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How to cite this article:

Ramírez-Muñoz V, Gallegos-Carballo L, Bolado-García PB, Gamboa-López GJ, Medina-Escobedo CE. Percepción del familiar y el paciente sobre el trato digno otorgado por el personal de enfermería. Rev Enferm Inst Mex Seguro Soc. 2016;24(2):109-14.

Relative’s and patient’s perception about fair treatment provided by nurses

Verónica Ramírez-Muñoz,¹ Lilia Gallegos-Carballo,¹ Patricia Berenice Bolado-García,² Gonzalo de Jesús Gamboa-López,³ Carolina Elizabeth Medina-Escobedo⁴

¹Subjefatura de Enfermería, ²División de Investigación en Salud, ³Quirófano-Hemodinamia, ⁴Dirección de Educación e Investigación en Salud. Hospital de Especialidades, Centro Médico Ignacio Garcia Téllez, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México.

Correspondence: Verónica Ramírez-Muñoz

Email: investigacion.umae.imss@gmail.com

Received: October 12^th 2015

Judged: January 15^th 2016

Accepted: March 8^th 2016

Abstract

Introduction: Patient safety has become essential object of health systems from the perspective of quality of care and the improvement health services. The International Nursing Commission proposes fair treatment as a quality indicator. The nurse is the character who interacts more with the patient.
Objective: To know the perception of family and patient on fair treatment by the nursing staff.

Methodology: We conducted a survey of 114 subjects in the Hospital de Especialidades “Ignacio García Téllez” at Merida, Yucatan. The dignified treatment questionnaire was used; data underwent descriptive analysis and the results are presented in tables and figures.

Results: The mean age was 40.62 ± 7.77 years. 55.3% were female and 44.7% was male. 31.6% of subjects was from hematology and 28.1% was from oncology. The predominant academic level was highschool. In 82.5% of the answers subjects stated that they always received fair treatment.

Conclusions: The nursing staff met the criteria of fair treatment to hospitalized patient; however, it is not enough to achieve the INDICAS goal; consequently, it is necessary to propose improvement projects to reach the quality of care.

Keywords: Personhood; Humanism; Nursing staff

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Introduction

Patient safety has become an essential goal of health systems, since processes of health service improvement are immediately identified from the perspective of quality of care. Safety is defined as the absence of avoidable harm to a patient during the process of health care.¹ The magnitude and severity of the damage and the health and economic consequences for patients, professionals, and health care organizations have led patient safety to be considered as a priority at global, national, regional, and local levels.²

Therefore, patient safety goals have been established as indispensable international standards for hospital certification. Quality and safety must be rooted in the daily work of each and every one of the members of the establishment. In this context, one of the sections of certification standards is to improve quality and patient safety (QPS), which mentions in its plan identifying and reducing risks, as well as quality. Donabedian points out that medical care quality is defined as achieving the greatest possible benefits of health care with the least risk to the patient, the greatest possible benefits in terms of what is achievable within the resources available (to provide care), and with prevailing social values.^3,4

The Comisión Interinstitucional de Enfermería defines quality of nursing services as "continuous, timely, personalized, humane, and efficient care provided by nursing staff, according to standards defined for a competent and responsible professional practice, for the purpose of achieving customer and service provider satisfaction".⁵ In the interpersonal dimension the decent treatment indicator was established, which refers to patient or family perception about the treatment and care provided by the nursing staff during the hospital stay. This is based on respect for General Patient Rights and the Code of Ethics for nurses in Mexico.⁶

In the 2000 Encuesta Nacional de Satisfacción con los Servicios de Salud, the population said that health services in their communities had worsened compared to the 1994 results: 15% of the population claimed not to have received decent treatment in the institution in which they sought health care.⁷

At the international level, according to the Instituto Nacional de Salud Pública and the World Health Organization, the rate of decent treatment in hospitals in 2001 was 5.7, a figure that reflects the system's ability to meet patients’ non-medical expectations, placing our country in a middling position globally, where the United States had a rate of 8.1 and Switzerland 7.4, while Asia and Africa occupied the bottom spots.⁸

On the other hand, the results of the 2002 Encuesta Nacional de Evaluación del Desempeño showed that decent treatment was well qualified in most states with 79% approval for public and private services. However, 3.8% of users said they had received some kind of mistreatment.⁷

In a study carried out in a Family Medicine Unit of the Instituto Mexicano del Seguro Social (IMSS) of Tijuana,8 it turned out that 25% of patients said their rights as people were never respected and 46.74% said that they were almost never treated with respect, unlike a study in a hospital in Mexico City,⁹ in which the users' perception about decent treatment by nurses was adequate in 91% while for the remaining 9% it seemed inadequate.

