Poland—A Cross-Sectional Pilot Study
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Home Mechanical Ventilation: A Patient’s Perspective Survey Study

Department of Aneasthesiological and Intensive Care Nursing, Medical University of Lublin, 20-093 Lublin, Poland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(8), 4048; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084048
Submission received: 20 January 2021 / Revised: 23 February 2021 / Accepted: 10 March 2021 / Published: 12 April 2021
(This article belongs to the Special Issue Intensive and Critical Care Nursing Research)

Abstract

:
Background: An increasing number of patients included in home mechanical ventilation (HMV) care has been under observation for many years. The study aimed to assess the patients opinion concerning the expected and perceived quality of care in an HMV system and a patient’s satisfaction with care. Methods: In 2017, patients treated with HMV were surveyed in Poland with the modified SERVQUAL questionnaire. Results: One hundred correctly completed surveys were analyzed. Patient Satisfaction Index was high. In every examined area, the expectations were statistically significant larger than the perception of the services. The biggest gap was in the tangibility dimension and the smallest gap was in the empathy dimension. Perceived respect and understanding for a patient’s needs are close to the expectations. Conclusions: The level of satisfaction with health care among patients treated with HMV in majority of investigated components is high. Moreover, the difference between perceived and expected quality of health care in the HMV system was relatively small in the opinion of the patients themselves. Further investigations with alternative methods are needed.

1. Introduction

An increasing number of patients included in home mechanical ventilation (HMV) care has been under observation for many years [1,2,3,4,5]. HMV is a complex and multidisciplinary treatment for patients with symptoms of chronic respiratory insufficiency due to pulmonary disorders, scoliosis or neuromuscular disorders. Treating these patients with home mechanical ventilation programs decreases the frequency of visits in emergency departments and hospitalizations in general [6]. Several studies have shown increased survival among HMV patients [4,7,8]. Recent guidelines of several scientific associations recommend the use of HMV for patients, with symptoms of chronic respiratory insufficiency [9,10,11,12,13].
The number of patients treated with ventilation at home has been increasing constantly. The prevalence of HMV differs greatly in different parts of the world [14] The prevalence of HMV in Canada is 12.9 patients/100,000 [15,16]. In Australia and New Zealand, these values are 9.9 and 12.0 patients/100,000 accordingly [16]. The most current data from East-Central Europe come from Hungary and show that the prevalence of HMV is 3.9 patients/100,000 [14].
The experiences of caregivers of patients undergoing HMV have been described in the literature [15], as well as the experiences of the patients themselves [16,17,18]. These experiences are related to the psychological functioning of these patients [19], as well as to the health-related quality of life [20,21,22]. Very few studies describe the patient’s perspectives concerning the system of home mechanical ventilation.
The measurement of the quality of medical services and patient’s satisfaction is performed in many medical disciplines. However, HMV is very rarely assessed in this perspective. The association between medical service quality and patient’s satisfaction was already suggested by other researchers [17,18]. Nevertheless, the process of assessment of the patient’s perspective of quality of health care services has been a challenge for years [17], especially if the care is delivered at home [19]. Until now, the best way to measure its quality in medicine has not been defined [17,19,20]. The SERVQUAL gap model and importance performance analysis (IPA) are used in the measurement of quality of services [17,21,22]. SERVQUAL, originally used in the measurement of quality in production units, was also used in medical services in order to measure a patient’s opinion concerning nurse care [23,24], specialist ambulatory health care [21], and other medical branches [25,26,27]. The SERVQUAL model was designed in 1985 by Parasurman et al. and allows measuring the quality of services according to a tested person’s opinion by measuring the differences between the quality expected and the quality perceived [28]. This difference may be recognized as the measure of satisfaction with the received services [18].
To analyze the HMV system in the aspect of its functioning, its patients and their feeling of safety would be very valuable. The satisfaction assessment of patients with HMV services related to perception of the quality of medical services in the HMV system would be a source of an important piece of information, which is helpful in the optimization of system functioning.

