Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Caroline Etland, PhD, RN, CNS, ACHPN, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN; Laurie Ecoff, PhD, RN, NEA-BC, CNL


Patient Preference, Patient Experience, Covid-19, HCAHPS, Patient Satisfaction, Pandemic, Visitation, Adult, Inpatients, Retrospective Studies, Logistic Models, Length of Stay, Perception, SARS-CoV-2


Background: It has been nearly 20 years since the National Academy of Medicine released the report Crossing the Quality Chasm, which emphasized the importance of patients receiving individualized health care that is responsive to their preferences. Since that time, the term patient experience has become a staple in health care vernacular. Personal preferences are a key attribute of the patient experience and shape all its aspects. The COVID-19 global pandemic necessitated patient isolation, visitor restrictions, and has skewed the patient experience for the sake of patient, staff, and community safety. Understanding the impact of the pandemic on patient preference measures has significance for organizations, nurses, and patients.

Study Population: The study population consisted of inpatient adults, ages 18 and greater, at an acute care community hospital in southern California who completed a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Purpose/Aims: This study examined patient perceptions of staff respecting their preferences as measured by a score of always on the HCAHPS items 1, 2, 5, 6, and 20 prior to and during the pandemic.

Methods: A retrospective correlational comparative design study was conducted. HCAHPS raw data (N = 5,094) was analyzed from October 2019 to February 2021. Descriptive statistics characterized the sample and chi-square analyses were conducted to describe the relationships of the variables. Logistic regression identified the amount of variance for variables that had statistically significant associations.

Results: HCAHPS question 20, the most direct patient preference question, was the only question with a statistically significant association between when the survey was administered, pre-pandemic or during the pandemic, and whether the patient perceived the hospital staff considered their preference, and those of family and caregiver, into account (χ2(1) = 9.13, p = .003). More notably, in the during the pandemic group, the relationships among nearly all independent variables were significantly associated with a top box response to question 2, which asked whether the nurse listened carefully: Race (χ2 = 14.62, p = .040), education level (χ2 = 13.17, p = .022), length of stay (χ2 = 21.92, p = χ2 = 4.86, p = .027).

Implications: Nursing care provided during a pandemic influenced patients’ perceptions of staff respecting their preferences more than any other factors. Qualitative analysis is needed to further explore associations among the variables.

Document Type

Dissertation: USD Users Only