Patient/client advocacy has been claimed as a new role for the professional nurse. This paper presents a critical review of the literature on advocacy in nursing. After briefly outlining the conditions which may have instigated the need for patient advocacy, meanings and models of advocacy are discussed. It is argued that although there are many examples of the advocacy role in health care, models proposed for the nurse as advocate are indeterminate which leads to multiple interpretations and lack of clarity in operationalizing advocacy. Much of the literature focuses on justification arguments for claiming the advocacy role. Key themes are outlined and include: patient advocacy as a traditional role, nurses are in the best position in the health care team, nurses have the knowledge to advocate and finally nurses and patients can be partners in advocacy. However, critical examination reveals many counter-arguments to the above claims and finally concludes that advocacy is a potentially risky role to adopt. It is argued that support systems are inadequate except in low-risk situations and ultimately acts of advocacy remain a moral choice for the individual nurse. Finally the need to conduct research into the interpretation of the patient advocate role by nurses in the United Kingdom is highlighted.
This paper reports on a qualitative study which examined the interpretation of patient advocacy by practising nurses. Focus group interviews, which allowed respondents to recount and share their particular 'stories' of patient advocacy, were used to collect data. Results indicate that a triadic model of advocacy predominated which involved the nurse in a conflict/potential conflict situation. The patient's requests, the patient's fear, the patient's vulnerability or threats to the patient's human rights provoked an advocacy response in the perceptive nurse. The nurse was sustained in the role through patient recognition, the nurse-patient relationship, emotional strength, moral justification and knowledge/expertise legitimacy. The nurse used direct and indirect means to protect the patient against incompetent/inappropriate practice and/or represent patient/family choice, the advocacy activity resulting in positive or negative outcomes. In conclusion it is argued that if the triadic conflict model of advocacy outlined by this research is to be sustained by practising nurses, the potential risks involved should be recognized. Professionalization of the role may be the only way forward if the ethical code (United Kingdom Central Council, 1992) continues to make patient advocacy a mandatory activity for the professional nurse.
In recent years, patient advocacy has been claimed as an integral part of the nurse's role in health care delivery in the United Kingdom (UK). Support from the nursing leadership/elite is seen as important in the promulgation and diffusion of any 'new' role in nursing. This paper explores the perceptions and attitudes of nurse leaders in the UK to the adoption of the patient advocate role as an 'innovation' in nursing. Using a qualitative methodology, semi-structured interviews with six of nursing's 'elite' were conducted over a period of 5 months. Results revealed contradictions and paradoxes within the views of the elite. Although leaders recognized patient advocacy as a role integral to the moral value system in nursing enhanced by the nurse-patient relationship, they objected to the professionalization of the role, seeing an exclusive claim to patient advocacy as intensifying interprofessional conflicts in health care. It is argued that unless professionalized, the individual nurse will continue this potentially risky activity without adequate authority or support systems. The results overall question the role of the nursing leadership in the diffusion of innovations in nursing.
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