Patients’ perceptions of Quality Nursing Care and Services in Emergency rooms of West Bank hospitals

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Understanding patient perspectives regarding nursing care quality in emergency settings provides crucial insights for enhancing service delivery and patient outcomes. Objective This investigation aimed to evaluate patient perceptions regarding nursing care quality and associated services within emergency departments of West Bank healthcare institutions. Methodology: A descriptive cross-sectional design was employed, encompassing 219 patients who received emergency care services across three major West Bank hospitals. Data collection utilized a validated 36-item instrument measuring multiple dimensions of nursing care quality perception. Findings: Analysis revealed that 52.1% of participants demonstrated favorable perceptions of emergency nursing care quality. Domain-specific analysis indicated the highest satisfaction levels for nurse-patient interpersonal dynamics (73.1%), followed by clinical competency (67.1%), service efficiency (63.9%), instructional provision (63.0%), personal information management (55.3%), physical environment (47.5%), and sanitation standards (27.9%). Educational attainment emerged as a significant predictor of care perception quality (p < 0.05). Conclusions Approximately half of the study population expressed positive perceptions of emergency nursing care quality. Educational background significantly influenced patient perceptions, suggesting the need for tailored communication strategies in diverse patient populations. healthcare quality assessment emergency nursing patient satisfaction healthcare perception Palestine Introduction Emergency healthcare delivery necessitates rapid clinical decision-making and immediate therapeutic interventions that significantly impact patient trajectories and outcomes¹. The temporal constraints inherent in emergency care environments create unique challenges for healthcare providers attempting to deliver comprehensive, patient-centered services while maintaining clinical excellence and safety standards²,³. Contemporary healthcare organizations face increasing pressure to demonstrate measurable improvements in care quality while simultaneously achieving optimal patient satisfaction outcomes⁴. This dual imperative has elevated the importance of systematic patient feedback collection and analysis as essential components of quality improvement initiatives⁵. Patient perspectives provide invaluable insights into care delivery effectiveness, highlighting areas of excellence and identifying opportunities for enhancement⁶. The concept of nursing care quality encompasses multiple interconnected dimensions that collectively contribute to patient experiences and clinical outcomes⁷. These dimensions include technical competency, interpersonal communication effectiveness, environmental factors, information provision adequacy, and service efficiency⁸. Understanding how patients perceive these various aspects of care enables healthcare organizations to develop targeted improvement strategies that address specific deficiencies while building upon existing strengths⁹. Emergency department settings present unique challenges for nursing care delivery due to high patient acuity, time pressures, resource constraints, and the unpredictable nature of patient presentations¹⁰. These environmental factors can significantly influence patient perceptions of care quality, making it essential to understand how emergency-specific contextual elements affect patient experiences and satisfaction levels¹¹,¹². The quality of care, as defined by the Institute of Medicine (IOM) is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge"¹¹. The American Nurses Association defines the quality of nursing care as "the measures to meet patients' ideas, which are necessary to meet their healthcare needs"¹². Research examining patient perceptions of healthcare quality has consistently demonstrated the critical importance of these assessments in driving organizational improvements and enhancing patient-centered care delivery⁶,⁹. Patient feedback provides authentic insights into care experiences that may not be captured through traditional clinical quality metrics, offering a more comprehensive understanding of healthcare effectiveness from the consumer perspective¹³. Patients have described the quality of nursing care in terms of many aspects, including interpersonal care, efficiency, competency, comfort, personal information, the physical environment, and general instruction¹³,¹⁴. Emergency department patients are not always satisfied with the care delivered, and nursing care is often characterized as instrumental and non-holistic in emergency departments¹⁵. The perceptions of patients about the quality of care they receive are a significant and challenging problem in the development of health care services¹⁶. Patient perception is a significant measure that provides an impression of the efficiency of nursing care⁷. Also, it is considered an important factor in improving the quality of the hospital⁹. The theoretical framework underlying this investigation recognizes that patient perceptions are influenced by multiple factors, including individual characteristics, previous healthcare experiences, cultural backgrounds, and specific situational contexts. Understanding these influencing factors enables healthcare providers to develop more nuanced approaches to care delivery that acknowledge and respond to diverse patient needs and expectations. This study addresses a significant gap in the regional healthcare literature by providing empirical evidence regarding patient perceptions of emergency nursing care quality within the West Bank healthcare context. The findings contribute to the broader understanding of healthcare quality assessment while offering practical insights for local healthcare improvement initiatives. Therefore, the purpose of the study was to assess the patients' perceptions of the quality of nursing care and services in the emergency rooms of the West Bank hospitals. Literature Review Healthcare quality assessment has evolved significantly over recent decades, with increasing recognition of patient perspectives as essential components of comprehensive quality measurement frameworks. The Institute of Medicine's definition of healthcare quality emphasizes the alignment between services provided and desired health outcomes, while considering consistency with current professional knowledge standards. Patient satisfaction research has demonstrated strong correlations between positive care experiences and improved clinical outcomes, reduced readmission rates, and enhanced treatment adherence. These findings underscore the clinical significance of patient perception assessments beyond their value for service improvement initiatives. Emergency care settings present unique challenges for patient satisfaction measurement due to the acute nature of patient presentations, time constraints, and emotional stress associated with emergency situations. Despite these challenges, research has consistently shown that patient perceptions of emergency care quality can be reliably measured and provide valuable insights for service enhancement. Cross-cultural studies of healthcare quality perceptions have revealed significant variations in patient expectations and satisfaction determinants across different populations. These findings highlight the importance of culturally sensitive approaches to quality assessment and improvement planning that acknowledge local contexts and patient characteristics. Recent investigations in similar healthcare settings have demonstrated varying levels of patient satisfaction with emergency nursing care, ranging from moderate to high satisfaction levels depending on specific care dimensions and organizational factors. These studies consistently identify interpersonal communication, clinical competency, and environmental factors as primary determinants of patient satisfaction. Methodology Study Design and Setting This investigation employed a descriptive cross-sectional design to examine patient perceptions of nursing care quality within emergency departments. The study was conducted across three major referral hospitals in the West Bank region, selected based on their status as primary healthcare destinations and their representative patient demographics. The hospitals were chosen because they were the largest and referral hospitals. Participants and Sampling The target population comprised adult patients who received emergency care services and met specific inclusion criteria. Eligibility requirements included: minimum age of 19 years, cognitive