Nursing Students’ Awareness and Familiarity with the Ghana Patients’ Rights Charter: Implications for Nursing Education

Nursing Students’ Awareness and Familiarity with the Ghana Patients’ Rights Charter: Implications for Nursing Education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nursing Students’ Awareness and Familiarity with the Ghana Patients’ Rights Charter: Implications for Nursing Education Clement Naayaara Zuuri, Rachael Nyarko, Benedicta Princess Dotse, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7095575/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: The Ghana Patients’ Rights Charter (PRC), established in 2002, serves as a critical framework to protect patient dignity, autonomy, and safety. Despite its significance, awareness and understanding of the PRC among nursing students—future frontline healthcare providers—remain inadequately explored in Ghana. Objective: This study assessed the level of awareness, knowledge, sources of information, and attitudes toward the PRC among nursing students in two selected Ghanaian nursing training institutions. It also examined demographic and academic factors influencing awareness and identified barriers affecting learning about the Charter. Methods: A descriptive cross-sectional survey was conducted among 274 nursing students from College of Nursing and Midwifery, Tanoso and St. Michael’s Nursing and Midwifery Training College, Pramso. Data were collected via structured online questionnaires and analyzed using descriptive statistics and Chi-square tests to assess associations. Results: Approximately 73% of students reported awareness of the PRC, with 60% perceiving it as legally binding; however, only 40% had seen the Charter document. Classroom lectures (45%) and clinical placements (36%) were the primary information sources. Knowledge of specific patient rights ranged from 68% to 71%, yet notable uncertainty and misinformation persisted. While 74.5% considered the Charter very important, only 30.7% applied it in clinical practice. Awareness was strongly associated with familiarity but not with demographic variables or perceived importance. Major barriers included insufficient emphasis by lecturers (60%), lack of discussion during clinicals (55%), poor access to materials (50%), staff disinterest (35%), and complex language (30%). Conclusion: Despite general awareness and positive attitudes, critical gaps exist in familiarity, knowledge certainty, and clinical application of the PRC among nursing students. Addressing these requires curriculum integration, faculty development, improved resource accessibility, and stronger institutional support to foster a nursing workforce capable of upholding patient rights and enhancing quality care in Ghana. Clinical trial number : Not applicable Patients’ Rights Charter Nursing Students Awareness Clinical Practice Nursing Education Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. INTRODUCTION Patient rights are a vital aspect of ethical healthcare delivery worldwide, highlighting the importance of autonomy, dignity, and safety. Global research has identified ongoing difficulties in the awareness and comprehension of patients' rights among healthcare professionals, particularly health profession students. For example, ( 1 ) reported limited awareness of patient rights among Iranian healthcare students, particularly regarding autonomy and informed consent. These disparities provoke ethical dilemmas and impede patients' engagement in their care, highlighting the necessity for thorough education on patient rights within global health training programs. In Sub-Saharan Africa, these challenges are exacerbated by systemic deficiencies in health infrastructure and inadequate health literacy among both providers and patients ( 2 ). Across the region, efforts to implement patient rights charters or similar policies face obstacles due to inadequate dissemination and training ( 3 ). Research indicates that healthcare personnel frequently possess insufficient understanding regarding patients' rights frameworks, hindering effective advocacy and safeguarding of patients in clinical environments ( 4 ). This gap is especially critical as nurses and midwives represent the bulk of frontline healthcare workers responsible for patient care( 5 ). The Patients’ Rights Charter (PRC) was established in 2002 by the Ghana Health Service to protect the dignity, safety, and welfare of patients in Ghana. The Charter delineates fundamental rights such as access to care, confidentiality, respect, informed consent, and the freedom to refuse treatment. Notwithstanding its policy importance, empirical research indicates considerable deficiencies in awareness and comprehension of the PRC among patients and healthcare practitioners alike. ( 6 ) in their study indicated that more than 20% of doctors did not see patient involvement in diagnostic and treatment decisions as important. This attitude is likely influenced by over half of the doctors believing that patients cannot make informed decisions and that their participation does not necessarily improve outcomes. More recently, Atta-Doku et al., (2024a) evaluated the knowledge of Ghanaian nurses and discovered that while 87% had encountered the Charter, understanding was limited due to intricate language; the PRC’s Flesch Reading Ease score of 34% signifies it is challenging to comprehend without higher education. Comprehension emerged as the most significant predictor of PRC knowledge, underscoring the necessity to simplify the Charter's language and improve educational outreach. Notwithstanding its significance, evidence indicates that awareness and comprehension of the PRC among healthcare providers, including nursing students, are inadequate. Nurses and nursing students serve as primary caregivers, significantly contributing to the enforcement of patients' rights during clinical treatment; therefore, their understanding and disposition regarding the PRC are essential for its efficacy ( 7 ). Nonetheless, research has revealed deficiencies in knowledge and understanding among nursing practitioners, potentially due to insufficient focus on patients' rights in nursing education and the intricate language employed in the Charter ( 8 ). The awareness level among nursing students is crucial as their training time significantly shapes professional attitudes, ethical norms, and competencies that affect future practice ( 9 ). Yet, the inclusion of the PRC in nursing education in Ghana appears limited, often confined to brief discussions under professional ethics without structured teaching or practical application ( 10 ). This gap risks perpetuating poor understanding of patients’ rights and compromises the quality of patient care once these students enter professional practice. Understanding nursing students’ awareness and sources of knowledge about the PRC can inform curriculum reforms, enhance educational strategies, and ultimately improve rights-based care delivery in Ghana ( 9 , 11 ). Several studies within and outside Ghana emphasize that improving healthcare students’ knowledge of patient rights contributes to better patient outcomes and strengthens health systems ( 1 , 12 , 13 ). Therefore, assessing the awareness of the Ghana Patients’ Rights Charter among nursing students is essential for identifying educational gaps and informing policy interventions that promote patient advocacy and ethical nursing practice. This study focuses on nursing students in two selected health institutions, exploring their awareness of the Charter, sources of knowledge, and the influence of demographic and academic factors such as level of study and clinical exposure. The findings aim to support curriculum reforms and policy efforts to strengthen the capacity of future nurses to uphold patient rights and enhance healthcare outcomes. 2. METHODOLOGY 2.1 Study Area The study was conducted in two selected nursing training institutions in Ghana, chosen to represent diversity in geographical location and institutional structure (public versus mission-based). The institutions included: College of Nursing and Midwifery, Tanoso, Sunyani; located in the Bono Region, this public institution has been training nurses for over 20 years. The college offers a range of nursing and midwifery programs, including Registered General Nursing (RGN), Registered Midwifery (RM), and Community/public Health Nursing. The student population typically ranges between 700 and 1000, with an annual intake of approximately 300 students across various courses. St. Michael’s Nursing and Midwifery Training College (NMTC), Pramso, Ashanti Region is a mission-based institution with a history spanning over 15 years. It offers similar programs including Registered General Nursing and Registered Midwifery. The college enrolls about 400 to 600 students annually, with a strong emphasis on both theoretical and practical nursing education grounded in Christian values. The total population typically ranges from 1000 to 1500 across both programs. 2.2 Research Design This study employed a descriptive cross-sectional design using a quantitative approach. The design was chosen to assess the level of awareness of the Ghana Patients’ Rights Charter (PRC) among nursing students at a single point in time, enabling the researcher to capture current knowledge levels, sources of information, and socio-demographic influences ( 14 ) 2.3 Study Population The target population comprised nursing and midwifery students in their second and third years of study. These students were assumed to have had some exposure to patient rights either through clinical practice or classroom instruction. 