UNIT 4: CLIENT AND PATIENT
Key Unit Competence
Perform clients’ rights and responsibilities when providing care
1.0 Introductory activity
Mrs Q. is working in the service of Accident and Emergency (A&E) as associate nurse and Mr N. a male patient is presented to the ward having life threatening signs. He is in unconscious status with GCS of 8/15, SO2 of 85%, pulse of 112beats/minute, BP of 200/165 mmHg and temperature of 38.9 Celsius degrees. He needs an emergency treatment and some important exams to be done like blood sugar test and head CT scan that require some payments. However, the patient does not have any health insurance and any contact from his family.
1) What are you going to do?
2) Explain some aspects related to the client’s rights and responsibilities that are presented in this case
4.1. Concepts of clients, patients and clients ‘rights
Learning activity 4.1
Mrs T. a 40 years old female patient female patient is presented to the ward where Nurse Mr H. is a nurse working with other two associate nurses. She presents acute abdominal pain with temperature of 38.8 degrees Celsius and tachycardia with pulse of 122 heartbeats/min and hypotension of 80/45 mmHg. However, the patient does not have any health insurance and any contact from his family.
1) Which rights of the clients that are challenged for Mrs T.?
2) How Mr H. will proceed to respond to those challenges?
Despite outlining the rights that every patient is expected to exercise, legal and human rights activists feel that much should have been done to educate the public on the document and make them aware of the rights they have when it comes to attain the best health care.
a) Clients: nursing client refers to an individual designated to be a recipient of nursing service in a health care situation. Nursing client may refer to groups of people such as families who receive nursing care as groups, or as aggregates such as a community or population especially in the context of public health and community health nursing. The concept of patient-centred/person-centred care has been developed in nursing as well as in medicine as an approach to uphold clients’ autonomy and self-determination.
b) Patient: an individual who sought the assistance of a healthcare professional
c) Client’s / patient’s rights: patient rights are those basic rules of conduct between patients and medical caregivers as well as the institutions and people that support those ones (Davis &Williams, 2020).
Self-assessment 4.1
Differentiate client and patient
4.2. Patients rights
Learning activity 4.2
Mrs Y. a female patient is presented to the health centre family planning services, where Mrs F. is a Registered Midwife (RM). However, his husband does not accept the use of family planning and Mrs Y., is asking the RM to keep secret so that his husband will not know that she is using those services.
1) Which right is Mrs Y is concerned about?
2) How Mrs F. will proceed to help Mrs Y. effectively
a. Access to health care
According to the patient’s right charter, every person should be able to access promotional, preventive, curative, reproductive, rehabilitative and palliative care without struggling. To access health care, the facility must be within the patient’s reach.
“This right also allows you, as a patient, to access health care without discrimination or stigma whatsoever”. Access to health care means having “the timely use of personal health services to achieve the best health outcomes” (Institute of Medicine, 1993).
Everyone has the right to access health care services that include:
• receiving timely emergency care at any health care facility that is open regardless one’s ability to pay, treatment must be made known to the patient to understand the consequences thereof;provision for special needs in the case of, children, pregnant women, the aged or disabled persons,
• counselling without discrimination, coercion or violence on matters such as reproductive health, cancer or HIV/AIDS; palliative care that is affordable and effective in cases of incurable or terminal illness; receive health information that includes the availability of health services, how best to use health services and health information shall be in the language understood by the patient.
b. Right to receive emergency treatment at any health facility and be informed health insurance policy : any patient who is in need of emergency treatment should receive treatment. ‘Emergency Care’ means inpatient and outpatient hospital services necessary to prevent the death or serious impairment of the health. Examples of cases with emergency treatment: bleeding, breathing difficulties, fit/epileptic seizure, severe pain and active labour. Patients are entitled to know all the privileges accorded to them by their health insurer.Those ones include the contents and decisions of the medical scheme and health insurance policy. The insurance coverage should be without discrimination on the basis of age, pregnancy, disability or illness (including mental disorders). c. Right to choose a health care provider and continuity of care: the patients have the right to choose, the doctor or nurse they would like to treat them. Furthermore, this right is also hard to exercise in public hospitals where human resources are overloaded.
• Access to health care consists of four components (Healthy People 2020):
– Coverage: facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status.
– Services: Having a usual source of care is associated with adults receiving recommended screening and prevention services.
– Timeliness: ability to provide health care when the need is recognized.
