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A Survey of Factors Related to Nurses’ intention to respect for the law based

on “Reasoned Action Theory” in Tehran University Hospitals in 2010

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CNB Scholar Journals

Journal of Biology and Today's World

Journal home page: http://www.biology.cnbjournals.com

ISSN 2322-3308 2013, volume 2, issue 12, pages: 520-523

Research Article

A Survey of Factors Related to Nurses’ intention to respect for the law based on “Reasoned Action Theory” in Tehran University Hospitals in 2010

Meimanat Hosseini1, Tahereh Ashktorab2, Zohreh Khavari3*, Maryam Mohammadi4, Saeed Ghasemi5, Kazem Barzegar6

1PhD of nursing , Dept. of Community Health Nursing, Faculty member of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Associate Professor, Dept. of Medical –Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3faculty member of nursing, school of nursing and midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 4Nurse Manager of Vali e Asr hospital, Imam Khomeini Complex Hospital, Tehran, Iran 5faculty member of nursing, School of nursing and midwifery, Neyshabor University of Medical Sciences, Neyshabor, Iran 6PhD S. in TEFL and faculty member at the English Language Department, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran A R T I C L E I N F O A B S T R A C T Article history: Received 25 December 2013 Accepted 01 January 2014 Published 26 January 2014 Keywords: Law, Nursing, Theory of Reasoned Action, path analysis *correspondence should be addressed to zohreh khavari, faculty member of nursing school of nursing and midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Email: khavaryz394@gmail.com

Nursing Care providers and clients have rights and responsibilities and have rules and conditions, which must be always observed and respected. This descriptive–correlational study was conducted to determine factors related to intention to respect for the lawbased on the Theory of Reasoned Action in nurses at university’s hospitals. 145 nurses were selected by purposive sampling method. A questionnaire with 65 items was used including 4 parts: external variable, attitude, subjective norm and in-tention to respect law. Content and face validity was used for this questionnaire and reliability of the instrument was determined by internal consistency and test-retest methods, respectively. Using analysis variances, T-test, regression, and correlation coefficient, the relations between variables were obtained. Finally, using the path anal-ysis test, the causality model was assessed. The results showed that %67 of nurses had positive attitude, %56.9 of nurses had positive subjective norm, and %93.6 of nurses had high intention to respect for the law. Causality assessment revealed that the model derived from research. Using path analysis it was shown that nurses’ inclination to respect law was related to intention. However, subjective norm did not relate to re-specting the nursing law. © Copyright 2013 Meimanat Hosseini et al. This is an open access article distributed under the Creative Commons Attribu-tion License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Law can be defined as a collection of regulations, which have increased in recent years parallel to the changes in the role of nurses, and its domain and complexity in nursing. However, nurses have been en-couraged for their activities as supporters of patients and protectors of immunity and safety standards, and for prevention of risks and dangers [1-2]. Nurses are increasingly concerned with legal and ethi-cal dilemmas in clinical decision-making. The law impacts across a wide range of issues in nursing practice. It is important for healthcare professionals to be aware of the way in which the law regulates their professional practice. In this article John Tingle and Jean McHale, in-troduce a new series of articles on law for nurses [3]. The legal aspects of nursing activity and understanding the relations between nurses and law and legal responsibilities of a nurse’s profession scope are of utmost significance [4]. The rules and regulations of the nursing pro-fession are compiled to make sure of health, safety, and welfare of the masses and maintaining the integrity of the nursing profession. Any debate of the legal foundations of the nursing activity should start with determining an understanding of the rules and regulations su-pervising their activities [5]. The most logical principle of becoming a nurse is recognition of the legal responsibilities and duties in the nurse’s profession. Failure in recognizing these duties and ineffective defense in specific circumstances exposes the nurse to legal conse-quences [1]. During their daily round, nurses provide patients with special cares, treatments, and medicines, examine the patients physi-