4.4 Sample Size and Sampling Technique A proportionate stratified random sampling technique was employed to ensure fair representation across the three institutions and between year groups. Within each stratum, simple random sampling was used to select participants. The sample size was determined using Yamane’s formula( 15 ) for a known population: n = N/(1 + N(e)2 Where: n = sample size N = total population of eligible students e = margin of error (0.05) Step 1: Total Population The two selected nursing schools has approximately 874 students in their second and third years. Substituting the values: \(\:\varvec{n}=\frac{874}{1+874\:\left(0.05\right)\left(0.05\right)}\) = 274 Therefore, the calculated sample size is approximately 274. Step 2: Proportional Allocation by School and Year Group Institution Year Population Proportion (%) Sample Size (n) Pramso (St. Michael’s) Second Year 300 34.3% 94 Pramso (St. Michael’s) Third Year 200 22.9% 63 Tanoso (College of Nursing) Second Year 250 28.6% 78 Tanoso (College of Nursing) Third Year 124 14.2% 39 Total 874 100% 274 2.5 Data Collection Instrument A structured questionnaire was developed to assess the awareness, knowledge, and application of the Ghana Patients’ Rights Charter among nursing students. The items were constructed with reference to the official Ghana Patients’ Rights Charter (Ghana Health Service, 2012) ( 16 ), and adapted from previously validated questionnaires used in similar studies conducted in Ghana and elsewhere ( 17 – 19 ). The instrument comprised sections on socio-demographic information, awareness of the Charter, knowledge of specific rights, sources of awareness, and practical application in clinical settings. To ensure content validity and clarity, the questionnaire was reviewed by three senior nurse educators and piloted among a small sample of students prior to the main data collection ( 20 ). 2.6 Data Collection Procedure After obtaining permissions from the institutions and written informed consent from participants, the questionnaires were administered online to the selected students via a secure survey platform. Participants received invitations and instructions through their official email addresses or learning management systems. The researchers were available virtually via chat or email to clarify any questions or ambiguities during the data collection period. The data period lasted for one month (May), 2025. 2.7 Data Analysis Data were cleaned, coded, and entered into SPSS version 26 for analysis. Descriptive statistics (frequencies, percentages,) were used to summarize demographic data and awareness levels. Chi-square tests was employed to determine associations between socio-demographic variables and awareness of the PRC. Statistical significance was set at p < 0.05. 2.8 Ethical Considerations Permission to conduct the study was granted by the authorities of the participating institutions. Participation was entirely voluntary, and informed consent was obtained from each respondent prior to data collection. To protect the privacy of participants, anonymity and confidentiality were strictly maintained throughout the study. The inclusion criteria required participants to be enrolled students at the selected nursing training institutions who were willing to participate and provide informed consent. Students who were absent during data collection or those who declined to participate were excluded from the study. 3. RESULTS 3.1 Sociodemographic Characteristics Table 1 below summarizes the socio-demographic characteristics of the nursing students who participated in the study. Regarding age, the majority of students, approximately 54%, fall within the 20–24 years age group, indicating that most participants are young adults, which is typical for students in health training institutions. Smaller proportions are found in the older age group of 25–29 years (19%) and the younger group below 20 years (15%). In terms of gender distribution, females constitute over 71% of the respondents, reflecting the female predominance commonly observed in nursing programs both globally and within Ghana. The year of study among participants is nearly evenly split, with 53% in their second year and 47% in their third year, providing a balanced representation across different academic levels. As for the program of study, most students (57%) are enrolled in General Nursing, followed by Midwifery at 23%, Public Health Nursing at 12%, and Registered Nurse Assistant Clinical at 8%. This distribution highlights the varied focus of nursing programs included in the sample. Table 1 Sociodemographic Characteristics Variable Category Number (n) Percentage (%) Age 20–24 151 55.1 25–29 53 19.3 Below 20 42 15.3 30 and above 28 10.2 Gender Female 195 71.2 Male 79 28.8 Year of Study Second Year 144 52.6 Third Year 130 47.4 Program General Nursing 157 57.3 Midwifery 62 22.6 Public Health Nursing 34 12.4 Registered Nurse Assistant Clinical 21 7.7 3.2: Awareness of the patients’ rights charter The pie chart (Fig. 1 ) below depicts the awareness levels of the Ghana Patients’ Rights Charter among nursing students, showing that approximately 73% of the students are aware of the Charter, while 27% are not. 3.3: PRC legally binding/ seen document Approximately 60% of nursing students believe that the Patient Rights Charter (PRC) is legally binding, indicating a moderate level of understanding regarding its legal status. While a substantial 40% of students have read or seen the PRC document, the majority (60%) have not, highlighting limited direct exposure to the Charter (Table 2 ). Table 2 PRC legally binding/ seen document Question Option Percentage (%) Frequency (out of 274) PRC legally binding? Yes 60% 164 No 20% 55 I don’t know 20% 55 Read or seen PRC? Yes 40% 110 No 60% 164 3.4 Sources of Information on the Patients’ Rights Charter Nearly half of the nursing students (45%) reported learning about the Patients’ Rights Charter through lectures or classroom teaching. Clinical placements/practical experience (36%) and textbooks/course materials (34%) are also important sources. Seminars/workshops, social media, and friends or colleagues are less frequently cited, highlighting potential areas for expanding awareness through diverse channels (Fig. 2 ). 3.5 knowledge of specific rights within the charter The majority of nursing students, ranging from about 68–71%, correctly identify their rights under the Ghana Patients’ Rights Charter, including the right to information, refusal of treatment, privacy, participation, respect, and the right to complain. However, approximately 18–22% of students remain uncertain (“Not sure”) about these rights, highlighting existing knowledge gaps. Additionally, a smaller yet significant proportion, roughly 9–13%, are either unaware of these rights or incorrectly believe they do not possess them (Table 3 ). Table 3 Knowledge of Specific Rights Right to... Yes (n) Yes (%) Not Sure (n) Not Sure (%) No (n) No (%) Information 194 70.8 56 20.4 24 8.8 Refuse Treatment 190 69.3 50 18.3 34 12.4 Privacy & Confidentiality 193 70.4 57 20.8 24 8.8 Participate in Decisions 190 69.3 59 21.5 25 9.1 Respect and Dignity 187 68.3 56 20.4 31 11.3 Complain About Care 188 68.6 50 18.3 36 13.1 3.6 Familiarity with the Ghana Patients’ Rights Charter Regarding familiarity with the Ghana Patients’ Rights Charter, about 31% of nursing students reported being somewhat familiar with the Charter, reflecting a moderate level of understanding among nearly one-third of the participants. Meanwhile, 27% marked “Not applicable,” which likely includes students who have either not heard of the Charter or do not find the question relevant to them, suggesting that a significant portion may lack direct exposure or engagement. Additionally, approximately 24.5% of students indicated they are not very familiar with the Charter, and 11.7% reported not being familiar at all, highlighting a substantial knowledge gap where over one-third of students have low or no familiarity with the Charter. Only a small minority, 5.8%, consider themselves very familiar, indicating that a deep understanding of the Charter among nursing students remains quite limited (Table 4 ). Table 4 Familiarity with the Ghana Patients’ Rights Charter Familiarity with Charter (n) Percentage (%) Somewhat familiar 85 31.0 Not applicable 74 27.0 Not very familiar 67 24.5 Not familiar at all 32 11.7 Very familiar 16 5.8 3.7 Importance of the Ghana Patients’ Rights Charter A substantial majority of nursing students (74.5%) perceive the Patients’ Rights Charter as very important, demonstrating strong recognition of its significance in healthcare practice. Additionally, 21.2% regard it as important, highlighting a broadly positive attitude toward the Charter within this group. Only a small fraction of students views it as slightly important (2.9%) or not important (1.5%), indicating minimal undervaluation of the Charter (Fig. 3 ). 3.8: Application of the Ghana Patients’ Rights Charter in Clinical Settings A majority of nursing students (59.5%) reported not applying the Patients’ Rights Charter in their clinical practice, highlighting a significant gap between theoretical understanding and practical implementation. Conversely, about 30.7% affirmed that they do apply the Charter, demonstrating that nearly one-third actively incorporate patient rights into their care. Approximately 9.8% of students were uncertain about whether they apply the Charter, which may reflect ambiguity in understanding or inconsistent application of the Charter in clinical settings (Fig. 4 ). 3.9: Association between nursing students’ awareness of the Ghana Patients’ Rights Charter There is a strong and statistically significant association between students’ awareness of the Patients’ Rights Charter and their reported familiarity with it (p < 0.0001). No significant association exists between students’ awareness status and how important they consider the Charter. Similarly, there is no significant association between awareness status and whether students apply the Charter in their clinical practice (Table 5 ). Table 5 Association between nursing students’ awareness of the Ghana Patients’ Rights Charter Variable Chi-square (χ²) Degrees of Freedom (df) p-value Age 7.19 7 0.41 Year of Study 0.19 1 0.66 Program 0.71 3 0.87 Familiarity with Charter 274.0 4 < 0.0001 Importance of Charter 5.79 3 0.12 Applied Charter in Clinical Setting 1.68 2 0.43 3.10. Awareness influencers and barriers The majority of respondents (76%) reported that clinical experience positively influences their awareness or use of the Patients’ Rights Charter. In contrast, 22% indicated that clinical experience does not affect their awareness or application of the Charter, while a small minority of 2% were unsure (Fig. 5 ). 