Table 5: Qualitative Articles Included in the Review (n=11).
Tomaschewski-Barlem et al.(2016)
Brazil		 To know how nurses have been practicing the patient advocacy in the hospital setting. Qualitative/Exploratory Descriptive 16 nonprobable snowball sampling Semi-structured interviews Two themes emerged:
(1) The real courage-the advocacy practice mediated by open dialogue (patient advocacy is carried out by the nurses, mainly through open and genuine dialogue).
(2) Resistance strategies for the exercise of patient advocacy (covers the coping strategies nurses adopt to practice patient advocacy, particularly the coping ways used for facing the barriers that arise in the practice of patient advocacy.		 Conduct studies on the practice of patient advocacy in other contexts, in particular, investigating whether nurses without job stability are also able to exert power and advocate for patients. 18
Davoodvand, Abbaszadeh and Ahmadi (2016)
Iran		 Clarify the concept of patient advocacy from the perspective of Iranian Clinical nurses. Qualitative/Descriptive Purposive sampling of 15 ICU, CCU, and ED clinical nurses Semi-structured interviews Patient advocacy included two themes: (1) empathy with patients, and (2) protecting the patient. Further studies to be conducted on the relationship between empathy and patient advocacy.
urther studies may be performed on the effect of religion on patient advocacy.		 15
Sundqvist and Carlsson (2014)
Sweden		 Describe advocacy in anesthesia care during the preoperative phase from the perspective of the registered nurse anesthetists. Qualitative/Explorative 20 nurse anesthetists from two hospitals in Sweden Semi-structured interviews The main theme ‘holding the patient’s life in my hands’ described the nurse anesthetists’ perception of advocacy. It consists of three subthemes: providing dignified care, providing safe care, and a moral commitment. 18
Negarandeh, Oskouie, Ahmadi and Nikravesh (2008)
Iran		 Inquire about the meaning of patient advocacy Qualitative/Grounded theory A purposive sample of 24 nurses working in a university hospital Interviews Advocacy was defined by: informing and educating; valuing and respecting; supporting; protecting; and promoting continuity of care.
Advocacy take place only if there is a respect for the patients’ individuality and their inherent human dignity.		 17
McSteen and McAlpine (2006)
USA		 To identify and illustrate the key activities of expert nurses who act as patient advocates in ethically difficult care situations involving terminally ill patients. Qualitative/hermeneutic phenomenological Purposeful peer-nominated sample of 7 RNs experienced in caring for dying or terminally ill patients Unstructured interviews Three themes depicting the meaning of the nurse’s role as advocate: (1) acting as a guide during transition at the end of life; (2) acting as a liaison between the healthcare and the family; and (3) acting to support the meaning of the illness to the patient and family. 18
Vaartio, Leino-Kilpi, Salanterä and Suominen (2006)
Finland		 Describe the way that nursing advocacy is defined, the activities through which nursing advocacy is accomplished. Qualitative/Descriptive A convenience sample of 21 nurses from four medical and four surgical wards in Finland and 22 patients Procedural pain care context Interviews Patients advocacy was defined by three themes: (1) exceptional care (beyond good care); (2) individual care (specifically in relation to the needs of this particular patient) and (3) continuous care.
Advocacy means “Voicing responsiveness”.		 Further research is needed to clarify the concept and to validate it and the whole advocacy process in different contexts. Explore the structure of nursing advocacy phenomenon in different settings 18
Boyle (2005)
USA		 To study the lived experiences of perioperative nurses as they advocate for their patients Qualitative/Phenomenology A purposive 33 perioperative nurses Interview Definition of patients advocacy were categorized into three themes: (1) protection, (2) communication/giving voice, and (3) doing. Data from this study could be used to support development of the perioperative patient advocate role. 18
O’Connor and Kelly (2005)
Ireland		 To investigate general nurses’ perceptions of being patient advocates in Ireland Qualitative/ Focus group 20 practicing nurses working in a general hospital Interviews The nurses recognized (1) patient vulnerability, (2) moral obligation, and (3) obligation as a nurse as trigger to nursing advocacy. Research to investigate patients’ perspective on the role of nurses as advocates. 19
Breeding and Turner (2002)
Australia		 To explore the lived experience of critical care RNs regarding patient advocacy Qualitative/Phenomenology 5 critical care nurses Interviews Patient advocacy is a multi-faceted process and embrace many kinds of activities that nurses engage in on behalf of their clients. Rigorous discussion and debate regarding the concept of patient advocacy is warranted. 14
Chafey, Rhea, Shannon and Spencer (1998) USA To describe how nurses define and characterize advocacy Qualitative/Descriptive 17 hospital and community nurses Interviews Nurses included actions within the nurseclient relationship when they were asked to define advocacy: (1) coordination with the system; (2) intervening with the system on the client’s behalf; (3) interpersonal relatedness; and (4) empowerment of the client Research on advocacy behaviors. 16
Mallik (1997) UK To examine the interpretation of patient advocacy by practicing nurses Qualitative/ Focus group 104 nurses with different areas of practice Interviews Individual perceptions of what constitute patient advocacy is different.
Analysis suggested a triadic model of advocacy predominated which involved the nurse in a conflict/potential conflict situation.
The triadic model emphasize representing and protecting patients’ needs/choices to/from the particular power broker within the advocacy situation.		 Further research is needed so that legitimacy of the claim to patient advocacy by nurses can be validated. 13