cally, and make various decisions related to their health [6]. Yet, they spend little time pursuing their ethical and legal charges. Nurses often make vital decisions regarding their patients’ care. They do this quick-ly due to great work pressure. Sometimes they make mistakes [7]. The nursing crimes in the USA include inappropriate behavior toward the patients, substandard nursing care, nursing activity without holding a license, giving a false nursing permission to the employee, burning the crippled with a chemical, giving lethal drugs to patients, and some-times giving a lethal dose of lidocaine, insulin, or potassium chloride to the old or very ill patients [8]. In Iran, the common complaints of patients against nurses include falling from the bed, the wrong injec-tion of medicine into the patient's vein, negligence in giving proper care, prescription or administration of drugs without the order or ad-vice of a physician, the injection of drug in the artery or in a site where it caused a peripheral nerve damage, leaving the catheter in place for an unusually long time, threatening or assaulting and beating the pa-tient specially the children, cooperation in illegal curettage, commit-ting euthanasia, manipulation and the illegal changing of the records in the patient's file, giving away the secrets of the patients, and avoid-ing to give help to the emergency clients [9]. Fortunately, a low per-centage of these mistakes lead to damage to patients and of these low cases, a few of them embark on legal pursuit and damage compensa-tion. Nevertheless, the number of legal pursuit against nurses is in-creasing constantly [7]. Based on the studies conducted so far, the “Reasoned Action Theory” is one of the best theories, which can be used in relation to behavioral attitudes and beliefs [10]. The Reasoned Action Theory is a socio-cognitive theory proposed for the first time

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by Fishbein in 1967 and expanded later on by Aizen&Fishbein in 1975[11]. This theory which contains a framework for the study of at-titudes towards behavior, was first introduced to describe the stability or instability of the relations between attitude and behavior[12]. Two factors related to the individual’s intention for behavior and perform-ing the behavior are known to be effective in this theory. They include attitude and subjective norm. With attitude we mean an individual’s assessment of the positivity or negativity of a particular behavior and with subjective norm we mean a kind of social pressure affecting the performance or avoidance of a behavior. In a study that conducted by Hosseini et al aimed at determining the factors related to the nurses’ intention for respecting the nursing rules based on Reasoned Action Theory in the psychiatrics departments of Tehran University teaching hospitals the assessment of causality model showed that the two vari-ables of age and the average monthly work hours were positively cor-related with attitude towards respecting the nursing ethical code. In addition, attitude was positively correlated with the intention for re-specting the nursing moral behavior [11]. The findings of the study al-so revealed that nurses’ attitudes towards respecting the nursing ethi-cal code was significantly correlated with age, working experience, monthly work hours, and training in nursing ethical code. Rigger& Meek carried out an investigation to discover nurses’ responses to the committed mistakes in their clinical activities in the USA [13]. Using by grounded theory, the process underwent by nurses who received their committed mistakes during their nursing activities was discovered. A number of 10 subjects reported 17 personal mistakes. The process of self-reconciliation was obtained with the four categories of the reality of damaging, weighting it, practicing, and reconciliation. The nurses’ responses to committed mistakes ranged from unsound responses as hesitation and silence to sounder responses as betrayal, apologizing, and correction of the mistake. Regarding the obvious lack sufficient research on legal aspects of nursing and the related factors in Iran, the present study was conducted with the purpose of determining the fac-tors related to nurses ‘intention to respect for the nursing law based on Reasoned Action Theory in Tehran University Hospitals in 2010.

