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Sjuksköterskor som patienters företrädare: Med huvudsakligt fokus på företrädarskap för äldre patienter i kommunal hälso- och sjukvård
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Nurses as patient advocates : With the main focus on advocacy for older patients in community healthcare (English)
Abstract [en]

The overall aim was to study nurses’ and managers’ attitudes towards micro social patient advocacy (I) and factors related to patient advocacy (II, III) with the main focus being on advocacy in the care of older patients in community health care together with psychometric testing of the instrument 'Attitudes toward Patient Advocacy Scale-Attitudes toward MIcrosocial Advocacy' (IV).

Methods: A quantiative cross-sectional study and a qualitative study were carried out. Nurses (n=207) and managers (n=23) in community health care responded to a questionnaire about patient advocacy, nursing competence, personal traits, quality of care and organisational climate (I, II, IV). Nurses' (n=18) perceptions of influencers of patient advocacy was studied in a phenomenographic study (III).

The results showed that nurses and managers reported positive attitudes to patient advocacy (I, II), especially for patients unable to speak for themselves (I). Two areas of nursing competence (Performing the nursing process, Supervision and cooperation) and a dimension of quality of care of older patients were positively associated with attitudes towards patient advocacy (II). Two organisational dimensions were, negatively (dynamism) respectively positively (playfulness), associated with attitudes towards patient advocacy. The nurses' perceptions of influencers of patient advocacy consist of three hierarchically related levels: The nurse's character traits, The nurse’s bond with the patient and The organisational conditions (III). The Swedish version of APAS-AMIA consists of 33 items in a four-factor structure (APAS-AMIA/SE): Support patients’ beliefs and decision-making, Safeguard patients' health care, Support patients to communicate their wishes and Respect patients’ wishes not to participate in decisions regarding care (IV).

Conclusions: Maintaining the continuing professional competence of nurses is important, and is ensuring the organisational prerequisites to enable nurses' advocacy for patients.

Abstract [sv]

Det övergripande syftet var att studera sjuksköterskors och chefers attityder till mikrosocialt företrädarskap för patienter (I), faktorer relaterade med företrädarskap (II, III) med huvudsakligt fokus på företrädarskap för äldre patienter inom kommunal hälso- och sjukvård samt psykometriskt testa instrumentet Attitudes toward Patient Advocacy Scale-Attitudes toward MIcrosocial Advocacy (IV).

Metod: En kvantitativ tvärsnittstudie och en kvalitativ studie genomfördes. Sjuksköterskor och chefer (n=230) i kommunal hälso-och sjukvård besvarade frågor om företrädarskap, yrkeskompetens, personlighet, vårdkvalitet och organisationsklimat (I, II, III). Sjuksköterskors (n=18) uppfattningar av vad som påverkar företrädarskap studerades i en fenomenografisk studie (III).

Resultat: Sjuksköterskor och chefer rapporterade positiva attityder till företrädarskap (I, II), framför allt för oförmögna patienter (I). Två områden av yrkeskompetens (Att utföra omvårdnadsprocessen, Arbetsledning och samarbete) liksom en dimension av kvalitet i vården av äldre var positivt associerade med attityder till företrädarskap (II). Två organisatoriska dimensioner var negativt (livfullhet) respektive positivt (lekfullhet) associerade med attityder till företrädarskap. Sjuksköterskors uppfattningar av vad som påverkar företrädarskap omfattar tre hierarkiskt relaterade nivåer: Sjuksköterskans karaktärsdrag, Sjuksköterskans förhållande till patienten och Arbetsplatsens beskaffenhet (III). Den svenska versionen av APAS-AMIA omfattar 33 påståenden i en fyrfaktorstruktur (APAS-AMIA/SE): Stödja patienternas önskemål och beslutsfattande, Värna om patienternas vård, Stödja patienterna att kommunicera sina önskemål och Respektera patienternas önskemål om att inte delta i beslut (IV).

