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Abstract
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.
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Hanks RG, Eloi H, Stafford L. Understanding how advanced practice registered nurses function as patient advocates. Nurs Forum 2019; 54:213-219. [PMID: 30561014 DOI: 10.1111/nuf.12319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
Although patient advocacy experiences for registered nurses (RNs) have been researched over the past 40 years, very little is known about patient advocacy at the advanced practice registered nursing (APRN) level. The APRN role is distinct from the RN role, in that APRNs are focused on diagnosing, prescribing, and management of treatment of various medical conditions in the settings where APRNs are used. The purpose of this study was to explore the APRN's experience with patient advocacy using a phenomenology-based qualitative design. A total of seven Texas APRNs were randomly selected for participation in telephone interviews. Interview transcripts were analyzed by the research team for repetitive statements and four themes emerged from the data: (a) patients with APRN advocacy is providing resources, information, and protection; (b) outcomes of patient with APRN advocacy: positive and negative; (c) patient advocacy mostly experientially learned at APRN level; and (d) increased medical knowledge increases advocacy ability. This pilot study provides important preliminary exploratory results regarding APRN advocacy and differentiates it from RN level advocacy. In addition, this study provides significant insight into APRN educational preparation for the APRN advocate role, thus serving as a foundation for improving educational approaches to advocacy.
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Affiliation(s)
- Robert G Hanks
- Department of Graduate Studies, UTHealth Cizik School of Nursing, Houston, Texas
| | - Hildreth Eloi
- Department of Graduate Studies, UTHealth Cizik School of Nursing, Houston, Texas
| | - Linda Stafford
- Department of Graduate Studies, UTHealth Cizik School of Nursing, Houston, Texas
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Reed FM, Fitzgerald L, Bish MR. A practice model for rural district nursing success in end-of-life advocacy care. Scand J Caring Sci 2017; 32:746-755. [PMID: 28840608 DOI: 10.1111/scs.12505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/20/2017] [Indexed: 11/27/2022]
Abstract
AIM The development of a practice model for rural district nursing successful end-of-life advocacy care. BACKGROUND Resources to help people live well in the end stages of life in rural areas can be limited and difficult to access. District nurse advocacy may promote end-of-life choice for people living at home in rural Australia. The lack of evidence available internationally to inform practice in this context was addressed by exploratory study. METHOD A pragmatic mixed method study approved by the University Faculty Ethics Committee and conducted from March 2014 to August 2015 was used to explore the successful end-of-life advocacy of 98 rural Australian district nurses. The findings and results were integrated then compared with theory in this article to develop concepts for a practice model. RESULTS The model illustrates rural district nurse advocacy success based on respect for the rights and values of people. Advocacy action is motivated by the emotional responses of nurses to the end-of-life vulnerability people experience. The combination of willing investment in relationships, knowing the rural people and resources, and feeling supported, together enables district nurses to develop therapeutic emotional intelligence. This skill promotes moral agency in reflection and advocacy action to overcome emotional and ethical care challenges of access and choice using holistic assessment, communication, organisation of resources and empowering support for the self-determination of person-centred end-of-life goals. Recommendations are proposed from the theoretical concepts in the model. LIMITATIONS Testing the model in practice is recommended to gain the perceptions of a broader range of rural people both giving and receiving end-of-life-care. CONCLUSION A model developed by gathering and comparing district nursing experiences and understanding using mixed methods and existing theory offers evidence for practice of a philosophy of successful person-centred advocacy care in a field of nursing that lacks specific guidance.
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Affiliation(s)
- Frances M Reed
- La Trobe School of Rural Nursing and Midwifery, La Trobe University, Bendigo, Victoria, Australia
| | - Les Fitzgerald
- La Trobe School of Rural Nursing and Midwifery, La Trobe University, Bendigo, Victoria, Australia
| | - Melanie R Bish
- La Trobe School of Rural Nursing and Midwifery, La Trobe University, Bendigo, Victoria, Australia
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Hanks RG, Starnes-Ott K, Stafford L. Patient Advocacy at the APRN Level: A Direction for the Future. Nurs Forum 2017; 53:5-11. [PMID: 28398600 DOI: 10.1111/nuf.12209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient advocacy is seen as a critical role for the nursing profession. Although there is an existing body of literature surrounding the registered nurse level of patient advocacy, little is known about the advanced practice registered nurse (APRN) and patient advocacy. This article examines the existing patient advocacy research literature and existing APRN competencies to provide direction for further research.
