Knowledge and Attitude Regarding Patients Right among Nurses in a Teaching Hospital: A Descriptive Cross-sectional Study

ABSTRACT Introduction: It is important to maintain trust and satisfaction among patients. The health personnel take an important role to overcome their right. The objective of this study was to find out knowledge and attitude regarding patients' rights among nurses in Teaching Hospital. Methods: A descriptive cross sectional study was conducted among 122 nurses in different wards of Teaching Hospital. Nurses were selected by using simple random sampling technique for data collection. Ethical clearance was taken from Chitwan Medical College institutional reviewers Committee (CMC-IRC) to conduct the study. A structured, self- administered questionnaire and five-point Likert scale were used to analyze the collected data. Data was collected from 27th Ashadh to 9th Shrawan 2075. Results: This study revealed that out of 122 respondents, 30 (24.6%) of respondents have an adequate level of knowledge whereas about half 62 (50.8%) of respondents had favorable and 60 (49.2%) had an unfavorable level of attitude regarding patients right. Sixty-one (50%) of the nurses were from the age group <22 years, 27 (77.9%) were unmarried, about 93 (76.2%) of nurses had completed Proficiency Certificate Level Nursing, 101 (82.2%) had work experience less than 24 months. Conclusions: According to the study, it concluded that one-fourth of the respondents have an adequate level of knowledge, one-half of the respondents had a favorable attitude. Therefore, knowledge and attitude regarding patients' rights should be increase through in-service education and seminars should be organized by the administration to promote quality health care service.


INTRODUCTION
The patient right is defined as the rule of conduct between people who benefit from health services and institution who provide them and is owed by the patient by physician and state. Condition and protection of this right related to nursing profession. 1 Health care personals as doctors, health assistance and most especially nurses are always in close contact with the patient as nurses remain with the patient all the time to provide care. For the quality of care, provision nurses should have not only the knowledge of disease but also should have the knowledge and be aware of human rights, abuses to the patient that may occur in the hospital while providing care. So nurses must play an active role in eradicating such usual or unusual abuses and preventing them from occurring within health institutions. And here this will require a nurse to be knowledgeable an awareness regarding patient's right. 2 The study was done among nurses of Chitwan Medical College Teaching Hospital in order to find out the knowledge and attitude regarding patients' rights.

METHODS
The descriptive cross-sectional research design was done at the ICU, orthopedic ward, OT, pediatric, respiratory, medicine, ENT, surgery, emergency and gyne/obstetric department of Chitwan Medical College Teaching Hospital (CMCTH), from 27 th Ashadh to 9 th Shrawan 2075. Ethical clearance was taken from Chitwan Medical College institutional reviewers Committee (CMC-IRC) to conduct the study. All the nurses who were working in the post of staff nurse, senior staff nurse, and nursing officers were included in the population of the study and nursing supervisor, matron was excluded because they mostly involve in administrative activities. The nurse of CCU and Dialysis was excluded because pretesting was done in that area. Staff nurse, senior staff nurse, and nursing officers were included because most of all they involve inpatient care, ward activities. Written informed consent was obtained from each respondent by clarifying the purpose of the study prior to data collection. Simple random sampling technique was used through the name list of nurses to select the desired sample.
Sample size estimation: n 0 = Z 2 x p x q/ e 2 = 1.96 2 x 0.68 x0.32/ 0.7 2 = 170 where, p= prevalence of previous study 2 (Thapa and Samson) q= 1-p, e= margin of error, 7% Z= 1.96 at 95 % CI For definite population, n= n 0 / 1+ (n 0 -1)/N = 170/ 1+ 170-1 342 = 114 Adding, 5% non-response rate, sample was calculated to be 120. where, N= Total population i.e. 342 nurses Therefore, the total sample size (n) was 122. Structured self-administered questionnaire was used to identify the level of knowledge of nurses developed based on research of 3-4 and 5 points Likert scale was used to identify level of attitude regarding patients' right among nurses developed based on research study of [5][6][7][8] Aka and her team as well as via literature review.
All collected data were reviewed and checked for completeness, consistency and accuracy. Coded data were entered in EPI data 3.1. The entered data was exported into IBM SPSS version 20. Data were analyzed by using descriptive statistics (frequency, percentage, mean and standard deviation). The findings of the study were presented in tables.
The research instrument consisted of three parts: Part I-Question-related to socio-demographic data Part II-Question-related to knowledge regarding patients right among nurses.
Part III-Question-related to attitude regarding patients' rights among nurses.

RESULTS
Out of 122 respondents, 61 (50%) of respondents belong to group of <22 years, 77.9% respondents were unmarried, 91% of respondents live in gaupalika, 84 (68.9%) belongs to ethnic group brahmin where as 13.9% belongs to dalit. In regard to source of information about 96 (78.7%) of respondent get information from book regarding the patient right (Table 1).  The level of knowledge regarding patient right, 24.6% had adequate knowledge ( Table 5). Out of total score 14, the maximum score obtained by the respondent was 14 and minimum score was 2 (Table 3). Sixty two (52.8%) of the respondents had satisfactory attitude regarding patients right (Table 4).

DISCUSSION
The study population consists of 122 nurses working in all wards of Chitwan Medical College Teaching Hospital, Bharatpur.
This study revealed that out of 122 respondents, 30 (24.6%) of respondent have adequate level of knowledge regarding patients' right and 92 (75.4%) of respondents have inadequate level of knowledge which is not the good result for nursing like profession as their low knowledge effect on their practice which consequently effects on patient wellbeing. Poor knowledge may be due to not utilizing the knowledge in practice when dealing with the patient. There is no statistically significant relationship between knowledge with age, marital status, place of residence, ethnic group, professional qualification, professional designation, experience in hospital, experience in the current ward, in-service education and self-directed learning. Majority 101 (80%) of the respondents have working experience of fewer than 24 months, which may be the cause that no association of working experience may occur. This study is a contrast to the study conducted by Nejad et al, who revealed that there is an association between knowledge of the nurse with their working experience and working hospital either private or governmental. 3 Regarding patients' right about half 62 (50.8%) of respondents had a favorable level of attitude and 60 (49.2%) had an unfavorable level of attitude it may be due to poor knowledge and more workload of nursing staff. Similarly, a study conducted in Turkey shows that attitude towards patient rights differs for every patient ranging from 35.8 to 98.1%.