Patient bills of rights and the implications to nurses and the nursing practice in nigeria.pdf

PATIENT BILLS OF RIGHTS, AND THE
IMPLICATIONS TO NURSES AND
NURSING PRACTICE IN NIGERIA
A PAPER PRESENTED
BY
Nr. HALLIRU KABIR KANKARA [RN, RPON, BNSC]
(Federal Teaching Hospital Katsina)
@
GENERAL HOSPITAL KATSINA
NURSES MONTHLY PRESENTATION
ON
FRIDAY 7th OCTOBER 2022
1
Nr. HALLIRU KABIR KANKARA (RN,RPON,
BNSC) FTH KATSINA
07/10/2022

OUTLINE
• Introduction
• Definition of terms
• Patient’s bills of right
• Nurses bills of right
• Implication to nurses
• Implication to nursing practice
• Some instances and scenario
• Recommendations
• Conclusion
• References
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INTRODUCTION
• It was first formalized and universally declared in
1948 (Nigeriahealthwatch.com//2022).
• It was officially drafted in the early 1970s by the
American hospital association.
• It was in existence in Nigeria’s health practices
but was first given official recognition and
declared a national issue of national health
interest by the consumer protection council (CPC)
jointly with the federal ministry of health on 31st
July 2018 (cpc.gov.ng//billsofrihts/2018).
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Intro. Cont.
• It tends to breach the gap between human rights, respect for
human dignity, and its intentional and unintentional violations
in health practice.
• The Rights are said to be the BENEFITS secured for persons by
rules and regulations backed by law enforcement agencies.
• The PBoR is an aggregation of patients’ rights that exist in
other instruments including, The Constitution, Consumer
Protection Act, Child Rights Act, Nursing and midwifery act,
Freedom of Information Act, National Health Act, the
Hippocratic Oath, other professional ethical codes, and sundry
regulations.
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Intro. Cont.
• The source for Nurses' bills of rights is; the
International Council of Nurse, the Nigeria
constitution, the nursing and midwifery act, and
common law (www.nursing.com,2022).
• The violation of either of the rights can lead to
the conviction of either of the party depending
upon the extent of the violation and could lead to
a criminal conviction in case of the violation
causes any harm or injury to either of the party.
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Definition of terms
• Patient; a person receiving or registered to receive
medical/nursing care. ( oxford dictionary).
• Nurses; a nurse is a person who has completed a
program of basic generalized nursing education and is
authorized by the appropriate regulatory authority to
practice nursing. (www.icn.ch.definations).
• Bills; are drafted proposed laws presented to parliament
for discussion or adopted by the parliament as the
bounding rules upon everyone. ( oxford dictionary, 2021).
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Def. Of terms cont.
• Rights; are legal, social, or ethical principles of
freedom or entitlement, or are the
fundamental normative rules about what is
allowed to people or owed to people
according to some legal system, social
convention, or ethical theory. (www.wikipedia.
org)
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Definitions of bills of rights
• Patient bills of rights; Are the policies and
laws that health facilities are obligated to
protect and preserve for patients and their
families.(cpc.gov.ng).
• Nurses' bills of rights; Are set of rules
extracted from the legal source and adopted
to protect the rights of nurses as caregivers in
their working environment. ( American
Nurses Association, 2022).
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Patients bills of right
There are basically eleven sets of patient bills
of rights adopted by the federal ministry of
health in Nigeria as declared by the consumer
protection council of Nigeria in July 2018.
which as well describes both provider and
patient responsibilities on each right for the
purpose of clarity.
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RIGHT TO ACCESS TO INFORMATION
• Patient rights
1) To have access to all relevant information in
a language that the patient understands,
including complete and accurate information
about the diagnosis, treatment, prognosis,
other procedures, and possible outcomes.
2) To fully participate in implementing the
treatment plan and making decisions.
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Right to Access to info. Cont.
• Patient Responsibilities
1) Seek information from the caregiver about
their services.
2) Understand the treatment plan.
3) Provide details about any changes occurring
during, or on account of treatment.
4) Report dissatisfaction through appropriate
channels provided by the facility.
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Right to Access to info. Cont.