2. Methods

The study aimed to assess the expected and perceived quality of care in an HMV system and assess the patient’s satisfaction with care. An attempt was undertaken to find these areas of care for HMV patients, which could be improved to increase the patient’s satisfaction.
In 2017, patients treated with HMV were surveyed in the South-East of Poland. Only adult patients were included in the study, with the length of HMV treatment being between 6 months and 10 years. The modified SERVQUAL questionnaire was used. The authors surveyed the relevant sociological and demographic data combined with a medical history. A total of 125 surveys were distributed by the members of the research team to the caregivers of the patients. Surveys were left and completed without the presence of the member of the therapeutic team. The survey in the envelope was taken by the next visit. Finally, the envelope with the survey was passed to the research team. The traditional form of a paper and pencil survey was used.
The classic SERVQUAL questionnaire is composed of 22 items in five dimensions (tangibility, reliability, responsiveness, confidence, and empathy) [17,21]. In this study, a modified questionnaire was used. In every dimension, the questionnaire was composed of variables specific to the medical services delivered to the patient’s home. In the classic SERVQAL questionnaire, the visual appearances of facilities in the place of service giving and modern equipment are assessed. If the care is delivered at the patient’s home, the service giver has no influence on this area. As a result, in the tangibility dimension, only the material status of the participants was assessed. In the reliability dimension, the accuracy of medical services was assessed, as well as a will to help the patient and their family in solving medical problems. Keeping calm and the level of care were assessed, as well. In the responsiveness dimension, the rapidity in the response to the patient’s requests was assessed. In the confidence dimension, the safety of the patient as well as the courtesy and competence of personnel were assessed, along with the availability of a physician, nurse, and physiotherapist. In the empathy dimension, the individual attitude to a patient was assessed: respect and understanding for the patient’s needs, intimacy preservation, way of passing on information, and ability to listen to the patient. Each of the aspects was assessed by the respondents in the expectation perspectives and received services perspective. A five-degree (1 to 5) Likert scale was used. The modified SQRVQUAL questionnaire used in the study is provided in the Supplementary Material (Table S1). For every question and dimension, the gap between the perceptions and expectations was calculated.
With five dimensions: tangibility, reliability, responsiveness, confidence, and empathy patients (PSI) satisfaction index (with 100% maximum) was calculated by the formula (Equation (1)):
P S I = x ¯ 1 max x 1 · 20 % + x ¯ 2 max x 2 · 20 % + x ¯ 3 max x 3 · 20 % + x ¯ 4 max x 4 · 20 % + x ¯ 5 max x 5 · 20 %
when:
where x ¯ i ,   i = 1 , , 5 represents mean value of the current dimension and   max x i ,   i = 1 , , 5 represents the maximum values of this dimension.
In this study, the tangibility dimension of the material status of the participants was assessed. The service giver has no influence. This is why, with four dimensions: reliability, responsiveness, confidence, and empathy, the patient’s (PSI) satisfaction index (with 100% maximum) was also calculated using the following formula (Equation (2)):
P S I = x ¯ 1 max x 1 · 25 % + x ¯ 2 max x 2 · 25 % + x ¯ 3 max x 3 · 25 % + x ¯ 4 max x 4 · 25 %
where x ¯ i ,   i = 1 , , 4 represents the current dimension and   max x i ,   i = 1 , , 4 represents the maximum values of this dimension.

Statistical Methods

The data were analyzed statistically using the STATISTICA 13.3 program Tibco Software (Inc. Palo Alto, Ca, USA). The qualitative variables were characterized by multiplicity and percentage, while the quantitative variables were characterized by basic classical statistical measures: mean and standard deviation. If the features were far from the normal distribution, the positional measure of the average value—median and quartile intervals Q1–Q3—were used. The scope of minimal and maximal was given. The Wilcoxon test for two related samples was used and the ANOVA Kruskal–Wallis was used for a larger amount of independent samples.

