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.

Effects of student-led drama on nursing students' attitudes to interprofessional working and nursing advocacy: A pre-test post-test educational intervention study

BACKGROUND

Nursing educators need to equip students to work in interprofessional teams and advocate for patients in increasingly integrated health and social care settings. Drama-based education has been used in nursing to help students understand complex concepts and practices, including communication, empathy, and patient safety. However, few studies have evaluated drama-based education to promote understanding of interprofessional care and advocacy, and none have involved student-led drama where students create dramatic performances to support learning.

OBJECTIVES

To examine the effects of student-led drama on student nurses' attitudes to interprofessional working and advocacy.

DESIGN

Pre-test post-test educational intervention study.

SETTINGS

Public university in Scotland.

PARTICIPANTS

400 undergraduate student nurses enrolled on a 15-week module focussed on health and social care integration and interprofessional working.

METHODS

Students completed paper questionnaires at the start (n = 274, response rate: 80.1 %) and end (n = 175, 63.9 %) of the module. Outcome measures were the validated Attitudes Towards Healthcare Teams Scale (ATHCTS) and Protective Nursing Advocacy Scale (PNAS). Change in mean ATHCTS and PNAS scores were assessed using paired samples t-tests, with Cohen's d to estimate effect size.

RESULTS

ATHCTS scores significantly increased from 3.87 to 4.19 (p < 0.001, d = 0.52). PNAS scores increased from 3.58 to 3.81 (p < 0.001, d = 0.79), with significant improvements in the 'acting as an advocate' (4.18 to 4.51, p < 0.001, d = 0.81) and 'environmental and educational influences' subscales (3.79 to 4.13, p < 0.001, d = 0.75). Statements focussed on promoting holistic, dignified care and enabling health professionals to be responsive to emotional and financial needs of patients, showed greatest change.

CONCLUSIONS

Education based on plays created and performed by student nurses led to significant improvements in student nurses' attitudes towards interprofessional working and nursing advocacy. Student-led drama should be embedded in nursing curricula to enable students to understand the realities and complexities of health and social care integration and interprofessional working.

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.

NURSING AND HEALTH ADVOCACY: DEVELOPMENT PROCESS OF AN EDUCATIONAL MANUAL

ABSTRACT Objective: to describe the development and validation of an educational manual for nurses on the practice of health advocacy in their professional experience. Method the method used to develop the manual was composed of three stages carried out from 2018 to 2020: an integrative review of studies published from 2010 to 2018, development of the content, and validation of the educational manual by experts. Results: based on the integrative literature review, 91 final articles related to the theme of advocacy in health and nursing were selected, which subsidized the definition of four themes: The meaning and fundamental elements for the practice of advocacy in nursing; Advocacy in teaching and the involvement of other care actors; Advocacy as a professional, moral, and ethical obligation; Advocacy about specific population groups. The themes contributed to the development of the educational manual content. After submission and validation by specialists, it was possible to define the layout, size, number of pages, and final design of the educational manual, which will be printed and handed out to nursing professionals and students, and made available online. Conclusions: the elaboration and validation of the manual help to build knowledge related to the professional practice of the nursing team and the exercise of advocacy in health.

ENFERMAGEM E A ADVOCACIA EM SAÚDE: PROCESSO DE ELABORAÇÃO DE CARTILHA EDUCATIVA

RESUMO Objetivo: descrever a elaboração e validação de uma cartilha educativa para enfermeiros sobre o exercício da advocacia em saúde em sua prática profissional. Método para a elaboração da cartilha foi utilizado o método composto de três etapas realizadas de 2018 a 2020: revisão integrativa de estudos publicados no período de 2010 a 2018, construção do conteúdo e validação da cartilha educativa por especialistas. Resultados com base na revisão integrativa de literatura, foram selecionados 91 artigos finais relacionados ao tema de advocacia em saúde e enfermagem e que subsidiaram a definição de quatro temas: Do sentido e elementos fundamentais para a prática de advocacia em enfermagem; Advocacia no ensino e o envolvimento de outros atores do cuidado; Advocacia como obrigação profissional, moral e ética; Advocacia com relação a grupos específicos da população. Os temas contribuíram para a construção dos conteúdos da cartilha educativa. Depois de realizar o envio e a validação por especialistas, foi possível definir a diagramação, dimensão, quantidade de páginas e o design final da cartilha educativa, que será impressa e distribuída aos profissionais e estudantes de enfermagem e disponibilizada online. Conclusões: a elaboração e validação da cartilha contribui para a construção de conhecimentos relacionados à prática profissional da equipe de enfermagem e o exercício da advocacia em saúde.

