https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Patient Satisfaction with the Quality of Nursing Care in Public and Private Hospitals in Erbil City ABSTRACT Background and Objectives: Patient satisfaction is an essential parameter in assessing the quality of care and healthcare facility performance and the most important competitive advantage of the government and private hospitals. The study aims to investigate pa- tients’ satisfaction regarding the quality of nursing care in both public and private hospitals. Methods: A quantitative, comparative study was conducted among 330 patients (165 from public hospitals and 165 from private hospitals) in Erbil City from October 2023 to February 2024. Data were collected through structured interviews using a standardized questionnaire and analyzed using descriptive and inferential statistics via the Statistical Package for the Social Sciences. Results: Among the 330 patients surveyed, the majority were aged 18 to 39 years (55.8%), predominantly female (65.5%) and married (75.2%). Notably, 50.3% had been hospitalized over four times in public hospitals. Patients reported their health status as fair (38.8% before hospitalization), with 64.2% transferred from other facilities. In private hospitals, 100% of patients had single occupancy in their rooms. Satisfaction scores for nursing care were significantly higher in private hospitals compared to public ones (p < 0.001). Significant associations were observed between sociodemographic factors and nursing care satisfaction (p < 0.001), with gender showing no significant association (p = 0.819). Conclusions: The study concludes that patients in private hospitals exhibit strong satisfac- tion with the quality of nursing care compared to those in public hospitals. This highlights the importance of addressing disparities in nursing care quality between hospital types to enhance overall patient satisfaction and healthcare outcomes. Keywords: Patient Satisfaction; Quality of Nursing Care; Public Hospitals; Private Hospitals. Ali Taher Mohammedameen; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: ali.mohammedameen@hmu.edu.krd) Azzadin Kamal Mahmod; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. Yousif Bakr Omar; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. Haval Mohammed Qadir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. Sideeq Sadir Ali; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. Burhan Ezzadin Sabir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 115 Received: 19/05/2022 Accepted: 22/10/2024 Published: 30/11/2024 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:ali.mohammedameen@hmu.edu.krd mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Patient satisfaction with nursing care is a critical part of healthcare quality assess- ment, directly affecting patient outcomes, adherence to treatment plans, and overall healthcare delivery. It measures the pa- tient’s perception to which extent they are satisfied with receiving healthcare from their healthcare provider. [1] The quality of nursing care includes several features that contribute to providing the highest care to patients, such as effectiveness, efficiency, patient safety, best patient outcomes, and effective communication by addressing pa- tients' physical, psychological, emotional, sociocultural, and spiritual aspects of care needs competently, resulting in the best possible outcomes. [2, 3] Providing holistic nursing care rather than physical nursing care only increased the patient’s level of satisfaction. As such, exploring the rela- tionship between holistic care and patient satisfaction becomes imperative for opti- mizing healthcare delivery and improving patient-centered outcomes. [4]Access to quality nursing care is a fundamental hu- man right that significantly impacts patient Well‐being. [5] One of the measurement methods to assess the quality of nursing care is by assessing patients' level of satis- faction. It can be improved by providing proper nursing care. [6, 7] A study con- ducted in Erbil City in 2021 compared pa- tient satisfaction levels between private and public hospitals. The research findings revealed a significant disparity in satisfac- tion levels, with patients in private hospi- tals being approximately 10 times more satisfied with overall healthcare services compared to those in public hospitals. This result underscores the importance of ex- amining differences in patient experiences between healthcare sectors and highlights potential areas for improvement within the public healthcare system. Factors contrib- uting to higher satisfaction rates in private hospitals may include shorter wait times, perceived higher quality of care, more personalized attention, and better amenities. [8]Lack