Nsg. Research Chap. 1 - 3

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INSTITUTE OF NURSINGDr. Nicanor Reyes St., Sampaloc, Manila

S.Y. 2011 - 2012

IN PARTIAL FULFILLMENTOF THE REQUIREMENTS INNURSING RESEARCH

Level of Awareness on the Magna Carta of Patients Rights of 2008Among Patients and the Health Care Team

MENDOZA, Fahren JoeMENDOZA, Schelma

NAGUIT, Anna Mae PaulaOCAMPO, Marjorie AnnPAGAPONG, Nicole Irish

PARAISO, AleliPASCUAL, Catherine

PATAWARAN, Emmar SonRAMOS, Kristine Nicole

TORRALBA, Raesar Jay

PEREZ, John HarveyGroup Leader

FAR EASTERN UNIVERSITY Institute of NursingBSN 217 Group 68

August 13, 2011

Mrs. Amelia Sta. Maria, RN, MAN, PhDResearch Adviser

CHAPTER 1

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INTRODUCTION

Background of the Study

Health as a fundamental human right was recognized in the World Health

Organization's Constitution stating that the enjoyment of the highest attainable standard of

health is one of the fundamental rights of every human being without distinction of race,

religion, and political belief, economic or social condition. During the last fifteen years, an

increasing number of countries have adopted laws or other legal instruments respecting and

protecting the rights of patients. This reflects the progressive recognition of the inherent

dignity and of the equal and inalienable rights of all potential users of the health care

system. (WHO)

Each person has rights regardless of what one have and do not have, what a person

is and what a person is not. In jurisprudence and law, a right is a legal or moral in

entitlement to do or refrain from doing something or to obtain or refrain from obtaining an

action, thing or recognition in civil society. Rights serve as rules of interaction between

people, and, as such, place constraits and obligations upon the actions of individuals or

groups, for example, if a person has right to live, this means that others do not have the

liberty to kill a person (Coleman andd Shapiro 2002) .

It is hereby declared by the policy of the Philippines to promote the right to health of

the people and instill health consciousness among them. It shall likewise protect and

enhance the right of all people to human dignity thereby establishing the Magna Carta of

Patient's Rights and in order to ensure a decent, humane and quality Health Care for.all

patients and Health Care Team. (14th Congress of the Republic of the Phil.)

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As the next generation of nurses, student nurses are compelled to commit ourselves

with medical profession and rules and regulations imposed by it. Accordingly, student nurses

are accountable to be mindful of rights as health care providers and especially, the rights of

our patients, for them to receive eminent nursing care. In contrast, the patient themselvesshould atleast ascertain awareness regarding their own rights to eliminate unjust, inhumane

treatment to them, and also protect them from different kinds of exploitations and

discrimination.

Together with the goal of achieving the highest quality of care for patients, the study

is focused in assessing and evaluating the patients level of awareness about the Magna

Carta of Patients Rights especially among those in the general ward of selected public and

private hospitals.

Statement Of The Problem

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This study aims to determine the level of awareness of patients, nurses and doctors in

selected private and public hospitals regarding Magna Carta of Patient's Rights of 2008.

Specifically, this study is conducted to answer the following questions:

1.) What is the demographic profile of the patient with regards to:

1.1. Age

1.2. Highest Educational Attainment

2.) What is the demographic profile of the nurse with regards to:

2.1 Age

2.2 Highest Educational Attainment

2.3. Length of Hospital Experience

3.)What is the demographic profile of the doctor with regards to:

3.1. Age



4.) What is the level of awareness regarding the Magna Carta of Patients Rights of 2008 in

selected public and private hospitals according to:

4.1 Patients

4.2. Nurses

4.3. Doctors

5.) Is there significant relationship in the level of awareness regarding the Magna Carta of

Patients Rights of 2008 of the patients when grouped according to:

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5.1 Age


6.) Is there significant relationship in the level of awareness regarding the Magna Carta of Patients Rights of 2008 of the nurses when grouped according to:

6.1. Age

6.2. Highest Educational Attainment


7.) Is there significant relationship in the level of awareness regarding the Magna Carta of

Patients Rights of 2008 of the nurses when grouped according to:

7.1 Age



8.) Is there a significant difference of the level of awareness of the Magna Carta of Patients

Rights of 2008 between patients, nurses and doctors?

9.) Is there a significant difference of level of awareness of the Magna Carta of Patients

Rights of 2008 among public and private hospitals?

Significance Of The Study

Magna Carta of Patients Rights largely confine themselves to regulating the

relationship between the patient and the health care team or institution and do not seem to

have much normative meaning in the relationship between the patient and public authority.

However, in the area of health, the individual is very much dependent on good advice

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because the expertise, skills and knowledge are in the hands of others, i.e., the health care

team. (Ducinskiene & Vladickiene, 2006)

The aim of this study was to explore the awareness and practice of the Magna Carta

of Patients Rights of 2008 from the perspective of the medical patients, doctors and nurses,

and to elucidate any possibly existing discrepancies between perceptions in these groups.

