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Aref et al
__________________________________________________________________________________
PATIENT RIGHTS: EVALUATION OF THE CURRENT KNOWLEDGE,
ATTITUDES AND PRACTICES AMONG EL-MINIA UNIVERSITY
HOSPITAL PHYSICIANS, NURSES AND PATIENTS
By
Sanaa M. Aref* and Ashraf A. Ewis** and Mohamed A. El-Dydamouny***
Departments of *Nursing Administrations, Faculty of Nursing, Minia University.
**
Public Health and Occupational Medicine, Faculty of Medicine, Minia University.
***Consultant of Public Health – Tabuk Region – MOH – KSA.
ABSTRACT:
Background Patient rights encompass legal and ethical issues in the provider-patient
relationship, including the patient's right to privacy, the right to quality medical care
without prejudice, the right to make informed decisions about care and treatment
options, and the right to refuse treatment. The patient is also expected to meet a fair
share of responsibility. The patient is to follow the plan of care, provide complete and
accurate health information. The patient is further responsible for consequences of
refusal of treatment, following rules and regulations of a hospital, and to be
considerate of others' rights. The patient is also responsible for providing assurance
that financial obligations of care are met. Aim of the study To Evaluate of the
Current Knowledge, Attitudes and Practices among Minia University Hospital
Physicians, Nurses and Patients about patient right Setting Minia University
Hospitals. Sample all doctors and nurses working in general departments in the
Minia University Hospitals at the time of collection data Tools based on patient bill of
right and American Medical Assossiation guide line Three questionnaires were
prepared to evaluate the knowledge, attitude and practice of physicians, nurses and
patients at Minia University Hospital regarding patients’ rights. Three questionnaires
were prepared: For patients 18 items, for nurses 22 items, for doctors 18 items. Result
the nurse's opinion that the highest score in patient's choice their doctors and has the
right to explain the cost of the treatment. The patient's opinion (64%) of patient only
feels that the treatment team satisfies their needs, and that they have knowledge about
the complication of their surgery (75%). The doctor opinion (92%) agree that he
patient has right to keep their secret and privacy during clinical examination.
Conclusion: The result of this study revealed that knowledge and practice of patient
right by doctors and nurses need to be improved.
KEY WORD:
Patient rights
Patient's bill of rights
Confidentiality
Medical records
Doctor-patient relationship
Nurse-patient relationship
Privacy
Informed consent
the
right
to
refuse
treatment.(http://health.enotes.com/n
ursing-encyclopedia/patient-rights)
INTRODUCION:
Patient rights encompass legal
and ethical issues in the providerpatient relationship, including the
patient's right to privacy, the right to
quality medical care without prejudice,
the right to make informed decisions
about care and treatment options, and
The patient is also expected to
meet fair share of responsibility. The
patient is to follow the plan of care,
provide complete and accurate health
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EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007
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__________________________________________________________________________________
information,
and
communicate
comprehension of instructions on
procedures and treatment. The patient
is further responsible for consequences
of refusal of treatment, following rules
and regulations of a hospital, and to be
considerate of others' rights. The
patient is also responsible for
providing assurance that financial
obligations of care are met.
(http://health.enotes.com/nursingencyclopedia/patient-rights)
It is certain that patient rights are a
growing concern for the public at large,
and such rights cannot be ignored for
long by health-care providers, patients
and
legislators..(http://www.emedicinehealt
h.com/patient_rights/article_em.htm,Sar
aTFry)
Educations of patients make
them more concerned about capability
of their health care facility and their
providers. These rights include the
right to participate in the development
and implementation in the plan of care;
the right to be treated with respect and
dignity; the right to be informed about
condition, treatment options, and the
possible results and side effects of
treatment; the right to refuse treatment
in accordance with the law, and
information about the consequences of
refusal; the right to quality health care
without discrimination because of race,
creed, gender, religion, nationality, or
source of payment; the right to privacy
and confidentiality, which includes
access to medical records upon
request; the right to personal safety; the
right to know the identity of the person
treating the patient, as well as any
relationship between professionals and
agencies involved in the treatment; the
right of informed consent for all
procedures; the right to access to
related information, including the
medical records by the patient or by
355
the patient's legally authorized
representative and hospital charges; the
right
to
consultation
and
communication; the right to complain
or compliment without the fear of
retaliation or compromise of access or
quality
of
care.