– Workforce: capable, qualified, culturally competent providers.
b. Right to receive emergency treatment at any health facility and be informed health insurance policy : any patient who is in need of emergency treatment should receive treatment. ‘Emergency Care’ means inpatient and outpatient hospital services necessary to prevent the death or serious impairment of the health. Examples of cases with emergency treatment: bleeding, breathing difficulties, fit/epileptic seizure, severe pain and active labour.
Patients are entitled to know all the privileges accorded to them by their health insurer. Those ones include the contents and decisions of the medical scheme and health insurance policy. The insurance coverage should be without discrimination on the basis of age, pregnancy, disability or illness (including mental disorders).
c. Right to choose a health care provider and continuity of care: the patients have the right to choose, the doctor or nurse they would like to treat them. Furthermore, this right is also hard to exercise in public hospitals where human resources are overloaded.
d. Right to refuse treatment: the charter of patient’s rights states that any patient or client may refuse treatment provided if it does create an immediate danger to them or the health of other people. However, it states that such refusal shall be documented in writing by the medical service provider in the presence of an independent witness. It is wise to document that the patient clearly understands the risks and benefits of their decision. Patients with an altered mental status because of alcohol, drugs, brain injury, or medical or psychiatric illness may not be able to make a competent decision. Although laws have established the right of an adult to refuse life-sustaining treatment, they do not allow parents or guardians to deny children necessary medical care. “The right to practice religion freely does not include the liberty to expose the community or child to communicable disease, or the latter to ill health or death.
e. Right to confidentiality: while every person has a right to have their medical information kept confidential. Confidentiality shall be upheld except where consent has been expressly given. Confidentiality should be maintained even after the patient dies.
f. Right to information: Patients should be able to get their information concerning his/her diagnosis and treatment. A patient has a right to be given accurate information about his/her health status in a language that is easily understood. Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions.
g. Right to complain: the charter notes that you have a right to complain about the health services of any health facility to the relevant authorities and have such complaints investigated and a response from the authority received within 12 months (one year), many patients are not even aware of this provision.,
h. Right to a second medical opinion: patients have a right to a second opinion about their diagnosis, procedures and treatment to undergo, if they wish Patient should receive quality drugs e.g. check expiration date. Allergies or other severe side effect s of drugs have to be taken into consideration to ensure patient’s safety.
i. Right to informed consent to treatment: art of communication in medicine involves informed consent for treatment and procedures. This is considered a basic patient right. This is not only about the health care provider seeking the patient’s permission to perform a procedure. Thereafter, decision should be made willingly and free from compulsion.
Informed consent involves the patient’s understanding of the following:
• What the health care provider is proposing to do
• Whether the health care provider’s proposal is a minor procedure or major surgery
• The nature and purpose of the treatment
Intended effects versus possible side effects
• The risks and anticipated benefits involved
• All reasonable alternatives including risks and possible benefits.
Some factors may make a patient incapable of providing competent consent either temporarily or permanently. Those include the following: mental illness or mental retardation, alcohol or drug intoxication, altered mental status, brain injury, being too young to legally make decisions concerning health care.
j. Right to be treated with respect and dignity: every person has inherent dignity and the right to have that dignity respected and protected.
Self-assessment 4.2
1) What are situations to give patients emergency care?
2) What elements the patient need to understand before giving informed consent?
4.3. Clients’ / Patient’s Responsibilities
Learning activity 4.3
Mr B. a male patient with 24 years old is admitted in the ward of Internal Medicine where he receives treatment for leukemic cancer. He receives pain killer every four hours and is waiting for an appointment to the oncologist. However, during his hospitalization, he was disturbing other patients due to the noise in his room. He plays his radio to the maximum volume and receives too much visitors who have long discussions and shouting with laughs in the room. All the patients are claiming that they are not comfortable with the noise from the room of Mr B. He says that it is his right to listen to music and have conversations with his friends.
As a nurse what advise will you give to Mr B.?
a) Provide accurate and complete information: patients are responsible for providing correct and complete information about their health condition and past medical history.
b) Patients are responsible for taking care of own health: they are expected to report on unexpected health changes in their general health condition, symptoms, or allergies to the responsible health care provider.
c) Compliance to the treatment: patients are responsible for reporting if they do not understand the planned treatment.
d) Acceptance on informed consent: patients are responsible for what happens if they refuse the planned treatment.
e) Relation to others: patients are responsible for treating others with respect, respecting the property and rights of others; they are responsible for respecting the rights of health providers and other patients.
