Abstract

Forces in contemporary society including technological advances, scarce resources, heightened ethical awareness, and patient empowerment have created a need for nurse advocates. Research shows that new graduates do not feel prepared to address ethical issues. Concern about ethical decisions increases stress, leading to professional burnout which may be magnified in Intensive Care Units. Advocacy must be examined, defined, advanced in nursing education and supported by health care infrastructures. Concepts of nurses as moral agents and dimensions of patient advocacy must be better articulated so that educators can provide opportunities for acquisition of required knowledge, skills and behaviors. ;This descriptive, comparative research study asked four questions; how important nurses perceive the advocacy role in their practice, how advocacy is expressed or practiced, which aspects of the healthcare infrastructure are perceived as supports or barriers to the advocacy role and, if there were relationships in advocacy scores and behaviors based on selected demographic characteristics. Further, the study sought to determine differences in advocacy perceptions and behaviors between two targeted groups of nurses: critical care and non-critical care nurses, and nurses who work in federal hospitals as opposed to community hospitals. ;Instruments were developed, validated, and reliability assured. A stratified sample was targeted, instruments were completed by a total of sixty-five nurses prior to three ethics educational programs in one federal and two community hospitals. Data were analyzed with the NCSS Statistical Package, "Number Cruncher," utilizing descriptive and inferential statistics. ;There is increasing ethical awareness, nurses strongly agreed with the need for advocacy and identified fourteen role dimensions. Advocacy Perception Scores varied directly with RN educational preparation and were significantly higher in masters prepared nurses. Nelson's "Patient Rights Advocate" model was selected as the preferred model for patient advocacy, as opposed to the mediator and protector models. Federal nurses selected advocacy behaviors significantly more often, critical care nurses had higher advocacy perception scores and utilized support infrastructures significantly more than non-critical care nurses. Barriers and supports to advocacy were identified utilizing a systems theory context. The strongest advocacy support identified "other nurses," whereas physicians were the most frequent barrier perceived. Implications for nursing administration, research and education were identified