“A Study to Assess the Knowledge Regarding Legal and Ethical Concepts in Nursing Care of Children Among Staff Nurses in Selected Hospitals at Tumkur with a View to Provide an Information Booklet”

Introduction

Children are perceived as the happiness of the family. They satisfy parent’s emotional, psychological, social and spiritual needs. They prevent loneliness and boredom and provide affection. Children prolong the parent’s existence into future. They enliven the family life. Practitioners in healthcare delivery have to adhere to a set of ethical principles that guides professional practice and decision making. These principles are common to all the professions in healthcare. The ethical principles that are autonomy, beneficence, non-maleficence, justice, fidelity etc, are generally accepted by all the members of a profession. A profession’s ethical code states about the groups of expectations, and standards of behavior.

Ethics and law are necessary in nursing because nursing is concerned with providing services that impact human life and health and some of the situations the nurse encounters in practice pose dilemma that if not well handled, may impact negatively on the client and all who are concerned.⁴ The first step in preventing entanglement in legal issues is awareness of the law.  

A neonatal nurse is a professional with special training, skills, and knowledge in the care of newborns and their families. The neonatal nurse is accountable to the patient, profession, and the employer. Failure of the neonatal nurse to meet these obligations can result in liability in the profession, liability in the employment, a civil suit, or a criminal conviction. Regardless of the healthcare setting, professional nurses, whether at the bedside or in advanced practice, are morally, ethically, and legally accountable for their nursing judgments and actions. Although most nurses assume they will never be named in a lawsuit, and it is true that few are, their professional actions can be the focus of a suit. An overview of the legal implications found within neonatal nursing practice is presented. Two recent legal cases are presented and discussed to illustrate neonatal nursing and advanced practice liability.

Problem statement

“A study to assess the knowledge regarding legal and ethical concepts in nursing care of children among staff nurses in selected hospitals at Tumkur, with a view to provide an information booklet.” 

Objectives of the Study

•   To assess the knowledge regarding legal and ethical issues among staff nurses. 
•  To determine the association between the knowledge of staff nurses with selected demographic variables. 
•  To prepare an information booklet regarding legal and ethical concepts in nursing care of children. 

Methodology

Research approach: Descriptive survey approach

Study design: Descriptive research design was applied.

Sampling technique: Non-probability convenient sampling technique

Sample size: A sample of 100 staff nurses who met the inclusion criteria.

Tool: The instrument used for the data collection was a self- administered, structured, knowledge questionnaire.

Part-I - Socio-Demographic profile

Investigator constructed the tool to collect the sociodemographic data of the study subjects. It consisted of demographic variables.

Part-II 

•  Section A: It consisted of 15 multiple choice questions related to legal and ethical concepts in nursing care of children 
• Section B: It consisted of 12 multiple choice questions related to elements of informed consent and confidentiality in nursing practice. 
• Section C: It consisted of 15 multiple choice questions related to measures for prevention of medico-legal issues and professional malpractice. 

Results

“Success is a science; if you have the conditions, you get the result” - Oscar Wilde

Analysis is defined as categorizing, ordering, manipulating and summarizing of data and reducing it to intelligible and interpretable form, so that research problem can be studied and tested including relationship between variables.

This chapter deals with the analysis and interpretation of data obtained from 100 subjects to assess the knowledge regarding legal and ethical concepts in nursing care of children. Descriptive and inferential statistics such as mean, median, standard deviation, percentage, chisquare test were used to analyze the collected data.

Section I: Description of the demographic variables of the staff nurses.

Section II: Assessment of the knowledge of legal and ethical concepts in nursing care of children.

Section III: Association between the knowledge regarding the legal and ethical concepts with selected demographical variables. 

Section - I:

Description of Demographic Variables

This part deals with data pertaining to the demographic profile of the respondents in terms of frequency and percentage.

Statistical Techniques with Formulas:

Section I: Description of Sample Characteristics

Table 2.1 shows the age distribution of staff nurses who had participated in the study. Twenty eight nurses were in the age group of 21-25 yrs. Thirty five nurses were in the age group of 26-30yrs, 37 nurses were in the age group of above 30 years. Maximum participants were from the age group of above 30 years and the least number of participants were in the age group of 21-25 years.

In table 2.2, the pie diagram shows the gender of participants in the study. About 30 male nurses and 70 female nurses participated in the present research study.

The above cylindrical diagram depicts professional qualification distribution of staff nurses. Forty-seven staff nurses were GNM holders. Twenty-eight staff nurses were post B.Sc nursing degree holders, while the remaining 25 were basic B.Sc nursing candidates. None of the staff nurses had any other certified degrees.

The above bar diagram represents working area distribution of staff nurses. Forty staff nurses were working in the medical wards, 19 staff nurses were working in Intensive Care Unit, 31 staff nurses were working in surgical ward and remaining 10 staff nurses working in operation theatre and causality were included in the study

The above diagram represents the professional experience distribution of staff nurses. Nine staff nurses had less than 2 years of experience, 19 staff nurses had 2-4 years of experience, while the remaining 22 staff nurses had more than four years of experience.

Above drawn table shows that 70% of staff nurses were residing in the urban area and the rest (30%) were residing in rural area.

The above conical diagram depicts the working hospital distribution of staff nurses. Twenty staff nurses included in the study were from Govt. District hospital, Tumkur, while the remaining 25 staff nurses were from Shridevi hospital, Tumkur.

Fifty of the hundred subjects had no prior in-service education, but a mere 50 attended in-service programs related to legal and ethical concepts in nursing care of children.

Table 2.9 shows that majority of the subjects acquired information regarding legal and ethical concepts in nursing care of children from pediatrician [42(42%)]. Twenty-eight (28%) received information from health workers, 16 (16%) and 14(14%) subjects received information from journals and mass media respectively.

Section I

Assessment of Knowledge of Subjects Regarding Legal and Ethical Concepts in Nursing Care of Children

The above table shows the level of knowledge of the subjects regarding legal and ethical concepts in nursing care of children. As per the table, knowledge of the staff nurses regarding legal and ethical concepts was mean 8.66, standard deviation 1.464 and mean percentage score was 57.73%, where a maximum possible score was 15. Considering legal and ethical concepts, the mean was 6.9, standard deviation 1.3, and mean percentage score 57.75%, where the maximum possible score was 12. Considering the section c, mean was 8.54, standard deviation 1.329, and mean % score was 56.93%, where the maximum score was 15. The overall score displayed mean 23.85, SD of 2.272, and a mean score percentage of 23.85%, where the maximum possible score was 42.

Section-II

Frequency and percentage distribution of samples based on level of knowledge regarding legal and ethical concepts in nursing care of children 

The above table shows the frequency and percentage distribution of samples based on level of knowledge regarding legal and ethical concepts in nursing care of children. The results showed that out of all 100 subjects, 12 (12%) subjects had adequate knowledge, 80 (80%) subjects had moderate knowledge and only 08 (8%) subjects had inadequate knowledge.

Section III

Frequency and percentage distribution of samples based on level of knowledge regarding legal and ethical concepts in nursing care of children

From the above table 11, professional qualification and working hospital had a significant influence on the knowledge scores of staff nurses on legal and ethical concepts in nursing care of children. The remaining characters i.e. age, gender, professional experience, present working area, area of permanent residence, inservice education and source of information were not significantly associated with the knowledge scores of staff nurses.

Discussion

This chapter presents the major findings of the study and reviews them in relation to the findings from other studies.

The discussion brings the research report to closure. A well-developed discussion section “makes sense” of the research results. This is the most important section of research report.

The findings of the study have been discussed with reference to the objectives and hypothesis stated in the information and findings of other studies.

The present study evaluated the knowledge regarding legal and ethical concepts in nursing care of children among staff nurses in selected hospitals in Tumkur. This study was descriptive in nature. A total of 100 staff nurses were selected by using non-probability convenient sampling technique from selected hospitals, Tumkur. After the selection of sample, the structured questionnaire method was used with the help of instrument. The data findings have been organized and discussed under the following sections.

Findings

“A study to assess the knowledge regarding legal and ethical concepts in nursing care of children among staff nurses in selected hospitals at Tumkur, with a view to provide an information booklet” which are discussed below: 

It is a descriptive research design, which was conducted by including 100 staff nurses who met the inclusion criteria by non-probability convenient sampling and knowledge was assessed using a structured knowledge questionnaire.

The first objective of the study was to assess the knowledge of staff nurses regarding legal and ethical concepts in nursing care of children. The knowledge scores of staff nurses regarding legal and ethical concepts in nursing care of children were determined with mean percentage score 56.78%. It showed that the staff nurses had moderate knowledge regarding legal and ethical concepts in nursing care of children.

The second objective of the study was to find out the association between demographic variables with knowledge scores of legal and ethical concepts in nursing care of children. The present study found that the calculated chi-square value for association of knowledge with selected demographic variables like age, gender, professional qualification, professional experience, present working area, area of residence, working hospital, in service education and source of information was found to be significant.

The chi-square test value revealed that there was a significant association of knowledge of staff nurses with selected demographic variables regarding legal and ethical concepts in nursing care of children.

The third objective of this study was to develop an information booklet regarding legal and ethical concepts in nursing care of children. After collecting the information from the participants, information booklet was distributed and they were satisfied. 

The findings of the present are in accordance with the study conducted to determine the role of the pediatric nurse in promoting pediatric right to consent. The study examined the process involved in obtaining informed consent, focusing on the information booklet of staff nurses’ abilities and legalities related to a child’s right to consent. Most they who have researched when a child may be considered competent to given a valid consent propose that the child must be 14 years old and thus able to think abstractly and consider the risks and benefits of the planned treatment. Qualitative research on this topic revealed that a child’s previous life experiences can influence their ability to comprehend the intervention. This suggests that children less than 14 years of age may be regarded as competent. The confusion around the prevailing legal situation was examined. The study concluded that role of the pediatric nurse is explored to distinguish areas in which the nurse could potentially make a contribution to the process of gaining consent from children. The pediatric nurse’s role as an assessor, educator and evaluator were identified.

Conclusion

The study findings revealed that the knowledge levels of the staff nurses were determined with mean of 23.85 and standard deviation of 2.272. The mean percentage score was computed and it was observed as 56.78%. The results showed that female staff nurses had moderate knowledge regarding legal and ethical concepts in nursing care of children.

The chi-square test values revealed that there was a significant association between post knowledge test scores of the staff nurses and the selected demographic variables regarding legal and ethical concepts in nursing care of children. Hence, hypothesis H₂ was accepted.

Since majority of the staff nurses had moderate knowledge regarding legal and ethical concepts in nursing care of children, education is very essential for their proper decision making and healthy baby in their future.

The information booklet was distributed to the staff nurses which was aimed to provide knowledge to the staff nurses, thereby enabling them to take a correct decision by planning their and having a healthy baby in their future.