• Provider responsibilities
1) Inform patients about services that are available at the facility
and eligibility based on health insurance or out-of-pocket costs
and responsibilities.
2) Inform the patient whether the proposed treatment or
procedure is experimental or part of ongoing research.
3) Answer questions about proposed treatment and/or
procedures and provide information about potential risks,
alternative treatment, and/or procedures.
4) Provide the patient's medical records on request by the patient
or other authorized persons, in accordance with prevailing
laws.
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Right to Patient Related Information
• Patient right
• Access to records, including explicit
information about the range and scope of
services available.
• Access to the record of the identity, skills,
and credentials of treating professionals and
care providers published by the Federal/
State Ministry of Health or other relevant
authorities.
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Right to Patient Related Information cont.
• Patient responsibility
1) Request information about the range and
scope of services available including identity,
skills, and credentials of treating professionals
and care providers.
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Right to Patient Related Information
cont.
• Provider Responsibilities
1) Conspicuously display the scope of practice and
available services; and customer care phone numbers,
email addresses, and other contact information.
2) Communicate clearly with the patient, including,
providing translation in the case of the language barrier,
or adaptation in the case of other disabilities.
3) Ensure the patient demonstrates a sufficient
understanding of the information provided.
4) Provide sufficient identification when on duty, including
displayed rosters and apparel with visible identity tags.15
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Right to Fee Related Information
• Patient right
1) Full disclosure of cost or estimation of
recommended treatment plan services.
2) Transparent and itemized billing.
1. Pay bills or make provision for prompt
payment of bills. In the event of an
emergency, demonstrate the ability and
intention to pay for the services.
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Right to Fee Related Information cont.
• Provider responsibility
1. In the event of an emergency, provide
immediate and sufficient intervention and
care, prioritizing such needed attention over
other factors including cost and payment.
Care providers have a right to fees and
therefore should use legal means to recover
fees owed.
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Right to Confidentiality
• Patient right
1) Privacy and confidentiality of all information and
medical records unless disclosure is vital and in the
interest of public health in accordance with prevailing
law.
1) Complete, truthful, and accurate disclosure of medical
history, medication, and complaints to the authorized
and attending caregiver.
• Provider responsibility
1) Respect and maintain the confidentiality of patient's
personal records, except disclosure by operation of law
or in the interest of public health.
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Right to Quality of Care
• Patient right
1) Access to a clean, safe and secure healthcare
environment.
2) Access to equitable quality care and caregivers,
irrespective of disability.
1) Explanations during treatment where necessary.
2) Not to constitute a nuisance or in any way
endanger others.
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Right to Quality of Care cont.
1) Maintain records of personnel's current certificates
and/or licenses to practice.
2) Maintain a current Certificate of Standards as
evidence of authorization to operate within its
approved scope of practice.
3) Deliver care that minimizes risk and harm to patients,
including preventable injury and errors.
4) Adopt clinical governance standards and provide the
best care while protecting patients from harm, or
abuse.
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Right to Patient’s Dignity
• Patient right
1) To be treated with respect and dignity, without prejudice to gender,
religion, race, ethnicity, the allegation of crimes, geographical
location, disability, or socioeconomic circumstances.
2) That prior wishes of the patient or in the absence of some of the
next of kin (where legally applicable) are respected to the fullest
extent practicable during last offices (at the time of death) including
cultural or religious preferences, to the extent consistent with extant
laws including coroners laws.
• Patient responsibilities
1) Respect and consider the rights of other patients.
2) Conduct all interactions with consideration and respect for others.
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Right to Patient’s Dignity cont.
1) Treat patients, human remains, and tissue samples with care, consideration,
and dignity without prejudice to gender, religion, race, ethnicity, allegations
of crimes, geographical location, physical ability, and socioeconomic
circumstances.
2) Ensure comprehensive information, guidance, and support to bereaved
relatives.
3) Prepare remains for viewing at the mortuary/rest room by relatives in
compliance with guidelines for last offices unless harmful to public health,
and to the extent consistent with extant laws, including coroners law.
4) Counsel and encourage patients on the disclosure of diseases of public
health importance (deadly, infectious, or non-infectious disease) to spouses
or close relatives in accordance with public health laws.
