KNOWLEDGE AND PERCEPTION OF NURSE TOWARDS PATIENT ADVOCACY IN FEDERAL UNIVERSITY TEACHING HOSPITA, ENUGU

TOPIC IS SUITABLE FOR:
1-Department of Nursing Science
2-Department of Public Health
3-Department of Health Education
4-Department of Medical Laboratory Science

TOPIC: KNOWLEDGE AND PERCEPTION OF NURSE TOWARDS PATIENT ADVOCACY IN FEDERAL UNIVERSITY TEACHING HOSPITA, ENUGU

TABLE OF CONTENT
Abstract
CHAPTER ONE: INTRODUCTION
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives of the Study
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Definition of Terms
CHAPTER TWO: LITERATURE REVIEW
2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design
3.2 Area of the Study
3.3 Population of the Study
3.4 Sample and Sampling Techniques
3.5 Research Instrument
3.6 Method of Data Collection
3.7 Validity of Instrument
3.8 Reliability of Instrument
3.9 Method of Data Analysis
3.10 Ethical Consideration
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.0 Introduction
4.1 Demographic Analysis 
4.2.1 Analysis of the level of knowledge of nurses towards patient advocacy at the Federal University Teaching Hospital, Enugu
4.2.2 Analysis of the perception of nurses towards patient advocacy at the Federal University Teaching Hospital, Enugu
4.2.3 Analysis of extent to which nurses are involved in patient advocacy at the Federal University Teaching Hospital, Enugu
4.2.4 Analysis of the factors influencing nurses’ participation in patient advocacy at the Federal University Teaching Hospital, Enugu
CHAPTER FIVE: DISCUSSION OF FINDINGS
5.1 Key findings    
5.2 Implications of findings to nursing  
5.3 Limitations of the study 
5.4 Summary of the study
5.5 Conclusion    
5.6 Recommendations  
5.7 Suggestions for further studies
References
Appendix   