3.11: Barriers to Learning the Patients’ Rights Charter The most prominent barrier reported by 60% of nursing students (164 out of 274) is the lack of emphasis from lecturers, suggesting that insufficient integration of the Charter in teaching may hinder student awareness and comprehension. Additionally, 55% of students (151) noted that the Charter is not discussed during clinical placements, indicating that practical training settings may not effectively reinforce its importance. Half of the students (50%, 137) identified poor access to educational materials as a significant challenge, pointing to difficulties in obtaining relevant resources such as textbooks or guidelines. Staff disinterest was reported by 35% (96 students), reflecting possible low motivation among clinical supervisors to prioritize patient rights in training environments. Finally, 30% of students (82) cited the complex language of the Charter or related materials as a barrier, indicating that wording may be difficult for some students to understand fully (Fig. 6 ). 4. Discussion This descriptive cross-sectional study was conducted in two selected nursing training institutions in Ghana—College of Nursing and Midwifery, Tanoso, and St. Michael’s Nursing and Midwifery Training College, Pramso. These institutions were purposively selected to reflect diversity in geographic location and governance (public vs mission-based), which is critical for enhancing external validity ( 21 , 22 ). The quantitative cross-sectional design was appropriate for capturing nursing students’ awareness and knowledge of the Ghana Patients’ Rights Charter (PRC) at a specific time point ( 23 ). The participants were predominantly young adults, with the majority falling within the early twenties age bracket. Female students constituted more than two-thirds of the sample, a finding that aligns with global patterns in nursing education where the profession remains largely female-dominated ( 24 , 25 ). This gender imbalance may have implications for policy and recruitment strategies, especially in efforts to promote diversity within the healthcare workforce. The distribution of participants across different academic years and nursing programs was well-balanced, reflecting the standard structure of nursing education in Ghana ( 26 , 27 ). The vast majority of nursing students demonstrated awareness of the Ghana Patients’ Rights Charter (PRC), reflecting moderate awareness levels similar to those reported in other sub-Saharan African contexts ( 28 – 30 ). However, the fact that approximately one in four students remained unaware points to an enduring gap in educational outreach, emphasizing the need for more robust integration of patient rights into nursing curricula ( 2 ). Only about two-thirds of the students accurately identified core rights such as the right to information, refusal of treatment, and confidentiality. These figures are comparable to findings from ( 7 , 31 , 32 ), who reported that nursing students globally often possess only a partial understanding of patient rights. The educational implications are critical; without comprehensive knowledge of such principles, students may struggle to translate ethical obligations into practice, particularly in complex or high-pressure clinical environments. The substantial proportion expressing uncertainty (18%-22%) and denial (9%-13%) highlights ongoing gaps needing curriculum strengthening ( 2 ). In terms of legal understanding, more than half of the students perceived the PRC as legally binding. However, fewer than half had ever read or directly engaged with the document. This disconnects points to a reliance on second-hand knowledge, likely acquired through lectures or peer discussions, rather than personal study. Such indirect familiarity may limit students’ ability to interpret and apply the Charter in clinical settings. As ( 33 ) argued, direct access to and engagement with foundational legal and ethical documents is essential for developing critical thinking and professional accountability. Ensuring students can easily access and comprehend the Charter—possibly through simplified formats or integration into digital learning platforms—could significantly improve understanding and application in practice. Formal classroom instruction (45%) was the leading source of information, consistent with the recognized role of nursing education programs in patient rights dissemination ( 34 ). Clinical placements (36%) and academic materials (34%) complemented classroom learning, supporting evidence that practical and theoretical learning environments jointly shape knowledge ( 35 ). Limited use of informal and digital channels like social media and peer discussions (under 20%) suggests missed opportunities to leverage these platforms for wider awareness ( 34 ). Only a small fraction (5.8%) reported being very familiar with the PRC, with over a quarter finding the question non-applicable, indicating limited in-depth exposure. Despite high perceived importance (74.5%), actual application in clinical settings was low (30.7%), highlighting the theory-practice gap frequently noted in nursing education literature ( 36 – 38 ). No meaningful association was observed between awareness of the PRC and socio-demographic characteristics such as age, gender, or year of study. This finding supports existing literature suggesting that awareness of patient rights may cut across demographic lines in relatively homogenous academic settings ( 12 ). In contrast, a strong association was identified between students’ awareness and their familiarity with the Charter, underscoring the value of direct engagement. This suggests that simply introducing the Charter is not sufficient—students must actively interact with its content to develop meaningful understanding. Furthermore, clinical experience emerged as a key driver of awareness, with roughly three-quarters of students acknowledging its influence. This aligns with existing research that emphasizes the importance of experiential learning in ethical and rights-based nursing education ( 35 ). From a public health perspective, this highlights the need to ensure that clinical placements not only focus on technical competencies but also reinforce ethical responsibilities and patient advocacy. Strengthening the linkage between theory and real-world practice could enhance students’ preparedness to uphold patient rights effectively in future professional roles. Key barriers to learning about the PRC included limited emphasis from lecturers and the absence of structured discussions during clinical practice—issues cited by more than half of the students. These findings are consistent with earlier research from Ghana and other African countries, which have highlighted the challenges posed by inconsistent teaching methods and weak clinical mentorship in nursing education ( 39 , 40 ). Inadequate access to learning materials and perceived disinterest from clinical staff were also frequently mentioned, pointing to systemic limitations in both educational resources and workplace culture ( 41 ). Additionally, nearly one-third of students cited the complex language of the Charter as a barrier to comprehension. This observation supports earlier findings by ( 7 ), which noted that the PRC’s technical vocabulary poses difficulties for students without strong legal or academic literacy. From a public health standpoint, these barriers are critical—they may prevent future nurses from fully internalizing the ethical principles required to advocate for and protect patients. Simplifying the language of the PRC, enhancing resource availability, and training educators to integrate patients' rights more intentionally into their teaching could significantly improve understanding and long-term application in clinical settings. 5. Study Limitations This study’s cross-sectional design prevents causal conclusions and reflects only a single time point. The use of self-reported data may introduce bias, and conducting the study in just two institutions limits the generalizability of results to all nursing students in Ghana. Online data collection could have excluded participants without reliable internet access, introducing selection bias. Additionally, the study did not deeply explore other potential influencing factors or include qualitative data, which may have limited the depth of insights into students’ experiences and barriers regarding the Patients’ Rights Charter. 6. Conclusion The study indicates that while nursing students in Ghana generally demonstrate awareness and positive attitudes toward the Patients’ Rights Charter, important gaps remain in their familiarity, certainty of knowledge, and clinical application. To address these gaps in familiarity and clinical application of the Patients’ Rights Charter among nursing students, we recommend making PRC lessons more practical by using real-life examples and case-based teaching. Educators should receive ongoing training and support to deliver this content effectively. Providing students with simple, easy-to-understand PRC materials and digital resources can also enhance learning. Additionally, reinforcing the PRC during both classroom sessions and clinical practice, along with regular assessment and feedback, will help ensure nursing students are well-prepared to uphold patient rights in healthcare settings. Abbreviations PRC Patients’ Rights Charter GHS Ghana Health Service RGN Registered General Nursing RM Registered Midwifery NMTC Nursing and Midwifery Training College Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Local Ethical Committee of College of nursing and Midwifery, Tanoso-Ahafo Sunyani Ghana, on the 15th April 2025. Permission was also sought and received from the institutional authorities of the participating institutions. Participation was entirely voluntary, and only students who provided informed consent were included in the study. Strict measures were implemented to ensure the anonymity and confidentiality of all participants. Only enrolled students who were present and willing to participate were included; students who were absent or declined to participate were excluded. Ethics approval and consent to participate Ethical approval for this study was obtained from the local ethical committee of the College of Nursing and Midwifery, Tanoso, on 15th March 2025. Permission to conduct the study was also granted by the authorities of the participating institutions. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection. Participation was entirely voluntary, and strict measures were implemented to ensure anonymity and confidentiality throughout the study. Consent for publication Not applicable Availability of Data and materials Data used to support this study are available from the corresponding author upon request. Competing Interest The authors declared that they have no competing interest. Funding Statement The authors did not receive any funding for this work. Authors' contributions C.N.Z. and R.N. conceptualized the study and developed the study design. B.P.D., P.D., F.M.D., G.K.M., E.M., and B.B. G., were responsible for data collection and initial data analysis. S.G. and L.K. prepared the tables and figures. C.N.Z. and B.P.D. wrote the main manuscript text. All authors reviewed, contributed to, and approved the final version of the manuscript. Acknowledgements The authors gratefully acknowledge the management of the two health training institutions for their support and for granting permission to conduct this study. We also extend our sincere appreciation to all the nursing students who participated in the study for their time and valuable contributions. Special thanks are due to the nurse educators whose insights and guidance were instrumental in validating the data collection instrument. References Galehdar N, Heydari H. 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Available from: https://dx.doi.org/10.1093/ijcoms/lyab016 Content Validity - Measurement and Examples - Research Method [Internet]. [cited 2025 Jul 12]. Available from: https://researchmethod.net/content-validity/ Adam AM. Sample Size Determination in Survey Research. J Sci Res Rep. 2020 Jun 25;90–7. Ahmad N, Astifar Alias F, Abdul Razak A. UNDERSTANDING POPULATION AND SAMPLE IN RESEARCH: KEY CONCEPTS FOR VALID CONCLUSIONS. 2023. Wang X, Cheng Z. Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations. Chest. 2020 Jul 1;158(1):S65–71. Prosen M. Nursing students’ perception of gender-defined roles in nursing: a qualitative descriptive study. BMC Nurs. 2022 Dec 1;21(1). Smiley RA, Allgeyer RL, Shobo Y, Lyons KC, Letourneau R, Zhong E, et al. The 2022 National Nursing Workforce Survey. J Nurs Regul. 2023 Apr 1;14(1):S1–90. Asamani JA, Amertil NP, Ismaila H, Akugri FA, Nabyonga-Orem J. The imperative of evidence-based health workforce planning and implementation: Lessons from nurses and midwives unemployment crisis in Ghana. Hum Resour Health. 2020 Mar 6;18(1). Asamani JA, Amertil NP, Ismaila H, Francis AA, Chebere MM, Nabyonga-Orem J. Nurses and midwives demographic shift in Ghana - The policy implications of a looming crisis. Vol. 17, Human Resources for Health. BioMed Central Ltd.; 2019. Thema AM, Mulaudzi FM, Lavhelani NR. Assessment of nurses’ compliance with Patients’ Rights in South Africa: a scoping review. IJQHC Communications [Internet]. 2024 Nov 20;4(2). Available from: https://academic.oup.com/ijcoms/article/doi/10.1093/ijcoms/lyae004/7829107 Al-Khafaji M, Sajit N, Bazmi S, Kiani M. Patient’s Rights in Iran and Iraq. Vol. 11, International Journal of Medical Toxicology and Forensic Medicine. Shaheed Beheshti University of Medical Sciences and Health Services; 2021. p. 34653. Amoo SA, Aderoju YBG, Sarfo-Walters R, Doe PF, Okantey C, Boso CM, et al. Nursing Students’ Perception of Clinical Teaching and Learning in Ghana: A Descriptive Qualitative Study. Nurs Res Pract. 2022;2022. Kupcewicz E, Grochans E, Kadučáková H, Mikla M, Bentkowska A, Kupcewicz A, et al. Personalized healthcare: The importance of patients’ rights in clinical practice from the perspective of nursing students in Poland, Spain and Slovakia—A cross-sectional study. J Pers Med. 2021 Mar 1;11(3). Syed S Al, Hashish EAA, Bajamal E, Abdaljabbar L, Alammari N, Alotaibi R, et al. Knowledge of the Patients’ Bill of Rights and Influencing Factors Among University Nursing Students. Cureus [Internet]. 2023 May 2 [cited 2025 Jun 13];15(5):e38433. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10234609/ Olejarczyk JP, Young M. Patient Rights and Ethics. Encyclopedia of Privacy: Volume 1, 2 [Internet]. 2024 May 6 [cited 2025 Jun 13];2:376–9. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538279/ Baker C, Cary AH, da Conceicao Bento M. Global standards for professional nursing education: The time is now. Journal of Professional Nursing. 2021 Jan 1;37(1):86–92. Wuni A, Ibrahim MM, Diebieri M, Nyarko BA, Salifu MA, Abdul-Karim HA, et al. Perceptions and satisfaction with the quality of clinical training placements among nursing and midwifery students in Northern Ghana. BMC Nurs. 2025;24(1):245. Mbakaya BC, Kalembo FW, Zgambo M, Konyani A, Lungu F, Tveit B, et al. Nursing and midwifery students’ experiences and perception of their clinical learning environment in Malawi: a mixed-method study. BMC Nurs. 2020 Sep 14;19(1). Ravik M, Bjerkelund GM, Hvalvik S, Reierson IÅ. Student nurses’ learning of practical skills in hospital placements: Perspectives of registered nurse mentors. Nurse Educ Pract. 2025 Feb 1;83. Ziba FA, Yakong VN, Ali Z. Clinical learning environment of nursing and midwifery students in Ghana. BMC Nurs. 2021 Dec 1;20(1). Hobenu KA, Adefuye AO, Naab F, Nyoni CN. Clinical education in undergraduate nursing in Ghana: a gap analysis. BMC Nurs. 2025 Dec 1;24(1). Amoo SA, Aderoju YBG, Sarfo-Walters R, Doe PF, Okantey C, Boso CM, et al. Nursing Students’ Perception of Clinical Teaching and Learning in Ghana: A Descriptive Qualitative Study. Nurs Res Pract. 2022;2022. Osorio D, Ribera A, Solans-Domènech M, Arroyo-Moliner L, Ballesteros M, Romea-Lecumberri S. Healthcare professionals’ opinions, barriers and facilitators towards low-value clinical practices in the hospital setting. Gac Sanit. 2020 Sep 1;34(5):459–67. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Aug, 2025 Reviewers agreed at journal 19 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers invited by journal 14 Jul, 2025 Editor assigned by journal 14 Jul, 2025 Editor invited by journal 14 Jul, 2025 Submission checks completed at journal 12 Jul, 2025 First submitted to journal 12 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7095575","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484932171,"identity":"27c7bf69-40fd-4456-a556-aceddaf8e8a8","order_by":0,"name":"Clement Naayaara Zuuri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACdiT2gQ9Ago0dl1IYYAaTBmDy4AyQFmZStDDzIERwA/5m5qMbPu74Y29wI/fhYZtf2+T5mBkYP3zMwa1F4jBb2s2ZZwyYDW6kGxzO7btt2MbMwCw5cxtuLQbMPGa3edsM2AxupDEczu25zQjUwsbMi1cL/7fbf9sMeMBaLHtu2xOhhYcNaLKBBFgLw4/biQS1AP1idrO3zdhA8swzhoO9DbeT25gZm/H6hb+9+dmNn21y9nzH05g//Phz23Z+e/PBDx/xaEEFjG1gsoFY9SDwhxTFo2AUjIJRMFIAAIlrTh3E1TYOAAAAAElFTkSuQmCC","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":true,"prefix":"","firstName":"Clement","middleName":"Naayaara","lastName":"Zuuri","suffix":""},{"id":484932172,"identity":"b36a69dc-3b57-48a7-b10c-d16f2f50e068","order_by":1,"name":"Rachael Nyarko","email":"","orcid":"","institution":"Seventh Day Adventist (SDA) Nursing and Midwifery Training College. Box PC 96, Kwadaso- Kumasi.","correspondingAuthor":false,"prefix":"","firstName":"Rachael","middleName":"","lastName":"Nyarko","suffix":""},{"id":484932173,"identity":"4743c6b6-f542-46b5-b8d9-3e29ef717ec1","order_by":2,"name":"Benedicta Princess Dotse","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Benedicta","middleName":"Princess","lastName":"Dotse","suffix":""},{"id":484932174,"identity":"59e410fc-62db-4d97-a7c1-f1879cec3157","order_by":3,"name":"Phanuel Dzamenu","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Phanuel","middleName":"","lastName":"Dzamenu","suffix":""},{"id":484932175,"identity":"f3bf6271-612d-407f-b7f7-54045ae4c662","order_by":4,"name":"Stephanie Gyamfi","email":"","orcid":"","institution":"St Patrick's Nursing and Midwifery Training College","correspondingAuthor":false,"prefix":"","firstName":"Stephanie","middleName":"","lastName":"Gyamfi","suffix":""},{"id":484932176,"identity":"fd718f42-8bd6-41aa-975c-1815610b0992","order_by":5,"name":"Esther Munufie","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Esther","middleName":"","lastName":"Munufie","suffix":""},{"id":484932177,"identity":"d1d158c6-9cff-4134-8c77-494b487a3d79","order_by":6,"name":"Frank Manu Darko","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"Manu","lastName":"Darko","suffix":""},{"id":484932178,"identity":"d7e42246-9288-4419-8794-ea84132ab288","order_by":7,"name":"Gloria Kyere Mensah","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Gloria","middleName":"Kyere","lastName":"Mensah","suffix":""},{"id":484932179,"identity":"7a73276e-08ee-490b-a338-0804e744c665","order_by":8,"name":"Leticia Kyei","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Leticia","middleName":"","lastName":"Kyei","suffix":""},{"id":484932180,"identity":"53e57e6f-0e7b-4945-9a81-c43979bf6bbd","order_by":9,"name":"Bertrand Bayor Gyeng","email":"","orcid":"","institution":"College of Nursing and Midwifery, Tanoso-Ahafo","correspondingAuthor":false,"prefix":"","firstName":"Bertrand","middleName":"Bayor","lastName":"Gyeng","suffix":""}],"badges":[],"createdAt":"2025-07-10 18:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7095575/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7095575/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87028640,"identity":"4f5e14e6-4045-44c2-af40-6b1cbe851bc0","added_by":"auto","created_at":"2025-07-18 12:34:16","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53268,"visible":true,"origin":"","legend":"\u003cp\u003eAwareness levels of the Ghana Patients’ Rights Charter among nursing students\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/54c507b0b835da14b6fb591c.jpeg"},{"id":87028644,"identity":"0597d83e-4aae-4688-8a50-212b801a7c40","added_by":"auto","created_at":"2025-07-18 12:34:17","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":272493,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSources of Information on the Patients’ Rights Charter\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/7be5e41a19f5a59eaff7722d.jpeg"},{"id":87030216,"identity":"5c525f3a-4553-452b-b870-7c1e833901d6","added_by":"auto","created_at":"2025-07-18 12:42:17","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":189146,"visible":true,"origin":"","legend":"\u003cp\u003eImportance of the Ghana Patients’ Rights Charter\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/3e219bdce2caa4445a1a706a.jpeg"},{"id":87028641,"identity":"1e39cfff-a407-4297-9fcf-ed1c2df6952b","added_by":"auto","created_at":"2025-07-18 