Nurse managed patient focused assessment and care: A grounded theory of qualified nurses in acute and critical care settings assessing the mental capacity of adult patients

AIMS

To explore processes used by qualified nurses in assessing mental capacity of acutely and critically ill hospitalised adult patients.

BACKGROUND

Mental capacity is the ability to understand, reason and make decisions. Acute and critical illness may impact upon the decision-making abilities of hospitalised adult patients but little is known about how qualified nurses across a range of acute settings assess the capacity of such patients in their care.

DESIGN

A qualitative grounded theory approach informed by the Corbin and Strauss (Basics of Qualitative Research (Third Edition). London, UK: Sage, 2008) methodological pathway.

METHODS

Data were collected through digitally recorded, semi-structured interviews to explore assessment of capacity processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales, UK. Data were analysed using iterative constant comparative processes leading to a core category and grounded theory. The study is presented in accordance with the COREQ checklist.

RESULTS

Informal, intuitive, holistic nurse-led processes were used to assess the mental capacity of patients which combined processes for the assessment of their physiological and mental capacity status, recognising the need to support their rights, dignity and autonomy. The assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi-professional assessment was necessary and ongoing, and in which qualified nurses had a co-ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care.

CONCLUSION

This theory provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness.

RELEVANCE TO CLINICAL PRACTICE

This framework may inform related clinical practice and can serve as a basis of an assessment tool in what has been identified as a fundamental role of the qualified nurse.

Patient advocacy actions by intensivist nurses

OBJECTIVE

To explore the actions and factors associated to patient advocacy by intensivist nurses using the Protective Nursing Advocacy Scale.

METHOD

A quantitative, descriptive-exploratory, cross-sectional study. The questionnaire was answered by nurses who worked in Intensive Care Units in the South and Southeast regions of Brazil. A factorial exploratory analysis of the data, T-tests and the chi-square test were used for association between factors.

RESULTS

451 nurses participated in the study. A greater number of nurses disagreed with the negative consequences that patient advocacy may have or bring to them. Greater dialogue among nursing staff would enhance teamwork results. Nurses with two or more job relationships need more physical and mental effort, which compromises their quality of life and work, leading to them being those who least practice patient advocacy.

CONCLUSION

Nurses understand patient advocacy as an important part of their work, as well as factors which may influence their decision to defend their patients, but are still unaware of the benefits of advocacy.

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.

School Nurse Advocacy for Student Health, Safety, and School Attendance: Impact of an Educational Activity

School nurses are expected to advocate for policies and procedures that support student health, safety, and school attendance. An educational activity to improve school nurse advocacy was developed and implemented based on advocacy literature, self-efficacy theory, and continuing education guidelines. A quantitative, repeated measure descriptive project design was used to compare school nurses’ advocacy measures before and following an educational activity and 6 weeks after the activity. Immediately after the education, there were significant increases in advocacy knowledge ( p < .001), confidence ( p < .001), and recalled behaviors ( p < .01) for a convenient sample of 51 Massachusetts school nurses. There were no significant differences across pre-, post-, and 6-week survey responses ( n = 6); however, advocacy outcomes from immediately after the education were maintained at 6 weeks. More effective school nurse advocacy may improve youth population health, increase safety for students at school, and improve school attendance.

