INTRODUCTION:

Without man the world is not complete, in the same way without law the man is not complete. When the man becomes gradually civilized, he accepts the mutual relationship with others. Such mutual relations are seen within the society.

The society consists of so many individuals and there are needs desired by them. These needs arise by virtue of customs, norms or morals to be fulfilled or through the just demands placed in a right way. Each country has its own laws. Laws of no two countries are alike. The law is rooted in traditions, culture, customs and beliefs. Law is a system of principles and processes by which people in a society deal with their disputes and problems, seeking to solve or settle them without resorting to force. In other terms laws are general rules of conduct that are enforced by government, which imposes penalties when prescribed laws are violated

Nurses today are acutely aware of the need to understand the legal environment in which they practice .Ever shrinking resources, shorter lengths to stay, high-acuity patients, the availability of more complex information, and the use of technology means the nurses must understand the legal rights inherent to us by their practice. These legal aspects include the legal environment, regulation of nursing practice, standards of care, prevention of malpractice, professional liability, insurance and issues related to nurses as witness and when refusing an assignment.

Nurses constitute the largest workforce of professionals working in any health care setting. Their presence in the health care system plays a vital role and helps in the speedy recovery of the patients from their illness. In the recent times, legal liability and accountability of professional nursing conduct has emerged as an urgent concern, and the practicing nurses face legal issues very often. These issues may be in connection to negligence in conduct and advocating for the patient. If these duties and regulations are not followed and a positive attitude is not developed, the nurse is at risk of losing his/her license and facing a malpractice suit.

It differentiates nursing attitude and practice from that of other health care professions and describes and protects the rights of clients as well as nurses. For these reasons, the nurses should have an understanding of the basic legal concepts as they relate to nursing practice. The role of professional nurse has changed in a pragmatic sense from that of the legal dependency to legal accountability. All citizens must be aware of their legally defined duties and rights and should have an understanding of the law which governs their professional and personal lives. First legal responsibility of every citizen, and thus of a nurse is to perform his / her duties ethically. Ignorance of law is not accepted as an excuse for violation of law. As in all branches of medicine and surgery, a patient who feels that he/she has suffered harm as a result of professional negligence can sue for damage in respect of injury sustained.

A nurse working as per the professional standards can avert many of the risks and legal suits. Nurses must know the law that governs her profession to avoid law suits against her. The knowledge of legal responsibilities is integral with the expanding clinical role, and a logical application of the planned, systematic and focused care, which should be the goal of modern nursing^I

MATERIALS AND METHODS:

The Research design selected for this study was one group pre test post test design,

OK₁- OA₁ – X -Ok₂ -OA₂

OK₁- Represents the knowledge test scores of staff nurses on legal responsibilities before providing information booklet.

OA₁- Represents attitude score of staff nurses on legal responsibilities before providing information booklet.

X- Represents the treatment with information booklet on legal responsibilities of staff nurses.

OK2- Represents the knowledge test of staff nurses on legal responsibilities after providing information booklet.

OA2- Represents attitude test of staff nurses on legal responsibilities after providing information booklet.

Table-1: One group pre-test post –test design

Group

Day -1

Day -7

PRE –TEST

TREATMENT

POST-TEST

Staff nurses working in Medical and surgical Units.

Knowledge test

Attitude test.

Introduction of information booklet on legal responsibilities of staff nurses.

Knowledge test

Attitude test

SAMPLE AND SAMPLING TECHNIQUES:

Simple Random Sampling Technique was used to draw the sample. The sample for the present study comprised of staff nurses working in Medical and surgical units selected hospital of J&K.

SAMPLE SIZE:

Total sample size for the present study is 50 staff nurses from Sher-e-Kashmir Institute of Medical Sciences (SKIMS) Srinagar.

DATA COLLECTION TOOLS AND TECHNIQUES

Based on objectives and conceptual framework of the study, the following tools were developed in order to obtain required information.

Structured knowledge questionnaire was prepared to assess the knowledge of staff nurses before and after the administration of information booklet.

5-point Likert Scale Attitude questionnaire was developed to assess the attitude of staff nurses before and after the administration of information booklet.

DEVELOPMENT OF INFORMATION BOOKLET

The content of information booklet was organized under the following subheadings:

· Introduction

· What is Law?

· Tort

· Negligence

· Malpractice

· Standard of care

· Nursing code of ethics

· Legal safe guard

· Guides for legal responsibility

· Legal responsibilities of the registered Nurse

· Glossary.

