Date of Award

Spring 5-16-2015

Degree Type


Degree Name

PhD Nursing




Bonnie A. Sturm

Committee Member

Mary Patricia Wall

Committee Member

Judith Lothian

Committee Member

Violet Malinski


Patient advocacy, power, fetal monitoring, research utilization, Rogerian science


A problem identified in nursing practice was the routine use of continuous fetal monitoring (CEFM) with low risk laboring women. CEFM is associated with worsened outcomes for the low risk laboring woman with no benefit to the newborn. In addition, this routine practice does not allow most laboring women the right to make an informed choice regarding treatment options. Nursing includes the role of patient advocacy. There was a need to better understand what is associated with a labor and delivery nurse’s attitude toward patient advocacy.

This descriptive correlational research design examined the relationships of power as knowing participation in change, attitudes regarding intermittent fetal monitoring, and perceived barriers to research utilization with a labor and delivery nurse’s attitude toward patient advocacy using the theoretical framework of the Science of Unitary Human Beings. Labor and delivery staff nurses (N = 248), who were also members of the Association of Women’s Health, Obstetric, and Neonatal Nurses Association (AWHONN), participated in a web-based survey over the course of a month in 2014.

A moderate positive relationship was found between power as knowing participation in change and patient advocacy (r = .39, p < .01). A smaller, yet statistically significant positive relationship was also found between attitudes regarding intermittent fetal monitoring and patient advocacy (r = .16, p < .01). Inverse relationships were found between the variable perceived barriers to research utilization and patient advocacy (r = -.18, p < .05). The R2 indicated that collectively the three independent variables in this sample accounted for 16% of the variance of labor and delivery nurse’s attitudes toward patient advocacy. However, power as knowing participation in change was found to have the most impact in explaining a labor and delivery nurse’s attitude toward patient advocacy as evidenced by the standardized Beta (.36) and showed a small to medium effect size of .19. Additionally, only power as knowing participation in change remained significant (p ≤ .001) in the final regression model.

The findings from this study support empirical literature showing nurses do have a positive attitude toward patient advocacy and intermittent fetal monitoring. Although barriers to research utilization are present, the participants in this study are open to change, and actively engaging in change as it relates to patient advocacy and the use of intermittent fetal monitoring.



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