Iran Journal of Nursing

Introduction
Observance of patient rights is a necessity for nurses, and it plays a very important role in patient satisfaction and health. An efficient health system requires active participation and proper interaction between patients and healthcare providers. Sometimes, despite all the efforts and education, these rights are not respected. Also, due to the different knowledge and attitudes of nurses and the ignorance and unfamiliarity of patients and their companions with patient rights, there is a difference in the level of observance from the perspective of nurses and patients. Observance of patient rights in the emergency department (ED) is more important due to special conditions and the urgency of referrals. With this in mind, this study aimed to determine and compare the rate of the observance of patient rights from the perspective of nurses and patients referred to the EDs of selected hospitals in Golestan province, northern Iran.

Materials & Methods
This descriptive cross-sectional study was performed in 2020 on 185 nurses and 370 patients referred to the EDs of hospitals in Golestan province, including Panje Azar, Taleghani, Shahid Sayad Shirazi, Shahid Motahari, and Shohada. The sampling method for patients was a convenience method, and a purposive method was used for selecting nurses. Inclusion criteria for nurses were at least a bachelor’s degree and at least one year of clinical experience in the EDs. It was also important for patients and their companions to be literate and alert. Patients with moderate to severe pain, mental health problems, and depression, as well as patients who had spent less than 24 hours in the hospital, were excluded from the study. 
To collect information, two questionnaires were used, including (a) a demographic checklist surveying age, sex, marital status, educational level, occupation, economic status, religion, and place of residence; (b) a questionnaire based on five patients’ rights charters including the right to: receive appropriate service, access desired and enough information, choose and decide freely about receiving health services, privacy, and access to an efficient system of dealing with complaints. It also had nine dimensions: politeness, justice, responsibility and accountability, priority of patients’ comfort, quality of services, priority of patient’s interest, access to information, and the right to choose and decide freely. Data were collected through interviews and took about 20-30 minutes, depending on the sample. 
The validity of the questionnaires was confirmed by experts in patients’ rights (five professors from the Faculty of Nursing, Iran University of Medical Sciences). To assess the reliability of the patients’ rights questionnaire, the split-half method was used, and Cronbach’s alpha coefficient for its internal consistency was obtained as 0.83. Data analysis was performed using the Kolmogorov-Smirnov test, independent t-test, and Mann-Whitney U test in SPSS software, version 16. The significance level was set at 0.05.

Results
The majority of nurses were 25-35 years old, male, married, and local residents with 4-6 years of work experience. The clients were mostly 25-35 years old, female, married, and local residents with moderate economic status. 
From the nurses’ point of view, treating patients politely had the highest mean (79.48±12.86), while the patient’s right to choose and decide freely had the lowest mean (42.71±8.04). The total score of the patient rights scale for nurses was 264.64±20.89 (or 67.58±7.25 based on percentage). From the patients’ point of view, treating patients politely also had the highest mean (78.62±12.95), and the right to choose and decide freely had the lowest mean (41.97±9.63). The total score of the patient’s rights scale for patients was 262.09±27.43 (66.70±9.52 based on percentage). The rate of observance of the patients’ rights chapters perceived by nurses was higher than that perceived by patients (75.6% with a mean of 3.72±0.29 vs. 74.88% with a mean of 3.80±0.17), but there was no statistically significant difference (P=0.31), except for the domain of “priority of patients’ comfort” (P=0.04), where the mean score based on the nurses’ point of view was significantly higher.

Conclusion 
The level of the observance of patient rights by ED nurses in Golestan province is moderate to high from the perspective of both clients and nurses. This is an important and appropriate outcome that should be maintained. More attention to the domains that received lower scores is necessary to be at a proper and desired level from the patients’ perspective. There was homogeneity between the perceptions of nurses and clients, especially patients, regarding ED nurses’ observance of patients’ rights. This indicates that patients are satisfied with the nurses’ attempts to observe the patient rights. However, it is necessary for hospital officials to provide a suitable environment for patients to be aware of their rights and to implement the laws related to the observance of patients’ rights by ED personnel.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC,1398.829). The information of the participants was kept confidential, and they were free to leave the study at any time.

