Knowledge about patients' rights among professionals in public health care in Finland

Legal consciousness of psychiatric patients in Israeli hospitals: Awareness and satisfaction

The paper contributes to the literature on legal consciousness in medical settings by focusing on psychiatric patients' understanding of rights during hospitalization in Israeli psychiatric wards. It asks whether hospital personnel act as agents who promote patients' legal consciousness and whether patients are aware of their legal and social rights during hospitalization. The data for this study were derived from the Patient Experience Survey of Psychiatric Public Hospitals, a comprehensive survey conducted by the Israel Ministry of Health in 2017. The survey included two variables that were used to measure patients' legal consciousness: legal consciousness with hospitalization rights and legal consciousness with social rights. To predict legal consciousness and patient satisfaction, a logistic regression model was employed. The analysis reveals low rates of patients' awareness of hospitalization and social rights, varying between 55 and 66%, respectively. Variations in awareness are not strongly associated with patients' socioeconomic and demographic attributes or with hospital characteristics but are somewhat associated with hospitalization conditions. The data also reveal that awareness of legal rights (whether hospitalization rights or social rights) is likely to increase satisfaction with the hospitalization experience. The analysis underscores a significant finding. Patients' awareness of their legal rights during hospitalization is limited. Interestingly, this awareness is more influenced by the conditions of hospitalization than by the patients' socio-demographic attributes. This research also provides insights into the potential role of legal awareness in shaping patients' attitudes toward treatment and enhancing their satisfaction during hospitalization.

A Cross-Sectional Survey on Professionals to Assess Health Needs of Newly Arrived Migrants in Spain

Heightened conflicts and lack of safety due to reasons related to economic, social, ethnic, religious, sexual orientation, political, or nationality matters have increased migratory movements during the last, few decades. Unfortunately, when migrants arrive in new territories, they can face many barriers. For example, in Spain, some migrants have difficulties in accessing health services. The main objective of this study was to describe, from the perspective of social and healthcare professionals, health needs and barriers faced among migrants who recently arrived in Spain when accessing the health system. To accomplish this aim, we carried out a cross-sectional descriptive study using a newly created self-administered questionnaire. Statistical analysis was done using the SPSS 23.00® program. Survey collection was from April 2018 to October 2018, and the cohort comprised a total of 228 professionals. Most participants were females (76%), with an average age of 35 years [interquartile range (IQR) 29.8-43.0]. The most represented profession in the cohort was physician (48%), followed by social care professionals (32%), nursing (11%), and other (8%). Of these individuals, 61% stated having either little or limited knowledge of international migrant health rights, and 94% believed migrants must overcome barriers to receive health services. The four most reported barriers were as follows: language, cultural differences, administrative issues, and fear of being undocumented. Additionally, by order of importance, professionals viewed mental health disorders and infectious diseases as the most common contributors to disease burden in this group. The four most popular strategies implemented by professionals to improve healthcare access further for migrants included intercultural competency training for professionals; access to community health agents; access to translators; and development of health system navigation skills among those newly arrived. Study results suggest that governments should make greater efforts to provide social and healthcare professionals with more effective tools that overcome communication barriers and cultural competence training modules.

Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman

Background

A different ethos with respect to the perception of medical ethics prevails in societies in transition such as those in the Arabian Peninsula, which makes it difficult to apply international principles of bioethics in medical practice. This study aimed to develop and psychometrically test an instrument that measures physicians’ awareness of bioethics and medical law and their attitudes towards the practice of medical ethics. Additionally, it examined physician correlates influencing the awareness of bioethics.

Methods

Following a rigorous review of relevant literature by a panel of experts, a 13-item instrument, the Omani physicians’ bioethics and medical law awareness (OBMLA) questionnaire was developed with the aim of assessing physicians’ awareness of bioethics and medical law. The study tool’s construct validity and internal consistency reliability were examined by exploratory factor analysis (EFA) and Cronbach’s alpha. In a cross-sectional study, the questionnaire was distributed among a random sample of 200 physicians at a tertiary hospital in Muscat, Oman. Participant characteristics that may influence awareness of bioethics and medical law were explored.

Results

The EFA of the OBMLA questionnaire resulted in three well-loading factors: (1) Physicians’ bioethics practice subscale (2) incentive related bioethics subscale and (3) medical law awareness subscale. Internal consistency reliability ranged between Cronbach’s α: 0.73–0.8. Of the total 200 participants, 52% reported that teaching medical ethics during medical school was inadequate. The overall mean (standard deviation, SD) of the bioethics awareness score and Omani medical law awareness were 27.6 (3.5) and 10.1 (2.1) respectively. The majority of physicians (73%) reported that they frequently encountered ethical dilemmas in their practice and 24.5% endorsed the view that unethical decisions tended to occur in their practice.