This information and evidence that the study is expected to contribute to the

following beneficiaries:

NURSING PRACTICE

The research study will enhance the knowledge of both the patient and the medical

team about the Magna Carta for the Patients Rights, thus it will help them in providing

quality and standardized delivery of care which the patients deserve to receive. Through

this, the client will be ensured safety and dignified nursing practices without violating any of

their rights. This inquiry will help the nurses to improve their standards in clinical nursing

practice in the hospitals for the betterment of the patients outcome and for them to avoid

malpractice or negligence to their patients. These standards reflect the values and priorities

of the nursing profession, provide direction for professional nursing practice, provide a

framework for the evaluation of nursing practice, and define the professions accountability

to the public.

NURSING ADMINISTRATION

This nursing research will be beneficial because it will help the administration to

decide or to make protocol wherein every patients should be informed about their rights as

well as the nursing staffs and other health care providers must be aware of this so-called

Magna Carta for Patients Rights of 2008. This inquiry will also be a help in providing value

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care in patients by maximizing the awareness of the staff and clinicians in bestowing

eminent and quality care to the consumers of the health care services.

NURSING RESEARCH

The research study will provide new information and increase awareness to patients,

to healthcare professionals and to future researchers. Through this study the researchers

can advance knowledge and improve the delivery care system of all healthcare

professionals as to increase in patients satisfaction. Researchers can use this as a baseline

for further development and study. Researchers can undertake a new study and use this as

a related literature or even a baseline for the new study. Researchers may also include the

study as a vital part in providing information and raises awareness not only to the field of

nursing but also to the field of medicine and to people seeking care. Researchers can use

this as a data for evaluating patient and healthcare professionals level of understanding to

the Magna Carta of the Philippines.

NURSING EDUCATION

The research study will educate nursing students and everyone about the Magna

Carta of the Philippines. In order to improve the situation, the practical implementation of

the Magna Carta of the Philippines could be given an extra drive through spreading the new

views on the quality assurance in health care through training institutions for healthcare

professionals and to everyone. Thus, provide teaching strategies to educators on how to

address it to the public and to heighten the knowledge of nursing students. Through this

study, it can raise awareness to clinical instructors and can include the Magna Carta of the

Philippines to the curriculum for better understanding and to educate everyone about their

medical rights.

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Scope and Limitations

This quantitative study is primarily concerned on the Level of awareness of Doctors,

Nurses and Patients regarding the Magna Carta of Patients Rights of 2008 during the period

of August - September 2011.

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This study will be conducted in the General Ward of the following; two (2) public

hospitals namely: Ospital ng Maynila and Ospital ng Sampaloc ; and two (2) private

hospitals namely: Dr. Fe Del Mundo Memorial Hospital and Mary Johnston Hospital .

The study will consist of 170 respondents: 100 patients, 40 nurses and 30 doctors.

This research will not include the nursing administration i.e. the management of the

hospitals and will only be conducted at selected private and public hospitals. Also, this

research is only limited to the patients in the general ward regardless of their illness.

This research will only be limited to the relationship of level of awareness between

the patients age, educational attainment and the nurses and doctors age, educational

attainment and length of hospital experience. And this will only be limited to the 15 Patients

rights as stated in the Magna Carta of Patients Rights and Obligations of 2008 as amended

by Senator Pia Cayetano.

CHAPTER 2

THEORETICAL FRAMEWORK

Review of Related Literature and Studies

Formalized in 1948, the Universal Declaration of Human Rights recognizes the

inherent dignity and the equal and unalienable rights of all members of the human

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family. And it is on the basis of this concept of the person, and the fundamental dignity and

equality of all human beings, that the notion of patient rights was developed. In other words,

what is owed to the patient as a human being, by physicians and by the state, took shape in

large part thanks to this understanding of the basic rights of the person. (WHO)

Foreign Literature

According to the United Nations, Universal Declaration of Independence

proclaims the self-evident truth that men are created equal and endowed with inalienable

rights to life, liberty, and the pursuit of happiness. Because of the U.S. Bill of Rights, the

world was able to witness the first practical experiment in the government that is committed

for the respect and protection of its citizen.

On March 26, 1997, Pres. Clinton created the Advisory Commission on Consumer

Protection and Quality in the health care industry and charged it with recommending such

measures as may be necessary to promote and assure health care quality and value and

protect consumers and workers in the health care system. As part of the charge, the

president asks the commission to develop patients Bill of Rights in health care (Clinton,

1997).

Effective health care requires collaboration between doctors, nurses and patients.

