Perceived interpersonal and institutional challenges to patient advocacy in clinical nursing practice: a qualitative study from Ghana / Interpersonelle und institutionelle Herausforderungen für die Rolle als Patientenfürsprecher/-in aus Sicht der Pflege: eine qualitative Studie aus Ghana

Abstract Background Nurses often speak on patients’ behalf and safeguard their safety through their advocacy role. However, some challenges like the negative attitude of team members and lack of institutional support often hamper this role. These challenges have not been well studied in the Ghanaian context. Aim This study explores the perceived environmental challenges to patient advocacy among nurses in Ghana. Setting The study was conducted at a regional hospital in Ghana. Participants Participants were nurses or midwives working in the hospital. Methods A qualitative exploratory descriptive design was employed in the study of 15 purposively sampled participants. Participants were interviewed individually and data were analysed using content analysis. Findings The study revealed interpersonal challenges and institutional challenges to patient advocacy, such as hierarchical nurse–doctor relationships and ineffective multidisciplinary team, time constraints and lack of institutional support. Nurses often failed to advocate because they did not want to risk conflict with doctors. Limited interprofessional interaction, suspicion and resentment in the multidisciplinary team negatively affected nurses’ role as patient advocates. Inadequate curricular support for patient advocacy and lack of support for training programmes or to undertake further studies were the additional challenges. Conclusion Patient advocacy could be a stressful role for nurses; thus, efforts to strengthen teamwork and increase nurse involvement in hospital decision-making are required. Implications for nursing and health policy The findings could influence hospital management policies to enhance stronger interprofessional collaboration, increase opportunities for professional advancement for nurses and nurses’ inclusion in decision-making.