“We are the best to stand in for patients”: a qualitative study on nurses’ advocacy characteristics in Ghana

Abstract

BackgroundPatient advocacy has been identified as a core duty of the nurse, and certain nurse characteristics influence the performance of the role. However, these characteristics have not been adequately explored in Ghana. This study aimed to explore the perspectives of nurses about the characteristics of nurses that influence their role as patient advocates.MethodsAn exploratory descriptive qualitative study was conducted among 15 nurses from a regional hospital in Ghana. Purposive sampling was used to select participants and individual in-depth interviews were conducted in English using a semi-structured interview guide. The interviews were audio-taped and transcribed. Data analysis was done concurrently employing the principles of thematic analysis. Ethical approval was obtained for the study from the Noguchi Memorial Institute of Medical Research and the Ghana Health Service Ethical Review Committee.ResultsThemes generated revealed nurse traits which enhanced the advocacy role of nurses such as being empathetic, nurturing, ethical, assertive and persistent and nurse states which hindered the performance of the role such as fatigue and frustration. However, “compassionate” emerged as an additional nurse trait from this study. Out of empathy, participants availed themselves for patients to share their problems with them. In their nurturing roles, spending more time with patients and providing personal care fostered closeness which helped in identifying patients’ problems. Helping patients navigate the health system was also found. They perceived patient advocacy as a moral responsibility and identified good communication skills and determination to help patients get their problems solved as important in patient advocacy. Some participants also described compassion-based activities such as pleading on patients’ behalf, providing material and financial assistance, facilitating care and providing emotional support in their advocacy. However, heavy workload and lack of appreciation from patients were found to hinder the performance of the advocacy role.ConclusionsWe concluded that nurse characteristics that influence patient advocacy are comparable to those identified internationally such as being empathetic, assertiveness and fatigue. Enhancing these characteristics could help nurses overcome the negative states that undermine the patient advocacy role of nurses.

Barriers to nurses using their health advocacy role in nursing practice: A Ghanaian perspective

“…A study in Ghana reported Inter-personal barriers similar to our findings, with Dadzie, Aziato and Aikins [16] noting that a lack of appreciation from clients was found to hinder the performance of their health advocacy role. Our participants reported that clients' inconsiderate behaviours and lack of appreciation for the nurses were barriers that prevent them from using their health advocacy on their behalf.…”

“…In Ghana, a study conducted on advocacy characteristics reported that nurses' state of fatigue and frustrations were hampering their ability to perform their health advocacy roles [16]. These findings were similar to those recorded earlier in the USA, where the advocacy role was reported to cause stress, fatigue and depression among nurses [17].…”

“…Professional inadequacies due to a lack of knowledge and practical experience in health advocacy have been reported as intra-personal barriers to nurses using their health advocacy role in both Ghana and the USA [1,16,31]. Professional inadequacies were also reported in the teaching field in a study by Lindqvist, Weurlander, Wernerson and Thornberg [32], where newly qualified teachers reportedly felt professionally inadequate during emotional stress.…”

“…This was confirmed by participants who reported "being treated as children at work" and prevented them from standing up for their and their clients' rights. The culture of never challenging authority has been reported to make the practice of advocacy role very frustrating, leading to feelings of powerlessness and a lack of enthusiasm to intervene on behalf of clients [11,13,16].…”

Health advocacy and primary health care: evidence for nursing

“…The work burden and lack of recognition by patients impair their performance of the advocacy role though. The patients' ingratitude may lead to these professionals' dissatisfaction (29) .…”