(Http//health.cnotes.com
nursing
encycipeda/patientright,
Robert
M.veatch 2007, Stewart, M 2001, and
Kobs, Ann 1997)
 A patient's rights occur at many
different levels, and in all
specialties. The American Medical
Association
(AMA)
outlines
fundamental elements of the
doctor-patient relationship in their
Code of Medical Ethics. These
rights include the following:
o The
right
to
receive
information from physicians
and to discuss the benefits,
risks,
and
costs
of
appropriate
alternatives
treatment
o The right to make decisions
regarding the health care that
is recommended by the
physician
o The
right to courtesy,
respect,
dignity,
responsiveness, and timely
attention to health needs
o
The right to confidentiality
o
The right to continuity of
health care
o
The basic right to have
adequate health care
(AMA. Code
of
Medical Ethics. Council
on Ethical and Judicial
Affairs)
 A patient must be competent in
order to give voluntary and
informed
consent.
Thus,
competent consent involves the
ability to make and stand by an
informed, freely made decision.
In clinical practice, competence
is often equated with capacity.
EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007
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Decision-making
capacity
refers to a patient's ability to
make decisions about accepting
health care recommendations.
To have adequate decisionmaking capacity, a patient must
understand the options, the
consequences associated with
the various options, and the
costs and benefits of these
consequences by relating them
to
personal
values
and
priorities. (Alderson, Goodey
1998, and McKinstry, 2000)
Some factors may make a
patient
incapable
of
providing
competent consent either temporarily
or permanently. Examples include the
following:
 Altered mental status (Mental
illness or mental retardation)
 Alcohol or drug intoxication
 Brain injury
 Being too young to legally
make decisions concerning
health care (Moreno, Caplan,
Wolpe 1998)
The issue of patient rights in
medical research has developed over
the years because of unethical practices
that have occurred in the past. A recent
article in the (Journal of the American
Medical Association) proposed 7
requirements that provide a framework
for evaluating the ethics of clinical
research studies:
o Values
o Scientific validity
o Fair subject selection
o Favorable risk-benefit ratio
o Independent review
o Informed consent
o Respect for enrolled subjects
(Emanuel, Wendler, Grady 2000; and
JAMA. World Medical Association
declaration of Helsinki 1997)
about the patients duties and
responsibilities. Therefore, the healthcare organization is expected to inform
patients of their responsibilities.
Patients' responsibilities include:
 Providing
information:
A
patient has the responsibility to
provide, to the best of his or her
knowledge, accurate and complete
information about present complaints,
past
illnesses,
hospitalizations,
medications and other matters relating
to his health. Changes in health status
and level of understanding also must
be communicated.
 Complying with instructions: A
patient is responsible for following the
treatment plan recommended by the
practitioner primarily responsible for
his care. A patient also is expected to
keep appointments, abide by hospital
rules and inform the practitioner if he
is unable to keep an appointment.
 Informing the practitioner of
refusal of treatment: If a patient refuses
treatment or to be complaint with a
treatment regimen, he must inform the
practitioner.
 Following hospital rules and
regulations: The patient is responsible
for following the hospital's rules and
the regulations affecting patient care
and conduct.
 Showing
respect
and
consideration: The patient must be
considerate of the rights of other
patients and hospital personnel and
assist in the control of noise, smoking
and number of visitors. The patient is
responsible for being respectful of the
property of other persons and of the
hospital.
 Paying hospital charges: The
patient is responsible for ensuring that
the financial obligations of his health
care are fulfilled as promptly as
possible.
(http://www.emedicinehealth.com/pati
However, this work is basically
designated for evaluating patient’s
rights but we would like to give a hint
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EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007
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__________________________________________________________________________________
ent_rights/article_em.htm, and Kobs,
Ann 1997)
driven health counseling, where
patients' life situation are respected,
patient-initiated actions are supported
and shared knowledge and deep
understanding are nurtured.
The role of nursing in the protection
of patient rights:
Nursing plays the role of
guardian, "one who has the care of
another person", of the patient's rights.
Since nurses are the closest caregivers, they are the most logical
"guardians" of the patients' rights. The
nurse supports the patient's right to
treatment or service, for example, this
includes ensuring that patients receive
hospital services, they have returned to
their rooms after a scheduled mealtime. Providing for timely delivery of
medications and treatments also would
demonstrate respect for a patient's right
to treatment. The nurse, as guardian,
plays a key role in protecting the
patient, e.g., the nurse covers the
patient with a sheet to protect modesty
or
limits
visitors
if
needed.
(Mcwilliam, 1997, Haggman and
Asedt-Kurki, 1994)
Significance of the study:
In the recent years, so many
complaints against doctor, nurse even,
health care organization like hospital
and center because of unethical
practices have been occared, e.g the
health care provider did to care to keep
the patient information confidenial.