Preditores da advocacia em saúde identificados por enfermeiros no contexto hospitalar

Objetivos: identificar los predictores del ejercicio de la abogacía en salud por enfermeros en el contexto hospitalario. Materiales y método: estudio cuantitativo, transversal analítico, realizado con 157 enfermeros de dos instituciones hospitalarias del sur de Brasil, una pública y una filantrópica. Se realizó la recolección de datos entre los meses de septiembre y octubre del 2015. Se utilizó el instrumento Protective Nursing Advocacy Scale — versión brasileña, constituido por 20 ítems, dispuestos en cinco constructos. Para el análisis de los datos, se utilizaron elementos de la estadística descriptiva, la correlación de Pearson y el análisis de regresión lineal. Resultados: los resultados evidenciaron moderada asociación entre facilitadores al ejercicio de la abogacía y percepciones que favorecen su ejercicio. La dimensión “facilitadores al ejercicio de la abogacía” obtuvo el mayor promedio del instrumento y fue el principal predictor jurídico en salud en el contexto hospitalario, capaz de provocar en los enfermeros la sensibilidad y el deseo en abogar. Conclusiones: el sentimiento de responsabilidad por parte de los enfermeros en mantener el buen funcionamiento del equipo y manejar cuestiones conflictivas en ofrecer seguridad a los pacientes, aun ante resistencias oriundas del local de trabajo.

AÇÕES DOS ENFERMEIROS NO EXERCÍCIO DA ADVOCACIA DO PACIENTE: REVISÃO INTEGRATIVA

RESUMO: Objetivo: identificar as ações dos enfermeiros no exercício da advocacia do paciente, na literatura científica internacional publicada nos últimos dez anos. Método: revisão integrativa da literatura, cujos dados foram coletados na base de dados Cumulative Index to Nursing and Allied Health Literature e SAGE Journals Online, utilizando-se os descritores "patient advocacy" e "nursing", sendo encontrados 27 artigos. Resultados: como resultados, emergiram duas categorias: ações de advocacia exercidas por enfermeiros em diferentes nações e culturas; e ações de advocacia nos diferentes ambientes de atuação dos enfermeiros. Conclusão: acredita-se que os achados deste estudo poderão contribuir para a produção de pesquisas e conhecimentos em enfermagem, ampliando a compreensão da advocacia do paciente como um componente ético da prática dos enfermeiros.

Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions

PURPOSE

To translate and adapt the Protective Nursing Advocacy Scale (PNAS) into a Swedish version (PNAS-Swe), evaluate its psychometric properties, and describe registered nurse anesthetists' (RNAs) advocacy beliefs and actions from a protective perspective.

DESIGN

A cross-sectional design was used.

METHODS

First, the PNAS was translated into Swedish. Next, the content and construct validity of the PNAS four subscales was evaluated. Finally, the PNAS-Swe was used to describe Swedish RNA beliefs and actions regarding protective nursing advocacy.

FINDINGS

The final PNAS-Swe has 29 items in four subscales. The RNAs reported that they feel that they should provide protective nursing advocacy for their patients. There were no differences in gender, or associations with age, or work experience regarding their advocacy beliefs or actions.

CONCLUSIONS

The PNAS-Swe is valid for use in a Swedish context. Protective nursing advocacy is important to the RNAs, which is in congruence with earlier qualitative studies.

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

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.

Ethics interventions for healthcare professionals and students: A systematic review

Background:

The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.

Objectives:

To examine ethics interventions conducted on healthcare professionals and healthcare students to achieve ethics-related outcomes.

Research design:

A systematic review.

Methods:

Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.

Ethical consideration:

This systematic review was conducted following good scientific practice in every phase.

Findings:

It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.

Conclusion:

Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals.

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.

Predicting Levels of Policy Advocacy Engagement Among Acute-Care Health Professionals

This study aims to describe the factors that predict health professionals' engagement in policy advocacy. The researchers used a cross-sectional research design with a sample of 97 nurses, 94 social workers, and 104 medical residents from eight hospitals in Los Angeles. Bivariate correlations explored whether seven predictor scales were associated with health professionals' policy advocacy engagement and revealed that five of the eight factors were significantly associated with it (p < .05). The factors include patient advocacy engagement, eagerness, skills, tangible support, and organizational receptivity. Regression analysis examined whether the seven scales, when controlling for sociodemographic variables and hospital site, predicted levels of policy advocacy engagement. Results revealed that patient advocacy engagement (p < .001), eagerness (p < .001), skills (p < .01), tangible support (p < .01), perceived effectiveness (p < .05), and organizational receptivity (p < .05) all predicted health professional's policy advocacy engagement. Ethical commitment did not predict policy advocacy engagement. The model explained 36% of the variance in policy advocacy engagement. Limitations of the study and its implications for future research, practice, and policy are discussed.

COMO ENFERMEIROS VÊM EXERCENDO A ADVOCACIA DO PACIENTE NO CONTEXTO HOSPITALAR? - UMA PERSPECTIVA FOUCAULTIANA

Objetivou-se conhecer como os enfermeiros vêm exercendo a advocacia do paciente no contexto hospitalar. Realizou-se uma pesquisa qualitativa, do tipo exploratório-descritiva, em um hospital universitário do Sul do Brasil. Foram respondentes da pesquisa 16 enfermeiros, selecionados por meio de amostragem não probabilística, do tipo bola de neve. Para a coleta de dados, foram realizadas entrevistas semiestruturadas, gravadas e transcritas, analisadas mediante análise textual discursiva e referencial teórico foucaultiano. Como resultados, emergiram duas categorias: a coragem de verdade: o exercício da advocacia mediado pelo diálogo franco; estratégias de resistência para o exercício da advocacia do paciente. Conclui-se que a estabilidade profissional e o apoio da instituição contribuem para que os enfermeiros se sintam encorajados a exercer a advocacia, mesmo diante de situações de difícil enfrentamento, utilizando-se da parrésia e de estratégias de resistência para garantir a defesa efetiva dos interesses dos pacientes.

Nursing beliefs and actions in exercising patient advocacy in a hospital context

AbstractOBJECTIVEAnalyzing beliefs and actions of nurses in exercising patient advocacy in a hospital context.METHODA quantitative cross-sectional exploratory and descriptive study, conducted with 153 nurses from two hospitals in southern Brazil, one public and one philanthropic, by applying Protective Nursing Advocacy Scale - Brazilian version. Data were analyzed using descriptive statistics and analysis of variance.RESULTSNurses believe they are advocating for patients in their workplaces, and agree that they should advocate, especially when vulnerable patients need their protection. Personal values and professional skills have been identified as major sources of support for the practice of advocacy.CONCLUSIONNurses do not disagree nor agree that advocating for patients in their working environments can bring them negative consequences. It is necessary to recognize how the characteristics of public and private institutions have helped or not helped in exercising patient advocacy by nurses.

Nursing Actions in practicing inpatient advocacy in a Burn Unit

OBJECTIVEUnderstanding nursing actions in the practice of inpatient advocacy in a burn unit.METHODA single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis.RESULTSThree emerging categories were identified, namely: (1) instructing the patient; (2) protecting the patient; and (3) ensuring the quality of care.CONCLUSIONSThis study identified that the nurses investigated exercised patient advocacy and that the recognition of their actions is an advance for the profession, contributing to the autonomy of nurses and the effectiveness of patients' rights and social justice.

Cross-cultural adaptation and validation of the Protective Nursing Advocacy Scale for Brazilian nurses

OBJECTIVE

to adapt culturally and validate the Protective Nursing Advocacy Scale for Brazilian nurses.

METHOD

methodological study carried out with 153 nurses from two hospitals in the South region of Brazil, one public and the other philanthropic. The cross-cultural adaptation of the Protective Nursing Advocacy Scale was performed according to international standards, and its validation was carried out for use in the Brazilian context, by means of factor analysis and Cronbach's alpha as measure of internal consistency.

RESULTS

by means of evaluation by a committee of experts and application of pre-test, face validity and content validity of the instrument were considered satisfactory. From the factor analysis, five constructs were identified: negative implications of the advocacy practice, advocacy actions, facilitators of the advocacy practice, perceptions that favor practice advocacy and barriers to advocacy practice. The instrument showed satisfactory internal consistency, with Cronbach's alpha values ranging from 0.70 to 0.87.

