Patients` opinion on the observance of patient rights by hospital

●●JOURNAL
●
JOURNALOF
OFPUBLIC
PUBLICHEALTH,
HEALTH,NURSING
NURSINGAND
ANDMEDICAL
MEDICALRESCUE
RESCUE●● No.1/2014
No. 1/2014(28-31)
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28
Patients’ opinion on the observance of patient
rights by hospital nursing staff
(Opinia pacjentów na temat przestrzegania praw pacjenta przez personel pielęgniarski zatrudniony w oddziałach szpitalnych)
Z Tokarski 1, A, D, E, F, M Wojciechowska 2, B, C
Abstract - Polish patient rights are derived from the Constitution of
Poland and various ratified international agreements. Patient rights
determine the status of a patient provided with health services and are
an important part of medical law under the Patient Rights and Proponent of Patient Rights Act of 6th November 2008. In the Polish law,
entries related to the patient rights are to be found in the Nurse and
Midwife Profession Act in Art. 16 (Dz. U. no. 174, item 1039 - Official Journal of Laws), the Medical Profession Act, the Code of Professional Ethics for Nurses and Midwives described in Section 2 and
the Health Care Centres Act in Chapter 1a, Patient Rights, Art. 19.
The aim of this paper was to present the opinion of hospital patients
on the observance of selected patient rights by the nursing staff.
The diagnostic poll method was applied in the study. The technique
used was a survey and the research tool was an original questionnaire. 200 patients hospitalised in the departments of internal medicine in the Łódzkie province participated in the study.
92% of the respondents got familiar with the patient rights currently
in force. According to 59% of them, patient rights are displayed on
the notice board at the hospital ward; 23% of respondents did not
notice such information and 18% claim there is no such information
displayed at the ward. 87% of the participants consented to be provided healthcare and 13% did not. According to 89% of the participants, nurses observed the right to privacy. A patient staying at the
hospital ward should receive information about his/her state of health
– 85% did receive such information. Contact with relatives was not
restricted for 93% respondents, 7% had the contact restricted due to
the complaints of other patients about very loud conversations they
had with their relatives.
According to the analysis carried out, it can be concluded that according to hospitalised patients, nurses do observe basic patient
rights.
Key words - patient’s rights, nurse.
Streszczenie – W Polsce prawa pacjenta wynikają z Konstytucji
Rzeczpospolitej Polskiej i ratyfikowanych umów międzynarodowych. Prawa pacjenta określają status pacjenta w trakcie udzielania
świadczeń zdrowotnych i stanowią ważny dział prawa medycznego
zgodnie z Ustawą z dnia 6 listopada 2008 roku o Prawach i Rzeczniku Prawa Pacjenta. W prawie polskim zapisy dotyczące praw pacjen
ta znajdują się w Ustawie o Zawodzie Pielęgniarki i Położnej w art.
16 (Dz. U. Nr.174, poz.1039), w Ustawie o Zawodzie Lekarza, w
Kodeksie etyki zawodowej pielęgniarki i położnej przedstawionej w
ust.2 oraz w Ustawie o Zakładach Opieki Zdrowotnej w rozdziale 1a
prawa pacjenta, art.19.
Celem pracy było przedstawienie opinii pacjentów przebywających w
oddziałach szpitalnych na temat przestrzegania wybranych praw pacjenta przez personel pielęgniarski.
W pracy zastosowano metodę sondażu diagnostycznego, techniką
była ankieta, narzędziem badawczym autorski kwestionariusz ankiety. W badaniu wzięło udział 200 pacjentów hospitalizowanych w
oddziałach chorób wewnętrznych na terenie woj. łódzkiego.
