Barriers to nursing advocacy: a concept analysis

Barriers to nurses health advocacy role

BACKGROUND

Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role.

RESEARCH QUESTION

What would cause nurses to take no action when they witness situations that require them to act as health advocates for their clients or communities?

RESEARCH DESIGN

An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions.

ETHICAL CONSIDERATIONS

The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study.

FINDINGS

Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role.

CONCLUSIONS

Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates.

The principle of double effect and external whistleblowing in nursing

Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.

Empowerment as an alternative to traditional patient advocacy roles

There has long been acceptance within healthcare that one of the roles that nurses fulfil is to do with patient advocacy. This has historically been positioned as part of the philosophical and inherent requirements of the nursing profession at large and is supported through shared conceptualisations of the nursing profession. Such conceptualisations are communicated to nursing professionals by way of first their education, and second their professional codes, guidelines and standards for practice. The focus on advocacy is further embedded within patient-centred care frameworks and concepts of the nurse-patient therapeutic relationship. Nurses have also been considered ideally placed to undertake the work of patient advocacy due to the 24/7 nature and intimacy of the care provided. What this means is that nurses are under the impression that that they must be an advocate for their patients through their nursing practice. However, for a fundamental concept of nursing, advocacy is poorly defined, and practices commonly associated with advocacy are undercut by the professionalisation of nursing and other constraints. In addition, nursing standards and frameworks of care are being actively reframed around ideas of empowerment which do not necessarily fit well with those of advocacy. This article thus suggests that it is time to recognise that the work of advocacy is no longer representative of what nurses (can) do in practice, and to explicitly reorient conceptualisations of nurse practice around empowerment. This article will further analyse what this may look like in practice.

Perception and opinion of nursing faculties regarding advocacy role: A qualitative research

BACKGROUND

The nursing literature emphasizes that there are still inadequacies, differences, and inconsistencies in the definition of nurses' advocacy role, and that nursing education plays an important role in educating nurses for patient advocacy.

OBJECTIVE

The aim of this descriptive qualitative study is to determine nurse academics' perception of and opinions about advocacy in nursing.

METHODS

The study group consisted of five academics working as nurse educators in a university. A questionnaire and focus group interview methods were used to collect the data.

RESULTS

A framework that consisted of three categories, including the scope of advocacy in nursing; today's health system and advocacy; nurses' foundation/knowledge base for an advocacy role was set by considering the opinions of participants.

CONCLUSION

It was emphasized that nurse academics regarded advocacy as an ethical obligation and saw it from a broad perspective including social justice, that changing health system has increased the importance of advocacy role in nursing, that the personality characteristics of prospective nurses are important, and that nursing education should be improved in terms of advocacy.

Nurses defending the autonomy of the elderly at the end of life

ABSTRACT Objective: to understand how nurses deal with the elderly’s autonomy at the end of life. Method: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. Results: nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. Final considerations: the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.

Barriers deterring patient advocacy in a Saudi Arabian critical care setting

AIM

To explore the perceptions of patient advocacy among Saudi Arabian intensive care unit (ICU) nurses.

BACKGROUND

Despite advocacy being a crucial role for nurses, its scope is often limited in clinical practice. Although numerous studies have identified barriers to patient advocacy, their recommendations for resolution were unclear.

METHOD

The study employed a constructivist grounded theory methodology, with 13 Saudi Arabian registered nurses, working in critical care, in a tertiary academic teaching hospital. Semi-structured interviews, with broad open-ended questions, and reflective participant journals were used to collect data. All interviews were concurrently analysed and transcribed verbatim.

RESULTS

Gender, culture, education, subjugation, communal patronage, organisational support and repercussions, and role-associated risks were all revealed as factors affecting their ability to act as advocates for critically ill patients.

CONCLUSION

Saudi Arabian ICU nurses in the study believed that advocacy is problematic. Despite attempting to advocate for their patients, they are unable to act to an optimal level, instead choosing avoidance of the potential risks associated with the role, or confrontation, which often had undesirable outcomes. Patient advocacy from a Saudi Arabian nursing perspective is contextually complex, controversial and remains uncertain. Further research is needed to ensure patient safety is supported by nurses as effective advocates.

Nurse Knowledge and Engagement in Health Policy Making: Findings From a Pilot Study

Although nurses constitute the largest segment of the health care workforce in the United States, their participation in all levels of health policy advocacy remains low. We surveyed practicing nurses on their current knowledge about health policy advocacy, current and desired involvement in health policy advocacy, and desired components in a continuing education program on health policy advocacy. One hundred eighteen nurses responded to the e-mail solicitation, and 84 (71%) of those nurses were eligible. The sample was Caucasian, and the majority were women, aged 45 to 64 years, and registered to vote. Most had obtained an advanced degree and saw patients 25 to 48 hours per week. Respondents reported understanding the differences between health policy and health advocacy. Approximately one third of the nurses reported currently engaging in political/legislative health policy advocacy and patient advocacy. Open-ended responses indicated confusion between patient and political advocacy, suggesting that an easily accessible continuing education program could provide education about different advocacy approaches to help nurses leverage their clinical expertise specifically to influence health policy advocacy. J Contin Educ Nurs. 2018;49(9):407-415.

