Swedish nurses' perceptions of influencers on patient advocacy: a phenomenographic study.
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.


METHODS
Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method.


METHODS
Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University.


RESULTS
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.


CONCLUSIONS
The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels.


CONCLUSIONS
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.
Karlstad University, Sweden anna.eklund@kau.se.
Anna
A
Josse-Eklund
Karlskoga Hospital, Sweden.
Marie
M
Jossebo
Karlstad University, Sweden; Värmland County Council, Sweden.
Ann-Kristin
AK
Sandin-Bojö
Karlstad University, Sweden; Hedmark University College, Norway.
Bodil
B
Wilde-Larsson
Karlstad University, Sweden; Gjøvik University College, Norway.
Kerstin
K
Petzäll
D000328:Adult; D002983:Clinical Competence; D004645:Empathy / Q000941:ethics*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000941:ethics; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009014:Morals; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D015279:Organizational Culture; D010344:Patient Advocacy / Q000523:psychology*; D017009:Professional Autonomy; D036301:Qualitative Research; D013548:Sweden
Nurse–patient relationship; nursing qualities; organisation; patient advocacy; phenomenography