In the Unidad Médica de Alta Especialidad (UMAE) in Merida, no results of assessments of decent treatment are known, even when this is done and delivered as a monthly report. The importance of analyzing this indicator is that nursing care involves reducing risk factors and increasing safety and user satisfaction upon receiving good treatment, which is a key point for the professionalization of the nursing process.

Methodology

A survey of decent treatment was made in the UMAE in Merida, Yucatan, Mexico. A questionnaire on decent treatment was applied in family and hospitalized patients in the Oncology and Hematology services. Based on a random selection (raffle), patients and families who agreed to answer the questionnaire and signed the informed consent were included. They were male and female, aged 18 and older, plus they had to be patients with more than 48 hours of hospitalization (or their family members). The sample calculation was done using the finite population formula, according to which the maximum acceptable was calculated at 5%, with an estimated result percentage of 90% and a confidence level of 95%; losses were estimated at 20%, so the number of subjects to be included was 114. The patient was directly interviewed if they were an adult, and their relative in the case of minors. Those who did not fully answer the questionnaire were excluded. The research group explained extensively to each subject how to fill out the questionnaire, and they were subsequently given the instrument. The information collected was organized in a database designed for the study and analyzed with descriptive statistics. The results were presented by means of tables and figures.

Decent treatment was considered as the patient or relative’s perception of treatment and care provided by nurses during their hospital stay. Decent treatment was 55 to 37 points, the result > 18 and < 37 was fair treatment, and < 18 was considered was bad treatment. Perception was considered the first cognitive process through which subjects capture information from the environment. Study subjects were asked directly, and answers as were classified as Received decent treatment, Did not receive decent treatment, Do not know, or They treat me okay. Statistical analysis was performed using SPSS version 20.

The study complied with the considerations issued in the Nuremberg Code and the Helsinki Declaration, adopted in 1964, and its various modifications, including the update from Fortaleza, Brazil (2013). It also adhered to international guidelines for medical research involving human beings, adopted by the World Health Organization (WHO) and the Council for International Organizations with Human Beings. In addition, the protocol was reviewed and approved by the Local Committee on Research and Ethics in Health Research of the UMAE, with registration number R-2014-3203-6.

As for confidentiality, each patient was assigned an identification number which was captured in the database. This was only available to researchers or the legally authorized entities if so required. In drafting the manuscript, the names or any information that might lead to the identification of the patient were omitted. Researchers pledged to keep the participants’ identity and details confidential and make good use of the databases that resulted from research, by omitting details such as name and social security number of each of the patients.

In relation to the benefits to society, by understanding how nurses treat the patient and their families while performing their comprehensive care functions, we learned the weaknesses and strengths of the nursing process and where the areas of opportunity were to develop improvement projects in order to raise the quality of care provided by the nursing staff of the medical unit.

Results

Type of treatment was qualified as follows: 55 to 37 points = good treatment; 18 to 36 = fair treatment; and ≤ 18 = bad treatment.
The average age of the subjects included in the study was 40.62 ± 7.77 years. 55.3% of the subjects interviewed were female and 44.7% were male. Secondary education level predominated with 26.3%, primary with 25.4%, and high school with 21.9%. Undergraduate and graduate education was identified to a lesser extent. 31.6% were in the service of Hematology and 28.1% in Oncology (Figure 1).

Each question on the instrument applied was a categorization of their responses at the time of the evaluation and the frequency of each of the items regarding the perception of decent treatment (Figure 2); 82.5% of the subjects interviewed said they always received decent treatment (Figure 3). Despite finding that the nursing staff treats patients and family decently, the standard indicator was not reached.