Open and honest communication, respect for personal and professional values, and

sensitivity to differences are integral to optimal patient care. As the setting for the provision

of health services, hospitals must provide a foundation for understanding and respecting the

rights and responsibilities of patients, their families, doctors and other caregivers such as

nurses. Hospitals must ensure a health care ethic that respects the role of patients in

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decision making about treatment choices and other aspects of their care. Hospitals must be

sensitive to cultural, racial, linguistic, religious, age, gender, and other differences as well as

the needs of persons with disabilities. (American Hospital Association, 1998)

During the last 15 years, an increasing number of European countries have adopted

laws or other legal instruments respecting and protecting the rights of patients. This reflects

the progressive recognition of the inherent dignity and of equal and inalienable rights of all

potential users of the health care system. The mechanism of the patients rights and their

real contents vary between countries universally. However, the development of a strategy to

promote patients rights and responsibilities has to be carefully prepared in order to ensure

the intervention is translated into practical action which commands the support of all

parents involved. (Vladickiene, 2006)

Kwon (2001) suggested that the ambiance of health care is quickly changing

because of the many factors affecting it. Nowadays, patient bill of rights becomes the center

of attention in the practice of medicine. These rights include the right to receive information

from physicians and discuss the benefits, risks, costs of appropriate treatment alternatives;

the right to make decisions regarding the health care that is recommended by the physician,

the right to courtesy, respect, dignity, responsiveness and timely attention to health needs,

the right to confidentiality, the right to continuity of health care and the basic right to have

adequate health care.

In the study of Ducinskiene et al. (2006) on the awareness and practice of Patient

Rights Law in Lithuania, the authors stated that patients rights law is intended to secure

good medical practice, but it can also serve good to improve understanding between

patients and medical staff of both were aware of their rights. In the study, awareness and

practice of new patients right law in Lithuanian health care institutions was explored

through a survey of 255 medical staff and 45 patients in the four Kaunas City medical units.

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The study reflected that majority of the medical staff (85%) and little over one half of the

patients actually knowing (37% - 54%) their treatment prognosis, disease and complications

or possible alternative treatment methods. The result suggests a need for awareness rising

among patients to improve the practical implementation of the Patients Rights Law inLithuania.

Patients have the right to receive or decline spiritual and moral comfort including the

help of a minister of an appropriate religion (UNHCO, 2002). There is no awareness about

the right to receive moral or spiritual comfort amongst patients. Health providers are more

aware, but not overwhelmingly: Only 28% identified access to moral and spiritual comfort as

a patients right.

The right to receive equal treatment was examined by asking patients whether they

experienced differential treatment in general, and, more specifically, whether the order of

the queue was respected. Almost all patients felt that they were treated equally, although

one in ten felt that the order of the queue was not respected. These patients were primarily

from government and NGO health units. There was no systematic bias against vulnerable

groups, such as poor people or women. The right to optimum treatment was interpreted by

investigating whether malaria patients received a blood test during the course of treatment.

(UNHCO, 2002)

A majority of these patients were women typically treated in a government health

unit, which did not have the necessary resources to perform a blood test, according to the

health providers. The patients, however, were unaware of why they were never tested.

Patients are generally unaware of the right to know, and as a consequence this right is

frequently being violated. (UNHCO, 2002)

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A majority of patients are never told about the kind of illness they suffer from, the

cause of this illness, the side effects of medication prescribed nor the cost before treatment.

In contrast, more than half of the health providers are aware of the right, and although they

claim to respect it in practice, the evidence from patients reveal that this is not the case.Theright to self-determination was measured by asking patients and health providers whether

alternative medication is offered and whether the patients have a say in the choice of

medication. The survey reveals that patients are unlikely to be offered alternative

medication, especially poor patients. This right is therefore not respected in practice.

(Uganda National Health Users/ Consumers Organization, 2002)

From the American Journal of Nursing, patients need to know what extent

confidentiality will be maintained and under what types of circumstances information will be

shared with others. (Nov, 2004 / Vol. 104, No. 11) The right to privacy is generally respected,

if measured by asking patients whether they were comfortable with the persons present in

the examination room. There were, nevertheless, 16 patients who did not feel comfortable,

of which 13 were women, thus revealing a gender bias. (UNHCO, 2002)

Based on the executive summary of the Reagents Advisory Commission on Consumer

Protection and Quality in the Health Care Industry, too many Americans are injured during

the course of their treatment and some die prematurely as a result. A study of injuries to

patients treated in New York State found that 3.7% experienced adverse events of which

13.6% led to death and 2.6% to permanent disability, and that about one fourth of these

adverse events were due to medication errors raised more than two fold, with 7391

attributed to medication errors in 1993 alone (Health Care Quality Commission, 1998)

A survey that was made to determine the patients ability to understand what is

written in the patients bill of rights. It was conducted in 50 states of the USA by going to

each website one by one to gather information and data about the PBOR and by contacting

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a counsel for the health welfare or counsel for the state legislature if ever the information

gathered was unclear. The finding shows that the PBOR documents presented in the

hospitals far exceed the reading capacity of the majority of adults. Meaning, these

documents is not at all clear and understandable for majority of their people. This is a realproblem because this situation may lead to the patients being more passive on their care

and it may instill fear on those patients who have limited literacy or English proficiency. This

is one of the main reasons why we chose this topic. In 1st world countries like the US of A,

this has seemed to be a problem because of the limited literacy or reading capacity in

majority of the adults.