CONTENT VALIDITY OF THE TOOL:

The tools i.e. knowledge questionnaire and likert scale attitude questionnaire along with the information booklet were submitted to nine experts. The experts were from various specialty areas with seven experts from nursing service, and an Advocate and one from medical side. Comments and suggestions were incorporated and the suggested modification for the items was made to prepare the final draft of the tools.

CONTENT VALIDITY OF THE INFORMATION BOOKLET:

A checklist was prepared to evaluate the validity of the information booklet. The checklist consisted of nine items with three point rating scale viz. ‘fully met’, ‘partially met’ and ‘not met at all’. Against each criterion column of remarks was also made. Criteria for the evaluation of general features of booklet were also prepared.

RELIABILITY OF TOOL:

The reliability of the tool was established by Kudar Richardson 20 and the value was found to be 0.75.

5-point likert scale attitude questionnaire having 42 items attitude were administered to staff nurse in order to establish the reliability of the attitude questionnaire and the reliability established by test-retest and reliability was found to be 0.85.

PILOT STUDY:

On the first day knowledge and attitude pre-test was done on the staff nurses followed by the administration of Information booklet on legal responsibility. On the seventh day, knowledge and attitude post test was conducted.

DATA COLLECTION PROCEDURE:

On the first day, knowledge and attitude pretest was conducted. Information booklet was given on the same day. On the seventh day, knowledge and attitude post test was conducted.

Table-2: Frequency and percentage distribution of staff nurses by demographic characteristics n=50

S.no.

Socio-demographic variables

Frequency

Percentage (%)

Age (in years)

20-30

31-40

Above 40

Gender

Male

Female

100

Marital status

Married

Unmarried

Professional qualification

GNM

Post-basic B.Sc Nsg.

B.Sc Nursing

Clinical experience(years)

2-5

6-10

11-15

In-service education programme attended, if any

Yes

The data presented in Table 2 reveals that:

· Majority of staff nurses 37(74%) were in the age group of 31-40 years, followed by 13 (26%) in the age group of 31-40 years.

· All the study subjects 50(100%) were females.

· Majority of study subjects 44 (88%) were married and only 6(12%) were unmarried.

· Majority of the subject‘s 23 (46%) were GNM. and 22 (44%) were post basic B Sc and only 5 (10%) were basic B Sc nursing.

· Majority of staff nurses 44 (88%) had a working experience of l1-15 years whereas 4 (8%) staff nurses had 6-10 years and 2( 4%) has more than 15 years of clinical experience in field of nursing.

· Majority of the study subjects 40 (80%) had attended in-service programme and only 10 (20%) has not attended any in-service education programme.

Table-3: Mean, Mean difference, standard deviation, of pre test and post test knowledge scores of staff nurses n=50

Knowledge score

Range of obtained score

Mean

Mean difference

Median

S.D

Pre –test

3-50

21.16

13.32

4.032

Post-Test

35-50

34.48

3.558

Maximum possible score: 39

The data in the Table-3 indicates that the mean post test knowledge scores of staff nurses (34.48) was higher than their median pre test knowledge scores ( 21.16) .It is observed that all the subjects achieved higher scores in the post –test (34.48) than in the pre-test (21.16) suggesting the information booklet was effective in increasing the knowledge of each subject. It was found that the post test scores were homogenous (S.D= 3.558) than the pre test scores (S.D=4.032).It suggests that information booklet was effective in enhancing the knowledge of staff nurses. The data in table 2 shows that the knowledge, pre-test range of obtained score is 3-50, its mean 21.16 and mean difference 13.32, and standard deviation 4.032 score .The post- test range of obtained score 35-50 score, mean 34.48, mean difference 13.32, median 35 and standard deviation 3.558 .The standard deviation of post test is 3.558 which is less than pre test indicating that the group is now more homogenous with the mean and median increasing from 21.16 to 34.48. This shows an increase in the knowledge of the group.

Table-4: Mean, mean difference, and‘t’ value of knowledge scores of staff nurses n=50

Knowledge test

Mean ±S.D

Mean Difference

‘t’ value

‘p’ value

Pre-test

21.16

13.23

16.120

<0.001*

Post-test

34.48

*Significant at 1% level of significance.

The data presented in Table 4 indicates that, the information booklet on legal responsibilities of nurses was effective for increasing the knowledge of staff nurse

Table- 5: Mean, Mean difference, standard deviation, of pre test and post test attitude scores of staff nurses n=50

Attitude score

Range of obtained score

Mean

Mean difference

Median

S.D

Pre –test

111-171

150.44

35.66

155

14.46

Post-Test

171-210

186.10

184.00

13.46

Maximum possible score = 210

The Table 5 reveals that the mean post test attitude scores of staff nurses (186.10) was higher than their mean pre test attitude scores (150.44).

