Keywords |
| Patient rights, phenomenology, model, Sari |
Introduction |
| In giving an effective care, patient's right is
generally demanded by patients, while the
hospital is responsible to fulfill this particular
expectation.1 The charter of the patient's right
is a defense of human right, i.e. to prevent
patient’s honor and dignity and to ensure that
he or she gets a good quality of care in illness
situations, specifically in medical emergencies, without any age or gender
discrimination and with the financial strength
of the his or her body, life and health.2 The
aim of the patient's right charter is that the
basic rights of the patients who receive care
from health institutions are explained to them
according to the rules and regulations.3,4
European regional office of the World Health
Organization writes in its statements that
promoting the patient's right is a multi categorized topic and achieving this goal
should be done through multilateral efforts.5
In addition, WHO has also presented solutions
in this field, most of which involve active
participations by both the service recipients
and service providers in formulating health
policy and developing training programs
specifically for service providers and the
entire community. The notification of the
charter of patient's right and the guidelines of
the relevant plans by the Ministry of Health
and Medical Education in 2002 is another
important issue 6, but this particular rights
charter has not been fully accepted and
understood, despite its approval. The
following provision needs a major center
because many of them are not easily
accessible without the cooperation of the
different sectors.7 |
| Monitoring and control of the hospital’s
regulations is the main principle for staff and
physicians because disregarding it will cause a
gap in providing healthcare and could create
irreparable psychological mental injury,
patient’s dissatisfaction, health risks,
endangering patients’ lives and safety, as well
as deteriorating the relationship between the
staff and the patients. All of these will
consequently increase the problem of hospital
management and reduce the effectiveness of
care given.8 In addition, medical health staff
cannot deal with the present challenges
without possessing required knowledge about
the ethical and legal concepts and adapting
themselves with the needs created by
demographic characteristics and technologists
of the current century.9 |
| In most countries, patient's right has been
standardized with legal or civil law and a
common understanding of respect to this right
lie between care providers (physician and
nurses) and care recipients. This is necessary
for care providers to follow standards and
provide services with high quality.10 Albishi 11
carried out a phenomenological study using the data on the experiences and understanding
of patients, physicians and nurses of the
patient's right in Saudi Arabia. The main
extracted themes from the analysis of the
interviews conducted in Albishi research
consisted of the current understanding of the
definition of basic rights, as well as cultural
and occupational resources of the right, family
priority, cultural adaptation, lack of standards
among the hospitals, the lack of rules and
legal system and the impact of work pressure
on the patients right. Until now, most studies
have focused on comparing and measuring
knowledge in different groups. Hence, the
researcher decided to conduct this study to
investigate the understanding of the
physicians, nurses, patients and their
attendants, as well as care providers about the
patient rights charter so that it will provide a
deeper understanding of this particular law
from various perspectives. |
Methods |
| This study made use of the phenomenology
approach using the three dimensional model
of Kaufman, Kurigan and Jason 12 at Imam
Khomeini Hospital, Sari, Iran. The three
dimensions of this particular model consist of
service recipients (patients and attendants),
service providers (nurses and physicians) and
managers (including the managers of the
different levels). Suitable participants were
selected based on the inclusion criteria of the
study, namely, they: |
| • had been admitted in the hospital for
more than Two days; |
| • had intact cognitive skills and mental
functions as determined by the Mini-
Mental State Examination (MMSE)
scale, with a score of more than 20 -
30 for patients; |
| • were willing to share their experiences
and knowledge; |
| • had given their consent and signed the
informed consent document |
| The accuracy of the information in this study
was ensured by considering several formal
and informal interviews with the participants.