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Right to Access to Emergency Care
• Patient right
1) Receive urgent, immediate, and sufficient intervention and
care in the event of an emergency, prioritizing such needed
attention over other factors including cost and payment, as
well as law enforcement requirements.
1) Recognize that emergency treatment and prioritization do
not mean a waiver of the obligation to pay for services.
1) Immediately evaluate patients with medical emergencies,
including prioritization where necessary.
2) Maintain a sufficiently responsive and efficient 24- hour
uninterrupted emergency unit in the facility.
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Right to reasonable Visitation
• Patient right
1. Receive visitors including for religious purposes according to the rules and
regulations of the facility.
1. Recognize that health care facilities are for several people. As such, respect
operational rules and systems for the safety and security of all.
2. Respect the fact that health care facilities reserve the right to modify rules
to maintain decorum and ensure the security of patients and caregivers,
provided reasonable notice of modification is given.
1. Inform patients and relatives of visitation rules upon admission and any
subsequent modification.
2. Conspicuously display visitation rules/ schedule of the facility
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Right to Patient’s Refusal of Care
• Patient right
1. Patients at all times retain control of their personal and must be informed
of their power to decline care upon full disclosure of the consequences of
such decisions.
2. Patients have the right to consent or decline participation in medical
research, experimental procedures, or clinical trials in the course of
treatment.
1. Comply with rules and regulations of the facility as well as directives,
instructions, and advice of attending professionals.
1. Recognize that minors (less than 18 years) are under the care of parents or
guardians whose consent must be secured in clinical management and
procedures to the extent permitted by law.
2. All medical research, experimental procedures, or clinical trials must comply
with approved ethical procedures.
3. The provider may detain the patient in the interest of public health
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Right to be informed about interruption
of Service by Provider
• Patient right
1) To be informed about impending interruption or disengagement of
services of primary or attending professionals responsible for
patient's care.
2) The methodical and practical transition of treatment for patient
safety and continuity of care.
1. Inquire about any contingency plan or other suitable alternatives
with respect to continuing care.
1. Reschedule patients' appointments in the event of inevitable service
interruption.
2. Render sufficient intervention to in-patients and emergency cases in
the event of inevitable service interruption.
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Right to reasonable Complaints
• Patient right
1. To express dissatisfaction regarding service and/or provider, including
personnel changes and abuse.
1. Complain in accordance with the redress mechanism of the facility.
2. Provide sufficient details of dissatisfaction.
3. If dissatisfied with the outcome, report to the appropriate regulatory
authority e.g. Nursing Midwifery Council of Nigeria (NMCN), Medical and
Dental Council of Nigeria (MDCN), and subsequently to the Consumer
Protection Council (CPC). if not satisfied with the additional interventions
then seek redress in the court of law.
1. Encourage patients to ask questions about the services.
2. Maintain records of complaints and redress procedures of the facility and
address complaints in accordance with procedure.
3. Inform the patient at the onset of the redress mechanism provided by the
facility and regulatory bodies, with timelines for action on complaints.
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Nurses bills of right
• Introduction
Nurses are known for having vast knowledge and expertise in
every health care setting across a wide range of specialties,
nurses serve their patients and communities throughout the
continuum of life and care. Nurses provide mental and physical
health care and wellness services while maintaining respect for
human dignity and delivering equitable, patient-centred care
regardless of race, origin, or background. It is vitally important to
acknowledge and respect the rigor of nursing practice as both an
art and science. To that end, and for their indisputable
contributions to society, education, public health, science, and
the health of all communities. (American Nurses
Association,2020).
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Nurses bills of right Cont.
With regards to the above contribution to global
human development, the American Nurses
Association (ANA) Board of Directors concluded
its discussion and voted to approve this revised
version of the Nurses Bill of Rights as of April
26,2022.(www.nursingworld.com/
nursesbillsofright/2022). They are
nonnegotiable rights for all nurses to meet up
with the increasing complexities of health care
delivery.
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Nurses bills of right cont.