3. Results

One hundred and twenty-five surveys were distributed among the HMV patients. Only 100 correctly completed surveys were included in the analysis. Twenty-one surveys were incomplete. The mean age in the examined population was 66 (Q1–Q3; 57–72). The examined population included 71 (71%) patients with pulmonary diseases. Among these patients, 65 were diagnosed with COPD (chronic obstructive pulmonary disease), two with bronchial asthma, two with apnea syndrome, one person with amyloidosis, and one with pulmonary emphysema. Twenty-nine (29%) of patients from the entire examined population had respiratory insufficiency due to neuromuscular disorders (NMD), such as ALS (amyotrophic lateral sclerosis) (13 persons), MD (muscular dystrophy) (six persons), myasthenia gravis (four persons), SM (sclerosis multiply) (two persons), cerebral palsy (two persons), central core disease (one person), and Arnold–Chiari Syndrome (one person). Twenty-nine patients from the examined population were treated with IV (invasive ventilation). The characteristics of the examined population are shown in detail in Table 1.
The calculation of the patient satisfaction index (PSI) for all five dimensions is high: at 87.16%. The calculation of the patient satisfaction index (PSI) for four dimensions (without tangibility) is 91.2%.
In every examined area, the expectations were statistically important and larger than the perceptions of the services. The biggest gap was in the tangibility dimension. It reflects the material status of the family. Here, the difference between the expectations and perceptions is largest in all dimensions (Table 2 and Table 3).
The smallest gap (however statistically important) between the expectations and perceptions was in the empathy dimension. The perceived respect and understanding for the patient’s needs (gap −0.18, p < 0.001 and −0.19, p < 0.001 accordingly) are close to the expectations. The perceived intimacy preservation and way of passing on information, as well as the ability to listen to the patient (gap −0.21, p < 0.001 and −0.23, p < 0.001, accordingly) are also close to the expectations. In the confidence dimension, the difference between the expectations and perceptions was relatively small (−0.27, p < 0.001). In particular, the competence of personnel, the availability of the nurse, and courtesy of the personnel were close to the patient’s expectations. A comparison of the expected and perceived quality of care is shown in Table 2. In Table 3, a comparison of the expected and perceived quality of care in particular dimensions is shown.
A distribution of values in particular dimensions divided by groups created by demographical variables (gender, marital status, level of education, place of living, as well as living conditions) was performed. Respondents with bad and very bad living conditions showed a significantly lower level of satisfaction than the tangibility dimension compared to people with good and very good conditions (Table 4).
No significant differences were found in the satisfaction with the dimension of reliability, responsiveness, confidence, and empathy, depending on gender, marital status, level of education, and place of living.

4. Discussion

The seldom-described experiences of patients undergoing HMV show that this treatment causes distress and anxiety in the patients’ lives [29], as they have a constant feeling of dependence. In the German study of Schaepe and Ewers, one of the respondents described the total necessity of trusting one’s nurse [30], which reflects this high feeling of dependence. Similar feelings of patients concerning their caregivers were described in a Scottish study by MacLaren et al. [31].
The reflections of a patient who is treated with HMV in the context of satisfaction with the received services were investigated only vary rarely. In the study from Taiwan, the satisfaction of HMV patients was assessed with the SERVQUAL method. The authors of this study described very small gaps between the level of expectations and perceived quality in every examined dimension [17]. It reflects a high satisfaction of patients with the received medical services, which correlates with the results of our study. In the Taiwan study, the gap in the tangibility dimension is smaller than in the present study. Here, this dimension reflects the material and living conditions of respondents. However, patients in the Taiwan study were treated in health care institutions.
The functioning of the HMV system is rarely investigated and has not been examined in Poland. The HMV services in Poland are delivered in the patient’s place of living [2]. There are many health care providers in the HMV system in Poland, which are all covered by a public payer (National Health Fund) [2]. Ventilators, oxygen concentrators, and respiratory care equipment are delivered by the health care providers at the cost of the taxpayer. The nurse, physiotherapist, and physician care takes place in the patient’s home and is provided by the health care provider. The physician is a specialist of anesthesiology, pulmonology or neurology. The frequency of follow up depends on the type of ventilation (NIV or IV). The IV patients are supervised more often than the NIV patients. The NMD patients are followed up more often than the COPD patients (similarly to the IV patients and NIV patients).
The calculated PSI for five and four dimensions are high (91.2% and 87.16% accordingly). However, there are significantly statistical differences in the expected and perceived components of care. Moreover, in the present study, patients’ expectations concerning care are close to the perceived quality of care in the majority of assessed components. It reflects patient’s satisfaction with the care system. It reflects the high quality of health care in this area of medicine.
The biggest gap between the expectations and the perceptions of quality was found in the tangibility dimension, which may reflect the material and living conditions of respondents. This is the area, which if better, could improve the perceived quality of health care and the level of patient satisfaction. Supporting respondents with better living facilities, which are helpful when it comes to caring for themselves or optimizing local conditions, could decrease the gap in the tangibility dimension.
Special attention should be paid to the fact that the smallest gap is in the empathy dimension. The perceived respect and understanding of a patient’s needs are close to the expectations. It reflects the high competences of personnel in this dimension and the high satisfaction of a patient with this dimension of care.
In the confidence dimension, the gap was relatively small, as well. The patients feel safe in this system of care. The competence of personnel, availability of the nurse, and courtesy of the personnel are very close to the patient’s expectations.