of understanding of patients’ perception regarding the level of satisfaction with adult nursing care provided in private and public hospitals; the main part of hospital care is nursing care, and there is a critical gap in understanding healthcare quality. To compare satisfaction levels between these two types of hospitals, this study aims to provide insights to assess and compare the level of patient satisfaction with the adult nursing care provided by public and private hospitals in Erbil City. This investigation holds significance for healthcare providers, administrators, and policymakers, as it can inform strategies to enhance the quality of nursing care delivery and improve overall patientsatisfaction. A quantitative, comparative study was designed to assess patients' satisfaction with the quality of adult nursing care in private and public hospitals in Erbil City from October 2023 to February 2024. The sample size for this study was determined using a standard formula based on power analysis to detect statistically significant differences in patient satisfaction between public and private hospitals. With nearly 2250 patients admitted monthly to public hospitals, key parameters were established: a confidence level of 95% (with a Z-value of approximately 1.96), a margin of error of 5% (0.05), and an estimated proportion (p) assumed to be 0.5 to maximize variability. Using these parameters, the initial sample size was calculated with the formula n=Z2*p*(1−p)/ E2. Substituting the values, the calculation yielded approximately 384.16. To account for the finite population size [32] of 2250, the sample size was adjusted. 116 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article socio-demographic characteristics, while Part II employed the "Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ)" developed by Laschinger et al. [9]. This questionnaire was originally devel- oped by a multidisciplinary research team and was adapted from “The Patient Judg- ments of Hospital Quality (PJHQ)” ques- tionnaire. Prior assessments of reliability, as indicated by Cronbach coefficients, have consistently demonstrated high values. The scoring of the questionnaire involves calculating a general satisfaction score for each patient by summing the scores for all items and dividing by the total number of items. This process yields a single average score that reflects the patient’s overall satisfaction with the nursing care received. Ethical approval was initially obtained from the Ethics Committee at the College of Nursing, Hawler Medical University (Approval No. 5, January 21, 2024). Subse- quently, official permission was secured from the General Directorate of Health for data collection in public hospitals. For pri- vate hospitals, an official request was made by the university through adminis- trative channels to obtain permission from each hospital's administrative department. Additionally, verbal consent was obtained from each patient before data collection. The collected data were analyzed using descriptive statistics to calculate frequency and percentage distributions. Additionally, for finding the mean difference, the T-test was used, and for finding the level of sig- nificance, the Mann-Whitney U test (because they were not normally distribut- ed) was employed to compare variables between groups. All statistical analyses were conducted using the Statistical Pack- age for Social Sciences (SPSS), version 23. The adjustment helps maintain the statisti- cal validity of the study. Without this cor- rection, the results may be skewed, lead- ing to incorrect conclusions about the pop- ulation. Using the formula nadjusted=n/1+ (n−1)/N [33], resulting in an adjusted sam- ple size of about 328.6. Ultimately, the study recruited a total of 330 patients, with 165 from public hospitals and 165 from private hospitals. This sample size calculation, based on a 5% margin of error and a 95% confidence level, ensured suffi- cient statistical power for the study, facili- tating meaningful comparisons of patient satisfaction across hospital types. Patients were selected from most of the public hos- pitals in Erbil City, including Rizgary Teach- ing Hospital, Hawler Teaching Hospital, Maternity Teaching Hospital, West Emer- gency Hospital, and East Emergency Hospi- tal. In this study, a total of seven private hospitals were initially identified as eligible candidates for inclusion, namely Paky Hos- pital, Serdem Private Hospital, Zheen Inter- national Hospital, CMC Private Hospital, Mehrabani Surgical Hospital, Hawler Pri- vate Hospital, and Zanko Hospital. Howev- er, five private hospitals were selected for participation to maintain confidentiality and impartiality without singling out any specific institution. The selection process was