EVALUATING THE PRIMARY HEALTH CARE SERVICES PROVIDED BY NURSES BASED ON DONABEDIANS' MODEL AT MANSOURA CITY

Background: Donabedian Model was the most common evaluation framework of quality in health system in the context of structure, process and outcome (SPO). A cross sectional descriptive study aimed to evaluate the PHC services provided by nurses based on Donabedians' Model at Mansoura City. Stratified random sample involved (16) PHC units at Mansoura City, purposive sample composed of all nurses on duty during the study they were 100 nurse and convenient sample of 400 clients. The data were collected through seven tools: to evaluate structure 1) An observational checklist to assess PHC units' services, 2) An observational checklist to assess PHC units' infrastructure, 3) An observational checklist to assess PHC units' infection control measures, 4) Nurses’ knowledge assessment questionnaire which include: (a) Demographic data sheet of the nurses and (b) Nurses’ knowledge assessment questionnaire, to evaluate process 5) Nurses’ performance observational check list, and to evaluate outcome 6) Nurses' satisfaction assessment scale and 7) clients’ satisfaction assessment scale which include: (a) Demographic data sheet and (b) Clients' satisfaction. Results of the present study illustrated that all of the studied PHC units provide the services of vaccination, early detection of thyroid hormone deficiency, family planning, and registration of births and deaths, while the minority (12.5%) of the studied PHC units provide health education about breast feeding, diagnosis, and treatment of infectious, and parasitic diseases, dealing with the emergency cases, and monitoring of food hygiene. More than two thirds (68.8%) of the studied PHC units had unsatisfactory safety measures, nursing staff, and laboratories. More than half (56.3%) of the studied PHC untis had unsatisfactory personal protective equipment, environments, and health care teams' role in infection control. All the nurses had a poor knowledge about principles, dimensions of quality services, and quality standards. The means of nurses' performance in vaccinations, family services and practitioner role were 11.75±1.25, 5.50±1.50, and 11.31±2.56 respectively. Nurses' job satisfaction means in relation to salaries, and incentives, organizational policy, interaction components, and methods of autonomy were 4.74±8.93, 8.21±3.85, 2.96±11.02, and 18.74±5.50 respectively. Finally means of clients' satisfaction from quality of nursing care related to nurses' knowledge, and information, professional behavior, clinical skills, and nursing care, and decision-making skills were 8.11±2.90, 17.38±4.38, 16.21±5.51, and 4.48±2.90 respectively. The study recommended that continuous assessment and evaluation for PHC units' quality of services. On job training programs for nurses working at PHC units regarding quality should be provided periodically. Equipping PHC units with standard structured and process of care to achieve desirable outcome. Estimate clients' satisfaction via different tools as questionnaire and suggestions boxes and other valuable channels must be available to pick relevant feedback from the clients. The outlined areas of clients’ dissatisfaction should be addressed by concerned.