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.
INTRODUCTIONPatient advocacy can be considered as a vital part of the registered nurses (RNs) profession. The RN advocates for the patients when she/he speaks or acts on behalf of the patients, support and protects the patients when they themselves cannot. According to Bu and Jezewski´s1 theory (2007) patient advocacy consists of three core attributes; safeguarding the patients autonomy, acting on behalf of patients and championing social justice in provision of health care. Factors on an individual and an organisational level can influence patient advocacy. Individual factors described in the literature are the RNs nursing competence, educational level and her/ his personality.AIMSThe aims of the study was to describe registered nurses (RNs) attitudes toward patient advocacy and to explore individual factors influencing attitudes toward patient advocacy in the context of community care of older patients.METHODSThe cross sectional study was carried out in 16 communities in a region of Sweden, between March and September in 2009. Mailed questionnaires were used to collect data and a total of 226 RNs participated in the study (rr=52 %). Besides demographics, the questionnaire consisted of the instruments the APAS2 (to measure RNs attitudes towards patient advocacy), the AssCe3 (to measure the RNs self assessed nursing competence) and the SIMP4 (to measure personality traits). Descriptive statistics and multiple regression analysis were used to analyze data.RESULTSThe RNs showed positive attitudes towards patient advocacy. Nursing competence proved to be an influencing factor to attitudes towards patient in the regression model. The model explained 18.4 % of the variance in attitudes toward patient advocacy.CONCLUSIONThe results from this study can contribute to the available knowledge about patient advocacy since new insights about influencing factors have been added. The vital results from this study are that RNs in a community context showed a positive attitude towards patient advocacy and that attitudes towards patient advocacy were influenced by the RNs nursing competence but not by their nursing experience, educational level or personality traits. The results can contribute to the knowledge about patient advocacy but further research regarding patient advocacy and influencing factors is needed.REFERENCES1. Bu X. & Jezewski MA. Developing a mid-range theory of patient advocacy through concept analysis. J Adv Nur 2007; 57(1): 101-110.2. Bu X. & Wu Y.B. Development and Psychometric Evaluation of the Instrument: Attitude Toward Patient Advocacy. Res Nurs Health 2008; 31(1): 63- 75.3. Löfmark A. & Thorell-Ekstrand I. An assessment form for clinical nursing education: a Delphi study. J Adv Nurs 2004; 48(3): 291-298.4. Woods S.A. & Hampson S.E. Measuring the Big Five with Single Items using a Bipolar Response Scale. Eur J Pers. 2005; 19: 373-390.
Rationale, aims and objectives: Patient advocacy can be defined as a process for maintaining and monitoring patients’ rights, values and best interests. To measure attitudes toward patient advocacy, Bu and Wu (2008) developed the Attitudes toward Patient Advocacy Scale (APAS), which required further testing and refining in different contexts. This two-phased study aimed to: (1) translate and cross-culturally validate the APAS section for microsocial patient advocacy (AMIA) in accordance with the Swedish context and (2) test the instrument’s psychometric properties in the community care of older patients.
Methods and results: The first phase consisted of back-translation and cultural validation of the APAS-AMIA in accordance with the Swedish context and resulted in a 39-item Swedish version of the APAS-AMIA. In the second phase, data were collected using the 39-item APAS-AMIA in 2009 from a sample of 230 registered nurses and nurse managers covering 16 communities. Subsequently, psychometric testing was conducted with exploratory factor analysis and reliability analysis in a final sample of 201 RNs. The exploratory factor analysis revealed a 4-factor structure, explaining 52.1% of the total scale variance in a 33-item instrument called the APAS-AMIA/SE. The Cronbach’s alpha for the APAS-AMIA/SE was 0.92 and varied between 0.82 and 0.88 for the factors.
Conclusion: When the APAS-AMIA/SE semantic and conceptual equivalence to the APAS-AMIA, its distinct factor structure, internal consistency values and theoretical attachment are all added together, the conclusion is that the APAS-AMIA/SE is an acceptably reliable and valid instrument.