1. Full authority for nurses to practice at the top of their license, credentials,
and professional standards without barriers, and in a manner that fulfils
their obligations to society, patients, and communities.
2. Continuous access to training, education, and professional development, as
well as pathways for nurses to be recognized as leaders and in roles to direct
shared decision-making on nursing practice, resources, staffing concerns,
and patient safety issues.
3. Work and practice in environments that ensure respect, inclusivity, diversity,
and equity with leaders who are committed to dismantling systemic racism
and addressing racist behaviours that negatively impact nurses of colour.
4. Just care settings that facilitate ethical nursing practice, standards, and care
in accordance with the Code of Ethics for Nurses with Interpretive
Statements.
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Nurses bills of right cont.
5) Safe work environments that prioritize and protect nurses’ well-
being and provide support, resources, and tools to stay
psychologically and physically whole
6) Freedom for nurses to advocate for their patients and raise
legitimate concerns about their own personal safety without
the fear of retribution, retaliation, intimidation, termination,
and criticism.
7) Competitive compensation consistent with nurses’ clinical
knowledge, experience, and professional responsibilities and
that recognizes the value and rigor of nursing practice.
8) Collective and individual rights for nurses to negotiate terms,
wages, and work conditions of their employment in all practice
settings. 31
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Implications to Nurses
1. Nurses as patients advocate are required to master and become
used to the PBoR to enable them, advocates, for their patient at
any instance.
2. Nurses as patient advocates need to strictly ensure the proper
compliance of patient bills of rights.
3. Nurses as patient educators should take it as their duty to educate
the patient on the bills of rights.
4. Nurse managers should ensure strict compliance of PBoR by Nurses
and those found wanting should be finalized according to national
laws of nursing and midwifery act, not by hospital by-laws.
5. Nurse managers should ensure no Nurses' bills of rights is infringed
in an attempt to enforce patient bills of right.
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Implications to Nursing Practice
1. It makes the nursing role of advocacy more prominent, and clearly stated
the role of nurses in protecting the interest of patients.
2. It shows the uniqueness of Nursing Practice as the only profession that
can guarantee the safety of the patient.
3. Proper compliance of nurses on PBoR will help in bringing sanity to the
profession which will consequently redeem back the societal respect for
the profession.
4. Proper compliance by the nurses, will give the profession the respect and
full autonomy it deserves from other health professionals as the most
discipline profession.
5. Nurse managers should take ensuring the strict compliance of PBoR by
Nurses, and other health professionals as part of their managerial role,
thereby creating more schedules for nurse managers and makes the
nursing profession grow more in the aspect of patient advocacy. 33
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Some instances and scenarios
• If a patient is discharged by the doctor and has some pending balance on
his bills should the patient be allowed to go home or should be retained in
the hospital until the bill is settled?
• A known hypertensive, 70 years old man was on his way to his hometown
alongside his entire family got involved in R.T.A and had all the entire
family died except him that sustained serious injuries. On examination, his
B/P was found 200/160mmhg and anxiously asked about his family. Should
the patient be informed about his family at that instance?
• A terminally ill C.a patient was brought by midnight to the A&E unit been
referred from another hospital on examination you found SPO2 reading
72% and 15% PCV, and you don’t have enough oxygen to be served and
there is no reserve blood in the blood bank. Which patient right is been
violated and who violate it?
34
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Instances and scenarios cont.
• Hospital management created some bye laws that directly or indirectly
violated the PBoR which by common sense will surely help the hospital
to grow, in which when the nurses refused to comply will be punished
for insubordination in accordance with civil service rules. Please as
nurse manager which law will you recommend for the younger nurses
to comply upon?
• As a nurse manager, a case of violation of PBoR is reported to you by
the hospital management against a nurse who is on night duty alone
managing more than 40 patients, 5 of them are on hourly RBG/FBG
monitoring, 4 on 2 hourly N.G tube feeding, and more than half are on
8 hourly I.V/I.M medication, and all are on 12 hourly vital sign
observation, plus other routing nursing care. And your investigation
proved the violation. Will you recommend the management to punish
that nurse? 35
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Recommendations
• To Nurses
1. Use it as an opportunity to reclaim back the autonomy to
practice the independent role of nurses in some hospitals
where nurses are denied to do so, as failure to do so will
amount to a breach in PBoR.