To conclude, violation of patients rights and health professionals ignorance of

appropriate practice means that there is an urgent need to reconsider how to approach that

issue. It should be included in continuing education programs at both graduates and

postgraduate midwifery and nursing schools and also demands more research. (Ozdemir,

2008)

Local Literature

In the Philippines, Medical Action Group conducted a study aiming at

determining the level of awareness of urban poor residents on their rights as patients and at

describing the health behavior of patients regarding the use of public health facilities in the

community. The result of the research revealed that patients awareness on their rights is

limited owning to lack of access to information. The study also underscored the importance

of education and information dissemination among patients and health care providers. It

stressed the need to educate health care providers on ethics and human rights in order to

make them more aware of their duties to treat their patients with dignity and respect

(Human Rights, 2007)

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In 2004, in the 13 th Congress of the Republic of the Philippines, Villar explains

that there are increasing complains of the medical malpractices. There are over a hundred

cases reported in the Professional Regulatory Commission as early 1993 and 53 cases of medical malpractice from 1992 o 1996 in Visayas alone. The cases include lack of skills,

foresight and diligence, misdiagnosis, wrong medication, wrong blood transfusion, adverse

effects of anesthesia and medicine prescribed and administered by health care providers. In

relation, he added that there is a need for a law that will protect, promote and defend the

rights of patients.

In news gathered from Bukidnon, Philippines, the patients and their babies were

supposed to have gone home but the Bukidnon Provincial Annex Hospital here has been

holding them because patients cannot pay their medical bills. (Manila Bulletin, Sept 2, 2009

issue)

In spite of the recent enactment of RA 9439 or the Hospital Detention Law, patients

are still being detained in the Bukidnon Provincial Hospital in Maramag for failure to settle

their Hospital bills. Resembling an unsanitized evacuation area, 18 patients lay in makeshift

carton mats in the hospitals abandoned out-patient department. A newly born baby, who

was previously diagnosed with Pneumonia, was again afflicted by the said disease due to

the cramped and unsanitary conditions of the detention room. Some patients have been

languishing in the dilapidated ward for almost three months amidst their willingness to sign

promissory notes. . (Manila Bulletin, Sept 2, 2009 issue)

With their present state of vulnerability, every day of the patients detention

exposes them to infections and other hospital acquired diseases. The Health Workers of

Bukidnon Provincial Hospital should know better than detain patients for an extended

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period in spite of any remaining hospital fees, Edeliza Hernandez, Executive Director of

Medical Action Group, Inc. (MAG) said.

It is the states responsibility to respect, protect and fulfill the Right to Health of itsconstitutents. The Local Government Unit of Bukidnon not only failed in this aspect, they

even exacerbated the situation by implementing policies that are anti-poor and anti-

people, she added.

Republic Act No. 9439 or the Hospital Detention Law states that it shall be unlawful

for any hospital or medical clinic to detain fully or partially recovered patients for reasons of

non-payment of hospital expenses. Patients with unsettled hospital fees have the right to

demand for the issuance of a medical certificate and other pertinent papers for the release

of the patient upon the execution of a promissory note. The said promissory note should be

secured by mortgage or by a guarantee from a co-maker which will be held equally liable for

the unpaid hospital bills.

In other news gathered from Cebu City, Philippines, a spokesman of the government-

run Vicente Sotto Memorial Medical Center (VSMMC) said the hospital was willing to

apologize to the male florist who became the brunt of jokes when a video of his emergency

surgery was posted on the popular video-sharing website YouTube. This video lasted for 2

minutes and 28 seconds where the patient said he was humiliated to see in the video how

the health care team and nursing students laughed, jeered and conducted themselves

during the patients surgery. This act clearly violated the Magna Carta of Patients Rights

and Obligations of 2008, the patients right to dignity and the patients right to privacy and

confidentiality. (Manila Bulletin, Oct. 8, 2009 issue)

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"I trusted them and yet they ridiculed me. Was that something a professional would

do? I cant even walk on the streets without being laughed at by my neighbors. I want my

ordeal to end. I hope it doesnt happen to anyone else, the male florist said.

The Philippines Department of Health has a standing policy that it must pre-authorize

any documentation of medical procedures on film, even before a patients consent is

requested. Magdalena Lepiten, the attorney for the male florist, was initially asked to handle

the administrative case to revoke the license of the hospital and doctors involved. She adds,

"Patients have no rights in the Philippines. They cant even access their own medical

records. One woman gave birth at this hospital and asked for her medical records and was

told she had to perform sexual favors. This was in the newspapers and the hospital staff

involved was fired. When single mothers go to this hospital, they are treated badly and told,

Oh you are not married and you are pregnant! Since abortion is illegal in the Philippines,

women who have abortions privately and go to the hospital face discrimination. So the issue

here is not just a gay issue. Its a communitywide issue. What we need is a comprehensive

healthcare bill."

