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Perioperative patient advocacy: having the patient's best interests at heart
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-9002-6145
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patient advocacy implies taking action on someone else’s behalf, and has been described as a key element of nurses’ professional care. In the perioperative setting, it involves not only critical decision making, but also all the small things that the nurses do for the sake of the patients during their working day. Since previous research on the advocacy role of a registered nurse anesthetist (RNA) is sparse, and has not been conducted in a Swedish context, this thesis was intended to contribute to a greater understanding of advocacy in the perioperative context. The overall aim was therefore to explore the characteristics and consequences of perioperative patient advocacy (Study I), and to describe RNAs’ views of advocacy in anesthetic nursing through interviews (Study II), a questionnaire (Study III), and observations (Study IV).

The synthesis of the characteristics and consequences of perioperative patient advocacy was interpreted in this thesis as the RNAs having the patient’s best interests at heart, in that they (1) had control of the situation, (2) preserved human values, and finally (3) were emotionally affected, as the results from the four studies suggested this as the core of perioperative patient advocacy.

Perioperative patient advocacy is not always perceived as easy. In praxis, it is linked to the code of ethics outlined by the International Council of Nurses, which states that all registered nurses, regardless of their working context, shall respect human rights, promote health, prevent illness, and ensure that the individual receives accurate and sufficient information. This thesis elaborates on how this is done by describing how RNAs exert perioperative patient advocacy and how they interact in order to facilitate the best possible care for the patient. The results deepen the understanding of perioperative patient advocacy from the RNA’s perspective and contribute to a new insight in the RNA’s professional role.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , p. 89
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 71
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-55998ISBN: 978-91-7529-187-1 (print)OAI: oai:DiVA.org:oru-55998DiVA, id: diva2:1077898
Public defence
2017-05-19, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-03-01 Created: 2017-03-01 Last updated: 2017-10-18Bibliographically approved
List of papers
1. Perioperative Patient Advocacy: An Integrative Review
Open this publication in new window or tab >>Perioperative Patient Advocacy: An Integrative Review
2016 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 31, no 5, p. 422-433Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this review was to identify the characteristics and consequences of perioperative patient advocacy.

Design: An integrative review method was employed.

Methods: A database search to identify peer-reviewed articles that focused on perioperative patient advocacy was conducted in PubMed and CINAHL, followed by a manual search for additional articles. Studies were selected if they reported original empirical research findings with regard to perioperative patient advocacy. The data abstraction and synthesis were achieved with an inductive qualitative content analysis.

Finding: The analysis resulted in seven categories, two subthemes, and one main theme. The main theme, “Doing good for another human being—a balancing act between philanthropy and personal gratification,” was the core of perioperative patient advocacy.

Conclusion: Perioperative patient advocacy is part of the professional role of the perioperative nurse, and it affects the perioperative nurse emotionally. This advocacy shares similarities with descriptions of patient advocacy in general nursing.

Place, publisher, year, edition, pages
New York, USA: Elsevier, 2016
Keywords
Advocacy, integrative review, perioperative nursing
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-49820 (URN)10.1016/j.jopan.2014.12.001 (DOI)000385340100010 ()27667349 (PubMedID)2-s2.0-84962502652 (Scopus ID)
Projects
Anestesisjuksköterskan, patientens advokat
Note

Funding Agencies:

Örebro University

Research Committee at Örebro County Council, Örebro, Sweden OLL-426621

Available from: 2016-04-14 Created: 2016-04-14 Last updated: 2017-11-30Bibliographically approved
2. Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy
Open this publication in new window or tab >>Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 281-288Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Hoboken: Wiley-Blackwell, 2014
Keywords
advanced practice nursing, nurse anaesthetist, advocacy, content analysis, nursing
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-34993 (URN)10.1111/scs.12057 (DOI)000334503400009 ()23713584 (PubMedID)2-s2.0-84898893862 (Scopus ID)
Available from: 2014-05-09 Created: 2014-05-09 Last updated: 2018-06-07Bibliographically approved
3. Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions
Open this publication in new window or tab >>Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions
2018 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 1, p. 58-68Article in journal (Refereed) Published
Abstract [en]

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.

Finding: 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.

Place, publisher, year, edition, pages
WB Saunders, 2018
Keywords
nursing advocacy, Protective Nursing Advocacy Scale, psychometrics, Rasch analysis
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-57127 (URN)10.1016/j.jopan.2016.10.002 (DOI)000425223700009 ()29362048 (PubMedID)2-s2.0-85011295515 (Scopus ID)
Note

Funding Agencies:

Örebro University  

Research Committee at Region Örebro County 

Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2018-03-06Bibliographically approved
4. Registered nurse anaesthetists practicing of perioperative patient advocacy: an observational study
Open this publication in new window or tab >>Registered nurse anaesthetists practicing of perioperative patient advocacy: an observational study
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-57177 (URN)
Available from: 2017-04-24 Created: 2017-04-24 Last updated: 2017-10-18Bibliographically approved

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