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Original Article 

Volume 13 (Suppl.)     Number 33      December 2020 
Copyright © 2020 Tehran University of Medical Sciences. 
This work is licensed under a Creative Commons Attribution-NonCommercial 
4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/).  
Non-commercial uses of the work are permitted, provided the original work is 
properly cited. 

Observance of patients’ rights by physicians and nurses from the 

COVID-19 patients’ perspective 

*Corresponding Author 
  
Mohsen Kamali 

Abhar School of Nursing, Next to Alghadir 

Hospital, Parastar Blvd., Abhar, Zanjan, 

Iran. 

Tel: (+98) 24 35 27 94 12 

Email: mkamali@zums.ac.ir  

 

Received: 15 Nov 2020 

Accepted: 16 Dec 2020 

Published: 30 Dec 2020 

 

Citation to this article:  

Kamali M, Mousavi SK. Observance of 

patients’ rights by physicians and nurses 

from the COVID-19 patients’ perspective. 

J Med Ethics Hist Med. 2020; 13(Suppl.): 

33. 

Mohsen Kamali*, Seyed Kazem Mousavi  
Researcher, Department of Nursing, Abhar School of Nursing, Zanjan University of Medical Sciences, Zanjan, Iran. 
 

Abstract  
Observance of patients' rights is a significant indicator in evaluating 

the quality of healthcare services. The COVID-19 pandemic has 

become a global crisis and affected the interactions between 

healthcare providers and patients. This study examined the COVID-

19 patients’ viewpoint about the observance of their rights by 

physicians and nurses. This study is a descriptive cross-sectional 

work of research conducted on the COVID-19 patients in Zanjan 

Province, Iran, in September 2020. The subjects were selected 

through convenience sampling, and data was collected using a two-

section questionnaire consisting of a demographic characteristics 

survey and a Likert-type scale for evaluating patients' rights 

observance. The validity and reliability of the questionnaire were 

found to be acceptable, and the collected data was analyzed in SPSS 

v.26 using descriptive statistics, independent t-test, and ANOVA test. 

The mean score of observance of patients' rights was 69.60±7.36, 

representing a moderate level. The highest and lowest scores for the 

observance of patients' rights were related to the dimensions of 

courteous communication and responsibility, respectively. A 

significant relationship was found between the observance of 

patients’ rights and their marital status, health insurance, and 

education level (P<0.05). This study showed that the observance of 

the COVID-19 patients' rights has not been affected by the social 

agitation caused by this disease. 

Keywords: Patient's rights; Physicians; Nurses; COVID-19. 

  



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Volume 13 (Suppl.)     Number 33      December 2020 

 

  Introduction 

Patients are one of the most vulnerable 

groups suffering not only from physical 

health issues but also from mental and 

emotional stress. Hence, the foundation of 

medical and nursing care is based on respect 

for patients’ self-esteem and identity (1, 2). 

An efficient healthcare system involves 

active interactions and satisfactory 

relationships between medical and 

healthcare team and patients (3). Courteous 

communication, respect for patients’ 

privacy, responsibility, and attention to the 

cultural values are the primary components 

of cooperative relationships in healthcare 

systems (4). In every society, the principle 

of respect for patients' rights is vital from a 

medical ethics perspective (5). The patient's 

rights charter is a framework to defend 

patients’ rights in emergency situations and 

to satisfy their needs without discrimination 

in a respectful environment (6, 7), as well as 

to promote communication between patients 

and healthcare providers (4, 8, 9). The first 

serious step in establishing the concept of 

patient rights was the Universal Declaration 

of Human Rights (UDHR) where in its 

article 2, intrinsic dignity and equal rights 

are an indispensable part of human rights 

based on freedom, justice, and peace around 

the world (10). Thus, patients' rights, 

including patients' physical, psychological, 

spiritual, and social needs, are expected to 

be observed by healthcare providers (11), 

and oncoming ethical controversies in 

medical care has challenged fulfilling 

patients' rights (11 ,12). Advances in 

medical technology have led to many new 

ethical challenges requiring legal 

instructions to protect care recipients' human 

dignity (13). As in other countries, the 

patients' rights charter in Iran has been 

developed while carefully considering 

religious and cultural issues incorporated in 

all the articles of the charter (14, 15). 