f) Protection of environment: patients are responsible for following facility rules regarding smoking, noise, and use of electrical equipment assisting in the control of noise and the number of visitors in their rooms. Patients are responsible to access and use the health system properly and not abuse it
g) Adopt positive attitudes toward their health and life: patients are responsible to follow the recommended treatment plan they have agreed to, including instruction from health personnel. Patients are responsible to follow all instructions and adhere to treatments prescribed
h) Respect of appointment: patients are responsible for keeping appointments
Self-assessment 4.3
1) Use an example to illustrate at least five among the client’s responsibilities
2) Explain the responsibility to adopt positive attitudes toward their health and life
4.4. End unit assessment
End unit assessment
A. MCQ
1. Which one among the following is not included in the patient’s rights?
a. Access to healthcare
b. Confidentiality
c. Taking photos of other patients
d. Informed consent
2. Access to health care include the following component
a. Coverage
b. Services
c. Timeliness
d. Workforce
e. All of the above
3. A patient has got right to an informed consent that comprises the following:
a. What the health care provider is proposing to do
b. The nature and purpose of the treatment
c. Intended effects versus possible side effects
d. All reasonable alternatives including risks and possible benefits.
e. All of the above
4. Risks for drug products include the following except
a. Allergies
b. Drug forms
c. Medical errors
d. Side effects
5. Organ donation include the following organs except
a. Kidney
b. Brain
c. Lungs
d. Liver
6. Which one among the following is included in medical emergencies?
a. Breath difficulties
b. Bleeding heart attack
c. Stroke
d. All of the above
7. The following factors influence the choice of health care provider by the patient except
a. Interpersonal factors
b. Availability of information
c. Educational qualification
d. Quality of treatment.
8. Patient’s responsibilities include the following except
a. Provide accurate information about their health status
b. Pay the cost relevant to their health services delivery
c. Protect the environment and respect other patients
d. Claim and bring health care providers to courts
B. True or false questions
1. A patients has right to be treated for free every time they are presented at the healthcare settings
2. A patient without money or insurance may receive essential health care in case of emergency
3. Patients ought to take responsibility to their own health
4. Patients are not obliged to accept treatment plan without consent
5. Patients are allowed to do whatever they want in the hospital for it is their right
6. Patient are allowed to donate their organ using only their verbal statement
7. Quality product include identity, strength and purity
8. Quality product does not present any side effect
9. Choice of healthcare provider by the patient depends on his qualification and specialty
10. The patient chooses a health care provider depending to the quality of care and interpersonal relationship
C. Short Answer Questions
1. Explain patient’s right regarding confidentialty
2. Clarify patient’s responsibility in regards to other patients
• CASE STUDIES
1. Mr G. RN receives a female patient Mrs I. in the ward of Internal medicine. Mrs I. has got Diabetes Mellitus and has been treated for 10 years with long acting Insulin and the nurse comes for checking blood sugar and he identifies a sudden rise of blood sugar that requires an immediate injection of rapid insulin. However, Mrs I. refused the treatment because the colour of the vial containing Insulin is different from the colour for vial containing long acting Insulin.
a. Clarify reasons that cause Mrs I. to refuses the treatment?
b. Illustrate how Mr G. will proceed enable the patient accept the treatment?
2. Mrs M. a 35 years old female patient is presented to the ward where Nurse Mr K. is a nurse working with other two associate nurses. She presents acute abdominal pain, hematemesis (blood vomiting) with temperature of 36.8 degrees Celsius and tachycardia with pulse of 122 heartbeats/ min and hypotension of 80/45 mmHg. However, the patient does not have any health insurance and is socially unable to pay for treatment. a. Identify the signs that may lead to the emergency care for Mrs T.? b. Describe which emergency care to be given to Mrs M. how Mr H. will proceed to respond to that challenge?
3. Mrs Y. a female patient is presented to the maternity ward for antenatal care services, where Mrs F. is a Registered Midwife and Mr J. is Gynaecologist. Mrs Y was told by her friends that that Mr J. is a good doctor and collaborative. She is Gravida 2, Para 1 in week 20 and has no special problems that require special examination. On the other side Mr J. is called for an emergency C-section for a woman who has got an abnormal labour with decreased foetal heart rate and requires an emergency to save the baby. Mrs F. is in the consultation room to provide antenatal care when Mrs Y gets in the consultation room. However Mrs Y. refuses to be examined by the registered Midwife claiming that she wants to be examined by a gynaecologist and says that it is her right. a. Which right of the client that is challenged for Mrs Y.? b. How Mrs F. will proceed to respond to that challenge?