Meanwhile, the data was collected using the
open-ended questions throughout 68 interview
sessions with 12 patients, 12 attendants, 18
nurses, 12 physicians and 14 senior, middlelevel
and operational managers. |
| In the interview phase, the participant’s
informed consent was obtained which
indicated that they had fully understood the
procedure and the purpose of the research, and
voluntarily participated in this study. Hence,
prior to the commencement of each interview,
the participants were briefed on and explained
about the research, and they were later asked
to sign the consent form if they decided to
willingly take part in the research. With the
permission of the participants, a digital
recorder was used to record the interview
session. The interviews were conducted in the
participants’ rooms and offices. All the
recorded interviews were then backed up by
duplicating them and saving them in two
different places. The recorded interviews were
then transcribed verbatim immediately after
leaving the field, i.e. on the same day or the
day after by the researchers. In the data
analyzing phase, the factor analysis test was
used for match and mismatch structures. |
Findings |
| All the concepts that were common in at least
2 views were selected and analyzed with the
expert's groups, and these are presented in
table 1. As it can be seen, content themes were
divided into ten categories, namely:
appropriate care with high quality, the right to
have information, the right to confidentiality
of information and secretiveness, the right to sign an informed consent, and observe
patient's privacy, the right to rote
independence, the right to be at peace, the
right to express objections and complaints, the
right to get compensation, as well as the right
to enjoy the adequate resources and individual
behavior. |
Discussion and Conclusion |
| The concept of patient's right is an issue that
needs more research and discussions. Taking
every step two can help patients to receive
care based on human and moral rights. More
knowledge of service recipients, service
providers and service producers with regards
to patient rights charter will definitely
improve patients' right and consequently
provide better health care to its recipients.
Thus, through focusing on patients’ rights and
improving the laws pertaining to this
particular subject, patients’ satisfaction can be
enhanced. And given the fact that satisfaction
is one important indicator of performance
effectiveness, as well as productivity and
quality of health care services, it can ensure
organizational survival and competitiveness.
Moreover, Patients Satisfaction that is the
most important customers of health care
centers is an important issue in achieving
excellence in health care. Taking this concept
a step further, Tabatabaei et al.13 pointed out
that “an important instrument to assess the
quality of healthcare is patient satisfaction as
because of it, the unmet needs can be defined
and subsequently, the services can be
provided”. Furthermore, satisfaction of the
patients can be described as meeting Patient
Expectations or offering service exceeding
Patient Expectations.14 Consequently, the
implementation of patients’ rights can increase
the quality of care, as well as achieve equal
distribution of responsibility between the
patients, nurses, and physicians. |
| Based on the findings of this study, the
participants looked at patient's right more
from natural dimension than the legal
dimension. The recipients knew they are
entitled to receive natural and human rights,
whereas service providers believed that the
patients’ right is legal and is a government’s
duty. According to Salimi et al.9, many
scholars such as Jean Jacques and Johan Lock
have supported natural rights in their writings,
while civil rights had rooted in the west
revolutions and were stabilized with the
growth and social development and attention
to oriented customer. |
| A research study conducted by Leino-Kilpi et
al.15 in Finland concluded that patient rights
with regards to privacy protection might be
better secured in university hospitals than in
state hospitals. Such findings were based on
laboratory examinations. |
| In the current study, one of the highlighted
themes extracted from the service recipient is
the effectiveness of individual behaviors, from
which self-concepts such as openness,
empathy, positivism, supportiveness and
equality had emerged. The effectiveness of the
individual behaviors mentioned was beyond
the accommodation and physical presence and
so forth. Meanwhile, both respect and dignity
were highlighted more often than services
(treatment and care) by the patients. Thus,
considering the existing problems and the lack
of knowledge in the ability of the treatment
system and also in clearing the areas of
responsibility of organization about right,
special attention by policy makers and
managers in health and treatment, the
improvement in the quality of care and the
establishment of clinical sovereignty to
increase service recipients’ satisfaction are
inevitable. |
| Finally, as well as Barofsky16 already
mentioned, “Patients’ right statements are
needed so that the patient can fully participate in the process whereby acceptable care is
defined”. Based on the discussion on the
oriented customers and the stability and
competitiveness of organizations, it is time
that countries consistently match the charters
of the patient’s right with stakeholders’
expectations and analyze their strengths and
weaknesses and create the required match
between stakeholders. More importantly,
doing so will help to overcome problems
related to the decrease and deficiency in
relation to their social and civil laws and
medical system. |
Acknowledgement |
| The authors are grateful to all the patients and
their attendants, nurses, physicians and
managers at Imam Khomeini Hospital, as well
as to the Health Sciences Research Centre of
Mazandaran University of Medical Sciences,
Sari, Iran. |
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