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Affiliation(s)
- Robert G Hanks
- University of Texas Health Science Center-Houston School of Nursing, Houston, TX
| | - Kristen Starnes-Ott
- University of Texas Health Science Center-Houston School of Nursing, Houston, TX
| | - Linda Stafford
- University of Texas Health Science Center-Houston School of Nursing, Houston, TX
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Wermström J, Ryrlén E, Axelsson ÅB. From powerlessness to striving for control - experiences of invasive treatment while awake. J Clin Nurs 2017; 26:1066-1073. [DOI: 10.1111/jocn.13440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Johanna Wermström
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Health and Care Science; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Eva Ryrlén
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Health and Care Science; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Åsa B Axelsson
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Health and Care Science; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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6
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O'Connor T, Kelly B. Bridging the Gap: a study of general nurses’ perceptions of patient advocacy in Ireland. Nurs Ethics 2016; 12:453-67. [PMID: 16178342 DOI: 10.1191/0969733005ne814oa] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advocacy has become an accepted and integral attribute of nursing practice. Despite this adoption of advocacy, confusion remains about the precise nature of the concept and how it should be enacted in practice. The aim of this study was to investigate general nurses’ perceptions of being patient advocates in Ireland and how they enact this role. These perceptions were compared with existing theory and research on advocacy in order to contribute to the knowledge base on the subject. An inductive, qualitative approach was used for this study. Three focus group interviews with a total of 20 practising nurses were conducted with a sample representing different grades in a general hospital setting. Data analysis was carried out using elements of Strauss and Corbins’ approach to concept development. The findings indicate that the principal role of the nurse advocate is to act as an intermediary between the patient and the health care environment. The results highlight that advocacy did, however, result in nurses becoming involved in conflict and confrontation with others and that it could be detrimental to nurses both professionally and personally. It was also clear that when enacting advocacy, nurses distinguished between ‘clinical advocacy’ (acting directly for patients in the clinical environment) and organizational advocacy (acting on an organizational level for one or more patients).
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Affiliation(s)
- Tom O'Connor
- School of Nursing and Midwifery, University College Dublin, Belfield, Dublin 4, Republic of Ireland.
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7
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Abstract
BACKGROUND The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway. OBJECTIVE This paper traces the development of legislation for advocacy. CONCLUSION The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.
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Skogstad L, Hem E, Sandvik L, Ekeberg O. Nurse-led psychological intervention after physical traumas: a randomized controlled trial. J Clin Med Res 2015; 7:339-47. [PMID: 25780483 PMCID: PMC4356095 DOI: 10.14740/jocmr2082w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Emergency room nurses were trained to provide a short-term psychological intervention in physically injured patients with Impact of Event Scale (IES) scores > 20. The aims were to study the effects of the psychological intervention relative to usual care (UC). METHODS In a randomized controlled trial, psychological distress, daily functioning and the personality traits optimism/pessimism were compared with patients who received the UC. The interventions were provided 1 - 3 months after discharge. RESULTS The IES scores were significantly reduced in both groups at 3 months (intervention: 41.1 - 28.6, P < 0.001 vs. UC: 35.4 - 26.2, P < 0.001), but not significantly different between groups. Baseline IES score was a significant predictor of IES scores at 3 (β = 0.4, P < 0.05) and 12 months (β = 0.3, P < 0.05), whereas overall daily functioning at 3 months predicted IES scores at 12 months (β = -0.5, P < 0.001). Patients receiving intervention became significantly more optimistic during the year, and had an increase in overall daily functioning from 3 to 12 months (P < 0.001). Patients declining intervention were more pessimistic and had lower daily functioning. Patients who talked with nurses with more training in psychological processing had a larger reduction in IES symptoms at 3 months (β = -0.3, P = 0.081). CONCLUSION The nurse-led intervention had a significant effect on optimism and overall daily functioning. Nurses may become a low-cost option to perform short-term psychological interventions with physically injured hospitalized patients.
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Affiliation(s)
- Laila Skogstad
- Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval, Oslo, Norway ; Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Erlend Hem
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Leiv Sandvik
- Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Oivind Ekeberg
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway ; Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Josse-Eklund A, Jossebo M, Sandin-Bojö AK, Wilde-Larsson B, Petzäll K. Swedish nurses' perceptions of influencers on patient advocacy: a phenomenographic study. Nurs Ethics 2014; 21:673-83. [PMID: 24477259 DOI: 10.1177/0969733013515488] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. OBJECTIVE This study's aim was to describe Swedish nurses' perceptions of influencers on patient advocacy. RESEARCH DESIGN AND CONTEXT Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method. ETHICAL CONSIDERATIONS Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University. FINDINGS Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse's character traits, was described in the perceptions that advocacy is influenced by nurse's having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse's bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy. DISCUSSION The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. CONCLUSION The nurse's character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies.