capacity to provide informed consent, and willingness to participate voluntarily. Exclusion criteria encompassed patients with severe cognitive impairments, unconscious individuals, and those experiencing significant pain or discomfort that would compromise their ability to participate meaningfully. A convenience sampling approach was utilized to recruit 219 participants during the data collection period. Sample size adequacy was confirmed through power analysis calculations, ensuring sufficient statistical power to detect meaningful differences in perception scores across demographic subgroups. Data Collection Instrument Data collection employed a validated questionnaire comprising two primary sections: Demographic Information Section This component captured participant characteristics including age, gender, marital status, educational background, monthly income, frequency of emergency department utilization, and chronic disease history. Patient Perception of Quality Nursing Care Scale This section utilized the instrument developed by Senarat and Gunawardena¹⁴, subsequently validated in Arabic by Al-Hussami and colleagues¹⁷. The 36-item scale encompasses eight distinct dimensions Interpersonal relationships between patients and nurses (12 items) Service delivery efficiency (7 items) Ward comfort provisions (4 items) Sanitation standards (3 items) Personal information management (3 items) Physical environment quality (3 items) General instruction provision (2 items) Clinical competency demonstration (2 items) The questionnaire items score on a 5-point Likert scale ranging from 1 (fully disagree) to 5 (fully agree). The scoring system is classified into two groups: ( 1 ) high level of perception for domains and statements their mean scores are higher than the mean score of perception scale, and ( 2 ) poor level for domains and statements their mean scores are less than the mean score of perception scale. The instrument has high internal consistency (Cronbach's alpha = 0.91). The Arabic version of this instrument has good psychometric properties, with an internal consistency reliability using Cronbach's alpha coefficient of 0.979 for the total scale¹⁷. Pilot Study A pilot study conducted on 20 patients before starting the actual study and their comments revealed that the items were clear, not confusing, comprehensive, suitable, and easy to complete. The questionnaire took around 15–20 minutes to be completed. The pilot study participants were excluded from the actual study. Data Collection Procedures Data collection occurred between March 20, 2021, and May 29, 2021, following receipt of institutional ethical approvals. The patients who were admitted to the wards from emergency rooms were chosen by the researcher. For several reasons, the emergency rooms at government hospitals are overloaded. There is no waiting area in the emergency room to collect data after patients have completed their treatments, and most patients, after completing treatment in the emergency room, are in a hurry to leave. The researcher visited the targeted hospitals after receiving ethical approval. The approval was also obtained from the hospitals and the nursing managers. The researchers then contacted all patients admitted to emergency rooms who met the inclusion criteria. The researcher provided a complete description to the participants, and those who agreed to participate gave their informed consent. The researcher clarified that participation is voluntary, and they can withdraw from the study at any time. Ethical Considerations Ethical approval was obtained from the Palestinian Ministry of Health (approval number: 162/308/2021) and participating hospital administrations. All procedures adhered to international research ethics standards, including the Declaration of Helsinki principles. Each participant was given a detailed description of the study's objectives as well as enough time to fill out questionnaires. Patients are informed about voluntary participation. All information was kept confidential and was only used for research purposes. Participant confidentiality was maintained through anonymous data collection, with all information stored securely and used exclusively for research purposes. Statistical Analysis Data analysis employed descriptive and inferential statistical methods using appropriate software packages. Descriptive statistics characterized participant demographics and perception scores across all measured dimensions. Multiple linear regression analysis examined relationships between demographic variables and overall perception scores, identifying significant predictors of care quality perceptions. Statistical significance was established at p < 0.05 for all analyses. Missing data were handled through appropriate statistical techniques to minimize bias and maintain analytical validity. Results Participant Characteristics Two hundred and nineteen participants were completed and returned for analysis. The findings revealed that the mean age of participants was 47.6 (SD = 15.3) years. With regard to gender, the majority of 137 (62.6%) were males, and the remaining were females. Also, approximately 71 (32.4%) had a secondary education level, and 66 (30.1%) had a primary education level. Further, 161 (73.5%) of the participants were married. The analysis revealed that their average visits to hospital were 3.4(SD = 3.5) and their monthly income average were 1949.8 (SD = 1517.8) NIS. Also, the analysis revealed that more than half of the participants' 120 (54.79%) reported having a history of chronic illness, as seen in Table 1 . Table 1 Demographic characteristics of the participants (N = 219) Characteristics Category M (SD) n (%) Age 47.6 (15.3) Gender Male 137(62.6%) Female 82(37.4%) Education Primary school 66(30.1%) Secondary school 71(32.4%) Diploma 20(9.1%) Bachelor 59(26.9%) Postgraduate studies 3(1.4%) Marital status Single 35(16.0%) Married 161(73.5%) Divorced 5(2.3%) Widowed 18(8.2%) Number of visits in previous year 3.4 (3.5) Monthly income 1949.8 (1517.8) History of chronic disease Yes 120(54.8%) No 99(45.2%) M = Mean, SD = standard deviation Nursing Care Quality Perceptions The participants' perceptions of the quality nursing care level and the eight domains are presented in Table 2 . The level of the overall scale of the good perception was 114 (52.1%). Also, on average, the domain that scored the highest level of good perception was Interpersonal relationship between patients and nurses with 73.1%, followed by 67.1% the competency of nurses in caring for patient, then efficiency in serving patient 63.9%, the provision of general instructions by the nurses 63.0%, Personal information 55.3%, Physical environment in the ward 47.5%, and finally Sanitations with 27.9%. Table 2 Patients' perceptions of nursing care at emergency rooms in West Bank hospitals (N = 219) Domain Good perception N (%) Poor perception N (%) Interpersonal relationship between patients and nurses 160(73.1) 59(26.9) Efficiency in serving patient 140(63.9) 79(36.1) Comforts provided in the ward 106(48.4) 113(51.6) Sanitations 61(27.9) 158(72.1) Personal information 121(55.3) 98(44.7) Physical environment in the ward 104(47.5) 115(52.5) The provision of general instructions by the nurses 138(63.0) 81(37.0) The competency of nurses in caring for patient 147(67.1) 72(32.9) Total 114(52.1%) 105 (47.9%) Predictive Factors Analysis Multiple linear regression analysis revealed that the level of education accounted for 3.8% of the variance in perception of quality nursing care. As shown in Table 3 , gender, history of chronic disease, age, marital status, and number of visits in the previous year had no effect on perception of nursing care quality. Table 3 Predictors of patients' perceptions of the quality of nursing care (N = 219) Variable Unstandardized Coefficients Standardized Coefficients t P. Value 95.0% Confidence Interval for B B Std. Error Beta Lower Bound Upper Bound Gender − .200 .128 − .111 -1.563 .120 − .452 .052 History of chronic disease .132 .147 .075 .901 .369 − .157 .422 Age .001 .005 .013 .135 .893 − .010 .011 Level of education − .121 .050 − .167 -2.423 .016 − .219 − .023 Marital status .018 .101 .015 .176 .860 − .181 .217 Number of visits to emergency room last year .000 .017 − .002 − .026 .980 − .035 .034 Dependent Variable: nursing care Note. R² = 0.038, adjusted R² = 0.010, F-statistic = 1.382, df = 6 Discussion According to the findings of this study, 114 (52.1%) of patients had a positive perception of the quality of nursing care, while 105 (47.9%) had a negative perception. This finding was consistent with the Twayana & Adhikari study done in Nepal¹⁸. Another study supported this results conducted by Buchanan et al. revealed that 59.9% of