12:34:17","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":48201,"visible":true,"origin":"","legend":"\u003cp\u003eApplication of the Ghana Patients’ Rights Charter in Clinical Settings\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/794a3fdb55c21501e2698984.jpeg"},{"id":87028647,"identity":"6a4fc4ae-0900-4d48-ade9-1e9c41d6f2fc","added_by":"auto","created_at":"2025-07-18 12:34:17","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":203052,"visible":true,"origin":"","legend":"\u003cp\u003eAwareness influencers and barriers\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/aa8b80f0089efcf3d97162e9.jpeg"},{"id":87028658,"identity":"eea6cb5a-0ce4-43e0-8da7-13e648163243","added_by":"auto","created_at":"2025-07-18 12:34:17","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":227678,"visible":true,"origin":"","legend":"\u003cp\u003eBarriers to Learning the Patients’ Rights Charter\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/feeff7b8593b5c5d8adfe1c6.jpeg"},{"id":87032389,"identity":"dc6e4c74-6744-44e6-87ef-8b033bdf0dfb","added_by":"auto","created_at":"2025-07-18 12:58:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2241767,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7095575/v1/97a665cc-18e6-4865-8802-7fab9dc58ee8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nursing Students’ Awareness and Familiarity with the Ghana Patients’ Rights Charter: Implications for Nursing Education","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003ePatient rights are a vital aspect of ethical healthcare delivery worldwide, highlighting the importance of autonomy, dignity, and safety. Global research has identified ongoing difficulties in the awareness and comprehension of patients' rights among healthcare professionals, particularly health profession students. For example, (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) reported limited awareness of patient rights among Iranian healthcare students, particularly regarding autonomy and informed consent. These disparities provoke ethical dilemmas and impede patients' engagement in their care, highlighting the necessity for thorough education on patient rights within global health training programs. In Sub-Saharan Africa, these challenges are exacerbated by systemic deficiencies in health infrastructure and inadequate health literacy among both providers and patients (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Across the region, efforts to implement patient rights charters or similar policies face obstacles due to inadequate dissemination and training (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Research indicates that healthcare personnel frequently possess insufficient understanding regarding patients' rights frameworks, hindering effective advocacy and safeguarding of patients in clinical environments (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This gap is especially critical as nurses and midwives represent the bulk of frontline healthcare workers responsible for patient care(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Patients\u0026rsquo; Rights Charter (PRC) was established in 2002 by the Ghana Health Service to protect the dignity, safety, and welfare of patients in Ghana. The Charter delineates fundamental rights such as access to care, confidentiality, respect, informed consent, and the freedom to refuse treatment. Notwithstanding its policy importance, empirical research indicates considerable deficiencies in awareness and comprehension of the PRC among patients and healthcare practitioners alike. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) in their study indicated that more than 20% of doctors did not see patient involvement in diagnostic and treatment decisions as important. This attitude is likely influenced by over half of the doctors believing that patients cannot make informed decisions and that their participation does not necessarily improve outcomes. More recently, Atta-Doku et al., (2024a) evaluated the knowledge of Ghanaian nurses and discovered that while 87% had encountered the Charter, understanding was limited due to intricate language; the PRC\u0026rsquo;s Flesch Reading Ease score of 34% signifies it is challenging to comprehend without higher education. Comprehension emerged as the most significant predictor of PRC knowledge, underscoring the necessity to simplify the Charter's language and improve educational outreach.\u003c/p\u003e\u003cp\u003eNotwithstanding its significance, evidence indicates that awareness and comprehension of the PRC among healthcare providers, including nursing students, are inadequate. Nurses and nursing students serve as primary caregivers, significantly contributing to the enforcement of patients' rights during clinical treatment; therefore, their understanding and disposition regarding the PRC are essential for its efficacy (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Nonetheless, research has revealed deficiencies in knowledge and understanding among nursing practitioners, potentially due to insufficient focus on patients' rights in nursing education and the intricate language employed in the Charter (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe awareness level among nursing students is crucial as their training time significantly shapes professional attitudes, ethical norms, and competencies that affect future practice (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Yet, the inclusion of the PRC in nursing education in Ghana appears limited, often confined to brief discussions under professional ethics without structured teaching or practical application (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This gap risks perpetuating poor understanding of patients\u0026rsquo; rights and compromises the quality of patient care once these students enter professional practice.\u003c/p\u003e\u003cp\u003eUnderstanding nursing students\u0026rsquo; awareness and sources of knowledge about the PRC can inform curriculum reforms, enhance educational strategies, and ultimately improve rights-based care delivery in Ghana (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Several studies within and outside Ghana emphasize that improving healthcare students\u0026rsquo; knowledge of patient rights contributes to better patient outcomes and strengthens health systems (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Therefore, assessing the awareness of the Ghana Patients\u0026rsquo; Rights Charter among nursing students is essential for identifying educational gaps and informing policy interventions that promote patient advocacy and ethical nursing practice. This study focuses on nursing students in two selected health institutions, exploring their awareness of the Charter, sources of knowledge, and the influence of demographic and academic factors such as level of study and clinical exposure. The findings aim to support curriculum reforms and policy efforts to strengthen the capacity of future nurses to uphold patient rights and enhance healthcare outcomes.\u003c/p\u003e"},{"header":"2. METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Area\u003c/h2\u003e\u003cp\u003eThe study was conducted in two selected nursing training institutions in Ghana, chosen to represent diversity in geographical location and institutional structure (public versus mission-based). The institutions included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCollege of Nursing and Midwifery, Tanoso, Sunyani; located in the Bono Region, this public institution has been training nurses for over 20 years. The college offers a range of nursing and midwifery programs, including Registered General Nursing (RGN), Registered Midwifery (RM), and Community/public Health Nursing. The student population typically ranges between 700 and 1000, with an annual intake of approximately 300 students across various courses.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSt. Michael\u0026rsquo;s Nursing and Midwifery Training College (NMTC), Pramso, Ashanti Region is a mission-based institution with a history spanning over 15 years. It offers similar programs including Registered General Nursing and Registered Midwifery. The college enrolls about 400 to 600 students annually, with a strong emphasis on both theoretical and practical nursing education grounded in Christian values. The total population typically ranges from 1000 to 1500 across both programs.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Research Design\u003c/h2\u003e\u003cp\u003eThis study employed a descriptive cross-sectional design using a quantitative approach. The design was chosen to assess the level of awareness of the Ghana Patients\u0026rsquo; Rights Charter (PRC) among nursing students at a single point in time, enabling the researcher to capture current knowledge levels, sources of information, and socio-demographic influences (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Study Population\u003c/h2\u003e\u003cp\u003eThe target population comprised nursing and midwifery students in their second and third years of study. These students were assumed to have had some exposure to patient rights either through clinical practice or classroom instruction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Sample Size and Sampling Technique\u003c/h2\u003e\u003cp\u003eA proportionate stratified random sampling technique was employed to ensure fair representation across the three institutions and between year groups. Within each stratum, simple random sampling was used to select participants. The sample size was determined using Yamane\u0026rsquo;s formula(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) for a known population:\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;N/(1\u0026thinsp;+\u0026thinsp;N(e)2\u003c/p\u003e\u003cp\u003eWhere:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;sample size\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;total population of eligible students\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003ee\u003c/em\u003e\u0026thinsp;=\u0026thinsp;margin of error (0.05)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eStep 1: Total Population\u003c/p\u003e\u003cp\u003eThe two selected nursing schools has approximately 874 students in their second and third years.