ABSTRACT
This study was carried out to examine the knowledge and perception of nurses towards patient advocacy at the Federal University Teaching Hospital, Enugu. The study was specifically carried out to assess the level of knowledge of nurses on patient advocacy, examine the perception of nurses towards patient advocacy, determine the level of nurses’ involvement in patient advocacy, and identify factors influencing nurses’ participation in patient advocacy at the Federal University Teaching Hospital, Enugu. The study employed a descriptive cross-sectional survey research design. The population of the study consisted of all registered nurses in Federal University Teaching Hospital, Enugu, totaling 471. A sample size of 201 nurses was determined using Taro Yamane’s formula and selected through stratified random sampling technique to ensure proportional representation across medical, surgical, paediatric, obstetric, and emergency departments. The primary instrument used for data collection was a structured questionnaire developed in a five-point Likert scale on demographic information, knowledge, perception, involvement, and factors influencing advocacy. Data obtained were analysed with the help of descriptive statistics in the form of frequencies, percentages, and means and standard deviations and presented in tables. The results showed that the nurses demonstrated a high knowledge on patient advocacy whereby 65.7% of nurses strongly agreed that nurses should speak up when the rights of patients are threatened. Nurses also had positive perceptions, with 58.7% strongly agreeing that advocacy leads to better healthcare outcomes. Involvement in advocacy was high, with 55.7% ranking highly for helping patients understand what treatment options are. Key factors which impacted participation were heavy workload (47.3% strongly agreeing) and lack of institutional support (45.8% strongly agreeing). The study therefore recommends that nursing management should implement continuous in-service training, hospital administration should provide adequate support, supervisors should foster collaborative environments, and the Nursing Services Department should establish recognition systems to motivate nurses in advocacy practices.
Keywords: Patient Advocacy, Nurses’ Knowledge, Perception, Involvement, Healthcare Quality.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background of the Study
The nursing profession has gone through a transformation from being primarily concerned with bedside care to now encompassing the multifaceted role of advocacy, ethics and policy involvement. Patient advocacy has become recognised as an important component of the professional practise of nursing and an ethical mandate to ensure that patients' rights, safety, and dignity are upheld during the health care process. According to Saleh et al. (2020), patient advocacy is an important aspect of nursing professionalism and it bridges the gap between patient vulnerability and the health care systems. Similarly, Heck et al (2022) highlighted that advocacy is not only a process that protects the patient but also ensures equality and empowerment in the clinical setting. This advocacy role is increasingly understood throughout the world as nurses are the largest group of healthcare providers and have the closest and most prolonged contact with their patients, making them able to play a useful role in identifying and expressing the needs and concerns of patients.
The global nursing advocacy discourse has been expanded to the ethical, legal, and professional arena. Kurt and Gurdogan (2022) argue that the professional autonomy allows the nurses to be advocates to provide quality and justice of care to the patients. In line with this point of view, Luca et al. (2021) described that both interpersonal and institutional levels of advocacy could be seen in which nurses deconstruct the systemic barriers and support the patient-centred care. In addition, Nesime and Belgin (2022) stressed that ethics sensitivity is not sufficient for advocacy and that preparation through education will help patients to have confidence and competency in expressing their concerns. This indicates that there is an international concern of the integration of advocacy training in nursing education so that the professionalism and ethical awareness of nursing practise can be improved.
In most health care systems, the role of nurses as advocates is indissociably tied to their understanding of the rights of patients, and their capacity to mediate the wishes of the institutional system and the ethical demands of the situation. Abdel-Fattah et al. (2022) stated that awareness of the patient rights is the foundations of effective advocacy, which will ensure that the patient will be treated in a way that is full of respect and equity. Furthermore, Hassen et al. (2022) indicated that nurses' knowledge about advocacy is important in improving the safety, dignity, and justice in healthcare settings. When properly informed and empowered, nurses are powerful agents of change who adhere to ethical principles and make sure that patient voices are heard in the decision-making process related to their care (Laari, 2024). Thus, advocacy is not just a humanitarian act but a professional duty and a profound understanding and conscience of ethics.
Aside from individual knowledge, a nurse's perception of advocacy is a factor in their willingness to take part in such roles. Alanezi (2021) states that nurses' attitudes and perceptions towards advocacy is the determining factors of the extent to which nurses intervene on behalf of patients especially when faced with hierarchical or institutional barriers. In support of this, Tadie et al (2024) noted that positive perceptions of advocacy were positively linked with involvement and proactive patient representation. Moreover, Laari and Duma (2023) indicated that its perception is affected by contextual issues such as organisational culture, leadership encouragement and access to continuous education. Given that nurses view advocacy as part of their professional identity and not as an optional activity, they are more likely to integrate it into their daily practise and positively influence the outcome of institutional care.
The significance of knowledge and perception is also portrayed in the way the nurses put into practise the concept of advocacy. Cerci et al. (2025) clarified that advocacy practise of nurses enhances the professional values such as justice, integrity, and accountability. In addition, Ahmed et al. (2025) emphasised that nurses' involvement in decision-making that relates to advocacy is one of the important factors in strengthening their professional voice in healthcare systems. According to Arowolo et al. (2023) empowerment assists in the advancement of the overall health system via promotion of nursing practise with the international standard ethically and patient-centred care. Thus, knowledge, perception, and participation in advocacy is a complex of interrelated dimensions that constitutes the quality of nursing practise in different health settings.
In the African context, the role of nurses as advocates is gaining increasing recognition as important in achieving equitable and ethical delivery of healthcare. Laari and Duma (2020) argue that even though the African nurses are practising in a system where resources are limited, their advocacy role plays a significant role in the vulnerabilities and access to better care for the patient. Likewise, Nduka et al. (2025) highlight that advocacy has begun to mirror broader developments in the reinforcement of the rights of the patient and professional accountability in Nigeria and other African nations. According to Enebeli et al (2024), the emphasis on health promotion and advocacy within rural and urban health care settings in Nigeria is the new paradigm shift in health practise toward holistic nursing practise which incorporates the ethics sensitivity as well as engagement of the community.
Nursing advocacy has gained new relevance within the Nigerian context, given the country's health system reform agenda and move towards a patient-centred approach to care. For instance, Okpala et al. (2021) and Lateef and Mhlongo (2022) have demonstrated that nurses' perceptions and experiences have a profound impact on the delivery of compassionate, ethical, and culturally responsive care. Moreover, Adeleye et al (2023) reported that there is a close relationship between the knowledge of the rights of patients and advocacy and education, exposure, and organisational culture for nurses in Nigeria. Such findings lead to the emerging need to assess the knowledge and views of nurses and their level of involvement in advocacy activities in tertiary healthcare institutions.
Focusing on the Federal University Teaching Hospital, Enugu, it becomes imperative to understand knowledge and perception of patient advocacy by nurses due to the fact that Federal University Teaching Hospital, Enugu is a major tertiary health institution that offers specialised care, training and research. According to Okpala et al. (2021), the Enugu health context mirrors the general findings of the country where the nurses play a crucial role in the provision of quality and ethical patient care. In this regard, following the opinions of researchers like Kombo et al. (2024), Abazie et al. (2021), the analysis of the knowledge and perception of nurses in patient advocacy will shed light on how professional education, institutional culture, and ethical awareness contribute to the practise of patient advocacy. This contextual understanding situates the study in a broader discourse of the role of nursing professionalism and patient centred care in the development of the healthcare landscape in Nigeria.