patients were very satisfied with nursing care in the emergency department¹⁹. Also, this result was supported by another study conducted in Nepal by Gupta, which found that respondents' positive perception of nursing care was 91%¹³. Similarly, results revealed in a study conducted in Turkey revealed that patients had a positive view of nursing services⁴. Another study conducted in Sri Lanka supported the current study findings, which revealed that 70.0% of respondents had a positive perception and 30.0% had a negative perception of the overall aspect of nursing care⁹. In addition, the current findings are supported by a recent study conducted in Lahore, Pakistan. The results revealed that patients' perceptions of the quality of nursing care are good, and patients have a positive response about the quality of nursing care in hospitals²⁰. On the other hand, other studies contradict the current study's results. A study conducted by Ogunlade et al. in south-western Nigeria revealed that 67% of the patients perceived unsatisfactory (negative perception) emergency nursing care in the selected hospitals¹⁶. However, 18.5% of the patients reported a positive or satisfactory experience. Another study conducted by Samina et al. in India revealed a higher percentage of patients had a negative perception of nursing care regarding "explanation and information" and "caring attitude" (31% and 11.5%, respectively)²¹. The current results showed that the domain of interpersonal relationships between patients and nurses scored the highest level of good perception (73.1%), followed by (67.1%) of the competency of nurses in caring for patients, and then (63.9%) of efficiency in serving patients through the provision of general instructions by the nurses. However, Sanitations had the lowest domain scores (27.9%). Similar results by Twayana and Adhikari study revealed that 33.6% of respondents had a negative perception of the dimension of physical environment and facilities¹⁸. Also, a study of Muraleeeswaran and Thenuka revealed that 37.6% of respondents had a negative perception in the category of physical environment and facilities⁹. The highest satisfaction levels observed for interpersonal relationships and clinical competency highlight the fundamental importance of human interaction quality and professional expertise in shaping patient experiences. These findings underscore the critical role of communication skills and clinical knowledge in emergency nursing practice. Conversely, the significantly lower satisfaction with sanitation standards represents a critical area requiring immediate attention. Poor sanitation perceptions can negatively impact overall care experiences and may indicate underlying infrastructure or procedural deficiencies that compromise patient safety and comfort. According to predictors of nursing care quality, the results revealed that level of education was the only predictor of nursing care quality. This result was supported by Negussie et al. study in north Ethiopia, which found that there was a statistically significant association between patient education and patient perception of quality nursing care⁷. Satisfaction with nursing care was associated with clients' education¹⁹. Also, Dikmen & Ylmaz found that factors such as the level of education of patients influenced nursing perception⁴. A similar result was found in Ethiopia by Gishu et al., who found that patient education has the strongest relationship with satisfaction²². However, this result was inconsistent with Twayana & Adhikari study, which found no association between education levels and levels of perception in nursing care¹⁸. Also, the same result was revealed by the Gupta study, which showed no significant difference in perception in relation to total nursing care by the education level of the respondents as the highest percentage of respondents had a positive perception¹³. Muraleeeswaran and Thenukas' study revealed a similar result, revealing that there was no association between education level and level of perception with nursing care⁹. The identification of educational attainment as a significant predictor of care quality perceptions provides important insights for healthcare providers. This relationship suggests that patients with different educational backgrounds may have varying expectations, communication preferences, and evaluation criteria for care quality. Limitations of the Study The study has several limitations that warrant consideration. First, the reliance on self-administered questionnaires may introduce response bias, as participants might have provided socially desirable answers rather than fully objective responses. Additionally, the sample was limited to three hospitals in the West Bank, which restricts the generalizability of findings to other regions or healthcare contexts. The cross-sectional design further constrains the ability to establish causal relationships, as perceptions were captured at a single point in time. Critically ill or cognitively impaired patients were excluded, potentially omitting valuable perspectives from vulnerable populations. Moreover, the study focused solely on patient perceptions and did not incorporate nurses' viewpoints, which could have enriched the understanding of care quality dynamics. Finally, cultural and contextual factors specific to the West Bank may limit the applicability of the results to diverse healthcare settings with differing norms and resource availability. Implications for Nursing Practice, Education, and Policy The findings underscore actionable steps to enhance emergency care. In nursing practice, prioritizing sanitation (27.9% satisfaction) through stricter protocols and resource allocation is critical, alongside strengthening interpersonal and communication skills to align with patient-valued competency (67.1%) and rapport (73.1%). Tailoring care to patients' educational backgrounds can address perception disparities. For nursing education, integrating patient-centered care, sanitation management, and cultural competence into curricula, supplemented by simulation-based emergency scenarios, can bridge training gaps. Continuous workshops on empathy and crisis communication will further refine skills. At the policy level, advocating for infrastructure funding, standardized patient perception metrics, and interdisciplinary collaboration ensures systemic improvements. Empowering patients through advocacy programs fosters feedback-driven care, advancing equitable, high-quality emergency services in resource-limited settings. Conclusions This study assessed patients' perceptions of the quality of nursing care and services in emergency rooms across West Bank hospitals, revealing critical insights for healthcare improvement. Approximately half (52.1%) of participants reported positive perceptions, with the highest satisfaction linked to interpersonal relationships (73.1%) and nurse competency (67.1%), underscoring the value of empathetic communication and clinical expertise in emergency care. Conversely, sanitation (27.9%) and physical environment (47.5%) emerged as areas requiring urgent attention, highlighting infrastructural and procedural gaps. The significant association between education level and patient perceptions further emphasizes the need for tailored communication strategies to accommodate diverse patient backgrounds. While the findings provide actionable pathways for enhancing emergency care, such as prioritizing sanitation, strengthening interpersonal training, and addressing educational disparities, the study's limitations, including its regional focus and exclusion of critically ill patients, suggest opportunities for future research. Expanding similar assessments to broader populations, integrating nurses' perspectives, and employing longitudinal designs could deepen understanding of care quality dynamics. By addressing these gaps and implementing targeted interventions, healthcare systems in the West Bank and comparable settings can advance equitable, patient-centered emergency care that aligns with global standards while fostering trust and satisfaction among patients. Abbreviations IOM: Institute of Medicine ER: Emergency Room IRB: Institutional Review Board NIS: New Israeli Shekel (currency) SD: Standard Deviation Declarations Acknowledgements We extend our sincere gratitude to all patients who participated in this study and shared their experiences. We also thank the nursing staff and administrative teams at the West Bank hospitals for their cooperation during data collection. Ethics Approval and Consent to Participate This study received ethical approval from the Palestinian Ministry of Health (approval number: 162/308/2021) and adhered to the ethical principles outlined