Background : Discharge against medical advice (DAMA) not only jeopardizes patient health but also indicates dissatisfaction with healthcare services and leads to increased medical costs. This study aimed to determine the effect of a nurse-patient negotiation intervention on the rate of DAMA and patient satisfaction with the quality of nursing care.

Methods: This quasi-experimental study was conducted in 2023 on 60 inpatients at hospitals affiliated with Birjand University of Medical Sciences. Patients were randomly allocated into intervention and control groups (30 patients each) using block randomization. For the intervention group, a structured negotiation process based on the 7-step "Greenhalgh" model was implemented. The control group received routine care. Data were collected using demographic questionnaires, a DAMA causes checklist, and the standard LaMonica-Oberst Patient Satisfaction Scale (LOPSS) and were analyzed using SPSS software with independent t-tests, paired t-tests, Chi-square, and Fisher's exact tests.

Findings: Before the intervention, there was no significant difference in the mean satisfaction scores between the two groups (P=0.72). After the intervention, the mean satisfaction score in the intervention group increased significantly compared to the control group (P<0.001). Furthermore, the rate of DAMA in the intervention group was significantly lower than in the control group (P<0.001).

Conclusion: Employing structured negotiation skills by nurses can simultaneously lead to increased patient satisfaction with the quality of care and a significant reduction in the rate of discharge against medical advice. Therefore, incorporating negotiation skills training into nursing education programs and its application in the care process is recommended as an effective operational strategy for improving service quality indicators and patient safety.