A field study of the role of nurses in advocating for safe practice in hospitals

Advanced practice nurses' experiences of patient safety: a focus group study

BACKGROUND

Patient harm from unsafe care is an increasingly global phenomenon leading to death or disability. Drawing on their expertise, Advanced Practice Nurses provide the opportunity to improve care quality and safety.

AIM

To explore Nurse Practitioners and Clinical Nurse Consultants' experiences in patient safety.

DESIGN

A qualitative design was used involving six audio-visually recorded focus group interviews. Participants working in an acute or community adult nursing speciality were involved.

METHODS

Twenty-eight Advanced Practice Nurses (female 82.1%, mean age 47.5 ± 10 years) were recruited by convenience and snowball sampling. After transcription of interview data, qualitative content analysis was conducted.

RESULTS

Six categories were identified: patient safety as the highest priority (1), special contribution to patient safety (2), patients/relatives role in safety (3), multidisciplinary team approach (4), government regulation in safety (5), and further needs to improve safety (6). Advanced Practice Nurses saw themselves as role models and leaders for other healthcare staff through their expertise and professional experience and thus able to see the bigger picture in health. They identified as change agents at the system-level due to their decision-making ability and multi-professional team connectivity.

CONCLUSIONS

This study emphasises the key position of extended nursing roles and the need for future development of patient safety strategies in hospitals and community care. As influential leaders, Advanced Practice Nurses are best placed to identify improvements. They play a central role in guiding the multi-professional team, the patient and their family, educating nursing staff, and identifying and addressing system-wide safety gaps to improve patient safety.

Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BACKGROUND

Emergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses' health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.

PURPOSE

The purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.

METHODS

The study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.

RESULTS

A total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Future strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

The functionality of unit practice councils and its relationship with nurses' accountability: A cross-sectional study

AIM

This study aimed to examine the relationship between perceived unit practice councils' functionality and nurses' accountability in Saudi Arabia.

DESIGN

A descriptive, correlational and cross-sectional design was used.

METHODS

Convenience sampling of 160 nurses working in multiple sites of a large, tertiary medical centre in Saudi Arabia was performed. Structured self-administered questionnaires were used to measure perceived unit practice council functionality and levels of nurse accountability.

RESULTS

Nurses perceived that unit practice councils had moderate levels of functionality; however, nurses had high levels of accountability. Also, perceived unit practice councils' functionality had a significant positive relationship with nurses' accountability (r = 0.49, p < 0.001). More studies are needed to investigate the impact of different shared governance models on nurses' work environments.

Exploring Ghanaian nurses knowledge and application of bio-ethical principles in postoperative pain management

Managing postoperative pain require good understanding of the bio-ethical principles in order to preserve patients’ rights. Bio-ethical principles in health care include autonomy, beneficence, justice and nonmaleficence. It is important that health care professionals understand that patients in pain have the right to satisfactory management. Good insight on ethical principles and how they relate to pain management places the nurse on a better pedestal to manage postoperative pain effectively. However, there is scanty literature on the level of Ghanaian nurses’ knowledge and application of bio-ethical principles in postoperative pain management. Therefore, the study objectives were to: explore nurses’ understanding of the bio-ethical principles in postoperative pain management; explore how nurses apply bioethical principles in postoperative pain management. The study employed qualitative exploratory descriptive design. Purposive sampling technique was used to recruit participants from the surgical wards. Semi-structured interview guide was designed for data collection. Data saturation was reached at the fourteenth participant. Thematic analysis method was used and themes emerged inductively. Three main themes identified through inductive content analysis of data were: beneficence, autonomy and justice. Findings showed that nurses had some appreciable level of knowledge of the fundamental principles related to ethics and applied them in postoperative pain management. Nurses knew their duties in advocating for patients. Patients rights to refuse treatment was also appreciated by some nurses. Nurses also demonstrated humanity by helping patients financially to settle hospital debts which explicitly shows the empathetic characteristics of nurses. The study concluded that nurses are knowledgeable in bioethical principles underpinning post operative pain management and also applied these principles when caring for surgical patients.

