INSTITUTE OF NURSING Dr. Nicanor Reyes St., Sampaloc, Manila S.Y.

2011 - 2012

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN NURSING RESEARCH

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

MENDOZA, Fahren Joe MENDOZA, Schelma NAGUIT, Anna Mae Paula OCAMPO, Marjorie Ann PAGAPONG, Nicole Irish PARAISO, Aleli PASCUAL, Catherine PATAWARAN, Emmar Son RAMOS, Kristine Nicole TORRALBA, Raesar Jay

PEREZ, John Harvey Group Leader

FAR EASTERN UNIVERSITY Institute of Nursing BSN 217 Group 68 August 13, 2011

Mrs. Amelia Sta. Maria, RN, MAN, PhD Research Adviser

CHAPTER 1

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.)

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 themselves should 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

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 3.2 Highest Educational Attainment 3.3. Length of Hospital Experience

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:

5.1 Age 5.2 Highest Educational Attainment

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 6.3. Length of Hospital Experience

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 7.2 Highest Educational Attainment 7.3. Length of Hospital Experience

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

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

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.

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.

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

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 in Lithuania.

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.The right 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 This right is therefore not respected in practice.

medication, especially poor patients.

(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 real problem 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 13th 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 its constitutents. 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 antipeople, 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 governmentrun 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 5 family 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 3rd 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 4th 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 and societal 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 threat wherever 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 Variable Dependent

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A. Patients
demographic data Age Educational Attainment B. Nurse s demographic data Age Educational Attainment Hospital experience

Level of Awareness on the Magna Carta of Patiens Rights of 2008 among Patients and Health Care Team on Selected Public and Private Hospitals

C. Doctors demographic data Age Educational Attainment Hospital exprience

D. Hospital Private hospital Public hospital

Analysis:

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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 health facility.

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 to choose 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 to the 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 3 - Continuous follow up has been made regarding the approval of conducting the study. Upon assessment, the chief nurse approved the study to be conducted.

Phase II Pilot Testing

Pilot study is a small scale version of trial, done in preparation for the major study. The purpose of the pilot study is not so much to test research hypothesis, but rather to test protocols, data collection instrument, sample recruitment strategies and other aspects of a study in preparation for a larger study. (Polit and Beck, 2004)

The researcher conducts a pilot study on 3 subjects. The participants are handpicked based on the set of eligibility criteria. Questionnaires were distributed.

Through this pilot study, the researchers will able to identify the possible errors and conflict that may occur during the actual implementation.

Phase III - Implementation

Step 1- The researchers informed the staff nurses of the service ward regarding the research implementation.

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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

2.2 Highest Educational Attainment

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 3.11 3.12 3.13 3.14 3.15 Right to Disclosure of, and Access to, Information Right to Correspondence and to Receive Visitors Right to Medical Records Right to Health Education Right to Leave Against Medical Advise 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 4.20 5.00 3.40 4.19 2.60 3.39 1.80 2.59 1.00 1.79

Interpretation Highly Aware Moderately Aware Aware Slightly Aware Unaware

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