According to Parsapoor et al., along with 

political laws, educating the general public 

and professionals is required to ensure that 

patients' rights are properly respected in the 

healthcare system (15). 

When people are exposed to psychological 

stress, their cognitive, behavioral, and 

support resources have a fundamental role in 

controlling their adaptation and emotional 

reactions, such as fear, anxiety, and panic. 

Under the psychological stress of an illness, 

personal and social resources are known as 

influential factors that can positively or 

negatively affect treatment results (16, 17). 

Emphasis on patients' rights in healthcare is 

especially important for patients with a 

special disease. These patients are more 

vulnerable in terms of physical, mental, and 

social problems (18). According to Al-

Rabiaah et al., the perceived stress of a 

special disease can affect interactions 

between patients and healthcare providers 

(e.g. physicians and nurses) (19). Kord et al. 

reported that Acquired Immune Deficiency 

Syndrome (AIDS) patients, as individuals 

with a special disease, expect healthcare 

providers to observe their rights equally and 

without discrimination, and treat them as 

other patients (20).  

Near the end of 2019, the outbreak of a new 

viral disease, called COVID-19, was 



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Volume 13 (Suppl.)     Number 33      December 2020 

reported in the city of Wuhan, China (21). 

Due to its rapid transmission, the COVID-19 

pandemic became a global health crisis in all 

countries within a few months (22). 

Healthcare workers and their family 

members have been among the most 

vulnerable populations in this pandemic and 

have suffered from psychological tensions 

due to the fear of getting infected (23). 

Social anxiety arising from the quick spread 

of COVID-19 affected the relationships and 

interactions between healthcare providers 

and the COVID-19 patients. Therefore, this 

study aims to assess the observance of patients’ 

rights by physicians and nurses from the 

viewpoint of the COVID-19 patients 

hospitalized in Zanjan Province, Iran.  

 

Method 

This study is a cross-sectional work of 

research conducted on the COVID-19 

patients admitted to one of the hospitals in 

September 2020 in Zanjan Province of Iran. 

The subjects were selected through 

convenience sampling from the COVID-19 

patients. The total number of known patients 

with COVID-19 admitted and hospitalized 

in 11 public hospitals during the study was 

342. After obtaining permission from the 

research department and ethics committee of 

Zanjan University of Medical Sciences and 

making arrangements with the hospitals' 

managers, the researchers explained the 

objectives of the study to the participants 

and assured them of the confidentiality of 

their information. To ensure maximum 

accuracy in data collection, the researchers 

were present at the patients' bedsides in full 

compliance with health protocols, including 

the use of gowns, gloves, masks, and 

shields, and orally interviewed the patients 

and completed the questionnaires. The 

researchers assured the patients that their 

responses would have no effect on their 

treatment plans and that they were orally 

interviewed just to prevent virus spread. 

Then, as a further precaution, the researchers 

took photos of the completed questionnaires 

and then discarded all the paper questionnaires. 

The participants' informed consent, having been 

hospitalized for more than one day, and being 

in stable physical and mental conditions as 

verified by a physician were the inclusion 

criteria of this study. The subjects were 

selected via convenience sampling, and the 

duration of access to the samples and data 

collection was between one to three visits to 

the hospitals. 

Data was collected through a two-section 

questionnaire consisted of a demographic 

characteristics survey and a Likert-type scale 

for measuring compliance with the patients' 

rights charter–the scale was designed and 

tested in the Ph.D. thesis of Parsapoor in 

2014. Demographic characteristics included 

age, gender, marital status, education level, 

economic status, health insurance, history of 

hospitalization, and length of hospital stay. 

