Beyond the ceiling effect: Using a mixed methods approach to measure patient satisfaction

Sharon Andrew, Yenna Salamonson, Bronwyn Everett, Elizabeth J. Halcomb, Patricia M. Davidson

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


This study reports patient satisfaction with the nursing care on a neurosurgical critical care unit. A modified version of the Ludwig-Beymer Patient Satisfaction Questionnaire (PSQ-7) was used, and included structured items and semi-structured interview questions. Data were collected from 149 patients. Participants rated their satisfaction as high (Mean = 25.14; SD = 2.96). The distribution of scores was skewed and every item demonstrated a ceiling effect. Principal component analysis yielded a one-component solution which explained 48% of the variance. NVivo ® was used to match PSQ-7 scores with qualitative data. Participants’ comments were categorised as positive, negative or ‘yes, but’. Just over half the patients made positive comments and 29% of patients in the low group made negative comments. Three categories: ‘communication’, ‘nursing care delivery’ and ‘the hospital environment’ emerged from the qualitative data. A mixed method approach enables researchers to move beyond the ceiling effect of quantitative measures of patient satisfaction and to gain a more meaningful explanation of patient satisfaction.

Original languageEnglish (US)
Pages (from-to)52-63
Number of pages12
JournalInternational Journal of Multiple Research Approaches
Issue number1
StatePublished - Apr 2011
Externally publishedYes


  • Communication
  • Mixed methods
  • Patient safety
  • Patient satisfaction
  • Quality assurance

ASJC Scopus subject areas

  • Education


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