The practice of health advocacy in nursing has been defined as a process aimed at promoting the independence and autonomy of users of health services, in addition to providing information on healthcare decision-making and offering support for decisions taken.
Ethical considerations
Ethics approval was not required to conduct this review.
Aim
This integrative review aims to synthesize evidence in the literature on health advocacy in professional nursing practice.
Methods
An integrative review methodology guided by Whittemore and Knalf was used. Studies were identified by conducting searches on PubMed, Scopus, Web of Science, CINAHL, and LILACS databases. Of 2179 records, 34 studies matched the inclusion criteria.
Results
The main aspects involved in the practice of health advocacy by professional nurses are related to the ethical principles of the nursing profession, such as protecting patients seeking autonomy and care. Furthermore, the practice of health advocacy by nurses requires an empathetic attitude, responsibility, and assertive communication.
Conclusion
The diverse possibilities for the practice of advocacy synthesized in this study allow nurses to approach and become familiarized with the topic, being able to acquire and complement knowledge that will reflect on their professional practice in different work environments such as the educational field, in hospital practice, or basic health care.
HearrellCL. Advocacy: nurses making a difference. J Emerg Nursing2011; 37: 73–74.
2.
Gonçalves GermaniACCAITHF. Advocacia em promoção da saúde: conceitos, fundamentos e estratégias para a defesa da equidade em saúde. Revista de Direito Sanitário2013; 14(1): 34–59.
3.
CanetRCCastroCGJ. A advocacia em saúde como uma estratégia para a promoção da saúde. Revista de Direito Sanitário2008; 9(1): 74–85.
4.
DallariSGBarber-MaddenRTorres-FernandesMDC, et al.Advocacia em saúde no Brasil contemporâneo. Revista de Saúde Pública1996; 30(6): 592–601.
5.
VaartioHLeino-KilpiH. Nursing advocacy-a review of the empirical research 1990-2003. Int J Nurs Stud2005; 42: 705–714.
6.
FarrerLMarinettiCCavacoYK, et al.Advocacy for health equity: a synthesis review. Milbank Q2015; 93(2): 392–437.
7.
CohenBEMarshallSG. Does public health advocacy seek to redress health inequities? A scoping review. Health Soc Care Community2017; 25(2): 309–328.
8.
DavisAJKonishiETashiroM. A pilot study of selected Japanese nurses’ ideas on patient advocacy. Nurs Ethics2003; 10(4): 404–413.
9.
HanksRG. Development and testing of an instrument to measure protective nursing advocacy. Nurs Ethics2010; 17(2): 255–267.
10.
SchlaireMC. Bioethics mediation: the role and importance of nursing advocacy. Nurs Outlook2009; 57(4): 185–193.
11.
VenturaCAAMelloDFDAndradeRD, et al.Aliança da enfermagem com o usuário na defesa do SUS. Revista Brasileira de Enfermagem2012; 65(6): 893–898.
12.
McgrathPHolewaHMcgrathZ. Nursing advocacy in an Australian multidisciplinary context: findings on medico-centrism. Scand J Caring Sci2006; 20(4): 394–402.
13.
Tomaschewski-BarlemJGLunardiVLBarlemEL, et al.Cross-cultural adaptation and validation of the protective nursing advocacy scale for Brazilian nurses. Revista Latino-Americana de Enfermagem2015; 23(4): 669–676.
14.
BarlemELDLunardiVLTomaschewskiJG, et al.Moral distress: challenges for an autonomous nursing professional practice. Revista da Escola de Enfermagem da USP2013; 47(2): 506–510.
15.
WhittemoreRKnaflK. The Integrative Review: Update Methodology. Blackwell Publishing Ltd, 2005.
HuttonBCatalá-LópezFMoherD. La extensión de la declaración PRISMA para revisiones sistemáticas que incorporan metaanálisis en red: PRISMA-NMA. Medicina Clínica2016; 147(6): 262–266.
18.
UrsiESGavãoCM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Revista Latino-Americana de Enfermagem2006; 14: 124–131.
19.
Fineout-OverholtE.WilliamsonK. M.Gallagher-FordL., et al. Evidence-based practice, step by step: following the evidence: planning for sustainable change. AJN, Am J Nurs2011; 111(1): 54–60.
Josse-EklundAJosseboMSandin-BojöA-K, et al.Swedish nurses’ perceptions of influencers on patient advocacy. Nurs Ethics2014; 21(6): 673–683.
22.
SundqvistASNilssonUHolmefurM, et al.Registered nurse anaesthetists practicing of perioperative patient advocacy: an observational study. Digitala Vetenskapliga Arkivet2017; 27(11–12): 2403–2415.
23.
DadzieGAziatoLAikinsAD. “We are the best to stand in for patients”: a qualitative study on nurses' advocacy characteristics in Ghana. BMC Nursing2017; 16(1): 61–68.
24.
MortellMAbdullahKLAhmadC. Barriers deterring patient advocacy in a Saudi Arabian critical care setting. Br J Nurs2017; 26(17): 965–971.
25.
Brasil. Ministério da Saúde. Department of Health Care and Department of Primary Care. National Primary Health Care Policy2012.
26.
FigueiraABBarlemELDTomaschewski-BarlemJG, et al.Ações de advocacia em saúde e empoderamento do usuário por enfermeiros da Estratégia Saúde da Família. Revista da Escola de Enfermagem da USP2018; 52.
27.