2. Take it as an opportunity to advocate for the patient
without fear of victimization.
3. Neglecting it will gradually make Nurses irrelevant to in
health care industry as the patient will gradually lose
confidence in Nurses and others will take advantage of
that to flush nurses out, so take it as an our added value.
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Recommendations cont.
• To Nurse managers
1. Making it the managerial role of nurses to reinforce the compliance
of PBoR will earned the nurses and the profession much respect
from society and other health professionals, please take it as one.
2. Making its reinforcement a managerial role for nurses will create
more schedules for nurse managers thereby creating more
vacancies in the carrier progression aspect.
3. An independent unit can be created as a subunit in the department
of nursing services which may be named a patient advocacy unit to
ensure the compliance of PBoR. This will create more schedules for
nurses and create more vacancies for employment and promotions.
4. Nurse managers should also ensure the proper implementation of
nurses' bills of right.
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• To National Association of Nigeria Nurses And Midwives (NANNM).
1. Even though few among our nurses have understood the logic why NANNM was
sidelined in the official launching of PBoR by CPC and FMHN which is dominated by
medical doctors. But was deliberately done, been them fully aware nurses are the
patient advocate and equipping nurses with those bills will be a big threat to their
illegal practice. Hence the reason for NANNM to take it as a challenge, to ensure every
nurse is well equipped both theoretically and practically through seminars and
workshops from the national, state, and local chapters on PBoR. And educate them on
how to use them to advocate for the patients.
2. NANNM in collaboration with NMCN should ensure the compliance of nurse
managers by making it a compulsory role of nurse managers to ensure compliance by
all nurses and other health professionals.
3. Creating awareness through the media houses to let the public know about the
advocacy role of nurses.
4. Recommend and bargain with the government to adopt nurses' bills of rights as a
national policy as adopted by the international council of nurses and the American
nurses association.
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• To Nursing And Midwifery Council of Nigeria
1. Ensure its inclusion in the training curriculum of every school of nursing and
department of nursing science of all universities.
2. Ensure the nurses are well equipped with PBoR by giving it special
consideration in the final council examination for nurses.
3. Ensure compliance of nursing leaders in creating patient advocacy subunit
under the nursing services department in all hospitals across the federation.
4. Creating awareness through the media houses to let the public know about
the advocacy role of nurses.
5. Collaborating with all relevant authorities like CPC, FMH, and MDCN, to
ensure the advocacy unit is given the special recognition it deserves to
function effectively.
6. Include respect for PBoR and NBoR in the professional conduct of nurses
and recommend a special punishment for the violators.
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conclusion
• PBoR is seen as a great tax and opportunity for Nurses to
be used in changing the public perceptions toward
Nurses and the Nursing profession and to claim back their
respect from the general public and other health
professionals.
• It is also seen as a tool that is once utilize properly can
lead to professional growth and expansion in the nursing
profession.
• It is also a tool that can make the nursing profession so
unique in its practice and increases the professional
autonomy of the nursing profession by making nurses'
advocacy role possible without fear of intimidation or
victimization.. 40
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Conclusion cont.
• Nurses' bills of rights are drafted to protect
the right of nurses because Nurses are also
human like patients as such their
fundamental rights need to be protected.
• Nurses should use PBoR and NBoR as tools
for better nursing care not as tools for self-
defence or self-victimization
41
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References
• www.health.gov.ng/patientbillsofright2018.
• fccpc.gov.ng/patientbillsofright/2018.
• www.nigeriahealthwatch.org/
nigeriabillsofright2018.
• Https//:Thenigerianlawyer.com/
nigeriapatientbillsofright/18/jul/2018.
• www.crhnigeria.org/
nigeriapatientbillsofright/15/9/2022.
• www.nursingworld.com/icn/
nursesbillsofright/2022.
• Online oxford dictionary updated 2022.
42
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THANK YOU
FOR
LISTENING,
NURSES ARE GREAT!!!
NURSES ARE BEAUTIFUL!!!
43
BNSC) FTH KATSINA
07/10/2022

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