Konklusioner: Sjuksköterskors yrkeskompetens bör upprätthållas för att de ska ha förutsättningar att företräda patienter. Det är viktigt att skapa organisatoriska förutsättningar för att sjuksköterskor ska kunna etablera en relation till patienten som underlag till företrädarskap.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2013. , p. 89
Series
Karlstad University Studies, ISSN 1403-8099 ; 2013:2
Keyword [en]
APAS-AMIA/SE, community care, instrument, patient advocacy, psychometrics, older patients, organisation, nursing competence
Keyword [sv]
företrädarskap, omvårdnad, äldre, APAS-AMIA/SE, företrädarskap, kommunal hälso-och sjukvård, organisation, psykometri, sjuksköterskans yrkeskompetens, äldre patienter
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-16127ISBN: 978-91-7063-474-1 (print)OAI: oai:DiVA.org:kau-16127DiVA, id: diva2:575734
Public defence
2013-03-01, Lagerlöfssalen 1A 305, Karlstads universitet, Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2013-02-07 Created: 2012-12-11 Last updated: 2017-12-06Bibliographically approved
List of papers
1. Swedish registered nurses’ and nurse managers’ attitudes towards patient advocacy in community care of older patients
Open this publication in new window or tab >>Swedish registered nurses’ and nurse managers’ attitudes towards patient advocacy in community care of older patients
2013 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 21, no 5, p. 753-761Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keyword
community care, nurse managers, older patients, patient advocacy
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-15281 (URN)10.1111/j.1365-2834.2012.01453.x (DOI)000321981800006 ()23409794 (PubMedID)
Available from: 2012-10-23 Created: 2012-10-23 Last updated: 2017-12-07Bibliographically approved
2. Individual and organisational factors influencing registered nurses' attitudes towards patient advocacy in Swedish community health care of elders
Open this publication in new window or tab >>Individual and organisational factors influencing registered nurses' attitudes towards patient advocacy in Swedish community health care of elders
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 486-495Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keyword
community health care, geriatric nursing, nursing comptence, patient advocacy, quality of health care
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-29345 (URN)10.1111/scs.12073 (DOI)000340288100008 ()
External cooperation:
Note

The article was published in manuscript form at the time of the thesis defense. It was then titled: Individual and organizational factors influencing nurses’ attitudes towards patient advocacy in community healthcare of older people.

Available from: 2013-10-09 Created: 2013-10-09 Last updated: 2017-12-06Bibliographically approved
3. Swedish nurses’ perceptions of influencers on patient advocacy – a phenomenographic study
Open this publication in new window or tab >>Swedish nurses’ perceptions of influencers on patient advocacy – a phenomenographic study
Show others...
2014 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 21, no 6, p. 673-683Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Sage Publications, 2014
Keyword
Nurse–patient relationship, nursing qualities, organisation, patient advocacy, phenomenography
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-29346 (URN)10.1177/0969733013515488 (DOI)000341857900006 ()24477259 (PubMedID)
Note

Ingick i Anna Josse Eklunds avhandlingen som manuskript med titeln The three levels of influencers of patient advocacy. Swedish registered nurses’ perceptions of influencers to patient advocacy- a phenomenographic study.

Available from: 2013-10-09 Created: 2013-10-09 Last updated: 2017-12-06Bibliographically approved
4. Cross-cultural validation and psychometric testing of the Swedish version of the microsocial section of the Attitudes toward Patient Advocacy Scale
Open this publication in new window or tab >>Cross-cultural validation and psychometric testing of the Swedish version of the microsocial section of the Attitudes toward Patient Advocacy Scale
2012 (English)In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 473-481Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Open Journal Systems, 2012
Keyword
Community care, exploratory factor analysis, nursing, older patients, patient advocacy, person-centered medicine, psychometric testing
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-15276 (URN)10.5750/ijpcm.v2i3.269 (DOI)
Available from: 2012-10-23 Created: 2012-10-23 Last updated: 2017-12-06Bibliographically approved

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