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2. BAHADUR ALI
MSc.N student
INSTITUTE OF NURSING
DOW UNIVERSITY OF HEALTH SCIENCES
KARACHI
2

3. Nurses’ Perceptions related to Interaction of
Medical Representatives with Doctors and Nurses
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4.  huge number of medical representatives are seen
in OPDs, Wards, clinics
 busy in interaction with doctors and rarely with other health
professionals
to promote their new products.
to influence doctor’s prescription behavior (Lexchin, 1993;
Fugh-Berman & Ahari 2007)
through offering gifts, dinners, and other incentive such as
paying cost all travelling and educational symposiums to
increase drug sales (Wazana, 2000; Crigger, 2005)
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5.  Accepting gifts from pharmaceutical companies is a relative conflict
of interest from the perspective that all the costs they spend on gifts
and other drug promotion activities are added to the cost of the
medication for the patient (Chimonas & et al 2007).
 While Physician argued that interaction with medical representative do
not influence on their prescription behavior (Hodges,1995; Chimonas
& et al 2007; Korenstein, Keyhani, & Ross, 2010)
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6.  Patient concerns that drug representative’s
relationship with doctors influence doctors to
prescribe their medication (Gibbons & et al, 1998;
Mainous, Hueston & Rich, 1995),
 instead of patient needs particularly when drug
representative present in doctors’ room that may
shows a threat to patients’ trust in doctors (Goff,
Mazor, Meterko, Dodd & Sabin, 2007).
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7.  These controversies are directly concerned and impacting on
our patient’s health out comes and morality of health care
providers including nurses (Mainous, Hueston, & Rich,
1995; Gibbons & et al. 1998).
 Unfortunately, nurses who interact with medical
representatives during drug promotion and get opportunity
to participate in medical workshop have less awareness
about ethical aspects of these issues.
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8. The purpose of this study is to explore Nurses perceptions
related to interaction of medical representatives with doctors and
nurses to determine ethical issues related to patient's health care
needs.

9.  Lacking in ethical knowledge of nurses toward
pharmaceutical representatives’ interaction.
 Being a part of health care system nurses are more
prone to be influenced by pharmaceutical
representatives during their practice.
 The majority of Pakistani researches has identified
doctors role on this topic but no single research
has addressed nurses perspective and role who
have the key role in drug administration to
patients.
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10.  How nurses perceive the interaction of medical
representatives with doctors and nurses?
 How interaction of medical representatives with doctors
and nurses ethically impact on patients’ health care
needs?
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11.  Study design
Descriptive
 subjects’ description, and sample
(still no any such quantative study is conducted regarding Nurses
perception related to interaction with medical representatives. So I am
selecting 100 charge nurses sample due to limited time of study
duration)
Study subjects will be 100 Charge Nurses working at Jinnah
Postgraduate Medical Centre JPMC, Karachi
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12.  Study Setting and Duration
Research will be conducted at JPMC, Karachi.
03 Months Period of time. (from 1st
April 2014 to 30 June 2014)
 Sampling Technique
Purposive
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13.  Inclusion criteria
Charge Nurse having at least 2 years experience at JPMC,
Karachi
Attended at least one time Medical Seminar/ CME workshop
 Exclusion criteria
Refuse to give written informed consent

14.  Method of Data Collection
Questionnaires
(Saira Baloch* et al. International journal Of Pharmacy & Technology)
 Ethical Consideration
Approval will be taken from IRB.
written informed consent from participant
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15. Name: age: ……..years Design: sex :
Qualification: Professional experience:
1. It is unethical for a nurse to accept a gift of any type from medical representative.
(1) agree (2) neutral (3) disagree
2. I would feel no harm in accepting following gifts from a pharmaceutical company: pens, house
hold gadgets, lunch, stethoscope, textbook etc.
(1) agree (2) neutral (3) disagree
3. The information provided by MRs about the effectiveness of new product is trustworthy.
(1) agree (2) neutral (3) disagree
4. The information provided by MRs about the effectiveness of older drug is trustworthy.
(1) agree (2) neutral (3) disagree
5. The nurses should not have any interaction with medical representatives at their working place.
(1) agree (2) neutral (3) disagree
Nurses’ Perceptions related to Interaction of Medical Representatives with Doctors
and Nurses

