Patient advocacy: Barriers and facilitators

Background: During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses. Method: This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method. Results: Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role. Conclusion: Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in this study. It is concluded that advocacy is contextually complex, and is a controversial and risky component of the nursing practice. Further research is needed to determine the possibility of a correlation between identified barriers/ facilitators and the use of advocacy. © 2006Negarandeh et al; licensee BioMed Central Ltd

Expert nurses’ use of implicit memory in the care of patients with Alzheimer's disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73899/1/j.1365-2648.2006.03864.x.pd

Nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards: a qualitative study

Background Frail elderly people admitted to hospital often receive help from relatives in managing their daily lives. These relatives are likely to continue to feel responsible after admission, and to hold valuable knowledge, which may contribute to decision-making related to care and treatment. Objective To illuminate nurses’ experience of collaboration with relatives of frail elderly patients in acute hospital wards, and of the barriers and promoters for collaboration. Design and setting The design was descriptive. Three acute units in a large Danish university hospital participated. Participants Six registered nurses and two auxiliary nurses in charge of discharge planning for the patients were included. Method Open interviews using an interview guide. Manifest and latent content analysis was applied. Result The main theme Encountering relatives—to be caught between ideals and practice reflected the nurses’ two sets of conflicting attitudes towards collaboration with relatives, one in accordance with professional nursing values, the other reflecting the values of every day practice. The dual attitudes were reflected in two themes The coincidental encounter—the collaboration and Relatives—a demanding resource, which appeared in the text along with a number of sub-themes. Ideally, collaboration was considered important and described as a planned process, but in practice encounters with relatives were coincidental. Relatives were ideally considered a resource but also experienced as demanding, and nurses sometimes even avoided them. The nurses seemed unaware of the conflict of values, and their response pattern of escape-avoidance and labelling of relatives as difficult may be an indication of counter transference as a reaction to moral conflict. Macro level factors, such as organisational and societal values, and micro level factors, such as organisation of care, nurse's competence and communication skills, seemingly governed nurses’ collaboration with relatives. Conclusion Although the nurses could be seen as mere victims of conflicting values, there appeared to be potential for improving collaboration practice within the restrictions of macro level factors by interventions at the micro level

Professional care providers in dementia care in eight European countries: their training and involvement in early dementia stage and in home care

Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the Right Time Place Care-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor's level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor's degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with