Ging Cristobal, co-founder of Lesbian Advocates Philippines (LeAP) and media

relations officer for Ang Ladlad, a national organization of lesbian, gay, bisexual and

transgender Filipinos in the Philippines sheds more light on the hospital. "Vincente Sotto

Medical Center is a government-run teaching hospital and the only one in Cebu that treats

HIV positive people. A former medical resident and closeted gay man who received his

training at the same hospital was not surprised by what happened to Jan Jan because he had

witnessed homophobic jokes during his training there." (Philippines: Will Hospital Be Held

Accountable For Violating Gay Man?, May, 2008)

On other news, a former Manila policeman is set to file illegal detention charges

against the management of the UST Hospital for its continued refusal to discharge three

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members of his family until their hospital expenses are fully paid. Eight family members of

the policeman were rushed at the UST Hospital after they were seriously injured in a

vehicular accident in Bulacan when the vehicle they were riding was bumped from behind by

a dump truck along the Pulilan viaduct on March 27, after paying Php 700,000.00 for the 5family members, 3 were left still.

He said the three do not receive any medical attention now, but the bills continue to

increase for the use of the hospital rooms. According to Republic Act 7875 or the National

Health Insurance Law refrains any medical institution from detaining patients which will be

his basis in filing complaint against the hospital. (Nestor Estolle, the Philippine Star, April 25,

2010)

On other news, on a current controversy fuelled by an alleged leak to media of

medical information concerning President Gloria Macapagal Arroyo, where she had had a

surgery, since she is the top leader of the country, has an obligation to make her medical

condition publicly known. That is a well-established principle of public governance and is

based on the principle of national security.

The patients right to privacy hall include the patients right not to be subjected to

exposure, private or public, either by photography, publications, video-taping, discussion,

medical teaching or by any other means that would otherwise tend to reveal his person and

identity and the circumstances under which he was, he is, or he will be under medical or

surgical care or treatment. Based on this provision alone, as one member of the medical

community, there may have been a violation of the right of the patient, President Arroyo.

(Dr. Casimiro A.Ynares III, Manila Bulletin, July 11, 2009)

However, as to how and when the disclosure is to be made remains in the hands of

the patient. Not on the doctor, nor on the hospital. The medical condition can be made

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public only with the patients full consent. The Philippine Medical Association (PMA)

declaration enumerates situations under which the confidentiality may be dispensed with.

From where I stand, none of these cover the Presidents current situation. Respect for rights

make for good order within our society. A patients rights deserve that utmost respect. (Dr.Casimiro A.Ynares III, Manila Bulletin, July 11, 2009)

On other news, the Ellen (not her real name) had an spontaneous abortion by taking

medicol -pain reliever; a day after she had spotting and after that day she couldnt bare the

pain in her hips, so she decided to go to the hospitals as an emergency case. She talked to

the doctors and let her sign her waiver. In the first hospital the doctor never believe her that

she didnt do abortion, she just take a pain reliever.

In the next tertiary hospital the doctor said they dont have any equipment like

oxygen to her concern. She sent away and signed a waiver to leave the hospital. In the 3 rd

hospital the doctor shouted her that they cannot admit her because their limited bed are for

among emergency cases only. Her sister tell to the hospital staffs that Why isnt my sister

an emergency case? Again she went away and looks for another hospital. The 4 th hospital a

tertiary hospital in manila, Ellen endured more of the same. But she refused to sign a waiver

and this time the doctor asked her to just seat for a while. The doctor decided to conduct

dilatation and curettage to the patient. (Philippine Daily Inquirer, Sept 3, 2003) This news

clearly violated the Magna Carta of Patients Rights of 2008, Section 4-A, Right to Good

Quality Health Care and Humane Treatment where it clearly states Every person has a right

to a continuity of good quality Health Care without discrimination and within the limits of the

resources, manpower and competence available for health and medical care.

To give substance and spirit to the above constitutional precepts, a bill seeks to

provide a "Magna Carta of Patients Rights". Under this proposal, the duties and

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responsibilities of the government vis-a-vis the people's concomitant rights are stressed in

order to give them decent, humane and quality health care. (Cayetano, 2008)

According to Cayetano (2008), the proposed measure provides for individual andsocietal rights, as well as that the bill also proposes a grievance mechanism wherein any

complaint arising from violations of any of the rights of patients shall first be submitted for

mediation.

How much more if we conducted this survey in a 3rd world country like the

Philippines? The literacy and reading capability in majority of adults in the Philippines is not

just limited, they may also be completely illiterate and unable to read at all which, is a big

problem in terms of the patients bill of rights reading document because to understand the

bill of rights, you need to analyze and remember what you have read in the document or

what the health care provider taught you. Analyzing may be possible but being literate &

able to read is different and it has been a major problem in this country. So, we chose this

topic/study to determine the current status of the patients level of awareness when it

comes to the patients bill of rights in selected hospitals here in -. This study would

contribute a lot in the nursing field for it will suggest new knowledge in health teaching and

nursing intervention.

