Health Science

Communication

Biosci. Biotech. Res. Comm. 10(2): 108-111 (2017)

Awareness and observance of bill of rights among

patients with heart disease

Samiramiss Qavam,

Siros Norozi,

Amir Hosein Salimi,

Milad Borji

* and Asma Tarjoman

Department of Cardiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran

Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran

Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran

ABSTRACT

Advances and developments in medical science have greatly extended the scope of medical interventions in recent

decades, which has raised numerous ethical challenges in this domain. Therefore, the present study investigated levels

of awareness of a patient’s bill of rights and its observance in 2015 in hospitals in the city of Ilam in Iran among

patients with heart disease. In this cross-sectional descriptive study, 200 patients with heart problems admitted to

hospitals in Ilam were recruited using the convenience sampling method. The research instrument was a three-part

questionnaire about a patient’s bill of rights completed using the interview method. The data were analyzed via SPSS

Version 21 with respect to descriptive statistics (means and standard deviations), inferential tests (Pearson’s correla-

tions), and interpreted at a statistical signi cance cutoff of 0.05. Analysis of awareness of a patient’s bill of rights

revealed that 38% (76) had poor awareness, 59.5% (119) had moderate awareness, and  ve participants (5%) had

good awareness. Regarding observance of a patient’s bill of rights, 22% (44) had a poor level of awareness, 34.5%

(69) reported moderate awareness, and 43.5% (69) had high awareness. Moreover, no statistically signi cant differ-

ence was found between the level of awareness of a patient’s bill of rights and its observance. Only a small number

of patients had good levels of awareness of a patient’s bill of rights. Thus, healthcare policymakers must take the

necessary steps regarding patients’ awareness of a patient’s bill of rights.

KEY WORDS: PATIENT’S BILL OF RIGHTS, OBSERVANCE, AWARENESS, HEART PATIENTS

108

ARTICLE INFORMATION:

*Corresponding Author: Borji_milad@yahoo.com

Received 2

April, 2017

Accepted after revision 23

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/10.2/19

Samiramiss Qavam et al.

INTRODUCTION

Patients are one of the most vulnerable groups in a soci-

ety, and they need special attention. In recent decades,

advances and developments in medical science have sig-

ni cantly extended the scope of medical interventions

and provoked many ethical challenges in this domain.

The purpose of a patient’s bill of rights is to defend

human rights to maintain patient sanctity and dignity.

Therefore, observance of a patient’s bill of rights can

establish patients’ beliefs that they will be supported

when they are ill, particularly during medical emergen-

cies, without discrimination regarding race, gender, age,

or  nancial power (Kazemnezhad & Hesamzadeh, 2013,

Karimyar, Hojat, & Karami, 2015).

Respect for patient rights refers to patients’ legiti-

mate expectations of their healthcare system (Özdemir

et al., 2009), A patient’s bill of rights gives every patient

the right to receive private care; ask doctors and other

caregivers for detailed information on diagnoses, treat-

ments, and prognoses; and the right to make necessary

decisions regarding continuation or not of ongoing or

recommended treatment (Kuzu, Ergin, & Zencir, 2006).

Thus, respect for patient choice, use of patients’ physical

and mental potential to make decisions, and not patron-

izing patients are among the provisions of a patient’s

bill of rights (Karimyar, et al., 2015). Despite the devel-

opment and declaration of a patient’s bill of rights in

healthcare centers in Iran and information provided

to patients regarding decision-making, studies have

found that the levels of awareness and observance of

these bills of rights differ globally and in Iran (Jahan-

pour & Rasti, 2014; Mousavi, Yaghobian, & Ranjbar,

2016).

The idea of patients’ rights developed from concepts

about the person as well as the human sanctity and

dignity of all individuals. It also was published in the

global statement on human rights. Thus, understand-

ing patients’ levels of awareness regarding their rights

could provide a picture of the facts and shortcomings of

the situation, which could support important and fun-

damental steps toward promoting the quality of patient

care. Because laws alone cannot imply implementation

and observance of patient rights, and because awareness

of the laws usually precedes their implementation, one

way to ensure that this important issue is addressed is

to understand the bene ciaries’ awareness of their rights

(Ghaljeh, et al., 2015).

