Giving voice to the vulnerable: Advocacy and oncology nursing
Pamela J Haylock
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Despite common use of the term, there is no consensus among nursing professionals on a definition of advocacy, how to teach it, measure it, and determine its effectiveness. The purpose of this grounded theory study was to generate descriptions of the cognitive and social processes of advocacy as it is practiced by a purposely selected group of expert oncology nurse clinicians. Informants, nineteen registered oncology nurses working in direct care roles, participated in semi-structured interviews which were audio-recorded and transcribed verbatim to comprise data collection. Informant recruitment and data collection continued until saturation was apparent. Analytic techniques of constant comparative analysis, theoretical coding, and development of theoretical concepts were consistent with grounded theory methodology. Oncology nurses as voices for the vulnerable, the core finding, characterizes the lived experience of advocacy among the study sample. Identified themes were: 1) The meaning of advocacy as a component of ethical practice; 2) Nurses’ ways of being combine holistic philosophy, expertise, knowledge and personal values; 3) Nurses’ ways of knowing includes recognition of patients’ inherent vulnerabilities, knowing the population, and modeling patients’ worlds; 4) Nurses’ ways of doing incorporates the nurse-patient relationship, informing, educating and navigating; and 5) Value of nurses’ advocacy to the health care system, individual patients, and nurses. Interpretation of findings suggest that core components of advocacy are nurses’ 1) Intention to give voice; 2) Provision of a lifeline of love; and 3) Fulfillment of a moral covenant with patients. Nurses recognize patients’ needs and intentionally enter into relationships with patients, acting on the knowledge that their advocacy can assist patients with directing their energy to their healing work rather than being diverted to surviving the health care system. The data-driven theory can serve as a basis for defining, teaching, measuring, and supporting advocacy among students and practicing nurses, contribute to codifying advocacy competencies for clinical practice, and could serve as a catalyst for additional research and translation into practice of this complex and still immature construct.