Any person ask about patient condition
they will talk without caring if patient
want to inform this one a net even
when they plan for patient care they
depend on patient need and diagnosis,
they did not care if the patient agree
about this plan even without given the
patient enough information about his
condition. Because patient right have
recently become the center of national
attention in the practice of medicine.
Aim of the study
This is a descriptive study
planned to Evaluate of the Current
Knowledge, Attitudes and Practices
Among El-Minia University Hospital
Physicians, Nurses and Patients
Nurses are expected to help
patients participate in their own care.
This means that patients are part of the
decision-making team regarding their
current or future care. Nurses can play
a valuable role by listening to patients,
clarifying questions and arranging
future meetings with members of the
health-care team to assure patients that
they are involved in a meaningful way
in making decisions about their care
and treatment. (Wensing, Elwyn,
Edwards, 2002, and McKinstry, 2000)
SUBJECTS & METHODS:
Setting:
El-Minia
University
Hospitals.
Sample: All doctors and nurses
working in general department in the
Minia University Hospitals at the time
of collection of data.
Tools: Based on patient bill of right
and American Medical Association
guide line three questionnaires were
prepared to evaluate the knowledge,
attitude and practice of physicians,
nurses and patients at El-Minia
University hospital regarding patients’
rights.
Nurses recognize and respect
patients' experiences, knowledge and
skills and make their own professional
knowledge and expertise available to
them, which are important aspects of
nurse –patient relationships that are
also reported by patients (Haggman
and Astedt-kurki, 1994; Lindsey, 1996)
the emphasis is placed on patient-
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EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007
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Three questionnaires were prepared:
 For patient 18 items
 For nurse 22 items
 For doctor 18 items
Researchers distributed 300
questionnaires among physicians,
nurses and patients (100 for each
group) and asked them to fill out and
return the questionnaires back to the
investigators.The response percent was
lower than expected.
Only 25
physicians, 50 nurses and 75 patients
filled their questionnaires and gave it
back. Then the collected data were
checked, coded, entered and analyzed
using SPSS (the statistical package for
social sciences) version 12.0 software.
Methods :
Official
permission
was
obtained from the director of the
hosptial and the head of the department
of the study setting. The questionnaires
were tested for validity and reliability
by conducting pilot study includes (ten
doctors, ten nurses, ten patients).
Modification was done according to
the result. The tools was revised by
statistcal expert,
Statistical analysis
Data collected were tabulated
and statistically analyzed using SPSS
program (Number and percentage)
RESULTS:
Table (1): Demograhpic data
Gender
Male
Female
Social status
Single
Married
Widowed
Departments
G. Medicine
Dialysis
Cardiology
I.C.U
G. Surgery
Anesthesia
Obs & Gyna
Special Surgery
Doctors
no.
%
no.
%
10
15
40%
60%
12
38
40%
60%
15
60
20%
80%
12
13
--
48%
52%
--
8
82
--
16%
84%
--
7
67
1
9.33%
89.33%
1.34%
9
2
3
1
5
1
3
1
36%
8%
12%
4%
20%
4%
12%
4%
10
10
3
10
8
3
3
3
20%
20%
6%
20%
16%
6%
6%
6%
12
2
4
27
30
----
16%
2.7%
5.3%
36%
40%
----
358
Nurses
Patients
no.
%
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Aref et al
__________________________________________________________________________________
Table (2): Descriptive Study for Nurse Knowledge Attitude and Practice As regard Patient Right
Nurses
Studied Items
Did the Nurses Know the patient rights?
Did the patient have to know the name of health
care provider?
Did the Nurses Know the patient name?
Did the patient have a right to Know the name of
the treatment doctor?
Did the patient have The right to choose the
doctor
Did the patient have The right to change the
doctor or the treatment?
Did the patient have The right to get Explanation
about the hospital working system?
Did the patient have The right to get Explanation
about the hospital facilities?
Did the patient have The right to get Explanation
about the treatment requirement after discharges?
Did the patient have The right to get Explanation
about the surgery risks (complications)?
Did the patient have The right to get Explanation
about the treatment costs?
Did the patient have The right to get Explanation
about how the illness danger?
Did the patient have The right to get accept his
care plan?
Did the patient have The right to get acceptance
to participate the scientific research?
Did the Nurses Accept the patient decision when
he/she refuse the treatment?
Did the Nurses Keep the confidentional of the
patient treatment information?
Did the Nurses Keep the privacy of the patient
when Examination?
Did the Nurses Keep the patient secrets?
Did the patient have The right to Sign the
informed consent?
Did the Nurses Calling the patient by his/her
name?