conducted based on factors such as accessibility, patient volume, and diversity of services offered. By including a diverse representation of private hospitals, the study aims to comprehensively compare private and public hospitals regarding the quality of adult nursing care in Erbil City while ensuring fairness and confidentiality. This study included adult patients aged 18 years and older, regardless of gender. Pa- tients who were unconscious or had signifi- cant mental health issues were excluded to ensure valid responses. Data were collect- ed through structured interviews utilizing a two-part questionnaire. Part I captured 117 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Table 1 shows the socioeconomic charac- teristics of patients in both private and public hospitals. In terms of age distribu- tion, the majority of patients in both hospi- tal types were young adults aged between 18 and 39 years, comprising 55.2% in pri- vate hospitals and 55.8% in public hospi- tals. Middle-aged adults (40-59 years) ac- counted for 30.9% in private hospitals and 25.5% in public hospitals, while old adults (60-99 years) constituted 13.9% in private hospitals and 18.8% in public hospitals. The mean age and standard deviation for pa- tients in private hospitals were 39.47 ± 15.857 years, whereas in public hospitals they were 40.62 ± 16.797 years. Regarding gender distribution, more patients were females in both private (58.2%) and public (65.5%) hospitals. The majority of patients in both hospital types were married, comprising 75.2% in private hospitals and 73.3% in public hospitals. Regarding time of hospitalization, the majority of patients in private hospitals (39.4%) were admitted only once in the past two years, whereas in public hospitals, the majority (50.3%) were hospitalized over four times, likely due to the high cost of private hospitals. Before hospitalization, most patients in private hospitals (38.8%) reported their health sta- tus as fair, while in public hospitals, a slightly lower percentage (33.9%) reported fair health status. In terms of admission manner, a significant proportion of pa- tients in both private (64.2%) and public (53.3%) hospitals were transferred from another facility. Lastly, in private hospitals, the majority of patients (100%) stayed alone in their rooms, whereas in public hospitals, the majority (79.4%) stayed with more than one other person. 118 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT Variable Private hospitals n=165 Public hospitals n=165 N (%) N (%) Age group (years) 18-39 Young Adult 91 (55.2) 92 (55.8) 40-59 Middle-aged Adult 51 (30.9) 42 (25.5) 60-99 Old-Adult 23 (13.9) 31 (18.8) M ± SD 39.47 ± 15.857 40.62 ± 16.797 Gender Male 69 (41.8) 57 (34.5) Female 96 (58.2) 108 (65.5) Marital status Single 23 (13.9) 28 (17) Married 124 (75.2) 121 (73.3) Divorced 4 (2.4) 2 (1.2) Widowed 14 (8.5) 14 (8.5) Table 1: Socioeconomic Characteristics of patients in Private and Public hospitals https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 119 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Socioeconomic Characteristics of patients in Private and Public hospitals Variable Private hospitals n=165 Public hospitals n=165 N (%) N (%) Times of hospitaliza- tion during the past 2 years Only once 65 (39.4) 38 (23) Twice 23 (13.9) 27 (16.4) 3 Times 14 (8.5) 11 (6.7) 4 Times 10 (6.1) 6 (3.6) Over 4 Times 53 (32.1) 83 (50.3) Overall patient’s health before hospital- ization Excellent 1 (0.6) 0 (0) Good 39 (23.6) 22 (13.3) Fair 64 (38.8) 56 (33.9) Poor 44 (26.7) 58 (35.2) Very Poor 16 (9.7) 29 (17.6) Unsure 1 (0.6) 0 (0) Manner of admission toward Admitted through the Emergency Department 20 (12.1) 67 (40.6) Transferred from another facility 106 (64.2) 88 (53.3) Admitted through patient registration/to the unit di- rectly 36 (21.8) 8 (4.8) Admitted after day procedure or test 1 (0.6) 2 (1.2) Others 2 (1.2) 0 (0) The number of pa- tients in a room for most of the hospital stay By yourself 165 (100) 30 (18.2) With another patient 0 (0) 4 (2.4) With 2 or more patients 0 (0) 131 (79.4) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article private hospitals, a total of 90.3% of re- spondents in this setting reported being “excellent” and “very good.” In contrast, only 21.8% of patients in public hospitals fell into the same categories. The data re- veal that a significant proportion of public hospital patients, 41.2%, reported a “good”, 28.5% were “fair”, and 8.5% were “poor”. Therefore, the total percentage in those similar lower categories was 9.7% among private hospitals. The mean satisfaction score in private hos- pitals was 4.678 with a standard deviation of 0.451, whereas in public hospitals, the mean satisfaction score was lower at 3.478 with a standard deviation