The Concept of Advocacy in Nursing: A Critical Analysis

How do nurses advocate for the remaining time of nursing home residents? A critical discourse analysis

INTRODUCTION

Due to the global aging trend, the number of older people who will spend the last years of their lives in nursing homes is increasing. However, nursing homes have long confronted negative social and public discourses, including stigmas on dementia and life in such facilities. Nevertheless, the remaining time of residents with dementia holds significance, for them and their families, as they seek respect and the ability to make meaningful end-of-life decisions.

OBJECTIVE

To explore how nursing home nurses advocate for the remaining lifetimes of residents with dementia.

DESIGN

A qualitative research design.

SETTING(S)

Four nursing homes in Korea from January 2023 to February 2023.

PARTICIPANTS

Twenty nurses who provide direct caregiving for residents with dementia and have a minimum of two years' experience in nursing homes were recruited.

METHODS

This study employed a critical discourse analysis. Twenty interviews conducted with nursing home nurses were examined to explore the connections between the grammatical and lexical aspects of the language used by the nurses to construct their identities as advocates for residents with dementia and the broader sociocultural context.

FINDINGS

Four discourses regarding nursing home nurses advocating for the value of life of residents with dementia were identified: (1) Bridging perspectives: I am a negotiator between medical treatment and residents' families with differing views; (2) Embracing a shared humanity: Residents are no different from me; they just need professional help; (3) Affirming belongingness: Residents still belong to their families, even when care has been delegated; and (4) Empowering voices for change: We are struggling to provide better care in a challenging reality.

CONCLUSIONS

This paper highlights the importance of nursing advocacy in safeguarding the remaining time and dignity of individuals with dementia, challenging the stigma surrounding dementia and nursing homes and calling for greater societal and political recognition of the efforts nurses make to preserve the personhood and well-being of these older adults.

The advocacy process in Canadian community health nursing: A collaborative ethnography

AIMS

To shed light on the process of advocacy in the context of community health nursing, through a methodology inspired by the epistemologies of the South.

DESIGN

We conducted a collaborative ethnography in a community health centre in Canada.

METHODS

de Sousa Santos' epistemologies of the South, a typology of advocacy and main themes from historic research informed the methodology. Data were collected between 2016 and 2018 through 420 h of fieldwork observations and three group discussions, including a collective process to co-construct interpretations with participants. Twenty-one nurses participated in the study.

RESULTS

Nurses had sufficient work flexibility to practice advocacy actions focused on individuals and groups. They also engaged in attempts at policy reform in the form of defending access to appropriate care and changing the mode of care organization. However, these were curbed by bureaucracy and administrative rules, resulting in the eventual dismissal of health promotion actions and experiences of moral distress.

CONCLUSION

Despite the political climate of their work environment impeding social justice agendas, nurses' advocacy practices showed a persistence of moral values and ideals in coherence with the regional nursing legacy.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Acting at the organizational level and involving field nurses in decision making are potential avenues for increasing policy advocacy efficacy.

IMPACT

Examining contexts through another epistemic lens and methods of research drawing on history and anthropology has shed light on a process of advocacy. This research shows that organizations need to equip themselves with mechanisms to promote the sharing of realities between nurses, thereby building collective advocacy.

REPORTING METHOD

The research adheres to the EQUATOR guidelines with SRQR and COREQ methods.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Experiences of patient advocacy among nurses working in a resource constrained emergency department in Ghana

BACKGROUND

Patient advocacy at the emergency department is stressful and cumbersome as a result of the increasing patient-to-nurse ratio and high patient turnovers. It is also unclear what patient advocacy entails and the experiences of patient advocacy in a resource-constrained emergency department. This is significant because advocacy underpins the care provided in the emergency department.

AIM

The primary aim of this study is to explore the experiences and underpinning factors that influence patient advocacy among nurses working in a resource constrained emergency department.

METHODS

A descriptive qualitative study was conducted among 15 purposively sampled ED nurses working at a resource-constrained secondary-level hospital facility. Study participants were individually interviewed via a recorded telephone conversation, after which the interviews were transcribed verbatim and inductively analyzed using the content analysis approach. The study participants described patient advocacy, situations in which they advocated for patients, the factors that motivated them and the challenges they encountered practicing patient advocacy.

RESULTS

Three major themes generated from the study included: "stories of advocacy", "motivating" factors and "challenging" factors. ED nurses understood patient advocacy and also advocated for patients in various instances. There were factors such as personal upbringing, professional training and religious training that motivated them and they were challenged by negative inter-professional experiences, patient and relatives' attitudes and healthcare system factors.