Table-6: Level of attitude scores of Staff Nurses Regarding Legal responsibilities. n =50

Various areas in nursing practice	Level of score
Various areas in nursing practice	Pretest attitude	Post test attitude
Legal issues and responsibilities	Inadequate	Adequate
Rights of the client.	Inadequate	Adequate
Malpractice	Inadequate	Adequate
Informed consent for procedure and Surgery	Inadequate	Adequate
Administration of medication	Adequate	Adequate
Documentation.	Adequate	Adequate
Confidentiality	Inadequate	Adequate

Maximum possible Scores = 210

Adequate Score ≥ 70%

Inadequate Score < 70%

The Data presented in Table 6 reveals that the booklet was effective in increasing the level of attitude in the Staff nurses.

Table-7: Fishers Exact Test between Pre-Test Knowledge Scores of the staff nurses and their Selected Factors n=50

S.No	Selected Variables	Knowledge scores				*‘p’* value
		Adequate		Inadequate
		Frequency	percent-age	Frequency	percent-age
1	Age 21-30years	0	(0%)	0	(0%)	<0.001
	31-40 years	02	(5.4%)	35	(96.6%)
	Above 40 years	01	(7.7%)	12	(92.3%)
	Total	3	94.0%	47	6.0%
2	Professional Education GNM	02	8.7%	21	91.3%	<0.001
	Post-basic BSc Nursing	01	4.5%	21	95.5%
	BSc Nursing	00	0.0%	05	100%
	Total	03	06%	47	94%
3	Clinical Experience 2- 5 years	00	0.0%	00	0.0%	<0.001
	5-10years	00	0.0%	4	100%
	10-15 years	3	6.8%	41	93.2%
	Above 15 years	0	0.0%	2	100%
	Total	3	6%	47	94%

Insignificant at 0.05 level of significance p<0.001. Maximum Possible scores =50

The data given in the Table 7 shows the computed Fishers Exact value between pre test knowledge scores and age ,clinical experience, and professional qualification the ‘p’ value was found to be 1.000 which

is higher than 0.05 level of significance hence, statistically not significant. Thus, it can be interpreted that there is no significant relationship between pre test

knowledge scores and, age ,clinical experience, professional qualification.

Table 8: Coefficient of Correlation showing relationship between post-test knowledge and post-test attitude scores of staff nurse n=50

Variables

Coefficient of co-relation

‘r’

‘p’ value

Post- Test knowledge scores

0.067

0.644

Post-Test attitude scores

Data presented in Table 8 reveals that the Co-efficient of Correlation is 0.067 between post test knowledge and attitude scores and considered statistically insignificant with ‘p’ value 0.664. This indicates a weak positive relationship between post-test knowledge and attitude scores at 5% level of significance

SUMMARY OF THE STUDY:

All nurses should be familiar with nursing law and ethics and understand how nursing legal issues can affect them. Nurses must know the basic laws and avoid lawsuits and liability: Nursing is legally sensitive because it is the people’s business. The nurse deals with people, safe nursing practice includes an understanding of the legal boundaries in which nurses must function. An understanding of the implication of the law supports critical thinking on the nurse’s part. Laws are changing constantly to reflect changes in society, changes in the delivery of health care and advancement in medical technology. Nurses face legal issues daily. Issues may in connection to negligence, administering medication and advocating for the patient, the Nurse Practice Act lists all of the duties and role of a nurse, except the legal and ethical ones. If these duties and regulations are not followed, the nurse is at risk of losing his license and facing a Malpractice act. All these points keeping in mind the researcher felt the importance of the study.

MAJOR FINDINGS OF THE STUDY:

· Majority of staff nurses 37(74% ) were in the age group of 31-40 years, followed by 13 (26%) in the age group of 31-40 years.

· All the study subjects 50(100%) were females.

· Majority of study subjects 44 (88%) were married and only 6(12%) were unmarried.

· Majority of the subject‘s 23 (46) were GNM. and 22 (44%) were post basic B Sc and only 5 (10%) were basic B Sc nursing.

· Majority of staff nurses 44 (88%) had a working experience of l1-15 years , whereas 4 (8%) staff nurses had 6-10 years, 2 (4 %) has 2-5 years .

· Majority of the study subjects 40 (80%) had attended in-service programme and only 10 (20%) has not attended any in-service education programme.

· Mean post test knowledge score (34.48) of staff nurses was found to be significantly higher than their mean pre-test knowledge scores (21.16) suggesting gain in the knowledge of staff nurses on legal responsibilities of nurses.

· Mean post-test attitude score 184.00of staff nurses was found to be significantly higher than their mean pre-test attitude scores 150.44, suggesting the effectiveness of booklet in adopting the positive attitude of staff nurses on legal responsibilities.

