Running head: THE ROLE OF ADVOCACY AND PROFESSIONAL NURSING 1

The Role of Advocacy and Professional Nursing

Bonnie J. Grubbs

Liberty University

Nursing Communications 350 Section D03

December 05, 2010

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Abstract

Nursing advocacy has become an essential part of nursing today, although not completely

understood. Based on the theory that there is a lack of education associated with the nurse

advocate role, the goal of this paper is to bring a clearer and mutual understanding to the role of

nurse advocate so that competency may increase in the work place. By examining several

articles, the intent is to gather the information and assemble it into a format that will inform the

reader with evidence based material established through numerous studies.

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The Role of Advocacy and Professional Nursing

Introduction

The role of nurse advocate is considered an important function of nursing; however, it is

not quite understood. We may begin to realize the meaning of the phrase “nursing advocacy” by

looking at the two words defined individually. According to Merriam-Webster the word “nurse”

means: “a person who looks after or gives advice to another” or “a person skilled in caring for

and waiting on the infirm, the injured, or the sick”. (Merriam-Webster, 2002) The word

“advocate” is defined as: “one that pleads the cause of another; (defender)” or “one that argues

for, defends, maintains, or recommends a cause or proposal”. (Merriam-Webster, 2002)

Nursing advocacy is a fairly new concept that was introduced in the 1970’s and became a

“recognized component of nursing practice in the 1980’s”. (Hanks, 2008, p. 469) Nurses were

considered suitable for the role of advocate because of their “increased amount of direct patient

contact time [they] have with patients as opposed to other health care professionals”. (Hanks,

2010, p. 255) With the changes that have taken place in healthcare over the years it’s become

increasingly more essential to assume the role of a nurse advocate.

When a person is ill, it’s often difficult for them to make their own decisions. Time and

again they need someone that can stand-up for them when they are unable. It’s important for the

nurse advocate to be educated in many areas to provide the support required. Unfortunately, “the

concept of patient advocacy lacks a consistent definition and research into nurses’ patient

advocacy roles is limited”. (Bu & Jezewski, 2007, p. 101)

A consistent finding amongst the researchers in this survey is the lack of education in

nursing advocacy. Because of the newness of this component of nursing, there is still much

research being made to determine the best way to teach this phenomenon.
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One of the ways to begin research on advocacy education and to get a closer look at it is

to dissect it. Nursing advocacy education (by one author) can be divided into different areas.

According to Hanks (2008) there are four different areas of knowledge: 1.) teaching, education,

and learning; 2.) influencing factors; 3.) components of nursing advocacy; and 4.) consequences

of nursing advocacy. (p. 469)

Through several studies: teaching, education, and learning played a major role in the

success of being a nurse advocate. One study states, “Before we can properly explore whether

nurses are in the best possible position to advocate or what the most effective means of teaching

advocacy is, for example, we should know what advocacy is, how it is pursued and how it is

experienced.” (Vaartio, Leino-Kilpi, Salantera, & Souminen, 2006, p. 282) Many nurses believe

that they understand what a nurse advocate is, but when asked to define the role, they don’t quite

understand all of the knowledge required to competently act as a nurse advocate.

To begin to cultivate advancement in the knowledge of becoming a nurse advocate, some

researchers believe that teaching nursing ethics to nursing students is a good starting point. One

author believes that advocacy is a learned skill that needs to be experienced through a number of

different involvements. Still, others believe that nurses at higher levels of education make better

advocates.

Based on the literature, there is a controversy that advocacy cannot be taught through

text. They believe that learning to be an advocate is best absorbed by surveying other nurses as

they assume their roles as advocates. There are also those that believe that teaching clinical

studies beyond patient care enable nurses to gain more knowledge of advocacy. (Hanks, 2008, p.

470)
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There are several influencing factors that affect a nurses’ ability to be an effective nurse

advocate. A major influential factor is how the nurse views their self. Inner feelings about one’s

self may trigger the nurse to advocate. If the nurse is confident, they will be less resistant to

advocate for the client. Some nurses are motivated by their emotions or beliefs and may advocate

on behalf of the patient because of empathy or sympathy. A client that the nurse feels is

vulnerable may be another influential factor. This brings a feeling of moral obligation to the

nurse and will thus cause the nurse to act as an advocate on the client’s behalf.

