Patient Advocacy at the APRN Level: A Direction for the Future

Development of the Patient Advocacy Scale for Intensive Care Nurses

Background and Purpose: To describe the process of developing and validating the content of the Patient Advocacy Scale for Nurses in Intensive Care (EAPEnf-UTI). Methods: Methodological research. To achieve the elaboration objective, five stages were developed: (a) definition of the theme, (b) generation of the number of items, (c) determination of the measurement format, (d) validation of face and content, and (e) content adjustment. Results: The instrument elaborated from a survey and integrative literature review, and the measurement format chosen was the 5-point Likert scale. The validation of face and content was performed by expert judges and by pretest. The final instrument had 57 items. Conclusion: EAPEnf-UTI is a pioneering instrument built in the Brazilian context, whose future validation will allow the capturing of situations specific to intensive care units and the professional practice of intensive care nurses.

Attitudes of Nursing Students Regarding Nurses' Involvement in Health Care Policy: A New Model Predicting Future Involvement

AIM

The purpose of this study was to examine the attitudes of nursing students regarding nurses' involvement in health care policy and influencing factors.

BACKGROUND

Nurses have the potential to influence health care policy. In practice, their involvement in policy-making decisions has been unremarkable.

METHOD

A cross-section study was performed. A self-report questionnaire measuring nurses' involvement in determining health care policy was distributed among 400 nursing students from three universities in Israel.

RESULTS

Most students intended to become involved in determining health care policy; however, they claimed that their level of awareness and training in the field was not adequate. Recently, a new model predicted a 74.8 percent involvement of future nurses in determining health care policy.

CONCLUSION

Nursing leaders and designers of nursing education programs must create professional and personal resources through political activism among nursing students in order to preserve patients' rights and treatment quality.

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.

Understanding how advanced practice registered nurses function as patient advocates

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.