Z obowiązującymi prawami pacjenta zostało zapoznanych 92% respondentów. Zdaniem 59% prawa pacjenta są umieszczane na tablicy
ogłoszeń w oddziale szpitalnym, takiej informacji nie widziało 23%
respondentów, 18% stwierdziło, że nie ma takiej informacji
w oddziale. Zgodę na udzielanie świadczeń zdrowotnych wyraziło
87% badanych, nie wyraziło zgody 13%. Zdaniem 89% ankietowanych pielęgniarki przestrzegały prawa do intymności. Pacjent przebywający w oddziale szpitalnym powinien uzyskać informację na
temat swojego stanu zdrowia - 85% badanych uzyskało taką informację. Kontaktu z bliskimi nie ograniczano 93% respondentom, 7%
kontakt ograniczono z powodu skarg chorych na temat bardzo głośnych rozmów jakie prowadzili ze swoimi najbliższymi.
Na podstawie przeprowadzonej analizy można stwierdzić, że: w opinii pacjentów przebywających w oddziałach szpitalnych zatrudnione
pielęgniarki przestrzegają podstawowe prawa pacjentów.
Słowa kluczowe - prawa pacjenta, pielęgniarka.
Author Affiliations:
1. The University of Humanities and Economics in Lodz
2. Collegium Masoviense - College of Health Sciences
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
Correspondence to:
Zbigniew Tokarski, Ph.D, University of Humanities and Economics
in Lodz Rewolucji 1905 r. 64 Str., PL- 90-222 Lodz, Poland, e-mail:
[email protected]
I. INTRODUCTION
or many years, the normative source of patient rights in
Poland has been constituted by various legal acts. As there
was no general and uniform approach to the matter, patient
rights were considerably difficult to determine. Patients had
problems getting familiar with their rights and hence they
found it difficult to execute them successfully. Patient rights
are an integral part of human rights in the broad sense. As their
nature demands, patient tights need to be determined specifically in valid legal regulations.
Polish patient rights are derived from the Constitution of
Poland [1] and various ratified international agreements. Patient rights determine the status of a patient provided with
health services and are an important part of medical law under
the Patient Rights and Commissioner for Patient Rights Act of
6th November 2008. In the Polish law, entries related to the
patient rights are to be found in the Nurse and Midwife Profession Act in Art. 16 (Dz. U. no. 174, item 1039 - Official Journal of Laws), the Medical Profession Act, the Code of Professional Ethics for Nurses and Midwives described in detail in
section I (nurse/midwife and patient) of paragraph 2 and the
Health Care Centres Act in Chapter 1a, Patient Rights, Art. 19.
[2]. Healthcare regulated by acts beyond legislation is an important constituent of social rights everyone has; it is also included in human rights in general [3]. Article 68, par. 1 of the
Constitution of Poland gives everyone, not only Polish citizens, a right to healthcare. This constitutional norm guarantees
the right to healthcare and the respect of the necessary range of
health benefits. The constitutional right to healthcare included
the duty to take actions for the benefit of the people and individuals. However, the actions taken are to consider different
aspects of human and citizen rights as far as receiving
healthcare, promotion of healthy lifestyle and elimination of
health-related threats are concerned. The Patient Rights Act
determines general and detailed patient rights. The range of
rights is extensive and includes:
1) the right to healthcare benefits that are adequate to the
requirements of up-to-date medical knowledge,
a) the right to a clear, objective procedure based on medical criteria applied to determine the order in which
healthcare benefits should be provided,
F
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b) the right to seek the opinion of other doctor, nurse or
midwife and to organize a case-related staff conference,
c) the right to the immediate provision of health benefits
in cases where life or well-being is at risk;
2) the right to information:
a) on one’s condition, the diagnosis, proposed and
available diagnostic and therapeutic measures,
foreseeable consequences of their application or
rejection, the results of treatment and prognosis,
including demanding full information,
b) on one’s condition, sufficiently for the provision
of nursing care,
c) on one’s condition, sufficiently for a relevant consent,
d) on patient rights,
e) on the type and the extent of the health benefits
provided by a given entity;
3) the right to demand that the doctor withhold information to the extent specified by the patient;
4) the right to share one’s opinion on the information received with the doctor;
5) the right to a timely enough information on the doctor’s
intention to discontinue the treatment;
6) the right to secrecy of the information related to the patient;
7) the right to consent to the provision of health benefits;
8) the right to respect for one’s privacy and dignity;
9) the right to die in peace and dignity;
10) the right to the provision of benefits aimed at soothing the pain and suffering in terminal condition;
11) the right to access medical documentation;
12) the right to object to doctors’ opinions and decisions;
13) the right to respect for one’s private and family life:
a) to contact other people directly, by phone and letter,
b) to additional nursing care,
c) to additional nursing care provided to patients
who are pregnant, are giving birth or are in their
postpartum period;
14) the right to pastoral care;
15) the right to deposit valuable belongings for safekeeping;
16) the right to seek the assistance of a Commissioner for
Patient Rights;
17) the right to file a motion to a regional adjudicating
committee for medical issues [4].
