Awareness among nurses in Hawaii toward advocacy for benefits and rights of adult patients : A comparison of nurses' awareness between Japan and Hawaii

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  • 米国ハワイ州における「成人患者の利益・権利を守るアドボカシー」に関する看護師の意識 : 日本とハワイの看護師の意識の比較を試みて
  • ベイコク ハワイシュウ ニ オケル セイジン カンジャ ノ リエキ ケンリ オ マモル アドボカシー ニ カンスル カンゴシ ノ イシキ ニホン ト ハワイ ノ カンゴシ ノ イシキ ノ ヒカク オ ココロミテ

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Background Do patients receive medical care services based on their own decision in current clinical settings? To clarify the roles of nurses, we need to understand how they perceive human rights, particularly patients' rights, and address relevant issues; what factors may promote the practice of advocacy. While I have reported the result from my survey in Japan in nurses working at hospitals with 300 or more beds in the Kinki region and offered a conceptualization of the term "advocacy," whether the concept of advocacy can be universally applicable has not yet been studied. Objective To study the concept of nursing advocacy from the standpoint of practice nurses in the USA, where people have a high awareness of rights, in order to clarify the values and elements that compose the concept of advocacy; and to compare the result with the result obtained from the survey in Japan. It is hoped that this study will help assess whether the concept of advocacy can be universally applicable. Method A questionnaire survey was conducted in 48 nurses with five or more years of clinical experience at medical facilities in Hawaii, using the questionnaire form used for the survey in Japan. Results While nurses in Japan play a role as a coordinator between patients and doctors, nurses in Hawaii play a more active role from the patient's point of view: They offer their opinions and advice to doctors in a way to respect patients' wishes. While factors that interfere with advocacy efforts in Japan were "stressful working schedule," " dominant-subordinate doctornurse relationship" and "less democratic environment," those in Hawaii was "stressful working schedule." As for the involvement of nurses in advocating for patients' rights, significant differences were observed in rights for patients to "delegate decisions to their representative," "die with dignity," "have their living will be followed," "discontinue and/or refuse treatment," "access their own medical and nursing records," "participate in nursing and treatment planning," "decide whether or not to participate in a clinical study" and "perform a religious ceremony." As for factors affecting the elements of advocacy, "information provision (right)" was positively correlated with the learning of advocacy and "subjective participation (right)" was negatively correlated with an earned academic degree in Japan. In Hawaii, "subjective participation (right)" was negatively correlated with clinical experience. In the survey result, 90% of the respondents had learned about advocacy, indicating that a major factor to encourage nurses to engage in advocacy is whether or not they have learned about advocacy. Conclusion While the accuracy may not be very high due to the limited number of samples in the survey in Hawaii, there was more than a little difference in understanding of nurses' rights and advocacy between nurses in Hawaii and those in Japan due to different medical systems. The survey result indicates the positive attitude toward advocacy supported by laws and regulations to protect patients' rights in the USA.

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