Bill of Patient Right Awareness and Its Implementation in Operation Room from Viewpoit of Anesthesiology and Operating Room Students in Jahrom University of Medical Science

1BSc of Nursing, Jahrom University of Medical Science, Jahrom, Iran. 2Medical Surgical Nursing, Faculty member of nursing & para-medicine school, Jahrom University of Medical Sciences, Jahrom, Iran. 3Medical Surgical Nursing, Teacher of nursing & para-medicine school, Jahrom University of Medical Sciences, Jahrom, Iran. 4Medical Surgical Nursing, Teacher of Nursing & para-medicine school, Jahrom University of Medical Sciences, Jahrom, Iran.

An individual who visits a medical center has physical , psychological,spiritual and social needs , so he or she not only be treated with respect, but his/her legal rights as a patient must be observed 1,2,3 .Patient are the most vulnerable groups because during a disease persons not only lose their physical ability but also they have economic, social and psychological stresses because of the disease 4 .So These rights include patients' legitimate physical, psychological, spiritual and social needs, all of which are considered in medical regulations which must be followed by all the members of medical teams.In other words, they are part of the responsibilities that a medical center has for its patients 5,6,7 .The objective of patients' rights charter is to protect patients' rights and dignity as human beings irrespective of race, age, gender, and financial status.In the patients' rights charter, it is stated that patients are entitled to private care, receiving precise information about their diagnosis, treatment, and prognosis, and making decisions about their treatment plans; yet, generally, a patient's treatment plan is considered confidential 3,8 .
In Iran, the patients' rights charter was enacted in 2002, when the Ministry of Health, Medical Treatment, and Education began to adopt a new and more comprehensive perspective on both the rights of the individuals who sought medical care and the observance of professional ethics in medical professions 9 .
Studies shows in every clinical care center that patients were more satisfied , patients' right has been considered better, which in turn expedites patients recovery process and decreases their lengths of hospital stay.Therefore, all the individuals who are involved in caring for patients should respect their rights, be adequately aware of the related regulations, and make an effort to fulfill their patients' expectations and provide them with quality care while treating them with respect 10 .If a medical team is not aware of patients' rights, it cannot observe those rights, which will result in a slower recovery process for patients, longer hospital stays, patients' irritability and dissatisfaction, and higher treatment costs (11) (12).Clinical students should be aware of patients' right and consider it in relation with patients, especially in patients who are anesthetized in the operation room and noting have the ability to protect themselves 13 .So piety and honesty should be one of the characteristics of operating room and anesthesiology students 14 .
Since students begin to learn the basic concepts and principles during their education, they should be taught patient right concepts to internalize moral values during their education 15 .The operating room and anesthesiology students are in contact with patient directly and it is necessary they be aware of patients' rights 13 .so this issue should be considered by universities of Medical Science as a special responsibility 16 The topic of patients' rights has become increasingly important in many countries over the past decade 17 ; a review of the history of patients' rights in the world will verify the claim 18 .In many valid Islamic documents, too, observance of patients' rights and providing patients with the best possible care are frequently stressed and a great divine reward is promised for such behavior 19 .
The results of the study of Shiraz et al. show that intern and surgery students' knowledge of medical ethics is very poor and ethical issue should be considered in their education 20 .Also, according to sanagoo et al.study ethical communication with patients can improve the professional ethic and result in patient satisfaction 13 .
A review of the available literature on patients' rights revealed that there were no studies on observance of patients' rights in operating rooms.In operating rooms, where patients have to go through various procedures, among them receiving local and general anesthetics, it is mandatory that students be aware of patients' rights; every clause in the Iranian patients' rights charter is based on our religious beliefs and national values, it is important that we identify the barriers to and strategies for implementing the charter.Accordingly, the present study aims to determine the current level of awareness and observance of patients' rights from the perspective of the students in the operation room of the jahrom university of medical science.

Study Population, Sample, and Sampling Method
The present study is a descriptive, crosssectional project which aims to determine the patients' rights from the perspectives of students in the operation room.Based on a review of the available literature on awareness and observance of patients' rights charter, sample size was set at 130 subjects.The Jahrom university of medical science formed the research environment .All the operating room and anesthesiology students who passed at least one course in the operation room were included in the study.

Study Instruments
A researcher-designed questionnaire was used to collect data ; The questionnaire was developed in three parts: demographics, awareness of patients' rights charter (6 items), and observance of patients' rights charter (9 items) from the perspectives of the students in the operating rooms.These items summarized in four parts include: rights for access to medical services, rights for Access to information, Choice of treatment right and right of Providing patient privacy.The items were scored based on a 5-point Likert scale, ranging from 0 to 4, and the score results were reported as averages.
The questionnaire was completed by the students .To ensure the validity of the questionnaire, the researchers did a comprehensive review of the available literature, including the Patients' Rights Charter as enacted by the Ministry of Health, Medical Treatment, and Education, and consulted the faculty members of Jahrom University of Medical sciences.
To determine the reliability of the questionnaire, the researchers used the pretestposttest method: the researchers had 20 individuals complete the questionnaire and found the Cronbach's alpha for awareness and observance to be 0.7 and 0.83 respectively.

Data Analysis
Collected data were analyzed using descriptive and inferential statistics on SPSS (statistical pakage for the social science, version 21, Inc., Chicago, IL, USA).using descriptive statistics, standard deviations , frequencies,correlation and Mann-Whitney test.