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Affiliation(s)
| | | | | | | | - Kerstin Petzäll
- Karlstad University, Sweden; Gjøvik University College, Norway
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10
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Choi SPP, Cheung K, Pang SMC. A field study of the role of nurses in advocating for safe practice in hospitals. J Adv Nurs 2013; 70:1584-93. [DOI: 10.1111/jan.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Sandy Pin-pin Choi
- Division of Nursing and Health Studies; The Open University of Hong Kong; China
| | - Kin Cheung
- School of Nursing; The Hong Kong Polytechnic University; China
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11
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Senften J, Engström Å. Critical care nurses' experiences of helicopter transfers. Nurs Crit Care 2013; 20:25-33. [PMID: 24238003 DOI: 10.1111/nicc.12063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/21/2013] [Accepted: 09/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intensive care is conducted in intensive care units (ICUs), and also during the transportation of critically ill people. AIM The aim of the study was to describe critical care nurses' (CCNs) experiences of nursing critically ill patients during helicopter transport. PARTICIPANTS Seven CCNs, five women and two men participated in this study. DESIGN Seven participants from two centres in Sweden were recruited. The design uses an inductive, qualitative approach with data collected by means of qualitative interviews with seven CCNs. METHODS The interviews were transcribed verbatim and subjected to qualitative thematic content analysis. RESULTS The analysis resulted in one theme which is safe nursing care, but sometimes feeling afraid and six categories as follows: experiencing the care environment as an ICU with limited space; a loud environment complicates communication; planning and checking to minimize risks; experience and good co-operation; facing the dilemma of allowing relatives to accompany the patient or not; feeling the patient's and their own fear. CONCLUSION CCNs plan for the transportation and control of patients to improve patient safety, but can sometimes feel afraid. Good co-operation is necessary. RELEVANCE TO CLINICAL PRACTICE The possibilities for CCNs to provide effective nursing care in helicopters are good, although in some cases limited by the environmental conditions.
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Affiliation(s)
- Jonah Senften
- J Senften, RN, CCN, MSc, Critical Care Nurse, Intensive Care Unit, Gällivare Hospital, Gällivare, Sweden
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12
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Rejnö Å, Danielson E, Berg L. Next of kin's experiences of sudden and unexpected death from stroke - a study of narratives. BMC Nurs 2013; 12:13. [PMID: 23590246 PMCID: PMC3637261 DOI: 10.1186/1472-6955-12-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/05/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Death always evokes feelings in those close to the afflicted person. When death comes suddenly the time for preparation is minimal and the next of kin have to cope with the situation despite their own sorrow. The suddenness is found to be stressful for the next of kin and communication both with healthcare professionals and information about what has happened has been found helpful. The aim of this study was to illuminate the experiences of next of kin from the sudden and unexpected death of a relative from acute stroke. METHODS Data was collected over a 12-month period in 2009-2010. Twelve next of kin of patients cared for in stroke units who died suddenly and unexpectedly from stroke were interviewed using a narrative method. The narratives were analyzed using narrative thematic analysis. RESULTS Three themes emerged showing facets of next of kin's experiences of a relative's sudden and unexpected death from stroke: Divided feelings about the sudden and unexpected death; Perception of time and directed attention when keeping vigil; Contradictions and arbitrary memories when searching for understanding. CONCLUSIONS To have to live in the aftermath of severe stroke is absolute horror in people's imagination and death is seen as the lesser of two evils. The sudden and unexpected death totally pervades the next of kin's life, directs their attention to the dying person and even causes them to forget themselves and their own needs, and leads to difficulties in information intake. It is a challenge for the healthcare professionals to be able to identify the individual needs of the next of kin in this situation.
