RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS. / JOMOL ACHANKUNJUIST YEAR M.Sc. NURSING,
RATNA COLLEGE OF NURSING,
B.M ROAD, HASSAN.
2 / NAME OF THE INSTITUTION. / RATHNA COLLEGE OF NURSING, HASSAN.
3. / COURSE OF THE STUDY AND SUBJECT. / M.Sc. NURSING,
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO THE COURSE / 30TH JUNE 2008
5. / TITLE OF THE TOPIC / “ASSESS THE KNOWLEDGE AND PRACTICE OF STAFF NURSES ON PATIENT’S RIGHTS WITH VIEW TO DEVELOP INFORMATION GUIDE SHEET ON PATIENT RIGHTS”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF STAFF NURSES ON PATIENT’S RIGHTS WITH VIEW TO DEVELOP INFORMATION GUIDE SHEET ON PATIENT RIGHTS IN SELECTED HOSPITAL HASSAN.”
6. BRIEF RESUME OF THE INTENDED WORK;
6.1. INTRODUCTION;
“We will never have true civilization until we have learned to recognize the rights of others”.
-Will Rogers
Nursing is an integral part of the health care system and nurses direct their energies towards the promotion, maintenance and restoration of health. The role of nurses has expanded rapidly within the past ten years to include expertise specialization, autonomy and accountability. With the advent of the Consumer Protection Act of 1986, all professionals that is medical, architects, solicitors, chartered accountants, nurses etc. have come within the purview of the Act. The impact of health care consumer movement has been to promote increased accountability on the part of all health professionals including nurses7.
When professional liability is recognized, it defines the parameters of the profession and the standards of professional conduct. Nurses should therefore enhance their professional and legal knowledge. The patient is considered the consumer of nursing and health care. Thus, the nurses who are in the clinical area need to be aware of the patients' rights and nurses' responsibility towards them.
Nursing as a profession internationally, exists in diverse and changing social contexts which are experiencing the impact of globalization more so than in previous decades. Rapid technological developments, increasing inter-country workforce mobility and ongoing discovery of new evidence based health care practices, creates challenges for Governments as they strive to ensure the maintenance and continuation of high quality health care delivery. Performance outcomes Identifies environmental and behavioral factors which may compromise patient safety Identifies and implements appropriate actions to reduce risk and harm Intervenes and follows-up on incidents to reduce likelihood of reoccurrence.
Formalized in 1948, the Universal Declaration of Human Rights recognizes “the inherent dignity” and the “equal and unalienable rights of all members of the human family”. And it is on the basis of this concept of the person, and the fundamental dignity and equality of all human beings, that the notion of patient rights was developed. In other words, what is owed to the patient as a human being, by physicians and by the state, took shape in large part thanks to this understanding of the basic rights of the person17.
Patients should be aware of the practical contributions they can make to the optimal functioning of the health system. Their active participation in the diagnosis and treatment process is often desirable and sometimes indispensable. It is always important that they provide the relevant health professionals with all the information required for the purposes of diagnosis and treatment. The patient has an essential role, the reciprocal of the provider's, in ensuring that the dialogue between them is carried out in good faith.
Health is a subject closer to everybody’s heart. Improvement of one’s health and health of one’s family is a universal aspiration. However health has been always given a low priority status in the nation’s political and social agenda. With the increasing privatization of the health care services in the country, the state is slowly abdicating its responsibility to provide health care to the people. Medical profession contributes to the healthcare to the extent of only 25-30%. Approximately 70% input in the health care is by various sectors like the pharmaceutical industry, hospitals, blood banks etc. This 70% inputs are mostly managed on a commercial basis and therefore patient as a consumer must have certain rights. These rights of a patient as a consumer are more important than the rights of a general consumer because patient usually has very little choice in the treatment.
The Universal Declaration of Human Rights has been instrumental in enshrining the notion of human dignity in international law, providing a legal and moral grounding for improved standards of care on the basis of our basic responsibilities towards each other as members of the “human family”, and giving important guidance on critical social, legal and ethical issues. But there remains a great deal of work to be done to clarify the relationship between human rights and right to health, including patient rights. Recognizing this challenge, the United Nations Commission on Human Rights (UNHCR) has designated a Special Rapporteur to provide it with a report that examines and clarifies the broader relationship between human rights and the right to health. This report has great importance for the World Health Organization, whose mission is to ensure “health for all”. Grounding this mission in a fundamental human right to health would be an important milestone, and a great step forward realizing this goal 17.
6.2 NEED FOR THE STUDY.
Nurses and entire staff are committed to providing patient with excellent care, both clinical and personal. In addition it is nurses’ policy to respect patient individuality and dignity. We support the patient right to know about patient health and illness and also the right to participate in the critical / vital decisions that affect patient well-being7.
A nurse to be effective needs to have high degree of knowledge; knowledge regarding the rights of his or her client. When you we know the patients rights, you know where you stand, where your patient stands and where other stand. Nurses have duties to facilitate patient exercise of rights in appropriate ways .The nurse should be able to critically evaluate the legal and institutional rights by reference to human rights and should act as a patient’s advocate8.
Today’s patient is viewed as an active member of health team rather than a passive recipient of care. Average citizen today is much more knowledgeable about the complete mechanism of human body. He knows that he has the right to question the treatment he is being given, to have a stay in this treatment and to keep informed of his progress. There has been an active and growing consumer movement in the health field in recent years. Increasing public awareness of health issues and raising the cost of health services are some of the factors contributing to this movement. The patient wants to be involved in the treatment decision, patient have certain rights. Some are guaranteed by federal law, such as the right to get a copy of patient medical records, and the right to keep them private. Many states have additional laws protecting patients, and healthcare facilities often have a patient bill of rights8.