1.2 Statement of the Problem
Patient advocacy is a cornerstone of ethical and professional nursing practise, however, there is evidence to suggest that nurses often have varying level of knowledge and engagement in the role of advocacy especially in developing health systems. Ideally, nurses should have a thorough understanding of the rights of patients, exhibit confidence in advocating for the patient's concerns, and play an active role in any decision-making process that will ensure the welfare of the patient (Heck et al., 2022; Kurt & Gurdogan, 2022). In practise, however, studies have found inconsistencies in nurses understanding and carrying out advocacy duties. For example, Hassen et al. (2022) found that many nurses are not well knowledgeable about the principles of advocacy and thus do not intervene on the rights of the patient. Similarly, Laari (2024) and Saleh et al. (2020) explained that though nurses appreciate the involvement of advocacy in their professional activities, the extent of practical application is still low and is often limited by institutional hierarchies, ethical uncertainty and lack of adequate policy support. This disconnect between expected standards and current realities suggests there is a continuing disconnect between translating theoretical advocacy concepts into nursing practise.
In Nigeria, this is a sign of a broader problem within the healthcare system in which advocacy roles are not always integrated into clinical practise routines and supported by institutional culture. Studies by Okpala et al. (2021) and Adeleye et al. (2023) have shown that despite the fact that nurses recognise the need for advocacy, their actual participation is hindered by such issues as inadequate instruction, job pressures, and lack of empowerment at the organisational level. The ideal scenario would involve a knowledgeable nursing workforce that is also positively interested in advocacy so that the rights and safety of patients are at the forefront of care provision. However, recent findings by Tadie et al., (2024) and Laari and Duma (2023) indicate a gap on empirical understanding of the interrelationship between nurses knowledge, perception and involvement in advocacy within Nigerian tertiary healthcare context. This study, therefore, aims to fill this gap in knowledge by determining the level of knowledge, perception and factors influencing nurses' participation in patient advocacy at the Federal University Teaching Hospital, Enugu--thus providing evidence in the improvement of training, policy and practise.