\u003c/p\u003e\u003cp\u003eSubstituting the values:\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{n}=\\frac{874}{1+874\\:\\left(0.05\\right)\\left(0.05\\right)}\\)\u003c/span\u003e\u003c/span\u003e \u003cb\u003e= 274\u003c/b\u003e Therefore, the calculated sample size is approximately 274.\u003c/p\u003e\u003cp\u003eStep 2: Proportional Allocation by School and Year Group\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstitution\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eProportion (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSample Size (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePramso (St. Michael\u0026rsquo;s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecond Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePramso (St. Michael\u0026rsquo;s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThird Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTanoso (College of Nursing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecond Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTanoso (College of Nursing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThird Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e874\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e274\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data Collection Instrument\u003c/h2\u003e\u003cp\u003eA structured questionnaire was developed to assess the awareness, knowledge, and application of the Ghana Patients\u0026rsquo; Rights Charter among nursing students. The items were constructed with reference to the official Ghana Patients\u0026rsquo; Rights Charter (Ghana Health Service, 2012) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and adapted from previously validated questionnaires used in similar studies conducted in Ghana and elsewhere (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The instrument comprised sections on socio-demographic information, awareness of the Charter, knowledge of specific rights, sources of awareness, and practical application in clinical settings. To ensure content validity and clarity, the questionnaire was reviewed by three senior nurse educators and piloted among a small sample of students prior to the main data collection (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Data Collection Procedure\u003c/h2\u003e\u003cp\u003e After obtaining permissions from the institutions and written informed consent from participants, the questionnaires were administered online to the selected students via a secure survey platform. Participants received invitations and instructions through their official email addresses or learning management systems. The researchers were available virtually via chat or email to clarify any questions or ambiguities during the data collection period. The data period lasted for one month (May), 2025.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Data Analysis\u003c/h2\u003e\u003cp\u003eData were cleaned, coded, and entered into SPSS version 26 for analysis. Descriptive statistics (frequencies, percentages,) were used to summarize demographic data and awareness levels. Chi-square tests was employed to determine associations between socio-demographic variables and awareness of the PRC. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.8 Ethical Considerations\u003c/h2\u003e\u003cp\u003ePermission to conduct the study was granted by the authorities of the participating institutions. Participation was entirely voluntary, and informed consent was obtained from each respondent prior to data collection. To protect the privacy of participants, anonymity and confidentiality were strictly maintained throughout the study. The inclusion criteria required participants to be enrolled students at the selected nursing training institutions who were willing to participate and provide informed consent. Students who were absent during data collection or those who declined to participate were excluded from the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Sociodemographic Characteristics\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below summarizes the socio-demographic characteristics of the nursing students who participated in the study. Regarding age, the majority of students, approximately 54%, fall within the 20\u0026ndash;24 years age group, indicating that most participants are young adults, which is typical for students in health training institutions. Smaller proportions are found in the older age group of 25\u0026ndash;29 years (19%) and the younger group below 20 years (15%). In terms of gender distribution, females constitute over 71% of the respondents, reflecting the female predominance commonly observed in nursing programs both globally and within Ghana. The year of study among participants is nearly evenly split, with 53% in their second year and 47% in their third year, providing a balanced representation across different academic levels. As for the program of study, most students (57%) are enrolled in General Nursing, followed by Midwifery at 23%, Public Health Nursing at 12%, and Registered Nurse Assistant Clinical at 8%. This distribution highlights the varied focus of nursing programs included in the sample.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eSociodemographic Characteristics\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e71.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYear of Study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecond Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThird Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProgram\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMidwifery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Health Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegistered Nurse Assistant Clinical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.2: Awareness of the patients\u0026rsquo; rights charter\u003c/h2\u003e\u003cp\u003eThe pie chart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) below depicts the awareness levels of the Ghana Patients\u0026rsquo; Rights Charter among nursing students, showing that approximately 73% of the students are aware of the Charter, while 27% are not.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.3: PRC legally binding/ seen document\u003c/h2\u003e\u003cp\u003eApproximately 60% of nursing students believe that the Patient Rights Charter (PRC) is legally binding, indicating a moderate level of understanding regarding its legal status. While a substantial 40% of students have read or seen the PRC document, the majority (60%) have not, highlighting limited direct exposure to the Charter (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePRC legally binding/ seen document\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOption\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (out of 274)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePRC legally binding?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRead or seen PRC?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Sources of Information on the Patients\u0026rsquo; Rights Charter\u003c/h2\u003e\u003cp\u003eNearly half of the nursing students (45%) reported learning about the Patients\u0026rsquo; Rights Charter through lectures or classroom teaching. Clinical placements/practical experience (36%) and textbooks/course materials (34%) are also important sources. Seminars/workshops, social media, and friends or colleagues are less frequently cited, highlighting potential areas for expanding awareness through diverse channels (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.5 knowledge of specific rights within the charter\u003c/h2\u003e\u003cp\u003eThe majority of nursing students, ranging from about 68\u0026ndash;71%, correctly identify their rights under the Ghana Patients\u0026rsquo; Rights Charter, including the right to information, refusal of treatment, privacy, participation, respect, and the right to complain. However, approximately 18\u0026ndash;22% of students remain uncertain (\u0026ldquo;Not sure\u0026rdquo;) about these rights, highlighting existing knowledge gaps. Additionally, a smaller yet significant proportion, roughly 9\u0026ndash;13%, are either unaware of these rights or incorrectly believe they do not possess them (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eKnowledge of Specific Rights\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight to...\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Sure (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot Sure (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRefuse Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e12.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivacy \u0026amp; Confidentiality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipate in Decisions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespect and Dignity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplain About Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.6 \u003cb\u003eFamiliarity with the Ghana Patients\u0026rsquo; Rights Charter\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eRegarding familiarity with the Ghana Patients\u0026rsquo; Rights Charter, about 31% of nursing students reported being somewhat familiar with the Charter, reflecting a moderate level of understanding among nearly one-third of the participants. Meanwhile, 27% marked \u0026ldquo;Not applicable,\u0026rdquo; which likely includes students who have either not heard of the Charter or do not find the question relevant to them, suggesting that a significant portion may lack direct exposure or engagement. Additionally, approximately 24.5% of students indicated they are not very familiar with the Charter, and 11.7% reported not being familiar at all, highlighting a substantial knowledge gap where over one-third of students have low or no familiarity with the Charter. Only a small minority, 5.8%, consider themselves very familiar, indicating that a deep understanding of the Charter among nursing students remains quite limited (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFamiliarity with the Ghana Patients\u0026rsquo; Rights Charter\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamiliarity with Charter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomewhat familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot very familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot familiar at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Importance of the Ghana Patients\u0026rsquo; Rights Charter\u003c/h2\u003e\u003cp\u003eA substantial majority of nursing students (74.5%) perceive the Patients\u0026rsquo; Rights Charter as very important, demonstrating strong recognition of its significance in healthcare practice. Additionally, 21.2% regard it as important, highlighting a broadly positive attitude toward the Charter within this group. Only a small fraction of students views it as slightly important (2.9%) or not important (1.5%), indicating minimal undervaluation of the Charter (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.8: Application of the Ghana Patients\u0026rsquo; Rights Charter in Clinical Settings\u003c/h2\u003e\u003cp\u003eA majority of nursing students (59.5%) reported not applying the Patients\u0026rsquo; Rights Charter in their clinical practice, highlighting a significant gap between theoretical understanding and practical implementation. Conversely, about 30.7% affirmed that they do apply the Charter, demonstrating that nearly one-third actively incorporate patient rights into their care. Approximately 9.8% of students were uncertain about whether they apply the Charter, which may reflect ambiguity in understanding or inconsistent application of the Charter in clinical settings (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e3.9: Association between nursing students\u0026rsquo; awareness of the Ghana Patients\u0026rsquo; Rights Charter\u003c/h2\u003e\u003cp\u003eThere is a strong and statistically significant association between students\u0026rsquo; awareness of the Patients\u0026rsquo; Rights Charter and their reported familiarity with it (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). No significant association exists between students\u0026rsquo; awareness status and how important they consider the Charter. Similarly, there is no significant association between awareness status and whether students apply the Charter in their clinical practice (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between nursing students\u0026rsquo; awareness of the Ghana Patients\u0026rsquo; Rights Charter\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChi-square (χ\u0026sup2;)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDegrees of Freedom (df)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear of Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgram\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamiliarity with Charter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e274.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImportance of Charter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApplied Charter in Clinical Setting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e3.10. Awareness influencers and barriers\u003c/h2\u003e\u003cp\u003eThe majority of respondents (76%) reported that clinical experience positively influences their awareness or use of the Patients\u0026rsquo; Rights Charter. In contrast, 22% indicated that clinical experience does not affect their awareness or application of the Charter, while a small minority of 2% were unsure (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e3.11: Barriers to Learning the Patients\u0026rsquo; Rights Charter\u003c/h2\u003e\u003cp\u003eThe most prominent barrier reported by 60% of nursing students (164 out of 274) is the lack of emphasis from lecturers, suggesting that insufficient integration of the Charter in teaching may hinder student awareness and comprehension. Additionally, 55% of students (151) noted that the Charter is not discussed during clinical placements, indicating that practical training settings may not effectively reinforce its importance. Half of the students (50%, 137) identified poor access to educational materials as a significant challenge, pointing to difficulties in obtaining relevant resources such as textbooks or guidelines. Staff disinterest was reported by 35% (96 students), reflecting possible low motivation among clinical supervisors to prioritize patient rights in training environments. Finally, 30% of students (82) cited the complex language of the Charter or related materials as a barrier, indicating that wording may be difficult for some students to understand fully (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis descriptive cross-sectional study was conducted in two selected nursing training institutions in Ghana\u0026mdash;College of Nursing and Midwifery, Tanoso, and St. Michael\u0026rsquo;s Nursing and Midwifery Training College, Pramso. These institutions were purposively selected to reflect diversity in geographic location and governance (public vs mission-based), which is critical for enhancing external validity (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The quantitative cross-sectional design was appropriate for capturing nursing students\u0026rsquo; awareness and knowledge of the Ghana Patients\u0026rsquo; Rights Charter (PRC) at a specific time point (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe participants were predominantly young adults, with the majority falling within the early twenties age bracket. Female students constituted more than two-thirds of the sample, a finding that aligns with global patterns in nursing education where the profession remains largely female-dominated (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This gender imbalance may have implications for policy and recruitment strategies, especially in efforts to promote diversity within the healthcare workforce. The distribution of participants across different academic years and nursing programs was well-balanced, reflecting the standard structure of nursing education in Ghana (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe vast majority of nursing students demonstrated awareness of the Ghana Patients\u0026rsquo; Rights Charter (PRC), reflecting moderate awareness levels similar to those reported in other sub-Saharan African contexts (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, the fact that approximately one in four students remained unaware points to an enduring gap in educational outreach, emphasizing the need for more robust integration of patient rights into nursing curricula (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Only about two-thirds of the students accurately identified core rights such as the right to information, refusal of treatment, and confidentiality. These figures are comparable to findings from (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), who reported that nursing students globally often possess only a partial understanding of patient rights. The educational implications are critical; without comprehensive knowledge of such principles, students may struggle to translate ethical obligations into practice, particularly in complex or high-pressure clinical environments.\u003c/p\u003e\u003cp\u003eThe substantial proportion expressing uncertainty (18%-22%) and denial (9%-13%) highlights ongoing gaps needing curriculum strengthening (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In terms of legal understanding, more than half of the students perceived the PRC as legally binding. However, fewer than half had ever read or directly engaged with the document. This disconnects points to a reliance on second-hand knowledge, likely acquired through lectures or peer discussions, rather than personal study. Such indirect familiarity may limit students\u0026rsquo; ability to interpret and apply the Charter in clinical settings. As (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) argued, direct access to and engagement with foundational legal and ethical documents is essential for developing critical thinking and professional accountability. Ensuring students can easily access and comprehend the Charter\u0026mdash;possibly through simplified formats or integration into digital learning platforms\u0026mdash;could significantly improve understanding and application in practice.\u003c/p\u003e\u003cp\u003eFormal classroom instruction (45%) was the leading source of information, consistent with the recognized role of nursing education programs in patient rights dissemination (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Clinical placements (36%) and academic materials (34%) complemented classroom learning, supporting evidence that practical and theoretical learning environments jointly shape knowledge (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Limited use of informal and digital channels like social media and peer discussions (under 20%) suggests missed opportunities to leverage these platforms for wider awareness (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Only a small fraction (5.8%) reported being very familiar with the PRC, with over a quarter finding the question non-applicable, indicating limited in-depth exposure. Despite high perceived importance (74.5%), actual application in clinical settings was low (30.7%), highlighting the theory-practice gap frequently noted in nursing education literature (\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNo meaningful association was observed between awareness of the PRC and socio-demographic characteristics such as age, gender, or year of study. This finding supports existing literature suggesting that awareness of patient rights may cut across demographic lines in relatively homogenous academic settings (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In contrast, a strong association was identified between students\u0026rsquo; awareness and their familiarity with the Charter, underscoring the value of direct engagement. This suggests that simply introducing the Charter is not sufficient\u0026mdash;students must actively interact with its content to develop meaningful understanding. Furthermore, clinical experience emerged as a key driver of awareness, with roughly three-quarters of students acknowledging its influence. This aligns with existing research that emphasizes the importance of experiential learning in ethical and rights-based nursing education (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). From a public health perspective, this highlights the need to ensure that clinical placements not only focus on technical competencies but also reinforce ethical responsibilities and patient advocacy. Strengthening the linkage between theory and real-world practice could enhance students\u0026rsquo; preparedness to uphold patient rights effectively in future professional roles.