Δικαιώματα των ασθενών εντατικής θεραπείας: στάσεις και απόψεις νοσηλευτών, συγγενών και ασθενών εντατικής θεραπείας και ηθικό αδιέξοδο νοσηλευτών

Abstract

Introduction: Patients’ rights legislation has been introduced in Cyprus since 2005, with the aim of ensuring the level of patients’ care and human rights. Nurses legally and institutionally promote patients’ rights. Intensive care nurses, care for critically ill patients with critical and rapidly disorders and the provision of health care involves many ethical dilemmas and legal liabilities. Aim: The aim of this research is to explore the attitudes and experiences of adult patients, relatives and nurses patients’ rights in intensive care units in Cyprus and associate it with intensive care nurses’ moral distress. Sample and method: This is a descriptive study with cross-sectional comparisons and correlations. The modified scale of Chrysospathi and Papathanassoglou 2011 has been used, in intensive care nurses, patients and their relatives and the Corley Moral distress scale (Hamric and Blackhall 2007) in intensive care nurses. A targeted sampling was used of all intensive care nurses in Cyprus. All public intensive care units were included in the sample and selected private intensive care units. As for the sample of patients and their relatives, a convenience sampling was used, and specifically, sampling of patients hospitalized in Nicosia Intensive Care Unit during the period June to September 2014. Sample consisted intensive care nurses of all public hospitals and selected private hospitals in Cyprus and Nicosia Intensive care patients and their relatives. For the media level comparisons of attitudes t-test was used. Where inequality was held non-sample parametric Kruskall Wallis was used and where was required ANOVA testing was used. Questions correlations of the questionnaires were done with the non-parametric Spearman’s rank – order correlation. In addition, the effect of the total score for patients and relatives and the level of nurses’ frequency of occurrence were investigated using multiple regression. The level of statistical Introduction: Patients’ rights legislation has been introduced in Cyprus since 2005, with the aim of ensuring the level of patients’ care and human rights. Nurses legally and institutionally promote patients’ rights. Intensive care nurses, care for critically ill patients with critical and rapidly disorders and the provision of health care involves many ethical dilemmas and legal liabilities. Aim: The aim of this research is to explore the attitudes and experiences of adult patients, relatives and nurses patients’ rights in intensive care units in Cyprus and associate it with intensive care nurses’ moral distress. Sample and method: This is a descriptive study with cross-sectional comparisons and correlations. The modified scale of Chrysospathi and Papathanassoglou 2011 has been used, in intensive care nurses, patients and their relatives and the Corley Moral distress scale (Hamric and Blackhall 2007) in intensive care nurses. A targeted sampling was used of all intensive care nurses in Cyprus. All public intensive care units were included in the sample and selected private intensive care units. As for the sample of patients and their relatives, a convenience sampling was used, and specifically, sampling of patients hospitalized in Nicosia Intensive Care Unit during the period June to September 2014. Sample consisted intensive care nurses of all public hospitals and selected private hospitals in Cyprus and Nicosia Intensive care patients and their relatives. For the media level comparisons of attitudes t-test was used. Where inequality was held non-sample parametric Kruskall Wallis was used and where was required ANOVA testing was used. Questions correlations of the questionnaires were done with the non-parametric Spearman’s rank – order correlation. In addition, the effect of the total score for patients and relatives and the level of nurses’ frequency of occurrence were investigated using multiple regression. The level of statistical Introduction: Patients’ rights legislation has been introduced in Cyprus since 2005, with the aim of ensuring the level of patients’ care and human rights. Nurses legally and institutionally promote patients’ rights. Intensive care nurses, care for critically ill patients with critical and rapidly disorders and the provision of health care involves many ethical dilemmas and legal liabilities. Aim: The aim of this research is to explore the attitudes and experiences of adult patients, relatives and nurses patients’ rights in intensive care units in Cyprus and associate it with intensive care nurses’ moral distress. Sample and method: This is a descriptive study with cross-sectional comparisons and correlations. The modified scale of Chrysospathi and Papathanassoglou 2011 has been used, in intensive care nurses, patients and their relatives and the Corley Moral distress scale (Hamric and Blackhall 2007) in intensive