Aim To describe and compare registered nurses’ (RNs) and nurse managers’ (NMs) attitudes towards patient advocacy in the community care of older patients.
Background RNs may act as patients’ advocates in the care of older patients. NMs should support patient advocacy in order to make the best care available to patients.
Method A modified Attitudes towards Patient Advocacy Scale was used to collect data from 207 RNs and 23 NMs in the Swedish community care of older patients. The response rate was 52%. Descriptive and inferential statistics were used.
Results Both RNs and NMs showed positive attitudes towards patient advocacy. They were more positive towards patient advocacy for patients unable to help themselves than for competent patients.
Conclusions This study showed that RNs and NMs did not differ in their attitudes towards patient advocacy. This result is consistent with the idea of giving the neediest and vulnerable patients greater care.
Implications for Nursing Management It is important for NMs to clarify their own and RNs attitudes towards patient advocacy as disparities may affect cooperation between the groups. Any effects on cooperation may, by extension, affect the quality of care.
Aim: The aim of this study was to describe and explore individual and organisational factors potentially influencing registered nurses' (RNs) attitudes towards patient advocacy. Methods and Sample: In a quantitative cross-sectional study, data were collected from 226 RNs in community health care of elders. A questionnaire was used to measure a number of factors including attitudes towards patient advocacy, nursing competence, personality traits, individual preferences regarding the quality of health care and working climate. A multiple regression analysis was performed. Results: The results showed that individual factors of nursing competence and individual preferences of the quality of health care, as well as organisational factors of the working climate, explained 26.2% of the variance in the RNs' attitudes towards patient advocacy. Conclusions: Although the mentioned individual factors may be intertwined, the conclusion is that both individual and organisational factors influenced RNs' attitudes towards patient advocacy. The results do not verify that nursing experience, workplace experience, educational level or personality traits influence the RNs' attitudes towards patient advocacy. The proportion of explained variance indicates that additional factors also influence attitudes towards patient advocacy, and more research is needed to shed further light on these factors.
In conjunction with the introduction of the Bologna process in Sweden, specialist nursing education programmes were moved up to the second cycle of higher education with the opportunity to take a one-year master's degree, which also meant that students would undertake a degree project carrying 15 ECTS. Thepurpose of this study was to examine the introduction of postgraduate degree projects on the second-cyclelevel into Swedish specialist nursing programmes in accordance with the Bologna process. Five universities were involved and the study design took the form of action research.
Problem formulation, planning, evaluation and follow-up with reflection led to new actions over a period of 2 1/2 years. Through a review oflocal curriculum documents, the implementation of a postgraduate degree project was monitored and thesereviews, together with field notes, were analysed by means of constant comparative analysis. The results revealed a variety of tensions that arose when postgraduate degree projects were introduced, taking the form of differing views on the relationship between research, clinical development, specific professional objectives and academic objectives. These tensions were reflected in six areas of change. In summary, it can be noted that implementation of the postgraduate degree projects highlighted tensions related to basic views of learning.
Transportation with road ambulances is increasing because of a concentration of hospitals to larger units, with high quality in the acute care of the patients. The concentration implies longer distances to receiving units, which increases the transportation time. The purpose of the present study was to investigate the time difference in ambulance transportation with high speed emergency driving, compared to non-emergency driving in normal traffic pace. Data was collected from 30 emergency high speed ambulance transportations in urban and rural areas. These transportations were then repeated experimentally with an ambulance driving at normal traffic pace. The average speed and duration for the emergency transportations were shorter than for the experimental driving, both in urban and rural areas. The mean time saved was 2.9 min (urban areas) and 8.9 min (rural areas). Regardless of the patient's clinical status or need of care the emergency transportations were carried out in higher speed than the experimental driving. However, patients with life threatening conditions were not included in this study. Procedures and methods should be developed to identify the patients for which fast transportation has clinical relevance to the outcomes.