Synthesis:

Human rights comprise wide and interrelated topics. It has broad and different

definition around the globe. The literature gathered provides a supplemental definition

about human rights. In addition, it focuses on health as well as rights of patients. The

literatures present different points of view, ideas and opinions regarding patients rights.

Local and foreign writings reflect that right of patient must be given due attention.

Other related studies show that some are not aware among different rights as patient. In

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order to promote and practice one of the fundamental rights as an individual, who is right to

health, awareness must be established first. In relation, a joined effort among the

government, the health care team and the citizen of the country must be initiated for it is

beneficial and for the common good.

Research Paradigm

The present study is based on Hierarchy of Needs, a theory of Abraham Maslow. The

theory represents a five layer pyramid which includes physiologic needs, safety needs, love

and belongingness, self-esteem needs and needs for self- actualization wherein safety

occupies the second largest layer next to physiologic needs. According to the theory, after

satisfying the physiological needs of the individual, safety and security needs will take over

and will dominate ones behavior. These needs include protection from procedure that can

affect the condition of ones health , alleviating fear and anxiety and promotion of well

being. ( Huitt, 2004)

In the Philippine hospital setting, there are still patients who did not know the

importance of knowing patients rights inside the institution. For sick persons, knowing their

rights can really give patients safety and security with regards to their health. It can also be

advantageous for it can trigger the health care team to become more cautious and prevent

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error in rendering care. Unfortunately, some patients were just taking what is being given by

the health care team in the hospital without even sking the purpose of a particular drug.

Knowing ones rights can protect an individual from a foreseeable danger or threatwherever he or she is, thus giving a patient a feeling of security. In relation, the researchers

are interested in assessing the level of awareness of patients with their rights in order to

help them in satisfying their safety and security needs in a health institution.

Conceptual Framework

Independent Variable Dependent

Variable

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A. Patients

demographic data

- Age

- Educational

Attainment

B. Nurse s demographic

data

- Age

- Educational

Attainment

- Hospital experience

C. Doctors demographic

data

- Age

- Educational

Attainment

- Hospital exprience

D. Hospital

- Private hospital

- Public hospital

Analysis:

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Level of Awareness on the

Magna Carta of Patiens

Rights of 2008 among

Patients and Health Care

Team on Selected Public

and Private Hospitals


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This indicates that the Level of Awareness of the respondents varied into

independent variables namely: Demographic Data of Patients (Age, Educational Attainment);

Demographic Data of Doctors and Nurses ( Age, Educational Attainment, Length of Hospital

Experience)

Hypothesis

1. There is no significant relationship between the demographic profile of the

patients and their level of awareness on the Magna Carta of Patients Rights of

2008.

2. There is no significant relationship between the demographic profile of the

doctors and their level of awareness on the Magna Carta of Patients Rights of

2008.

3. There is no significant relationship between the demographic profile of the nurses

and their level of awareness on the Magna Carta of Patients Rights of 2008.

4. There is no signifant relationship between the level of awareness of patients,

doctors and nurses on the Magna Carta of Patients Rights of 2008/

5. There is no significant relationship of the level of awareness of patients, doctors

and nurses between public and private hospitals on the Magna Carta of Patients

Rights of 2008.

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Definitions of Terms

a. Conceptual Definition

Age The length of time a person or thing has existed.

Awareness - the state or ability to perceive, to feel, or to be conscious of events, objects or

sensory patterns. In this level of consciousness, sense data can be confirmed by an observer

without necessarily implying understanding.

Doctors - a practitioner of medicine, as one graduated from a college of medicine,

osteopathy, dentistry, chiropractic, optometry, podiatry, or veterinary medicine, and

licensed to practice or to render medical assistance.

Educational Attainment - refer to the highest degree of education an individual has

completed.

General ward - a ward wherein it is occupied by two or more patients.

Healthcare team - The group of physicians and health care professionals who are

responsible for a patients medical needs.

Magna Carta of Patients Rights basis of individual rights

Nurse - a healthcare professional who, in collaboration with other members of a health care

team, is responsible for: treatment, safety, and recovery of acutely or chronically ill

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individuals, families, community and population; health promotion and maintenance as well

as in treatment of life-threatening emergencies in a wide range of health care settings.

Occupation - The act or process of occupying or taking possession;

Patient - Any recipient of medical attention, care, or treatment. An individual or a group of

people who is the center in the delivery of care, promotion nd maintenance of health and

well-being.

Public Hospital - a hospital run by the government.

Private Hospital - a hospital that is owned by a person or a group of person.

Rights That which justly belongs to one; that which one has a claim to possess or own; the

interest or share which anyone has in a piece of property; title; claim; interest; ownership.

b. Operational Definition

Age number of years that a person (doctors, nurses, patients) currently living from birth

up to the present.

Awareness - It is the measure of respondents knowledge and understanding about certain

idea or a subject.

Doctors - Professionals who render medical assistance to either healthy and ill individuals .