Conclusion

The study provides an insight into the practice of bioethics, and the awareness of bioethics and medical law among physicians in a teaching hospital in Oman. The OBMLA questionnaire appears to be a valid and reliable tool to assess a physician’s awareness of bioethics and medical law. In this preliminary study, it appears that participants have suboptimal scores on the indices which measure practice and awareness of bioethics and medical law.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-021-00619-1.

Nurses' attitudes and knowledge regarding patient rights: a systematic review

OBJECTIVE

To synthesize current evidence on nurses' attitudes and/or knowledge on the entire spectrum of patient rights.

METHOD

A systematic search of the literature was performed in Web of Science, PubMed, Scopus and CINAHL. Studies were selected according to pre-defined inclusion/exclusion criteria. The Cochrane and PRISMA guidelines, including templates for systematic reviews, were applied. For rigor assessment, the Critical Appraisal Skills Program Qualitative Research Checklist, and the Center for Evidence-Based Management tool were employed.

RESULTS

Thirteen studies were included, that exhibited important methodological limitations, such as convenience sampling, mediocre response rates and inadequate instrument validity. Findings indicated: a) low level of awareness regarding patient rights among nurses, b) knowledge discrepancies on specific aspects of patient rights, c) low priority ascribed to a patient's right to access information, and d) insufficient evidence on formal educational sources of knowledge on the topic of patient rights.

CONCLUSION

Narrow geographical localization, heterogeneity and methodological limitations render generalizability of the conclusions difficult. Further research based on robust methodology is proposed.

Ethical competence in a profession: Healthcare professionals' views

Aim

Ethical competence is a crucial component for enabling good quality care but there is insufficient qualitative research on healthcare professionals' views on ethical competence. The aim of this study was to investigate healthcare professionals' views on ethical competence in a student healthcare context.

Design

A qualitative design and a hermeneutical approach were used.

Methods

The material consists of texts from interviews with healthcare professionals (N = 10) in a student healthcare context. The method was inspired by content analysis.

Results

One main theme and four subthemes emerged. The main theme was as follows: safeguarding the vulnerability of the other. The subthemes were as follows: using sensitivity to establish a trustful relationship, acting in an objective and flexible manner, using a reflective process in decision-making, and maintaining confidentiality and honesty. Future research should focus on investigating ethical competence from various perspectives in student health care, for example the student perspective or observational studies.

Comparison of the importance and observance of the patient's bill of rights from the perspectives of patients and personnel of hospitals in Kerman

Patients' rights are among the most important criteria for evaluating the quality of health services. The current study aimed to determine the importance and observance of the patient's bill of rights. This cross-sectional study was done in Kerman, Iran. The research samples were 217 patients and 204 personnel. The data collection tool was a researcher-made questionnaire in the scope of the patient's bill of rights, and data were analyzed by SPSS 15. The results showed a significant difference between patients and the personnel on the subject of the patient's bill of rights and most of its dimensions (P < 0.01). However, no significant difference was found between their views on the observance of the patient's bill of rights and its dimensions. Also, 35.9% of patients as well as 25% of personnel considered the observance of patients' rights unfavorable. The participants were aware of the importance of the patient's bill of rights. It is necessary, however, to codify and approve the laws related to the rights of patients.

Observance of patients’ rights in emergency department of educational hospitals in south-east Iran

Purpose

Patient right is the most important ethical right in the hospital, which equally, belongs to every human kind. Observance of patient right is responsibility of all treatment staff when they offer treatment and care for patient. This study aims to investigate observance of patients’ rights in emergency department of educational hospitals in south-east Iran.

Design/methodology/approach

This study used a cross-sectional design and was conducted in four educational hospitals affiliated with the Kerman University of Medical Sciences in 2018. Using a two-section standard questionnaire of Patients’ Rights Charter, this study assessed patients’ rights observance using a census method, N = 382. The data from the questionnaire were analyzed using descriptive statistics including mean and standard deviations and analytic statistics such as Kolmogorov – Smirnov, ANOVA, t-test and Pearson test using SPSS 21.

Findings

Means of total score for observing all essentials of patients’ rights in emergency department of educational hospitals were at a moderate level (43.10 ±15.05) from the viewpoint of patients. The area of “providing health services based on respecting patient’s privacy and observing the essentials of secrecy and confidentiality” enjoying the highest mean score (86.89 ± 24.39), was at a good level compared to other areas. The area of “having access to effective complaint management system” showed the lowest mean score (23/85 ± 23/07) from the participants’ perspective proving a poor level. Between the patient rights observance and gender, education level, resident status and duration of hospitalization, a significant relationship was observed.