in the Declaration of Helsinki. All participants were fully informed about the study's purpose, procedures, and tools. Participation was entirely voluntary, and participants retained the right to withdraw at any time without penalty. Written informed consent was obtained from all participants after they were given time to review the study details, ask questions, and clarify concerns. No names or identifying information were collected to ensure confidentiality and anonymity. Data were stored securely in password-protected systems and used solely for research purposes. The study upheld the highest standards of ethical research practice, prioritizing participant autonomy and privacy. Consent for Publication Not Applicable. Availability of Data and Materials The datasets generated and analyzed during this study are not publicly available due to confidentiality agreements but are available from the corresponding author upon reasonable request. Clinical Trial Not applicable. Competing Interests The authors declare no competing interests. Funding This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' Contributions O.M., A.A., L.H., and I.A. conceptualized and designed the study. O.M. and A.A. led data collection. A.A., L.H., and I.A. performed data analysis and interpretation. All authors contributed to drafting, revising, and finalizing the manuscript. I.A. supervised the project and ensured ethical compliance. All authors read and approved the final manuscript. References Pavedahl V, Holmström IK, Meranius MS, von Thiele Schwarz U, Muntlin Å. Fundamentals of care in the emergency room: an ethnographic observational study. Int Emerg Nurs. 2021 Sep;58:101050. DOI: 10.1016/j.ienj.2021.101050. Abu Arra AY, Ayed A, Toqan D, Albashtawy M, Salameh B, Sarhan AL, et al. The factors influencing nurses' clinical decision-making in emergency department. INQUIRY. 2023 Jan;60:00469580231152080. DOI: 10.1177/00469580231152080. Batran A, Al-Humran SM, Malak MZ, Ayed A. The relationship between nursing informatics competency and clinical decision-making among nurses in West Bank, Palestine. Comput Inform Nurs. 2022 Aug;40(8):547-53. DOI: 10.1097/CIN.0000000000000890. Dikmen Y, Yılmaz D. Patient's perceptions of nursing care: a descriptive study from Turkey. Ann Nurs Pract. 2016;3(3):1048. Habibi Soola A, Ajri-Khameslou M, Mirzaei A, Bahari Z. Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study. BMC Health Serv Res. 2022;22(1):547. DOI: 10.1186/s12913-022-07962-y. Sim J, Crookes P, Walsh K, Halcomb E. Measuring the outcomes of nursing practice: a Delphi study. J Clin Nurs. 2018;27(1-2):e368-78. DOI: 10.1111/jocn.13971. Kewi SY, Tesema AA, Negussie BB. Patient's perception towards quality of nursing care in inpatient department at public hospitals of Benishangul Gumuz Regional State, North West Ethiopia. J Nurs Care. 2018;7(4):1-0. DOI: 10.4172/2167-1168.1000467. Yilmaz AT, Cagan O. 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Satisfaction with nursing care in the emergency department of an urban hospital in the developing world: a pilot study. Int Emerg Nurs. 2015;23(3):218-24. DOI: 10.1016/j.ienj.2015.01.001. Khan A, Afzal M, Ali A, Hussain M, Gilani SA. Patient's perception towards quality of nursing care at public hospitals in Lahore, Pakistan. Indep J Allied Health Sci. 2018;1(3):175-82. Samina M, Qadri GJ, Tabish SA, Samiya M, Riyaz R. Patient's perception of nursing care at a large teaching hospital in India. Int J Health Sci. 2008;2(2):92-7. Gishu T, Weldetsadik AY, Tekleab AM. Patients' perception of quality of nursing care; a tertiary center experience from Ethiopia. BMC Nurs. 2019;18(1):37. DOI: 10.1186/s12912-019-0361-z. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6727771","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463283942,"identity":"5944e845-4edc-4a55-9712-a3d77ddc722a","order_by":0,"name":"Omar Majdoubeh","email":"","orcid":"","institution":"Arab American University Palestine","correspondingAuthor":false,"prefix":"","firstName":"Omar","middleName":"","lastName":"Majdoubeh","suffix":""},{"id":463283943,"identity":"7bdeb268-1fd0-4cee-ad38-5ec7f7ae12e2","order_by":1,"name":"Ahmad Ayed","email":"","orcid":"","institution":"Arab American University Palestine","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Ayed","suffix":""},{"id":463283945,"identity":"c1d87112-abd5-4a89-8bf2-9f7150ea2ccb","order_by":2,"name":"Lobna Harazneh","email":"","orcid":"","institution":"Arab American University Palestine","correspondingAuthor":false,"prefix":"","firstName":"Lobna","middleName":"","lastName":"Harazneh","suffix":""},{"id":463283946,"identity":"908f0514-ca5c-4476-a45f-717dbf2d354f","order_by":3,"name":"Ibrahim Aqtam","email":"data:image/png;base64,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","orcid":"","institution":"Ibn Sina College for Health Professions, Nablus University for Vocational and Technical Education","correspondingAuthor":true,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Aqtam","suffix":""}],"badges":[],"createdAt":"2025-05-22 20:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6727771/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6727771/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84970880,"identity":"4cc538d0-32e1-4583-92c0-88cdb5abd782","added_by":"auto","created_at":"2025-06-19 11:02:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":843664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6727771/v1/f695b325-ff0e-4e75-b604-5ecf34011c5e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patients’ perceptions of Quality Nursing Care and Services in Emergency rooms of West Bank hospitals","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEmergency healthcare delivery necessitates rapid clinical decision-making and immediate therapeutic interventions that significantly impact patient trajectories and outcomes\u0026sup1;. The temporal constraints inherent in emergency care environments create unique challenges for healthcare providers attempting to deliver comprehensive, patient-centered services while maintaining clinical excellence and safety standards\u0026sup2;,\u0026sup3;.\u003c/p\u003e \u003cp\u003eContemporary healthcare organizations face increasing pressure to demonstrate measurable improvements in care quality while simultaneously achieving optimal patient satisfaction outcomes⁴. This dual imperative has elevated the importance of systematic patient feedback collection and analysis as essential components of quality improvement initiatives⁵. Patient perspectives provide invaluable insights into care delivery effectiveness, highlighting areas of excellence and identifying opportunities for enhancement⁶.\u003c/p\u003e \u003cp\u003eThe concept of nursing care quality encompasses multiple interconnected dimensions that collectively contribute to patient experiences and clinical outcomes⁷. These dimensions include technical competency, interpersonal communication effectiveness, environmental factors, information provision adequacy, and service efficiency⁸. Understanding how patients perceive these various aspects of care enables healthcare organizations to develop targeted improvement strategies that address specific deficiencies while building upon existing strengths⁹.\u003c/p\u003e \u003cp\u003eEmergency department settings present unique challenges for nursing care delivery due to high patient acuity, time pressures, resource constraints, and the unpredictable nature of patient presentations\u0026sup1;⁰. These environmental factors can significantly influence patient perceptions of care quality, making it essential to understand how emergency-specific contextual elements affect patient experiences and satisfaction levels\u0026sup1;\u0026sup1;,\u0026sup1;\u0026sup2;.\u003c/p\u003e \u003cp\u003eThe quality of care, as defined by the Institute of Medicine (IOM) is \"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge\"\u0026sup1;\u0026sup1;. The American Nurses Association defines the quality of nursing care as \"the measures to meet patients' ideas, which are necessary to meet their healthcare needs\"\u0026sup1;\u0026sup2;.\u003c/p\u003e \u003cp\u003e Research examining patient perceptions of healthcare quality has consistently demonstrated the critical importance of these assessments in driving organizational improvements and enhancing patient-centered care delivery⁶,⁹. Patient feedback provides authentic insights into care experiences that may not be captured through traditional clinical quality metrics, offering a more comprehensive understanding of healthcare effectiveness from the consumer perspective\u0026sup1;\u0026sup3;.