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Despite vigorous national debate between 1999±2001 the federal
patients¶ bill of rights (PBOR) was not enacted. However,
states have enacted legislation and the Joint Commission
defined an accreditation standard to present patients with
their rights. Because such initiatives can be undermined by
overly complex language, we surveyed the readability of
hospital PBOR documents as well as texts mandated by state
law.

State Web sites and codes were searched to identify PBOR
statutes for general patient populations. The rights addressed
were compared with the 12 themes presented in the American
Hospital Association¶s (AHA) PBOR text of 2002. In addition,
we obtained PBOR texts from a sample of hospitals in each
state. Readability was evaluated using Prose, a software
program which reports an average of eight readability
formulas.
 
Of 23 states with a PBOR statute for the general public, all
establish a grievance policy, four protect a private right of
action, and one stipulates fines for violations. These laws
address an average of 7.4 of the 12 AHA themes. Nine states¶
statutes specify PBOR text for distribution to patients. These
documents have an average readability of 15th grade (range,
11.6, New York, to 17.0, Minnesota). PBOR documents from 240
US hospitals have an average readability of 14th grade (range,
8.2 to 17.0).

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While the average U.S. adult reads at an 8th grade reading
level, an advanced college reading level is routinely required
to read PBOR documents. Patients are not likely to learn about
their rights from documents they cannot read.
Reference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659155/

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This study tested the interrater reliability and criterion-

related validity of structured violence risk judgments made by
using one application of the structured professional judgment
model of violence risk assessment, the HCR-20 violence risk
assessment scheme, which assesses 20 key risk factors in three
domains: historical, clinical, and risk management.


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The HCR-20 was completed for a sample of 100 forensic

psychiatric patients who had been found not guilty by reason of
a mental disorder and were subsequently released to the
community. Violence in the community was determined from
multiple file-based sources.




Interrater reliability of structured final risk judgments of

low, moderate, or high violence risk made on the basis of the
structured professional judgment model was acceptable
(weighted kappa=.61). Structured final risk judgments were
significantly predictive of postrelease community violence,
yielding moderate to large effect sizes. Event history analyses
showed that final risk judgments made with the structured
professional judgment model added incremental validity to the
HCR-20 used in an actuarial (numerical) sense.

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The findings support the structured professional judgment model

of risk assessment as well as the HCR-20 specifically and
suggest that clinical judgment, if made within a structured
context, can contribute in meaningful ways to the assessment of
violence risk. 

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http://psychservices.psychiatryonline.org/cgi/content/abstract
/54/10/1372
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Reaction:
 Information for patient is one of the patient¶s bill of
rights, a right to accurate and easily-understood information
about patient health plan, health care professionals, and
health care facilities. If patient speak another language,
have a physical or mental disability or just don¶t understand
something, help should be given so that they can make informed
health care decisions.
My stand as a student nurse is to assess the patient, by
taking history and baseline data including his/ her
educational attainment, in order to know whether s/he can able
to read or understand written documents and if not I must help
him/her understand the information so that s/he can
participate in his/her health care plan.
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Reaction:

The study concludes that the clinical judgment might be

helpful in assessing violence risks. As a nursing student, we
must know the signs of violence and how we can intervene in
that situation. We must also aware of patient¶s potential for
self-destructive or aggressive behavior. We must not reluctant
to ask information from the patient about abuse. We must also
provide safety measures and help the patient to cope with
stress and emotions. And most of all, do not make decisions
for them or give advice but support his or her efforts and
teach him or her how to solve problem and teach some coping
skills.