Making a difference: A study of patient advocacy among expert dialysis nurses

The incidence of end-stage renal disease has increased steadily over the last decade. There are approximately 240,000 dialysis patients in the United States and 3,500 freestanding centers delivering dialysis therapy. There is a lack of empirical research exploring advocacy among nurses caring for patients with a chronic illness and, in particular, patients with end-stage renal disease. The overall purpose of this grounded theory study was to explore the process, nature and outcomes of nursing advocacy on behalf of dialysis patients. A theoretical sample of 12 participants was necessary to achieve data saturation and redundancy. Demographic data were collected to describe the sample of expert dialysis nurses. Interviews were audio-taped and transcribed. The constant comparison method was used to analyze and code emergent categories to answer the research questions: (1) What is the nature of patient advocacy behaviors among nephrology nurses in an outpatient dialysis facility? (2) How do nephrology nurses enact advocacy behaviors on behalf of their patients in an outpatient dialysis facility? (3) What do nephrology nurses report as the short term and long term outcomes of their advocacy actions for dialysis patients? The substantive theory that emerged from the data was Making a Difference; the basic social process was the Nurse-Patient Relationship and its three phases: Establishing, Cultivating, and Transforming.; Findings revealed the Nurse-Patient Relationship was crucial for the nurses to advocate for their patients. Advocacy was not a separate intervention nor was it incidental; rather, advocacy was a part of the nurses' everyday nursing practice. The data revealed that expert nurses in an outpatient dialysis clinic setting actively practiced advocacy on behalf of their patients. Advocacy in this study was the nurses' actions and interactions that made a difference in the lives of their patients within the context of the Nurse-Patient Relationship.