Study Limitations

The study has several limitations.
Firstly: The number of patients recruited is relatively low. The process of recruiting patients to the study was not randomized and the respondents live in one region of the country. This could be a limitation to the generalization of the results.
Secondly: The group of patients with pulmonological disorders was significantly bigger than the patients with neurological disorders. The analysis in the subgroups could be more valuable and may be more precise, which could be investigated in future research.
Thirdly: It must be noted that some surveys were completed by the respondents in the presence of another person (not a member of the therapeutic team). This fact was related to the physical possibilities of the examined patients. Twenty-one surveys were incomplete and deleted from the analysis. This is a relatively high proportion, which reflects the difficulties in communication with the ventilated patient.
Additionally, it is worth mentioning that only one method was used to measure the gaps between perceived and expected quality of services and patient’s satisfaction, which is the modified SERVQUAL questionnaire. A modification of the questionnaire was necessary. Nevertheless, in the tangibility dimension, more detailed investigations would be desirable. A deeper investigation of the tangibility dimension may increase the validity of the scale.
The patient’s perspective of the quality of services and patient’s satisfaction in HMV services need further investigations with an alternative method.

5. Conclusions

In conclusion, the level of satisfaction with health care among patients treated with HMV in the majority of investigated components is high. Moreover, the difference between perceived and expected quality of health care in the HMV system was relatively small in the opinion of the patients themselves. In this study, the biggest gap between the expectations and perceived quality is in the tangibility dimension, which may reflect the material and living conditions of respondents. Therefore, a deeper investigation of the tangibility dimension is needed.

Supplementary Materials

The following are available online at https://0-www-mdpi-com.brum.beds.ac.uk/article/10.3390/ijerph18084048/s1, Table S1. Modified SERVQUAL questionnaire

Author Contributions

Conceptualization, B.K., M.K.-M.; Data curation, B.K.; Formal analysis, M.K.-M., B.K.; Funding acquisition, M.K.-M.; Investigation, B.K.; Methodology, B.K., M.K.-M.; Project administration, M.K.-M.; Resources, B.K.; Supervision, M.K.-M.; Writing—original draft, M.K.-M., B.K.; Writing—review and editing, M.K.-M.; Critical revision: M.K.-M., B.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Medical University of Lublin grant number 548.

Institutional Review Board Statement

The Ethics Committee of the Medical University of Lublin approved the study (Approval No KE-0254/211/2015).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, (MKM), upon reasonable request.