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Affiliation(s)
- Åsa Rejnö
- Institute of Health and Care Sciences, University of Gothenburg, The Sahlgrenska Academy, Box 45740530, Göteborg, Sweden
- The Stroke Unit, Kärnsjukhuset, Skaraborg Hospital, 54185, Skövde, Sweden
| | - Ella Danielson
- Institute of Health and Care Sciences, University of Gothenburg, The Sahlgrenska Academy, Box 45740530, Göteborg, Sweden
- Department of Health Sciences, Mid Sweden University, 83125, Östersund, Sweden
| | - Linda Berg
- Institute of Health and Care Sciences, University of Gothenburg, The Sahlgrenska Academy, Box 45740530, Göteborg, Sweden
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Zaforteza Lallemand C, García Mozo A, Amorós Cerdá SM, Pérez Juan E, Maqueda Palau M, Delgado Mesquida J. [Limiting and facilitating factors of changes in the care of families of the critically ill patient]. ENFERMERIA INTENSIVA 2012; 23:121-31. [PMID: 22300883 DOI: 10.1016/j.enfi.2011.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 12/13/2011] [Accepted: 12/16/2011] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective. MATERIALS AND METHODS Qualitative methodology. DESIGN Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed. RESULTS Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection. CONCLUSIONS A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work.
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Affiliation(s)
- C Zaforteza Lallemand
- Departament d'Infermeria i Fisioteràpia y Grupo de Investigación Crítica en Salud, Universitat de les Illes Balears, Palma de Mallorca, Islas Baleares, España
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Flodén A, Lennerling A, Fridh I, Rizell M, Forsberg A. Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS). Open Nurs J 2011; 5:65-73. [PMID: 22046210 PMCID: PMC3204424 DOI: 10.2174/1874434601105010065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/15/2011] [Accepted: 08/12/2011] [Indexed: 11/22/2022] Open
Abstract
The consequences of advocacy in nursing are critical when caring for a potential organ donor. No specific instrument has been available to measure attitudes toward organ donor advocacy. The aim of this study was to develop and psychometrically evaluate an instrument for measuring intensive and critical care (ICU) nurses' attitudes toward organ donor advocacy. The study was conducted in two stages: instrument development and instrument evaluation and refinement. A questionnaire was developed (Attitude Toward Organ Donor Advocacy Scale (ATODAS)), which was sent to half of all nurses working in ICUs (general-, neuro-, thoracic- or paediatric-) in Sweden (n=1180). The final response rate was 42.5% (n=502). In order to explore validity and reliability, the expected scale dimensionality of the questionnaire was examined both by explorative principal component analysis (with oblique, varimax rotation) and by confirmatory multi-trait analysis. The confirmatory factor analysis indicated that the ATODAS could best be explained by five factors; Attitudes toward championing organ donation at a structural hospital level; Attitudes toward championing organ donation at a political and research level; Attitudes toward actively and personally safeguarding the will and wishes of the potential organ donor, Attitudes toward safeguarding the potential donor's will and wishes by a professional approach and Attitudes toward safeguarding the will and wishes of the relatives. This initial testing indicated that the ATODAS has good psychometric properties and can be used in future research to explore if interventions may influence attitudes and behaviors related to organ donor advocacy.
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Affiliation(s)
- Anne Flodén
- The Unit for Organ and Tissue Donation, Sahlgrenska University Hospital, Blå stråket 5, SE-413 45 Gothenburg, Sweden
| | - Annette Lennerling
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, & The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabell Fridh
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Forsberg
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, & The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Barbosa GOL, Wanderley LD, Oliveira PMPD, Rebouças CBDA, Almeida PCD, Pagliuca LMF. Comunicação verbal e não verbal de mãe cega e com limitação motora durante alimentação da criança. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000500011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar a comunicação verbal e não verbal, de mãe cega e com limitação motora com o filho e enfermeira durante alimentação da criança. MÉTODOS: Estudo exploratório, descritivo, tipo estudo de caso, com abordagem quantitativa realizado no ano de 2009. As entrevistas foram gravadas, filmadas e analisadas por três avaliadores. RESULTADOS: Os resultados da comunicação verbal mostraram a predominância da mãe como destinatária e a utilização da função emotiva nas verbalizações com a criança, e a comunicação não verbal mostrou a prevalência da distância íntima entre mãe/filho, da pessoal entre mãe/enfermeira e da postura sentada. Houve pouco contato face a face e sobressaíram-se os contatos físicos com a criança. CONCLUSÃO: A mãe não sofreu prejuízos verbais no estabelecimento de seu processo comunicativo. A distância facilitou a interação mãe com o bebê e com a profissional.