The patients' rights charter questionnaire 

consisted of 70 questions scored on a Likert 

scale from 1 (non-observance) to 5 

(complete observance) for every item. This 



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Volume 13 (Suppl.)     Number 33      December 2020 

questionnaire measured observance of the 

patients' rights in nine dimensions using the 

following weight coefficients: (i) courteous 

communication (weight: 2.5); (ii) justice 

(weight: 9.2); (iii) privacy (weight: 4.4); (iv) 

responsibility (weight: 15.8); (v) patient's 

welfare and comfort (weight: 3.1); (vi) 

quality of services from a  scientific point of 

view (weight: 25.6); (vii) patients’ interest 

(weight: 16.3); (viii) access to information 

(weight: 10.9); and, (ix) respect for patients’ 

choices (weight: 12.2). Dimension’s weight 

represented its impact on the respondent’s 

total score for the observance of patients' 

rights, and hence the dimensions with the 

highest and the lowest weights had the most 

and the least impacts on the total score, 

respectively. 

The total score range of the observance scale 

is between 20 and 100 based on every 

dimension's weight. Respondents’ scores 

were interpreted as follows: low observance 

(20 to 51), moderate observance (51.01 to 

76), and high observance (76.01 to 100). As 

for courteous communication, based on the 

dimension’s weight, low, moderate, and high 

observance were indicated, respectively, by 

the following scores: 0.5 to 1.27, 1.28 to 

1.90, and 1.91 to 2.5. As for justice, based 

on the dimension’s weight, low, moderate, 

and high observance were indicated by the 

following scores, respectively: 1.84 to 4.69, 

4.70 to 6.99, and 7 to 9.2. As for privacy, 

based on the dimension’s weight, low, 

moderate, and high observance levels were 

indicated by the following scores, 

respectively: 0.88 to 2.24, 2.25 to 3.34, and 

3.35 to 4.4. As for responsibility, based on 

the dimension’s weight, low, moderate, and 

high observance levels were indicated by the 

following scores, respectively: 3.16 to 8.05, 

8.06 to 12, and 12.01 to 15.8. As for the 

patients’ welfare and comfort, based on the 

dimension’s weight, low, moderate, and high 

observance were indicated by the following 

scores, respectively: 0.62 to 1.58, 1.59 to 

2.35, and 2.36 to 3.1. As for the quality of 

service from a scientific point of view, based 

on the dimension’s weight, low, moderate, 

and high observance were indicated by the 

following scores, respectively: 5.12 to 13.05, 

13.06 to 19.45, and 19.46 to 25.6. As for 

patients’ interests with five questions, based 

on the dimension’s weight, low, moderate, 

and high observance levels were indicated 

by the following scores, respectively: 3.26 to 

8.31, 8.32 to 12.38, and 12.39 to 16.3. As for 

patients’ access to information, based on the 

dimension’s weight, low, moderate, and high 

observance levels were indicated by the 

following scores, respectively: 2.18 to 5.55, 

5.56 to 8.28, 8.29 to 10.9. Finally, as for 

respect for patients’ choices with eight 

questions, based on the dimension’s weight, 

low, moderate, and high observance levels 

were indicated by the following scores 

respectively: 2.42 to 6.20, 6.21 to 9.22 and, 

9.23 to 12.2. The dimensions of the patients' 

rights charter, the number of questions in 

each dimension as well as their score ranges 

and weights are listed in Table 1.  

The reliability, internal consistency, and 



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Volume 13 (Suppl.)     Number 33      December 2020 

validity of this questionnaire were tested in 

Parsapoor’s Ph.D. thesis, and the results 

were within acceptable limits. Parsapoor 

used the intra-class correlation (ICC) and 

Cronbach’s alpha indexes to assess the 

questionnaire's reliability and internal 

consistency. Total ICC was 0.87 and the 

Cronbach's alpha was 0.91, showing that the 

reliability and internal consistency of this 

questionnaire were satisfactory. Parsapoor 

evaluated the questionnaire's validity by 

measuring the relevance and clarity of its 

items. The questionnaire's total relevance 

and clarity were found to be, respectively, 

97.2 and 90.2, indicating that the tool was 

suitable for evaluating the observance of 

patients' rights. The relevance and clarity of 

the items were assessed by experts in the 

field of patients’ rights, cooperative patients 

who had been informed of the study’s 

objectives, and an experienced methodologist 

(24). The collected data was analyzed in SPSS 

v.26 using descriptive statistics, independent t-

test, and ANOVA test. 

