The Effectiveness of Evidence-Based Practice-Based Midwifery Services in Reducing the Number of Obstetric Interventions in Hospitals

Abstract

This study aimed to examine Emergency Department (ED) nursing service quality using the SERVQUAL model and its impact on patient satisfaction. A qualitative approach with an exploratory case study design was applied to capture how satisfaction is constructed through both clinical processes and interpersonal communication in time-pressured emergency contexts, where numeric indicators alone may miss key experiential drivers. The study was conducted in the ED of an urban referral hospital in Indonesia. A purposive sample of 24 informants was recruited, including staff nurses, an ED shift coordinator, quality personnel, and patients/family members, to ensure variation in roles and service experiences. Findings indicate that patient satisfaction reflects the combined performance of SERVQUAL dimensions: tangibles shape initial expectations, reliability and responsiveness influence perceptions of procedural consistency and timely action, and assurance and empathy strengthen trust, safety, and perceived dignity during crisis. Participants emphasized that delays were tolerated more when nurses provided clear updates and demonstrated attentive presence. The study recommends reinforcing triage and intervention standardization, embedding concise therapeutic communication as a core ED nursing competency, improving workload management to sustain responsiveness and empathy, and implementing continuous patient feedback loops to support ongoing quality improvement.