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Lindahl B. Experiences of exclusion when living on a ventilator: reflections based on the application of Julia Kristeva's philosophy to caring science. Nurs Philos 2010; 12:12-21. [DOI: 10.1111/j.1466-769x.2010.00471.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
UNLABELLED Nursing advocacy for patients is viewed as a vital role for the nursing profession; however, there is little empirical research regarding nursing advocacy. PROBLEM The medical-surgical nursing specialty is the largest specialty in acute care settings, but few advocacy studies have focused exclusively on this specialty population. METHODS The purpose of this study was to explore the nurse advocacy actions and workplace support for advocacy using written narrative responses to a mailed survey using a medical-surgical nursing sample. FINDINGS The responses help to illuminate the importance of the advocate role for this nursing specialty and provide preliminary information on the advocacy actions and workplace support as reported by the nurses. CONCLUSIONS The resulting data provide a basis for examining the workplace environmental support for nursing advocacy, further delineate the actions of the nurse advocate, and clarify how nurse advocates follow patient desires regarding care. In addition, the results can be used in education, improving advocacy skills, and safety initiatives.
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Affiliation(s)
- Robert G Hanks
- The University of Texas at Arlington School of Nursing, Arlington, TX, USA.
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Hanks RG. Development and testing of an instrument to measure protective nursing advocacy. Nurs Ethics 2010; 17:255-67. [DOI: 10.1177/0969733009352070] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient advocacy is an important aspect of nursing care, yet there are few instruments to measure this essential function. This study was conducted to develop, determine the psychometric properties, and support validity of the Protective Nursing Advocacy Scale (PNAS), which measures nursing advocacy beliefs and actions from a protective perspective. The study used a descriptive correlational design with a systematically selected sample of 419 medical-surgical registered nurses. Analysis of the 43-item instrument was conducted using principal components analysis with promax rotation, which resulted in the items loading onto four components. The four subscales have sufficient internal consistency, as did the overall PNAS. Satisfactory evidence of construct, content, and convergent validity were determined. Implications for nursing practice include using the PNAS in conjunction with an educational program to enhance advocacy skills, which may help to improve patient outcomes.
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Affiliation(s)
- Robert G Hanks
- The University of Texas at Arlington School of Nursing, USA,
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19
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Holm S. The phenomenological ethics of K. E. Løgstrup – a resource for health care ethics and philosophy? Nurs Philos 2009. [DOI: 10.1046/j.1466-769x.2001.00035.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Søren Holm
- Reader in Bioethics, Institute of Medicine, Law and Bioethics, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PT, UK, and Professor of Medical Ethics, Centre for Medical Ethics, University of Oslo
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Andersson BT, Fridlund B, Elgán C, Axelsson AB. Radiographers' areas of professional competence related to good nursing care. Scand J Caring Sci 2008; 22:401-9. [PMID: 18840224 DOI: 10.1111/j.1471-6712.2007.00543.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiographers' ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer's work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession. AIM The aim was to describe the radiographer's areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions. METHOD A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden. ETHICAL ISSUES The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives. RESULTS The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers' skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient's immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient. CONCLUSIONS The study highlights the different areas of the radiographer's unique professional competence. The findings provide insight into the radiographer's profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer's work encompasses a variety of components--from caring for the patient to handling and checking the technical equipment.
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Negarandeh R, Oskouie F, Ahmadi F, Nikravesh M. The Meaning of Patient Advocacy for Iranian Nurses. Nurs Ethics 2008; 15:457-67. [DOI: 10.1177/0969733008090517] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient advocacy has been a topic of much discussion in the nursing literature for a number of decades. Ambiguities remain, however, concerning definitions of advocacy in nursing. This qualitative grounded theory-type study aimed to inquire into the meaning of patient advocacy from Iranian nurses' perspective. A purposive sample of 24 nurses (staff nurses, head nurses and supervisors) working in a large university hospital in Tehran was used. Data were collected using in-depth semistructured interviews and reflective diaries kept by the participants. The data were analyzed using elements of Strauss and Corbin's' approach. Advocacy was defined by the participants as: informing and educating; valuing and respecting; supporting; protecting; and promoting continuity of care for patients. The participants also believed that advocacy could take place only if there was respect for patients' individuality and their inherent human dignity. Many of the descriptions given by the participants are consistent with previous research in this area and represent a comprehensive account of their perceptions of patient advocacy.
