The nature of existential advocacy from the oncology nurses', cancer patients', and families' perspectives

The purpose of the study were to understand: (1) the nature of existential advocacy from oncology nurses', patients', and families' perspectives, and (2) the process of assisting patients and families to exercise self-determination. Hermeneutic phenomenology was used as a method to reveal the meaning of existential advocacy in everyday lived experiences of the nurses, patients, and families.; Unstructured, open-ended interviews were conducted with eleven participants in a large Midwestern medical center. The data analysis was based on Benner, Dieklmann and Allen's approach to Heidegerrian hermeneutics.; Five relational themes in the findings describe the context of the patients' and families' experiences of cancer: the emotional turmoil of life with cancer, the uncertainty and unpredictability of life, integrating the experience of cancer into daily life, the need for information and help for taking care their significant others, and learning to reprioritize life and appreciate every day.; The nurses' perception of existential advocacy was focused on a conflict between the lived body versus the object body of the patient. The nursing goal was: assisting in the patient's transition from the lived body to the object body so that the body was experienced as one. Six strategies of advocacy included: (1) helping the patients to become aware of their bodies, (2) promoting listening to the body, (3) providing care and comfort in a healing environment, (4) assisting the patients to gain confidence to take care of the self, (5) instilling hope through interpreting information about the body positively, and (6) teaching to live for today and reprioritize life.; Five relational themes of nursing existential advocacy from the patients' and families' perceptions were: respecting and caring for the unique individual over time, providing and interpreting key information based on changing meaning, instilling a sense of hope and supporting to the unique individual throughout the cancer journey, providing guidance through the illness and treatment trajectory, and providing a sense of security.; The constitutive pattern or overarching theme described the praxis of discovering personal meaning throughout the cancer journey. Through deliberate actions, the nurses helped the patients and families exercise self-determination by verifying and discerning their values in dynamic situations. Implications for nursing practice are discussed.