ABSTRACT
Patient advocacy plays a critical role in promoting patient
safety and quality care. Yet, there is little or no data documenting the practice
of patient advocacy among nurses in Ghana. This study explored and provided an
in-depth description of experiences of registered nurses in carrying out their
role of patient advocacy within the Ghanaian context at the Cape Coast Metro
Hospital (CCMH). A qualitative approach with descriptive study design was used
to meet the set objectives. The study was guided by Peplau’s interpersonal
relations theory. Purposive sampling technique was used to select twenty-five
registered nurses who were willing to participate in the study. Data were
collected from the twenty-five research participants through a semi-structured
interview. Interviews were audio taped, transcribed and analysed using
qualitative content analysis. Key findings based on this study revealed that
the nurses had adequate understanding of the meaning of patient advocacy and
were willing to advocate for their patients. Yet, advocating for the patients
within the clinical setting was practically difficult owing to several existing
barriers. These barriers included the health institution, physicians, patients,
anticipated negative outcome of advocacy, fear of loss of job, limited
communication and poor inter-personal relationships. Nurses who overcame the
existing barriers succeeded in advocating for the patients, enjoyed positive
physical, emotional, psychological and professional experiences as well as
positive effects on the health institution. The contrary, however, occurred
when the advocacy activities became unsuccessful. Based on study findings,
recommendations were made for improved patient advocacy.
CHAPTER ONE
INTRODUCTION
Background to the Study
The key goal of every heath care facility is to ensure
patient safety and quality care. Yet, as Black (2011) ascertained, this goal
cannot be achieved effectively without nurses carrying out their advocacy role.
Advocacy has been described as speaking up on behalf of somebody who cannot
speak for him or herself (Amidei, 2010).
Similarly, Abbaszadeh, Borhani and Motamed-Jahromi (2013) have described
patient advocacy (PA) as standing in on behalf of the patient in terms of the
patient’s needs, interests, care and preferences. Advocating for a patient is a
process or a strategy containing a series of particular actions for protecting,
representing and safeguarding patent’s rights, best interests and values.
Patient advocacy has been an essential component of
professional nursing ethics since the time of Florence Nightingale. Attree
(2007) affirmed that patient advocacy is the essence of professional nursing
and it promotes patient safety, ensures less complication, increases
satisfaction and leads to quick recovery of the physical, mental and spiritual
health of the patient. Patient advocacy is highly practiced in Iran, Sweden,
Australia, United Kingdom, Canada, United States of America and other developed
countries across the globe due to its benefits (Black, 2011; Attree, 2007). The
role of the nurse as patient advocate is very beneficial to the patient, the
nurse, the health institution and the nation as a whole. For instance, studies
by Amidei (2010),
Black (2011) and Attree (2007) have shown increased infections, more
complications, readmissions due to relapse and unnecessary patients deaths of individual patients in facilities where nurses were not
empowered to advocate for patients.
According to Negarandeh and co-workers (Negarandeh, Oskouie,
Ahmadi, Nikravesh & Hallberg, 2006), patients admitted into healthcare
facilities are vulnerable and must be advocated for to enhance their safety and
quality care. Besides, the Patent Charter introduced by the Ghana Health
Services (GHS) mandates all practicing nurses in Ghana to advocate for their
patients in healthcare facilities (GHS, 1992). Yet, it does not clearly define
the advocacy role or provide the practicing nurse with a guide to carry out such
role. The goal of this study is therefore to explore and provide an in-depth
description of experiences of registered nurses in carrying out their role as
patients’ advocate. This study also sought to provide empirical evidence with
regard to the practice of patient advocacy by nurses in healthcare facilities.
Outcomes from the study will increase understanding of registered nurses’ (RNs)
role in patient advocacy and also promote nurses’ ability to develop an
effective approach to undertake their advocacy role to enhance positive patient
outcomes. Outcome of the study will further inform nursing education
institutions, healthcare authorities and policy makers as to the support and
policies needed to be put in place to ensure quality nursing care.
Statement of the Problem
Current emphasis on patient safety has increased the
awareness of the critical role advocacy plays in promoting safe clinical
practice. For instance, a study by Black (2011) revealed an increased in
hospital acquired infections due to the nurses’ inability to advocate for their
patients. Yet, there seems to be little documentation about how nurses experience and carry
out the advocacy role in Ghanaian health care settings.
Norman et al. (2012) seem to suggest that patients suffer
complications and in some cases die in some Ghanaian hospitals not because of
their sickness but rather as results of physicians or health professionals’
refusal to attend to the patients in time. A study by Abekah-Nkrumah (2010)
also found that most nurses in Ghana (61.8%) demonstrated better knowledge of
the patients’ charter but did not carry out their responsibility under it.
Abekah-Nkrumah (2010) noted complaints of impolite treatments of patients from
hospital staff. Another assertion of the author that gave further credence to
patient advocacy was that health workers including nurses had been
disrespectful towards patients during the course of receiving health services.
In addition, an exclusive interview a midwife at the Cape
Coast Metropolitan Hospital granted the Ghana news Agency on January 1, 2015,
disclosed that advocating for patients’ rights and ensuring patient’s safety
and quality care was a challenge for nurses at the CCMH. However, some studies
have indicated that absence of patient advocacy has negative consequences. It
limits the possibility of addressing patient’s safety issues such as, patient
education, medication errors, and the use of aseptic techniques that promotes
healing and quality care (Amidei, 2010;
Black, 2011; Attree, 2007). Further consequences of limited patient advocacy
include more complications, readmissions, unnecessary deaths, and expensive
health care cost (Amidei, 2010;
Black, 2011; Attree, 2007; Choi et al., 2014).
Furthermore there are several definitions and nurses’
experiences in patient advocacy in nursing literature. However, one may
question whether or not this role is similar to reality in the Ghanaian context.
Answer to this question can only be obtained through empirical evidence.
Abbaszadeh et al. (2013) have supported the idea that the nurse’s sense of
confidence, values, empathy, assertiveness, and persistency determines the
effectiveness in patient advocacy. There seems to be knowledge gaps with
regards to nurses’ role as patients’ advocate in Ghana.
This study would assist in identifying nurses’ understanding
of their role as patient advocate and how they experience and carry it out in
practice at the Cape Coast Metropolitan Hospital (CCMH). It is the belief of
the researcher that this study will help to identify challenges related to
nurse’s role in patient advocacy at the CCMH for an improvement in patient
safety and quality care.
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===================================================================Item Type: Ghanaian Topic | Size: 147 pages | Chapters: 1-5
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