Volume 13, Issue 1 (March 2026)                   Health Spiritual Med Ethics 2026, 13(1): 37-46 | Back to browse issues page

Ethics code: IR.MUQ.REC.1399.174

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Abbasinia M, Khoramirad A, Aghaie B, Parvaresh-Masoud M, Taheri L, Dehghani H et al . Development and Psychometric Properties of the Patient Advocacy Scale in the Intensive Care Units. Health Spiritual Med Ethics 2026; 13 (1) :37-46
URL: http://jhsme.muq.ac.ir/article-1-623-en.html
Development and Psychometric Properties of the Patient Advocacy Scale in the Intensive Care Units
Mohammad Abbasinia1 , Ashraf Khoramirad2 , Bahman Aghaie1 , Mohammad Parvaresh-Masoud3 , Leila Taheri4 , Hakimeh Dehghani5 , Atye Babaii *6
1- Department of Critical Care Nursing, Faculty of Nursing, Qom University of Medical Science, Qom, Iran., Qom University of Medical Sciences
2- Department of Community Health Nursing, Faculty of Health, Qom University of Medical Sciences, Qom, Iran., Qom University of Medical Sciences
3- Department of Emergency Medicine, Faculty of Paramedical, Qom University of Medical Science, Qom, Iran., Qom University of Medical Sciences
4- Department of Pediatric Nursing, Faculty of Nursing, Qom University of Medical Sciences, Qom, Iran., Qom University of Medical Sciences
5- Department of Community Health Nursing, Faculty of Nursing, Qom University of Medical Sciences, Qom, Iran
6- Student Research Committee, Qom University of Medical Science, Qom, Iran., Qom University of Medical Sciences , a.babaii1400@gmai.com
Abstract:   (711 Views)

Background and Objectives: Patient advocacy is a critical role of nurses, yet few instruments exist to measure this essential function. This study aimed to develop and evaluate the psychometric properties of the patient advocacy scale (PAS) in the intensive care units.

Methods: The study employed a two-phase sequential exploratory mixed-methods methodology, conducted between April and September 2023 at Shahid Beheshti and Khairin Salamat Hospitals in Qom, Iran. The first stage involved item generation using the Schwartz-Barcott and Kim hybrid model, which includes theoretical, fieldwork, and final analytical phases. In the theoretical phase, the results of a previously published systematic review were used. In the fieldwork phase, a conventional qualitative content study was conducted to explore nurses’ experiences with patient advocacy, involving 21 interviews. In the second step, the psychometric properties of the final scale, including face validity, content validity, construct validity, reliability and responsiveness were assessed. The responsiveness, interpretability, and feasibility of the scale were also determined to evaluate its utility in clinical and research settings. Data were analyzed using SPSS software, version 21 for quantitative analyses and MAXQDA software, version 10 for qualitative data analysis.

Results: In the first step, an item pool with 51 items was created. In the second step, the final version of the scale was developed and its psychometric properties were evaluated. The results indicated that the PAS had satisfactory face validity, content validity, and reliability. Exploratory factor analysis (EFA) revealed that the PAS, with 27 items in four subscales (safeguarding, valuing, informing, and mediating), explained 49% of the total variance. The internal consistency of the PAS was confirmed with a cronbach’s α value of 0.862.

Conclusion: These findings suggest that the PAS is a valid and reliable tool for assessing nurses’ performance in patient advocacy. It is recommended that this instrument be further utilized and evaluated in various clinical settings and future research studies.