ADVOCACIA DO PACIENTE NA ENFERMAGEM: BARREIRAS, FACILITADORES E POSSÍVEIS IMPLICAÇÕES

RESUMO Objetivo: realizar uma reflexão acerca das barreiras, facilitadores e possíveis implicações do exercício da advocacia do paciente pelos enfermeiros. Resultados: essa reflexão resulta de uma leitura minuciosa da literatura internacional acerca da advocacia do paciente, acrescida de estudos nacionais e internacionais acerca do sofrimento moral e suas relações com o exercício da advocacia. Conclusão: as barreiras diante do exercício da advocacia do paciente são notórias, pautando-se na própria estrutura organizacional das instituições de saúde e nas relações de poder entre equipes médica e de enfermagem, desafiando e desencorajando os enfermeiros a agirem de acordo com seus conhecimentos e consciências, implicando, muitas vezes, em situações reconhecidas como de sofrimento moral.

Knowledge and Beliefs about Chronic Non Cancer Pain Management for Family Medicine Group Nurses

To provide effective care for chronic pain sufferers, nurses must have a knowledge of chronic pain management. In Quebec, nurses working in Family Medicine Groups (FMGs) could play a major role in helping patients with chronic noncancer pain (CNCP); however, the extent of their knowledge about CNCP management is unknown. The primary goal of this study was to explore the knowledge and beliefs of FMG nurses about CNCP management. The secondary goal was to explore the obstacles seen by these nurses as preventing them from performing CNCP management. We used a mixed-methods design with quantitative preponderance. Fifty-three FMG nurses answered a self-administered mail-in questionnaire. A rigorous data collection method was used. FMG nurses have suboptimal knowledge about CNCP management. They identify their lack of training and lack of knowledge as major obstacles to conducting pain management interventions. There is a need for pain management training specifically designed around the realities of FMG nursing.

[Nursing activities in family medicine groups for patients with chronic pain]

INTRODUCTION

Thousands of people treated in primary care are currently experiencing chronic pain (CP), for which management is often inadequate. In Quebec, nurses in family medicine groups (FMGs) play a key role in the management of chronic health problems.

OBJECTIVE

The present study aimed to describe the activities performed by FMG nurses in relation to CP management and to describe barriers to those activities.

METHOD

A descriptive correlational cross-sectional postal survey was used. The accessible population includes FMG nurses on the Ordre des infirmières et infirmiers du Québec list. All nurses on the list who provided consent to be contacted at home for research purposes were contacted. A self-administered postal questionnaire (Pain Management Activities Questionnaire) was completed by 53 FMG nurses.

RESULTS

Three activities most often performed by nurses were to establish a therapeutic relationship with the client; discuss the effectiveness of therapeutic measures with the physician; and conduct personalized teaching for the patient. The average number of individuals seen by interviewed nurses that they believe suffer from CP was 2.68 per week. The lack of knowledge of possible interventions in pain management (71.7%) and the nonavailability of information on pain management (52.8%) are the main barriers perceived by FMG nurses.

CONCLUSION

FMG nurses are currently performing few activities in CP management. The nonrecognition of CP may explain this situation.

Effectiveness of narrative pedagogy in developing student nurses' advocacy role

BACKGROUND

The literature and research on nursing ethics and advocacy has shown that generally very few nurses and other clinicians will speak up about an issue they have witnessed regarding a patient advocacy concern and that often advocacy in nursing is not learned until after students have graduated and begun working.

OBJECTIVE

To evaluate the effectiveness of narrative pedagogy on the development of advocacy in student nurses, as measured by the Protective Nursing Advocacy Scale.

DESIGN

We tested the hypothesis that use of a narrative pedagogy assignment related to ethics would improve student nurse's perception of their advocacy role as measured by the Protective Nursing Advocacy Scale using a quasi-experimental nonrandomized study using a pre-test, intervention, post-test design. Data collection occurred during class time from October 2012 to December 2012. The Protective Nursing Advocacy Scale tool was administered to students in class to assess their baseline and was administered again at the completion of the educational intervention to assess whether narrative pedagogy was effective in developing the nursing student's perception of their role as a patient advocate.

ETHICAL CONSIDERATIONS

Students were informed that their participation was voluntary and that the data collected would be anonymous and confidential. The survey was not a graded assignment, and students did not receive any incentive to participate. The institutional review board of the college determined the study to be exempt from review.

SETTING

School of Nursing at a small liberal arts college in the Northeastern United States.