CONCLUSION

it was concluded that the Protective Nursing Advocacy Scale - Brazilian version, is a valid and reliable instrument for use in the evaluation of beliefs and actions of health advocacy, performed by Brazilian nurses in their professional practice environment.

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.

Swedish nurses' perceptions of influencers on patient advocacy: a phenomenographic study

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.

Problematising autonomy and advocacy in nursing

Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate.

Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy

BACKGROUND

Anaesthesia often induces a state of unconsciousness that includes inability to communicate and influence the situation. The patient has to rely on the nurse anaesthetist to speak up for her/him as well as maintain her/his dignity and safety. Consequently, the nurse anaesthetist can be likened to the patient's advocate.

AIM

The aim of the study was to describe advocacy in anaesthesia care during the perioperative phase from the perspective of the registered nurse anaesthetist.

METHOD

Data for this qualitative descriptive study were collected during March and April, 2011. Individual interviews were conducted with a purposive sample of 20 nurse anaesthetists from two hospitals in Sweden. The audio-taped interviews were transcribed verbatim and analysed by means of qualitative content analysis.

FINDINGS

The main theme, Holding the patient's life in my hands, described the nurse anaesthetists' perception of advocacy and comprised three subthemes: providing dignified care, providing safe care and a moral commitment.

CONCLUSION

Acting as the patient's advocate includes important health and well-being issues and could be stressful for the nurse anaesthetists'. A work environment where the nurse anaesthetists' can make their voices heard and feel that their opinion regarding the patient's best interests is taken seriously would be desirable, as all health professionals should ideally focus on those in their care.

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.

Moral distress in everyday nursing: hidden traces of power and resistance

OBJECTIVE: To know the strategies of resistance adopted by nursing staff, facing situations of moral distress, from an ethical perspective. METHOD: The authors conducted qualitative research through semi-structured interviews, with fifteen nursing staff members of a university hospital in the extreme south of Brazil, using textual discourse analysis and the theoretical reference of Foucault. RESULTS: Two categories were constructed: denial of oneself and the other - in which one perceives that the nursing staff can perform actions that are governed predominantly by immobility and conformism, avoiding confrontations with whoever represents power in situations that provoke moral distress in them; possibility to care for oneself and for the other - in which nursing workers in situations that provoke moral distress for them exercise power and endurance. CONCLUSION: it was perceived that some professionals seem to use ethical coping strategies, in order to ensure and preserve their professional values. However, often the choice of some nursing professionals may be to relapse into immobility and the absence of building strategies of endurance. This situation may represent their reduced exercise of power and insufficient resistance in the face of ethical problems, contributing to the intensification of their invisibility in the area of health.

Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS)

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.

ICU nurses' perceptions of responsibilities and organisation in relation to organ donation--a phenomenographic study

OBJECTIVES

According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses' perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death.

METHODS

A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas.

RESULTS

The findings pertain to three domains: ICU nurses' perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death.

CONCLUSION

The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses' opportunities to fulfil their professional responsibility during the organ donation process.

Development of the Basic Knowledge Assessment Tool for Medical-Surgical Nursing (MED-SURG BKAT) © and implications for in-service educators and managers

BACKGROUND OF THE PROBLEM: Medical-surgical nursing is now the largest specialty in acute care, and needs an objective measure of basic knowledge necessary to provide safe care to patients. The Joint Commission on Accreditation of Healthcare Organizations noted that healthcare organizations have in the past relied on education and experience to support competence, but an increasing number are seeking objective measures of a nurse's knowledge that is required for safe practice. The American Nurses Association adds that safe practice is both a professional and a moral responsibility.

PROBLEM

A review of the literature failed to locate a standardized test of basic knowledge in medical-surgical nursing. In-service educators and managers need such a test to facilitate orientation programs, and as a way to safely decrease the length of orientation for new employees with previous experience in medical-surgical nursing.

METHODS

The purpose of the study was to develop a valid and reliable test to measure basic knowledge in medical-surgical nursing.

FINDINGS

The Basic Knowledge Assessment Tool for Medical-Surgical nursing was developed with support for its validity and reliability.

The medical-surgical nurse perspective of advocate role

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.