Funding
This article was extracted from the master’s thesis of Asiyeh Soleimani, funded by  Iran University of Medical Sciences, Iran. 

Authors' contributions
Data collection and writing: Asieh Soleimani; supervision and project administration: Zahra Kashaninia; statistical analysis: Shima Haghani; Review: All authors.

Conflict of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors would like to thank the Deputy for Research of the School of Nursing and Midwifery, Iran University of Medical Sciences, as well as the officials of selected hospitals in Golestan province, and all the nurses who participated in this study for their support and cooperation.

 

References

1. Gholami M, Khojastefar M, Moravej H, Kavosi Z. Evaluation of patients’ expectations and observation of their rights in the emergency department of Nemazee Hospital during 2015. Iran J Med Ethics Hist Med. 2016; 9(1):50-62. [Link]
2. Nasr Esfahani M, Attari Moghadam J. [Development of the draft of law (mental health act) (Persian)]. Iran J Psychiatry Clin Psychol. 2017; 23(1):50-67. [DOI:10.18869/nirp.ijpcp.23.1.50]
3. Hadian Jazi Z, Dehghan Nayeri N. [Barriers in the performance of patient’s rights in Iran and appropriate offered solutions review article (Persian)]. J Holistic Nurs Midwifery. 2014; 24(4):69-79. [Link]
4. Parsapoor A, Bagheri A, Larijani B. [Review of revolution of patient’s right charter (Persian)]. Iran J Med Ethics Hist Med. 2010; 3(1, 2):39-47. [Link]
5. Nikbakhtnasrabdi A, Bozorgzad P, Yekaninejhad M, Jafarloo A, Rahmati M. [Effect of nursing ethics workshop on the rights of patients in the emergency department (Persian)]. Iran J Cardiovasc Nurs. 2015; 4(3):6-15. [Link]
6. Mokhtari L, Khorami Markani A. [Perspective of patients and their relatives about the patients’ rights in the hospitals of Khoy University of Medical Sciences (Persian)]. Sci J Nurs Midwifery Param Fac. 2017; 3(1):73-82. [DOI:10.29252/sjnmp.3.1.73]
7. Akbari L, Bagheri M, Baghersad Z, Aseman Rafaat N. [Evaluation of the observance of patients’ rights in the selected hospitals of Isfahan University of Medical Sciences (Persian)]. Med Law J. 2015; 9(33):175-96. [Link]
8. Chatruz A, Javadinasab H, Amini MK, Biglar M, Goudarzi N, Javad J. [A comparison of the cost of global surgery bills with approved tariffs in hospitals affiliated to Tehran University of Medical Sciences (Persian)]. J Payavard Salamat. 2015; 9(1):67-80. [Link]
9. Kaplan A, Kaçmaz HY, Öztürk S. An evaluation on the attitude toward using patient rights and satisfaction levels in emergency department patients. J Emerg Nurs. 2024; 50(2):243-53. [PMID]
10. MacIsaac M, Peter E. Emergency department crowding: An examination of older adults and vulnerability. Nurs Ethics. 2024; 9697330241238333. [DOI:10.1177/09697330241238333] [PMID]
11. Azizi M, hashemi B, barati H, barati M, vakili M. [The assessment of observing patients’ right and its Necessity from View of Nurses in educational hospitals of Yazd, 2014 (Persian)]. J Nurse Physician War. 2016; 10(4):36-43. [Link]
12. Demirsoy N, Kirimlioglu N. Protection of privacy and confidentiality as a patient right: Physicians’ and nurses’ viewpoints. Biomed Res. 2016; 27(4):1437-48. [Link]
13. Clark R. Australian Patient Safety Survey: Final Report to the Commonwealth Department of Health and Aged Care. Canberra: Australia Commonwealth of Australia; 2001. [Link]
