TEHRAN HOSPITALS MIDWIVES' KNOWLEDGE ABOUT PROCEEDING TRIAL FOR DISCIPLINARY VIOLATIONS AND FORUM OF TRIAL FOR OCCUPATIONAL CRIMES, YEAR 2003-2004

Simin Taavoni M Sc in Medical Education, M Sc in Midwifery, Faculty member of Iran University of Medical Sciences, Member of Nursing and midwifery Research Center of IUMS, Member of Pain research group of ACECR, IUMS Maryam Askari M Sc in Midwifery, Tehran University of Medical Sciences Farokh Taftachi, MD Associated professor of Iran University of Medical Sciences, Hamid Haghani Faculty member of Iran University of Medical Sciences Mahlega Allami M Sc in Nursing, Faculty member of Irastics, University of Rajshahi, Rajshahi-6205, Bangladesh University of Medical Sciences

Simin Taavoni E-mail: staavoni@iums.ac.ir

ABSTRACT Midwives who had been employed in hospitals have an important role in reproductive health and must be aware of the legal aspects of their occupation in order to prevent any problem in the course of their professional life. Aims: To evaluate the knowledge of midwives working in Tehran government hospitals about: 1) the proceeding trial for disciplinary violations, 2) forum of trial for occupational crimes. Methodology: This is a cross sectional study. We randomly selected 128 hospital midwives to fill in the questionnaire. The descriptive and ANOVA, T student, Toki tests were used. Results: The total average of samples' knowledge in the fields of proceeding trial for different disciplinary violations (37.57+- 20.92) and forum of trail for occupational crimes (38.56+ - 22.06) was weak. Referring to the proceeding trial for different disciplinary violations, there was a correlation between years of working and the questions in the fields of: care of delivery stage (P=0.002), and prescribing of drugs (P= 0.016). Also there was significant difference between the knowledge of samples with less than 5 years experience and 5-9 years experience (P < 0.05)(Toki test). There was significant difference between the knowledge of samples in the field of reproductive care, with having a second job in private midwifery office (P: 0.031). Conclusion and Discussion: It is recommended to revise the syllabus of the course "Midwifery Ethics and Regulations" in order to include topics discussed in this study and enhance the level of medico-legal knowledge of the midwives. In this study we selected our study group from hospitals in Tehran city. It is better to carry out the same study with the midwives' work in other areas in Tehran and other cities as well, and compare the results.

Key words: Proceeding trial for disciplinary violations, Forum of trial for occupational crime, Malpractice, Midwife. INTRODUCTION

As health care rapidly evolves medico legal issues play an increasingly important role.

1. The potential for errors is great in a complicated endeavour such as medicine and in complex settings such as hospitals.
   
2. Since the societies information about law and ethics has increased many institutions support patients and help them recognize their rights.
   
3. The incidence of complaints by clients is increasing.
   
4. Being accused and going to the court is a big crisis and can cause distress, depression and physical ailment for the medical groups.
   
5. There are different organizations to look into malpractice cases, and all Medical groups should know these organizations to save time.
   
6. In Iran despite the fact that the Ministry of Health and Medical education and Cure has paid much attention to Medical ethics and law, there is very little research in this field. Issues involving human reproduction have many interfaces between medicine and law.
   
7. As basic coordinators between families and health centers, midwives have an important role in the reproductive health of the community. Especially midwives who are employed in hospitals where they have a big responsibility. They must be aware of the legal aspects of their occupation in order to prevent any problem in the course of their professional life. Therefore being familiar with the organizations and systems, which clients can take their complaints to, will prevent malpractice, and waste of time,
   
8. Midwives need to get to know their rights and related punishment. Najafie Abarandie emphasises the effect of knowledge in the field of proceeding trial for disciplinary violations and forum of trial for occupational crime, as they can prevent malpractice.
   
9. A study which assessed the knowledge of 400 nurses employed in Mashed Medical Sciences University hospitals in year 1998 showed that only 1% of the samples had high knowledge in the above mentioned subjects and unfortunately 43.5% of samples' knowledge was weak and very weak.
   