Did the Nurses offer the whole care to the
patient?
Did the Nurses treat the patient as a human being
not as a case?
359
Yes
Number
%
34
86%
No
Number
%
16
32%
16
32%
34
68%
38
76%
12
24%
34
68%
16
32%
34
86%
16
32%
27
54%
23
46%
37
74%
13
26%
12
34%
33
66%
35
70%
15
30%
38
76%
12
24%
43
86%
7
14%
24
48%
26
52%
34
68%
16
32%
35
70%
15
30%
17
34%
33
66%
38
76%
12
24%
27
54%
23
46%
21
42%
29
58%
36
72%
13
26%
38
76%
12
24%
22
44%
28
56%
37
74%
13
26%
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Table (3): Descriptive Study For Patient Knowledge Attitude And Practice As Regard Patient Right
Patients
Yes
Number
Studied Items
Did the patient have The right to choose
the doctor?
Did the patient have The right to change
the doctor or the treatment?
Did the patient have The right to get
Explanation about the hospital working
system?
Did the patient have to know the name
of health care provider?
Did the patient have The right to get
Explanation about the hospital facilities?
Did the Nurses Keep the confidentional
of the patient treatment information?
Did the patient have The right to get
accept his care plan?
Did the patient have The right to Sign
the informed consent?
Did the patient have a right to Know the
name of the treatment doctor?
Did the Nurses / doctor Keep the privacy
of the patient when Examination?
Did the patient have The right to get
acceptance to participate the scientific
research?
Did the Nurses / Doctors Calling the
patient by his/her name?
Did the patient have The right to get
Explanation about the surgery risks
(complications)?
Did the patient have The right to get
Explanation about the treatment costs?
Did the Nurses / Doctors Keep the
patient secrets?
Did the Nurses / Doctors Offer the whole
care to the patient?
Did the Nurses / Doctors treat the patient
as a human being not as a case?
Did the patient have The right to get
Explanation to his/her question clearly?
360
%
No
Number
%
3
4%
72
96%
2
3%
73
97%
8
11%
67
89%
5
7%
70
93%
10
25%
56
75%
16
21%
59
79%
24
32%
51
68%
27
35%
48
65%
48
37%
27
63%
17
33%
58
77%
34
45%
41
55%
15
20%
60
80%
36
75%
39
25%
13
17%
62
83%
24
34%
51
68%
27
35%
48
65%
48
64%
27
36%
17
33%
58
77%
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Table (4): Descriptive Study For Doctor Knowledge Attitude And Practice As Regard Patient Right
Doctors
Studied Items
Did doctors Know the patient rights?
Did the doctor know that patient have
The right to choose the doctor?
Did the patient have The right to change
the doctor or the treatment?
Did the patient have The right to get
Explanation about the hospital working
system?
Did the Nurses Keep the confidentional
of the patient treatment information?
Did the patient have The right to get
accept his care plan?
Did the patient have The right to Sign the
informed consent?
Keep the privacy of the patient when
Examination
Did the patient have The right to get
acceptance to participate the scientific
research?
Did the Doctors Know the patient name?
Did the Nurses / Doctors Calling the
patient by his/her name?
Did the Doctors Accept the patient
decision when he/she refuse the
treatment?
Did the patient have The right to get
Explanation
about
the
treatment
requirement after discharges?
Did the patient have The right to get
Explanation about the surgery risks
(complications)?
Did the patient have The right to get
Explanation about the treatment costs?
Did the patient have The right to get
Explanation about how the illness
danger?
Did the Doctors Keep the patient secrets?
Did the Doctors Offer the whole care to
the patient?
Table
(1)
Represents
the
demographic data for studied groups:
For Doctors: Number of doctors who
participated in this study 25 (40%
Yes
number
%
12
48%
No
number
%
13
52%
3
12%
22
88%
11
44%
14
56%
13
52%
12
48%
11
48%
14
56%
6
24%
19
76%
3
12%
22
88%
2
8%
23
92%
3
12%
22
88%
7
28%
18
72%
6
24%
19
76%
5
16%
20
84%
3
12%
22
88%
3
12%
22
88%
3
12%
22
88%
3
12%
22
88%
2
8%
23
92%
6
24%
19
76%
males & 60% females) 52% of them
married, most of them work in general
medicine. For Nurses: Number of
nurses who participated 50 (84%
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married) most of them females, 60%
of them working in different departments (ten in medical department, ten
dialysis unit, ten I.C.U, and eight in
general surgery). For Patient: Number
of patients who participated 75 (20%
males & 80% females) most of them
married, and (40%) of them were
admitted in general surgery department.
subject became deeply rooted in the
medical culture. In this study, it is
unfortunately that, some of studied
nurses (66%) think that the patient
didn’t have the right to share in making
decision related to his/her plan of care,
and his right about any explanation on
health care facilities.
