SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERATATION
`
MR. RAJAPPA H. P.
I YEAR M.Sc. NURSING
MEDICAL SURGICAL NURSING
2012-2014
SHREESIDDAGANGA INSTITUTE
OF NURSING SCIENCES AND
RESEARCH CENTRE,
B.H.ROAD, TUMKUR-572102
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALORE, KARNATAKA
PROFORMA FOR THE REGISTRATION OF
SUBJECT FOR DISSERTATION
1 / NAME OF CANDIDATE AND ADDRESS / RAJAPPA H P1 YEAR M Sc NURSING
SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B H ROAD, TUMKUR
2 / NAME OF THE INSTITUTION / SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE
3 / COURSE STUDY AND
SUBJECT / I YEAR MASTER OF SCIENCE IN
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 10/07/2012
5 / STATEMENT OF THE PROBLEM / A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND ATTITUDE REGARDING SELECTED LEGAL RESPONSIBILITIES IN PATIENT CARE AMONG STAFF NURSES AT SELECTED HOSPITALS, TUMKUR
1
- BRIEF RESUME OF THE INTENDED WORK
6.1 Introduction
“The only stable state is the one in which all men are equal before the law”
-Aristotle
The legal aspects of nursing are taught and expected to be kept up on throughout every nurse's career. A nursing job is something many young people aspire to but without the legal knowledge behind them, many hospitals will not hire them now that legal issues are becoming more and more problematic01.
As a nurse it has become an important necessity to be aware of the legal aspects associated with caring and helping people in the health industry today. Unfortunately, the more and more negligence cases there are the less and less people want to get into the health care field fearing legal aspects and the inevitable law suites. The first nursing law created was that of nursing registration in 190302.
Nursing is an integral part of the health care system and nurses direct their energies towards the promotion, maintenance & restoration of health. The role of nurses has expanded rapidly within the past ten years to include expertise specialization, autonomy & accountability. The patient is considered the consumer of nursing and health care.
Nursing is one of the noblest professions, but its nobility can be sustained only if those in the profession are able to worthy of it. The nurse has to carry out the orders of the physicians while treating a patient in diagnostic, operative and therapeutic procedures and also proper records regarding the cases. Thus with an increase in responsibility, she has to bear in mind the legal aspects of nursing03.
Law can be defined as those rules made by humans who regulated social conduct in a formally prescribed and legally binding manner. Laws are based upon concerns for fairness and justice.
Law governs the relationship of private individuals with government and with each other. Types of laws are public Law, constitutional Law, criminal law and civil Law.
Negligence and Malpractice
Malpractice refers to the behavior of a professional person’s wrongful conduct, improper discharge of professional duties, or failure to meet the standards of acceptable care which result in harm to another person. Negligence (breach of duty) is the failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance04.
Assault & Battery
Assault is the intentional & unlawful offer to touch a person in an offensive, insulting or physically intimidating manner. Battery is the touching of another person without the person’s consent.
Nursing practice falls under both public law and civil law. In all states, nurses are bound by rules and regulations stipulated by the nursing practice act as determined by the legislature. Public laws are designed to protect the public. When these laws are broken, a nurse can be punished by paying a fine, losing her license, or being incarcerated. Civil laws deal with problems occurring between a nurse and a client05.
Nursing practitioners, according to Medismart: Nursing Educational Resources can protect themselves from most legal problems by following five basic guidelines: obtain an informed consent signature before treatment begins; document all actions regarding a patient's care;report any allegations of abuse toward a vulnerable population; protect the patient's right to privacy; pay strict attention to avoid medication dosing errors06.
Consumer protection act 1986,
The role of the Nurses and the ethical dilemmas associated with client care have increased and often becomes legal issues. The community is now better aware than in the past about their rights in health care. The Consumer Protection Act (CPA) was passed by the Government of India in 1986 to protect the interests of the consumer. Consumer means any person who buys any goods against consideration is a consumer. Similarly any person who hires services against consideration is also a consumer. In health care delivery, patient is a consumer. Government institutions do not come under the preview of CPA because the consumers pay only nominal amount of registration charges, so cannot fall within the ambit “Consumer”
Organisation of Consumer Protection Councilis a centralcouncil and consists of the following members:
1. The minister in charge of the consumer affairs in the central government who shall be its chairman.
2. Officials and non-official members representing such interests as may be prescribed.
The Central government is legal authority in three ways: (a) Through the Government Service Conduct Rules, (b) through the Indian Nursing Council Act, and (c) through British laws which continue to remain in effect even after independence07.
Recommendations
Health education and awareness programme for people should be conducted through media. This will help in reducing the litigation cases against medical practitioners.
The limit of penalty imposed on opposite party, if the complaint made against nursing practitioners is found to be frivolous or vexations (as per the amendment in section 26 of the CPAin 1993) should exceed from present Rs. 10,000/- to Rs. 50,000/- so that frivolous complaints will be reduced.