Originality/value

As regarded in this study, the degree of patients’ rights observance was moderate so, culture, paying attention to the rights of all stakeholders, identifying barriers and various factors, including the professional and environmental differences in the assessment of the need, should be considered by policymakers to design promotional and regulatory programs for improving the rights of the patient.

Congruence between perceived and theoretical knowledge before and after an internet-based continuing education program about venous leg ulcer nursing care

BACKGROUND

Previous research has revealed nurses' knowledge gaps in venous leg ulcer (VLU) nursing care, and continuing education is needed. The closer nurses' perceived knowledge is to their evidence-based theoretical knowledge, the better possibilities they have to conduct evidence-based VLU nursing care.

OBJECTIVES

To assess the congruence between nurses' perceived and theoretical knowledge about VLU nursing care before and after an internet-based education about VLU nursing care (eVLU).

DESIGN

Quasi-experimental study with intervention and comparison groups and pre- and post-measurements.

SETTING

Home health care in two Finnish municipalities.

PARTICIPANTS

Nurses (n = 946) working in home health care were invited to participate. In the intervention group, 239 nurses and 229 nurses in the comparison group met the inclusion criteria, and they were all recruited to the study.

METHOD

Nurses were divided into intervention and comparison groups with lottery between the municipalities. Nurses in both groups took care of patients with VLU according to their organizations' instructions. In addition to this, nurses in the intervention group received a 6-week eVLU while those in the comparison group did not. Data were collected with a questionnaire about perceived and theoretical knowledge before education, at six weeks, and at 10 weeks. The percentages of congruence were calculated at every measurement point, and the McNemar test was used to detect statistical significance of changes between measurements.

RESULTS

The increase of congruence was more often statistically significant in the intervention group than in the comparison group.

CONCLUSION

The results support the hypothesis that the congruence between perceived and theoretical knowledge will be higher among nurses receiving eVLU. Because of the low participation and drop-outs, the results should be interpreted with caution.

Awareness of the Importance of and Adherence to Patients' Rights Among Physicians and Nurses in Oman: An analytical cross-sectional study across different levels of healthcare

Objectives

This study aimed to determine the extent to which physicians and nurses in Oman were aware of the importance of and adhere to patients’ rights and whether this differed according to role, nationality, position and institutional healthcare level.

Methods

This analytical cross-sectional study was carried out between December 2015 and March 2016 at various governmental healthcare institutions in Oman. A self-administered questionnaire was distributed to 1,385 practitioners at all healthcare levels.

Results

A total of 1,213 healthcare practitioners (response rate: 87.58%) completed the survey, of which 685 (56.47%) were nurses and 528 (43.53%) were physicians. Overall, awareness of the importance of patients’ rights was high (91.51%), although adherence to these rights in practice was low (63.81%). The right of the patient to be informed was considered least important and was least adhered to (81.2% and 56.39%). Nationality, role and institutional level were significantly associated with awareness (P = 0.002, 0.024 and 0.034, respectively). Non-Omani staff were significantly more likely than Omani staff to be aware of (odds ratio [OR] = 1.696; P = 0.032) and adhere to (OR = 2.769; P <0.001) patient rights. Furthermore, tertiary care staff were twice as likely as primary care staff to perceive the importance of patient rights (OR = 2.076; P = 0.019). While physicians were more likely than nurses to be aware of the importance of patient rights, this difference was not significant (OR = 1.516; P = 0.126).

Conclusion

These findings may help inform measures to enhance awareness of and adherence to patients’ rights in Oman.

Ethics interventions for healthcare professionals and students: A systematic review

Background:

The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.

Objectives:

To examine ethics interventions conducted on healthcare professionals and healthcare students to achieve ethics-related outcomes.

Research design:

A systematic review.

Methods:

Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.

Ethical consideration:

This systematic review was conducted following good scientific practice in every phase.

Findings:

It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.

Conclusion:

Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals.

Ethos: The heart of ethics and health

Background:

Ethics in nursing care are traditionally discussed in terms of moral norms or principles. When taking an ontological approach to ethics, ethics is about ethos. Ethos involves both an internal and an external side of ethics. Considering ethics and health from an ontological perspective can provide a different understanding of ethics and health in caring and nursing.

Aim and research question:

The aim of this study is to deepen the ontological understanding of ethics and health in caring and nursing. The research question is as follows: What is the ontology of health and ethics in caring and nursing?

Research design:

The study follows a hermeneutical design inspired by Gadamer. Participants and research context: essays about ethics and health were gathered from PhD students in nursing and caring sciences.

Ethical considerations:

The research follows Responsible conduct of research guidelines provided by the Finnish Advisory Board on Research Integrity.

Findings:

An ethos with the values of freedom and responsibility seem to ontologically be important for ethics and health. These values allow a movement between the internal and the external sides of ethics that is important for health.