PARTICIPANTS

A consecutive, nonprobability sample of 44 senior-level nursing students enrolled in their final nursing semester was utilized.

FINDINGS

Results indicated significant differences in student nurse's perception of their advocacy role related to environment and educational influences following an education intervention using an ethics digital story.

CONCLUSION

Using the Protective Nursing Advocacy Scale, we were able to measure the effectiveness of narrative pedagogy on nursing student's perception of the nurse's advocacy role.

A comparative survey on potentially futile treatments between Japanese nurses and laypeople

In the issue of futile treatments, patients and healthcare professionals tend to disagree. We conducted an Internet questionnaire survey and explored the Japanese nurses' attitude toward this topic, comparing with that of laypeople. In total, 522 nurses and 1134 laypeople completed the questionnaire. Nurse respondents were significantly less in favor of providing potentially futile treatments in hypothetical vignettes and stressed quality of life of the patient for judging the futility of a certain treatment. Of them, 85.4% reported having experienced providing such treatments. Reasons for providing them included factors related to not only patients but also healthcare teams. Our results indicate that attitudes among Japanese nurses toward the issue of futile treatments are different from patients and that their actual practice is influenced by several situational factors.

Moral distress: challenges for an autonomous nursing professional practice

Constantly experiencing limiting situations that hinder a professional practice coherent with its principles - of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users.

Health and human rights advocacy: perspectives from a Rwandan refugee camp

Working at the bedside and within communities as patient advocates, nurses frequently intervene to advance individuals' health and well-being. However, the International Council of Nurses' Code of Ethics asserts that nurses should expand beyond the individual model and also promote a rights-enabling environment where respect for human dignity is paramount. This article applies the results of an ethnographic human rights study with displaced populations in Rwanda to argue for a rights-based social advocacy role for nurses. Human rights advocacy strategies include sensitization, participation, protection, good governance, and accountability. By adopting a rights-based approach to advocacy, nurses contribute to health agendas that include more just social relationships, equitable access to opportunities, and health-positive living situations for all persons.

Nursing priorities, actions, and regrets for ethical situations in clinical practice

PURPOSE

Nurses in all clinical settings encounter ethical issues that frequently lead to moral distress. This critical incident study explored nurses' descriptions of ethically difficult situations to identify priorities, action responses, and regrets.

METHODS

Employing the critical incident technique, researchers developed a questionnaire that collected information on ethically difficult situations, nurse actions, and situational outcomes. Data on nursing priorities and actions were analyzed and categorized using a constant comparison technique.

FINDINGS

Addressing patient autonomy and quality of life were ethical priorities in the majority of cases. In many cases, nurses analyzed ethics from a diffuse perspective and only considered one dimension of the ethics conflict. However, some nurses were specific in their ethical analysis and proactive in their action choices. Nurses also identified 12 ethics-specific nurse activities, five ways of being, three ways of knowing, and two ways of deliberating. In 21 cases, nurses chose not to pursue their concerns beyond providing standard care. Several nurses expressed significant regret in their narration; most regretted unnecessary pain and suffering, and some claimed they did not do enough for the patient.

CONCLUSIONS

Not enough specific, evidence-based ethics actions have been developed. Stronger and more proactive nursing voices with early ethics interventions would make valuable contributions to quality of care for patients, especially at the end of life.

CLINICAL RELEVANCE

Ever-expanding treatment options raise ethical issues and challenge nurses to be effective patient advocates. Evidence-based nursing interventions that promptly identify and address moral conflict will benefit patients, their families, and the entire healthcare team by mitigating potential moral distress and disengagement.

Perceptions of Professionalism Among Nursing Faculty and Nursing Students

Although there is no consensus about the definition of professionalism, some generally recognized descriptors include knowledge, specialization, intellectual and individual responsibility, and well-developed group consciousness. In this study, Q-methodology was used to identify common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged as humanists, portrayers, facilitators, and regulators. The humanists reflected the view that professional values include respect for human dignity, personal integrity, protection of patient privacy, and protection of patients from harm. The portrayers believed that professionalism is evidenced by one’s image, attire, and expression. For facilitators, professionalism not only involves standards and policies but also includes personal beliefs and values. The regulators believed that professionalism is fostered by a workplace in which suitable beliefs and standards are communicated, accepted, and implemented by its staff. The differences indicate that there may be numerous contextual variables that affect individuals’ perceptions of professionalism.

Health care policy development: a critical analysis model

This article describes a phased approach for teaching baccalaureate nursing students critical analysis of health care policy, including refinement of existing policy or the foundation to create new policy. Central to this approach is the application of an innovative framework, the Grand View Critical Analysis Model, which was designed to provide a conceptual base for the authentic learning experience. Students come to know the interconnectedness and the importance of the model, which includes issue selection and four phases: policy focus, colleagueship analysis, evidence-based practice analysis, and policy analysis and development.