Razi Journal of Medical Sciences

    Background & Objective: During two recent decades, patient advocacy has been an arguable topic in nursing profession. Although there is a common consensus on patient advocacy as a nurse’s role, some evidence points to difficulties that nurses encounter to advocate patients. Since recognition of barriers and facilitators is the first step to promote the role of advocacy among nurses, this paper investigates the factors influencing the utilization of advocacy.

Method: The present study was conducted through grounded theory method. Participants were 24 Iranian nurses(including clinical nurse, headnurse and supervisor) who were working in Rasoul-e-Akram Hospital in Tehran. Semi-structured interview was used for data gathering. All recorded interviews were transcribed verbatim and constant comparative analysis was used according to Strauss and Corbin method.

Results: Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. The nurses in this study identified powerlessness, lack of support, lack of law and code of ethics, limited communication, physicians’ leadership tendencies, risk of advocacy, loyalty to pers, lack of motivation and insufficient time to interact with patients and families as barriers to advocacy. Regarding factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing and paying attention to patients’ needs and conditions, nurses’ responsibilities, physician as a colleague and nurses’ knowledge and skills could be influential on adopting above mentioned role.

Conclusion: Considering the current condition and mentioned barriers, participants believe taking advocacy role is difficult for nurses. Therefore, they decide and act as a patient’s advocate in any situation with regard to patient’s needs and the status of barriers and facilitators. However in most cases, they cannot act at optimal level, but rather they accept only what they can do, which is called in this study “limited advocacy”. It can be concluded that advocacy is contextually complex, controversial and a risky component of nursing practice. Further research is needed to determine the correlation that might exist between identified barriers and facilitators and the use of advocacy. It also seems to be necessary to organize attempts to eliminate barriers and strengthen facilitators efficiently, so that nurses will perform their supportive roles in the national health care system.