Discussion:

The ethos of freedom and responsibility that is essential for ethics and health can provide the current ethical debate a new starting point that previous research asks for.

Conclusion:

Ontologically, an ethos of freedom and responsibility is essential for ethics and health in nursing and caring.

Organisational and individual support for nurses’ ethical competence: A cross-sectional survey

Background:

Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed.

Research questions:

This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support.

Research design:

A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis.

Participants:

The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland.

Ethical considerations:

Ethical approval was obtained from the university ethics committee. Results: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses’ and nurse leaders’ perceptions of provided support for nurses’ ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support.

Conclusion:

Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses’ ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.

Rights and duties policy implementation in Chile: health-care professionals' perceptions

Objective

To explore the perceptions of health professionals in an integrated network of public provision of health services regarding the implementation of the Law on Rights and Duties of People in Chile.

Method

Qualitative descriptive study. A stratified qualitative sample of 53 professionals from five low complexity centres and one from a high complexity centre, all part of the integrated network of health services in Valdivia, Los Rios Region, Chile, were selected according to the criteria of an overall saturation of the explored dimensions. The information was gathered through a semi‐structured, in‐depth interview carried out after signing the informed consent. Data were analysed using an inductive approach of content analysis.

Results

Three categories emerged from the interviews: conceptualization and knowledge, factors influencing the implementation and recommendations for strengthening the implementation, and seven subcategories. It was highlighted that health professionals in the health‐care network perceived difficulties in implementing the Law on rights and duties of patients. Among them were the lack of knowledge about the Law, poor exposure and a lack of resources for its implementation. They suggested adapting the infrastructure of the institution and offering training as recommendations to improve the implementation of the Law.

Conclusions

There are hindering factors for the implementation of the Law related to organizational and professional gaps in the institutions providing health care.

Patients' decision-making experiences in the acute healthcare setting--a case study

BACKGROUND

The transition from being an ordinary citizen to a hospitalised patient can be a daunting experience particularly for the uninitiated and inexperienced. Patients are likely to have questions such as 'where do I go?', 'what should I do?', 'when?' and 'who should I ask?' The process for making practical moment-to-moment decisions is often complex and fraught with difficulties. Identifying critical points in the hospitalisation experience may provide insights into the quality of hospital management systems and professional practices from a patient perspective.

OBJECTIVE

This study aimed to identify institutional practices and structures in the context of acute healthcare settings which impact on patient moment-to-moment decision-making experiences.

METHOD

A case study approach was used as the exploratory methodology, and interviews were conducted with three former adult inpatients. In order to gain an understanding of each participant's experiences, data collecting strategies used in this research were a semistructured interview and document analysis of information documents, such as hospital supplied pamphlets, provided to the researcher by the participants.

RESULTS

The study identified five major themes. Identified as being critical to the participants were information sharing by healthcare professionals, professional advice and professional role identification. Less so were environment and everyday life. Associated with these themes were the participant's common experience of being confined in unfamiliar surroundings, adjusting to institutional routines and of being heavily dependent on others.

CONCLUSION

Findings indicate that patient moment-to-moment decision-making may be informed and enhanced in several areas: relevant and timely information sharing, varying the dress code between the different professions, reducing conflicting professional advice, clear signage around the hospital, and flexible visiting hours, telephones and clocks in patient rooms.

The effect of an education-based intervention on self-reported awareness and practice of Iranian nurses in observing patients' rights

Background:

For patients’ rights to be observed, first patients and health care providers should be aware of these rights. Nurses’ lack of awareness of these rights leads to their inability to recognize patients’ legal and ethical issues, and reduces the quality of provided services. This study was conducted to determine the effect of an education-based intervention on self-reported awareness and practice of nurses in observing patients’ rights.

Methods:

In this quasi-experimental study, awareness and practice of 90 nurses on Patient’s Bill of Rights were examined in case and control groups, before, 2 and 4 weeks after an educational intervention program on. Participants were selected from teaching hospitals of Mazandaran University of Medical Sciences, Iran. Data was gathered using the valid and reliable 21-item questionnaire in a 3-point Likert scale during a 5-month period from October 2013 to March 2014. For data analysis, descriptive statistical methods, paired t-test, and repeated measure analysis of variance at significant level P<0.05 were used.

Results:

Participants’ mean age and work experience were found 37.1±5.71 years and 11.76±5.99 years respectively. Mean scores of nurses’ awareness and practice before intervention were 15.12±2.19 and 9.13±2.36, accordingly. Repeated measure analysis of variance test showed a significant difference in awareness and practice of nurses before and after intervention (P<0.001).

Conclusion:

Enhancing nurses’ awareness on Patient’s Bill of Rights through revision of educational curriculum in nursing schools, together with considering appropriate relevant content in continuous education programs in health systems can lead to improved quality of nursing care services.