Assess The Knowledge on Legal and Ethical Aspects in Nursing Practice Among Staff Nurses Working at Selected Hospital Puducherry.

: The study was conducted to assess the level of knowledge on legal and ethical aspects in nursing practice among staff nurses using quantitative approach, descriptive research design. Semi self structured questionnaire was used to assess the level of knowledge on legal and ethical aspects in nursing practice among staff nurses working at selected hospital Puducherry. Fifty subjects were selected from IGGGH &amp; PGI,East Coast Hospitals using convenient sampling technique. The findings revealed that knowledge 31 (62%) of them had adequate knowledge and 18 (36%) of them had moderately adequate knowledge 1(2%) of them had inadequate knowledge. with the mean and standard deviation of 14.83+2.669. This showed that the staff nurses are had adequate knowledge.


INTRODUCTION
Nursing ethics and law are necessary in nursing because nursing is concerned with providing services that impact on human life and health and some of the situations the nurse encounters in practice pose dilemma that if not well handled, may impact negatively on the client and all who are concerned. Standards must therefore be set to guide the nurse to conduct herself properly, make adequate decisions and carry out actions that are appropriate and safe for the client and thus protect her from litigation. This expansion has focused new concerns among nurses. [1] According to the INC Code of Nursing Ethics includes Advocacy, Responsibility, Accountability and Confidentiality. Nurses should be sensitive to the ethical challenges and do their best to fulfill their moral duties. It also emphasizes the importance of informed consent and address main ethical issues in everyday practice such as respect to privacy and confidentiality of patients, clients, relationship with colleagues, efficient performance of the professional duties and protection of participants in research. The nurse"s education, license and standard provide the framework by which nurses are expected to practice.

NEED FOR THE STUDY
Today nursing is considered as a discipline of higher technology coupled with a wealth of complex information. As technology is advancing at a rapid speed, nurses involved in patient care should up-to date their knowledge. Having knowledge only is not adequate they should apply this knowledge while providing care to patients to improve the health of patients and to prevent development of complications. This will lead to development of nursing profession. [7] Fierce Health Care journal posted Malpractice claims against nurses have increased in recent years, according to a new report published by the Nurses Service Organization (NSO) March 29, 2017. [7] Nursing professionals need to improve and update their knowledge in regards to legal and ethical principles and incorporate the knowledge in decision making in daily practice. This knowledge allows nurses to adopt the legal safeguards and adhere with ethical principles into their practice which in turn, enables them to understand and cope with new trends through updating their knowledge and to disseminate the same to the nursing professional for the betterment of their nursing care in the future. [13]

STATEMENT OF THE PROBLEM
A study to assess the knowledge on legal and ethical aspects in nursing practice among staff nurses working at selected hospital Puducherry.

OBJECTIVES
➢ To assess the level of knowledge on legal and ethical aspects in nursing practice among staff nurses.
➢ To associate the level of knowledge on legal and ethical aspects in nursing practice among staff nurses with selected demographic variables.

OPERATIONAL DEFINITION ASSESS
It refers to find out the knowledge of the nurses working in hospital on legal and ethical aspects.

KNOWLEDGE
• Knowledge can be defined as awareness of facts or as practical skills, and may also refer to familiarity with objects or situations. Knowledge of facts, also referred to as propositional knowledge, is often defined as true belief that is distinct from opinion or guesswork by virtue of justification.

LEGAL
• Legal is the word used to define anything that concerns the law or its workings. It is applicable to all practices, languages, processes, procedures, cultures, and other relative concepts in a system of the law.

ETHICAL
• Ethics is the word used to define the traditional norms and morals of an individual • Decisions regarding what is right or wrong, often a system that is use to protect the rights of humans.

NURSES
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.

ASSUMPTION
• Adequate knowledge on legal and ethical aspects in nursing practice among staff nurse and the knowledge same can be presented to appropriate assessment. • Nurses may have varying level of knowledge on legal and ethical aspects in care of patient.

