How To Promoting Rights And Dignity In Health Care Services
J Educ Health Promot. 2017; 6: 16.
Nurses' delivery to respecting patient dignity
Zahra Raee
Department of Nursing, Immature Researchers and Elite Club, Islamic Azad Academy Isfahan Co-operative (Khorasgan), Isfahan, Iran
Heidarali Abedi
1 Department of Nursing, Schoolhouse of Nursing and Midwifery, Islamic Azad University Isfahan Branch (Khorasgan), Isfahan, Islamic republic of iran
Mohsen Shahriari
2 Department of Adult Health Nursing, Nursing and Midwifery Care Enquiry Center, School of Nursing and Midwifery, Isfahan Academy of Medical Sciences, Isfahan, Iran
Abstruse
Background:
Although respecting man dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing intendance. Therefore, the present study aimed to investigate nurses' commitment to respecting patient dignity in hospitals of Isfahan, Iran.
Methods:
This descriptive-analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from unlike wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient-nurse relationships, privacy, and independence. All items were scored based on a 5-indicate Likert scale. The collected data were analyzed using descriptive statistics and Chi-square tests. P < 0.05 were considered pregnant in all analyses.
Findings:
Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection equally moderate/skilful. Only vi.v% of the subjects rated it as excellent. The bulk of the patients (84.4%) believed their independence was maintained. These subjects also canonical of taking part in conclusion-making.
Conclusion:
According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing regime and policy makers are thus required to introduce appropriate measures to improve the existing weather.
Keywords: Dignity, ethical values, hospital, Isfahan, nursing staff, privacy
INTRODUCTION
Human being nobility has attracted extensive attention in various academic fields including philosophy, ethics, nursing, medicine, social sciences, and politics.[1] Due to the significance of this subject in the wellness care manufacture during the 21st century, many countries accept focused on high-quality care provision simultaneous with patient nobility protection.[2,3]
The English word "nobility" comes from Latin words "dingus" (meaning worth) and "dignitas" (meaning merit)[4,5] and denotes respect, decency, humanity, and status.[half dozen] Human dignity has long been considered in medical fields and might actually stalk from Socrates'south emphasis on the importance of respecting patients' dignity.[vii] Moral philosophers have also traditionally assessed morality based on human being dignity.[eight] However, materialistic approaches gradually emerged following scientific developments and industrialization. Meanwhile, since contempo advances in health sciences were tending to increase life expectancy at the cost of patient dignity, criticisms began to raise.[9] As a consequence, studies on patient dignity initiated in 1989 in the U.S. and continued in Scandinavia, Commonwealth of australia, Hong Kong, Canada, and Europe.[10]
While dignity is obviously a basic need for both good for you and ill human beings, occurrence of diseases can definitely threaten human dignity.[11] Attributable to their increased dependence and the need to be taken care of, patients may actually feel loss of nobility during their whole hospitalization period.[12]
How nurses tin affect patient dignity has been evaluated in numerous western studies. Respecting patient nobility has been identified every bit a major principle in nursing practice[xiii] that promotes trust in health care services and enhances patient satisfaction.[xiv] It will not only establish desirable patient-staff relationships and a feeling of security, but besides lead to shorter hospitalization (by alleviating mental wellness issues), reduced costs, and staff motivation.[7] On the other hand, in addition to immediate emotional responses (due east.g., anger, hatred, and sadness), violation of patient dignity past nurses can provoke deep, long-lasting feelings of worthlessness, exhaustion, social isolation, and alienation and a want to commit suicide.[15]
Many researchers, including Henderson et al.,[three] Baillie and Gallagher,[5] Jo and Doorenbos,[9] Pleschberger,[11] Jackson and Irwin,[thirteen] and Matiti and Trorey,[16] have indicated the adventure for patients' loss of nobility in health intendance environments. Diverse Iranian studies take too examined the application of the patient's neb of rights in hospitals and measured patients' satisfaction and their awareness of their own rights. Although qualitative studies on patient needs have extracted man dignity from the participants' viewpoints,[17,18] no enquiry has peculiarly focused on this concept. All the same, such studies are warranted since the meaning of dignity differs amongst individuals, cultures, and countries.[12]
Therefore, the present study aimed to evaluate the behaviors of nurses regarding the protection of inpatients' nobility in hospitals of Isfahan (Iran). However, since as an abstract concept, patient nobility has largely been elucidated through three main parameters, that is, relationship, privacy, and independence,[ii,16,xix,20] nosotros also considered the same parameters in our assessments.