Regarding the patient right to
get respect and dignity, responsiveness
and timely attention to health needs.
The recent study cleared that (74%) of
nurses said yes about it, (76%) of them
said yes about calling the patients with
their names but for doctors only 24%
agreed to call the patient by his/her
name. (64%) of patient feel that they
get respect but 80% of them said that
the health provider did not call them
with their names and this also against
patient bill of right and A.M.A outline
Table (2) Shows that the
nursing opinion on patients’ right was
positive as regards 68.1% of asked
topics, and at the highest score in about
31.1%. But the lowest percent was in
of the patient has right to get
information about health facilities,
health care providers and the rights to
know to keep the patients’ secrets.
Table (3) Shows that only
13.3% of studied patients have some
ideas about their rights, while the
majority of them (86.7%) have no
ideas on patients’ rights.
Regarding patient right to have
informed consent about all procedures.
Informed consent involves the patient’s
understanding of the following: What
the doctor is proposing, Whether the
doctor’s proposal is a minor procedure
or major surgery, The nature and
purpose of the treatment , Intended
effects versus possible side effects, The
risks and anticipated benefits involved,
All reasonable alternatives this agree
with (Flocke, Miller, Crabtree, 2002,
and Stewart, Brown, and Donner,
2000).
Table
(4)
Describe
the
knowledge attitude and practice of
doctor as regard patient right, and
unfortunately all of studied physicians
were not aware about that subject.
DISCUSSION:
As a part of human rights,
patients’ rights today are politically
supported, and have more official
commitments. In spite of availability
of knowledge about patients’ right in
the field of medical sciences and
nursing practices since many decades,
this subject not taking proper
considerations in our medical culture
until now. The authors thought that,
this study may be new trial in this
field. Many issues comprise the rights
of patients in the medical field were
included in the questionnaires applied
in this study, and this revealed this
Voluntary consent means that
the patient understands these concepts:
Freedom from force, fraud, deceit,
duress, overreaching or other ulterior
form of constraint or coercion, the
right to refuse or withdraw without
influencing the patient’s future health
care, the right to ask questions and to
negotiate
aspects
of
treatment
(Lindsey, and Hartrick, 1996; and Fry,
and Robert 2007).
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Regarding the patient bill of
right to get privacy during the
examination or getting nursing care,
the 92% of doctors said no about the
right and 58% of nurses said yes about
it but (77%) of patient that they did not
feel that they have a privacy during
examination of getting care and this
also against all the references talk
about patient right like patient bill of
right
this
agree
with
(http://www.emedicinehealth.com/pati
ent_rights/article_em.htm).
without written permission of patient
or legal guardian, the patient has a
right to inspect and obtain copies of all
records about his/her care or treatment
(Alderson and Goodey C 1998).
While health care providers and
patients assume that medical records
are private, the widespread use of
electronic data systems opens the
potential for seriously compromising
patient confidentiality. Regulations
must be imposed by the government to
protect patient records by creating
limits on the methods in which medical
information is shared. (National
Commission for the Protection of
Human Subjects of Biomedical and
Behav. Report and recommendations).
This study revealed that the
(24%) of nurse involved in the study
said no that they did not keep all
information or patient personal
confedencilly even for personal
information only (44%) of nurses said
yes that agree to keep secret
Evolution of concepts of
patients’ right was run parallel with the
growth of democracy in democratic
countries, for this reason, in some
systems, the rules give patients
additional control over their private
medical information, except that
related to preventive measures and
restricted by law, and to activate this
concept of patients’ right, health-care
organization must be concerned with
patient education and improving
communication within the health care
system, encourages the partnership of
health care professionals and patients.
A patient who is educated about his or
her own medical condition can work
together with health care providers
regarding
treatment
decisions.
(Stewart, 2001, and Richard, 2003)
As regards patient: the majority
of patient (79%) feel that their
treatment or diagnosis not confidentially protected, while 76% of nurses
versus 48% of doctors know that the
nurses must keep the confidentiality of
patients.
Although patient’s right is a
part related to medical ethics, and
some of it is theoretically discussed
among professionals, but actually not
publicly known; in this study 83.3% of
studied patients not combated with
American bill of patients’ right; and
this is agree with (Alderson and
Goodey, 1998) who stated that: Low
and ethics state that the doctor patient
interaction should remain confidential.