of 0.682. This finding underscores the importance of hos- pital type in influencing patient satisfaction with nursing care. 120 Table 2 shows the overall level of satisfac- tion reported by patients, showing a nota- ble disparity between private and public hospitals. Patients in private hospitals ex- hibited higher levels of satisfaction with nursing care, with 79.4% expressing being 'excellent.' Conversely, a mere 7.9% of them in public hospitals expressed that they were “excellent” regarding the quali- ty of nursing care. In addition to the high percentage of “excellent” patients in Table 3 shows the comparative analysis of patient satisfaction with the quality of nursing care between private and public hospitals. The results indicate a very high- ly significant difference between the two types of hospitals (P-Value <0.001), with patients in private hospitals reporting no- tably significantly higher satisfaction lev- els. Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2: Overall patients’ Satisfaction with the quality of nursing care in Private and Public hospitals Overall Satisfaction Setting of Hospitals Total Private N=165 Public N=165 N (%) N (%) Excellent 131 (79.4) 13 (7.9) 144 (43.64) Very Good 18 (10.9) 23 (13.9) 41 (12.41) Good 13 (7.9) 68 (41.2) 81 (24.55) Fair 2 (1.2) 47 (28.5) 49 (14.85) Poor 1 (0.6) 14 (8.5) 15 (4.55) Total 165 (100) 165 (100) 330 (100) Table 3: Comparative between public and private hospitals regarding patients’ Satisfaction with the quali- ty of nursing care Total Mean of patients’ satisfaction Public Mean ±SD Private Mean ±SD Mean Difference 95% Confidence Inter- val of the Difference P-Value (Sig.) Lower Upper 3.491± 0.698 4.678± 0.451 1.187 1.060 1.314 2344.5* < 0.001 (VHS)** * Mann-Whitney U test ** Very High significant difference https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article ED-admitted patients reported “very good” or “excellent” satisfaction, whereas those admitted through patient registration or elective procedures reported much higher levels of satisfaction. A very significant re- lationship was found between room- sharing and satisfaction (p < 0.001). Pa- tients who were in a room alone or with one other person reported higher satisfac- tion levels, with 68.2% of these patients rating their experience as “excellent”. Con- versely, patients who shared rooms with multiple individuals reported lower satis- faction, with only 8.4% rating their care as “Excellent”. Table 4 reveals the association between the levels of patients’ satisfaction with some variables of socio-demographic data. The age group 18-39 years reported the highest level of “excellent” satisfaction, with 39.3% of patients indicating they were highly satisfied. In comparison, 25.9% of patients in the same age group rated their experience as “very good”. For the older age groups (40-59 and 60-99 years), satisfaction levels decrease, with fewer patients reporting “very good” or “excellent” are used. The relationship be- tween age and satisfaction was found to be statistically significant (p = 0.029), indi- cating that younger patients tend to ex- press higher levels of satisfaction. Gender did not show a significant relationship with patient satisfaction (p = 0.819), as the lev- els of satisfaction between male and fe- male patients were fairly comparable. However, slightly more females reported “very good” or “excellent” satisfaction than males, but the difference was not sta- tistically significant. Marital status was sig- nificantly associated with satisfaction (p = 0.020). Married patients were more likely to report “very good” or “excellent” satis- faction, with 44.9% of married patients indicating high satisfaction, compared to lower satisfaction among single individu- als, with only 33.3% of single patients re- porting similarly high levels of satisfaction. The number of times a patient had been hospitalized significantly impacted satis- faction (p = 0.003). Patients who had been hospitalized more than four times report- ed the lowest satisfaction levels, with only 33.8% rating their care as “very good” or “excellent”. On the other hand, those hos- pitalized only once were more likely to re- port high satisfaction (52.4%).Patients ad- mitted through the emergency depart- ment (ED) or transferred from another fa- cility showed significantly lower satisfac- tion levels (p < 0.001). Only 17.2% of 121 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 122 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4: Association between level of patients’ satisfaction with some variables of socio-demographic data Variables Level patients’ Satisfaction P- Value (Sig.) Poor N (%) Fair N (%) Good N (%) Very Good N (%) Excellent N (%) Age group (years) 18-39 11 (6) 39 (21.3) 42 (23) 19 (10.4) 72 (39.3) 0.029 S 40-59 4 (4.3) 5 (5.4) 25 (26.9) 12 (12.9) 47 (50.5) 60-99 0 (0) 5 (9.3) 14 (25.9) 10 (18.5) 25 (46.3) Gender Male 4 (3.2) 18 (14.3) 34 (27) 12 (9.5) 58 (46) 0.819 NS Female 11 (5.4) 31 (15.2) 47 (23)) 29 (14.2) 86 (42.2) Marital status Single 4 (7.8) 9 (17.6) 13 (25.5) 8 (15.7) 17 (33.3) 0.02 HS Married 10 (4.1) 37 (15.1) 59 (24.1) 29 (11.8) 110 (44.9) Divorced 0 (0) 0 (0) 1 (16.7) 0 (0) 5 (83.3) widowed 1 (3.6) 3 (10.7) 8 (28.6) 4 (14.3) 12 (42.9) Times of hospitaliza- tion Only once 5 (4.9) 9 (8.7) 14 (13.6) 21 (20.4) 54 (52.4) 0.003 HS Twice 4 (8) 8 (16) 14 (28) 2 (4) 22 (44) 3 Times 1 (4) 6 (24) 0 (0) 4 (16) 14 (56) 4 Times 1 (6.3) 1 (6.3) 5 (31.3) 1 (6.3) 8 (50) Over 4 Times 4 (2.9) 25 (18.4) 48 (35.3) 13 (9.6) 46 (33.8) Manner of admission toward Admitted through the ED 11 (12.6) 30 (34.5) 19 (21.8) 12 (13.8) 15 (17.2) <0.001 VHS Transferred from another facility 4 (2.1) 17 (8.8) 54 (27.8) 25 (12.9) 94 (48.5) Admitted through patient registration 0 (0) 2 (4.5) 6 (13.6) 3 (6.8) 33 (75) Admitted after day procedure 0 (0) 0 (0) 2 (66.7) 0 (0) 1 (33.3) Others 0 (0) 0 (0) 0 (0) 1 (50) 1 (50) The number of patients in a room By yourself 3 (1.5) 18 (9.2) 21 (10.8) 20 (10.3) 133 (68.2) <0.001 VHS With another patient 0 (0) 1 (25) 2 (50) 1 (25) 0 (0) With 2 or more patients 12 (9.2) 30 (22.9) 58 (44.3) 20 (15.3) 11 (8.4) NS= Not significant relationship S= significant relationship HS= High significant relationship VHS= Very High significant relationship https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article The study's investigation into overall pa- tient satisfaction with nursing care re- vealed notable disparities between private and public hospitals. The majority of par- ticipants in private hospitals reported ex- cellent levels of satisfaction, whereas those in public hospitals expressed a good level of satisfaction. These findings are in line with studies by Alhusban M. and Abu- alrub R. [21] and Mulugeta et al. [22]. Con- versely, Lotfi et al. [11], found that most patients were fair with nursing care in spe- cific hospital wards. Karaca A. and Durna Z. [12], found that the patients were more satisfied, which means very good with the nursing care from a private hospital in Is- tanbul Turkey. KOÇ et al. [23], indicate that patients were generally moderately satis- fied with the care they received. The study done by Yusefi et al. [3] in Shiraz, Tehran, revealed that the total quality of nursing care from the patient’s perspective was moderate. Thapa S, and Joshi A. [16] in Ni- pal, The finding revealed that the majority (51 %) of patients had poor satisfaction with the quality of nursing care provided; in this study, the good level equals moder- ate level because the researcher used five Likert scales. The comparison between public and private hospitals regarding pa- tient satisfaction further substantiates these disparities. The study identified a highly significant difference in satisfaction levels, with patients in private hospitals expressing higher satisfaction rates. These findings agree with Hepsiba R. and Bhattacharjee T. [24] in India, Dinsa et al. [25] in Ethiopia, and Khattak et al. (2012) in Pakistan. Similarly, Sharma S. and Kamra P. [26] observed differing nursing care prac- tices between public and private hospitals. Additionally, Mutiarasari et al. (2021) re- ported higher satisfaction levels among patients treated in private hospitals com- pared to public hospitals. This is supported by Ali S. [27], who observed differing In this study, the participants predomi- nantly comprised younger adults, with similar distributions observed in both pri- vate and public hospitals (55.2% and 55.8% respectively). Additionally, the ma- jority of the study samples were female and married, and the results align with previous studies conducted by Al-Khafaji Z and Al-Hussein I. [10], Lotfi et al. [11], Ka- raca A. and Durna Z. [12], and Goes et al. [13]. Concerning the frequency of hospi- talization over the past two years, the findings revealed that while the majority of participants in private hospitals were hospitalized only once, those in public hospitals experienced hospitalization over four times more frequently. This result corroborates the findings of studies con- ducted by Findik et al. [14], Eyasu et al. [15], and Thapa S. and Joshi A. [16] which revealed that most patients in private hospitals were hospitalized only once, compared with those in public hospitals. The study also found that the overall health status of patients in private hospi- tals before hospitalization was predomi- nantly fair. This finding is consistent with research conducted by Alsaqri S. [17] in Ha’il City, Saudi Arabia. Furthermore, a significant proportion of participants were transferred from another hospitalization facility, which supports the findings of Mi- lutinović et al. [18]. In terms of room ar- rangements, while most patients in public hospitals shared rooms, all participants in private hospitals stayed alone in their rooms. This trend is similarly observed in studies by Akhtari-Zavare et al. [19] In Tehran most cases were admitted in gen- eral wards, and Alharbi, et al. [20] In Saudi Arabia, more than half of the participants shared a hospital room with others, and nearly half had a family member with them during their hospitalization. 