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

Striving to Keep a Clear Conscience by Going Above and Beyond: The Experiences of Intensive Care Unit Nurses

Working as a nurse in the critical care unit may involve ethical challenges including conflict of conscience. Literature provides very limited knowledge about intensive care unit (ICU) nurses' perception of conscience. Considering the influence of culture on the perception of conscience, it is important to study it in diverse contexts. This study aims were to explore the meaning of conscience and the impact of conscience on nurses' practice in the ICU. A qualitative research approach was used to answer the research question, and qualitative content analysis guided the study. A total of 17 interviews were conducted with ICU nurses. Data were collected through semistructured tools by using videoconferencing and face-to-face interviews. Data analysis resulted in the formation of 2 main categories and 7 subcategories. The main categories included understanding the conscience and unlimited efforts in caretaking as the path to a clear conscience. The category of understanding the conscience includes 3 subcategories of conscience as an intrinsic asset and internal observer, dynamicity of conscience, and conscience as the cornerstone of morality. Also, the category of unlimited efforts in caretaking as the path to a clear conscience consists of 4 subcategories including giving full attention to the patient, putting oneself in another's shoes, taking responsibility, and working beyond the job description. Conscience plays an essential role in providing the ethical care among ICU nurses. The ICU nurses felt that they need to go above and beyond to keep their conscience clear. Nurses expressed the importance of following the call of conscience at their workplace, which demanded unlimited efforts to achieve a clear conscience.

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.

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.

Exploring the experts’ perceptions of barriers to using internet of things for chronic disease management in Iran

Purpose

Internet of things (IoT) promises advantages in different sectors, especially the health-care sector. Due to its capabilities for chronic disease management, IoT has attracted the attention of researchers. Nowadays, there is research that focuses on the use of IoT for chronic disease management. However, the use of IoT in various contexts faces different barriers. This paper aims to explore Iranian experts’ conceptions of the barriers to using IoT in Iran regarding its application for chronic disease management.

Design/methodology/approach

This study follows a phenomenographic method to investigate Iranian experts’ conceptions of the barriers to using IoT in Iran regarding its application for chronic disease management.

Findings

The results show that there are four categories of description (governance, technical, economic and social barriers) that vary among experts’ conceptions.

Originality/value

The findings of the present work could provide valuable insights for managers and policymakers who want to address IoT barriers.

Nurses' attitude towards patient advocacy in a single tertiary care hospital

Aim

To determine nurses’ attitude towards patient advocacy in a single tertiary care hospital.

Design

Descriptive/analytical cross‐sectional studies.

Methods

A comprehensive two‐part questionnaire about nurses’ views on nursing advocacy was administered to 371 nurses using a convenient random sampling. The first part included eight demographic variables, and the second part, the questionnaire, was used to measure nurses’ attitude towards patient advocacy.

Results

Nurses were more likely to act as patient advocate when their patient was in danger, and their employment was not at risk while acting as patient advocates. Female nurses scored higher than males; those with higher qualifications had higher behavioural and cognitive scores. A significant correlation was observed between cognitive (belief) aspects of attitude (p = .78, p ≤ .001) and behavioural (efficacy) aspects (p = .89, p ≤ .001).

The Concept of Advocacy in Nursing: A Critical Analysis

As health care professionals practice as a team, they take on responsibilities that are specific to their roles-responsibilities that are recognized and understood by the team and management as pertaining to their professional domain and expertise. Is advocacy part of the role of the nurse? Members of the nursing profession commonly maintain that it is, but is there a consensus on this issue, both within the profession and among other stakeholders? Is there a clear understanding of the term advocacy, and is this reflected in Codes of Practice and research into practice? An examination of significant documents and reports of empirical research reveals conflicting conceptions and opinions. There is potential for a common definition, but agreements need to be reached on whether advocacy is an essential function of nursing within the management of health care, and if so, what is advocacy's importance, focus, and limits.

Facilitators of the health advocacy role practice of the nurse in Ghana: A qualitative study

BACKGROUND

Identifying facilitators of health advocacy role practice of nurses is important in reducing health disparities and inequities in Ghana. The struggle to reducing these disparities and inequities needs a combination of bravery, courage, and professionalism. In many instances, many barriers hinder nurses from practicing their health advocacy role in Ghana. Facilitators that motivate nurses who would perform this health advocacy role have not been identified and adequately described in Ghana.

AIM

To explore and describe the facilitators of the health advocacy role of nurses in Ghana.

METHODS

This qualitative study used Strauss and Corbin's grounded theory approach to collect and analyze data from 2018 to 2019 in three regions in Ghana. Semistructured interviews (n = 24) and field notes were used to collect data.

RESULTS

Professional influence emerged as a core category among other three facilitators that motivate nurses to perform the health advocacy role. The other three are clientele influence, intrinsic influence, and cultural influence.

CONCLUSIONS

Facilitators to the health advocacy role practice of nurses are multidimensional and hidden. In this respect, educating hospital managers on these facilitators should be done through workshops and seminars to enhance the managers' strategies of motivating nurses to advocate for the less privileged and the disadvantaged of the society.

Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study

INTRODUCTION

Patient advocacy, acting on behalf of patients' unmet needs, is fundamental to nursing, and the perception of the need for advocacy motivated this study. Nurses experience moral discomfort, which results from a divergent view regarding medical or caregivers' decisions about patients' clinical proceedings, in which patients' involvement in making those decisions is either doubtful or absent.

OBJECTIVES

The aim of this study is to assess the need for advocacy and explore the perspectives of nurses engaged in the care of older patients.

METHODS

The methodological orientation is that of a qualitative design, by using a purposive and criterion sampling. The sample was of 14 nurses of a ward of general medicine. Focus group as collecting data tool was used, followed by a thematic analysis.

RESULTS

Nurses demonstrated a high level of moral sensitivity to ethical problems in clinical practice and on occasions, the courage to bring the problem to the physicians or patients' family's attention, or help patients develop self-determination. However, it is difficult to advocate because of insufficient communication between professionals, insufficient knowledge of ethics, and the emotional burden it places on nurses which results in emotional resignation in the face of interprofessional teams' lack of consideration of nurses' opinions.

CONCLUSION

This research highlighted nurses' need for advocacy to promote patients' rights, wishes, and values. It is essential for nurses to be aware of their level of moral sensitivity and develop a strategy to regain courage to engage in advocacy. Therefore, ethics education and interprofessional ethical leadership is desired, which inspires healthcare professionals' work and allows the foundations of an ethical decisionmaking process to be laid through patients and their families' active involvement.

Correcting medical decisions: a study in nurses' patient advocacy in (Finnish) hospital ward rounds

During daily hospital ward rounds, medical teams, led by doctors, assess the progress of an individual patient's health. It is widely reported in the research literature that nurses play a relatively passive role during these rounds, because although they may have valuable information about the patient's condition and progress, and indeed their role includes advocacy on behalf of their patients, nurses nevertheless can experience difficulties in participating during case constructions. Here we report an instance from a (gastro-surgical) ward round in a Finnish hospital, in which nurses played a key role in reversing a consultant's initial decision to discharge a patient. They did so not by directly challenging the consultant's opinion, but by employing indirect means to introduce their discrepant perspective: they provide descriptions and ask questions that draw attention to information that results in the doctor coming to a different assessment than theirs of the patient's condition, and a different decision about what should be done (the patient was not discharged from hospital). The encounter reported here is taken from a corpus of ward round discussions in a Finnish hospital. The method of our study is Conversation Analysis.

Here and now: Lived experiences of professional nurses practising caring presence in a rural public hospital in the North West Province, South Africa

BACKGROUND

Practising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of recommendations on how to encourage nurses to implement the practice of caring presence within nursing.

AIM

This study explored and described the lived experiences of PNs practising caring presence in a rural public hospital.

SETTING

The study setting was a 120-bed, level-two district hospital in the North West Province of South Africa.

METHODS

A descriptive phenomenological method, specifically Husserl's approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi's seven-step method.

RESULTS

Five themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not.

CONCLUSION

Professional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.

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.

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 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.