Furthermore, the Act regulates possible restrictions of patient rights (art. 5) and being charged for the execution of
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
specified rights (art. 28 and 35). The restriction of the rights
should lead to the precise interpretation of them [4].
Nursing is an autonomous medical occupation. Therefore, a
nurse is obliged to inform patients sufficiently for the provision of nursing care; patients must be informed on the nursing
treatment they are to receive. The nurses’ responsibility to
inform patients pertains to independent nursing tasks as well as
those ordered by doctors. However, when acting on the doctor’s orders, a nurse has to verify the patient’s identity and the
provisions of the order itself (for which the patient has to consent) as well as inform the patient on how the procedure concerned is going to be implemented and on the possible symptoms caused by the procedure. All patient rights are reflected
in the Code of Professional Ethics for Nurses and Midwives.
According to Wrońska, the protection of patient rights is within the moral responsibilities of a nurse. What is more, nurses
also “have the obligation to inform the patients on their rights.
A nurse is then to be the patients’ advocate (obviously, only to
the extent a patient allows the nurse to, without infringing his
or her autonomy). According to this theory, a nurse has to inform the patients on what rights they have, prevent from the
breach of those rights, help the patients verbalise their needs
and make conscious choices” [5]. It is, therefore, essential for
nurses to protect the rights of patients when they cannot do
that on their own. This pertains predominantly to the mentally
ill, minors, the elderly and those who are not aware of their
situation on account of their education [6-8].
The aim of this paper was to present the opinion of hospital
patients on the observance of selected patient rights by the
nursing staff.
II.
MATERIALS AND METHODS
The diagnostic poll method was applied in the study. The
technique used was a survey and the research tool was an original questionnaire. 200 patients hospitalised in the departments
of internal medicine in the Łódzkie province participated in
the study, 113 of whom were female (57%) and 87 – male
(43%).
III. RESULTS AND DISCUSSION
Staying in hospital is a new situation for many patients,
which may lead them to behave in an undesirable manner.
Hospitalised patients should be aware of their rights. The respondents were asked if they were familiarised with the basic
patient rights – 92% of them claimed to have been informed on
patient rights, whereas 8% denied. Another important question
was if basic patient rights are displayed conspicuously at the
30
ward. The analysis determined that 59% of the respondents did
encounter such rights on a notice board at the ward. 23%
claimed they had not noticed any information of that kind,
while 18% of them were certain there were no patient rights
displayed at the ward at all. In accordance with the valid law, a
patient should consent to receive health benefits. The analysis
conducted showed that 87% of the patients interviewed did
consent to receive healthcare benefits – 47.5% of them did so
in the hospital admission room and 39,5% at a hospital ward.
