The effect of patient advocacy education on advocacy skills, ethical sensitivity, and patient safety culture in nurses: A randomized controlled education

This study was conducted to examine the effects of patient advocacy training given to nurses within the framework of Bloom's Taxonomy program on advocacy skills, ethical sensitivity, and patient safety culture. The research was planned as a Randomized Controlled Trial (RCT) with pre-test, post-test, and parallel group measures. Seventy nurses (experimental group: 35, control group: 35) who directly interact with patients in a medical school hospital participated in the study. Data were collected using a personal information form, the Patient Advocacy Scale (PAS), the Moral Sensitivity Questionnaire (MSQ), and the Patient Safety Culture Questionnaire (PSC). The experimental group received an eight-week advocacy training program, while the control group received no intervention. Descriptive statistics, t-tests, and analysis of variance were used to analyze the data, with a significance level of (p<0.05). Pre-test results were used to assess baseline levels between groups, and post-training changes were analyzed using post-test and follow-up measurements. Student t-tests were used to compare scale scores and sub-dimensions between groups, while paired t-tests were used for intra-group comparisons of scale scores in the experimental group. Following the training, the experimental group's PAQ scores increased significantly compared to the control group, and the effect size was found to be strong. MSQ scores, however, decreased significantly compared to the control group (increased ethical sensitivity), and the effect size was also found to be strong. A significant increase was observed in the percentage of positive responses to the PSQ (Patient Safety Questionnaire) test, and the H0 hypothesis was rejected. The significant increases observed in the experimental group indicate that the training intervention was effective in achieving the targeted outcomes. These results demonstrate that patient advocacy training, structured according to Bloom's Taxonomy, improves nurses' cognitive, affective, and behavioral competencies. The positive changes observed, particularly in ethical sensitivity and patient safety culture, show that the training provides a powerful transformation not only at the knowledge level but also in professional attitudes and decision-making processes. In this context, it becomes possible for nurses to assume more effective roles in areas such as protecting patient rights, providing safe care, and professional autonomy in clinical practice. The findings indicate that advocacy-based, structured programs should be integrated into nursing in-service training curricula, and that such interventions have the potential to improve the quality of care at both individual and systemic levels. Keywords: Nurse Advocacy Training, Advocacy Skills, Ethical Sensitivity, Patient Safety Culture, Bloom's Taxonomy.