\u003c/p\u003e \u003cp\u003ePatients have described the quality of nursing care in terms of many aspects, including interpersonal care, efficiency, competency, comfort, personal information, the physical environment, and general instruction\u0026sup1;\u0026sup3;,\u0026sup1;⁴. Emergency department patients are not always satisfied with the care delivered, and nursing care is often characterized as instrumental and non-holistic in emergency departments\u0026sup1;⁵.\u003c/p\u003e \u003cp\u003eThe perceptions of patients about the quality of care they receive are a significant and challenging problem in the development of health care services\u0026sup1;⁶. Patient perception is a significant measure that provides an impression of the efficiency of nursing care⁷. Also, it is considered an important factor in improving the quality of the hospital⁹.\u003c/p\u003e \u003cp\u003eThe theoretical framework underlying this investigation recognizes that patient perceptions are influenced by multiple factors, including individual characteristics, previous healthcare experiences, cultural backgrounds, and specific situational contexts. Understanding these influencing factors enables healthcare providers to develop more nuanced approaches to care delivery that acknowledge and respond to diverse patient needs and expectations.\u003c/p\u003e \u003cp\u003e This study addresses a significant gap in the regional healthcare literature by providing empirical evidence regarding patient perceptions of emergency nursing care quality within the West Bank healthcare context. The findings contribute to the broader understanding of healthcare quality assessment while offering practical insights for local healthcare improvement initiatives. Therefore, the purpose of the study was to assess the patients' perceptions of the quality of nursing care and services in the emergency rooms of the West Bank hospitals.\u003c/p\u003e"},{"header":"Literature Review","content":"\u003cp\u003eHealthcare quality assessment has evolved significantly over recent decades, with increasing recognition of patient perspectives as essential components of comprehensive quality measurement frameworks. The Institute of Medicine's definition of healthcare quality emphasizes the alignment between services provided and desired health outcomes, while considering consistency with current professional knowledge standards.\u003c/p\u003e \u003cp\u003ePatient satisfaction research has demonstrated strong correlations between positive care experiences and improved clinical outcomes, reduced readmission rates, and enhanced treatment adherence. These findings underscore the clinical significance of patient perception assessments beyond their value for service improvement initiatives.\u003c/p\u003e \u003cp\u003eEmergency care settings present unique challenges for patient satisfaction measurement due to the acute nature of patient presentations, time constraints, and emotional stress associated with emergency situations. Despite these challenges, research has consistently shown that patient perceptions of emergency care quality can be reliably measured and provide valuable insights for service enhancement.\u003c/p\u003e \u003cp\u003eCross-cultural studies of healthcare quality perceptions have revealed significant variations in patient expectations and satisfaction determinants across different populations. These findings highlight the importance of culturally sensitive approaches to quality assessment and improvement planning that acknowledge local contexts and patient characteristics.\u003c/p\u003e \u003cp\u003eRecent investigations in similar healthcare settings have demonstrated varying levels of patient satisfaction with emergency nursing care, ranging from moderate to high satisfaction levels depending on specific care dimensions and organizational factors. These studies consistently identify interpersonal communication, clinical competency, and environmental factors as primary determinants of patient satisfaction.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Methodology","content":"\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis investigation employed a descriptive cross-sectional design to examine patient perceptions of nursing care quality within emergency departments. The study was conducted across three major referral hospitals in the West Bank region, selected based on their status as primary healthcare destinations and their representative patient demographics. The hospitals were chosen because they were the largest and referral hospitals.\u003c/p\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003eThe target population comprised adult patients who received emergency care services and met specific inclusion criteria. Eligibility requirements included: minimum age of 19 years, cognitive capacity to provide informed consent, and willingness to participate voluntarily. Exclusion criteria encompassed patients with severe cognitive impairments, unconscious individuals, and those experiencing significant pain or discomfort that would compromise their ability to participate meaningfully.\u003c/p\u003e \u003cp\u003eA convenience sampling approach was utilized to recruit 219 participants during the data collection period. Sample size adequacy was confirmed through power analysis calculations, ensuring sufficient statistical power to detect meaningful differences in perception scores across demographic subgroups.\u003c/p\u003e\n\u003ch3\u003eData Collection Instrument\u003c/h3\u003e\n\u003cp\u003eData collection employed a validated questionnaire comprising two primary sections:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDemographic Information Section\u003c/strong\u003e \u003cp\u003eThis component captured participant characteristics including age, gender, marital status, educational background, monthly income, frequency of emergency department utilization, and chronic disease history.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePatient Perception of Quality Nursing Care Scale\u003c/strong\u003e \u003cp\u003eThis section utilized the instrument developed by Senarat and Gunawardena\u0026sup1;⁴, subsequently validated in Arabic by Al-Hussami and colleagues\u0026sup1;⁷. The 36-item scale encompasses eight distinct dimensions\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eInterpersonal relationships between patients and nurses (12 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eService delivery efficiency (7 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWard comfort provisions (4 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSanitation standards (3 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePersonal information management (3 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePhysical environment quality (3 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGeneral instruction provision (2 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eClinical competency demonstration (2 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire items score on a 5-point Likert scale ranging from 1 (fully disagree) to 5 (fully agree). The scoring system is classified into two groups: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) high level of perception for domains and statements their mean scores are higher than the mean score of perception scale, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) poor level for domains and statements their mean scores are less than the mean score of perception scale. The instrument has high internal consistency (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.91). The Arabic version of this instrument has good psychometric properties, with an internal consistency reliability using Cronbach's alpha coefficient of 0.979 for the total scale\u0026sup1;⁷.\u003c/p\u003e\n\u003ch3\u003ePilot Study\u003c/h3\u003e\n\u003cp\u003eA pilot study conducted on 20 patients before starting the actual study and their comments revealed that the items were clear, not confusing, comprehensive, suitable, and easy to complete. The questionnaire took around 15\u0026ndash;20 minutes to be completed. The pilot study participants were excluded from the actual study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedures\u003c/h2\u003e \u003cp\u003eData collection occurred between March 20, 2021, and May 29, 2021, following receipt of institutional ethical approvals. The patients who were admitted to the wards from emergency rooms were chosen by the researcher. For several reasons, the emergency rooms at government hospitals are overloaded. There is no waiting area in the emergency room to collect data after patients have completed their treatments, and most patients, after completing treatment in the emergency room, are in a hurry to leave.