16. 6. If three drugs from three different drug companies are same in term of price, effectiveness and
efficacy. I would prefer to prescribe the drug from the company which will provide me gifts
and incentives over those companies that did not.
(1) agree (2) neutral (3) disagree
7. Drug representatives should not banned from making presentations in this institute/ ward.
(1) agree (2) neutral (3) disagree
8. Interactions with drug representatives have no impact on physician's prescribing behavior.
(1) agree (2) neutral (3) disagree
9. It is acceptable for pharmaceutical companies to sponsor educational seminars and events
during nursing training.
(1) agree (2) neutral (3) disagree

17. 10. I have sufficient knowledge about interaction with Medical representatives.
(1) agree (2) neutral (3) disagree
11. I would always maintain the same degree of contact with MRs if no gifts or foods were
distributed.
(1) agree (2) neutral (3) disagree
12. Drug representatives employ marketing techniques in their interactions with residents.
(1) agree (2) neutral (3) disagree
13. It is ethical to accept marketing gifts having patient benefit e.g. Drug samples.
(1) agree (2) neutral (3) disagree

18. INFORMED CONSENT FORM
Title of study:Title of study: Nurses` perception related to interaction of medical representatives with doctors and nurses.
Principal Investigator: BAHADUR ALI
Institute: Institute Of Nursing, Dow University of Health Sciences Karachi.
Purpose of Study:: To explore Nurses` perceptions related to interaction of medical representatives with doctors
and nurses and to determine ethical issues related to patients` health care needs.
Procedure:
In this study we will ask you few questions about perceptions related to interaction of medical
representatives with doctors, nurses and its` ethical issues related to patients` health care needs. Interviews will be
conducted at your job place through a Questionnaire this will take about half an hour. All information will be kept
secret to maintain confidentiality.
Possible risk or benefits:
There is no risk involved in this study except your valuable Time. There is no direct benefit to you also.
Confidentiality: The information provided by you will remain confidential. No body except principal investigator
will have an access to it. Your name and identity will also not be disclosed at any time. Your name identity will not be
disclosed in any publication of this research.
Available sources of information: If you have any question you may Contact principal investigator: BAHADUR ALI
MSc Nursing Student at institute of Nursing Dow University of Health Sciences.
Contact # +92301-2668673, +92333-8272955
Authorization:
I have read and understand this consent form and I volunteer to participate in this research study. I understand that
my consent does not take away any legal rights in the case of negligence or other legal fault of anyone who is involved
in this study. I further understand that nothing in this consent form is intended to replace any applicable Federal
state, or local laws.
Participant Name: _________________ Signature: ________________ Date: / /2014
Principal investigator: BAHADUR ALI Signature: ________________ Date: / /2014
Consent taken by: _________________ Signature: _________________Date: / /2014

19.  Medical representative: (MR) Medical sales representatives
(widely referred to as reps) are a key link between medical and
pharmaceutical companies and healthcare professionals.
(https://www.google.com.pk/?
gws_rd=cr&ei=x4coU66pMJGthQfd_oGgCQ#q=Medical+representative+means)
 Perception: the act or faculty of perceiving, or apprehending by means
of the senses or of the mind; cognition; understanding.
(http://dictionary.reference.com/browse/perception)
 Ethic : A system of accepted beliefs which control behavior especially
such a system based on morals.
(Advance learner's dictionary CAMBRIDGE university press 2nd
edition)
 CME: Continuous Medical Education.

20. My research shall be conducted at Jinnah Institute of post
graduate & medical Sciences karachi. I shall get approval
from IRB and Department then approaches to different
wards and OPDs where mostly medical representatives
visits.
100 those Staff Nurses who have at least 2 years of
practical experience and also will have participated in at
least one CME will be included after selection, take
informed Consent from participants then structured
Questionnaires will be filled out.

21.  1st
of all I will enter data through EpiData software.
 After successfully entry of all data check and then create spss file.
 On SPSS software (16 version) apply descriptive statistics /Frequency
percentage

22. Sr.No. Subject/Activity
Duration
Week #
1st
Apr
to
7th
apr 2014
8th
Apr
To
14th
apr
2014
15th
Apr
to
30th
apr
2014
1st
may
to
30th
may
2014
1st
June
to
20th
June 2014
21st
June
to
31st
June 2014
1 Introduction (Writing) 1 Weeks
2 Methodology 1 Weeks
3 Questionnaire
Development
2 Weeks
4 Data Collection 4 Weeks
5 Data Analysis 3 Weeks
6 Completion of Research 1 Weeks
Total 12 Weeks (3 months)

23. S.N
O
ITEMS COST
Approximately in pak
rupees
1 Traveling Expenses 5000/=
2 Questationnaire & consent
form printing
2000/=
3 Stationary 1000/=
4 Others 2000/=
5 Total 10000/=