Nursing and advocacy in health: An integrative review

BACKGROUND

The practice of health advocacy in nursing has been defined as a process aimed at promoting the independence and autonomy of users of health services, in addition to providing information on healthcare decision-making and offering support for decisions taken.

ETHICAL CONSIDERATIONS

Ethics approval was not required to conduct this review.

AIM

This integrative review aims to synthesize evidence in the literature on health advocacy in professional nursing practice.

METHODS

An integrative review methodology guided by Whittemore and Knalf was used. Studies were identified by conducting searches on PubMed, Scopus, Web of Science, CINAHL, and LILACS databases. Of 2179 records, 34 studies matched the inclusion criteria.

RESULTS

The main aspects involved in the practice of health advocacy by professional nurses are related to the ethical principles of the nursing profession, such as protecting patients seeking autonomy and care. Furthermore, the practice of health advocacy by nurses requires an empathetic attitude, responsibility, and assertive communication.

CONCLUSION

The diverse possibilities for the practice of advocacy synthesized in this study allow nurses to approach and become familiarized with the topic, being able to acquire and complement knowledge that will reflect on their professional practice in different work environments such as the educational field, in hospital practice, or basic health care.

The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses’ statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients’ values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients’ voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients’ values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.

Nursing during the COVID-19 outbreak: A phenomenological study

Aim

The aim of this study was to explore the experience of Italian nurses engaged in caring for patients with COVID‐19.

Background

COVID‐19 found the health care world unprepared to face an emergency of such magnitude. Italy was one of the most affected European countries, with more than 250,000 cases. Understanding the impact of events of this magnitude on nurses provides a framework of knowledge on which educational training could be based to face similar situations in the future to prevent further breakdown.

Methods

The hermeneutic approach by Cohen was used. Semi‐structured interviews were conducted using a voice‐over Internet protocol. Interviews were transcribed, read in depth and analysed.

Results

Twenty nurses were interviewed. Four themes were extracted: uncertainty and fear, alteration of perceptions of time and space, change in the meaning of ‘to care’ and changes in roles and relationships.

Conclusions

Psychological support in association with emergency training prevents stress and helps tackle compassion fatigue.

Implications for nursing management

Policies to improve nursing science should be developed to ensure better quality of care, a higher number of professionals and, consequently, an increase in the safety of patients.

Nebulous Intentioning - Acute hospital nurses' struggle to deliver core nursing care

AIM

To explore the influences on nursing practice in acute hospital care.

DESIGN

A Classic Grounded Theory study.

METHODS

Data collection (2013-2015) was through interviews and non-participant observations. Analysis was undertaken using constant comparative data analysis and theoretical sampling. Memo writing was used as an aid to understanding and conceptualizing data during analysis. Theoretical coding served to integrate emerging concepts.

RESULTS

This theory explains core nursing as a nebulous intention, an idea which acute care nurses retain throughout each shift, that they will nurse their patients fully when they have the opportunity. It reveals this as the resolution of their main problem which is the constant deferral of core nursing care. This study explains its two sub-core categories, accommodating and integrity eroding.

CONCLUSION

The theory highlights nurses' attitudes towards their role, demonstrated by deferring it to accommodate the work of others, but offers a new perspective on the significant contribution nurses make to the safe and cohesive transition of patients through the acute healthcare system.

IMPACT

The theory adds a new understanding of the unique contribution nurses make to patient health and safety in acute care environments. It also provides insight into nurses' attitudes towards their own professional work. It explains the consequences of attitudes which undermine core nursing when it competes for priority with accommodating. Accommodating indicates a greater workload for nurses than has been previously understood in explaining the activities, additional to core nursing care, which nurses undertake to contribute safety and cohesion to the patient's acute care journey. These new insights suggest a role for managers in recognizing accommodating in decisions about staffing and resources and for educators in improving the profession's regard for its theoretical underpinnings and for its self-image.

Perceived interpersonal and institutional challenges to patient advocacy in clinical nursing practice: a qualitative study from Ghana / Interpersonelle und institutionelle Herausforderungen für die Rolle als Patientenfürsprecher/-in aus Sicht der Pflege: eine qualitative Studie aus Ghana

Background

Nurses often speak on patients’ behalf and safeguard their safety through their advocacy role. However, some challenges like the negative attitude of team members and lack of institutional support often hamper this role. These challenges have not been well studied in the Ghanaian context.