care nurses. A targeted sampling was used of all intensive care nurses in Cyprus. All public intensive care units were included in the sample and selected private intensive care units. As for the sample of patients and their relatives, a convenience sampling was used, and specifically, sampling of patients hospitalized in Nicosia Intensive Care Unit during the period June to September 2014. Sample consisted intensive care nurses of all public hospitals and selected private hospitals in Cyprus and Nicosia Intensive care patients and their relatives. For the media level comparisons of attitudes t-test was used. Where inequality was held non-sample parametric Kruskall Wallis was used and where was required ANOVA testing was used. Questions correlations of the questionnaires were done with the non-parametric Spearman’s rank – order correlation. In addition, the effect of the total score for patients and relatives and the level of nurses’ frequency of occurrence were investigated using multiple regression. The level of statistical significance was defined as p=0.05. Statistical analysis was performed with the logistic program Statistical Package for Social Sciences (SPSS), v. 21. Results: The sample consisted of 206 intensive care nurses, 136 patients and 136 relatives. The factor analysis of intensive care nurses questionnaire contained five factors. As to the effect of demographic characteristics of intensive care nurses, the factor “attitudes towards patients’ advocacy”, women had higher levels than men (p=0.051). In public hospitals the factor “experience in information of patients/relatives” has higher levels than in private hospitals (p = 0.07). As regards the levels of knowledge of intensive care nurses, the majority is aware of the existence of legislation referred to patients’ rights (82,5%), but they do not know the content of the legislation (61.6%). In addition, the majority (68,8%) is not aware of the existence of the legislation that refer to the nurses code of ethics. The mean value of moral distress of 206 nurses was 106.75+51, 4 with minimum observed 0 and maximum observed 248. The moral distress seems to associate with the “experience in observance of patients’ rights in intensive care units” (r=0.189 p<0.05), and with the “attitudes towards patients’ advocacy” (r=0.257 p<0.01). Nurses’ level satisfaction (scale 1 .. 10) doesn't seem to have any correlation with either the frequency (r =-0.081) either with the intensity of an annoying occurance (r =-0.128 p = 0.23) nor with the total moral distress (r = 0.02). The mean age of patients is 61.2 ± 14.8, while relatives are 51.8 ± 16.3. The majority of patients are men n = 103, (75,7%), in contrast with relatives where the majority are women n = 93 (68.4%). The majority of patients (83,8%) and relatives (81,6%) state that they are not aware of patients’ rights in general. Patients and relatives’ self - assessment in accordance with the level of knowledge regarding patients’ rights on a scale of 0-10 it is in low levels (patients 3,4+3,3 and relatives 3,8 + 3,2). The statements of patients and relatives converge on themes: implementation of legislation, patients’ dignity, confidentiality and information. The differences are in themes of equality and taking action in case of not fulfilment of patients’ rights. The Hierarchical Multiple Regression for nurses’ attitudes showed that nurses in General intensive care units have reduced levels of attitudes in relation to nurses in other intensive units (b=-5.161, p=0.02). In addition, nurses in private hospitals have reduced levels of attitudes in relation to public hospitals (b=-4.766, p=0.06). Nurses in A do not seem to have different attitudes that the rest intensive care nurses (p=0.192). The hierarchical regression of nurses’ level of intensity showed that the level of intensity do not seem to be correlated with the type of the intensive care unit (p=0.59) but it seems that the total score of the scale has a correlation with their intensity (p=0.045). In addition, female nurses have increase intensity at 6,65 on average than men (p=0.05). Additionally, older nurses seem to have reduced levels of intensity moral distress in relation to younger nurses (p=0.047). The levels of intensity of nurses in the A city was lower compared with other cities (p=0.043). Nurses in private hospitals of A city does not differ from the rest nurses in other cities (p=0.207). Conclusion: There is lack of knowledge about the content of the patients’ rights legislation in Cyprus. As regards nurses, there is a need for increase courses in ethical issues and especially patients’ rights. It is obvious that there is lack of knowledge of nurses regarding the legal framework of patients’ rights and the content of it. The enrichment of knowledge on ethical and moral issues should be established as a review course or short courses for active health care professionals. Patients and public must be aware of the existence and content of patients’ rights legislation.