Understanding advocacy in children’s nursing: a Hermeneutic Study

This study describes how Irish registered children’s nurses understand and interpret the experience of being an advocate. Advocacy, both internationally and nationally, is endorsed as being an integral component of the role of the nurse. In children’s nursing, advocacy is viewed as central to the care of the child because of their perceived vulnerability and developing maturity. Despite its centrality in nursing care, advocacy continues to be difficult to define and operationalize in clinical practice. Few studies have explored advocacy in the context of children’s nursing therefore the advocacy role of the children’s nurse is not clearly delineated. Sampling was purposive and eight registered children’s nurses volunteered to participate in the study. This study used a qualitative approach, based on Gadamer’s hermeneutic philosophy. Data collection methods included identification of the researcher prejudices, purposive sampling, twelve hermeneutic interviews and the compilation of the researcher’s reflexive journal. Benner’s (1994) method of data analysis was used and paradigm cases, exemplars and themes were identified. The themes identified included advocacy as protection, advocacy as representing the expressed wishes of the parent/child, advocacy as enabling the voice of the child and the work of advocacy. The study identified advocacy as being integral to the role of the children’s nurse. Advocacy was described as a complex concept capable of encompassing various models of advocacy including those of Kohne, Gadow Curtin, Jezewski and Mallik. It highlights the interdisciplinary differences that exist in the conceptualization and operationalization of the concept. In particular, advocacy in children’s nursing comprised both acting in the best interests of the child and facilitation of child self-advocacy, thus supporting the differing ethical principles of autonomy and best interests. Representation of the parents and child’s views were also central to the role.