Discussion

Based on analysis of the instrument used to measure decent treatment, priority care should be given to patients with unfavorable responses, without neglecting the other elements. This should affect the process of nursing care, which must be of high quality, as the user requires and demands. Most of the questions in the instrument got some answers of never and rarely (introduces themselves, addresses them by name, explains, is nice, creates an atmosphere of privacy [i.e., cares for the patient’s modesty], offers safety and respect, teaches care for their condition, provides continuity of care, and user satisfaction). This means that in such cases the nurse does not perform the action described and demeans the quality of service provided. The Sistema Nacional de Indicadores de Calidad en Salud II (INDICAS II)4 proposes 90% as a minimum compliance standard expected for the decent treatment indicator and perceived user satisfaction. Based on this premise, we find that the questionnaire conducted only reached 82.5%, which is not discouraging but which makes a commitment to a process of continuous improvement with permanent monitoring, even though the result of the analysis was considered good. For the overall rating of the instrument, Carrillo et al.,¹⁰ in their 2009 study on decent treatment, categorized the answers through a Likert scale and assigned them a value based on the number of affirmative responses collected: 7 responses = excellent, 6 responses = very good, 5 responses = good, 3 or 4 responses = fair, 2 or 1 responses = poor. 98.25% reported that the nurse greeted them kindly, 73.7% introduced themselves, 73.7% addressed them by name, 94.7% explained the procedures or activities that had to be done, 93% offered conditions to protect the patient’s privacy or modesty, 98.25% treated the patient with respect, and 99.1% of patients were satisfied with treatment. However, only 56.1% of patients reported that decent treatment was excellent.

Although the structure described for INDICAS II focuses on units of primary and secondary care, satisfaction with perceived treatment is important at all levels of care in the health sector, especially in highly specialized hospitals, where the complexity of the conditions, multiple co-morbidities, and the treatments, often mutilating and aggressive, favor a series of very marked biopsychosocial conditions. Our work was done in a tertiary care hospital in the highly specialized services with the most patients, such as Hematology and Oncology, where the complexity of the conditions and the organ, functional, and psychological effects are different from the subjects of published studies. Perception can then be different because patients have complex conditions, multiple comorbidities that have several treatments with very unpleasant side effects, and, on several occasions, are in terminal stage; therefore, there may be a bias in the appreciation of their environment, given the psychological situation that accompanies their condition. The results of our study found that a significant percentage of enrollees and relatives who received the survey said they received decent treatment, contrary to what was reported by Puebla-Vieira et al.,¹¹ who concluded that the treatment provided by nursing was poor.

The quality of care that nursing staff can provide should be reflected in the treatment provided to the patient. Torres-Mora et al.¹² reported 98% satisfaction for female nursing staff and 96% for male staff, figures that show numerically minimal differences by gender, but that denote the perception of high quality in the services received. On the other hand, the study by Gogeascoechea-Trejo in 2009¹³ reported that 97.6% of users who had an assessment of satisfaction and decent treatment in a university hospital in Veracruz far exceeded the cutoff point established by INDICAS II.

This is interesting because the units are at different levels of care, with different workloads and processes. In our work unit, work overload can cause stress on nurses due to patient demand, and it has been reported that this results in unkindness (Escriba and Burguete, 2005),⁹ a situation that was not studied in this work, since the aim was not to analyze the influence of this factor. Of the 114 patients interviewed, 26 were relatives of minors, and all perceived decent treatment by the nursing staff. Because of the disparity of patients and families, separate statistical analysis was not done. This may be the subject of another future study, since the perception of the parents or any relative of a child tends to be more scrutinizing and, on several occasions, distrustful of procedures that the children undergo.

In conclusion, we can say that decent treatment in our UMAE was good; in addition, the good results obtained from the relatives of pediatric patients imply that the nurse is able to be empathetic with the family, a situation that is very important for the proper performance of comprehensive and quality care in any Health System.

Further studies must be done on the psychological condition of the patient or family, verifying whether this influences their perception of treatment given.

It is also necessary to take these results into account and plan improvement projects aimed at raising the quality of care and achieving the indicator of 90% or more.

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