The physicain should never reveal
confidential information unless the
patient
wants
this
information
disclosed to other except if the patient
at risk, or if there a medico-legal
allegations, no one except the physiccian and medical center staff involving
in planning care or receiving your care
may look at your medical records
For balance between right and
responsibility; the patient is also
expected to meet a fair share of
responsibility. The patient is to follow
the plan of care, provide complete and
accurate health information, and
communicate
comprehension
of
instructions on procedures and treatment. The patient is further responsible
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__________________________________________________________________________________
for consequences of refusal of
treatment,
following
rules
and
regulations of a hospital, and to be
considerate of others' rights. The
patient is also responsible for
providing assurance that financial
obligations of care are met.
(http://www.emedicinehealth.com/
patient_rights/article_em.htm)
even the hosptial system did not allow
this right this is in accordance with
(Roter, D. L. and Hall, J. A. 1993, and
Van Ryn, M. and Heancy, C. A 1997)
Most of doctors shared in this
study stated that they didn’t practice the
right to patient even about explanation
about the operation or plan of treatment,
76% they didn’t know the patient name or
call the patient with his name in general;
only for chronic patient they will do, may
be due to long stay of patient in hospital.
The doctor explanation for these result
that they have so many patients especially
in general wards, and shortage of time
assigned for patient education, another
cause some doctors believe that this is the
role of nunrse only. A complete Explanation from physician about patients’
diagnosis, treatment, procedures, and
prognosis in understandable terms, is a
right
for
patients
(http//www.
genesishealth.com/ rights. aspx).
Regarding these right
the
majority of the patient themselves said
no if they give information about this
condition or hospital facilities, the
name of their health team provider,
only the (75%) of them say yes about
the doctor explain to them the risk of
treatment or operation this accordance
with patient bill of right and code of
ethics(http://health.enotes.com/nursing
-encyclopedia/patient-rights
and
http://www.emedicinehealth.com/patie
nt_rights/article_em.htm)
In this study (66%) of studied
nurses revealed that patient have a
right to choose his doctor, but 54% of
them said yes about the right of patient
to change the doctor or treatment plan
(34%) said yes about right of patient to
refuse his treatment This means that
the nurses accept these patient right but
they did not practice it effectively most
of patients themselves did not practice
these right, may because they did not
know that they have the right to choose
doctor or change treatment or refuse if
they like, they even did not have an
active role in their treatment plan agree
with (Fry, Robert. veatch 2007, and
Stewart, 2001)
They thought that they have to
accept and in the most cases carry out
what doctor and nurse said without any
Explanation, they said sometimes
when they ask about their own
treatment few answer only, they may
get and not form all the staff, most
nurses gave few information about it
Continuity of adequate medical
care and health care is one of the main
patients’ right and is known since long
time as a part of Primary Health Care
elements. When we find most of
doctors and nurse have no idea about
these patient rights. This means that
there is a defect in the education and
training programs.
Regarding patient right to
participate in the medical and nursing
research this issue of patient right has
developed over the years because of
unethical practices that have occurred
in the past e.g The Nuremberg Code
was formulated in 1947 because of the
trial of Nazi physicians who had
Regarding patient right to
choose a doctor and to refuse the
treatment or to change the doctor most
of doctors said no about the patient
right and they said for explain only one
or two doctors have to see all patient,
364
EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007
Aref et al
__________________________________________________________________________________
experimented on unwilling subjects.
The Code states that "the voluntary
consent of the human subject is
absolutely essential.", In 1964, the
Declaration of Helsinki softened the
stipulations of the Nuremberg Code by
allowing the legal guardians of
incompetent persons to provide
consent on their behalf, at least for
"therapeutic" research. After the
exploitation of subjects in the Tuskegee study of syphilis, the National
Commission for the Protection of
Human Subjects of Biomedical and
Behavioral Research was created in
1974. The Commission discussed the
problem of using vulnerable groups as
research subjects. A recent article in
the Journal of the American Medical
Association proposed 7 requirements
that provide a framework for evaluating the ethics of clinical research
studies (Trials of War Criminals 1949)
(34%) said yes about patient has to
know the hospital facilitiy. As regard
doctor the result revealed that the
highest score is only (52%) as regards
patient have the right to get
explanation about the hospital working
system while the (8%) Keep the
privacy of the patient when examination and keeping the patient secrets
and this may be because they don't
know that they need a permition from
patient to talk to anyone about his
condition or personal information. For
the patient the highest score is that they
are getting explained what about
treatment or surgery complication and
risks (75%) and the (97%) say no
about if they get their right to choose
the doctor or treatment. That is because
of the hospital policy don't allow this
for general patient.
