Clustering the engagement of Brazilian nurses in political advocacy

observational study, with a quantitative approach. A total of 184 nurses working in primary, secondary, and tertiary care in a city in the south of Brazil completed the Policy Advocacy Engagement Scale. Data analysis consisted of descriptive statistics, cluster analysis, analysis of variance, and chi²2 Vargas CP, Vargas MAO, Barlem JGT, Ramos FRS, Schneider DG, Camponogara S. Patient advocacy actions by intensivist nurses. Rev Esc Enferm USP. 2019;53:e03490. https://doi.org/10.1590/S1980-220X2018011703490
https://doi.org/10.1590/S1980-220X201801... . The Institutional Review Board approved the study.

Results:

four differentiated clusters were found according to professional experience, level of healthcare complexity, and unit. The cluster analysis revealed that patient advocacy for community-based obtained the highest mean, indicating that political advocacy is effective in organizational environments and that professional qualification favors greater engagement in political advocacy.

Conclusions:

the results reveal that nurses play an active role in political advocacy, seeking to promote positive changes in health, especially those working in tertiary care, the nurse group that obtained the highest means.

Descriptors:
Nurse; Health Policies; Work Engagement; Patient Advocacy; Health

	Cluster 1	Cluster 2	Cluster 3	Cluster 4
Participants	60 ± 32.6 a	14 ± 7.6 b	45 ±24.5 c	65 ±35.3 d
Average age	34 ± 8.14 a	41 ± 9.1b	40 ±7.4 c	36 ± 8.9 a, b, c
Experience	59 ±61.3 a	157 ± 111.6 a, b, d	140 ±89.5 b, c	111 ±100.3 b, d
Mean of political Advocacy Among Clusters	3.5 ± 0.73 a	3.51 ± 0.59 a, b, c	4.04 ±0.77 b	3.46 ±0.54 c

		Total of valid answers	Cluster 1	Cluster 2	Cluster 3	Cluster 4	p
Education
Bachelor’s degree		74	25 (41.7%)	5 (35.7%)	10 (22.2%)	34 (52.3%)	0.000
Specialization		28	3 (5.0%)	2 (14.3%)	19 (42.2%)	4 (6.2%)	0.000
Residency		17	1 (1.7%)	3 (21.4%)	4 (8.9%)	9 (13.8%)	0.000
Master’s degree		16	1 (1.7%)	2 (14.3%)	7 (15.6%)	6 (9.2%)	0.000
Doctoral degree		49	30 (50%)	2 (14.3%)	5 (11.1%)	12 (18.5%)	0.000
Level of care
Primary care		72	--	7 (50%)	--	65 (100%)	0.000
Secondary care		67	60 (100%)	7 (50%)	--	--	0.000
Tertiary care		5	--	--	45 (100%)	--	0.000
Field
Care delivery		170	60 (100%)	--	45 (100%)	65 (100%)	0.000
Administrative		14	--	14 (100%)	--	--	0.000
Structural characterization of the work environment
Review	Yes	108	39 (65%)	--	25 (55.6%)	35 (60.3%)	0.720
Board	No	76	21 (35%)	--	20 (44.4%)	30 (39.7%)
Continuing	Yes	146	53 (88.3%)	12 (92.3%)	33 (73.3%)	48 (78.7%)	0.158
Education	No	33	7 (11.7%)	1 (7.7%)	12 (26.7%)	13 (21.3%)
Staff meeting	Yes	98	--	12 (85.7%)	38 (84.4%)	48 (76.2%)	0.633
	No	24	--	2 (14.3%)	7 (15.6%)	15 (23.8%)
Institutional Dialogue	Yes	150	46 (76.7%)	13 (92.9%)	42 (93.3%)	49 (77.8%)	0.070
	No	32	14 (23.3%)	1 (7.1%)	3 (6.7%)	14 (22.2%)
Management open dialogue	Yes	170	56 (93.3%)	14 (100%)	44 (97.8%)	56 (88.9%)	0.215
	No	12	4 (6.7%)	--	1 (2.2%)	7 (11.1%)
Multiprof staff open dialogue	Yes	159	53 (88.3%)	11 (78.6%)	42(93.3%)	53(84.1%)	0.379
	No	23	7 (11.7%)	3 (21.4%)	3 (6.7%)	10 (15.9%)
Nursing staff open Dialogue	Yes	174	57 (95%)	14 (100%)	43 (95.6%)	60 (93.8%)	0.804
	No	9	3 (5%)	--	2 (4.4%)	4 (6.3%)

	Cluster	n	Mean	Factor total mean	p value
Factor 1	1 secondary care	60(32.6%)	2.88
(patient advocacy)	2 managers/primary care	14(7.6%)	2.68	2.98	0.000
	3 tertiary care	45(24.5%)	3.60
	4 primary care	65(35.3%)	2.71
Factor 2	1	60	3.51
(quality care advocacy)	2	14	3.94	3.68	0.009
	3	45	4.04
	4	65	3.54
Factor 3	1	60	3.81
(advocacy for culturally competent care)	2	14	3.80	3.94	0.13
	3	45	4.35
	4	65	3.80
Factor 4	1	60	3.07
(advocacy for preventive care)	2	14	3.25	3.46	0.000
	3	45	4.28
	4	65	3.30
Factor 5	1	60	4.02
(advocacy for accessible care)	2	14	3.64	3.96	0.328
	3	45	4.16
	4	65	3.85
Factor 6	1	60	3.22
(advocacy for mental health care)	2	14	3.32	3.27	0.036
	3	45	3.70
	4	65	3.01
Factor 7	1	60	3.99
(advocacy for family and community care)	2	14	3.94	4.03	0.581
	3	45	4.17
	4	65	3.98

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[1] Corresponding author: Aline Belletti Figueira E-mail: alinebelletti@gmail.com