123 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Discussion https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.11 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article [1] Manzoor F, Wei L, Hussain A, Asif M, Shah SIA. Patient Satisfaction with Health Care Services; An Application of Physician's Be- havior as a Moderator. International Journal of Environmental Research and Public Health. 2019;16 (18). DOI: 10.3390/ ijerph16183318. [2] Stavropoulou A, Rovithis M, Kelesi M, Vasi- lopoulos G, Sigala E, Papageorgiou D, et al. What Quality of Care Means? Exploring Clinical Nurses' Perceptions on the Concept of Quality Care: A Qualitative Study. Clinic and Practice. 2022;12 (4):468-81. DOI: 10.3390/clinpract12040051. [3] Yusefi AR, Sarvestani SR, Kavosi Z, Bahmaei J, Mehrizi MM, Mehralian G. Patients' per- ceptions of the quality of nursing services. BMC Nursing. 2022;21 (1):131. DOI: 10.1186/s12912-022-00906-1. [4] Rajabpour S, Rayyani M, Mangolian shahrb- abaki P. The relationship between Iranian patients’ perception of holistic care and satisfaction with nursing care. BMC Nursing. 2019;18 (1):48. DOI: 10.1186/s12912-019- 0374-7. [5] Fuseini AG, Bayi R, Alhassan A, Atomlana JA. Satisfaction with the quality of nursing care among older adults during acute hospitali- zation in Ghana. Nursing Open. 2022;9 (2):1286-93. [6] Aiken LH, Sloane DM, Ball J, Bruyneel L, Rafferty AM, Griffiths P. Patient satisfaction with hospital care and nurses in England: an observational study. BMJ Open. 2018;8 (1):e019189. DOI: 10.1136/bmjopen-2017- 019189. [7] Gishu T, Weldetsadik AY, Tekleab AM. Pa- tients' perception of quality of nursing care; a tertiary center experience from Ethiopia. BMC Nursing. 2019;18:37. DOI: 10.1186/ s12912-019-0361-z. [8] Qadir DO, Qader SS, Al-Banna DA, Rasool AA, Shakor JK. Patient’s Satisfaction with Health Care Services in Erbil City/Iraq. Erbil Journal of Nursing and Midwifery. 2021;3 (2):119 - 25. DOI: 10.15218/ejnm.2020.14. [9] Laschinger HS, Hall LM, Pedersen C, Almost J. A psychometric analysis of the patient satisfaction with nursing care quality ques- tionnaire: an actionable approach to meas- uring patient satisfaction. Journal of Nursing Care Quality. 2005;20 (3):220-30. DOI: 10.1097/00001786-200507000-00006. nursing care practices between public and private hospitals. Additionally, Mutiarasari et al. [28] in Indonesia reported higher satisfaction levels among patients treated in private hospitals compared to public hospitals. Regarding the association be- tween the levels of patients’ satisfaction with some variables of socio-demographic data related to the quality of nursing care, the study identified significant associations with all variables the biographical data of the patients in both (private and public) hospitals except gender, which did not show a significant relationship with patient satisfaction. These findings are consistent with Charalambous et al. [29] in Cyprus, Siraj S. and Arifa S. [30] in Srinagar, Jammu and Kashmir, India, and Sachdeva S. and Kaur H. [31] in New Delhi Hospital, India, who observed similar trends in patient satisfaction and sociodemographic factors. However, the study found no significant associations between sociodemographic characteristics and nursing care quality in either public or private hospitals, which is consistent with findings by Eyasu et al. [15] and Al-Khafaji Z. and Al-Hussein I. [10] in their examination of nursing care prac- tices. The quality of nursing care significantly influences patient satisfaction in both pri- vate and public hospitals in Erbil City. This study concluded that staff nurses in pri- vate hospitals provide higher-quality nurs- ing care compared to those in public hos- pitals. Patients’ satisfaction levels were higher in private hospitals; the difference was statistically significant. From the study, it has been clear that in private and public hospitals, patient satisfaction was positively associated with some socio- demographic variables related to nursing care. Finally, the quality of nursing care in public hospitals should be improved. 124 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. 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