患者维权：障碍与促进因素
Patient advocacy: barriers and facilitators.
作者信息
Negarandeh Reza, Oskouie Fatemeh, Ahmadi Fazlollah, Nikravesh Mansoure, Hallberg Ingalill Rahm
机构信息
Faculty of Nursing and Midwifery, Zanjan University of Medical Sciences, Parvin Etesami St,, Zanjan, Iran.
出版信息
BMC Nurs. 2006 Mar 1;5:3. doi: 10.1186/1472-6955-5-3.
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.
背景
在最近二十年里，倡导一直是护理行业备受争议的话题。尽管倡导对护士而言具有关键作用，但其在实践中的范围往往有限。世界各地虽已开展了各类研究，但患者倡导中的障碍和促进因素尚未完全明确。本文呈现了一项探索影响伊朗护士倡导角色的障碍和促进因素的研究结果。
方法
本研究采用扎根理论方法。参与者为24名在伊朗德黑兰一家大型大学医院工作的伊朗注册护士。采用半结构式访谈收集数据。所有访谈均逐字转录，并同时根据施特劳斯和科尔宾的方法进行持续比较分析。
结果
通过数据分析，出现了几个主要主题来描述阻碍或促进患者倡导的因素。本研究中的护士将无力感、缺乏支持、法律、道德规范和动机、沟通受限、医生主导、倡导风险、对同行的忠诚以及与患者和家属互动的时间不足视为倡导的障碍。至于促进护士充当患者倡导者的因素，发现护患关系的性质、认识患者需求、护士的责任、作为同事的医生以及护士的知识和技能可能对承担倡导角色有影响。
结论
参与者认为，在此背景下，由于上述障碍，护士难以承担倡导角色。因此，他们在任何涉及患者需求以及障碍和促进因素状况的情况下做出决策并充当患者的倡导者。在大多数情况下，他们无法达到最佳水平；相反，他们只接受力所能及之事，在本研究中我们称之为“有限倡导”。得出的结论是，倡导在背景上很复杂，是护理实践中一个有争议且有风险的组成部分。需要进一步研究以确定已识别的障碍/促进因素与倡导使用之间存在关联的可能性。
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