The nurses must not indulge in malpractices.
A nurse has right to refuse to assist any medical practitioner if he /she indulges in malpractice.
To prevent unnecessary defamation of the health care practitioners in society, the name of the health care practitioners and hospital on whom allegations are made regarding Nursing and Medical negligence should not be exposed till he /she is found guilty and is convicted by the court of law07S.
Right to information act
It is an act to provide for setting out the practical regime of right to information for consumers to secure access to information under the control of authorities, in order to promote transparency and accountability in the working of every authority, the constitution of a Central Information Commission and State Information Commissions and for matters connected therewith or incidental thereto. The documentation of the care provided, should be done properly as it is the legal document which saves the nurses or consumers from being convicted by the court of law for any kind of irresponsibility08.
Legal Responsibilities in Nursing
01.Safeguards for the nurse: Healthcare facilities may also be legally liable for their employee’s acts of negligence.
02.Common-Sense precautions: Follow accepted procedures as taught and as outlined in the procedure manual of healthcare facility.
03 Be competent in practice: Always be responsible for own behavior. Ignorance is not a legal defense.
04.Ask for Assistance: Always ask for help if unsure about how to perform a procedure. Admitting that do not know how to perform a procedure is always better than attempting to do it and injuring someone.
05.Document well: the importance of keeping exact records of all treatments and medications, as well as a record of a client’s reactions and behavior, cannot be overemphasized. The health record is the written and legal evidence of treatment. The record is to reflect facts only, not personal judgments. Careful and accurate documentation is vital for each client’s welfare. Do not give legal advice to clients: the laws governing personal and property rights of an individual are many and complex. Never attempt to advise a client on legal rights or financial matters. Encourage clients to confer their families and to consult an attorney. Do not accept gifts: accepting gifts from the client is unwise for several reasons. Some clients are considered vulnerable adults (e.g., mentally ill, retarded, orconfused individuals) exchange of gifts could compromise professional position, and could be accused of coercing the client09.
Nursing care errors will cause the loss of life of patient, time, manpower, resources and reputation of the professional nurses.
6.2 NEED FOR THE STUDY
“Judicial bodies provide a forum for truth telling”
-Louise Arbour
Nursing is one of the noblest professions, but its nobility can be sustained only if those in the profession are able to worthy of it. The nurse has to carry out the orders of the physicians while treating a patient in diagnostic, operative and therapeutic procedures and also proper records regarding the cases. Thus with an increase in responsibility, she has to bear in mind the legal aspects of nursing10.
Nursing is legally sensitive because it is people’s business. With the rapidly increasing knowledge of the medical sciences, the patients expect the application of the latest scientific knowledge and techniques to relieve them from pain and sufferings. A little of carelessness or lack of caution can expose the nurse or the hospital at large to the legal cases and therefore, it is necessary for nurse to possess some knowledge of the law relating to them11.
Nursing as a profession and nurses as individuals have been advocating for the welfare of the patients. The impact of consumer movements has been to promote increased accountability on the part of all health professional including nurses. Today’s nurses, whether student or staff nurse or those at the administrative level must be aware of the nursing standards, legal issues in nursing, legal limitations of nursing and the legal liabilities12.
Medical malpractice statistics for the USA in, shows that 16,339 (7.9%) nurses and nursing-related practitioners had a malpractice report made against them in the US (1990-2003, US DHHS) 13
A study was conducted by Barbara at CMC Ludhiana on 91 nurses to assess their knowledge on legal responsibility towards patient care where 67% of nurses had only average knowledge and remaining had only minimum knowledge regarding the legal responsibilities and concluded that even though the knowledge related to direct patient care is good they also need a well-conceived educational programme on specific areas of legal aspects. 14
A study was conducted at Indore to assess nurse’s knowledge on their legal responsibility to patient care among 60 staff nurses. The pretest and posttest knowledge of nurses was assessed by a questionnaire. The result showed that the graduate nurses scored better than the diploma nurses. It was also found that after the introduction of a booklet there was a significant increase in knowledge of staff nurses in all areas of legal responsibility. 15
Leaders in the nursing profession know that nurses are legally responsible for what nurses do but there have been very little specifically stated by the profession to serve as a guide. This was due to the fact that citizens of India were not aware of their rights of protection from harmful or careless professional practice. But with the growing awareness of the law by the public, an understanding of the legal responsibilities is becoming more important16.
Though the legal aspects of nursing are included early in the syllabus very little emphasis is given on its use. Nurses must know the law that governs her profession to avoid lawsuits against her. Legal issues confronting nurses today are many but the nurse should view the law not with apprehension but as a helpful adjunct to define nursing practice. Nurses who are aware of legal rights & obligations will be better prepared to care for clients. Knowledge of the law is essential for all nurses in the present health care market17.
Even though nursing today is considered a profession, nurses today are not well versed with the laws that regulate them & what is required of them to act professionally according to the law.
