Date of Award


Document Type


Degree Name

Doctor of Education (EdD)


Executive Leadership

First Supervisor

Guillermo Montes

Second Supervisor

David Bell


Advocacy in nursing has been provided to patients by nurses inconsistently with grave consequences for both patients and nurses. Patients have suffered debilitation or injury when nursing advocacy has not been operationalized effectively, and nurses have been ostracized, experienced job loss, and some have been prosecuted criminally for advocating for patients. The American Nurses Association (ANA) and the International Council of Nurses (ICN) have maintained that inherent to the role of nursing is advocating for patients, yet advocacy in nursing remains ill defined. The purpose of this research study was to investigate how advocacy was defined and taught in fundamental nursing textbooks, using discourse analysis. Four widely used fundamental nursing textbooks were analyzed. The analysis revealed that advocacy definitions were inconsistent, and the textbooks failed to prepare nurses for the complexities of real-world applications of advocacy. Nurses are asked to support patient autonomy and well-being, but nurses are not instructed with reasonable ways to do so in realistic, complex, modern healthcare settings. Recommendations for those who educate nursing students should consider adding additional, more realistic, advocacy resources to supplement nursing advocacy education, and textbooks should be updated to improve the discussion of nursing advocacy. Recommendations for the ANA are to consider developing a code of advocacy to protect nurses while they follow instructions to protect patients and avoid potential personal, professional, and legal ramifications.

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