Acknowledgments

We wish to extend our special thanks to Anna Fijałkowska- Nestorowicz, for the supervision and essential support in finalizing the publication of results of hereby study. We wish to thank to Anna Aftyka, for her valuable suggestions and consultations given in the review of the final stage of the manuscript. Let us give special thanks to Rafał Rutyna, for his valuable consultations.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Povitz, M.; Rose, L.; Shariff, S.Z.; Leonard, S.; Welk, B.; Jenkyn, K.B.; Leasa, D.J.; Gershon, A.S. Home Mechanical Ventilation: A 12-Year Population-Based Retrospective Cohort Study. Respir. Care 2017, 63, 380–387. [Google Scholar] [CrossRef]
  2. Nasiłowski, J.; Wachulski, M.; Trznadel, W.; Andrzejewski, W.; Migdał, M.; Drozd, W.; Pytel, A.; Suchanke, R.; Czajkowska-Malinowska, M.; Majszyk, T.; et al. The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010. Respir. Care 2014, 60, 577–585. [Google Scholar] [CrossRef] [PubMed]
  3. Laub, M.; Berg, S.; Midgren, B. Home mechanical ventilation in Sweden—inequalities within a homogenous health care system. Respir. Med. 2004, 98, 38–42. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  4. Chailleux, E.; Fauroux, B.; Binet, F.; Dautzenberg, B.; Polu, J.-M. Predictors of Survival in Patients Receiving Domiciliary Oxygen Therapy or Mechanical Ventilation: A 10-year analysis of ANTADIR Observatory. Chest 1996, 109, 741–749. [Google Scholar] [CrossRef]
  5. Janssens, J.-P.; Derivaz, S.; Breitenstein, E.; De Muralt, B.; Fitting, J.-W.; Chevrolet, J.-C.; Rochat, T.; De Muralt, B. Changing Patterns in Long-term Noninvasive Ventilation: A 7-year prospective study in the Geneva Lake area. Chest 2003, 123, 67–79. [Google Scholar] [CrossRef] [PubMed]
  6. Annane, D.; Orlikowski, D.; Chevret, S. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders. Cochrane Database Syst. Rev. 2014, 12, CD001941. [Google Scholar] [CrossRef] [PubMed]
  7. Bourke, S.C.; Tomlinson, M.; Williams, T.L.; Bullock, R.E.; Shaw, P.J.; Gibson, G.J. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: A randomised controlled trial. Lancet Neurol. 2006, 5, 140–147. [Google Scholar] [CrossRef]
  8. Aboussouan, L.S.; Khan, S.U.; Meeker, D.P.; Stelmach, K.; Mitsumoto, H. Effect of noninvasive positive-pressure ventilation on survival in amyotrophic lateral sclerosis. Ann. Intern. Med. 1997, 127, 450–453. [Google Scholar] [CrossRef] [Green Version]
  9. McKim, D.A.; Road, J.; Avendano, M.; Abdool, S.; Côté, F.; Duguid, N.; Fraser, J.; Maltais, F.; Morrison, D.L.; O’Connell, C.; et al. Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline. Can. Respir. J. 2011, 18, 197–215. [Google Scholar] [CrossRef]
  10. Windisch, W.; Brambring, J.; Budweiser, S.; Dellweg, D.; Geiseler, J.; Gerhard, F.; Köhnlein, T.; Mellies, U.; Schönhofer, B.; Schucher, B.; et al. Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz. S2-Leitlinie herausgegeben von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V [Non-invasive and invasive mechanical ventilation for treatment of chronic respiratory failure. S2-Guidelines published by the German Medical Association of Pneumology and Ventilatory Support]. Pneumologie 2010, 64, 207–240. [Google Scholar] [CrossRef] [Green Version]
  11. Windisch, W.; Dreher, M.; Geiseler, J.; Siemon, K.; Brambring, J.; Dellweg, D.; Grolle, B.; Hirschfeld, S.; Köhnlein, T.; Mellies, U.; et al. S2k-Leitlinie: Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz—Revision 2017 [Guidelines for Non-Invasive and Invasive Home Mechanical Ventilation for Treatment of Chronic Respiratory Failure—Update 2017]. Pneumologie 2017, 71, 722–795. [Google Scholar] [CrossRef]
  12. Make, B.J.; Hill, N.S.; Goldberg, A.I.; Bach, J.R.; Criner, G.J.; Dunne, P.E.; Gilmartin, M.E.; Heffner, J.E.; Kacmarek, R.; Keens, T.G.; et al. Mechanical Ventilation Beyond the Intensive Care Unit. Report of a consensus conference of the American College of Chest Physicians. Suppl. Chest. 1998, 113, 289S–344S. [Google Scholar] [CrossRef] [PubMed]