During the clinical postings the researcher has come across various negligence and medication errors that arise due to the lack of knowledge of staffnurses which has put the hospital and themselves into various issues. This created an interest in the researcher to conduct a study on staff nurses knowledge and attitude on their legal responsibility.
6.3 REVIEW OF LITERATURE
A Quasi- experimental study was conducted to assess the nurses’ knowledge of their legal responsibilities towards patient care. The data were collected on a sample of 60 staff nurses through structured knowledge questionnaire. The study results showed that nurses had low knowledge of their legal responsibilities towards patient care. The study also found that after administration of self-instructional module on nurses’ legal responsibilities towards patients care, nurses had highly significant increase in their knowledge scores than the pre test scores and 86% nurses believed that the information booklet was a good source of learning; whereas 98%believed that booklet should be made available to all the staff nurses18.
A descriptive comparative study was conducted in Ludiana on 91 nurses who were selected by convenient sampling technique to assess their knowledge on legal responsibility towards patient care by using a structured questionnaire schedule. Major findings of the study were, the B.Sc nursing graduates exhibited better legal responsibility knowledge score (mean % of 71.43) than diploma graduates (mean %68.5). Nursing graduates in the age group of 20-30 years scored higher mean (=50.18) than diploma graduates (=47.73), the level of academic qualification did not influence knowledge of legal responsibility. There was no significant difference in knowledge of legal responsibilities among nurses with varying years of experience. The In-service education does play an important role in the enhancement of knowledge. The study concluded that even though overall knowledge of nurses in areas directly related to patient care was good, they need a well-conceived education programme on specific areas of legal aspects such as legal terms, basic rights, legal control and medico-legal cases because their knowledge was low in these areas.19
A study was conducted at west Indies to assess the knowledge, attitude and practice among health care professionals in relation to health care ethics and law in an attempt to assist in guiding their professional conduct and in curriculum development using a self-administered structured questionnaire about knowledge on health care ethics, law and the role of an ethic committee in health care system. The paper analyzed 159 responses from doctors, staff nurses. 52% of the doctors and 37% of the nurses knew little of the law pertaining to their work. Quarter of nurses knew nothing about nurse’s code of ethics.20
A study was conducted at Amritha institute of medical sciences to assess the knowledge and practice of trained nurses in protecting patient’s rights and factors that interfere in protecting patient’s rights. A descriptive survey design was used and self-administered questionnaire was administered to eighty trained nurses who were selected by convenient sampling technique. The result of the study showed, 56% of the subjects had moderate knowledge and only 37% had high level of knowledge. 21
A study was conducted at Indore to assess nurse’s knowledge on their legal responsibility to patient care by using a single group pretest posttest design. A knowledge assessment questionnaire was administered on 60 staff nurses who were selected by convenient sampling technique. The result of the study showed that the pretest knowledge mean score in each category were, legal terms 3.24/7. Admission and discharge2.28/5, safety and responsibility3.9/7, acts and negeligence4.56/7, consent and MLC’s1.4/4, clients right 2.96/4, safeguarding and interpersonal relationship 1.88/3. It was also found that after the introduction of a booklet there is a significant (p<0.01) increase in knowledge of staff nurses in all areas of legal responsibility. 22
A study was conducted to evaluate the knowledge of midwives working in Tehran government hospitals about the proceeding trial for disciplinary violations, forum of trial for occupational crimes. The study used a cross sectional design on128 hospital midwives who were randomly selected to fill the questionnaire. The results of the study showed total average of samples' knowledge in the fields of proceeding trial for different disciplinary violations (37.57+- 20.92) and forum of trail for occupational crimes (38.56+ - 22.06) was weak, Only 2.2% of samples had good knowledge. The studyrecommended to revise the syllabus of the course "Midwifery Ethics and Regulations" in order to include topics discussed in this study and enhance the level of medico-legal knowledge of the midwives.23
A cross-sectional survey was used to describe the level of knowledge and education nurses receive on advance directives (ADs), the Patient Self-determination Act, and the state law. A modified version of the Knowledge-Attitudinal-Experiential Survey on Advance Directives was used for the convenient sample of 110 nurses from medical center in Illinois. Results suggested that respondents were somewhat knowledgeable about general AD items, but less knowledgeable about the Patient Self-determination Act and state law. Clearly, nurses need further education regarding rules and regulations concerning Illinois law on ADs.24
A survey conducted to assess the knowledge, attitude, and practice of health care ethics among 159 physicians and nurses, used structured knowledge questionnaire to collect the data. The study results revealed that all physicians and 90% nurses expressed that in their work knowledge of ethics is important and little more half of physicians and nurses expressed that they had ‘no’ or little knowledge regarding law. The study results further found that 34% nurses and one sister in charge did not know the ‘nurses code’ and over 90% physicians and nurses did not know the legal terms or the ethics; more over this 29% physicians and 37% nurses were unaware of the existence of an ethics committee at the institution25.