The work setting may also be an influential source to the nurse. If the nurse has support

and feels comfortable addressing different situations to various staff coupled with support from

that staff (especially physicians), then advocating on the patient’s behalf becomes less hesitant.

The work environment is also a place where the nurse can learn by having a mentor that has

become comfortable with advocacy.

There are several components that are involved in advocacy. One of these is acting as the

patient’s voice. Respecting and knowing the patient’s rights is the essence of being a patient

advocate. One study sums this component up as: Being a patient advocate “presumes the ability

to recognize patients’ rights and to identify when advocacy is needed. Patients’ right to self-

determination is often a source of moral contention, as this fundamental right is constrained by

their limited knowledge of their health issues and inexperience with the healthcare system.”

(MacDonald, 2007, p. 120)

It is the role of an advocate to protect the patient and their rights as well as bridging the

gap between the various arms of the health care system. Relationship building is yet another

component of advocacy. Trust and communication are two other essential components of

advocacy. The nurse must be an expert in communication to establish trust with the patient and
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to ensure proper collection of pertinent information. These components together are required to

make a well-rounded presentation while bridging the gap for the client.

Although the aforementioned components are necessary to become a good patient

advocate, it is as equally as important to include respect, compassion, and concern. These are the

motivators that allow the other components to come into play.

In the article Sphere of Nursing Advocacy Model, the author composes a replica of a

sphere that represents the protection and assistance that nurses provide to their patients. It is a

belief of one of the authors that “nurses have a moral commitment in regards to enhancing a

patient’s autonomy.” (Hanks, 2005, p. 75) From the Sphere of Nursing Advocacy Model (2005)

researchers believe that there are two components of being an advocate: “informer to the client”

and “a supporter of the client’s decision.’ (2005, p. 76) As a result of the SNA study two tables

were implemented (see tables 1 & 2)

Table 1. Assumptions of Sphere of Nursing Advocacy

Model
Clients need advocacy when they are unable to advocate
for themselves.
Nurses need to advocate for clients.
Nurses should not doubt their actions when advocating
for clients.
Nurses should not allow prejudices to interfere with
advocating for clients.
Nurses should allow clients to self advocate when clients
are able to do so.
Nurses should provide a sphere of advocacy for the client.

Table 2. Propositions From the Sphere of Nursing Advocacy Model

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Nursing advocacy provides a protective shield for the client in vulnerable situations where the
client may have varying degrees
of belief in his/her own ability to self advocate within the external environment/circumstances.
Nurses provide a semipermeable sphere of advocacy between their client and the client’s
external environment, allowing for
protection of the client yet allowing the client to self advocate.
The client and the nurse can be simultaneously acting as advocates: the nurse may be advocating
on the client’s behalf, and the
client may be self advocating through the open areas of the nurse’s sphere of advocacy called
pores.
If the nurse provides a protective shield of advocacy for the client, then the client is protected
from the external environment.
If the client is able to self advocate, then the client will be able to work through the pores in the
nurse’s sphere of advocacy to interact with the external environment regardless of setting.

“The SNA model can be used in the practice setting to visually depict the concept of

advocacy for clients on the part of the practicing nurse. This model also could be utilized in the

educational setting as a model to teach student nurses about client decision making and client

advocacy.” (Hanks, 2005, p. 77&78) See figure 1

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Figure 1

Nursing Advocacy (lacing around core)

Patient (core)

“By providing a protective barrier of

advocacy for their clients, nurses are

surrounding their clients in a sphere of

advocacy.” (2005, pp. 77&78)

The role of a nurse advocate is that of a positive one. However, there can be

consequences. One author describes nursing advocacy as “a form of risk taking that can result in

frustration and anger.” (Hanks, 2008, p. 470) When advocating for patients, relationships can be
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put to the test. Some peers and other health care workers can label the advocate as an “instigator,

troublemaker or whistle-blower.” (2008, p. 470)

Overcoming the barriers of advocacy is necessary if full realization of becoming a

patient’s advocate can come to fruition. According to Hanks (2007), examples of barriers are:

lack of [institutional] support and power and lack of education and time. “Threats of punishment

are also considered an attribute of barriers to nursing advocacy.” (Hanks, 2007, p. 174) It is

important that the nurse understand that these barriers do exist and what is necessary to avoid or

eliminate them. Future research needs to be done in this area.

Discussion

In conclusion, there are many benefits that nursing advocacy can provide to patients.

Once a method of teaching and uniformity has been established, this area of nursing will prove to

be a very important component of patient care. Because of the newness of patient advocacy and

the gray areas of its definition, much more research will need to be done to perfect it.

“Developing a new theory of patient advocacy that can be operationalized is necessary for

advancing nursing science and patient advocacy practice.” (Bu & Jezewski, 2007, p. 109)

References

Bu, X., & Jezewski, M. A. (2007). Developing a mid-range theory of patient advocacy through

concept analysis. Journal of Advanced Nursing, 57, 101-110. doi: 10.1111/j.1365-

2648.2006.04096.x
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Hanks, R. G. (2005, July-September). Sphere of nursing advocacy model. Nursing Forum, 40(3),

75-78.

Hanks, R. G. (2007, October-December). Barriers to nursing advocacy: a concept analysis.

Nursing Forum, 42(4), 171-177.

Hanks, R. G. (2008, ). The lived experience of nursing advocacy. Nursing Ethics, 15(4), 468-

477.

Hanks, R. G. (2010). Development and testing of an instrument to measure protective nursing

advocacy. Nursing Ethics, 17(2), 255-267.

MacDonald, H. (2007). Relational ethics and advocacy in nursing: literature review. Journal of

Advanced Nursing, 57(2), 119-126. doi: 10.1111/j.1365-2648.2006.04063.x

Merriam-Webster, (2002). advocate. In Webster’s third new international dictionary,

unabridged. Retrieved from http://unabridged.merriam-webster.com

Merriam-Webster, (2002). nurse. In Webster’s third new international dictionary, unabridged.

Retrieved from http://unabridged.merriam-webster.com

Quallich, S. A. (2010, July-August). When worlds collide: advocacy. Urologic Nursing, 30(4),

216 & 254.

Steefel, L. (2006, April 1). A new paradigm for advocacy [Online exclusive]. Nursing Spectrum.

Retrieved from http://news.nurse.com/apps/pbcs.dll/article?AID=2006604010319

Vaartio, H., Leino-Kilpi, H., Salanterä, S., & Souminen, T. (2006, February 6). Nursing

advocacy: how is it defined by patients and nurses, what does it involve and how is it

experienced?. Scandinavian Journal of Caring Sciences, 20, 282-292.

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Vaartio, H., Leino-Kilpi, H., Suominen, T., & Puukka, P. (2008, July 22). The content of

advocacy in procedural pain care - patients’ and nurses’ perspectives. Journal of

Advanced Nursing, 64(5), 504-513. doi: 10.1111/j.1365-2648.2008.04817.x

Vaartio, H., Leino-Kilpi, H., Suominen, T., & Puukka, P. (2009). Nursing advocacy in

procedural pain care. Nursing Ethics, 16(3), 340-362.

FORMAL APA PAPER

GRADING GRID/CRITERIA

STUDENT NAME: Bonnie J Grubbs

DATE 12/05/10
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TOPIC SELECTION (15%)

 Relevant to professional nursing
 Timely/current
 Appropriate for length and course

STRUCTURE (35%)
 Correct use of grammar and spelling
 Expression of ideas well organized, clear, and concise
 Appropriate length of paper and paragraphs
 Appropriate use of tables, graphs, etc.
 Correct use of APA editorial format

CONTENT (35%)
 Information generates interest
 Illustrations and examples used as needed
 Information is accurate
 Resources/references underpin structure of the paper and salient points
 Implications for nursing practice or research identified

REFERENCES (15%)
 Less than 4 years, unless nursing or other theory or supporting reference
 Scientific nursing, medical, or allied health journal or other scholarly
Publication

The paper must consist of: Title page, Abstract, Introduction, Body with supporting statistics,
tables, graphs or illustrations; a discussion including implications for future research and for the
body of nursing knowledge; and references.

PLEASE ATTACH THIS GRADING GRID AS THE LAST PAGE OF THE APA PAPER.