Heart disease is one of the most common chronic

illnesses, which is increasing because of population

aging. Therefore, attention to the sanctity and dignity

of patients as a vulnerable societal group is increasingly

important (Borji, et al., 2015 Azami, et al., 2016) .Accord-

ingly, this study investigated the extents of awareness of

a patient’s bill of rights among patients suffering from

heart disease.

MATERIALS AND METHODS

Following previous similar studies (Erer, et al., 2008;

Mousavi, et al., 2016), in 2015, 200 patients diagnosed

with heart disease who were admitted to Shahid Mostafa

Khomeini Hospital in Ilam were recruited. Ilam has the

only center that treats heart disease. The inclusion crite-

ria were: (i) informed consent to participate, (ii) con r-

mation of a heart problem diagnosed by a cardiologist,

(iii) older than 18 years, (iv) no known mental disorders,

(v) ability to orally communicate, and (vi) at least 72

hours of hospitalization in Shahid Mostafa Khomeini

Hospital in Ilam. After con rmation of this study (with a

project code, code of ethics in research, and so on) and

approval obtained from the relevant authorities, I identi-

 ed the eligible participants in the cardiac/coronary care

unit (CCU) and post-CCU for men and women in Sha-

hid Mostafa Khomeini Hospital in Ilam. I completed the

questionnaire for each participant using the interview

method.

The data used in this study were derived from the ques-

tionnaire responses. The questionnaire had three parts. The

 rst part comprised questions on the participants’ demo-

graphic characteristics. The next part comprised 21 ques-

tions about the participants’ attitudes about a patient’s

bill of rights. The items measured the participants’ lev-

els of observing a patient’s bill of rights. To determine

the levels of observing a patient’s bill rights, each situa-

tion was scored 1 = observed patient rights and 0 = did

not observe patient rights. The participants’ total scores

ranged from zero to 21 and were categorized as three lev-

els: undesirable (0–7), moderate (8–14), and high (15–21)

(7, 11). The third part of the questionnaire was a 21-item

scale of awareness of patients’ rights. The following items

were measured: (i) the right to awareness and information

(four items), (ii) the right to choose and make decisions

(two items), (iii) the right to con dentiality and privacy

( ve items), (iv) the right to have respect (three items), (v)

the right to decline treatment and informed consent (three

items), (vi) the right to appropriate care and treatment

(three items), and (vii) the right to object and complain

(one item). The responses were coded 1 = awareness and 0

= no awareness. The  nal scores were classi ed into three

groups: low awareness (0–7), moderate awareness (8–14),

and good awareness (15–21) (Ghaljeh, et al., 2015; Mos-

sadegh Rad & Esna Ashari, 2004).

To observe research ethics, I  rst introduced myself

and explained the study’s objectives. Then, the par-

ticipants were assured that their personal information

would be held in strict con dence and their family

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS AWARENESS AND OBSERVANCE OF BILL OF RIGHTS AMONG PATIENTS WITH HEART DISEASE 109

Samiramiss Qavam et al.

names would not be mentioned. After the interviews, the

data were analyzed using the SPSS Version 21 statistical

package software through descriptive statistics (means

and standard deviations) and inferential tests (Pearson’s

correlation coef cients). Notably, 0.05 was the probabil-

ity cut-off used to determine statistical signi cance.

RESULTS AND DISCUSSION

The results of this study found that 59% (118) of the

participants were male and 41% (82) were female. The

mean age was 62.06 ± 12.19 years. Regarding education,

53.5% (107) was illiterate, 30.5% (61) held degrees below

diploma, and 16% (32) held diplomas or higher degrees.

Moreover, 42.5% (85) had a history of readmissions and

57.5% (115) did not report a history of hospital readmis-

sions. Table 1 shows that the majority of the partici-

pants (59.5%, 119) had a moderate level of awareness

of a patient’s bill of rights and only  ve (2.5%) reported

good levels of awareness.

Table 2 shows that participants’ attitudes regarding

observance of a patient’s bill of rights were moderate

(34.5%) and 87 individuals (43.5%) reported good levels

of observance. The  ndings revealed no statistically sig-

ni cant difference between observing a patient’s bill of

rights and awareness of a patient’s bill of rights.

DISCUSSION

The  ndings of this study demonstrate that the level

of awareness of patients with heart disease regarding

a patient’s bill of rights was low. Along these lines, a

study by Bateni et al. (Bateni, Sajadi, & Hoseini, 2011).

on patients admitted to hospitals in Isfahan found that

more than one-half of the participants were unaware

of a patient’s bill of rights. Hossein Jowzi Arakvazi et

al(Josi Arkvazy, Ashktorab T, AbbasI M, & A., 2011) .in

a study of 60 nurses and 160 patients in the internal

and surgical wards of teaching hospitals af liated with

Ilam University of Medical Sciences, assessed awareness

of a patient’s bill of rights and found that almost one-

half of the sample of nurses (48.3%) was aware of the

provisions of a patient’s bill of rights. However, majority

of the patients (82.5%) were unaware of the content of

a patient’s bill of rights. This study’s  ndings support

these results for patients with heart disease hospitalized

in CCU and post-CCU wards.

Ghiasvandian et al. (Ghiyasvandian & Bolourchifard,

2015) studied patients with cancer and the results sug-

gested that patient information regarding participation

in clinical trials and patients’ prior informed consent

before and after completing informed consent forms

were low. Furthermore, Mousavi et al. (Mousavi, et al.,

2016) .studied patients with cancer and found that the

majority (79%) had never seen a patient’s bill of rights.

Regarding observing patients’ rights, most of the par-

ticipants (98%) reported two cases of low observance:

“getting the contents of a patient’s bill of rights at the

time of admission” and “receiving predictable regula-

tions and costs at the time of admission.” The results of

another study that examined the extent of privacy given

to elderly patients and the extent of satisfaction with

observing their privacy in selected hospitals in Isfahan

found that the average of respect for overall privacy was

“good” in only 16.4% of the cases (Hajbaghery & Chi,

2015). Aghajani et al. (Aghajani & Dehghannayeri, 2009).

assessed different aspects of regarding patients’ privacy

in hospital emergency wards af liated with Tehran Uni-

versity of Medical Sciences. They found that about one-

half of the patients (50.6%) reported that observance of

their privacy was poor or moderate and 49.4% reported

that observance of their privacy was good. Last, Zirak et

al. (Zirak, Ghafourifard, Aghajanloo, & Haririan, 2015)

investigated the extent of observing patient privacy in

admissions to teaching hospitals in Zanjan, found that

most of the patients were unaware of patients’ rights,

and that some personal privacy standards had not been

observed, which was not in line with the results of the

present study.

CONCLUSION

We conclude that observing patients’ rights requires

providing patients and hospital staff with knowledge

about a patient’s bill of rights because results of previ-

Table 1. Distribution of absolute and

relative frequency of awareness of a

patient’s bill of rights

Level of

awareness

Absolute

frequency

Percentage

Poor 76 38.0

Moderate 119 59.5

Good 5 2.5

Total 200 100.0

Table 2. Distribution of absolute and relative

frequency of observing a patient’s bill of rights

Level of

awareness

Absolute

frequency

Percentage

Poor 44 22.0

Moderate 69 34.5

Good 87 43.5

Total 200 100.0

110 AWARENESS AND OBSERVANCE OF BILL OF RIGHTS AMONG PATIENTS WITH HEART DISEASE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Samiramiss Qavam et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS AWARENESS AND OBSERVANCE OF BILL OF RIGHTS AMONG PATIENTS WITH HEART DISEASE 111

ous studies have suggested that there is a statistically

signi cant relationship between the extent of awareness

of a patient’s bill of rights and its observance. (Basiri

Moghadam, Basiri Moghadam, Moslem, Ajam Zibad, &

Jamal, 2011; Mossadegh Rad & Esna Ashari, 2004) It is

important to appoint individuals as supervisors in hospi-

tals for all work shifts to monitor patients’ rights and to

require doctors and nurses to observe the rights of their

patients (Ghaljeh, et al., 2015).

CONFLICT OF INTEREST

The authors declare that there are no con icts of interest

regarding the publication of this article.

FINANCIAL SUPPORT

This study was part of a research project approved by

Ilam University of Medical Sciences, and the authors are

grateful to the relevant university authorities for their

 nancial and moral support.

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