ABSTRACT
The aim of this study was to assess ethical practice among radiographers practicing in UNTH Enugu, NAUTH Nnewi and FMC Owerri. The study was carried out using a non-experimental prospective design, using a sample size of 40 radiographers from the three hospitals. The data collection instrument was a questionnaire containing 23 items. The results show that more than half of the respondents, represented by 56.4% attach a strong importance to ethical conduct, most explain the examination procedure to the patient as supported by 64.1% response. Most of the respondents obtain consent from the patient before carrying out the examination, this is supported as 41% strongly agree and 38.4% agree that patients also need to give consent for radiographic procedures. 59% of the radiographers’ in this study will attend to a patient despite violent behavior from him or his relatives. 64.1% of the radiographers do not carry out iodine sensitivity test in contrast investigations. It was also discovered that the RRBN rarely carry out facility inspection in the three hospitals studied as shown by 69.2% response. This result shows that is there is not only a high awareness of ethics among practicing radiographers but also there is reasonable attempt made to make practice ethical. However more effort is required to make practice in these hospitals truly standard and above reproach. The significance of this work is to encourage not only ethical practice but to also The RRBN to increase its effort in standardizing radiography practice in these hospitals.
TABLE OF CONTENTS
Title page ---------i
Approval page--------ii
Certification---------iii
Dedication---------iv
Acknowledgement--------v
Table of contents --------vi
List of table ---------vii
Abstract ---------viii
CHAPTER ONE: INTRODUCTION
1.1 Background of study------1
1.2 Statement of problem-------4
1.3 Purpose of study-------5
1.4 Significance of study------5
1.5 statement of hypotheses ------5
1.6 Scope of study-------5
1.7 Limitation of study------6
CHAPTER TWO
2.1 Literature review-------7
2.2 Theoretical background------21
2.3 What makes a profession -----23
2.4 Basic principles of medical ethics ----25
2.5 Radiography in Nigeria------27
2.6 Law of tort Negligence------36
2.7 Negligence --------38
2.8 Causation --------38
2.9 Damages--------39
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research design-------40
3.2 Target population-------40
3.3 Source of data-------40
3.4 Sample size--------40
3.5 Sampling technique------41
3.6 Method of data collection-----41
3.7 Instrument of data collection-----41
3.8 Method of data analysis and presentation ---42
CHAPTER FOUR
4.1 Data Presentation and Analysis-----43
CHAPTER FIVE
5.1 Discussion--------55
5.2 Summary--------61
5.3 Conclusion--------62
5.4 Recommendation-------63
5.5 Further Study-------63
References -------64
Questionnaire-------68
Appendix
LIST OF TABLES
Table 1: Radiographers’ Response According To Place of Work
Table 2: Demographic Data of Respondents Based On Age and Educational Status
Table 3: The Importance of Ethical Conduct
Table 4: Explaining the Procedure to the Patient
Table 5: Patients Need To Consent For Operations but Not For Radiographic Procedures
Table 6: A Radiographer Should Not Attend To a Violent Patient
Table 7: Testing Iodine Sensitivity for Contrast Investigations
Table 8: How Much Is the Licensing Fee
Table 9: Facility Inspection by the RRBN
Table 10: Comparison between Place of Work and Facility Inspection by RRBN
Table 11: Comparison between Place of Work and Testing for Iodine Sensitivity In Contrast Exams
Table 12: Comparison between Place of Work and Obtaining Consent for Radiographic Procedures
INTRODUCTION
X-ray is electromagnetic radiation of the ionizing spectrum and the chief corner stone on which the profession of medical radiography rests upon. X-rays were discovered in 1895 by a German physicist named Wilhelm Conrad Roentgen. The use of the new rays ranged from finding shoes that fit to the more lasting medical uses1. Following the discovery there was much interest in application of the new rays in diagnosing and treating diseases2. Initially many groups of staff began to use the new rays to conduct medical practice example nurses, electricians, doctors, engineers etc. With time it was discovered that the practice of using x-rays involved a specific kind of knowledge concerning the properties of the rays and also knowledge of the human body upon which the x-rays where being used thus the birth of the radiography profession.
In the early years radiography basically involved the use of x-radiation to view the internal aspects of objects which cannot be observed with the naked eye. When new diagnostic tests using x-rays and other forms of energy were developed it was natural for radiographers to be trained in the new imaging modality. This happened first with mammography, ultrasound, computed tomography and magnetic resonance imaging were added to the list of skills practiced by radiographers3.
Diagnostic radiography entails the technical aspects of medical imaging and in particular the acquisition of medical images. The radiographer is usually responsible for acquiring images of diagnostic quality and is also required to interpret these images especially in ultrasound. Medical imaging is often perceived to encompass a set of techniques that non-invasively produce images of the internal aspect of the body.
In the radiography profession the client includes the patient and others whose work may bear on the expertise of the radiographer. The essence of professionalism is the delivery of service in response to the need of the client and there should be mutual trust and confidence between the client and the professional4. This confidence is fostered by the professional’s ability to deliver efficiently the services for which he is paid. With professionalism comes authority, this authority represents the power to study, have mastery of specialized knowledge and be able to engage in professional practice without undue interference from others but also with this authority comes the responsibility to answer to the law as regards the use of the knowledge5, in the case of medical radiography as it has to do with human life and the use of ionizing radiation.
Litigation is defined as legal proceedings in a courtroom. Litigation involving radiographers most commonly involve professional practice6. Whenever a patient feels dissatisfied over the way he has been handled or incurs an injury in the care of a medical professional he may take out legal action against the professional in whose care his injury occurred. Practices with medico legal implications can lead to litigation; these are practices which contravene the laws of the land, practices which are contrary to the ethics of the profession and those which may cause harm to the patient. Litigation in medical practice is as a result of breach in the code of ethics and practice. The cause of most legal cases encountered in radiography practice includes patient care or lack of it to radiation protection, wrong or misdiagnosis due to poor technique etc. Medico legal issues could also be classified as medical malpractice and or lack of informed consent for the procedures carried out on the patient, negligence of the duty owed to the patient and professional misconduct. The perception of carelessness on the part of a medical professional leads to some of the largest jury awards, and they often make little attempt to apportion guilt and does not hide its disgust with the medical professional involved7, this is because of public perceptions of medicine and its unwillingness to allow for imperfection in medical practice.
The growing numbers of medical malpractice claims worldwide has caused alarm in all areas of health care including ultrasonography and has led to an increasing awareness of the medico legal implications of practice, thus the likelihood that litigation cases against sonographers will be common in the future in Nigeria is highly anticipated7. In the USA various bodies are trying to stem the growth in medical litigation by raising public awareness to the detrimental effect it is having on health care because not only are medical doctors retiring early and closing down practices but also the cost of health care is spiraling via defensive medical practice8. Areas of frequent litigation in medical radiography includes patient falls and positioning injuries, lack of radiation protection, adverse contrast reaction and errors in diagnosis coupled with delay in communication which could lead to harm to the patient.
The purpose of this research is to evaluate clinical radiography practice in three hospitals in south eastern Nigeria with a view to assess ethical practice and identify practices which could lead to litigation in order to encourage good radiography practice so as to protect the reputation of the profession and its members. It is also the aim of the work to bring to the notice of the radiographer to areas he should pay attention to in order to safeguard himself and his practice.