METHODS
The population of this descriptive-analytical study was all inpatients in public, individual, and charity hospitals of Isfahan (Iran). Based on the sample size formula (with 95% confidence interval; z = 91.i; and P = 0.5), the sample size was calculated every bit 384 individuals which was extended to 401 participants to allow for loss to follow-up. In order to select the subjects through cluster sampling, a list of all hospitals in Isfahan was first extracted. The hospitals were then categorized (e.g., public, individual, and charity), and some of each type were randomly selected. In each hospital, some wards (emergency section, Intensive Care Units, internal medicine, and surgery) were simple random selected. Finally, the participants were randomly selected from the mentioned wards.
The inclusion criteria were age over 18 years, ability to communicate in Western farsi, absence of known mental problems, and a hospital stay of at least 24 h. Data were all collected in one stage.
Ethical considerations were observed throughout the study. Information collection started only after receiving approvals from the Ideals Committee of Isfahan University of Medical Sciences (Number 291216). The patients were explained about the nature and objectives of the written report, the anonymity of the questionnaires, and voluntariness of participation. They were also reassured that participation would not, in any form, touch on their grade of treatment. The researchers provided their contact details and so that the subjects could ask almost the written report results.
Following an intensive review of available literature[twenty,21] and consultation with relevant experts, a 2-function questionnaire was developed to appraise patient dignity protection under sociocultural weather of the Iranian society. The first part of the questionnaire comprised of two sections, showtime near n demographic characteristics, and the existing hospitalization data such every bit duration of hospital stay, and history of hospitalization along with infirmary name, ward, room type, and number of patients in each room. The second role included 31 questions regarding the components of patient dignity. It consisted of 10 items about the relationship, xiv about privacy, and vii about independence. All items of this part were scored based on a five-signal Likert scale. Each item could be responded as not applicable, never, sometimes, oftentimes, and ever. These corresponded to scores zero-iv (0 = poor = one, moderate = 2, expert = 3, and first-class = 4). Items implying poor behavior in respect of patient dignity were scored reversely.
Content and face up validity of the questionnaire was confirmed by 8 Nursing Kinesthesia Members of Isfahan Academy of Medical Sciences and Isfahan Azad Academy. Moreover, a Cronbach's blastoff equal to 0.83 suggested the acceptable reliability of the tool.
The questionnaires were filled out after obtaining informed consent from the patients. Data were collected from eight am to viii pm every weekday during November, 2012 to March, 2013. Descriptive statistics (frequency, per centum, mean, and standard difference) and Chi-square tests were then practical to analyze the collected data in SPSS for Windows 17.0 (SPSS Inc., Chicago, IL, United states). P < 0.05 were considered significant in all analyses.
Findings
The mean age of the patients was 51.29 (±xviii.01) years (range: 18–89 years). Females and married individuals constituted 58.9% and 75.6% of the written report sample. Only 11.nine% of the participants held an academic degree. About one-third of the subjects (32.nine%) were self-employed, and 15.5% were part workers. Most patients (71.3%) were hospitalized for 1–5 days (hateful hospital stay: 5.33 days). Moreover, 60.viii% of the patients had a history of hospitalization (1–5 times). The majority of the participants (80.8%) were staying in public rooms. The subjects had the greatest frequency (43.75%) in public hospitals and the lowest (nine.25%) in charity hospitals. The maximum (45.4%) and minimum (6.3%) frequency of the patients was seen in the internal medicine wards and emergency departments, respectively.
Almost all patients (91%) reported nurses to have first-class/good relationships with patients. On the other manus, 91.viii% of the participants rated privacy protection equally proficient/moderate and only 6.v% rated it as excellent. In addition, 84.4% of the subjects believed their independence was sustained. They actually agreed with taking role in decision-making [Table one].
