On the violation of hospitalized patients' rights: A qualitative study

Barriers to ethical treatment of patients in clinical environments: A systematic narrative review

Background and Aim

It is essential that healthcare providers display ethical behavior toward their patients. Despite development of codes of ethics for clinical practice, the occurrence of unethical behaviors toward patients is alarmingly high. The present study was conducted to identify the barriers to ethical treatment of patients in clinical environments.

Methods

Through systematic narrative review, the present study investigated the barriers to ethical treatment of patients. This study was carried out in line with Assessment of Multiple Systematic Reviews 2 and Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines.

Results

Ethical challenges in clinical environments can be classified into two categories: "organizational factors" and "personal factors." Organizational factors consist of three domains: managers and regulations, organizational environment, and human resources. Personal factors consist of two domains: factors related to patients and their families and factors related to care providers.

Conclusion

Research shows that encouraging healthcare teams to adopt ethical behaviors through education and having them persistently observe ethics in their clinical practice will not completely bridge the gap between theory and practice: it seems that the clinical environment, the personal characteristics of healthcare team members and patients, and the organizational values of the healthcare system pose the greatest barrier to bridging this gap. Accordingly, in addition to raising healthcare providers' awareness of the existing issues in clinical ethics, measures should be taken to improve organizational culture and atmosphere.

"It's like asking for a necktie when you don't have underwear": Discourses on patient rights in southern Karnataka, India

BACKGROUND

Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice.

METHODS

We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes.

RESULTS

Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators used a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. As a result, the capacity of care-seeking individuals to know and claim patient rights was restricted. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, patient rights discourses remained subdued in health facilities in Karnataka, India.

CONCLUSIONS

The empirical findings on the local expression of patient rights in the discourses allowed for theoretical insights on the translation of conceptual understandings of patient rights to practice in the everyday lives of health system actors and care-seeking individuals. The CDA approach was helpful to identify the problematic aspects of discourses and discursive practices on patient rights where health facility administrators and care-providers wielded power to oppress care-seeking individuals. From the practical point of view, the study demonstrated the limitations of care-seeking individuals in the discursive realms to assert their agency as practitioners of (patient) rights in health facilities.

Paradoxical perception of humanistic care in the intensive care unit: A qualitative study

AIM

The aim of this study was to explore the perceptions of nurses, patients and attendants of humanistic care in the intensive care unit.

DESIGN

The present study was a qualitative conventional content analysis conducted in the intensive care unit in a hospital in Iran, in 2019.

METHODS

Data were collected using semi-structured interviews and field notes through purposive sampling with 17 nurses who worked in an adult ICU in a teaching hospital, 4 attendants and 4 alert patients, and then analysed using the Elo-Kyngäs method in 2008.

RESULTS

Analysis of the data led to the extraction of Four main themes as follows: (1) Insufficient understanding of nurses and patients' families of each other's roles, needs and expectations; (2) The use of personal and situational reasoning rather than ethical principles; (3) Caring stagnation; and (4) Satisfaction with care.

Improving the perception of respect for and the dignity of inpatients: a systematic review

OBJECTIVES

The aim of this systematic review is to find evidence to determine which strategies are effective for improving hospitalised patients' perception of respect and dignity.

METHODS

A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE/PubMed, PsycINFO and Cochrane Library databases were searched on 9 March 2021. Observational studies, prospective studies, retrospective studies, controlled trials and randomised controlled trials with interventions focused on improving respect for patients and maintaining their dignity were included. Case reports, editorials, opinion articles, studies <10 subjects, responses/replies to authors, responses/replies to editors and review articles were excluded. The study population included inpatients at any health facility. Two evaluators assessed risk of bias according to the Cochrane Handbook of Systematic Reviews of Interventions criteria: allocation, randomisation, blinding and internal validity. The reviewers were blinded during the selection of studies as well as during the quality appraisal. Disagreements were resolved by consensus.

RESULTS

2515 articles were retrieved from databases and 44 articles were included in this review. We conducted a quality appraisal of the studies (27 qualitative studies, 14 cross-sectional studies, 1 cohort study, 1 quali-quantitative study and 1 convergent parallel mixed-method study).

DISCUSSION

A limitation of this study is that it may not be generalisable to all cultures. Most of the included studies are of good quality according to the quality appraisal. To improve medical and hospital care in most countries, it is necessary to improve the training of doctors and other health professionals.

CONCLUSION

Many strategies could improve the perception of respect for and the dignity of the inpatient. The lack of interventional studies in this field has led to a gap in knowledge to be filled with better designed studies and effect measurements.

PROSPERO REGISTRATION NUMBER

CRD42021241805.

The influential factors in humanistic critical care nursing

BACKGROUND

One of the main concerns in critical care units is the development of humanistic approaches. In this regard, recognizing the factors affecting humanistic nursing can contribute to humanizing nursing care in these units.

OBJECTIVE

The objective was to recognize the influential factors of humanistic nursing in critical care units.

RESEARCH DESIGN

This qualitative study was carried out using a phenomenology method. Thirty-nine in-depth unstructured interviews were performed. The data were analyzed using the phenomenological nursology approach. To guarantee trustworthiness, prolonged engagement, member check, triangulation of resources, and maximum variation sampling were used.

PARTICIPANTS AND RESEARCH CONTEXT

Purposeful sampling was employed to select 10 nurses, 8 patients, and 4 patient's relatives from the intensive care unit and critical care unit departments.

ETHICAL CONSIDERATION

This study was approved by the ethics committee of Lorestan University of Medical Sciences with the code of LUMS.REC.1395.121.

FINDING

The participants' experiences were reflected in the following three main concepts: (a) moral, educational, and existential nature of the two humans involved in the interaction; (b) maintenance of the nurses' dignity; and (c) interactions in the cultural and social context.

DISCUSSION

The nurse and patient, organizational environment, and society give rise to a set of intertwined characteristics which influence the realization of humanistic nursing. By affecting the nurses' educational background and maintaining their dignity, the atmosphere of the hospital and cultural readiness of the society pave the way for delivering the humanistic care.

The effect of knowledge brokering on nurses' empathy with patients receiving cardiac care: a study protocol

BACKGROUND

Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses' empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses' empathy with patients receiving cardiac care.

METHODS

This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins' knowledge translation framework 2009. Monica's Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant.

DISCUSSION

To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships.

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.