Open Access Highly Accessed Research article

Patient advocacy: barriers and facilitators

Reza Negarandeh1*, Fatemeh Oskouie2, Fazlollah Ahmadi3, Mansoure Nikravesh2 and Ingalill Rahm Hallberg4

Author affiliations

1 Faculty of Nursing and Midwifery, Zanjan University of Medical Sciences, Parvin Etesami St., Zanjan, Iran

2 Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Rasid Yasami st. Valiasr Ave. Tehran, Iran

3 Faculty of Medical Sciences, Tarbiat Modarres University, Jalal Al e Ahmad st., Tehran, Iran

4 Deputy Dean, Medical Faculty, Department of Nursing,157 SE 221 00, Sweden

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Citation and License

BMC Nursing 2006, 5:3  doi:10.1186/1472-6955-5-3

Published: 1 March 2006



During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses.


This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method.


Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role.


Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in this study. It is concluded that advocacy is contextually complex, and is a controversial and risky component of the nursing practice. Further research is needed to determine the possibility of a correlation between identified barriers/ facilitators and the use of advocacy.