Development of a Holistic Nursing Care Model to Improve the Psychological Well-being of Chronic Illness Patients

Abstract

This study aimed to examine nursing service quality in an Emergency Department (ED) using the SERVQUAL model and to explain its implications for patient satisfaction. A qualitative approach with an exploratory case study design was selected to capture in-depth patient experiences and operational realities in a time-pressured ED context, where satisfaction is shaped by both clinical urgency and service interaction. The study was conducted in a high-volume urban referral hospital ED, chosen because it reflects common constraints of emergency care, including crowding, rapid decision-making, and limited privacy. Fifteen informants were recruited purposively to ensure variation in perspectives: ten patients/family members and five nurses/coordinators. Findings indicated that responsiveness and reliability grounded in informational certainty were the most influential drivers of satisfaction, followed by assurance achieved through professional, calm communication and empathy maintained through brief but meaningful interactions. Key service gaps involved delayed responses during peak periods, inconsistent updates about waiting times and care steps, and environmental limitations affecting privacy. The study recommends standardizing triage communication and patient-status updates, implementing ED-specific brief communication training, strengthening surge coordination, and using continuous feedback to monitor SERVQUAL gaps over time.