Table 1- Observance level of patients’ rights in various dimensions of patients’ rights 

Categorization of scores 
Score 

range 
Weight 

Number of 

questions 
Lowest 

score 
Highest 

score 
Standard 

deviation 
Mean 

Dimensions of  

patients' rights 

Low: 0.5 – 1.27 
0.5 – 2.5 2.5 11 0.85 2.5 0.32 2.10 

Courteous 

communication 
Moderate: 1.28 – 1.90 
High: 1.91 – 2.5 
Low: 1.84 – 4.69 

1.84 – 9.2 9.2 4 3.07 9.2 1.52 6.76 Justice  Moderate: 4.70 – 6.99 
High: 7 – 9.2 
Low: 0.88 – 2.24 

0.88 – 4.4 4.4 5 1.32 4.4 0.71 3.01 Privacy  Moderate: 2.25 – 3.34 
High: 3.35 – 4.4 
Low: 3.16 – 8.05 

3.16 – 

15.8 
15.8 3 4.74 15.8 2.81 9.95 Responsibility Moderate: 8.06 - 12 

High: 12.01 – 15.8 
Low: 0.62 – 1.58 

0.62 – 3.1 3.1 15 1.15 2.92 0.3 1.91 
Patients’ welfare 

and comfort 
Moderate: 1.59 – 2.35 
High: 2.36 – 3.1 
Low: 5.12 – 13.05 

5.12 – 

25.6 
25.6 7 10.24 24.75 3.98 18.67 

Quality of 

service  
Moderate: 13.06 – 19.45 
High: 19.46 – 25.6 
Low: 3.26 – 8.31 

3.26 – 

16.3 
16.3 5 4.08 16.3 3.2 11.09 

Patients’ 

interests 
Moderate: 8.32 – 12.38 
High: 12.39 – 16.3 
Low: 2.18 – 5.55 

2.18 – 

10.9 
10.9 12 6.10 10.68 0.96 9.07 

Access to 

information 
Moderate: 5.56 – 8.28 
High: 8.29 – 10.9 
Low: 2.42 – 6.20 

2.42 – 

12.2 
12.2 8 4.15 10.03 1 6.99 

Respect for 

patients’ choices 
Moderate: 6.21 – 9.22 
High: 9.23 – 12.2 
Low: 20 – 51 

20-100 100 70 46.60 87.88 7.36 69.60 
Total 

observance score 
Moderate: 51.01 - 76 
High: 76.01 - 100 

 

 



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Volume 13 (Suppl.)     Number 33      December 2020 

 

Results 

All COVID-19 patients admitted to one of 

the hospitals of Zanjan Province were 

selected for data collection. Among these 

patients, 54 patients had been taken to 

Intensive Care Units (ICUs) and were unable 

to respond to the researchers’ questions due 

to their unstable conditions. Thirteen 

patients were unwilling to participate and 

were, therefore, excluded. Eventually, 275 

questionnaires were completed and 

analyzed. Analysis of the demographic 

characteristics showed that the participants' 

mean age was 58.25±10.2 years. Most of the 

participants were female (70.9%), married 

(82.2%), and had primary school education 

(64%). In terms of economic status, 52.7%, 

37.4 %, and 9.9% described their status as 

middle, low, and high, respectively. 

Moreover, 82.9% had health insurance and 

71.3% had a history of hospitalization. 

Additionally, the participants' average length 

of hospital stay at the time of this study was 

4.65±1.86 days.  