· The coefficient of correlation value ( 0.067 ) between post-test knowledge and post-test attitude scores indicates that there is no significant , but a weak positive relationship between knowledge and attitude at 0.05 levels

· There was no significant relationship between the knowledge of staff nurses and their age.

· There was no significant relationship between the knowledge of staff nurses and their professional experience.

· There was no significant relationship between the knowledge of staff nurses and their clinical experience

· There was weak positive relationship found between the post test knowledge and attitude scores.

DISCUSSION OF THE FINDINGS:

The findings conducted by Aveyard, H^II (2004) to find out the way nurses take consent of patient before the procedures also showed that there was no significant relationship of knowledge and practice of staff nurses with selected factors. The study conducted by Gebonbie , Kristine M and Barnbas^III (2004) revealed the same findings. They found relationship of knowledge and in-service education does play an important role in the enhancement of the knowledge.

Present study results also revealed that the staff nurses had less knowledge before administration of information booklet and there was a significant gain in knowledge after the administration of Information booklet regarding legal responsibilities. The findings of the study are consistent with the study done by Prema Paul and Grffith R^IV (2007) evaluates the effectiveness of information booklet on legal responsibilities of staff nurses. They also mentioned that 86% of nurses believed that information booklet was a good source of learning.

LIMITATIONS:

· The study was confined to a small sample of only 50 nurses selected hospital, which limits the generalization of the findings.

· The study was limited to only medical and surgical unit of a selected hospital only.

· The study was limited to selected hospital only.

· No attempt was made to measure the retention of knowledge gained and improved attitude due to time limitation

· Standardized tool could not be located by investigator, so researcher developed the tool for the study.

RECOMMENDATIONS:

· Similar study can be replicated on larger samples of staff nurses of different hospitals for generalization of the findings.

· A similar study can be done to evaluate the effectiveness of booklet regarding legal responsibilities in community nursing care settings.

· A survey can be conducted to know the opinion of the staff nurses regarding legal responsibilities.

· A study can be conducted to evaluate the effectiveness of information booklet in retention of knowledge and attitude and attitude.

· A similar study can be done through a standardized tool.

· A similar study can be done to evaluate the effectiveness of booklet regarding legal responsibilities in psychiatric nursing.

CONCLUSION:

There has been a revolution in health care in the last 50 years as a result of new technologies and treatment. In the new world of nursing attitude and practice, legal liability of professional nursing conduct has emerged as an immediate concern. The consumers are more vigilant about their rights and laws. The nurses should be update themselves on these issues.

The main purpose of this study was to create the awareness about the legal responsibilities among the staff nurses to protect the rights of the clients as well as the nurses from the any legal suits.

The findings revealed that the nurses had inadequate knowledge regarding legal responsibilities. It was also found that there was a significant relationship between knowledge of staff nurses and their professional qualification as well as their clinical experience. Therefore, all the nurses should be aware of the legal responsibilities by in-service education programme or orientation programmes. The nurses who have very less clinical experience as well as fresh graduates should be oriented to the hospital policies and guidelines. They should be closely supervised on their legal responsibilities.

The information booklet was an effective method in increasing the knowledge and improving the attitude of the staff nurses regarding legal responsibilities. The nurses found the information booklet, a very useful learning aid. They appreciated the booklet and expressed that the booklet was effective. It also helped them in learning many legal terms like tort, malpractice etc.

The entire study was fruitful experience to the investigator. It helped her to develop her knowledge regarding legal responsibilities and also helped the investigator to gain insight to improve critical thinking, analysis and effective communication. This study was an important learning experience which enabled the investigator to develop the skills in dealing with different people and strengthen the concepts about conducting a research study.

REFERENCES:

1. Shaw J. and Anthony, M.K. Factors influencing outcomes after delegation to unlicensed assistive personnel. Journal of Nursing Administration. 12 (3); 2013: 474-481.

2. Aveyard H. Nursing and Medical students attitudes towards nursing disclosure of information of patients. Journal of Advanced Nursing. 12 (10); 2004: 691-698.

3. Gebonbie T, Kristine M. and Barnbas S. Privacy: The patient Right. American journal of Nursing. 9 (3); 2004: 122-125.

4. Prema P, and Grffith R. Putting the Record straight that efforts the importance of documentation, British Journal of Nursing, Vol.9 (3); 2007: 122-125.

Received on 10.09.2015 Modified on 28.09.2015

Asian J. Nur. Edu. and Research. 2016; 6(3): 321-326

DOI: 10.5958/2349-2996.2016.00060.4