CONCLUSION

Participants understood patient advocacy and incorporated it into daily nursing care. Unsuccessful advocacy causes disappointment and frustrations. There were no documented guidelines on patient advocacy.

Speaking up about patient safety in psychiatric hospitals - a cross-sectional survey study among healthcare staff

Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up-related behaviour and climate for the first time in psychiatric hospitals. A cross-sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up-related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up-related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%-65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13-25% of HCWs, and speaking up was reported by 53%-72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self-reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.

The State of Lupus Clinical Trials: Minority Participation Needed

In the United States, the reported prevalence of lupus is 100,000 to 500,000 patients. Lupus disproportionately affects minority populations, including African Americans and Latinos, and the associated health disparities are substantial. Women are at a higher risk of lupus than men and lupus prevalence is the highest in African Americans and Latinos compared to non-Hispanic whites. African Americans and Latinos also have increased disease symptom severity, experience more lupus-related complications, and have a two- to three-fold mortality rate compared to non-Hispanic Whites. Lupus clinical trials offer opportunities for quality care and can result in new treatment options, but African Americans and Latinos are underrepresented in clinical trials because of substantial patient- and provider-side barriers. In conjunction with the limited knowledge of clinical trials that potential participants may have, the healthcare staff approaching participants have limited time to adequately educate and explain the aspects of clinical trials. Indeed, ninety percent of clinical trials fail to meet their recruitment goals on time, so a multi-faceted approach is necessary to address the issue of low minority participation in clinical trials.

Registered Nurses' description of patient advocacy in the clinical setting

AIM

To provide Registered Nurses description of patient advocacy in the clinical setting.

DESIGN

A qualitative approach with descriptive study design was used to meet the set objective.

METHODS

Purposive sampling was used to select the study participants. Through semi-structured interview, data were collected from 25 participants, transcribed and analysed using qualitative content analysis.

RESULTS

The Registered Nurses described patient advocacy as promoting patient safety and quality care which includes the following: protecting patients, being patients' voice, provision of quality care and interpersonal relationship as well as educating patients. The nurses had adequate understanding of patient advocacy and were willing to advocate for patients. There is, however, a need to research into barriers to patient advocacy in the clinical setting. This study made significant contribution to the understanding of patient advocacy and its positive effect on the provision of quality patient care.

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.

Essential Professional Nursing Practices in mental health: A cross-sectional study of hospital inpatient care

Quality organizational structures and nursing practices are key to positive patient outcomes. Whereas structures have been largely studied over the past few decades, less is known of the nursing practices that account for patient outcomes, such as patient satisfaction. This is especially true in psychiatric, mental health care settings. The aim of the present study is to determine the relative importance of eight Essential Professional Nursing Practices (EPNPs) on the satisfaction of hospitalized patients on mental health care units. A cross-sectional design was selected; 226 point-of-care mental health nurses completed the online EPNP questionnaire in Spring 2015. Statistical analyses included MANOVAs and a 2-step linear regression. A significant relationship was found between university preparation and scores on two EPNP subscales: autonomous decision-making and practicing with competent nurses. Scores on patient advocacy and control over practice subscales were significantly related to nurse-rated patient satisfaction. The findings reinforce the positive link between university education and the work of nurses and highlight the power dynamics that are salient in mental health care. The pertinence of EPNPs in psychiatric settings is brought to the fore, with practices of patient advocacy and nurse control over care examined in relation to empowerment. Implications for clinical and administrative leaders are addressed, with a focus on strategies for empowering patients and nurses.

Intersecting Health Policy and the Social Determinants of Health in Pediatric Type 1 Diabetes Management and Care

THEORETICAL PRINCIPLES

Type 1 diabetes health technologies are evolving. This is an expensive chronic condition to manage, hence a combination of public and private healthcare funding sources, as well as out-of-pocket payments support disease management. The aim of this paper is to describe two conceptual underpinnings, which can appropriately position the health policy and clinical context of pediatric type 1 diabetes management and care. PHENOMENA ADDRESSED: "The Main Determinants of Health" framework is used to position pediatric T1D management and care within the model's four interconnected layers: the structural environment, social and material conditions, support systems and individual health behaviors. A health policy in Ontario, Canada, the Assistive Devices Program for insulin pump therapy is also discussed relative to the model's outermost layer: the structural environment. Four dimensions of control, which characterize the "street-level bureaucrat" role including "distributing benefits and sanctions; structuring the context; teaching the client role; and, psychological benefits and sanctions" then position the policy context of the diabetes nurse educator role relative to the Assistive Devices Program policy.

RESEARCH LINKAGES

These conceptual underpinnings could extend beyond the pediatric T1D landscape to position global research in other nursing practice areas, as well as with other patient populations and professional disciplines such as social work and medicine.