The mean score for the observance of 

patients' rights by physicians and nurses 

from the COVID-19 patients’ perspective 

was found to be 69.60 with a standard 

deviation of 7.36, indicating moderate 

observance. Moreover, the dimension of 

courteous communication had the highest 

score (2.10 ± 0.32), while the dimension of 

responsibility had the lowest score (9.95 ± 

2.81); courteous communication and 

responsibility were the most and the least 

observed dimensions of the patients' rights 

charter, respectively. The mean scores, 

standard deviations, the highest and the 

lowest scores, and score ranges are shown in 

Table 1.  

According to Table 1, in addition to 

courteous communication, the dimensions of 

justice, quality of service from a scientific 

point of view, and access to information 

were reported to be highly observed. The 

participants evaluated the dimensions of 

privacy, patients’ welfare and comfort, 

patients’ interests, and respect for patients’ 

choices as moderately observed. Only the 

dimension of responsibility was reported to 

be poorly observed.  

Moreover, the researchers examined the 

relationship between the subjects’ 

demographic variables, namely age, gender, 

marital status, education level, economic 

status, health insurance, history of 

hospitalization, and length of hospital stay, 

as well as their total mean scores for the 

observance of patients' rights. Table 2 shows 

the frequency and percentage of the 

demographic variables, and the mean and 

standard deviation of the patients’ total 

scores for the observance of patients’ rights 

along with the results of the statistical tests 

used to investigate the relationship between 

the participants’ demographic variables and 

their scores.  

 



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Volume 13 (Suppl.)     Number 33      December 2020 

 

Table 2- Mean score and standard deviation of the patients' rights observance in terms of 

demographic characteristics variables 

Variable 
Frequency 

(Percentage) 

Mean and Standard 

Deviation 

for Observance of 

Patients' Rights 

Statistical 

Test 
P-value 

Gender 
Man 91 (33.1%) 69.90±7.73 Independent 

T-Test 
0.62 

Woman 184 (66.9%) 69.45±7.17 

Marital Status 

Single 8 (2.9%) 69.90±8.73 

ANOVA 0.001 
Married 226 (82.2%) 70.71±5.89 

Divorced 17 (6.2%) 60.94±10.26 

Widowed 24 (8.7%) 65.16±11.01 

Education Level 

Illiterate 87 (20.7%) 70.66±6.55 

ANOVA 0.005 
Primary School 176 (64%) 70.92±6.07 

High school/ Diploma 28 (10.2%) 68.40±8.21 

College 14 (5.1%) 60.26±8.77 

Economic Status 

Good 27 (9.8%) 71.19±5.99 

ANOVA 0.063 Moderate 146 (53.1%) 70.81±4.79 

Bad 102(37.1%) 69.38±5.97 

Health Insurance 

Yes 228 (82.9%) 70.85±6.23 
Independent 

T-Test 
0.005 

No 47 (17.1%) 63.55±9.25 

History of 

Hospitalization 

Yes 

 
196 (71.3%) 69.69±6.75 

Independent 

T-Test 
0.73 

No 79 (28.7%) 69.39±8.72 

 

Table 2 shows that the total score for the 

observance of patients' rights does not 

correlate with gender, economic status, or 

history of hospitalization. However, with 

regard to the impact of patients’ marital 

status on how they estimate the observance 

of their rights, the Analysis of Variance 

(ANOVA) test results showed a statistically 

significant relationship between the two (P-

value<0.05). The results of the post hoc test 

of Least Significant Difference (LSD), after 

equality of variances, had been ensured via 

Levene’s test, determined that the mean 

score of the married patients was 

significantly higher than those of the 

divorced and widowed patients. Moreover, 

the mean observance score of the single 

patients was significantly higher than that of 

the divorced patients (P-value<0.05). 