Josse‐EklundAPetzällKSandin‐BojöAK, et al.Swedish registered nurses’ and nurse managers’ attitudes towards patient advocacy in community care of older patients. J Nursing Management2013; 21(5): 753–776.
28.
ReedFMFitzgeraldLBishMR. A practice model for rural district nursing success in end-of-life advocacy care. Scand Journal Caring Sciences2018; 32(2): 746–755.
29.
PerryCEmoryJ. Advocacy through education. Pol Polit Nurs Pract2017; 18(3): 158–165.
30.
WaddellAAdamsJMFawcettJ. Exploring nurse leaders’ policy participation within the context of a nursing conceptual framework. Pol Polit Nurs Pract2017; 18(4): 195–205.
31.
KungYMLugoNR. Political advocacy and practice barriers: a survey of florida APRNs. J Am Assoc Nurse Pract2015; 27(3): 145–151.
32.
CawleyTMannix McNamaraP. Public health nurse perceptions of empowerment and advocacy in child health surveillance in West Ireland. Public Health Nurs2011; 28(2): 150–158.
33.
TarimanJDDhorajiwalaS. Genomic variants associated with cancer-related fatigue: a systematic review. Clin Journal Oncology Nursing2016; 20(5): 537–546.
34.
BlaževičienėANewlandJAČivinskienėV, et al.Oncology nurses’ perceptions of obstacles and role at the end-of-life care: cross sectional survey. BMC Palliative Care2017; 16(1): 1–8.
35.
TodaY.SakamotoM.TagayaA., et al. Patient advocacy. Nurs Ethics2015; 22(7): 765–777.
36.
Da Silva NeutzlingBRBarlemJGTBarlemELD, et al.Defending the rights of children in a hospital setting: nurses' advocacy in health. Escola Anna Nery Revista de Enfermagem2017; 21(1): 1–9.
37.
AndradeRDSantosJSPinaJC, et al.The child care as time defense of the right to health of children. Ciência, Cuidado e Saúde2013; 12(4): 719–727.
38.
ChoiSPPCheungKPangSMC. A field study of the role of nurses in advocating for safe practice in hospitals. J Advanced Nursing2014; 70(7): 1584–1593.
39.
PecanacKESchwarzeML. Conflict in the intensive care unit: nursing advocacy and surgical agency. Nurs Ethics2018; 25(1): 69–79.
40.
NogarioACDBarlemELDTomaschewski-BarlemJG, et al.Nursing Actions in practicing inpatient advocacy in a burn unit. Revista da Escola de Enfermagem da USP2015; 49(4): 0580–0588.
41.
SusiloAPDalenJVScherpbierA, et al.Nurses’ roles in informed consent in a hierarchical and communal context. Nurs Ethics2013; 20(4): 413–425.
42.
CarabezRScottM. ‘Nurses don’t deal with these issues’: nurses’ role in advance care planning for lesbian, gay, bisexual and transgender patients. J Clinical Nursing2016; 25(24): 3707–3715.
GormleyJM. School nurse advocacy for student health, safety, and school attendance: impact of an educational activity. J Sch Nurs2019; 35(6): 401–411.
45.
FigueiraABBarlemELDAmestoySC, et al.Health advocacy by nurses in the family health strategy: barriers and facilitators. Revista Brasileira de Enfermagem2018; 71(1): 57–64.
46.
KolawoleIO. Nurses’perception and patients’validation of nurses’advocacy roles in promotion of surgical patients’safety and rights in three hospitals, Ibadan, Nigeria. West Afr J Nurs2017; 28(1).
47.
GaluskaL. Advocating for patients: honoring professional trust. AORN J2016; 104(5): 410–416.
48.
SelandersLCCranePC. The voice of florence nightingale on advocacy. Online Journal Issues Nursing2012; 17(1): 1.
49.
Tomaschewski-BarlemJGBLunardiVLBarlemELD, et al.How have nurses practiced patient advocacy in the hospital context? - A Foucaultian perspective. Texto Contexto Enfermagem2016; 25(1).
50.
BegleyAM. On being a good nurse: reflections on the past and preparing for the future. Int J Nurs Pract2010; 16(6): 525–532.
51.
AlbinaJK. Patient abuse in the health care setting: the nurse as patient advocate. AORN Journal2016; 103(1): 73–81.
52.
SpenceK. Ethical advocacy based on caring: a model for neonatal and paediatric nurses. J Paediatrics Child Health2011; 47(9): 642–645.
53.
FarmerLLundyA. Informed consent: ethical and legal considerations for advanced practice nurses. J Nurse Pract2017; 13(2): 124–130.
MateyL. When advocacy extends life. J Hosp Palliat Nurs2018; 20(2): 114–117.
56.
MahlinM. Individual patient advocacy, collective responsibility and activism within professional nursing associations. Nurs Ethics2010; 17(2): 247–254.
57.
Tomaschewski-BarlemJGLunardiVLBarlemELD, et al.Advocacia do paciente na enfermagem: barreiras, facilitadores e possíveis implicações. Texto & Contexto-Enfermagem2017; 26.
58.
RAMOSAL. Adaptação transcultural e validação do instrumento Protective Nursing Advocacy Scale para enfermeiros brasileiros. Revista Latino-Americana de Enfermagem2015; 23(4): 670.
59.
NevesFBVargasMAOZilliF, et al.Health advocacy in oncology nursing: an integrative literature review. Esc Anna Nery2021; 25(1): e20200106.
