EFFECTIVENESS OF STRUCTURED GUIDELINES REGARDING MANAGEMENT OF MEDICO- LEGAL CASES ON THE KNOWLEDGE OF NURSING PERSONNEL

1. Assistant Professor, Himalayan College of Nursing, Swami Rama Himalayan University. 2. Associate Professor, Himalayan College of Nursing, Swami Rama Himalayan University. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 January 2020 Final Accepted: 12 February 2020 Published: March 2020


ISSN: 2320-5407
Int. J. Adv. Res. 8(03), 371-375 372 The nurse practitioners must furnish themselves with requisite information to be paced with the changing needs and situations.This information may include management in hospital as well as in community health centers in treatment and follow up care, organ donation and transplantation, Intrauterine insemination, euthanasia, amniocentesis. 4 The investigator's own experience in clinical area has many such situations in store; where nursing care decision in medico-legal cases in emergency unit itself was difficult because of the absence of guidelines on management of medico-legal cases.Hence a need for clear written guidelines defining the medico-legal situation is strongly felt by investigator.

Purpose:
To improve the knowledge of nursing personnel regarding management of medico-legal cases

Rationale:
Developing the written guidelines regarding medico-legal cases is an important part of systematic efforts to increase knowledge of staff nurses, so that MLC's can be managed effectively.
Objectives:-1. To assess the knowledge of nursing personnel regarding management of medico-legal cases 2. To assess the effectiveness of structured guidelines on the knowledge of nursing personnel regarding management of medico-legal cases 3. To find association between pre-test knowledge score of nursing personnel with selected demographic variables 4. To find correlation between pre-test knowledge score of nursing personnel with selected demographic variables

Materials and Methods:-
Quantitative research approach with Quasi Experimental one group pretest posttest designwas adopted in the present study.Total 34 nursing personnelwere selected through total Enumerative sampling technique from emergency unit of Himalayan Institute Hospital Trust, Jolly grant, Dehradun, Uttarakhand. Written permission was obtained from ethical committee, HIHT and Administrative permission from Medical Superintendent, Nursing Superintendent of Himalayan Hospital. Written consent was taken from nursing personnel individually.The knowledge questionnaire was given to assess their pretest knowledge regarding management of MLCs.
On the 8 th and 9 th day an in-service education programme was conducted to introduce the structured guidelines on management of medico-legal cases to nursing personnel working in emergency unit all together in three sessions. A handout containing structured guidelines on management of medico-legal cases was given to nursing personnel for easy accessibility. On the 10 th day of in-service education programme, structured questionnaire was administered to assess posttest knowledge score. Table no.1 depicts that less than half (44%) of nursing personnel were aged between 26 to 33 years, about more than half (53%) of participants were females, most of (85%) were with GNM qualification, about (44%) of nursing personnel duration of clinical experience in nursing was between 0 to 5 years and majority (68%) had clinical experience in emergency unit between 0 to 3 years.  The data presented in Figure No.1depicts that the mean post test knowledge score of all domainsrelated to management of medicolegal caseswas apparently greater than that of their respective mean pre-test knowledge score. The mean percentage of knowledge score of pretest ranged between 46% to 85%, and in post-test scores, it varied between 84% to 97%. The domain with highest gain was in management of medicolegal cases (97 %). Hence it could be inferred that the structured guidelines on management of medico-legal cases improved the knowledge of nursing personnel regarding all four domains. 13.5±2.14 Independent Sample 't'-test, t=1.69 at df=32 at the level of p<0.05* Significant Table no.3showsthat the pretest mean of knowledge score (15.1±1.98) of males was higher than that of the of females with(13.5±2.14) calculated' value 2.25, which was significantat p<0.05. Karl-Pearson's correlation coefficient 'r',r= 0.34 at df=32 at the level of P < 0.05 * Significant Table No.4 reveals that only duration of experience in emergency unit was having statistical significant correlation with the pre-test knowledge score (r= 0.417; p=0.014). Hence,it could be inferred that more the experience of nursing personnel in emergency unit better the knowledge regarding management of medicolegal cases.

Discussion:-
Outcomes of the present study showedthat about 44% of nursing personnel were aged between 26 and 33 years, the mean age was 29.5, most (53%) of themwere females. Regarding professional qualification (85%) were GNM, (44%) had clinical experience between 0 to 5 years and (68%) of nursing personnel had clinical experience in emergency unit between 0 to 3 years.The findings were consistent with a descriptive study conducted by Hyde E C,(2006)regarding the knowledge of critical care nurses on liability problems at critical care setting. The results showed that (43.86%) of nurses had critical care nursing experience, (37.43%) had a diploma in nursing, (28.65%) had less than 2years experience in critical care unit and majority (86.31%) were permanent employed. 5 Present study reveals that Mean posttest knowledge score was significantlygreater(18.02 ± 1.02) than pretest with calculated t' value 9.44 at p<0.05 level. Outcomes were supported by research conducted by Ghosh.S.(2013) on knowledge regarding legal and ethical issues in care of children among nurses working in pediatric unit. The results presented that the mean post-test knowledge was significantly more than the mean pre-test knowledge score, with calculated 't' value 13.031. 7

Implication:
The present study emphasized on increasing knowledge of nursing personnel concerning management of MLCs in emergency unit.The nursing personnel can use their knowledge in maintaining legal records and reports which are essential for nursing practice and also Nurse Administrator can use the guidelines prepared by investigator for Inservice education of nurses and handling medicolegal casesin areas of nursing care such as administration of chemotherapy, nursing care of unconscious patients etc.

Strength:
Guidelines developed by researcher was useful for emergency setting

Limitation:
1. Generalization of the study findings may be limited due to selection of single hospital and small sample size