 

 



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Volume 13 (Suppl.)     Number 33      December 2020 

Table 3- The LSD post hoc test’s results for the mean differences between the participants based on 

marital status and education level 

Variable Groups Mean 

Difference 

P-Value 

Marital Status 

Single 

Married -0.80 0.74 

Divorced 8.96 0.00 

Widowed 4.74 0.09 

Married 

Single 0.8 0.74 

Divorced 9.76 0.00 

Widowed 5.54 0.00 

Divorced 

Single -8.96 0.00 

Married -9.76 0.00 

Widowed -4.22 0.54 

Widowed 

Single -4.74 0.09 

Married -5.54 0.00 

Divorced 4.22 0.54 

Education Level 

Illiterate 

Primary -0.26 0.80 

High School/ Diploma 2.26 0.14 

College 10.40 0.00 

Primary 

Illiterate 0.26 0.54 

High School/ Diploma 2.52 0.06 

College 10.66 0.00 

High School/ Diploma 

Illiterate -2.26 0.14 

Primary -2.52 0.06 

College 8.13 0.00 

College 

Illiterate -10.40 0.00 

Primary -10.66 0.00 

High School/ Diploma -8.13 0.00 

 

The results showed a statistically significant 

relationship between the participants' total 

mean scores for the observance of patients’ 

rights and their education level (P-

value<0.05). The post hoc test results for 

identifying differences between the groups 

showed that only the mean observance score 

of the patients with a college degree was 

significantly lower than that of patients with 

other education levels (P-value<0.05). The 

LSD post hoc test’s results for identifying 

possible differences between the 

participants’ observance of patients’ rights 

scores based on their marital status and 

education level are shown in Table 3. The 

results also showed a statistical difference 

between the total mean scores of the 

patients' rights observance and their health 

insurance. The independent t-test’s results 

showed that the patients with health 



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Volume 13 (Suppl.)     Number 33      December 2020 

insurance evaluated the observance of 

patients’ rights more highly than the patients 

without health insurance, and the difference 

was statistically significant (P-value<0.05).  

To examine the relationship between the 

variables of age and length of hospital stay, 

the Pearson's correlation test was used. The 

results showed no significant relationship 

between the patients' mean scores for the 

observance of patients’ rights and their age 

or length of hospital stay (Table 4). 

Table 4- Pearson’s correlation coefficients 

between mean scores for observance of 

patients’ rights and their age and length of 

hospital stay 

Variable 
Correlation 

Coefficient 
P-value 

Age 0.038 0.53 

Length of 

hospital stay  
0.034 0.57 

 

Discussion 

This study’s results show that the 

observance level of patients' rights from the 

COVID-19 patients’ viewpoint is moderate, 

whereas many other studies reported 

different results. The results of the study by 

Sheikhbardsiri et al. consistent with the 

present study’s results, showed that the 

observance level of patients' rights in 

emergency wards from the patients’ 

viewpoint is moderate (43.10 ±15.05) (24). 

Similarly, Zandiyeh et al. reported that the 

observance level of patients' rights is 

average (50.2) (25). However, Ghaljeh et al. 

reported the mean and standard deviation of 

the observance level of patients' rights as 

perceived by patients to be 6.28±1.02, or 

low (26). Dehghan et al. showed that the 

mean and standard deviation of the 

observance level of patients' rights is 

2.91±0.74, in the range of 0 to 4 from the 

patients' viewpoint (11). Likewise, a study 

conducted in Oman showed that healthcare 

providers’ adherence to patients' rights in 

practice is low, while their awareness of the 

importance of respecting patients' rights was 

high. That study also suggested that devising 

measures to improve healthcare providers’ 

observance of patients’ rights is critically 

necessary (27). Another study conducted in 

Pakistan reported that only 41% of the 

patients who participated in the research 

were satisfied with the observance of their 

rights, and most of them were dissatisfied 

(28). According to a study conducted in Iran, 

although nurses' knowledge about patients' 

rights was inadequate, their performance in 

observing patients' rights was moderate (6). 

A comparison between the present study’s 

findings and those of previous researches 

shows that observance of patients' rights 

varies in different conditions, but most 

research results indicate a moderate 

observance level. The present study shows 

that the observance of patients' rights in the 

critical social conditions of the COVID-19 

pandemic is moderate to high. 

