Abstract
BackgroundHealthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal.MethodsThis was a cross sectional study conducted among resident doctors (n = 118) and ward nurses (n = 86) in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer’s V value was assessed to ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05.ResultsOur study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath (33 % of doctors and 51 % of nurses were unaware), Nuremberg code (90 % of both groups were unaware) and Helsinki Declaration (85 % of doctors and 88 % of nurses were unaware). A high percentage of respondents said that their major source of information on healthcare ethics were lectures (67.5 % doctors versus 56.6 % nurses), books (62.4 % doctors versus 89.2 % nurses), and journals (59 % doctors versus 89.2 % nurses). Attitude of doctors and nurses were significantly different (p < 0.05) in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula (97.4 % doctors versus 81.3 % nurses),paternalistic attitude of doctor was disagreed more by doctors (20.3 % doctors versus 9.3 % nurses). Notably, only few (9.3 % doctors versus 14.0 % nurses) doctors stood in support of physician-assisted dying.ConclusionsSignificant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0154-9) contains supplementary material, which is available to authorized users.
Highlights
Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal
Future doctors and nurses are expected to learn and abide by these ethical principles and documents as early as possible in their career. This warrants appropriate education of such principles; challenges remain in resource-poor settings such as Nepal, where curricula barely mandates the teaching of medical ethics didactically
Study settings A cross-sectional study was performed among resident doctors and ward nurses of Tribhuvan University Teaching Hospital (TUTH) which is one of the biggest and reputed medical institutions in Nepal
Summary
Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The four basic principles of medical ethics (autonomy, justice, beneficence and non-maleficence) form the foundation for health professionals to guide and decide what practices are ethical in clinical settings [4, 5]. These basic ethical principles are grounded on the major documents of healthcare ethics (Hippocratic Oath, Nuremberg code and Helsinki declaration). Future doctors and nurses are expected to learn and abide by these ethical principles and documents as early as possible in their career This warrants appropriate education of such principles; challenges remain in resource-poor settings such as Nepal, where curricula barely mandates the teaching of medical ethics didactically. Students and junior doctors in medical schools have been found to learn healthcare ethics subtly via the seniors popularly termed as the hidden or silent curriculum [7]
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