In response to: Hätönen, H. Jyrkinen A., Katajisto J., Kuosamen L.& Välimäki M. (2006) Patient satisfaction with inpatient psychiatric care. Journal of Advanced Nursing 55(6), 655–663.


Hätönen et al. (2006) do an excellent job of examining patient satisfaction in the acute inpatient psychiatric setting. The authors identify specific areas in need of improvement in order to obtain higher patient satisfaction ratings, particularly access to information, improvements on restrictions and compulsory care, and patient-staff relationships.

In my experience as a mental health nurse, patient dissatisfaction with information and restrictions may well be related. When restrictions are placed upon patient movements and actions without sufficient information being conveyed as to both cause and goal, these restrictions may seem arbitrary from a patient's perspective. The result: patient dissatisfaction from a sense of being unjustly and unnecessarily prohibited from certain actions.

Baraff and Krishel (1993) identified increased satisfaction with emergency department care when information regarding specific emergency room protocols and what to anticipate was provided to patients on arrival to the Emergency Department. Performing research with a similar intervention in the psychiatric setting would help determine if providing education about restrictions on admission would serve to improve patient understanding of and satisfaction with restrictions. Restrictions on an inpatient psychiatric unit typically involve the provision of safety and maintenance of therapeutic milieu (Kennedy 2002). Communicating these rationale with patients may serve to make restrictions more tolerable. Additional research regarding whether patient satisfaction with restrictions is improved in response to increased information and education from staff regarding the rationale of these restrictions may prove fruitful.

O'Connell et al. (1999) demonstrated difficulty rating patient satisfaction with inpatient care. An important conclusion reached was that pre-existing perceptions of nursing tended to correlate with patient satisfaction ratings. Follow-up studies on patient satisfaction in the inpatient mental health setting may benefit from including questions regarding the overall perception of mental health, mental illness, and mental health treatment to determine if these factors are significantly influencing patient satisfaction ratings. These factors may help explain variances between demographic groups when divided by previous psychiatric hospitalizations and length of illness. Patients without previous mental health treatment may have distorted expectations regarding mental health care delivery; conversely, patients with a significant history of mental health treatment may have developed the skills to effectively judge quality of mental health service delivery (Williams & Wilkinson 1995).

Patient–staff relationship is another area in which further research will be helpful in identifying specific factors contributing to lower satisfaction. The authors noted strong variances in patient satisfaction with staff–patient relationships based on patient demographics. Identifying what elements of the patient–staff interaction each group found satisfying and unsatisfying may help identify unique interaction needs of specific demographic groups. Determining whether quantity of interactions was a cause of dissatisfaction, for example, would allow interventions designed to ensure increased frequency of staff–patient interaction while identifying specific interaction elements (tone of voice, directive versus non-directive, body language, age and gender) may suggest possible changes in the way staff–patient interactions are managed.

This excellent article contributes significantly to the body of knowledge of nursing. Further research may benefit from including an option for patients to enter a narrative response on patient satisfaction surveys to identify specific issues that contributed to dissatisfaction in a general area. If details can be determined about the causes of dissatisfaction, nursing can work to develop specific interventions to improve patient satisfaction. Qualitative research may also prove useful in identifying themes among patients with lower satisfaction ratings.