Ethics in perioperative practice--patient advocacy

Patient advocacy in nursing: A concept analysis

Background:

The concept of patient advocacy is still poorly understood and not clearly conceptualized. Therefore, there is a gap between the ideal of patient advocacy and the reality of practice. In order to increase nursing actions as a patient advocate, a comprehensive and clear definition of this concept is necessary.

Research objective:

This study aimed to offer a comprehensive and clear definition of patient advocacy.

Research design:

A total of 46 articles and 2 books published between 1850 and 2016 and related to the concept of patient advocacy were selected from six databases and considered for concept analysis based on Rodgers’ evolutionary approach.

Ethical considerations:

This study was approved by the Research Ethics Committee of Tarbiat Modares University.

Findings:

The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources).

Discussion and conclusion:

The analysis of this concept can help to develop educational or managerial theories, design instruments for evaluating the performance of nurses in patient advocacy, develop strategies for enhancing patient advocacy, and improve the safety and quality of nursing care in the community and healthcare system.

Factors affecting conscience-based nursing practices: A qualitative study

BACKGROUND

Conscience is a guiding factor in nursing practice for delivering the ultimate care. In order to expand the concept of conscience-based care, factors affecting conscience in nursing practice need to be identified.

OBJECTIVES

The current study assessed nurses' experiences to explore factors affecting conscience in nursing practice.

RESEARCH DESIGN

This qualitative content analysis study employed purposive sampling to reach 14 nurses working at educational hospitals in Tabriz and Urmia, Iran. Data were analyzed using inductive and conventional analysis.

ETHICAL CONSIDERATIONS

This research was approved by the Ethics Committee of Urmia University of Medical Science. Voluntary participation, anonymity, and confidentiality were considered.

FINDING

Two themes emerged from our analysis for enhancing conscience in nursing practices, including environment of professional performance and personal factors.

DISCUSSION

The two important factors for enhancing conscience in nursing practice are environment and personal factors.

CONCLUSION

It is necessary to emphasize on religious beliefs, professional commitment, and communication skills in educational training structure. Also, establishing appropriate management systems will help nurses to provide moral care.

Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy

BACKGROUND

Anaesthesia often induces a state of unconsciousness that includes inability to communicate and influence the situation. The patient has to rely on the nurse anaesthetist to speak up for her/him as well as maintain her/his dignity and safety. Consequently, the nurse anaesthetist can be likened to the patient's advocate.

AIM

The aim of the study was to describe advocacy in anaesthesia care during the perioperative phase from the perspective of the registered nurse anaesthetist.

METHOD

Data for this qualitative descriptive study were collected during March and April, 2011. Individual interviews were conducted with a purposive sample of 20 nurse anaesthetists from two hospitals in Sweden. The audio-taped interviews were transcribed verbatim and analysed by means of qualitative content analysis.

FINDINGS

The main theme, Holding the patient's life in my hands, described the nurse anaesthetists' perception of advocacy and comprised three subthemes: providing dignified care, providing safe care and a moral commitment.

CONCLUSION

Acting as the patient's advocate includes important health and well-being issues and could be stressful for the nurse anaesthetists'. A work environment where the nurse anaesthetists' can make their voices heard and feel that their opinion regarding the patient's best interests is taken seriously would be desirable, as all health professionals should ideally focus on those in their care.

Nursing Advocacy in North Carolina

PURPOSE/OBJECTIVES

To identify the ways oncology nurses in one state advocate for patients, as well as the resources they use to do so.

DESIGN

Descriptive, cross-sectional survey.

SETTING

North Carolina.

SAMPLE

141 RNs in North Carolina who were members of the Oncology Nursing Society (ONS).

METHODS

Subjects completed a two-page, self-administered questionnaire comprised of fixed-choice and open-ended questions.

MAIN RESEARCH VARIABLES

Demographics, frequency of advocating for patient services, and awareness of ONS resources.

FINDINGS

Nurses in North Carolina advocate for patients in a variety of ways. A need exists to develop ongoing methods to keep nurses up to date on advocacy issues, as well as to establish mentoring opportunities for them. Nurses believe that they are most challenged in addressing patients' financial and insurance concerns.

CONCLUSIONS

Oncology nurses frequently advocate for patients' needs. The findings provide direction for future initiatives to educate nurses about their role in patient advocacy and available resources.

IMPLICATIONS FOR NURSING

Ongoing education and research are needed to enhance the role of oncology nurses as patient advocates.

Nursing ethics in practice: issues for perioperative nursing

Consent is a concept inherent in any nurse-patient relationship and provides nursing with both theoretical and practical challenges. Within the perioperative area written informed consent is obtained for surgical and anaesthetic interventions. Consent is not formally negotiated for the multitude of interventions undertaken to facilitate the most straightforward of surgical procedures. An explorative, qualitative research project was undertaken to explore the processes used by perioperative nurses for negotiating such consent. Data was collected from perioperative nurses working in an acute teaching hospital using ‘consent episodes’ as units of data focusing on daily tasks of perioperative patient care. Findings indicate there is a dominant discourse of implied consent in which perioperative nursing practice is located.

Nursing advocacy—a review of the empirical research 1990–2003

This paper provides an overview of the empirical research literature on nursing advocacy. It offers a description of the contexts, methods and issues of validity and reliability used in studies of nursing advocacy, as well as advocacy definitions, activities and consequences as results of those studies. The review focuses on empirical articles retrieved from the CINAHL and MEDLINE databases published between 1990 and 2003. It draws attention to complexity the concept of advocacy, difficulties in operationalisation, and concentration on reactive advocacy from nurses' perspective. There is a lack of research on patients' perspectives of nursing advocacy in general hospital settings.

The complexities of perioperative blood transfusion in Ireland

Issues surrounding blood and blood products are important considerations of patient care in Irish society. Consequently, political, socio-economic, cultural and ethicolegal issues, together with technological and pharmacological advances in new transfusion therapies, are important considerations while caring for clients across all areas of health care. Patient autonomy is proliferating and perioperative nurses have a duty of care to patients to provide information regarding impending surgery and available alternative treatments. This article will focus on issues surrounding blood and blood products in relation to perioperative nursing practice.