Intervention
After the research proposal had been approved by the Research Committee of Jahrom University of Medical Sciences, The students were sampled based on the census method.They were assured that their responses would remain confidential, and that their names were not required.The researchers observed the ethical considerations.Overall, the distribution and collection of the questionnaires took in 3 month.

RESULT
The total number of the students surveyed was 130, 68.5% of whom were female and 31.5% were male; their average age was found to be 21±1.93.The students' majors were either anesthesiology or operating room.The results showed that 63.1% were aware of patients' rights and their main source of information in this regard was their teachers (49.2%).The share of other ways, including receive information through books, articles and other resources was( 13%), (1% )and (4%).
The average patient's-rights-awareness score of the students was 20.061±3.411.thelowest and highest score was 9and24.The average patient's-rights-observance score of the students was 18.891±6.281.thelowest and highest score in this part was 6and32.
Also, based on the Mann-Whitney test, there is not a significant difference between the levels of awareness and observance of patients' rights from the students' perspective based on their majors (Pe"0.05).The result of the Mann-Whitney test shows that there is a significant difference between the levels of awareness and observance of patients' rights from the students' perspective based on their gender (Pe"0.05).( Table1) Although Awareness of Right for Access to information was in the high level in students' perspective,observance of right for access to medical services has the highest score in students' perspective.( Table2) Pearson test showed a significant correlation between awareness and observance of patients' rights from the students' perspective(r= .229)

DISCUSSION
According to the results of the study the students' awareness of patients' rights was in the high level.AlthoughIn his study, rangbar states that nursing students awareness was in the high level 21 , Gholch says the awareness of patient right among nurses was in the moderate level.Students are connected to the educational environment and as this study show they get a lot of information from their masters during their education.so The importance of education in the patient right issue is clear and it should be considered specially for operating room and anesthesiology students 22 .
Mosadegh rad states that just health provider awareness of patient right is not sufficient and they should apply these rights meanwhile care providing 23 .the result of this study show although the awareness of patient right was good, their attitudes toward observance of patients' rights is not Satisfying.The similar results  24 .This may be due to the work load of nurses, fatigue, lack of manpower and having multiple shifts 22 .
There was a difference between the female and male students' as there was a difference between their attitudes toward observance of patients' rights: although the female students' awareness was higher than the male students', their performance was poorer.there was the same difference In Rangraz et al. study (8).It can be attributed to the male students' greater courage for work in clinical environments, greater physical strength, or higher motivation (e.g.financial reasons) for participation in social activities 8 .
Although Bathaee reported that the anesthesiology students were more aware of patient right (16) , there was no difference between the levels of awareness and observance of patients' rights from the students' perspective based on their majors because the operating room and anesthesiology students has the similar work condition and so there was no considerable difference between them.
The researcher also reports that 68.4% of the students were satisfactorily aware of the patients' right to having access to medical services 25 .However, in the study of Ranjbar et al., only 23% of the students had a satisfactory awareness of patients' rights in this area; also, 35.6% of the students had a poor, 27.7% had a moderate, and 36.7% had a satisfactory awareness of the patients' rights charter 26 .On the other hand, in Yaghoubi's study, the majority of the medical and nursing students are reported to be sufficiently aware of patients' rights 27 .
In the study of Khodamoradi et al., 71.5% of the students had a sufficient awareness of a patient's right to accept or refuse treatment, while in Ranjbar's study, 46.8% of the students were found to have such awareness to a satisfactory extent.Also, regarding the confidentiality of a patient's information, 69.8% of the students in Khodamoradi's study and 32.7% in Ranjbar's study had a satisfactory awareness of this right of patients 25,26 .
Since during their clinical training, students are in direct contact with patients, they need to be aware of and observe patients' rights like the other members of medical teams.Yet, since students' participation in treatment plans may not directly benefit patients or may even cause problems for them, some people question such participation for ethical reasons; students also need to learn to respect patients and keep their information confidential 26 .
The result of this study show correlation between awareness and observance of patients' rights from the students' perspective .thesimilar result has been reported in Gholch et al.study.awareness is the first step for doing a work in a correct way, so regarding patient right issue is not possible without having knowledge about it 22 .

CONCLUSION
In the domain of health and medical treatment, where protecting people's health and lives is the primary goal of the individuals who work in this field, observing patients' rights is especially important .The results show although patient right awareness in perspectives of students is high ,observance of these right is not acceptable and researcher suggests more study should be done in the future.
Patients are the most vulnerable groups.Patient Rights are physical, psychological, spiritual and social needs that medical team should perform these rules meanwhile on duty.For achieving this aim, the knowledge of medical staff is important.operation room has a special condition for the patient because he should be present there alone .So the issue of patient right is more important in this ward .The objective of the present study is to investigate the Bill of Patient Right Awareness and Its Implementation In Operation Room from viewpoit of students.In this desciptive study ,130 students in operating room and anesthesiology major were choosed by census method.The data collection tool was a questionnaire that formed by the researcher .It was included three parts; demographic information,bill of patients' rights awareness & its' implementation.The data were analyzed by using SPSS software.The means of patient right awareness & its' implementation in viewpoint of students is 20.06±3.41 and 18.89±6.27.The results of Pearson correlation test showed that there was a significant relationship between awarenss score about patient right &its implementation.(r=0.229).The result showed although student awareness of ptient right was in a high level,implementation of this right is not so good.Keyword: Bills of Patint right, Awareness, Implimentation, Operation room.

Table 1 .
The levels of awareness and observance patients' rights from the students' perspective based on their gender and their majors

Table 2 .
Awareness and observance of patients' rights from the perspectives of students