Recommendations:
At the end of study the authors
recommend:
1. A written protocols and
guidelines for the patient’s rights and
duties which meets the international
standards while considering our
national cultural and religious beliefs.
After having such national guidelines,
our health-care providing facilities
should maintain their practices through
a system for accreditation of healthcare standards.
2. Each health-care organization
should have its committee for the
patient rights and ethics which will
exist to help ensure that each patient's
rights are respected and that the
organization conducts its business
relationships with patients and the
public in an ethical manner.
3. Recognizing the hospital's
responsibilities under the law;
4. Informing patients about their
responsibilities in the care process;
5. Managing
the
hospital's
relationships with patients and the
public in an ethical manner.
The result of the staff find that
(70%) of nurse accepted this right, but
(88%) of doctors said no about they
must get the acceptance of patient to
participate in the scienitific research,
and (55%) of patient said no, no one
get there accept to paticipate in the
research even they did not know about
this at all and this is aganist the
(A.M.A) preposed for evaluation the
ethics of clinical research
CONCLUSION:
The result of this study
revealed that knowledge and practice
of patient right by doctors and nurses
need to be improved, The hieghest
score the nurses get on the items for
inform the patient with the treatment
cost (86%) and the patient has right to
choose their doctors and having this
right
The lowest score about if the
patient has right to know the name of
the team working with him (32%) &
365
EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007
Aref et al
__________________________________________________________________________________
6. The guidelines and standards
for parient rights must be prepared by a
panel of members that includes
representatives from the National
Center for Ethics, university-based
centers for ethics, patient advocate
groups, various national professional
organizations and hospital ethics
committees and religious scholars to be
references for religious issues.
7. Develop strategy to improve
doctor-patient, and nurses-patient
relationship
10. Georg D. Pogar, (2007)
Nursing ethics: legal aspect of health
care administration: Patient right and
responsability. 10th ed pp 329-42.
11. Fry T. Sara and Robert M.
Veatch (2007): don't patient have a
right to refuse service they don't want?
2nd ed Page 115 : 335
12. Stewart, M (2001) Towards a
global definition of patient centered
care. BMJ 322,444-445
13. Flocke, SA, Miller, WL,
Crabtree, BF Relationships between
physician practice style, patient
satisfaction, and attributes of primary
care. J Fam Pract 2002; 51,835-840
14. Wensing, M, Elwyn, G,
Edwards, A, et al., Deconstructing
patient centered communication and
uncovering shared decision making: an
observational study. BMC Med Inform
Decis Mak 2002;2,2
15. McKinstry, B Do patients wish
to be involved in decision making in
the consultation? A cross sectional
survey with video vignettes. BMJ
2000;321,867-871
16. Stewart, M, Brown, JB,
Donner, A, et al The impact of patientcentered care on outcomes. J Fam
Pract 2000;49,796-804
17. Journal of the American
Medical Association. World Medical
Association declaration of Helsinki.
Recommendations guiding physicians
in biomedical research involving
human subjects. JAMA. Mar 19 1997;
277(11):925-6. [Medline].
18. National Commission for the
Protection of Human Subjects of
Biomedical and Behav. Report and
recommendations: research involving
those institutionalized as mentally
infirm. Government Printing Office;1978.58.
19. Rice MM. Legal issues in
emergency medicine. In: Rosen P,
Barkin R, eds. Emergency Medicine. 4th ed. St. Louis, Mo: Mosby;
1998:77,217,235-36,242-45.
REFERENCES:
1. Richard S. Irwin, MD, FCCP
and Naomi D. Richardson, Msc, MBA,
Paient-focused care
2. John R. Clarke, MD, Janet
Johnston, MSN, JD. And Edward I,
Getting Surgery Right
3. http://health.enotes.com/nursin
g-encyclopedia/patient-rights
4. http://www.emedicinehealth.co
m/patient_rights/article_em.htm
5. Alderson
P,
Goodey
C. Theories of consent. BMJ. Nov
7 1998;317(7168): 1313-5. [Medline].
6. AMA. Code of Medical Ethics.
Council on Ethical and Judicial
Affairs. Available at www.ama-
assn.org/ama/pub/category/24
98.html. Accessed 1997.
7. Emanuel EJ, Wendler D, Grady
C. What makes clinical research
ethical?. JAMA. May 24-31 2000;283
(20):2701-11. [Medline].
8. Moreno J, Caplan AL, Wolpe
PR. Updating protections for human
subjects involved in research. Project
on
Informed
Consent,
Human
Research Ethics Group. JAMA. Dec
9 1998;280(22):1951-8. [Medline].