  13. Piper, A.; Flunt, D.; Wark, P.; Murray, N.; Brillante, R.; Laks, L. Domiciliary Non-Invasive Ventilation in Adult Patients: A Consensus Statement. Intensive Care NSW. 2017. Available online: https://www.aci.health (accessed on 15 November 2020).
  14. Valko, L.; Baglyas, S.; Gal, J.; Lorx, A. National survey: Current prevalence and characteristics of home mechanical ventilation in Hungary. BMC Pulm Med. 2018, 18, 190. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  15. Rose, L.; McKim, D.A.; Katz, S.L.; Leasa, D.; Nonoyama, M.; Pedersen, C. Home mechanical ventilation in Canada: A national survey. Respir. Care 2015, 60, 695–704. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  16. Simonds, A.K. Home Mechanical Ventilation: An Overview. Ann. Am. Thorac. Soc. 2016, 13, 2035–2044. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  17. Chang, B.-L.; Kao, H.-O.; Lin, S.-J.; Yang, S.-H.; Kuo, Y.-W.; Jerng, J.-S. Quality gaps and priorities for improvement of healthcare service for patients with prolonged mechanical ventilation in the view of family. J. Formos. Med Assoc. 2019, 118, 922–931. [Google Scholar] [CrossRef] [PubMed]
  18. Kim, C.E.; Shin, J.-S.; Lee, J.; Lee, Y.J.; Kim, M.-R.; Choi, A. Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: A cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals. BMC Complementary Altern. Med. 2017, 17, 174. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  19. Cardona, B.; Fine, M.; Riley, S. Meeting the challenges of measuring outcomes of home care programs: The Australian Community Outcomes Measurement (ACCOM) tool. Home Health Care Serv. Q. 2020, 39, 141–153. [Google Scholar] [CrossRef]
  20. Olsen, R.M.; Bryant, C.A.; McDermott, R.J.; Ortinau, D. The better model to predict and improve pediatric health care quality: Performance or importance-performance? Health Care Manag. Rev. 2013, 38, 317–324. [Google Scholar] [CrossRef]
  21. Manulik, S.; Rosińczuk, J.; Karniej, P. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center. Patient Prefer. Adherence 2016, 10, 1435–1442. [Google Scholar] [PubMed] [Green Version]
  22. Sever, I. Importance-performance analysis: A valid management tool? Tour. Manag. 2015, 48, 43–53. [Google Scholar] [CrossRef]
  23. Scardina, S.A. SERVQUAL: A tool for evaluating patient satisfaction with nursing care. J. Nurs. Care Qual. 1994, 8, 38–46. [Google Scholar] [CrossRef] [PubMed]
  24. Chou, S.-M.; Chen, T.-F.; Woodard, B.; Yen, M.-F. Using SERVQUAL to evaluate quality disconfirmation of nursing service in Taiwan. J. Nurs. Res. 2005, 13, 75–84. [Google Scholar] [CrossRef] [PubMed]
  25. Babakus, E.; Mangold, W.G. Adapting the SERVQUAL scale to hospital services: An empirical investigation. Health Serv. Res. 1992, 26, 767–786. [Google Scholar]
  26. Reidenbach, R.E.; Sandifer-Smallwood, B. Exploring perceptions of hospital operations by a modified SERVQUAL approach. J. Health Care Mark. 1990, 10, 47–55. [Google Scholar]
  27. Pakdil, F.; Harwood, T.N. Factors that influence efficiency in performing ENT cases: A qualitative and quantitative analysis. J. Med Syst. 2005, 29, 285–301. [Google Scholar] [CrossRef] [PubMed]
  28. Parasuraman, A.; Zeithaml, V.A.; Berry, L.L. A Conceptual Model of Service Quality and Its Implications for Future Research. J. Mark. 1985, 49, 41–50. [Google Scholar] [CrossRef]
  29. Ørtenblad, L.; Carstensen, K.; Væggemose, U.; Løvschall, C.; Sprehn, M.; Küchen, S.; Nørregaard, O.; Jensen, L.G. Users’ Experiences with Home Mechanical Ventilation: A Review of Qualitative Studies. Respir. Care 2019, 64, 1157–1168. [Google Scholar] [CrossRef]
  30. Schaepe, C.; Ewers, M. ‘I need complete trust in nurses’—home mechanical ventilated patients’ perceptions of safety. Scand. J. Caring Sci. 2017, 31, 948–956. [Google Scholar] [CrossRef]