14. Ricci-Cabello I, Pons-Vigués M, Berenguera A, Pujol-Ribera E, Slight SP, Valderas JM. Patients’ perceptions and experiences of patient safety in primary care in England. Fam Pract. 2016; 33(5):535-42. [DOI:10.1093/fampra/cmw046] [PMID]
15. King D, Zaman S, Zaman SS, Kahlon GK, Naik A, Jessel AS, et al. Identifying quality indicators used by patients to choose secondary health care providers: A mixed methods approach. JMIR Mhealth Uhealth. 2015; 3(2):e65. [DOI:10.2196/mhealth.3808] [PMID] 
16. Sheikhbardsiri H, Abdar ZE, Sheikhasadi H, Mahani SA, Sarani A. Observance of patients’ rights in emergency department of educational hospitals in south-east Iran. Int J Hum Rights Healthc. 2020; 13(5):435-44. [DOI:10.1108/IJHRH-09-2019-0072]
17. Jabraeily M, Safdari R, Rahimi B, Ghasemzadeh N, Ghasemi F, Tymori M. [The perception of hospital inpatients from current status of observance about patients rights (Persian)]. J Urmia Nurs Midwifery Fac. 2013; 11(3):219-24. [Link]
18. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14:135. [DOI:10.1186/1471-2288-14-135] [PMID] 
19. Roudirashtabadi O, Borhani F, Abbaszadeh A. [Nurse’ knowledge of patients’ bill of rights, level of observation and determining effective factors on them from their viewpoints in Kerman University Hospitals (Persian)]. Tārīkh-i pizishkī. 2013; 5(17):37-62. [DOI:10.22037/mhj.v5i17.5795]
20. Joziarkavazi H, Ashktorab T, Abbasi M, Delpisheh A, Mennati R, Shahmir L. [Investigating the organizational factors related to the observance of patients’ rights from the perspective of nurses and patients in hospitals affiliated to Ilam University of Medical Sciences (Persian)]. J Med Hist. 2013; 7(23):141-60. [Link]
21. Vahedian Azimi A, Ghasem Kashani S, Avazeh A, Sepehri Nia M, Rohani M. [Awareness of nurses about patients’ rights and the extent they respect it (Persian)]. Prev Care Nurs Midwifery J. 2011; 1(1):55-63. [Link]
22. Rezaeian S, Noorossana R, Saghaei A, .Karimzadeh Y, Moradi S. [ Measuring Service Quality in Emergency department Based on patient rights: A cross sectional study from Iran. J Med Ethics. 2017; 7(23):161-85. [Link]
23. Tabatabaie SS, Sharifi T, Ghorbaninia R, Amiresmaeili M, Moghaddam M. [Awareness of Patients’ rights charter and respecting it from the perspective of patients and nurses: A study of limited surgical centers in Kerman city, 2013 (Persian)]. Bioethics J. 2016; 4(11):31-56. [Link]
24. Dehghan M, Mehdipour-Rabori R, Rayani M, Zakeri MA, Mobasher M, Iranmanesh M, et al. Comparison of the importance and observance of the patient’s bill of rights from the perspectives of patients and personnel of hospitals in Kerman. J Med Ethics Hist Med. 2020; 13:5. [DOI:10.18502/jmehm.v13i5.4070] [PMID]
25. Mohammed SA, Shabla AS, Wehieda SM. Patients’ Rights: Patients’ and Nurses’ Perspectives. J Nurs Health Sci. 2015; 4(4):54-60. [Link]
26. Parsapoor A, Mohammad K, Malekafzali H, Aalaedini F, Larijani B. [Regarding patients’ right in Tehran University of Medical Sciences Hospitals (Persian)]. Iran J Med Ethics Hist Med. 2009; 3(1):53-64. [Link]
27. Kazemnezhad SM, Hesamzadeh A. Implementation of patients’ bills of rights by physicians and nurses from their colleagues’ points of view in educational hospitals of Mazandaran university of medical sciences. J Mazandaran Univ Med Sci. 2013; 22(97):216-23. [Link]