Developments within health care systems such as their increasing complexity, the fact that medical practice has become more hazardous and in many cases more impersonal and dehumanized, often involving bureaucracy, and no less the progress made in medical and health science and technology have all placed new emphasis on the importance of recognizing the individual's right to self-determination and often on the need to reformulate guarantees of other rights of patients. so this situation provocative me to conduct study. 7
A patient, have certain rights. Some are guaranteed by federal law, such as the right to get a copy of your medical records, and the right to keep them private. Many states have additional laws protecting patients, and healthcare facilities often have a patient bill of rights. An important patient right is informed consent. This means that if patient need a treatment, nurse or health care provider should give the information to patient; patient need to make a decision. The WHO have standardized patient’s rights.
Patient Rights are,
· Right to access to care.
· Right to respect and dignity.
· Right to privacy and confidentiality.
· Right to refusal to treatment.
· Right to personal safety and security.
· Right to know the identity of individuals providing service to him/her.
· Right to information.
· Right to communication.
· Right to consent.
· Right to consultation.
· Right to transfer and continuity of care.
· Right to hospital rules and regulations.
· Right to complain. 7
Woogara J. (2001) has done a qualitative study in human rights and patients’ privacy in UK hospitals. The European Convention on Human Rights has been incorporated into UK domestic law. It gives many rights to patients within the National Health Service (NHS). This article explores the concept of patients' right to privacy. It stresses that privacy is a basic human right, and that its respect by health professionals is vital for a patient's physical, mental, emotional and spiritual well-being. I argue that health professionals can violate patients' privacy in a variety of ways. For example: the right to enjoy their property; the right to protect their medical and personal information as confidential; the right to expect treatment with dignity during intimate care; and the right to control their personal space and territory. Some preliminary evidence indicates that many health care practitioners, including nurses, are presently unaware of the articles of the Convention and the implications of the Human Rights Act 1998. In order to prevent litigation for breaches of patients' privacy, it is advocated that universities and other educational institutions, the Government and NHS trusts should help to produce a clear educational strategy and protocols so that students and practitioners are well informed in this field. Although 41 European countries are presently the signatories of the European Convention on Human Rights, including the UK, it is important to stress that the principles discussed in this article are applicable world-wide.
Patients' rights vary in different countries and in different jurisdictions, often depending upon prevailing cultural and social norms. Different models of the patient-physician relationship - which can also represent the citizen-state relationship -have been developed, and these have informed the particular rights to which patients are entitled. In North America and Europe, for instance, there are at least four models which depict this relationship: the paternalistic model, the informative model, the interpretive model, and the deliberative model. Each of these suggests different professional obligations of the physician toward the patient. For instance, in the paternalistic model, the best interests of the patient as judged by the clinical expert are valued above the provision of comprehensive medical information and decision-making power to the patient. The informative model, by contrast, sees the patient as a consumer who is in the best position to judge what is in her own interest, and thus views the doctor as chiefly a provider of information. There continues to be enormous debate about how best to conceive of this relationship, but there is also growing international consensus that all patients have a fundamental right to privacy, to the confidentiality of their medical information, to consent to or to refuse treatment, and to be informed about relevant risk to them of medical procedures17.
During clinical posting as an investigator I found that many nurses are unaware of patient’s rights, and the well aware nurses are not practicing while they proving patient care. Patient’s right will help to provide a high quality health care delivery to patient and also will protect nurses and patients from medical legal issues. So in the clinical area the nurses need to be aware of the patient rights and nurses’ responsibility towards the patient. So this situation stimulated me to conduct this study.
The nursing method is the basis of all clinical judgments and includes all dealings made by nurses in providing care to patients. Considerations for culture, safety, education, health and wellness, patient care, self-health promotion, and planning for long-term health maintenance are included in nursing measures. (Potter et al, 2005).
6.3. STATEMENT OF THE PROBLEM:
“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF STAFF NURSES ON PATIENT’S RIGHTS WITH VIEW TO DEVELOP INFORMATION GUIDE SHEET ON PATIENT RIGHTS IN S.C GOVERNMENT HOSPITAL HASSAN.”
6.4. OBJECTIVES OF THE STUDY:
The objectives of the study are:
Ø To determine existing knowledge of staff nurses regarding the patient’s rights.
Ø To determine existing practice of staff nurses on patient’s rights.
Ø To find out the association between the knowledge and practice on patient’s rights with staff nurses demographic variables.
Ø To compare and knowledge and practice of staff nurses on patient rights.
Ø To develop information guide sheet on patient’s rights.
6.5. HYPOTHESIS:
Ø There will be a significant association between knowledge and practice of staff nurses on patient rights with selected demographic variables.
6.6 ASSUMPTION:
Ø Nurses will have some amount of knowledge and practice on patient’s rights.
6.7 OPERATIONAL DEFINITIONS:
The terms used in this study are defined as follows:
1. Assess:
It is a statistically measurement of knowledge and practice items on the
patient’s rights.
2. Knowledge:
It refers to the correct response by staff nurses to knowledge items in closed
ended questionnaires related to patient’s rights.
3. Practice:
It refers to the correct response to practice items assessed through check list
related to patient rights.
4. Patient rights:
It refers to standardized patient rights in terms of agreement in maintaining
good services, injustice, morality followed by the staff nurse while providing
patient care.
5. Staff Nurses:
Registered nurses who are directly involved in patient care.
6.8 INCLUSION AND EXCLUSION CRITERIA:
1. INCLUSION CRETERIA:
Ø Staff nurses working in S.C Government hospital Hassan.
Ø Available at the time of study.
2. EXCLUTION CRITERIA: