Nursing and advocacy in health: An integrative review

Nurses' Advocacy in Intensive Care: What Insights Can Nurses' Experiences During the Pandemic Reveal?

Patient advocacy must be understood as an ethical component of nursing practice that involves respecting and defending patients' rights and autonomy. During the COVID-19 pandemic, the vulnerability of patients in intensive care units (ICUs) increased requiring that nurses advocate for those patients more than ever in a context in which changes in daily nursing practices of care imposed by the pandemic deeply impacted nurses' advocacy. In this study, we examined ICU nurses' patient advocacy during the pandemic, using feminist ethics as a theoretical lens. Twenty-five ICU nurses from Brazil participated in individual interviews. Our findings reflect that advocacy is a moral component of nursing identity. This moral identity represents the identity of nurses as a profession as it represents their values and responsibilities which are social in nature. Although the pandemic challenged nurses' advocacy practices these professionals had an important role to give voice to patients and to preserve their autonomy and dignity, strengthening patient-centered care.

Nurses' ethical responsibilities: Whistleblowing and advocacy in patient safety

BACKGROUND

In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives.

AIM

This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety.

RESEARCH DESIGN

A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale.

PARTICIPANTS AND RESEARCH CONTEXT

The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles.

RESULTS

Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making.

CONCLUSION

The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector.

Political action in nursing and medical codes of ethics

Political action has a long history in the health workforce. There are multiple historical examples, from civil disobedience to marches and even sabotage that can be attributed to health workers. Such actions remain a feature of the healthcare community to this day; their status with professional and regulatory bodies is far less clear, however. This has created uncertainty for those undertaking such action, particularly those who are engaged in what could be termed 'contentious' forms of action. This study explored how advocacy and activism were presented in nursing and medical codes of ethics, comparing disciplinary and temporo-spatial differences to understand how such action may be promoted or constrained by codes. The data for this study comes from 217 codes of ethics. Because of the size of the corpus and to facilitate analysis, natural language processing was utilised, which allowed for an automated exploration of the data and for comparisons to be drawn between groups. This was complemented by a manual search and contextualisation of the data. While there were noticeable differences between medical and nursing codes, overall, advocacy, activism and even politics were rarely discussed explicitly in most codes. When such action was spoken about, this was often vague and imprecise with codes speaking of 'political action' and 'advocacy' in general terms. While some codes were far more forthright in what they meant about advocacy or broader political action (i.e., Nursing codes in Denmark, Norway, Canada) more forceful language that spoke in specific terms or in terms of oppositional or specific actions (e.g., civil disobedience or marches) was almost completely avoided. These results are discussed in relation to the broader literature on codes and the normative questions they raise, namely whether such action should be included in codes of ethics at all.

A Qualitative Analysis of the Functions of Primary Care Nurses in COVID-19 Vaccination

AIM

To describe vaccination roles of primary care nurses during the COVID-19 pandemic in Canada.

DESIGN

This analysis was part of a larger mixed-methods case study.

METHODS

We conducted semi-structured qualitative interviews from May 2022 to January 2023 with primary care nurses across four provinces: British Columbia, Ontario, Newfoundland and Labrador, and Nova Scotia. We asked participants to describe their roles during various stages of the pandemic, facilitators and challenges encountered and possible roles that nurses could have played. We used thematic analysis and analysed codes relevant to vaccination.

RESULTS

We interviewed a total of 76 nurses and identified four key functions of primary care nurses' roles in COVID-19 vaccination: (1) education, (2) vaccine administration, (3) outreach and (4) advocacy. Themes outlined nurses' roles with respect to patient education, addressing vaccine hesitancy, partaking in vaccination roles outside of regular primary care practice and supporting accessibility in COVID-19 vaccination. Specific tasks varied by nursing professions.

CONCLUSION

Primary care nurses fostered trust through existing patient-provider relationships to enhance roles and activities related to education, outreach and advocacy in COVID-19 vaccination. Some COVID-19 vaccine-related roles were more easily integrated into primary care, whereas others competed with routine primary care roles.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Findings highlight the vital contributions of primary care nurses towards COVID-19 vaccination efforts in Canada. Leveraging nursing expertise can enhance future pandemic response efforts and improve patient care by addressing barriers to vaccination and promoting equitable access to vaccination services.

IMPACT

This study addresses a knowledge gap by describing the vaccination-related roles of primary care nurses during the pandemic. Findings illustrate that nurses demonstrated adaptability through their engagement in vaccine education, administration, outreach and advocacy. This research informs resource allocation, policy development and workforce planning for future vaccination efforts during a pandemic response.

REPORTING METHOD

The authors have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines included in the Empirical Research Qualitative reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides insight into the pivotal roles of primary care nurses during the COVID-19 vaccination efforts in Canada, highlighting their diverse contributions towards education, vaccine administration, outreach and advocacy. Offers implications for future pandemic planning by informing resource allocation, policy development and workforce planning for vaccination efforts.

Essential Nursing Actions to Reduce Inequities for Black Women in the Perinatal Period

Perinatal nurses play a critical role in the care of, advocacy for, and research with Black women in the perinatal period. Despite awareness of inequities in the perinatal health care system that stem from racism in the United States, many nurses report feeling detached from the crisis. In this critical commentary, we provide a five-step nursing action guide to address this health disparity that is aligned with the Future of Nursing report and the American Nurses Association Code of Ethics. We recommend nursing activities in each step: understand drivers of health inequities among Black women, reflect on implicit bias, use respectful care frameworks with Black women, conduct ethical research, and advocate for change. The article includes a sharable and printable action sheet that can be used in the work environment to remind nurses of their roles in enacting change.

Analysis of the health advocacy concept from the perspective of the evolutionary method

OBJECTIVE

To analyze the concept of Health Advocacy from the methodological framework of the Evolutionary Model.

METHOD

The concept of interest was evaluated from the perspective of published studies identified in the databases: Web of Science, CINAHL, EMBASE, SCOPUS, MEDLINE and articles of interest. The attributes were determined from 19 scientific productions. Data were analyzed using thematic analysis, proposed by Bardin.

RESULTS

The following operational definition was obtained: Health Advocacy is an intentional action, implemented jointly and in favor of individuals and communities, especially for those who suffer from health inequalities, with the aim of preserving and improving health, well-being and empowerment for health promotion.

FINAL CONSIDERATIONS

Thus, a broader concept of Health Advocacy was abstracted, from the micro to the macro, which contemplates the development of the patient's autonomy; includes individuals and groups in care plans and involves them in political activities as possibilities to provide assistance and correct health inequalities.

Moral distress and patients who forego care due to cost

BACKGROUND

In the US, many patients forgo recommended care due to cost. The ANA Code of Ethics requires nurses to give care based on need. Therefore, US nurses are compelled to practice in a context which breaches their professional ethical code.

RESEARCH OBJECTIVES

This study sought to determine if nurses do care for patients who forgo treatment due to cost (PFTDC) and if so, does this result in an experience of moral distress (MD).

RESEARCH DESIGN

Semi-structured interviews were transcribed and analyzed using a qualitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT

A convenience sample of 20 nurses in practice for at least one year from a variety of health care setting participated.

ETHICAL CONSIDERATIONS

This project was approved by the Michigan State University Biomedical Institutional Review Board.

RESULTS

There were 19 female and one male nurse-participants, averaging 47 years old with an average of 10 years in practice. 18 reported caring for PFTDC. These 17 nurse-participants experienced a moderate degree of MD as a result, averaging 5.4 of 10 on the Moral Distress Thermometer. In the interviews, the following themes were identified, strategies to help PFTDC, and the broken US health care system which had the subthemes of preference for business over patient-oriented benefit, PFTDC using the emergency department, and limited support for treatment/management of PFTDC.

CONCLUSIONS

The existence of this phenomenon places the profession of nursing in the US in a position of moral compromise and threatens to corrupt the institution of nursing in the US.

Exploring the impact of the COVID-19 environment on nursing delivery of family-centred care in a paediatric hospital

AIMS AND OBJECTIVES

To understand how the pandemic environment impacted the delivery of FCC of children and families from a nursing perspective in a major tertiary paediatric hospital.

BACKGROUND

Family-centred care (FCC) is a well-established framework to promote parental involvement in every aspect of a child's hospitalization, however, rules and restrictions in place during the COVID-19 pandemic affected the ways in which Family-centred Care could be delivered in practice.

DESIGN

This is a qualitative exploratory descriptive study to elicit the perspective of paediatric nurses delivering care to children in a hospital during the COVID-19 pandemic in Victoria, Australia.

METHODS

Nurses from all subspecialties in a tertiary paediatric hospital were invited to participate in virtual focus groups to discuss their experience of delivering FCC during the COVID-19 pandemic. Focus groups were recorded and transcribed, then analysed using Framework Analysis.

RESULTS

Nineteen nurses participated across seven focus groups during June and July 2020. The four themes-Advocating with empathy, Enabling communication, Responding with flexibility, and Balancing competing considerations-and the eight subthemes that were generated, outline how nurses deliver FCC, and how these FCC actions were impacted by the COVID-19 environment and the related hospital restrictions.

CONCLUSION

This study documents the experiences, resilience and resourcefulness of paediatric nurses in Australia during the COVID-19 pandemic as well as moving Family-centred Care from a theoretical framework into a practical reality.

IMPACT

The findings from this study should inform consideration of the impacts of public health policies during infectious disease outbreaks moving forward. In addition by describing the core actions of Family-centred Care, this study has implications for educational interventions on how to translate FCC theory into practice. No public or patient contribution as this study explored nursing perceptions only.

Informed choice of pregnant women regarding noninvasive prenatal testing in Korea: a cross-sectional study

PURPOSE

This study explored the degree to which pregnant women in Korea made informed choices regarding noninvasive prenatal testing (NIPT) and investigated factors influencing whether they made informed choices.

METHODS

In total, 129 pregnant women in Korea participated in a web-based survey. Multidimensional measures of informed choice regarding NIPT and decisional conflict were used to measure participants' levels of knowledge, attitudes, deliberation, uptake, and decisional conflict related to NIPT. Additional questions were asked about participants' NIPT experiences and opinions.

RESULTS

All 129 pregnant women were recruited from an online community. Excluding those who expressed neutral attitudes toward NIPT, according to the definition of informed choice used in this study, only 91 made an informed choice (n=63, 69.2%) or an uninformed choice (n=28, 30.8%). Of the latter, 75.0% had insufficient knowledge, 39.3% made a value-inconsistent decision, and 14.3% did not deliberate sufficiently. No difference in decisional conflict was found between the two groups. A significant difference was found between the two groups in the reasons why NIPT was introduced or recommended (p=.021). Multiple logistic regression analysis showed that pregnant women who were knowledgeable (odds ratio [OR], 4.77; 95% confidence interval [CI], 2.17- 10.47) and deliberated (OR, 0.74; 95% CI, 0.57-0.98) were significantly more likely to make an informed choice.

CONCLUSION

The results of this study help healthcare providers, including nurses in maternity units, understand pregnant women's experiences of NIPT. Counseling strategies are needed to improve pregnant women's knowledge of NIPT and create an environment that promotes deliberation regarding this decision.