Table 1
Frequency distribution of nurses' commitment to respecting patient dignity
The relationships between commitment to respecting patient dignity and demographic characteristics are shown in Table two. Equally seen, patient-nurse relationships were significantly correlated with patient's age (χ2 = 13.98; df = 6) and type of infirmary (χ2 = xix.iii; df = 6). In other words, older patients were more satisfied with the level of respect they received. In add-on, patient-nurse relationships were more favorable in private and charity hospitals than in public hospitals. On the other hand, both patients' privacy and independence had significant relationships type of infirmary and ward and number of patients in one room. In fact, these components of patient dignity had maximum and minimum scores in individual and public hospitals, respectively. Intensive Care Units and internal medicine wards had the highest and lowest scores in privacy protection, respectively. However, patients' independence was not well-maintained in Intensive Care Units, and internal medicine wards scored the highest in this regard. Finally, the participants believed that increased number of patients in one room decreased their independence and privacy. None of the other evaluated variables had significant relations with respecting patient dignity.
Table 2
Relations between demographic characteristics and nurses' delivery to respecting patient dignity
DISCUSSION
Respect todignity is a human being right and a responsibility, that is, nurses are responsible to promote their patients' interests and dignity. Patient-nurse relationships were rated as splendid, skilful, and moderate by 59.1%, 31.9%, and nine.0% of our participants, respectively. Eshkevari et al. reported the relationships betwixt wellness personnel and patients to be generally (threescore%) desirable.[22] Similarly, Hasanian suggested respectful behavior in 85% of the cases.[23] Most Indonesian patients (88.4%) were also satisfied or very satisfied with nurses' behaviors.[24] However, in a study on 122 patients in Pakistan, Khan et al. described communication skills of the nurses as poor (below threescore%) and identified negligence of nursing managers to be the main reason for such a shortcoming.[25] Also, Sangestani et al. plant 29.ix%, 40.half dozen%, and 29.5% of the patients in emergency departments to be highly, moderately, and poorly satisfied with the behavior of nurses. The researchers emphasized on unfavorable communication skills of Iranian nurses in emergency departments and justified the problem past lack of time, stressful environs, and nurses' inattention to the significance of advice in treatment.[26] Jackson and Irwin[13] and Galloway[27] confirmed the absence of appropriate patient-nurse interactions. They indicated that although desirable communication with patients is essential for respecting their dignity, nurses' inadequate cognition leads to poor relationships.
In the current study, privacy protection was proficient and moderate in the opinion of 46.four% and 45.four% of the patients, respectively. Meanwhile, a mere six.five% of the subjects considered it as excellent. Despite the importance of the right to privacy in maintaining patient dignity,[17] the existing conditions are alarming. In fact, Malekshahi concluded that only 10% of the subjects enjoyed complete privacy protection.[28] Besides, a qualitative study by Heidari et al. in Hamadan (Iran) showed that while nurses had to deal with various cultural demands of the patients, the inefficiency of the health system prevented them from protecting patient privacy.[29] Comparable results were also reported by Whitehead and Wheeler.[30] Baillie reported frequent patient complaints regarding the violation of privacy, east.g., inbound the room without permission and non respecting patients' information privacy.[10] According to Lin and Tsai, privacy protection was commonly ignored during clinical practices. They suggested that underestimating the importance of covering the patients' bodies could seriously damage their privacy and thus threaten their dignity.[2]
Most patients (52.9%) in the present study ranked respect to their independence as good. While others ranked it mainly as excellent (31.ix%) and moderate (14.5%), only 0.vii% reported poor independence. Previous studies have also indicated that patients' independence is generally maintained in hospitals. Farsinejad et al. reported 59% of their patients to take the liberty to make decisions.[31] In a study on cancer patients, 43% of the subjects believed they had the correct to reject treatment. Moreover, the patients typically canonical of their own participation in decision-making.[32] Conversely, Baba Mahmoodi et al. found just fourteen.fifteen% of the patients in Mazandaran Province (Iran) to benefit from the right to make decisions about medical treatments. Yet, since the majority of their 200 participants were rural residents with teaching levels lower than a high school diploma, they might take had difficulty understanding the medical explanations. They could thus feel they were not taking role in controlling.[33] Parsapoor et al. compared educational, private, and public health centers. They concluded that the level of patients' participation in making a medical decision was substantially lower in educational settings than in public and individual wellness centers. Of course, the nature of an educational therapeutic center can partly justify this finding.[34]
According to our participants, increasing age was associated with ameliorate patient-nurse relations and hence higher level of respect for patient nobility. Farsinejad et al.,[31] Arefi and Talaei,[35] Gahramanian et al.,[36] and Arab et al.[37] reported comparable findings and explained them past greater demands of younger patients as a issue of their awareness of their own rights.