2. Methods This descriptive-correlational study investigated the factors related to

nurses’ intention to respect for the nursing law based on the Reasoned Action Theory at Tehran University teaching hospitals. The population of the study consisted of the employed nurses at the teaching hospitals of Tehran holding post-diploma, BS, and MS certificates of nursing. The participants of the study included 145 employed nurses at the teaching hospitals of Tehran selected using the non-randomized pur-posive sampling. A self-report four-sectioned questionnaire was used for data collection. The items in this questionnaire were derived from a previous one developed by Hosseini et al which was reportedly valid and reliable [14]. The researchers had used Aizen’s recommended questionnaire to develop their own questionnaire via studying the re-lated articles, thesis, dissertations, and the related references and texts and modified it to fit the Iranian culture [15]. In this study, ques-tionnaire was a 5-scale Likert stylewith four sections as the following: Demographic information (11 items) including age, sex, marital status, working experience, education level, employment status, any training course on nursing law and its duration, the ward type, the nursing work shifts, and the average working hours; Attitude towards respect for the nursing law (21 items); The subjective norms of respect for the nursing law(10 items); And intention to respect for the nursing law(23 items).

3. Validity of the Instrument In this study, the validity of the questionnaire was determined by the

Waltz & Basel Index method [16]. To determine the face validity of the questionnaire, it was given to ten faculty members of the School of Nursing & Midwifery of Shahid Beheshti University and ten qualified nurses and their opinions on the questionnaire was surveyed and ap-plied to it. The content validity coefficients of attitudes, subjective norms, and intention were 96.43%, 92.26%, and 89.29%, respectively. The overall content validity index of the questionnaire was 90.8%.

4. Reliability of the Instrument To establish the reliability of the questionnaire, test-retest and internal

consistency coefficients were used. To arrive at the internalconsisten-

cy coefficient of the questionnaire, it was given to 15 qualified nurses. Then, the Cronbach-α coefficients were calculated to be α=0.95, α=0.90, and α=0.70 for attitudes, subjective norms, and intention, re-spectively. Due to the low value of the Cronbach- coefficient for inten-tion to respect for the nursing law, one of the items of this section was removed so that the coefficient rose to 0.80.To determine the con-sistency of the instrument, test-retest was used. To do so, it was given to 15 qualified nurses after a 15-day interval .Then; the correlation coefficient of the two was calculated. These individuals were omitted from the final sampling. The value of intraclass correlation (ICC) was measured to be 0.94, 0.80, and 0.65 for the variables of attitudes, sub-jective norms, and intention to respect for the nursing law, respective-ly. The questionnaires were given to the nurses at the beginning of each nursing shift and they were asked to return the completed ques-tionnaires at the end of their shifts. Additionally, sufficient clear ex-planation was given as to how to fill in the questionnaire.

5. Data Analysis To analyze the data, SPSS17 was used and the resulting descriptive and

inferential statistics were presented in tables. In this study, the items in each section (attitudes, subjective norms, and intention of the ques-tionnaire were scaled from 1 to 5 and for negative items a reverse weighting procedure was used. The points were then divided into 3 equal parts (1.6 points each section) to determine the negative limit, indifference, and positive attitude of the obtained points. The assump-tion of equality of variances of the classes was tested. Then, using Kruskal-Wallis test, ANOVA, T-test, regression, and correlation, the re-lations among the variables were calculated. Finally, causality model assessment was done using the path analysis. The Reasoned Action Theory is given in Figure 1 and the model used in this study is pre-sented in Figure 2.

Figure 1. Aizen&Fishbein’s (1975) “The Reasoned Action Theory

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Figure 2. The model use to respect for the nursing law

6. Results The mean and standard deviation of the age of the participants was

32.34 ± 7.84. Most of the subjects (91%) were female. 50.3% of the subjects were married and 0.7 hold a nursing BS. The mean and SD of monthly working hours were 179.92 ± 43.88 h. 64.1% of the subjects were satisfied with their nursingshifts. 20% of them had passed the law training course. The findings of some demographic properties of the study participants are presented in Table 1.ANOVA revealed a sta-tistically significant difference in the attitudes of various age groups and the groups satisfied and dissatisfied with the nursing shifts. The findings of the study also revealed that 78.6% of the subjects had a positive attitude, 73.8% of the subjects had positive subjective norms, and 98.6% showed high intention to respect for the nursing law.

