• Heli Vaartio, Helena Leino-Kilpi, Tarja Suominen, and Pauli Puukka.
• Department of Nursing Science, University of Turku, Finland. heli.vaartio@sydvast.fi
• J Adv Nurs. 2008 Dec 1;64(5):504-13.

AimThis paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care.BackgroundNursing advocacy is every nurse's professional duty, grounded in patients' legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle-blowing event from the nurse's perspective.MethodThis cross-sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically.ResultsAdvocacy in procedural pain care is a process which takes place in the patient-nurse relationship through role identification in decision-making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse's own role identification: in the context of pain care it seems that the nurse's pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision-making about their care; at worst, they are subjected to paternalism.ConclusionsAdvocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on-the-job training, feedback and collaboration.

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