9. Van Ryn, M. and Heancy, C. A
(1997) Developing effective helping
relationships in health education
practice,
health
education
and
behavior, 24, 683-702
366
‫‪EL-MINIA MED., BULL., VOL. 18, NO. 1, JAN., 2007‬‬
‫‪Aref et al‬‬
‫__________________________________________________________________________________‬
‫‪20. Trials of War Criminals before‬‬
‫‪the Nuremberg Military Tribu‬‬‫‪nals. Trials of war criminals before the‬‬
‫‪Nuremberg Military Tribunals under‬‬
‫‪Control Council Law No. 10. Vol‬‬
‫‪2. Government‬‬
‫‪Printing‬‬
‫‪Office; 1949. 181-182.‬‬
‫‪21. Witman AB, Park DM, Hardin‬‬
‫‪SB. How do patients want physicians‬‬
‫‪to handle mistakes? A survey of‬‬
‫‪internal medicine patients in an‬‬
‫‪academic‬‬
‫‪setting. Arch‬‬
‫‪Intern‬‬
‫‪Med. Dec 9-23 1996;156(22):2565‬‬‫‪9. [Medline].‬‬
‫‪22. Lindsey, E, and Hartrick, G.‬‬
‫‪(1996) Health promoting nursing‬‬
‫‪practice: the demise of the nursing‬‬
‫‪process? Jounal o advanced nursing,‬‬
‫‪23. 106-112‬‬
‫‪23. Haggman-Laitila,‬‬
‫‪A.‬‬
‫‪and‬‬
‫‪astedt-Kurki, P (1994) what is‬‬
‫‪expected of nurse-client interaction and‬‬
‫‪how these expectations are realized in‬‬
‫‪Finnish health care. International‬‬
‫‪journal of nursing studies, 31. 253-261‬‬
‫‪24. Kobs, Ann (1997): Ethics and‬‬
‫‪patient's right: Nursing Managament‬‬
‫‪1997: 28(7):20,22-23‬‬
‫حقوق المريض‬
‫تقييم الموقف الراهن للمعارف والمواقف والممارسات بين األطباء والممرضين ‪/‬‬
‫الممرضات والمرضى بمستشفى المنيا الجامعي‪.‬‬
‫سناء محمد عارف ‪ ،‬أشرف عبد العظيم ‪ ،‬محمد علي الديداموني‬
‫تتضمن حقوق المرضى كافة األشياء ذات الصفة القانونية واألخالقية التي تنظم العالقة بين‬
‫األطباء والمرضى سواء ما تعلق بحق المريض في المحافظة على خصوصيته‪ ،‬أو حصوله‬
‫على خدمة طيبة ذات كفاءة عالية بدون تخير؛ أيضا حق المريض في اختيار طرق الرعاية‬
‫المناسبة له بعد حصوله على معلومات صادقة‪.‬‬
‫إنه من المتوقع أن يحصل المريض على فرصة عادلة في المشاركة في تحمل المسؤلية‪ ،‬ومنها‬
‫اتباع خطة العالج وإعطاء معلومات صحيحة عن حالته الصحية‪ ،‬وأن يتحمل المسؤلية تبعات‬
‫رفضه للعالج‪ ،‬إال أنه في كل الحاالت ملزم باحترام كل القواعد والنظم المتبعة في المستشفى‬
‫مراعيا في ذلك حقوق المرضى اآلخرين‪ ،‬وفي األحوال التي يلزم فيها دفع تكاليف العالج فإن‬
‫عليه االلتزام بنفسه أو من ينوب عنه بالقيام بكل نفقات العالج‪ ،‬وتهدف هذه الدراسة إلى تقييم‬
‫الموقف الراهن لمعارف ومواقف وممارسات األطباء والممرضين ‪ /‬الممرضات والمرضى‬
‫بمستشفى المنيا الجامعي‪ ،‬حيث تم أخذ عينة ممثلة من األقسام العامة‪ ،‬ولقد استخدمت في‬
‫الدراسة ثالث استبيانات تم اختيارها من قائمة حقوق المريض الواردة في دليل الجمعية الطبية‬
‫األمريكية حيث شمل االستبيان الخاص بالممرضين ‪ /‬الممرضات على ‪ 22‬سؤاال بينما اشتمل‬
‫االستبيانان الخاصان بالمرضى و األطباء على ‪ 81‬سؤاال لكل واحد منهما‪.‬‬
‫وخلصت الدراسة إلى أن معارف المشمولين بالدراسة حول حقوق المريض في حاجة إلى‬
‫تحسن‪.‬‬
‫‪367‬‬