Protective Nursing Advocacy Scale



Journal Title

Journal ISSN

Volume Title



Nursing advocacy for patients is considered to be an important function of nursing practice. The research surrounding nursing advocacy is relatively new, with few psychometric instruments developed to measure nursing advocacy. The purpose of this study was to determine the psychometric properties of the Protective Nursing Advocacy Scale (PNAS) and provide measures to support validity.\r\n The study design was a descriptive correlational design using a randomly selected sample of 419 medical-surgical registered nurses in the State of Texas. The data were collected using a mailed survey and the mailed survey included demographic data, the PNAS, a nursing ethics instrument, the Nursing Professional Values Scale Revised (NPVSR), and an existing nursing advocacy instrument, the Attitudes toward Patient Advocacy Scale (APAS). In addition, narrative responses to three open-ended questions were analyzed for category response frequency. The resulting dataset of PNAS items was analyzed for significance of PNAS scores among the demographic groups. The PNAS items were further analyzed using an exploratory factor analysis along with other psychometric descriptions of the data.\r\n The PNAS analysis resulted in the items loading onto four theoretically connected components, subsequently referred to as subscales. The overall reliability of the PNAS demonstrated an acceptable level of reliability, as did the four subscales. No significant differences were noted between mean total PNAS scores and the majority of the demographic data. Construct validity evidence was provided by exploratory factor analysis. Convergent validity evidence was supported by correlations of the PNAS scores and the APAS and NPVSR scores. Content analysis by an expert panel demonstrated an acceptable level of validity index. Narrative responses to open-ended questions help provide support for the items from the PNAS. The six PNAS items that did not load onto components or that were not theoretically connected need revision and piloting in a future version of this instrument. \r\n Implications for nursing include using with practicing nurses to improve their advocacy skills, which may help improve patient outcomes. Additional versions of the PNAS could be written to be used in the education of nursing students and for use by patients in evaluating the nurse’s advocacy ability.\r\n



patient advocacy, nursing, instrument, advocacy