They are also chosen medical professionals from private and public hospitals as respondents

of the study.

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Educational Attainment - The highest level of education that a person attained or finished.

General Ward - rooms occupied by one or more individuals during a stay in a healthfacility.

Healthcare team - The doctors and nurses who would be involved in the study.

Length of Hospital Exprience the time the healthcare team working or practicing their

skills in the hospital.

Magna Carta Patients rights written legal document where stated the privileges of

every patients.

Nurse - Part of the healthcare team who helps in the delivery of holistic care and services

essential to or helpful in the restoration of the patientshealth and well-being.

Occupation - It refers to the work done and to which field of specialty a person belongs.

Patient - A health care Filipino recipient who is ill and was confined in either private or

public hospital. They are the respondents for this study.

Private Hospital - a hospital that it is controlled by a single practitioner or by the

practitioner and the associates in his or her office, a hospital operated for profit.

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Public Hospital - A health care institution owned by a federal, state, or local government;

This type of hospital provides medical care free of charge, the cost of which is covered by

the funding the hospital receives.

Rights the privileges of patients to decide to their own health.

Magna Carta of Patients Rights of 2008

1. Right to Good Quality Health Care and Humane Treatment

Every person has a right to a continuity of good quality Health Care without discrimination

and within the limits of the resources, manpower and competence available for health and

medical care.

2. Right to Dignity

The Patient's dignity, culture and value shall be respected at all times in medical care and

teaching.

3. Right to be Informed of His Rights and Obligations as a Patient

Every person has the right to be informed of his rights and obligations as a Patient. It shall

also be the duty of Health Care Institutions to inform Patients of their rights as well as of the

institutions rules and regulations that apply to the conduct of the Patient while in the care

of such institution.

4. Right to Choose His Physician/ Health Institution

The Patient is free to choose the services of a physician or health institution of his choice.

5. Right to Informed Consent

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The Patient has a right to self- determination and to make free decisions regarding

himself/herself. However, the attending physician shall inform the Patient of the

consequences of his/her decisions.

6. Right to Refuse Diagnostic and Medical Treatment

The Patient has the right to refuse diagnostic and medical treatment procedures, provided

that the following conditions are satisfied;

6.1. The Patient is of legal age and is mentally competent;

6.2. The Patient is informed of the medical consequences of hislher refusal;

6.3. The Patient releases those involved in his care from any obligation relative to the

consequences of his/her decision; and

6.4. The Patient's refusal will not jeopardize public health and safety.

7. Right to Refuse Participation in Medical Research

The Patient has the right to be advised of plans to involve him/her in medical research that

may affect the care or treatment of his/her condition.

8. Right to Religious Belief and Assistance

The Patient has the right to receive spiritual and moral comfort, including the help of a priest

or minister of his/her chosen religion. He/she also has the right to refuse medical treatment

or procedures which may be contrary to his religious beliefs.

9. Right To Privacy and Confidentiality

The patient has the right to privacy and protection from unwarranted publicity. The right to

privacy shall include the patient's right not to be subjected to exposure, private or public

10. Right to Disclosure of, and Access to, Information

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The Patient or his/her legal guardian has the right to be informed of the result of the

evaluation of the nature and extent of his/her disease. Any other additional or further

contemplated medical treatment on surgical procedure or procedures, shall be disclosed and

may only be performed with the written consent of the patient. The Patient has the right tochoose who he/she desires should be informed on his behalf, Provided however, That the

Patient also has the right not to be informed on his explicit request, unless it is required for

the protection of another person's life. The Patient has the right to be given, and examine,

an itemized bill for hospital and medical services rendered. He is entitled to a thorough

explanation of such bill.

11. Right to Correspondence and to Receive Visitors

The Patient has the right to communicate with his/her relatives and other persons and to

receive visitors subject to reasonable limits prescribed by the rules and regulations of the

Health Care Institution.

12. Right to Medical Records

The Health Care Institution and the physician shall ensure and safeguard the integrity and

authenticity of the medical records. The Patient, has the right to view, and obtain an

explanation of, the contents of his/her medical records from the attending physician. The

Patient may also obtain from the Health Care Institution a reproduction, at his/her expense,

of his/her medical records.

13. Right to Health Education

Every person has the right to health education that will assist him in making informed

choices about personal health and about available health services.

14. Right to Leave Against Medical Advise

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The Patient has the right to leave a hospital or any other Health Care Institution regardless

of his physical condition, Provided, That:

14.1. He/she is informed of the medical consequences of his/her decision;

14.2. He/she releases those involved in his/her care from any obligation relative tothe consequences of hasher decision; and

14.3. His/her decision will not prejudice public health and safety.

15. Right to Express Grievances.

Every Patient has the right to express valid complaints and grievances about the care and

services received and to know the disposition of such complaints.

CHAPTER III

RESEARCH METHODOLOGY

This chapter deals with the methods and procedures utilized by the researchers in

assessing the level of awareness of patients in the service ward regarding their rights. This

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includes the research design, the respondents study, data gathering procedure and

statistical treatment of the data.