Aim

This study explores the perceived environmental challenges to patient advocacy among nurses in Ghana.

Setting

The study was conducted at a regional hospital in Ghana.

Participants

Participants were nurses or midwives working in the hospital.

Methods

A qualitative exploratory descriptive design was employed in the study of 15 purposively sampled participants. Participants were interviewed individually and data were analysed using content analysis.

Findings

The study revealed interpersonal challenges and institutional challenges to patient advocacy, such as hierarchical nurse–doctor relationships and ineffective multidisciplinary team, time constraints and lack of institutional support. Nurses often failed to advocate because they did not want to risk conflict with doctors. Limited interprofessional interaction, suspicion and resentment in the multidisciplinary team negatively affected nurses’ role as patient advocates. Inadequate curricular support for patient advocacy and lack of support for training programmes or to undertake further studies were the additional challenges.

Conclusion

Patient advocacy could be a stressful role for nurses; thus, efforts to strengthen teamwork and increase nurse involvement in hospital decision-making are required.

Implications for nursing and health policy

The findings could influence hospital management policies to enhance stronger interprofessional collaboration, increase opportunities for professional advancement for nurses and nurses’ inclusion in decision-making.

"We are the best to stand in for patients": a qualitative study on nurses' advocacy characteristics in Ghana

Background

Patient advocacy has been identified as a core duty of the nurse, and certain nurse characteristics influence the performance of the role. However, these characteristics have not been adequately explored in Ghana. This study aimed to explore the perspectives of nurses about the characteristics of nurses that influence their role as patient advocates.

Methods

An exploratory descriptive qualitative study was conducted among 15 nurses from a regional hospital in Ghana. Purposive sampling was used to select participants and individual in-depth interviews were conducted in English using a semi-structured interview guide. The interviews were audio-taped and transcribed. Data analysis was done concurrently employing the principles of thematic analysis. Ethical approval was obtained for the study from the Noguchi Memorial Institute of Medical Research and the Ghana Health Service Ethical Review Committee.

Results

Themes generated revealed nurse traits which enhanced the advocacy role of nurses such as being empathetic, nurturing, ethical, assertive and persistent and nurse states which hindered the performance of the role such as fatigue and frustration. However, “compassionate” emerged as an additional nurse trait from this study. Out of empathy, participants availed themselves for patients to share their problems with them. In their nurturing roles, spending more time with patients and providing personal care fostered closeness which helped in identifying patients’ problems. Helping patients navigate the health system was also found. They perceived patient advocacy as a moral responsibility and identified good communication skills and determination to help patients get their problems solved as important in patient advocacy. Some participants also described compassion-based activities such as pleading on patients’ behalf, providing material and financial assistance, facilitating care and providing emotional support in their advocacy. However, heavy workload and lack of appreciation from patients were found to hinder the performance of the advocacy role.

Conclusions

We concluded that nurse characteristics that influence patient advocacy are comparable to those identified internationally such as being empathetic, assertiveness and fatigue. Enhancing these characteristics could help nurses overcome the negative states that undermine the patient advocacy role of nurses.

Paediatric inter-hospital transportation: a clinical governance project

This article discusses a quality improvement project in the context of paediatric inter-hospital transportation. The project was set in a large university teaching hospital in Ireland. Risk assessment on the clinical site revealed a gap in the application of best national and international standards in inter-hospital transportation practice. A project was undertaken to explore current paediatric transport services and respond to a clinical service deficit. Consequently, the proposed quality improvement initiative proposes a universal Paediatric Advanced Life Support Programme (PALS) to upskill and enhance the required clinical standards and competencies of neonatal nurses. This intervention was underpinned by attention to change management principles and organisational culture in health care. As a clinical practice development, it demonstrates how benchmarking against best practice can advance the quality and safety agenda in paediatric practice. Education initiatives are recommended to ensure that clinical standards in paediatric transportation are monitored and reviewed with the potential to improve clinical outcomes.