Assess Nurses’ Performance Regarding Patients’ Rights at Health Care Setting

Abstract

During the last fifteen years, an increasing number of countries worldwide have adopted laws or other legal instruments respecting and protecting the rights of patients. Patient rights must encompass one’s physical, mental, spiritual and social needs, which are manifested as criteria, standards, rules and laws (Bremer et al, 2014). The implementation of patient’s rights, as an extension of human rights, is an important index for health service quality. However, despite the efforts to prepare and spread the charter of patient rights, studies from different countries have reported infringement of patients' rights. Among health professionals, the greatest responsibility for preserving patients’ rights lies with nurses and physicians. Therefore, the nurses' profession has a duty to gain the appropriate knowledge and develop the necessary awareness and sensitivity to uphold the rights of their patients(Joolaee, 2008). The aim of this study was to assess nurses' performance regarding patients’ rights through assessing nurses' knowledge, attitude and performance. This comparative descriptive study was carried out at Al-Demerdash Hospital and Nasser Institute. It included 45 nurses from each of the two settings. The data were collected using a self-administered questionnaire for nurses’ knowledge and attitude, and an observation checklist for their performance. The tools were face and content-validated by a jury group of experts in nursing and medical administration. They were pilot-tested on 9 nurses to assess their clarity and applicability. The fieldwork lasted from November 2013 to January 2014. The main study findings were as follows.  Nurses’ age ranged between 20 and 57 years, with mean 33.4 years; only (5.6%) had a bachelor degree, and their mean experience years was 14.6 years.  The lowest level of satisfactory knowledge in Nasser institute was concerning the right of continuity of care (22.2%), while in Al-Demerdash Hospital it was the right to consent/refuse treatment plan (28.9%).  The rights with highest satisfactory knowledge were those of confidentiality at Nasser institute (97.8%), and of accepting/refusing participation in research (100.0%) in Al-Demerdash hospitals.  Although more nurses in Al-Demerdash Hospital had satisfactory knowledge (86.7%) compared with those in Nasser institute (71.1%) the difference was not significant (p=0.07).  The mean scores of Nasser Institute nurses’ positive attitudes towards patient rights ranged between 64.4for the right of continuity of care, 97.1 for the rights of respect and dignity and of safety in the hospital.  For nurses in Al-Demerdash hospitals, the percentages of positive attitudes ranged between 46.4for the right of complaining to 97.8 for the right of reviewing records.  The total positive attitude towards patient rights was higher among the nurses in Nasser institute (80.0%) compared with those in Al-Demerdash Hospital (46.7%), p=0.001.  The percentages of adequate performance in Nasser institute ranged between 8.9% for patient right to respect to 81.4% for the right of information in case of undergoing surgery. As for Al-Demerdash Hospitals, it ranged between 20% for the right of safety in the hospital to 65.9% for the right of information in case of undergoing surgery.  The performance of the nurses in Al-Demerdash Hospital was significantly higher regarding the rights to respect (p=0.048) and to information about investigations (p=0.02), whereas the practice of the nurses in Nasser Institute was significantly higher concerning the right to privacy (p=0.01).  Overall, although more nurses in Nasser Institute had adequate total performance (26.7%) compared with those in Al-Demerdash Hospital (11.4%) the difference was not of statistical significance (p=0.07).  The nurses with less than 10-year experience had more positive attitude compared to those with 10 or more years (p=0.04).  A higher percentage of the nurses having positive attitude had satisfactory knowledge (p=0.007).  A statistically significant positive correlation (r=0.443) was revealed between nurses’ knowledge and attitude scores.  Nurses’ attitude score had statistically significant positive correlation with their qualification (r=0.328), and negative correlations with their age (r=0.230) and experience years (r=-0.276).  In multivariate analysis, the positive predictors of nurses’ scores of attitude towards patient rights were higher qualification, and the knowledge score. In conclusion, high percentage of the nurses in Al-Demerdash Hospital and Nasser institute have satisfactory knowledge of patient rights, but attitude towards patient rights is significantly higher among the nurses in Nasser institute. Nurses’ performance is low in both settings, particularly in Al-Demerdash Hospital. The positive predictors of nurses’ scores of attitude towards patient rights were only the higher qualification, and the knowledge score. None of the nurses’ characteristics has a significant association with their knowledge or performance. The study recommends in-depth and specific training for nurses in patient rights, with more emphasis on changing their attitude, and fostering practical application and hands-on training. The hospital administration should provide nurses and other staff members with all the needed facilities and supplies necessary to fully implement patient rights, and should encourage the implementation of patient rights by all its staff. Further research is proposed to assess the effect of implementation of patient rights on patient outcomes, including patient satisfaction.