HYPOTHESIS
H1: There will be significant difference in knowledge on legal and ethical aspects among staff nurse. DELIMITATION 1. Age group >22years 2. Study delimited to period of 4weess.
3. This study is limited to staff nurses those who are working in selected hospitals. Suda, et.al., (2018)., has conducted a study on ethical guidelines for medical and health research involving human subjects enforced by the Japanese government requires investigators to endeavor to obtain informed assent from minors under 16 years old who are considered capable of expressing their intentions. One of the ethical issues surrounding birth cohort studies is how to obtain informed assent from children as they grow up. Investigators can provide materials that support parents and give children age-appropriate information about their participation, as well as ensure opportunities for children to express their feelings. [19] Hans Ulrich Bucher et al., (2018)., had conducted a survey among 552 neonatologists and neonatal nurses to analyze practices, difficulties and parental involvement in end-of-life decisions for extremely preterm infants in level III NICU in Switzerland. The study revealed the difficulties with EOL decisionmaking were reported more frequently by nurses than physicians: insufficient time for decision-making, legal constraints and lack of consistent unit policies. They concluded that the divergencies between nurses and physicians may be due to differences in ethics education and direct exposure to the patients. Acknowledging these differences is important to avoid potential conflicts within the neonatal team but also with parents in the process of end-of-life decision-making in preterm infants born at the limits of viability. [20] Eva Bergsträsse,et.al., (2017)., had conducted a study about qualitative approach study was done an integral part of a Nationwide observational study entitled, "Pediatric End-of-Life Care Needs in Switzerland" aimed to explore and understand human experiences and behaviours in different situations and how individuals perceive and interpret them. Paediatricians and Pediatric nurses, including community nurses and associated health/social professionals. Nurses often preferred to reflect on events in a less medical way with supervision during EOL care situations or in structured debriefing sessions. [22]

METHODOLOGY: Research design
Descriptive design was selected for study.

Variables
Variables included in the study were;

1.Dependent Variable :
Level of Knowledge on legal and ethical aspects in nursing practice.

2.Independent variable:
Assessing level of Knowledge on legal and ethical aspects in nursing practice

Extraneous Variable:
Individual difference in subjects, among peer group, social influence.

Settings of the study
The participants of the study were selected from selected Government and private hospitals. (IGGGH & PGI, East Coast hospitals) in Puducherry.

Population Target population:
Staff nurses age >22 years. Accessible population: >22 years of age who were working at selected hospital in Puducherry.

Sample
All the staff nurses who were working in selected hospital at Puducherry, who fulfilled the inclusion criteria and who were available during the period of data collection.

Sample size
The sample is a subset of population selected for particular study.
The sample size was about 50 staff nurse.

Sample technique
Convenient sampling technique was adopted for this study.

Criteria for sample selection Inclusion Criteria:
➢ Staff nurses who were working in selected hospital ➢ Age group of above 22 years. ➢ Staff nurses who were willing to participate in the study. ➢ Those who were all available during the period of data collection.

Tools and instrument: Development of data collection instrument:
The modified self structured tool was developed in English after expert's opinion, extensive review of literature and internet search which helped the investigator to select the suitable questionnaires for assessing the knowledge on legal and ethical aspects in nursing practice among staff nurses working at selected hospital.

Section -I Demographic variables;
It includes age, qualification, designation, area of working, year of experience.

Section II:
• This section consists of knowledge questions on legal and ethical aspects in nursing practice among staff nurses. Right answers was scored as 1, wrong answers was scored as 0

Validity of the tool
The validity of the tool was evaluated by nursing research experts. The suggestions given by the experts were adopted and the tool was modified accordingly.

Ethical consideration
Researcher was informed about the study and informed written consent was obtained from each participants. Hospital research committee clearance and permission was obtained from the hospital medical superintendent to conduct the study.

DISCUSSION AND ANALYSIS SECTION B:
Assess the level of knowledge on legal and ethical aspects in nursing practice among staff nurse.

LIMITATIONS
✓ The researcher could not generalize the study finding as the sample size small and also conducted the study in only two hospital setting. ✓ The researcher does have interventional study in large group and also for longer duration

RECOMMENDATIONS
On the basis of the study the following recommendations have been made for further study.
• This study can be replicated in different setting with larger subjects.
• A comparative study can be done with private and Govt. Hospital, urban and rural setting in nursing services. • The study can be done among student nurse.

CONCLUSION
Study was conducted to assess the knowledge of nurses, which is essential for performing their activities and update their knowledge and practice on legal and ethical aspects in nursing practice. Nursing personnel must have holistic knowledge on legal and ethical aspects in care of patients and its prevention. The present study had been supported by a series of other studies which confirmed that the knowledge on legal and ethical aspects in nursing practice. All the legal and ethical principles are aimed at safeguarding the rights of life.