Furthermore, the results of the present study 

show that observance of most dimensions of 

the patients' rights charter is moderate or 



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Volume 13 (Suppl.)     Number 33      December 2020 

high. Courteous communication (the 

highest), justice, quality of service from a 

scientific point of view, and access to 

information were found to be the highly 

observed dimensions. The dimensions of 

privacy, patients’ welfare and comfort, 

patients’ interests, and respect for patients’ 

choices were moderately observed. The least 

observed dimension from the patients’ 

perspective was responsibility. Overall, the 

observance level of the patients' rights 

charter was moderate to high.  

Parsapoor et al. reported a low observance 

level in access to information dimension, 

and they highlighted the necessity of closer 

attention to the management of information 

communication between healthcare 

providers and patients (29). The present 

study’s results about the highly observed 

dimension of patients' rights charter are 

consistent with those of Sookhak et al.  

where the highest score for the observance 

of patients' rights was related to "the right to 

be treated with respect" (43.4%), indicating 

nurses' good performance in this area (6). 

Sookhak et al. also reported that nurses' 

performance was unsatisfactory in 

respecting patients’ rights to have access to 

information, to choose, to receive 

appropriate care and treatment, and to 

complain. As with the present study, they 

reported the observance level of patients’ 

right to privacy to be moderate (6). On the 

contrary, Sabzevari et al. found the highest 

observance level of patients' rights to be in 

domains of respecting patients' privacy and 

maintaining patients’ confidentiality (9).  

A comparison between the present study and 

similar studies shows that respect and 

courteous communication with patients are 

still the most highly-observed aspects of the 

patients' rights charter. Even in the current 

critical conditions, physicians and nurses 

believe that patients should be treated with 

respect. One of the obvious differences 

between the findings of the present study 

and those of other studies concerns the 

dimension of access to information. The 

results of the present study regarding access 

to information are not consistent with those 

of Parsapoor et al., Sookhak et al., and 

Sabzevari et al. This discrepancy can be 

attributed to the social conditions caused by 

the COVID-19 pandemic where the COVID-

19 patients are regarded as patients with 

special conditions compared to other 

patients.  Furthermore, due to the pandemic, 

hospitalization of non-COVID-19 patients 

has greatly reduced due to fear of infection. 

Accordingly, physicians and nurses have 

enough time to provide information to 

COVID-19 patients. 

As with the present study, the study of 

Farzianpour et al. showed that patients' 

viewpoint on observance level of "access to 

medical records and information" as part of 

the patient's rights charter was found to be 

moderate to high (8). Farzianpour et al. also 

reported that the observance level of "the 

right to replace physicians and refuse 

treatment" was found to be average. This 

aspect of the patients’ rights is comparable 

with the dimension of "respect for patients’ 

choices" in the present study which was 



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Volume 13 (Suppl.)     Number 33      December 2020 

evaluated to be moderately observed (8).   

According to Dehghan et al., the essential 

aspect of the patient's rights was receiving 

optimal healthcare services from both 

nurses' and patients' viewpoints (11). They 

also concluded that the most observed aspect 

of the patients’ rights was patients’ privacy 

and confidentiality and the least observed 

aspects were compensation for medical 

errors, handling patient's complaints, and 

respecting patients’ rights to complain (11). 

Similarly, the present study’s participants 

reported the dimension of responsibility to 

be poorly observed. The dimension of 

responsibility in the present study assessed 

the handling of patients’ complaints by 

physicians and nurses.  

The present study’s results showed a 

statistically significant correlation between 

the total score of the observance level of 

patients' rights charter and the following 

variables: marital status, education level, and 

health insurance support. The married 

patients, compared to the divorced and 

widowed patients, reported a higher 

observance level of patients’ rights. 

Moreover, single patients, compared to 

divorced patients, reported a higher 

observance level of patients’ rights. In 

addition, patients with a college degree, 

compared to the patients with other 

education levels, evaluated the patients' 

rights observance level to be lower, which 

was statistically significant. The results also 

showed that the patients with health 

insurance, compared to the patients without 

health insurance, reported a higher 

observance level of patients’ rights. 