Keywords: Patient advocacy, Nursing, Patient rights, Psychometrics, Nursing performance
Full-Text [PDF 1103 kb]   (399 Downloads) |   |   Full-Text (HTML)  (133 Views)  
Type of Study: Original Article | Subject: General
Received: 2025/05/6 | Accepted: 2025/09/14 | Published: 2026/01/6
References
1. Boldt J. The concept of vulnerability in medical ethics and philosophy. Philos Ethics Humanit Med. 2019; 14(1):6.[DOI:10.1186/s13010-019-0075-6] [PMID]
2. Sossauer L, Schindler M, Hurst S. Vulnerability identified in clinical practice: A qualitative analysis. BMC Med Ethics. 2019; 20(1):87. [DOI:10.1186/s12910-019-0416-4] [PMID]
3. Bazmi S, Kiani M, Hashemi Nazari SS, Kakavand M, Mahmoodzade R. Assessment of patients' awareness of their rights in teaching hospitals in Iran. Med Sci Law. 2016; 56(3):178-83. [doi:10.1177/0025802415605536] [PMID]
4. Ravaghi H, Gohari MR, Adham Marellelu D, Mehrtak M, Jafari Oori M, Azari A, et al. [Assessing the inpatients awareness from patients rights and their satisfaction from observance of that rights in the general-educational hospitals of tehran university of medical sciences (Persian)]. J Health. 2016; 7(1):26-34. [Link]
5. Davoodvand S, Abbaszadeh A, Ahmadi F. Patient advocacy from the clinical nurses' viewpoint: A qualitative study. J Med Ethics Hist Med. 2016; 9:5. [PMID]
6. Nazareno J, Yoshioka E, Adia AC, Restar A, Operario D, Choy CC. From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens. Gend Work Organ. 2021; 28(4):1426-46. [DOI:10.1111/gwao.12657] [PMID]
7. Oldland E, Botti M, Hutchinson AM, Redley B. A framework of nurses’ responsibilities for quality healthcare - Exploration of content validity. Collegian. 2020; 27(2):150-63. [DOI:10.1016/j.colegn.2019.07.007]
8. Abbasinia M, Ahmadi F, Kazemnejad A. Patient advocacy in nursing: A concept analysis. Nurs Ethics. 2020; 27(1):141-51. [DOI:10.1177/0969733019832950] [PMID]
9. Bastani P, Mohammadpour M, Bahmaei J, Ravangard R, Mehralian G. Hospital management by health services management graduates: the change paradigm in Iran. Heliyon. 2021; 7(11):e08414. [DOI:10.1016/j.heliyon.2021.e08414] [PMID]
10. Dixon J. Improving the quality of care in health systems: Towards better strategies. Isr J Health Policy Res. 2021; 10(1):15. [DOI:10.1186/s13584-021-00448-y] [PMID]
11. Lenaerts G, Bekkering GE, Goossens M, De Coninck L, Delvaux N, Cordyn S, et al. Tools to assess the trustworthiness of evidence-based point-of-care information for health care professionals: Systematic review. J Med Internet Res. 2020; 22(1):e15415. [doi:10.2196/15415] [PMID]
12. Nsiah C, Siakwa M, Ninnoni JPK. Registered nurses' description of patient advocacy in the clinical setting. Nurs Open. 2019; 6(3):1124-32. [DOI:10.1002/nop2.307] [PMID]
13. Tíscar-González V, Gea-Sánchez M, Blanco-Blanco J, Moreno-Casbas MT, Peter E. The advocacy role of nurses in cardiopulmonary resuscitation. Nurs Ethics. 2020; 27(2):333-47. [DOI:10.1177/0969733019843634] [PMID]
14. Chen Q, Huang C, Castro AR, Tang S. Instruments for measuring nursing research competence: A protocol for a scoping review. BMJ Open. 2021; 11(2):e042325. [DOI:10.1136/bmjopen-2020-042325] [PMID]
15. Bu X, Wu YW. Development and psychometric evaluation of the instrument: Attitude toward patient advocacy. Res Nurs Health. 2008; 31(1):63-75. [DOI:10.1002/nur.20233] [PMID]
16. Hanks RG. Development and testing of an instrument to measure protective nursing advocacy. Nurs Ethics. 2010; 17(2):255-67. [DOI:10.1177/0969733009352070] [PMID]
17. Naderimagham S, Niknami S, Abolhassani F, Hajizadeh E, Montazeri A. Development and psychometric properties of a new social support scale for self-care in middle-aged patients with type II diabetes (S4-MAD). BMC Public Health. 2012; 12:1035. [DOI:10.1186/1471-2458-12-1035] [PMID]