13% did not provide such a consent. An important element in
nursing patients is respecting their dignity and privacy. As far
as the respect for a patient’s dignity is concerned, it has to be
emphasised that it is to be the foundation of every single action
undertaken by a nurse toward him or her. The analysis showed
that 78% of interviewees felt their dignity was respected,
whereas 14% of them had no opinion on the matter and 8%
decisively claimed that their dignity was not respected. A
nurse must always bear in mind the fact that each nursing activity she performs is in a way an intrusion of the patient’s
privacy. Therefore, all nursing activities should be performed
when no other people are present, in separate rooms or behind
screens. The patients were asked if their right to privacy was
observed when nurses attended to them – 89% of them claimed
that the nursed indeed observed that right. Nevertheless, the
remaining 11% of the patients stayed at a hospital hallway and
nurses made no effort to use screens, claiming there is not
enough equipment. According to valid rules, patients are entitled to additional nursing help provided by a person of their
choice. 52% of them were assisted by their relatives, 25% did
not need additional help and 23% were not allowed to have a
selected person to assist them by either the head of the ward
(16%) or the senior nurse at the ward (7%). Another right established in valid legislation is the one related to death in
peace and dignity. The analysis shows that 59% of the respondents had a positive opinion on the observance of this
right, whereas 7% of them had a negative viewpoint. 34% of
the interviewees stated that this right was not always observed
as patients often had to occupy beds in the hallway as there
were no vacant ones in the rooms and even screens were not
used. In order to ensure patients can die with dignity, a nurse is
to do her best to let the patients see a clergyman and those
close to them. The analysis showed that 81% of the respondents did execute their right to pastoral care; the remaining 19%
saw a clergyman of a faith other than the Catholic one, as required. Patients have a right to receive information on their
condition – 85% of them did learn about their condition, either
from a doctor (59%) or a nurse (26%). It has to be emphasised
that nurses provided guidance on nursing patients with cerebral stroke and educated patients on how to cope with diabetes
(how to take blood sugar, what diet is appropriate). However,
15% were not informed on their condition. It can be assumed
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
that not all relatives were interested in such information and
just came to visit. Another important patient right is the opportunity of contacting other people personally, by phone or letter. Nowadays, nearly all patients have a mobile phone with
them. Besides, telephones are fitted at hospital wards in clearly
visible spaces for the patients to use. The study analysis
showed that 93% of the respondents were not restricted in their
contacts with other people, whereas such contacts were restricted in the remaining 7% of the cases, as other patients
complained that the conversations with relatives were too loud.
It can be assumed that these 7% had problems with audibility
due to hearing impairments or the reception of mobile phones.
IV. CONCLUSIONS
On the basis of the analysis conducted, one can conclude that
hospitalised patients believe that hospital nurses do observe
the basic patient rights.
V. REFERENCES
[1] www.sejm.gov.pl – dostęp: 13 czerwca 2013 r.
[2] www.dlapacjenta.mz.gov.pl dostęp: 13 czerwca 2013 r.
[3] Karkowska D. Prawa pacjenta. Warszawa; Dom Wydawniczy ABC, 2004.
[4] Karkowska D. Prawo medyczne dla pielęgniarek. Warszawa; Wydawnictwo Wolters Kluwer , 2013.
[5] Wrońska I, Mariański J. Etyka w pracy pielęgniarskiej.
Lublin; Wydawnictwo Czelej, 2002.
[6] Kazura R, Cichá M, Brukwicka I, Kopański Z , Marczewska S, Kurowski A. Jakość w opiece zdrowotnej i
pielęgniarskiej. JPHNMR 2011; 1: 9-12.
[7] Szymańczak G, Lishchynskyy Y, Kozłowska D, Kopański Z, Bruchwicka I, Wojciechowska M. Profesjonalizacja pielęgniarstwa
polskiego. JPHNMR
2012; 1: 3-6.
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[8] Bartnik A, Szeląg E, Kopański Z , Brukwicka I, Wojciechowska M, Furmanik F, Machot M. Pielęgniarstwo - zawód czy misja? JPHNMR 2012; 2: 4-6.