In the current study, none of the components of nobility were significantly related with the patients' education level or occupation. Too, in a study on 404 Palestinian refugees, Khatib and Armenian could not establish significant relationships between dignity and either education or occupation.[38] All the same, Arab et al.[37] and Javadi et al.[39] found significant relations between patients' education level and their expectations and demands, that is, less educated individuals had lower knowledge about intendance provision and thus placed fewer demands on the health personnel.
Similarly, Arefi and Talaei highlighted an inverse relationship between the patients' satisfaction and educational activity levels. They suggested that individuals with higher social condition had greater demands and were hence less satisfied.[35] Although our findings showed a reduction in satisfaction as patients pedagogy levels increased, the observed difference was not significant. Therefore, better clarification of this relationship requires farther research.
Nosotros detected a significant relation betwixt the blazon of hospital and respecting patient dignity. In other words, patient dignity was more respected in private and charity hospitals. Similarly, Farsinejad et al. institute private and public hospitals of Tehran (Iran) to take significant differences in terms of advisable care provision and patient privacy and confidentiality protection. They introduced the presence of various groups of students to be responsible for these differences.[31] As stated by Baba Mahmoodi et al., many services in educational hospitals are provided past medical and paramedical students who may have insufficient knowledge about and inappropriate attitudes toward patient rights. Under such circumstances, the patients may feel their rights are abused.[33] Nurses, on the other mitt, have commonly justified their inappropriate behaviors toward patients by the existing problems in public hospitals. In fact, high number of patients and lack of coordination among the nursing, security, and service staff can negatively (although sometimes indirectly) affect patient satisfaction.[40]
Our findings revealed a meaning relation between the type of ward and patients' privacy protection and independence. The highest and lowest scores of privacy protection belonged to Intensive Care Units and internal medicine wards, respectively. In contrast, Intensive Intendance Units, where patients are severely ill, scored considerably lower than other wards when maintaining patients' independence was involved. The subjects in internal medicine wards were the virtually satisfied with their level of independence. Consistent with our findings, Kalroozi et al. reported higher respect for patient dignity in Intensive Care Units. They explained that while all patients crave conscientious scientific care, their needs may not be completely fulfilled in any wards except subspecialty wards.[41] A like relationship between the type of ward and patient correct protection was likewise discovered by Biranvand et al. who reported emergency, internal medicine, and surgery wards to have the lowest scores in this regard.[42]
In the present study, although room type and components of patient dignity were not significantly related, number of patients in each room had inverse relationships with patient privacy and independence. As asserted past Whitehead and Wheeler[30] and Bagheri et al.,[43] abiding presence of other patients in shared rooms cause various problems (e.g., not being able to have a private phone telephone call and issues such every bit exposing torso parts during diagnosis and treatment) tin can negatively affect patient nobility. On the contrary, Baillie believed that having a roommate helps patients communicate with and be supported by other individuals with similar conditions. They will, therefore, feel better during the course of treatment. However, depending on their personal characteristics, some patients may adopt to stay in individual rooms.[ten] Evidently, more inquiry is this field is warranted.
The present study had a number of limitations. Beginning, completing and collecting the questionnaires was time-consuming. Moreover, due to the special conditions of the patients, information technology was ofttimes necessary for the researchers to assist them fill up out the questionnaires.
Decision
Our findings indicated that nurses mostly respected patient dignity. Notwithstanding, relatively poor performance was detected in some aspects. For example, ix% of the participants scored patient-nurse relationships as moderate. Moreover, 91.8% of the patients believed that their privacy was moderately/well protected. Independence was scored every bit moderate by 14.5% of the patients and as poor by 0.7%. Therefore, measures have to be taken to promote patient dignity in health centers. Specific systematic courses and workshops are also essential to familiarize nursing students with the bailiwick of patient dignity. In addition, the presence of eager authorities who facilitate, monitor, and follow the implementation of patient dignity-related regulations would exist invaluable. Finally, it is crucial to consider patient dignity while designing and equipping health centers.
Financial back up and sponsorship
Isfahan University of Medical Sciences, Isfahan, Iran and Academy of Medical Sciences and Isfahan Branch Khorasgan of Islamic Azad Academy.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The nowadays report was a articulation enquiry project betwixt Isfahan University of Medical Sciences and Isfahan Branch Khorasgan of Islamic Azad University. The authors are grateful to the research councils of both universities and all hospitals and patients who kindly took part in this report.
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