Nurses' Perspectives on Human Dignity of Hospitalized Patients

Study of Patients' Privacy during the COVID-19 Pandemic in Iranian Health Care Settings

Background

Patient's privacy protection is a challenging ethical issue. The complex situation of the COVID-19 pandemic was a probable predictor of breaching confidentiality. This study aimed to assess the viewpoints of COVID-19-confirmed patients, who were hospitalized, and their healthcare providers about the compliance of different aspects of patient's privacy.

Methods

This cross-sectional study included 3433 COVID-19-confirmed patients who were hospitalized in Kerman, between 2020 and 2021, and about 1228 related physicians, nurses, and paraclinical staff. Two separate validated researcher-made questionnaires were developed, each including subscales for physical, informational, and spatial privacy, as well as a satisfaction rate of privacy protection. The data were analyzed using SPSS software version 26, with independent samples t test, Mann-Whitney-U, Kruskal Wallis, and Multiple Linear Regression tests at a 95% confidence interval.

Results

The mean percentages of the patients' privacy scores in physical, spatial, and informational areas were significantly lower (P<0.001) than the average of the medical staff's scores in all three areas (Difference: 10.27%, 14.83%, and 4.91%, respectively). Physical and spatial privacy scores could be predicted based on the participants' classification, patients or medical staff, and sex. The mean patients' satisfaction score was 9.25% lower than the medical staff's (P<0.001). Moreover, only academic hospitals showed a statistically significant difference between the patient's satisfaction with privacy protection and medical staff's viewpoints (P<0.001).

Conclusion

Although this study indicated the benefits of protecting patients' privacy in the healthcare setting, patients' privacy scores and satisfaction were lower than their healthcare providers. The pandemic conditions might have been an obstacle to preserving patients' rights. These findings demonstrated the importance of sensitizing healthcare providers to manage these ethical challenges in a complicated critical state such as the COVID-19 pandemic.

Development and Validation of a questionnaire on human dignity in nursing cares: an exploratory sequential mixed study

Objective

The current study aimed to develop and validate of human dignity questionnaire in nursing care.

Methods

The present research is a sequential exploratory mixed method study. The questionnaire was developed and validated in three phases: (1) the concept of human dignity was defined through conventional content analysis qualitative approach, (2) early items of questionnaire was generated according to findings of the first phase, (3) validation of the questionnaire was evaluated using face, content and construct validity as well as reliability. The study was conducted with the participation of 13 nurses in the qualitative section and 203 nurses in the quantitative section in teaching hospitals affiliated to Jahrom University of Medical Sciences (Iran).

Results

In the qualitative section, the definition and dimensions of the concept of human dignity in nursing care were discovered. In the quantitative section, the initial pool of items for the questionnaire of human dignity in nursing care was formed using the results of the qualitative section of the study and review of texts and related questionnaires. In factor analysis, four subscales including: respectful communication, equality of patient human value, preservation of privacy and patient-centered care were extracted by Eigen value above one. Internal consistency and stability of the questionnaire were calculated as 0.85 and 0.80, respectively, indicating an excellent reliability.

Conclusion

The 20-item developed questionnaire is valid and reliable for measurement of human dignity questionnaire in nursing cares.

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study

INTRODUCTION

Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards.

AIM

This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran.

METHOD

An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis.

RESULTS

The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'.

DISCUSSION

MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance.

IMPLICATIONS FOR MENTAL HEALTH NURSING

According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

The relationship between futile medical care and respect for patient dignity: a cross-sectional study

BACKGROUND

Various technologies and interventions at intensive care units can lead to futile medical care for critically ill patients. Futile medical care increases patients' suffering and costs, reduces nurses' attention to patients, and thus affects patients' dignity. This study aimed to investigate the relationship between futile medical care and respect for patient dignity from the perspective of nurses working in intensive care units of medical centers.

METHODS

We conducted this cross-sectional study on 160 nurses working in intensive care units in Kerman. We measured nurses' perceptions of futile care and respect for patient dignity using futile care and patients' dignity questionnaire. We used linear regression model to investigate the effect of futile care on the patient dignity.

RESULTS

The mean severity and frequency of futile care in the intensive care unit were 57.2 ± 14.3 and 54.1 ± 19, respectively. Respect for patient privacy and respectful communication were desirable, while patients' autonomy was not desirable. We found a significant direct relationship (p = 0.006) between the severity of futile care and respect for patient dignity, with every unit increase in futile care, a 0.01 unit increase was available in patient dignity. We observed no significant association between frequency of futile care and dignity.

CONCLUSION

Our results indicated the effect of futile care on nurses' respect for patient dignity. Nurses must raise their awareness through participating in training classes and specialized workshops to improve the level of care, the quality of care, and respect for patient dignity.

Investigating patients' attitudes toward receiving care from an opposite-gender nurse

BACKGROUND

The imbalance in nurse-to-patient ratio and limited physical space may lead to care provision by a nurse of the opposite gender. On the other hand, the relationship with the opposite gender in Iran is limited due to cultural and religious beliefs. The aim of this study was to investigate patients' attitudes toward receiving care from the opposite gender nurse.

MATERIAL AND METHOD

This descriptive cross-sectional study was carried out on 200 patients admitted to different hospital wards. The patients were recruited using convenience sampling. Data collection tools comprised of a demographic questionnaire and a researcher-made questionnaire. Data were analyzed using SPSS (version 16) and running descriptive statistics (i.e., χ² , independent t test, and linear regression analysis).

RESULTS

Male and female patients had 31.8% and 42.6% negative attitudes toward receiving care from the opposite gender, respectively, indicating a statistically significant difference (p = .05). Patients' attitudes had a significant and positive relationship with age, level of education, and experience of receiving care from a nurse of the opposite gender.

CONCLUSION

A significant percentage of patients had a negative attitude toward receiving care from the opposite-gender nurse. Since people's attitudes affect their relationships, it is necessary to provide conditions for assigning the same gender nurse for patients and improving patients' attitudes toward nurses of the opposite gender.

Human privacy respect from viewpoint of hospitalized patients

Patient-oriented care is for nurses a holistic science, of which the patient's privacy respect is an essential part. The aim of this study was to determine the hospitalized patients' viewpoints concerning their privacy respect. This descriptive, analytic and cross-sectional research administered to 370 patients that were selected through a random-stratified sampling in an educational hospital in the Khorramabad in Iran in 2013-2014. Data were collected by a questionnaire about respect of the patient's privacy by hospital staff, including physical-corporeal, psycho-mental, and informational domains. Data were gathered through constructed interviews and analyzed with Independent t-test, One-way ANOVA and Pearson correlation statistical tests. The privacy of patients and its physical-corporeal and informational domains were sometimes observed, while the psycho-mental domain was often respected. The privacy respect was significantly lower for male patients (p=0.000) in the emergency department, and with patients who spoke with a local accent (p= 0.016). It seems necessary to train the health care providers to have more respect in terms of patient physical-corporeal and informational privacy, to observe male patient privacy and to use all interpersonal communication skills when dealing with non-Persian language patients. Furthermore, it seems necessary to revise the structure and design of emergency departments in order to protect the privacy of the patients.