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Abstract
Nursing advocacy for patients is considered to be an essential component of nursing practice. This phenomenological qualitative pilot study explored registered nurses' lived experience of nursing advocacy with patients using a sample of three medical-surgical registered nurses. The guiding research questions were: (1) how do registered nurses practicing in the medical-surgical specialty area describe their experiences with nursing advocacy for their patients; and (2) what reflections on educational preparation for their professional roles do registered nurses identify as related to their practices of nursing advocacy with their patients? Data analysis procedures were based on Moustakas' data analysis method, and Lincoln and Guba's criteria were applied for rigor. The emergent themes were: speaking out and speaking for patients; being compelled to act on unmet needs of patients; fulfillment and frustration; the patient is changed; primarily learned on the job; and confidence gained through practice. The findings increase the body of knowledge surrounding nursing advocacy as practiced by nurses.
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Affiliation(s)
- Robert G Hanks
- The University of Texas Medical Branch, Galveston, TX, USA
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Meijers KE, Gustafsson B. Patient's self-determination in intensive care-from an action- and confirmation theoretical perspective. The intensive care nurse view. Intensive Crit Care Nurs 2008; 24:222-32. [PMID: 18403204 DOI: 10.1016/j.iccn.2008.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 12/25/2007] [Accepted: 01/14/2008] [Indexed: 11/28/2022]
Abstract
When becoming an intensive care patient life changes dramatically. In order to save life, different actions are performed by the caregivers and the patient's ability to exercise self-determination is non-existent. After the acute phase the patient is more awake and the possibilities for self-determination change. The purpose of this study was to describe intensive care nurses' (ICNs) views of patient's self-determination in an intensive care unit and to systematize ICNs' nursing actions for supporting patient's self-determination from an action- and confirmation-theoretic perspective. In order to answer these questions, 17 interviews with ICNs were conducted by the use of the Critical Incident Technique (CIT). The transcripts were then analysed using a hermeneutic analysis method and structured by the SAUC model for confirming nursing. The main findings were that the ICN thought that the ICU patient's self-determination was low and restricted. It was more common that the ICN acted to strengthen the patient's self-determination in nursing care, but there were no specific nursing goals for patient's self-determination. The most common actions for supporting self-determination were supplying the patient with information and engaging the patient in making a day plan. The nursing implications are that the ICN's view of human being as an acting subject is important for the ICN's awareness to recognise the patient's own personal resources to handle the critically ill situation and that the ICN's competence to manifest qualified nursing is necessary for strengthening patient's self-determination.
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Affiliation(s)
- Katarina E Meijers
- Intensive Care Unit, South Stockholm General Hospital, Stockholm, Sweden.
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Meiers SJ, Brauer DJ. Existential caring in the family health experience: a proposed conceptualization. Scand J Caring Sci 2008; 22:110-7. [DOI: 10.1111/j.1471-6712.2007.00586.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bu X, Wu YWB. Development and psychometric evaluation of the instrument: Attitude toward patient advocacy. Res Nurs Health 2008; 31:63-75. [DOI: 10.1002/nur.20233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Advocacy for clients is viewed as an essential function of nursing; however, to be effective advocates for patients, the nurse must often overcome barriers to being an effective advocate. This concept analysis of barriers to nursing advocacy uses the Walker and Avant method of concept analysis. By analyzing the barriers to effective nursing advocacy for clients, nursing can then find strategies to manage those barriers and maximize the nurse's advocacy efforts.
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Affiliation(s)
- Robert G Hanks
- School of Nursing, University of Texas at Arlington, Arlington, TX, USA.
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28
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Virtanen H, Leino-Kilpi H, Salanterä S. Empowering discourse in patient education. PATIENT EDUCATION AND COUNSELING 2007; 66:140-6. [PMID: 17349769 DOI: 10.1016/j.pec.2006.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 12/18/2006] [Accepted: 12/22/2006] [Indexed: 05/14/2023]
Abstract
OBJECTIVE A systematic literature review, using a metasummary technique for qualitative studies (n=15) was conducted to describe the nature of empowering discourses between patient and nurse. METHODS Computerised searches from 1995 to October 2005 were conducted on the Ovid Medline database using the keywords empower(*), power(*), resource(*), participat(*), facilitat(*), negotiat(*), communicat(*), interact(*), dialog(*), discours(*), discuss(*), encount(*), conversat(*) and 'nurse-patient relations'. All statements concerning empowering discourse were integrated into 29 abstracted findings. Frequency and intensity effect sizes were then calculated. RESULTS Empowering discourses vary from study to study. Analysed as a whole, an empowering discourse has specific characteristics and structure. Both patients and nurses have essential roles within this type of discourse and their relationship is characterized by an appreciation of each other's expertise within these roles. CONCLUSION The results of this review show empowerment during discourse between patient and nurse has a complex and multifaceted but analysable nature. More research is needed to find systematic methods of empowering discourse. PRACTICE IMPLICATIONS The results of this study increase nurses' understanding of empowering methods in patient education identifying ways of facilitating patient empowerment.