Table 1. Frequency, mean, SD, and P-value of some of the demographic variables of the

sample

Table2. The correlation between demographic variables and attitudes toward nursing law, and subjective norms of respect for the nursing law in the selected samples of nurses

working in university hospitals of Tehran in 2010

To investigate the correlation between some demographic variables and

attitudes toward respect for the nursing law and subjective norms of respect for the nursing law, Pearson correlation coefficient and T-test were used. The findings revealed that sex, marital status, and educa-tion level had no statistically significant correlation attitude toward respect for the nursing law and subjective norms of respect for the nursing law However, there was a statistically significant correlation between age and attitudes towards respect for the nursing law (P = 0.03, r = 0.21). To study the correlation between the components of the Reasoned Action Theory the Pearson correlation coefficient was used which revealed that attitudes towards respect for the nursing law had a direct positive correlation with subjective norms of respect for the nursing law (P = 0.001, r = 0.312). Furthermore, attitudes had a direct positive correlation with intention to respect for the nursing law (P = 0.002, r = 0.297). However, there was no correlation between subjective norms and the intention to respect for the nursing law

(Figure 3).

Figure 3. Path analysis model of factors related to intention to respect for the nursing law

based on the Reasoned Action Theory by the selected nurses at university teaching hospitals in Tehran in 2010

Using path analysis, the model above shows that attitudes towards re-

spect for the nursing law (β = 0.09) had a positive direct correlation with intention to respect for the nursing law. Also, subjective norms of respect for the nursing law (β = 0.09) had no correlation with inten-tion to respect for the nursing law. The causality assessment of the model showed that there was a statistically significant correlation be-tween attitudes towards respect for the nursing law and intention to respect for the nursing law. However, there was no significant correla-tion between subjective norms of nursing law respect and intention to respect for the nursing law.

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7. Discussion Regarding the significant correlation between attitudes and nursing law

respect revealed by the findings of this study, it can be predicted that responding appropriately to enhance the nurses’ positive attitudes towards nursing law respect will increase the probability of respect for the nursing law by them. On the other hand, the present study demonstrated that there was no significant correlation between nurs-es’ subjective norms and nursing law respect. This finding is not con-sistent with the logical behavior model. The findings showed that nurses were less concerned with the patients’ wants, lacks and opin-ions, their families, and hospital authorities. This can expose nurses of medico legal hazards and jeopardize their career. It seems that the nursing authorities should be concerned with this issue more than be-fore. The likely dangers may be reduced through holding law-training classes and debating the socio-legal challenges faced by nurses due to their lack of attention to the wants of the common people specially the patients’ families and attendants. Overall, there could not be found any issues related to nurses’ law observation based on the Reasoned Ac-tion Theory or similar studies. Therefore, we just refer to the relative-ly related research. Holt mentions some challenges of the assisted vol-untary death or euthanasia and the position of law authorities toward it and assistance in suicide in England in a review research [17]. The researcher enumerates the difficulties of conducting a research on at-titudes toward assisted death and the findings of reviewed published studies. A descriptive-correlational study by Hill, Nikoletti, and Myers was conducted on the ICU nurses to discover the correlation between the use of patient constrainers and attitude toward constraining pa-tients [18]. A questionnaire on understanding the use of confiners and attitude toward the meaning of old age was given to 201 nurses. The findings showed that there was a low positive attitude toward old age and patient confinement. Nevertheless, there was no correlation be-tween the scores of the two scales. Additionally, the nurses’ attitudes did not predict the use of confiners in their self-reports. Ultimately, it is recommended that more research be carried out on these issues due to the severe lack of studies on legal cases and its correlation with attitudes, subjective norms, and intention to respect for the nursing law.

8. Conclusion The results suggested that there is a significant relationship between at-

titude and respecting the law in nurses. Therefore, we can predict that measures, which affects positive attitude to respecting the law, can in-crease probability of respecting legal issues in nurses. On the other hand, this study showed that nurses’ attention to patients, their fami-lies and their official’s ideas were low. This could lead to nurses being exposed to legal risks. It seems that the nursing authorities should pay more attention to it.

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