A Study of the Quality of Nursing Services in Emergency Units Based on the SERVQUAL Model and Its Impact on Patient Satisfaction

Abstract

This qualitative embedded single-case study examined how emergency department (ED) nursing service quality, framed by the SERVQUAL model, influences patient satisfaction. The study was conducted in the ED of a tertiary referral hospital in an urban setting, chosen because high patient turnover and recurring crowding make service-quality trade-offs explicit. Sixteen informants were recruited purposively with maximum variation (six ED nurses, two nursing/quality managers, six adult patients, and two family companions) to capture diverse care trajectories and roles; recruitment stopped at thematic saturation. Data were collected through semi-structured interviews, non-participant observations, and review of relevant service documents, and analyzed using iterative thematic analysis combining inductive coding with SERVQUAL-guided categorization. Findings indicate that responsiveness and assurance were the strongest drivers of satisfaction, while tangibles amplified first impressions and dignity, reliability shaped perceptions during handovers and delays, and empathy operated through brief but meaningful micro-behaviors. Recommendations include communication-based responsiveness routines, standardized triage and discharge explanations, privacy-preserving practices, and workflow supports that sustain compassionate care under crowding. Future studies should triangulate these themes with operational metrics and test dimension-prioritized interventions across multiple ED settings.