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Affiliation(s)
- Heli Virtanen
- University of Turku, Department of Nursing Science, FIN-20014, Finland.
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29
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Abstract
AIM The aim of this paper is to clarify and refine the concept of patient advocacy through synthesizing the advocacy literature in nursing and to establish a theoretical basis for future studies on patient advocacy in nursing. BACKGROUND Patient advocacy is an essential component of the Registered Nurse professional role. During the past 30 years, the patient advocacy role has become more important, but the concept of patient advocacy lacks a consistent definition and research into nurses' patient advocacy roles is limited. There have been few quantitative empirical studies on patient advocacy in nursing. METHOD Walker and Avant's method of concept analysis was used as a guideline in examining the concept of patient advocacy through synthesizing the advocacy literature in English (1974-2006). FINDINGS A mid-range theory of patient advocacy emerges during the process of synthesizing and analysing the advocacy literature. Three core attributes of the concept of patient advocacy are identified: (1) safeguarding patients' autonomy; (2) acting on behalf of patients; and (3) championing social justice in the provision of health care. They reflect nurses' patient advocacy roles at both macro- and micro-social levels. Antecedents of patient advocacy occur at both macro- and micro-social levels and call for nurses' advocacy roles in the healthcare system. Consequences produced by nurses' patient advocacy behaviours are contextual. Nurses' patient advocacy behaviours not only can positively influence the patients, other nurses and the nursing profession, but also can cause negative consequences for nurses who take action to advocate for patients. CONCLUSION The proposed mid-range theory may be useful in guiding advocacy practice in nursing and in guiding research in the advocacy area. The proposed theory needs to be furthered refined and tested in the future.
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Affiliation(s)
- Xiaoyan Bu
- College of Nursing, University of South Carolina, SC, USA.
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Henricson M, Berglund AL, Määttä S, Segesten K. A transition from nurse to touch therapist--a study of preparation before giving tactile touch in an intensive care unit. Intensive Crit Care Nurs 2006; 22:239-45. [PMID: 16542838 DOI: 10.1016/j.iccn.2006.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 12/14/2005] [Accepted: 01/18/2006] [Indexed: 11/27/2022]
Abstract
Tactile touch is a complementary therapy that is rarely undertaken in intensive care units (ICUs) in Sweden. This study was a part of a larger project that examines whether tactile touch can relieve the suffering of patients in the ICU. The aim of this study was to describe nurses' lived experience of preparation before giving tactile touch in an ICU. Four assistant nurses and one registered nurse, each with diplomas in tactile touch working at three different ICUs in Sweden, participated in the study. A phenomenological approach was chosen to achieve experience-based and person-centred descriptions. Data were collected through interviews and analysed following Giorgi's method. The main finding was that before providing tactile touch, the nurses needed to add the new role as touch therapists, to their professional one. The essential aspect being the transition from nurse to touch therapist. Findings included a general structure, with four constituents; a sense of inner balance, an unconditional respect for the patients' integrity, a relationship with the patient characterised by reciprocal trust, and a supportive environment. Furthermore, the study underlines the difficulties to integrate a complementary caring act, such as tactile touch, in a highly technological environment.
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Affiliation(s)
- Maria Henricson
- University College of Borås, School of Health Science, Allegatan, SE-501 90 Borås, Sweden.
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Zaforteza C, Gastaldo D, de Pedro JE, Sánchez-Cuenca P, Lastra P. The process of giving information to families of critically ill patients: a field of tension. Int J Nurs Stud 2005; 42:135-45. [PMID: 15680612 DOI: 10.1016/j.ijnurstu.2004.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 05/10/2004] [Accepted: 05/20/2004] [Indexed: 10/26/2022]
Abstract
We conducted research to study nurses' views on factors that influence their relationship with patients' relatives in intensive care units in three hospitals in Mallorca (Balearic Islands, Spain). This article focuses on the findings related to the process of giving information to the family. We used a post-structuralist theoretical framework and data were collected through observations and interviews. The analysis revealed that nurses thought information eases relatives' worries, but they felt that in order to avoid conflicts with physicians they should restrain themselves from providing it. We propose that the existing power relationships in intensive care units should be challenged if we expect health care professionals to offer patients' relatives a planned information process.