How can health professionals contribute to the internet of things body of knowledge

Purpose

Internet of Things (IoT) as the new technological paradigm has found many applications in different domains. Nowadays, more than 30,000 records related to IoT research can be accessed in Scopus (Scopus.com). Health care is the one of domains which benefits from IoT. However, observations indicate that most active researchers in this area are technical people not health professionals. The purpose of this paper is to understand how health professionals can contribute to the IoT body of knowledge.

Design/methodology/approach

IoT professionals are asked to provide their views regarding research concerns, and the collected data are analyzed by phenomenography research methodology.

Findings

Findings indicate that health professionals can contribute through providing information, requirement or standards for developing IoT systems or devices. They can also introduce new applications or domains for which IoT is fit.

Originality/value

This paper tries to fill the gap concerning the lack of attention to undertaking IoT-related research from health professionals’ side and highlights ways that health professionals can contribute IoT body of knowledge.

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.

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.

Actions for health advocacy and user empowerment by nurses of the Family Health Strategy

OBJECTIVE

To understand the actions for health advocacy and user empowerment developed by nurses of the Family Health Strategy in Brazil.

METHOD

A qualitative study carried out with nurses working in the Family Health Strategy in a city in the South of Brazil. Participants were selected by non-probabilistic, snowball sampling. Data was collected from a semi-structured interview guide, recorded, transcribed and analyzed through discursive textual analysis.

RESULTS

Fifteen (15) nurses participated in the study. Three categories emerged: user participation; health environments; health advocacy actions related to the multiprofessional team.

CONCLUSION

The closer relationship that the Family Health Strategy enables between the multiprofessional team, users and the community promotes health advocacy practices, while user empowerment favors autonomy in health care, encouraging a healthier life and enabling them to intervene in the health decisions of the local community.

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.

Caring for patients with spinal metastasis during an MRI examination

INTRODUCTION

Magnetic resonance imaging (MRI) is without question the best tool used for diagnosing and evaluating spinal metastasis. An MRI examination is known to be of great value for the treatment planning and survival of these patients. Radiographers have an important role in how the quality of care is experienced by the patients during an MRI examination. The purpose of the study was to describe the radiographers' perceptions of caring for patients with spinal metastasis during an examination with MRI.

METHODS

Phenomenography was used to analyze the data in this study. Ten radiographers, one male and nine females were interviewed about their perception of caring for patients with spinal metastasis during an MRI examination.

RESULTS

The findings showed that the radiographers' caring perspective influenced their approach towards what they consider to be essential in the care of patients with spinal metastasis. This can impact the extent of the adjustment to the care needs of the patients. Furthermore, the findings showed that there was a strong connection between the radiographers' care approach and preparedness to personalize the care.

CONCLUSION

This study shows that it is important to be flexible when providing care for the patients. A person-centered care is achieved when the caring perspective is based on the patient's view and adjustments are made in agreement with the patient.

"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.

Exploring Nursing Students' Experiences of Learning Using Phenomenography: A Literature Review

BACKGROUND

The purpose of this extensive international and national literature review was to explore how phenomenography identifies nursing students' experiences of learning within preregistration (or prelicensure) nursing education.

METHOD

Data were collected utilizing a comprehensive search of electronic databases. Full text, peer-reviewed, and scholarly articles published in English using the search terms phenomengraph*, nurs*, student, education, and learning were reviewed.

RESULTS

Two discreet themes emerged exploring students' experiences of learning within preregistration nursing education: (a) Phenomenography was a beneficial method to expose variation in students' understandings of a challenging concept or topic and (b) phenomenography was beneficial to evaluate teaching methods in attempt to improve student learning of challenging and complex concepts.

CONCLUSION

On the basis of these findings, future research utilizing phenomenography within nursing education has potential to uncover variation in students' understandings of mental health, with future consideration of implications to nursing curriculum design and development. [J Nurs Educ. 2017;56(10):591-598.].

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.

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.

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.

Legislating for advocacy: The case of whistleblowing

BACKGROUND

The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway.

OBJECTIVE

This paper traces the development of legislation for advocacy.

CONCLUSION

The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.

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.