18. Garvey G, Beesley VL, Janda M, Jacka C, Green AC, O'Rourke P, et al. The development of a supportive care needs assessment tool for Indigenous people with cancer. BMC Cancer. 2012; 12:300. [doi:10.1186/1471-2407-12-300] [PMID]
19. McEwen M, Wills EM. Theoretical basis for nursing. 3th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2011. [Link]
20. Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022; 292:114523. [DOI:10.1016/j.socscimed.2021.114523] [PMID]
21. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2):105-12. [DOI:10.1016/j.nedt.2003.10.001] [PMID]
22. Ebadi A, Zarshenas L, Rakhshan M, Zareiyan A, Sharifnia SH, Mojahedi M. [Principles of Scale Development in Health Science (Persian)]. Tehran: Jame-e-Negar; 2017. [Link]
23. Gray JR, Grove SK. Burns and grove’s the practice of nursing research - E-book: Appraisal, synthesis, and generation of evidence. 9th ed. Chin: Elsevier Health Sciences; 2020. [Link]
24. Tappen RM. Advanced nursing research: From theory to practice. Massachusetts: Jones & Bartlett Learning; 2022. [Link]
25. Balthazar CH, Vendrely AM. Rehabilitation research - E-Book: Principles and applications. 6th ed. India: Elsevier Health Sciences; 2021. [Link]
26. Lim CR, Harris K, Dawson J, Beard DJ, Fitzpatrick R, Price AJ. Floor and ceiling effects in the OHS: An analysis of the NHS PROMs data set. BMJ Open. 2015; 5(7):e007765. [10.1136/bmjopen-2014-007765] [PMID]
27. Bouwmans C, De Jong K, Timman R, Zijlstra-Vlasveld M, Van der Feltz-Cornelis C, et al. Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P). BMC Health Serv Res. 2013; 13:217. [10.1186/1472-6963-13-217] [PMID]
28. Dong Y, Peng CY. Principled missing data methods for researchers. Springerplus. 2013; 2(1):222. [DOI:10.1186/2193-1801-2-222] [PMID]
29. Sharifi T, Shamsi Gooshki E, Mosadeghrad AM, Jaafaripooyan E. Practicing patients' rights in Iran: A review of evidence. J Med Ethics Hist Med. 2021; 14:28. [DOI:10.18502/jmehm.v14i28.8284] [PMID]
30. Ibrahim SA, Hassan MA, Hamouda SI, Abd Allah NM. Effect of patients' rights training sessions for nurses on perceptions of nurses and patients. Nurs Ethics. 2017; 24(7):856-67. [doi:10.1177/0969733015625365] [PMID]
31. Dabbagh A, Akbari ME, Fathi M. [Medical errors in the health system (Persian)]. Ann Mil Health Sci Res. 2006; 4(3):957-66. [Link]
32. Baldwin MA. Patient advocacy: A concept analysis. Nurs Stand. 2003; 17(21):33-9. [DOI:10.7748/ns2003.02.17.21.33.c3338] [PMID]
33. Negarandeh R, Oskouie F, Ahmadi F, Nikravesh M. The meaning of patient advocacy for Iranian nurses. Nurs Ethics. 2008; 15(4):457-67. [DOI:10.1177/0969733008090517] [PMID]
34. Mortell M, Abdullah KL, Ahmad C, Al Mutair AFM. The pyramid of patient advocacy: A practical model among muslim nurses. Malays J Nurs. 2018; 9(3):26-32. [Link]
35. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. New York: Oxford University Press; 2001. [Link]
36. Sundqvist AS, Holmefur M, Nilsson U, Anderzén-Carlsson A. Perioperative patient advocacy: An integrative review. J Perianesth Nurs. 2016; 31(5):422-33. [DOI:10.1016/j.jopan.2014.12.001] [PMID]
37. Choi PP. Patient advocacy: the role of the nurse. Nurs Stand. 2015; 29(41):52-8. [DOI:10.7748/ns.29.41.52.e9772] [PMID]
38. Negarandeh R, Dehghan Nayeri N. Patient advocacy practice among Iranian nurses. Indian J Med Ethics. 2012; 9(3):190-5. [10.20529/ijme.2012.063] [PMID]
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2026 CC BY-NC 4.0 | Health, Spirituality and Medical Ethics

Designed & Developed by : Yektaweb