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Affiliation(s)
- Concha Zaforteza
- Department of Nursing and Physiotherapy, University of Balearic Islands, Spain
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Berner KH, Ives G, Astin F. Critical care nurses' perceptions about their involvement in significant decisions regarding patient care. Aust Crit Care 2004; 17:123-31. [PMID: 15493860 DOI: 10.1016/s1036-7314(04)80014-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of the study was to explore and describe the perceptions of critical care nurses' (CCNs) actual and preferred levels of involvement in significant decisions regarding patient care in critical care areas. A convenience sample of CCNs was recruited from two centres (one public and one private) and a researcher generated survey distributed to participants. Of the 131 questionnaires distributed, 90 were completed, giving a response rate of 68.7%. Results showed that, although most CCNs believed that they had important information to contribute to decisions relating to patient care, less than half felt that they were actively involved in such decisions. They were aware of the legal limits to their scope of practice but, despite this, most admitted that they made decisions beyond these limits. Approximately three quarters of the respondents thought CCNs should not be making decisions beyond legal boundaries. On the whole, CCNs wanted to be more involved formally and to have more power in decisions regarding patient care. One way forward is for the CCNs to have an advanced practice role.
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Abstract
Qualitative data analysis may be daunting to nursing graduate students and other novice qualitative researchers. This article describes a qualitative research project required in a graduate nursing research course that was desired to guide students through their first qualitative data analysis. Common pitfalls novice researchers may encounter, such as data shuffling, premature closure, and overly delayed closure, also are discussed. The project reported in this article not only decreased students' anxiety concerning qualitative data analysis but also helped students gain respect for the amount of time, effort, and creativity this process entails.
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Affiliation(s)
- Cheryl Tatano Beck
- University of Connecticut, School of Nursing, Storrs, Connecticut 06269-2026, USA.
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35
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Lindahl B, Norberg A. Clinical group supervision in an intensive care unit: a space for relief, and for sharing emotions and experiences of care. J Clin Nurs 2002; 11:809-18. [PMID: 12427187 DOI: 10.1046/j.1365-2702.2002.00652.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.
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Affiliation(s)
- Berit Lindahl
- Department of Nursing, Umeå University, Umeå, Sweden and Nurse Educator, Borås University College of Health Sciences, Borås, Sweden.
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Delgado Hito P, Sola Prado A, Mirabete Rodríguez I, Torrents Ros R, Blasco Afonso M, Barrero Pedraza R, Catalá Gil N, Mateos Dávila A, Quinteiro Canedo M. [Modification of nursing practice through reflection: participatory action research]. ENFERMERIA INTENSIVA 2001; 12:110-26. [PMID: 11674947 DOI: 10.1016/s1130-2399(01)78029-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Technology and complex techniques are inevitably playing an increasing role in intensive care units. They continue to characterize nursing care and in some cases dehumanize it. The general aim of this study was to stimulate reflection on nursing care. The study was based on the participation of the investigators with the goal of producing changes in nursing practice. Qualitative methodology in the form of participatory action research and the Kemmis and McTaggart method were used. Data were collected through systematic observation, seven group meetings and document analysis. Eight nurses took part in the study. The meetings were recorded and transcribed verbatim into a computer. This process and the meaning of the verbatim transcription (codification/categorization process and document synthesis cards) were analyzed. The results of this study enabled exploration of the change in nursing practice and showed that the reflection in action method stimulates changes in practice. The new way of conceiving nursing action has increased nursing care quality and its humanization since it shows greater respect for the patient, provides families with closer contact and greater support, improves coordination of nursing care acts and increases collaboration among professionals.In conclusion, participatory action research is a valid and appropriate method that nurses can use to modify their daily practice.
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Affiliation(s)
- P Delgado Hito
- Profesora Colaboradora de la Escuela Universitaria de Enfermería del Hospital de la Santa Creu i Sant Pau. Licenciada en Enfermería por la Universidad de Montreal, Canada
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Bengoechea Ibarrondo M. Estudios sobre la comunicación pacienteenfermera en cuidados intensivos. El estudio de las líneas de investigación predominantes y otras relevantes. ENFERMERIA CLINICA 2001. [DOI: 10.1016/s1130-8621(01)73725-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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