Validation of the Policy Advocacy Engagement Scale for frontline healthcare professionals.

BACKGROUND: Nurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy. RESEARCH OBJECTIVE: To describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals' engagement in policy advocacy with respect to a broad range of issues, including patients' ethical rights, quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care. RESEARCH DESIGN: Cross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test-retest reliability of the Policy Advocacy Engagement Scale. Participants and context: In all, 97 nurses, 94 social workers, and 104 medical residents (N = 295) were recruited from eight acute-care hospitals in Los Angeles County. Ethical considerations: Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals. FINDINGS: Results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale's test-retest stability. Cronbach's α of .93 indicated strong internal consistency. DISCUSSION: The Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study's limitations, which include a low response rate and limited geographic scope. CONCLUSION: The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals' engagement in policy advocacy. With it, researchers can analyze variations in professionals' levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it.

Predicting Levels of Policy Advocacy Engagement Among Acute-Care Health Professionals.

This study aims to describe the factors that predict health professionals' engagement in policy advocacy. The researchers used a cross-sectional research design with a sample of 97 nurses, 94 social workers, and 104 medical residents from eight hospitals in Los Angeles. Bivariate correlations explored whether seven predictor scales were associated with health professionals' policy advocacy engagement and revealed that five of the eight factors were significantly associated with it (p < .05). The factors include patient advocacy engagement, eagerness, skills, tangible support, and organizational receptivity. Regression analysis examined whether the seven scales, when controlling for sociodemographic variables and hospital site, predicted levels of policy advocacy engagement. Results revealed that patient advocacy engagement (p < .001), eagerness (p < .001), skills (p < .01), tangible support (p < .01), perceived effectiveness (p < .05), and organizational receptivity (p < .05) all predicted health professional's policy advocacy engagement. Ethical commitment did not predict policy advocacy engagement. The model explained 36% of the variance in policy advocacy engagement. Limitations of the study and its implications for future research, practice, and policy are discussed.

Predicting Patient Advocacy Engagement: A Multiple Regression Analysis Using Data From Health Professionals in Acute-Care Hospitals.

Although literature documents the need for hospital social workers, nurses, and medical residents to engage in patient advocacy, little information exists about what predicts the extent they do so. This study aims to identify predictors of health professionals' patient advocacy engagement with respect to a broad range of patients' problems. A cross-sectional research design was employed with a sample of 94 social workers, 97 nurses, and 104 medical residents recruited from eight hospitals in Los Angeles. Bivariate correlations explored whether seven scales (Patient Advocacy Eagerness, Ethical Commitment, Skills, Tangible Support, Organizational Receptivity, Belief Other Professionals Engage, and Belief the Hospital Empowers Patients) were associated with patient advocacy engagement, measured by the validated Patient Advocacy Engagement Scale. Regression analysis examined whether these scales, when controlling for sociodemographic and setting variables, predicted patient advocacy engagement. While all seven predictor scales were significantly associated with patient advocacy engagement in correlational analyses, only Eagerness, Skills, and Belief the Hospital Empowers Patients predicted patient advocacy engagement in regression analyses. Additionally, younger professionals engaged in higher levels of patient advocacy than older professionals, and social workers engaged in greater patient advocacy than nurses. Limitations and the utility of these findings for acute-care hospitals are discussed.

Validation of the patient advocacy engagement scale for health professionals.

Codes of ethics of nursing, social work, and medicine, as well as Joint Commission Accreditation Standards, require members of these professions to engage in advocacy on behalf of patients. With use of expert panels, seven categories of patient problems in the healthcare milieu were identified: ethical rights, quality care, preventive care, culturally competent care, affordable/accessible care, mental health care, and care linked to patients' homes and communities. To measure the frequency with which healthcare professionals engage in patient advocacy related to these specific problems, the Patient Advocacy Engagement Scale (Patient-AES) scale was developed and validated through analysis of responses of 297 professionals (94 social workers, 97 nurses, and 104 medical residents) recruited from the personnel rosters of eight acute-care hospitals in Los Angeles County. Hospitals included public, not-for-profit, HMO, and church-affiliated hospitals that served general hospital populations, veterans, cancer patients, and children. Results supported the validity of both the concept and the instrument. Construct validity was supported by testing the hypothesized seven-factor solution through confirmatory factor analysis; 26 items loaded onto seven components. Pearson correlations for the overall scale and seven subscales in two administrations supported their test-retest stability. Cronbach α ranged from .55 to .94 for the seven subscales and .95 for the overall Patient-AES. The Patient-AES is, to our knowledge, the first scale that measures patient advocacy engagement by healthcare professionals in acute-care settings related to a broad range of specific patient problems. © 2014 Wiley Periodicals, Inc.

Expanding nurses' participation in ethics: an empirical examination of ethical activism and ethical assertiveness.

This research project investigated the extent to which nurses engage in two important kinds of ethical behaviours: ethical activism (where they try to make hospitals more receptive to nurses' participation in ethics deliberations) and ethical assertiveness (where they participate in ethics deliberations even when not formally invited). This research probed not only the extent to which nurses engage in these ethical behaviours but also whether this is influenced by professional, training and organizational factors. A random sample of 165 nurses from three major hospitals in Los Angeles provided the data. Regression analyses indicate that both ethical activism and ethical assertiveness are strongly influenced by nurses' perceptions of the receptivity of hospitals to their inclusion in ethics deliberations. In addition, nurses' education in ethics is a significant predictor of ethical activism. The findings have important implications for the content of nurses' ethics training as well as for expanding the boundaries of nurses' participation in ethics deliberations. The authors define ethics deliberations as specific meetings of a number of people to discuss an ethical issue, such as one regarding the care of a patient.

Ethical activism: strategies for empowering medical social workers.

Little empirical research examines the extent medical social workers try to change attitudes, norms, expectations, and protocols to create a hospital environment that encourages their participation in ethical deliberations. The researchers developed an ethical activism scale that measured the extent medical social workers engaged in such ethical activism, confirming its reliability from data obtained from a sample of 162 medical social workers in 37 hospitals in the Los Angeles basin. They tested seven hypotheses that probed the extent specific ethics-training, organizational, and demographic variables influence the extent social workers engage in ethical activism. Data strongly suggest the need to expand ethics training to include tactics of ethical activism, since many social workers do not engage in ethical activism. Data also suggest the need to target such training to social workers in hospitals that are relatively unreceptive to social workers' participation in ethical deliberations, since social workers are least likely to engage in ethical activism in such settings.