10. According to the above mentioned facts it eems that there should be a survey with the aim of assessing the knowledge of midwives who work in Tehran public hospitals about proceeding trial for disciplinary violations and forum of trial for occupational crime.

METHODOLOGY

This is a cross sectional study. In Iran, Ministry of health, Medical education and cure have Medical Sciences Universities in many big cities and each of these universities has some teachingand non-teachingpublic hospitals. In Tehran, there are three big Medical Science Universities (Tehran, Iran and Shahid Beheshtie University of Medical Sciences). Each of these universities covers 10-14 hospitals in which midwives offer their services. There were 251 employed hospital midwives. In this study we used multistage methods for choosing the samples during year 2003. Observing all ethical points finally 128 samples filled out the questionnaires. The questionnaires were valid and reliable and consisted of two main parts. Part one was personal characteristics and part two contained questions in the field of proceeding trial for disciplinary violations and forum of trial for occupational crimes. 24% of correct answers was named very weak, 24-49% weak, 50- 74% medium, and 75%- 100% was good. No one in the samples' family had law related professional education. We didn't include midwives with a PHD degree; M.SC nurse midwives and midwives with less than two years training courses. The descriptive statistics and ANOVA, T student, Toki test were used. Final data were put in 44 tables and then analyzed in year 2004. RESULTS

The results of the study showed that the mean knowledge of the employed midwives was weak about proceeding trial for different disciplinary violations and only 2.2% of the sample had a good knowledge (Total average= 37.57+- 20.92). It was weakest in the field of delivery stage care (31.78+ - 22.57) and midwifery ethics (26.55+ - 26.46). There was no significant difference knowledge of M. Sc midwives and B. Sc midwives. Using ANOVA the following results were obtained. There was correlation between averages of samples' knowledge with various job experience, in the field of delivery stage care (P=0.002) and prescribing drug rules. (P=0.016) Also there was significant difference between the knowledge of samples with less than 5 years experience and 5-9 years experience (P < 0.05)(Toki test was used). The knowledge of 5 years experience was lowest and knowledge of 5-9 years was highest. There was significant difference between samples' knowledge in relation to having a second job in the private office with the questions in the field of reproductive age care (P=0.031). The knowledge of the group which had asecond job in the private office was weaker. Referring to the knowledge of midwives in the field of forum of trial for occupational crimes the average samples' knowledge was weak and only 1.8% of the sample had a good knowledge (Total average= 38.56+- 22.06). It was weakest in the field of having a second job in the private office (19.76+ -17.48). There was no significant difference in knowledge of M. Sc midwives and B. Sc midwives. There was not any correlation in the field forum of trial for occupational crimes. CONCLUSION AND DISCUSSION

According to the Survey questions we found only 2.2% of the sample had a good knowledge of the proceeding trial for different disciplinary violations respectively. Pakdel and Madarshahian's results during their same survey in the field of nurses' knowledge were close to our results. (10) Jameison found lack of Medical students' Medico legal knowledge as well. (11) In this study we only found some correlations between averages of samples' knowledge in the field of proceeding trial for different disciplinary violations. There were correlations with various job experiences, in the field of delivery stage care and prescribing drug rules. Also there was significant difference between the knowledge of samples with less than 5 years experience and 5-9 years experience, (the highest one) and between samples' knowledge in relation to having second job in a private office, with the questions in the field of reproductive age care. Based on the findings of this study it is recommended to revise the syllabus of "Midwifery History, Ethics and Regulations" subjects to increase the level of medico-legal knowledge of the midwives. Also noting that the knowledge of M. Sc midwives, in the mentioned field was not higher than B. Sc, we suggest that at least 18 hours (one unit) in the above mentioned field to be added to their curriculum. It is also suggested that, the subjects of "rules' and regulations' " be instructed to the employees repeatedly. We didn't include midwives with a PHD degree; or M. Sc nurse midwives and midwives with less than two years training course in this study because there were not enough samples for comparing. We selected our study group from university public hospitals in Tehran; we suggest that similar study be done in other fields in Tehran and other cities for comparing of the results. ACKNOWLEDGMENT

This study supported by grants from the Research Deputy Department of Iran University of Medical Sciences. (Code: 2938/P, Year 2003-2005) REFERENCES

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