\u003c/p\u003e \u003cp\u003eThe researcher visited the targeted hospitals after receiving ethical approval. The approval was also obtained from the hospitals and the nursing managers. The researchers then contacted all patients admitted to emergency rooms who met the inclusion criteria. The researcher provided a complete description to the participants, and those who agreed to participate gave their informed consent. The researcher clarified that participation is voluntary, and they can withdraw from the study at any time.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from the Palestinian Ministry of Health (approval number: 162/308/2021) and participating hospital administrations. All procedures adhered to international research ethics standards, including the Declaration of Helsinki principles. Each participant was given a detailed description of the study\u0026apos;s objectives as well as enough time to fill out questionnaires. Patients are informed about voluntary participation. All information was kept confidential and was only used for research purposes. Participant confidentiality was maintained through anonymous data collection, with all information stored securely and used exclusively for research purposes.\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eData analysis employed descriptive and inferential statistical methods using appropriate software packages. Descriptive statistics characterized participant demographics and perception scores across all measured dimensions. Multiple linear regression analysis examined relationships between demographic variables and overall perception scores, identifying significant predictors of care quality perceptions.\u003c/p\u003e\n \u003cp\u003eStatistical significance was established at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all analyses. Missing data were handled through appropriate statistical techniques to minimize bias and maintain analytical validity.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eTwo hundred and nineteen participants were completed and returned for analysis. The findings revealed that the mean age of participants was 47.6 (SD\u0026thinsp;=\u0026thinsp;15.3) years. With regard to gender, the majority of 137 (62.6%) were males, and the remaining were females. Also, approximately 71 (32.4%) had a secondary education level, and 66 (30.1%) had a primary education level. Further, 161 (73.5%) of the participants were married. The analysis revealed that their average visits to hospital were 3.4(SD\u0026thinsp;=\u0026thinsp;3.5) and their monthly income average were 1949.8 (SD\u0026thinsp;=\u0026thinsp;1517.8) NIS. Also, the analysis revealed that more than half of the participants' 120 (54.79%) reported having a history of chronic illness, as seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the participants (N\u0026thinsp;=\u0026thinsp;219)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.6 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e137(62.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82(37.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66(30.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71(32.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59(26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(16.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e161(73.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(8.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of visits in previous year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1949.8 (1517.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of chronic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120(54.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99(45.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eM\u0026thinsp;=\u0026thinsp;Mean, SD\u0026thinsp;=\u0026thinsp;standard deviation\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eNursing Care Quality Perceptions\u003c/h2\u003e \u003cp\u003eThe participants' perceptions of the quality nursing care level and the eight domains are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The level of the overall scale of the good perception was 114 (52.1%). Also, on average, the domain that scored the highest level of good perception was Interpersonal relationship between patients and nurses with 73.1%, followed by 67.1% the competency of nurses in caring for patient, then efficiency in serving patient 63.9%, the provision of general instructions by the nurses 63.0%, Personal information 55.3%, Physical environment in the ward 47.5%, and finally Sanitations with 27.9%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients' perceptions of nursing care at emergency rooms in West Bank hospitals (N\u0026thinsp;=\u0026thinsp;219)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood perception N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor perception N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal relationship between patients and nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e160(73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59(26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEfficiency in serving patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140(63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79(36.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComforts provided in the ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106(48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113(51.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSanitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61(27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158(72.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121(55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98(44.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical environment in the ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104(47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115(52.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe provision of general instructions by the nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138(63.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81(37.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe competency of nurses in caring for patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147(67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72(32.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e114(52.1%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e105 (47.9%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePredictive Factors Analysis\u003c/h2\u003e \u003cp\u003e Multiple linear regression analysis revealed that the level of education accounted for 3.8% of the variance in perception of quality nursing care. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, gender, history of chronic disease, age, marital status, and number of visits in the previous year had no effect on perception of nursing care quality.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of patients' perceptions of the quality of nursing care (N\u0026thinsp;=\u0026thinsp;219)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP. Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95.0% Confidence Interval for B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLower Bound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUpper Bound\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of chronic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of visits to emergency room last year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eDependent Variable: nursing care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eNote. R\u0026sup2; = 0.038, adjusted R\u0026sup2; = 0.010, F-statistic\u0026thinsp;=\u0026thinsp;1.382, df\u0026thinsp;=\u0026thinsp;6\u003c/h2\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to the findings of this study, 114 (52.1%) of patients had a positive perception of the quality of nursing care, while 105 (47.9%) had a negative perception. This finding was consistent with the Twayana \u0026amp; Adhikari study done in Nepal\u0026sup1;⁸. Another study supported this results conducted by Buchanan et al. revealed that 59.9% of patients were very satisfied with nursing care in the emergency department\u0026sup1;⁹. Also, this result was supported by another study conducted in Nepal by Gupta, which found that respondents' positive perception of nursing care was 91%\u0026sup1;\u0026sup3;. Similarly, results revealed in a study conducted in Turkey revealed that patients had a positive view of nursing services⁴. Another study conducted in Sri Lanka supported the current study findings, which revealed that 70.0% of respondents had a positive perception and 30.0% had a negative perception of the overall aspect of nursing care⁹. In addition, the current findings are supported by a recent study conducted in Lahore, Pakistan. The results revealed that patients' perceptions of the quality of nursing care are good, and patients have a positive response about the quality of nursing care in hospitals\u0026sup2;⁰.