Regarding the history of hospitalization, 

Mack reported that patients with a history of 

hospitalization were more satisfied with the 

received healthcare services, while the 

present study’s results did not show a 

significant relationship between these two 

variables (30). According to Farzianpour et 

al., younger patients, compared to middle-

aged and older patients, were less satisfied 

with their healthcare services (8). In this 

study, most COVID-19 patients admitted to 

the hospitals were in a certain age range, and 

the age did not appear to affect the mean of 

the reported observance level of these 

patients' rights. As with the present study, 

Sabzevari et al. did not find a significant 

relationship between patients’ demographic 

characteristics, including age, gender, education 

level, and career, and their perception of 

observance of patients’ rights (9). 

Vakili et al., Mokhtari and Khorami 

Markani, and Rafiei et al., in their studies, 

did not found a statistically significant 

correlation between patients’ marital status 

and their perception of observance of 

patients’ rights (31,32,33). As with the 

present study, the results of Babamahmoudi 

et al. showed that the observance level of 

patients' rights from viewpoint of patients 

with an academic degree was statistically 

lower (34). Although more research is 

required on why subjects with higher 

education levels evaluate observance of 

patients’ rights less favorably than others, 



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Volume 13 (Suppl.)     Number 33      December 2020 

greater knowledge and awareness of such 

individuals could be a reason. 

The present study’s results can be extended 

to other provinces of Iran because not many 

cultural differences in the aspects considered 

in this study can be observed among other 

provinces. However, further research in 

other provinces is suggested for more 

accurate results. Major cultural differences 

among Iran and the other countries prevent 

the generalization of this study’s results to 

other countries. Furthermore, patients' 

psychological conditions, and satisfaction 

with hospital equipment could affect their 

assessment of observance of patients' rights, 

factors disregarded in the present study. 

Therefore, for a more accurate evaluation, 

all the factors affecting patients' perception 

of the observance of their rights, including 

the interactions of medical and non-medical 

staff with patients and their families as well 

as patients’ satisfaction with medical 

equipment and hospital facilities should be 

addressed. Future studies are recommended 

to cover more provinces with larger sample 

sizes, all dimensions affecting observance of 

patients’ rights, and dimensions of patients' 

rights charter with reported low observance 

level from the patients’ perspective. The 

outcomes of such studies should be considered 

by the healthcare system’s managers and 

policy-makers for planning improvement as 

well as future research and development. 

 

Conclusion  

Based on the present study’s findings, the 

observance level of patients' rights from the 

COVID-19 patients’ viewpoint was found to 

be moderate. Compared to similar previous 

studies, more dimensions of the patients’ 

rights charter were found to be well 

observed during the pandemic. Courteous 

communication was the most highly-

observed patient right from the participants' 

viewpoint, indicating that the COVID-19 

patients were treated with respect during 

their hospitalization by physicians and 

nurses. These findings refute the hypothesis 

that physicians and nurses, major human 

resources in healthcare systems, are 

disregarding patients' rights during the 

pandemic crisis due to their fear and anxiety 

as well as panic of getting infected and the 

possibility of transmitting coronavirus to 

their family. This study’s findings show that, 

from the COVID-19 patients’ viewpoint, the 

observance level of patients’ rights as 

prescribed by the patients’ rights charter has 

not diminished as a result of the uneasy 

atmosphere in the society following the 

outbreak of COVID-19.  

 

Ethical Considerations  

Permission to conduct the present study was 

obtained from the Research Department and 

Ethics Committee of Zanjan University of 

Medical Sciences (IR.ZUMS.REC.1399.164). 

All the study participants were informed 

about the objectives of the study, the 

confidentiality of the information, and the 

voluntary nature of their participation. 



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Volume 13 (Suppl.)     Number 33      December 2020 

Acknowledgements 

The researchers would like to thank the 

patients who participated in this study and 

the hospital personnel for their cooperation 

despite the restrictions caused by the 

COVID-19 pandemic.  

 

Conflict of Interests  

The authors declare no conflict of interests 

 

  



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