1.3 Objectives of the Study
The main objective of this study is to examine the knowledge and perception of nurses towards patient advocacy at the Federal University Teaching Hospital, Enugu. The specific objectives are to:
1.Assess the level of knowledge of nurses on patient advocacy at the Federal University Teaching Hospital, Enugu.
2.Examine the perception of nurses towards patient advocacy at the Federal University Teaching Hospital, Enugu.
3.Assess the level of nurses’ involvement in patient advocacy at the Federal University Teaching Hospital, Enugu.
4.Identify factors influencing nurses’ participation in patient advocacy at the Federal University Teaching Hospital, Enugu.
OTHER PARTS OF CHAPTER ONE INCLUDE:
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Definition of Terms

CHAPTER TWO
LITERATURE REVIEW (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who have previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of patient advocacy, the concept of nurses’ knowledge of patient advocacy, nurses’ perception of patient advocacy, roles of nurses in patient advocacy, factors influencing nurses’ knowledge and perception of patient advocacy, etc. The chapter covers the following subheadings:

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
METHODOLOGY (Preview)
Research Design: The study adopted a descriptive cross-sectional survey design.
Population of the Study: The population of the study comprises all registered nurses employed in the Federal University Teaching Hospital, Enugu, comprising 471 nurses.
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 216 nurses.
Sampling Technique: The study employed a stratified random sampling technique to select the individual respondents from the various departments and units of the hospital.
Research Instrument: The study utilized a structured questionnaire titled “Knowledge and Perception of Nurses Towards Patient Advocacy” as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies, percentages, means, and standard deviations to summarize and present the demographic characteristics of the respondents and their responses.

CHAPTER FOUR:DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables. Based on the results obtained from the analysis, the following findings are made:
i. The study found that nurses have a positive perception towards patient advocacy at the Federal University Teaching Hospital, Enugu, as evidenced by the generally high level of agreement across the perception items. The findings showed that 89.0% agreed that patient advocacy improves quality healthcare outcomes, 87.0% agreed that it strengthens nurse–patient relationships, 83.6% agreed that nurses should support patients’ decisions even when they differ from doctors’ opinions, 85.0% agreed that advocacy enhances professional autonomy, and 86.5% agreed that advocacy is morally fulfilling and increases job satisfaction. However, 73.6% also agreed that patient advocacy sometimes causes conflict with other healthcare professionals, indicating that although nurses perceive advocacy positively, they recognize potential interpersonal challenges associated with the role.

ii. The study found that nurses are highly involved in patient advocacy at the Federal University Teaching Hospital, Enugu, as evidenced by the high level of agreement across all the assessed advocacy activities. Specifically, 85.5% of the respondents agreed that they regularly advocate for patients when their safety is threatened, 86.5% agreed that they assist patients in understanding medical information and treatment options, 82.1% agreed that they engage physicians when treatment plans require clarification or review, 79.6% agreed that they participate in ethical decision-making affecting patient welfare, 85.0% agreed that they support patients in expressing their care preferences, while 82.6% agreed that they actively report unsafe or unethical practices affecting patients. These findings indicate a high level of nurses’ participation in patient advocacy activities.

iii. The study found that several factors influence nurses’ participation in patient advocacy at the Federal University Teaching Hospital, Enugu. The major factors identified were heavy workload, lack of knowledge or training, fear of conflict with doctors or colleagues, insufficient institutional support, cultural or societal norms, and lack of incentives or recognition. Specifically, 83.1% agreed that heavy workload limits their ability to advocate for patients, 78.6% agreed that lack of knowledge or training affects their advocacy role, 78.1% agreed that fear of conflict prevents advocacy, and 79.6% agreed that insufficient institutional support discourages advocacy efforts. Furthermore, 69.1% agreed that cultural or societal norms affect their participation, while 74.1% agreed that lack of incentives or recognition reduces their motivation to advocate. These findings indicate that workload, professional relationships, institutional support, training, cultural factors, and motivation are important determinants of nurses’ participation in patient advocacy.

CHAPTER FIVE:DISCUSSION OF FINDINGS
This chapter covers the following outline:
5.1 Key findings
5.2 Implication of the Findings
5.3 Limitations of the Study
5.4 Summary 
5.5 Conclusion
5.6 Recommendations
5.7 Suggestions for Further Studies
References
Appendix

UPLOADED BY MIRACLE.