\u003c/p\u003e\u003cp\u003eKey barriers to learning about the PRC included limited emphasis from lecturers and the absence of structured discussions during clinical practice\u0026mdash;issues cited by more than half of the students. These findings are consistent with earlier research from Ghana and other African countries, which have highlighted the challenges posed by inconsistent teaching methods and weak clinical mentorship in nursing education (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Inadequate access to learning materials and perceived disinterest from clinical staff were also frequently mentioned, pointing to systemic limitations in both educational resources and workplace culture (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Additionally, nearly one-third of students cited the complex language of the Charter as a barrier to comprehension. This observation supports earlier findings by (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), which noted that the PRC\u0026rsquo;s technical vocabulary poses difficulties for students without strong legal or academic literacy. From a public health standpoint, these barriers are critical\u0026mdash;they may prevent future nurses from fully internalizing the ethical principles required to advocate for and protect patients. Simplifying the language of the PRC, enhancing resource availability, and training educators to integrate patients' rights more intentionally into their teaching could significantly improve understanding and long-term application in clinical settings.\u003c/p\u003e"},{"header":"5. Study Limitations","content":"\u003cp\u003eThis study\u0026rsquo;s cross-sectional design prevents causal conclusions and reflects only a single time point. The use of self-reported data may introduce bias, and conducting the study in just two institutions limits the generalizability of results to all nursing students in Ghana. Online data collection could have excluded participants without reliable internet access, introducing selection bias. Additionally, the study did not deeply explore other potential influencing factors or include qualitative data, which may have limited the depth of insights into students\u0026rsquo; experiences and barriers regarding the Patients\u0026rsquo; Rights Charter.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThe study indicates that while nursing students in Ghana generally demonstrate awareness and positive attitudes toward the Patients\u0026rsquo; Rights Charter, important gaps remain in their familiarity, certainty of knowledge, and clinical application. To address these gaps in familiarity and clinical application of the Patients\u0026rsquo; Rights Charter among nursing students, we recommend making PRC lessons more practical by using real-life examples and case-based teaching. Educators should receive ongoing training and support to deliver this content effectively. Providing students with simple, easy-to-understand PRC materials and digital resources can also enhance learning. Additionally, reinforcing the PRC during both classroom sessions and clinical practice, along with regular assessment and feedback, will help ensure nursing students are well-prepared to uphold patient rights in healthcare settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePRC Patients\u0026rsquo; Rights Charter\u003c/p\u003e\n\u003cp\u003eGHS Ghana Health Service\u003c/p\u003e\n\u003cp\u003eRGN Registered General Nursing\u003c/p\u003e\n\u003cp\u003eRM Registered Midwifery\u003c/p\u003e\n\u003cp\u003eNMTC Nursing and Midwifery Training College\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Local Ethical Committee of College of nursing and Midwifery, Tanoso-Ahafo Sunyani Ghana, on the 15th April 2025. Permission was also sought and received from the institutional authorities of the participating institutions. Participation was entirely voluntary, and only students who provided informed consent were included in the study. Strict measures were implemented to ensure the anonymity and confidentiality of all participants. Only enrolled students who were present and willing to participate were included; students who were absent or declined to participate were excluded.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the local ethical committee of the College of Nursing and Midwifery, Tanoso, on 15th March 2025. Permission to conduct the study was also granted by the authorities of the participating institutions. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection. Participation was entirely voluntary, and strict measures were implemented to ensure anonymity and confidentiality throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used to support this study are available from the corresponding author upon request. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eC.N.Z. and R.N. conceptualized the study and developed the study design. B.P.D., P.D., F.M.D., G.K.M., E.M., and B.B. G., were responsible for data collection and initial data analysis. S.G. and L.K. prepared the tables and figures. C.N.Z. and B.P.D. wrote the main manuscript text. All authors reviewed, contributed to, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the management of the two health training institutions for their support and for granting permission to conduct this study. We also extend our sincere appreciation to all the nursing students who participated in the study for their time and valuable contributions. Special thanks are due to the nurse educators whose insights and guidance were instrumental in validating the data collection instrument.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGalehdar N, Heydari H. 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Nurs Res Pract. 2022;2022. \u003c/li\u003e\n\u003cli\u003eOsorio D, Ribera A, Solans-Dom\u0026egrave;nech M, Arroyo-Moliner L, Ballesteros M, Romea-Lecumberri S. Healthcare professionals\u0026rsquo; opinions, barriers and facilitators towards low-value clinical practices in the hospital setting. Gac Sanit. 2020 Sep 1;34(5):459\u0026ndash;67. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patients’ Rights Charter, Nursing Students, Awareness, Clinical Practice, Nursing Education","lastPublishedDoi":"10.21203/rs.3.rs-7095575/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7095575/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The Ghana Patients’ Rights Charter (PRC), established in 2002, serves as a critical framework to protect patient dignity, autonomy, and safety. Despite its significance, awareness and understanding of the PRC among nursing students—future frontline healthcare providers—remain inadequately explored in Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study assessed the level of awareness, knowledge, sources of information, and attitudes toward the PRC among nursing students in two selected Ghanaian nursing training institutions. It also examined demographic and academic factors influencing awareness and identified barriers affecting learning about the Charter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A descriptive cross-sectional survey was conducted among 274 nursing students from College of Nursing and Midwifery, Tanoso and St. Michael’s Nursing and Midwifery Training College, Pramso. Data were collected via structured online questionnaires and analyzed using descriptive statistics and Chi-square tests to assess associations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eApproximately 73% of students reported awareness of the PRC, with 60% perceiving it as legally binding; however, only 40% had seen the Charter document. Classroom lectures (45%) and clinical placements (36%) were the primary information sources. Knowledge of specific patient rights ranged from 68% to 71%, yet notable uncertainty and misinformation persisted. While 74.5% considered the Charter very important, only 30.7% applied it in clinical practice. Awareness was strongly associated with familiarity but not with demographic variables or perceived importance. Major barriers included insufficient emphasis by lecturers (60%), lack of discussion during clinicals (55%), poor access to materials (50%), staff disinterest (35%), and complex language (30%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eDespite general awareness and positive attitudes, critical gaps exist in familiarity, knowledge certainty, and clinical application of the PRC among nursing students. Addressing these requires curriculum integration, faculty development, improved resource accessibility, and stronger institutional support to foster a nursing workforce capable of upholding patient rights and enhancing quality care in Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable\u003c/p\u003e","manuscriptTitle":"Nursing Students’ Awareness and Familiarity with the Ghana Patients’ Rights Charter: Implications for Nursing Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 12:34:12","doi":"10.21203/rs.3.rs-7095575/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-16T19:10:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120755061524475571194736553863120693486","date":"2025-07-19T12:51:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158792980655874470942087333294150996236","date":"2025-07-18T04:05:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T02:01:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-15T01:58:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-14T07:02:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-12T22:57:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-12T22:54:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c976af8-6b85-47ef-8336-9908e9b6add5","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T12:34:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 12:34:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7095575","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7095575","identity":"rs-7095575","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}