\u003c/p\u003e \u003cp\u003eOn the other hand, other studies contradict the current study's results. A study conducted by Ogunlade et al. in south-western Nigeria revealed that 67% of the patients perceived unsatisfactory (negative perception) emergency nursing care in the selected hospitals\u0026sup1;⁶. However, 18.5% of the patients reported a positive or satisfactory experience. Another study conducted by Samina et al. in India revealed a higher percentage of patients had a negative perception of nursing care regarding \"explanation and information\" and \"caring attitude\" (31% and 11.5%, respectively)\u0026sup2;\u0026sup1;.\u003c/p\u003e \u003cp\u003e The current results showed that the domain of interpersonal relationships between patients and nurses scored the highest level of good perception (73.1%), followed by (67.1%) of the competency of nurses in caring for patients, and then (63.9%) of efficiency in serving patients through the provision of general instructions by the nurses. However, Sanitations had the lowest domain scores (27.9%). Similar results by Twayana and Adhikari study revealed that 33.6% of respondents had a negative perception of the dimension of physical environment and facilities\u0026sup1;⁸. Also, a study of Muraleeeswaran and Thenuka revealed that 37.6% of respondents had a negative perception in the category of physical environment and facilities⁹.\u003c/p\u003e \u003cp\u003eThe highest satisfaction levels observed for interpersonal relationships and clinical competency highlight the fundamental importance of human interaction quality and professional expertise in shaping patient experiences. These findings underscore the critical role of communication skills and clinical knowledge in emergency nursing practice.\u003c/p\u003e \u003cp\u003eConversely, the significantly lower satisfaction with sanitation standards represents a critical area requiring immediate attention. Poor sanitation perceptions can negatively impact overall care experiences and may indicate underlying infrastructure or procedural deficiencies that compromise patient safety and comfort.\u003c/p\u003e \u003cp\u003eAccording to predictors of nursing care quality, the results revealed that level of education was the only predictor of nursing care quality. This result was supported by Negussie et al. study in north Ethiopia, which found that there was a statistically significant association between patient education and patient perception of quality nursing care⁷. Satisfaction with nursing care was associated with clients' education\u0026sup1;⁹. Also, Dikmen \u0026amp; Ylmaz found that factors such as the level of education of patients influenced nursing perception⁴. A similar result was found in Ethiopia by Gishu et al., who found that patient education has the strongest relationship with satisfaction\u0026sup2;\u0026sup2;. However, this result was inconsistent with Twayana \u0026amp; Adhikari study, which found no association between education levels and levels of perception in nursing care\u0026sup1;⁸. Also, the same result was revealed by the Gupta study, which showed no significant difference in perception in relation to total nursing care by the education level of the respondents as the highest percentage of respondents had a positive perception\u0026sup1;\u0026sup3;. Muraleeeswaran and Thenukas' study revealed a similar result, revealing that there was no association between education level and level of perception with nursing care⁹.\u003c/p\u003e \u003cp\u003eThe identification of educational attainment as a significant predictor of care quality perceptions provides important insights for healthcare providers. This relationship suggests that patients with different educational backgrounds may have varying expectations, communication preferences, and evaluation criteria for care quality.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eThe study has several limitations that warrant consideration. First, the reliance on self-administered questionnaires may introduce response bias, as participants might have provided socially desirable answers rather than fully objective responses. Additionally, the sample was limited to three hospitals in the West Bank, which restricts the generalizability of findings to other regions or healthcare contexts. The cross-sectional design further constrains the ability to establish causal relationships, as perceptions were captured at a single point in time. Critically ill or cognitively impaired patients were excluded, potentially omitting valuable perspectives from vulnerable populations. Moreover, the study focused solely on patient perceptions and did not incorporate nurses' viewpoints, which could have enriched the understanding of care quality dynamics. Finally, cultural and contextual factors specific to the West Bank may limit the applicability of the results to diverse healthcare settings with differing norms and resource availability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Nursing Practice, Education, and Policy\u003c/h2\u003e \u003cp\u003eThe findings underscore actionable steps to enhance emergency care. In nursing practice, prioritizing sanitation (27.9% satisfaction) through stricter protocols and resource allocation is critical, alongside strengthening interpersonal and communication skills to align with patient-valued competency (67.1%) and rapport (73.1%). Tailoring care to patients' educational backgrounds can address perception disparities. For nursing education, integrating patient-centered care, sanitation management, and cultural competence into curricula, supplemented by simulation-based emergency scenarios, can bridge training gaps. Continuous workshops on empathy and crisis communication will further refine skills. At the policy level, advocating for infrastructure funding, standardized patient perception metrics, and interdisciplinary collaboration ensures systemic improvements. Empowering patients through advocacy programs fosters feedback-driven care, advancing equitable, high-quality emergency services in resource-limited settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003e This study assessed patients' perceptions of the quality of nursing care and services in emergency rooms across West Bank hospitals, revealing critical insights for healthcare improvement. Approximately half (52.1%) of participants reported positive perceptions, with the highest satisfaction linked to interpersonal relationships (73.1%) and nurse competency (67.1%), underscoring the value of empathetic communication and clinical expertise in emergency care. Conversely, sanitation (27.9%) and physical environment (47.5%) emerged as areas requiring urgent attention, highlighting infrastructural and procedural gaps. The significant association between education level and patient perceptions further emphasizes the need for tailored communication strategies to accommodate diverse patient backgrounds. While the findings provide actionable pathways for enhancing emergency care, such as prioritizing sanitation, strengthening interpersonal training, and addressing educational disparities, the study's limitations, including its regional focus and exclusion of critically ill patients, suggest opportunities for future research. Expanding similar assessments to broader populations, integrating nurses' perspectives, and employing longitudinal designs could deepen understanding of care quality dynamics. By addressing these gaps and implementing targeted interventions, healthcare systems in the West Bank and comparable settings can advance equitable, patient-centered emergency care that aligns with global standards while fostering trust and satisfaction among patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIOM: Institute of Medicine\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;ER: Emergency Room\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;IRB: Institutional Review Board\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;NIS: New Israeli Shekel (currency)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;SD: Standard Deviation\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere gratitude to all patients who participated in this study and shared their experiences. We also thank the nursing staff and administrative teams at the West Bank hospitals for their cooperation during data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Palestinian Ministry of Health (approval number: 162/308/2021) and adhered to the ethical principles outlined in the Declaration of Helsinki. All participants were fully informed about the study\u0026apos;s purpose, procedures, and tools. Participation was entirely voluntary, and participants retained the right to withdraw at any time without penalty. Written informed consent was obtained from all participants after they were given time to review the study details, ask questions, and clarify concerns. No names or identifying information were collected to ensure confidentiality and anonymity. Data were stored securely in password-protected systems and used solely for research purposes. The study upheld the highest standards of ethical research practice, prioritizing participant autonomy and privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are not publicly available due to confidentiality agreements but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eO.M., A.A., L.H., and I.A. conceptualized and designed the study. O.M. and A.A. led data collection. A.A., L.H., and I.A. performed data analysis and interpretation. All authors contributed to drafting, revising, and finalizing the manuscript. I.A. supervised the project and ensured ethical compliance. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePavedahl V, Holmstr\u0026ouml;m IK, Meranius MS, von Thiele Schwarz U, Muntlin \u0026Aring;. Fundamentals of care in the emergency room: an ethnographic observational study. Int Emerg Nurs. 2021 Sep;58:101050. DOI: 10.1016/j.ienj.2021.101050.\u003c/li\u003e\n\u003cli\u003eAbu Arra AY, Ayed A, Toqan D, Albashtawy M, Salameh B, Sarhan AL, et al. The factors influencing nurses\u0026apos; clinical decision-making in emergency department. INQUIRY. 2023 Jan;60:00469580231152080. DOI: 10.1177/00469580231152080.\u003c/li\u003e\n\u003cli\u003eBatran A, Al-Humran SM, Malak MZ, Ayed A. The relationship between nursing informatics competency and clinical decision-making among nurses in West Bank, Palestine. Comput Inform Nurs. 2022 Aug;40(8):547-53. DOI: 10.1097/CIN.0000000000000890.\u003c/li\u003e\n\u003cli\u003eDikmen Y, Yılmaz D. Patient\u0026apos;s perceptions of nursing care: a descriptive study from Turkey. Ann Nurs Pract. 2016;3(3):1048.\u003c/li\u003e\n\u003cli\u003eHabibi Soola A, Ajri-Khameslou M, Mirzaei A, Bahari Z. Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study. BMC Health Serv Res. 2022;22(1):547. DOI: 10.1186/s12913-022-07962-y.\u003c/li\u003e\n\u003cli\u003eSim J, Crookes P, Walsh K, Halcomb E. Measuring the outcomes of nursing practice: a Delphi study. J Clin Nurs. 2018;27(1-2):e368-78. DOI: 10.1111/jocn.13971.\u003c/li\u003e\n\u003cli\u003eKewi SY, Tesema AA, Negussie BB. Patient\u0026apos;s perception towards quality of nursing care in inpatient department at public hospitals of Benishangul Gumuz Regional State, North West Ethiopia. J Nurs Care. 2018;7(4):1-0. DOI: 10.4172/2167-1168.1000467.\u003c/li\u003e\n\u003cli\u003eYilmaz AT, Cagan O. Evaluation of patients\u0026apos; satisfaction levels from nursing care: a university hospital example. Int J Caring Sci. 2018;11(3):1875-80.\u003c/li\u003e\n\u003cli\u003eMuraleeeswaran R, Thenuka M. Patient\u0026apos;s perceptions regarding quality nursing care in a Sri Lankan Hospital. Imperial J Interdiscip Res. 2016;2(5):1553-6. DOI: 10.1186/s12912-019-0361-z.\u003c/li\u003e\n\u003cli\u003eZhao SH, Akkadechanunt T, Xue XL. Quality nursing care as perceived by nurses and patients in a Chinese hospital. J Clin Nurs. 2009;18(12):1722-8. DOI: 10.1111/j.1365-2702.2008.02315.x.\u003c/li\u003e\n\u003cli\u003eInstitute of Medicine (US). Medicare: a strategy for quality assurance. Washington, DC: National Academy Press; 1990.\u003c/li\u003e\n\u003cli\u003eAmerican Nurses Association. Nursing\u0026apos;s social policy statement: the essence of the profession. Silver Spring, MD: Nursesbooks.org; 2010.\u003c/li\u003e\n\u003cli\u003eGupta BS, Shrestha S, Thulung BK. Patient\u0026apos;s perception towards quality nursing care. J Nepal Health Res Counc. 2014;12:83-7. DOI: 10.33314/jnhrc.v0i0.494.\u003c/li\u003e\n\u003cli\u003eSenarat U, Gunawardena NS. Development of an instrument to measure patient perception of the quality of nursing care and related hospital services at the National Hospital of Sri Lanka. Asian Nurs Res. 2011;5(2):71-80. DOI: 10.1016/S1976-1317(11)60015-7.\u003c/li\u003e\n\u003cli\u003eJaklič TK, Kovač J, Maletič M, Bunc KT. Analysis of patient satisfaction with emergency medical services. Open Med. 2018;13(1):493-502. DOI: 10.1515/med-2018-0073.\u003c/li\u003e\n\u003cli\u003eOgunlade AA, Ayandiran EO, Olaogun AA, Okunola RN. Perception of emergency nursing care among patients in selected hospitals in Oyo state Nigeria. Int J Caring Sci. 2017;10(2):971-7.\u003c/li\u003e\n\u003cli\u003eAl-Hussami M, Al-Momani M, Hammad S, Maharmeh M, Darawad M. Patients\u0026apos; perception of the quality of nursing care and related hospital services. Health Prim Care. 2017;1(2):1-6. DOI: 10.15761/HPC.1000110.\u003c/li\u003e\n\u003cli\u003eTwayana S, Adhikari RH. Patient\u0026apos;s perception regarding nursing care at inpatient department of hospitals in Bhaktapur District. Int J Sci Res Publ. 2015;5(5):1-3.\u003c/li\u003e\n\u003cli\u003eBuchanan J, Dawkins P, Lindo JL. Satisfaction with nursing care in the emergency department of an urban hospital in the developing world: a pilot study. Int Emerg Nurs. 2015;23(3):218-24. DOI: 10.1016/j.ienj.2015.01.001.\u003c/li\u003e\n\u003cli\u003eKhan A, Afzal M, Ali A, Hussain M, Gilani SA. Patient\u0026apos;s perception towards quality of nursing care at public hospitals in Lahore, Pakistan. Indep J Allied Health Sci. 2018;1(3):175-82.\u003c/li\u003e\n\u003cli\u003eSamina M, Qadri GJ, Tabish SA, Samiya M, Riyaz R. Patient\u0026apos;s perception of nursing care at a large teaching hospital in India. Int J Health Sci. 2008;2(2):92-7.\u003c/li\u003e\n\u003cli\u003eGishu T, Weldetsadik AY, Tekleab AM. Patients\u0026apos; perception of quality of nursing care; a tertiary center experience from Ethiopia. BMC Nurs. 2019;18(1):37. DOI: 10.1186/s12912-019-0361-z.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"healthcare quality assessment, emergency nursing, patient satisfaction, healthcare perception, Palestine","lastPublishedDoi":"10.21203/rs.3.rs-6727771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6727771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePatient-centered care assessment represents a fundamental component of healthcare quality improvement initiatives. Understanding patient perspectives regarding nursing care quality in emergency settings provides crucial insights for enhancing service delivery and patient outcomes.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis investigation aimed to evaluate patient perceptions regarding nursing care quality and associated services within emergency departments of West Bank healthcare institutions.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional design was employed, encompassing 219 patients who received emergency care services across three major West Bank hospitals. Data collection utilized a validated 36-item instrument measuring multiple dimensions of nursing care quality perception.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eAnalysis revealed that 52.1% of participants demonstrated favorable perceptions of emergency nursing care quality. Domain-specific analysis indicated the highest satisfaction levels for nurse-patient interpersonal dynamics (73.1%), followed by clinical competency (67.1%), service efficiency (63.9%), instructional provision (63.0%), personal information management (55.3%), physical environment (47.5%), and sanitation standards (27.9%). Educational attainment emerged as a significant predictor of care perception quality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eApproximately half of the study population expressed positive perceptions of emergency nursing care quality. Educational background significantly influenced patient perceptions, suggesting the need for tailored communication strategies in diverse patient populations.\u003c/p\u003e","manuscriptTitle":"Patients’ perceptions of Quality Nursing Care and Services in Emergency rooms of West Bank hospitals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 06:30:01","doi":"10.21203/rs.3.rs-6727771/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85ffcc36-25da-4b1b-af5c-b94de10efe09","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-19T10:53:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-02 06:30:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6727771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6727771","identity":"rs-6727771","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}