RESEARCH DESIGN

This research study utilized the correlational research design. It focuses on the effect

of a potential cause that the researcher cannot manipulate. This research design examines

relationships between variables.

A correlational design is a method where researchers project an interrelationship or

association between two variables, that is, a tendency for variation in one variable to be

related to variation in another. (Polit and Beck 2004)

SAMPLE and SAMPLING TECHNIQUE

The sampling technique used in the study of Level of Awareness on the Magna Carta

of Patients Rights of 2008 is a non-probability sampling. A convenience sampling entails

using the most conveniently available people as study participants. This is the most

commonly used sampling method in many disciplines.

This study involves 170 respondents from the General ward of selected public and

private hospitals who had conformed to the criteria given by the researchers. There are 30

doctors, 40 nurses and 100 patients that are going to be involved in the study.

The following eligibility criteria have been used by the researchers in identifying the

subject of the study.

Inclusion Criteria:

1. Patients admitted in the general ward.

2. Respondents must be of legal age, 18 years old and above.

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3. Those who are conscious and coherent.

4. Patients admitted at least one day prior to survey.

5. Nurses can be a staff nurse/ a volunteer nurse, as long as a graduate of BSN.

Exclusion Criteria:

1. Those who are unconscious and incapable of sound judgement related to

present condition. (Illness and disease).

2. Children and those who are 17 years old and below.

Instrumentation

To be able to gather data, a revised questionnaire that is derived from previous

studies was formulated based upon the specific problem of the study. This instrument was

based on a study conducted to also determine the level of awareness of patients with regard

to the Magna Carta of Patients Right & Obligations of 2004. Continuous revisions have been

done to improve the instrument in order to ensure validity and reliability.

The questionnaire has two parts. The first part consists of the demographic profile of

the respondent which includes age and educational attainment (for patients); age,

educational attainment and length of hospital experience (for doctors and nurses). The

second part will assess the participants level of awareness about their rights. In addition,

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the following scale is utilized (5) Highly aware, (4) Moderately aware, (3) Aware, (2) Slightly

aware and (1) Not aware.

The questionnaire is presented in English Language and is translated into Filipino

language in order to elude communication barrier and for easy comprehension of the

patients ONLY.

Data Gathering Procedure

Phase I Gaining Entry

Step 1 Upon the approval of the researchers adviser, a representative of the group made

a phone call informing the selected public and private hospitals about the proposed study.

Basic information and basic requirement such as communication letter and a copy of the

study were advised via phone call.

Step 2 - After preparing the necessary requirements, a representative personally informed

the chief nurse about the purpose, objectives and goals of the study. A copy of the research

was left at the office of the chief nurse for her to be able to study the content.

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Step 2 - The researchers introduced the study to the respondents who met the eligibility

criteria. The purpose and the content of the questionnaire were thoroughly discussed.

Step 3 - The researchers gave the respondents the formulated questionnaire and asked to

answer it completely and honesty. The researchers guide the respondents who have

questions or experiencing some difficulty in acnswering the given question.

Phase IV- Data Gathering

Step 1 - Sort Similar Data by Using Frequency Distribution

Step 2 - Collection of Hospitalization and Background Specifically on

Patients

2.1 Age


Nurses and Doctors

2.1 Age

2.2. Educational Attainment

2.3 Length of Hospital Experience

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Step 3 - Collection of data regarding level of awareness of the following rights

3.1 Right to Good Quality Health Care and Humane Treatment

3.2 Right to be Informed of His Rights and Obligations as a Patient

3.3 Right to Dignity

3.4 Right to Choose His Physician/ Health Institution

3.5 Right to Informed Consent

3.6 Right to Refuse Diagnostic and Medical Treatment

3.7 Right to Refuse Participation in Medical Research

3.8 Right to Religious Belief and Assistance

3.9 Right To Privacy and Confidentiality

3.10 Right to Disclosure of, and Access to, Information

3.11 Right to Correspondence and to Receive Visitors

3.12 Right to Medical Records

3.13 Right to Health Education

3.14 Right to Leave Against Medical Advise

3.15 Right to Express Grievances

Phase V- Analysis and Interpretation

Step 1 - Analysis and Interpretation of data gathered were done with the help of the

researchers statistician

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Phase VI - Communication Phase

Step 1 - Documentation of all the findings and result into final draft

Step 2 - Communicate the findings in a research defense with the panellist

Phase VII - Utilization of Research Finding

Findings of the study will be a useful guide to ensure safe and quality care among

patients in an institution.

STATISTICAL TREATMENT

After the questionnaires were gathered the answers in each item was tabulated and

organize for the following computation:

Weighted Mean Range Interpretation4.20 5.00 Highly Aware3.40 4.19 Moderately Aware2.60 3.39 Aware1.80 2.59 Slightly Aware1.00 1.79 Unaware

Documents

Nsg. Research Chap. 1 - 3