  31. MacLaren, J.; Smith, P.; Rodgers, S.; Bateman, A.P.; Ramsay, P. A qualitative study of experiences of health and social care in home mechanical ventilation. Nurs. Open 2018, 6, 283–292. [Google Scholar] [CrossRef]
Table 1. Group characteristics.
Table 1. Group characteristics.
Variables(N = 100)
N%
Type of ventilationNIV7171
IV2929
Gendermale6565
female3535
Marital statusmarried6464
unmarried3636
Place of livingurban5151
rural4949
Educationno/elementary3636
vocational2828
secondary/higher3636
Living conditionvery good2424
good6666
difficult1010
NIV: Non-invasive ventilation; IV: Invasive ventilation.
Table 2. Comparison of perceived and expected service quality.
Table 2. Comparison of perceived and expected service quality.
Assessed ComponentsNMeanDifferenceWilcoxon’s Test
Perceived
P
Expected
E
P-Ep-value
Material status1003.554.52−0.97<0.001 ***
Accuracy of medical services1004.434.77−0.34<0.001 ***
Will to help1004.454.82−0.37<0.001 ***
Keeping calm and quiet1004.334.71−0.38<0.001 ***
Level of care1004.564.85−0.29<0.001 ***
Rapidity of help1004.544.85−0.31<0.001 ***
Response for patient’s requests1004.534.87−0.34<0.001 ***
Safety of the patient1004.404.84−0.44<0.001 ***
Courtesy of personnel1004.724.88−0.160.003 **
Competence of personnel1004.744.87−0.130.006 **
Availability of a physician1004.474.90−0.43<0.001 ***
Availability of a nurse1004.754.89−0.140.009 **
Availability of a physiotherapist834.514.88−0.37<0.001 ***
Respect for the patient1004.694.87−0.18<0.001 ***
Understanding for the patient’s needs1004.624.81−0.190.001 **
Intimacy preservation1004.674.88−0.21<0.001 ***
Way of passing on information and ability to listen to the patient1004.644.87−0.23<0.001 ***
** p < 0.05; *** p < 0.001.
Table 3. Comparison of perceived and expected service quality for assessed dimensions.
Table 3. Comparison of perceived and expected service quality for assessed dimensions.
Assessed DimensionsNMeanDifferenceWilcoxon’s Test
Perceived
P
Expected
E
P-Ep-value
Tangibility1003.554.52−0.97<0.001
Reliability1004.444.79−0.35<0.001
Responsiveness1004.544.86−0.32<0.001
Confidence1004.604.87−0.27<0.001
Empathy1004.664.86−0.20<0.001
Table 4. The distribution of values of tangibility dimension divided by groups created by demographical variables.
Table 4. The distribution of values of tangibility dimension divided by groups created by demographical variables.
Demographical Variable Tangibility DimensionTest
NMSDMe25–75%p
Gender 0.662 (1)
Male653.550.924.03.0-4.0
Female353.540.824.03.0-4.0
Marital status 0.546 (1)
Married643.560.924.03.0-4.0
Unmarried363.530.813.53.0-4.0
Education 0.706 (2)
No/elementary363.421.004.03.0-4.0
Vocational283.610.834.03.0-4.0
Secondary/higher363.640.804.03.0-4.0
Place of living 0.495 (1)
Rural493.470.964.03.0-4.0
Urban513.630.804.03.0-4.0
Living conditions 0.0001 (2)***
Very good243.83 b0.764.04.0-4.0
Good663.62 b0.824.03.0-4.0
Difficult102.40 a0.702.52.0-3.0
a,b: Post-hoc test designation; groups without a common designation differ significantly; *** p < 0.001; M: Mean; SD: Standard deviation; Me: Median; 25–75%: Quartile, (1) U Mann–Whitney, (2) ANOVA Kruskal–Wallis.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Kwiatosz-Muc, M.; Kopacz, B. Home Mechanical Ventilation: A Patient’s Perspective Survey Study. Int. J. Environ. Res. Public Health 2021, 18, 4048. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084048

AMA Style

Kwiatosz-Muc M, Kopacz B. Home Mechanical Ventilation: A Patient’s Perspective Survey Study. International Journal of Environmental Research and Public Health. 2021; 18(8):4048. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084048

Chicago/Turabian Style

Kwiatosz-Muc, Magdalena, and Bożena Kopacz. 2021. "Home Mechanical Ventilation: A Patient’s Perspective Survey Study" International Journal of Environmental Research and Public Health 18, no. 8: 4048. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084048

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop