INTRODUCTION:

Nurses play a pivotal role in the healthcare team, being involved in various aspects like clinical care, research and medical education. It is essential for nurses to be aware of the ethical practices for effective patient care. Nowadays, there has been growing public concern regarding the ethical conduct of healthcare professionals. This is often reflected as complaints about poor ethical conduct and an increasing use of litigation against health care practitioners including nurses. These matters have also included ethical issues that faced by nurses such as obtaining informed consent, patient’s confidentiality, autonomy and end of life issues. Many issues regarding unethical behaviour or poor ethical conduct arises due to lack of education about health care ethics.⁷

It is important for nursing students to have knowledge regarding health care ethics which practically applies their critical thinking skills while providing care to the patient. Yet, nursing graduates with less experience are not consistently having knowledge about ethics and lack of critical thinking skills. This lacking is due to their nursing curriculum focusing on the accumulation of knowledge rather than the application of knowledge to real situation.

Education about ethics provide nurses as well as student nurses with tools to reflect critically on their care practice and the application of codes of ethics can also help during their clinical practices. Today, nursing ethics in education has immense competition with an already content filled nursing program regulated by state and national accrediting bodies.⁶

Need for the study:

Nursing profession requires knowledge of ethics to guide performance. Nursing ethics is professional ethics of care. The nature of this profession necessitates ethical care m ore than routine care. Ethical concepts are one of the basic elements in this profession and the important indicator of its patient [6]. Ethics is a systematic study of what person's conduct and actions should be with regard to oneself, other humans, and environment, also refers to principles that guide a person's actions in regard to right and wrong and in regard to society at large. Ethical principles provide a foundation for nursing practice and basis for nurses' decisions on consideration of the consequences and of the universal moral principles when making clinical judgments.²

A study conducted in 2016 by a Supreme Court advocate Mahendra Kumar Bajpai in Nagpur who specialises in medical law, showed a 110 per cent rise in number of medical negligence cases in India every year. The study also revealed that 90 per cent of all cases in medical negligence involve hospitals, and 12 per cent of all the cases decided by consumer courts are on medical negligence. Between 60 to 66 per cent of the filed cases are because of hospitals taking improper consent from relatives before performing certain procedures or switching hospitals, or improper documentation throughout the course of diagnosis and treatment.⁴

A survey by the American Nurses Association (ANA) Centre for Ethics and Human Rights at the ANA Convention in 1994 reported that as high as 79% of their members were confronted with ethical issues on daily to weekly basis. To provide quality care and avoid liability, the nurse needs to be familiar with various consumer rights in health care system. It is vital to know the laws protecting the patient and the health care deliverer in this regard and also to be aware of the legal status as registered nurses.³

The researcher personally experienced few ethical issues during their clinical posting by the nurses as well as nursing students, mostly related to medication errors and showing negligence in some procedures, to avoid such incidences in future, the researcher felt that it needs to be started from the student nurses. So, they may develop more critical thinking and judgement skill to handle the situation.

STATEMENT OF THE PROBLEM:

A descriptive study to assess the knowledge on legal and ethical aspects of nursing among outgoing and final year BSc nursing students at Sacred Heart Nursing College, Madurai.

OBJECTIVES:

The objectives of the study are:

1. Assess the level of knowledge of nursing students regarding legal and ethical aspects of nursing.

2. Determine the association between knowledge regarding legal and ethical aspects of nursing and selected socio demographic variables.

HYPOTHESIS:

H1-There will be significant association between knowledge regarding legal and ethical aspects of nursing and selected socio demographic variables.

REVIEW OF LITERATURE:

A descriptive study conducted by Princy Koshy in Madhya Pradesh on knowledge regarding legal and ethical concepts in care of children among staff nurses. Survey approach, non experimental descriptive research design was used, by non probability randomized sampling technique 100 staff nurses were selected and knowledge was assessed by structured questionnaire. The study revealed that 9% of staff nurses are having poor knowledge, 36% are having average knowledge, 51% are having good knowledge and 4% are having excellent knowledge regarding legal and ethical concepts.⁵

Ashalata Devi, conducted a Cross sectional descriptive study regarding “nurses awareness on legal and ethical responsibilities in nursing among 101 nurses of Manipal Teaching Hospital, Nepal. Out of 101 nurses, maximum (58.4%) of the nurses had inadequate knowledge regarding legal and ethical responsibility in nursing. There was no significant association between the Knowledge score and selected variables like age, education, professional qualification and work experience. The study finding revealed that nurses were lacking knowledge on legal and ethical responsibility in nursing which is one of the most important aspects of nursing practice. There is need to improve the knowledge of the nurses on legal and ethical responsibility so that they can improve their practices and uplift the quality nursing services and effective nursing care that leads to patient’s satisfaction.¹

MATERIALS AND METHODS:

Research Design:

In this study the researcher used a quantitative approach and descriptive design.

Setting:

This study was conducted at Sacred Heart Nursing College, Madurai, Tamilnadu.

Population:

The target population was outgoing and final year BSc nursing students.

Sample:

Outgoing and Final year BSc nursing students.

Sample Size:

Sample size was 80.

Sampling Technique:

The researcher adopted convenience sampling technique.

Tools and Techniques:

The tool consists of following sections

1. Socio Demographic profile:

It consists of five items such as age, gender, previous awareness on ethical aspects and have you attended any conferences.

2. Structured knowledge questionnaire:

It consists of thirty items; all the items were multiple choice questions. Each question has four options, score of 1 was allotted for each correct answer and score zero was allotted for each incorrect answers.

Data collection process:

To conduct research study formal permission was obtained from the college authority and the ethical committee. After accepting the permission the following steps were taken up:

· Step 1-Researchers introduced themselves and explains the purpose of the research study to the subjects.

· Step 2–Administration of Socio Demographic Proforma and Self-structured questionnaire on knowledge regarding legal and ethical aspects of nursing.

· Step 3 - Collection of data.

· Step 4 - Analysis of collected data.

Data Analysis:

Data analysis was done by using descriptive and inferential statistics methods.

RESULTS:

Table 1: Major findings of frequency and Percentage distribution of subjects with regard to selected socio demographic variables (N=80).

Variables	Frequency (f)	(%)
AGE (In years)
18-19	3	3.75
20-21	64	80
22-23	13	16.25
24-25	0	0
GENDER
Male	19	23.75
Female	61	76.25
Have you attended any conference on Legal and ethical aspects of nursing?
Yes	16	20
No	64	80
Had previous awareness on legal and Ethical aspects of nursing?
Yes	64	80
No	16	20

Table 2: Subject wise Frequency and percentage distribution of level of knowledge on legal and ethical aspects of nursing.

Level of knowledge	Score	Frequency (f)	Percentage (%)
Inadequate	0-10	39	48.75
Average	11-20	24	30
Adequate	21-30	17	21.25

Figure 1: Subject wise Frequency and percentage distribution of level of knowledge on legal and ethical aspects of nursing N= 80.

Table 3: Association between the levels of knowledge with their selected socio demographic variables. (N=80).

Demographic character	Above mean	Below mean	Chi square value
Age (in years)
18-21	16	51	1.17# Df=1
22-25	5	8	1.17# Df=1
Gender
Male	5	14	0.015# Df=1
Female	17	44	0.015# Df=1
Previous Awareness
Yes	20	44	4.10*
No	1	15	Df=1

*Significant at 0.05 level # Not significant at 0.05 level

DISCUSSION:

Findings of the present study show that majority of the subjects 48.75% had inadequate knowledge, 30% had average knowledge and 21.25% had adequate knowledge.

Findings of the present study are similar with the study conducted by Thirunavukkarasu M.R and Velmurugan. A, in Kerala aim to assess the knowledge regarding law and ethics in nursing showed that majority of participants 78% had inadequate knowledge, nearly 7% of them had moderate knowledge and only 4% of them had adequate knowledge.⁷

CONCLUSION:

The findings of the study have shown that the knowledge of the students regarding legal and ethical aspects of nursing is average. Hence the study concludes that more importance to be given on legal and ethical aspects of nursing to the future nurses.

REFERENCE:

1. Ashalata Devi, “Nurse’s awareness on legal and ethical responsibilities in nursing”, International Journal of Nursing Research and Practice EISSN 2350-1324; Vol. 4 No. 1 (2017) January-June.

2. Fatma Elemam Hafez,et,al, “Assessment of Nurses” Knowledge and Practice Regarding Professional Ethics in Outpatient Clinics at Mansoura University Hospital”, IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 5, Issue 6 Ver. VII (Nov. - Dec. 2016), PP 20-28.

3. Hepsibha, “Knowledge regarding ethical and legal issues in nursing among staff nurses - A cross-sectional survey”, GJRA Volume-4, Issue-12, Dec-2015 • ISSN No 2277–8160.

4. Mahendra Kumar Bajpai, India Medicaltimes, “110% rise in number of medical negligence cases in India every year”, available from, https://www.indiamedicaltimes.com/2016/11/20/110-rise-in-number-of-medical-negligence-cases-in-india-every-year-study/

5. Princy Koshy, “A Study to Assess the Knowledge Regarding Legal and Ethical Concepts in Care of Children among Staff Nurses in Selected Hospital in MP”, Index Copernicus Value (2013): 6.14 | Impact Factor (2015): 6.391.

6. Solihatul Hafidzah Wan Mohd Annuar. W., et al, “Knowledge and Practice of Nursing Students on Health Care Ethics”, Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online), Sch. J. App. Med. Sci., 2017; 5(9C):3693-3699 ISSN 2347-954X.

7. Thirunavukarasu MR et al. Knowledge regarding law and ethics among nurses at a tertiary care hospital in rural India, International Journal of Community Medicine and Public Health 2018 Sep;5(9):3882-3886. https://www.indiamedicaltimes.com/2016/05/25/98000-people-lose-their-lives-because-of-medical-negligence/ extra.

Received on 03.11.2019 Modified on 29.11.2019

Int. J. Nur. Edu. and Research. 2020; 8(1): 105-108.

DOI: 10.5958/2454-2660.2020.00022.8