Community Health Nursing Advocacy: A Concept Analysis
Definition of the concept: After careful review of the literature and identification of the defining attributes, CHN advocacy is defined as an intentional act of promoting and protecting the health of individuals, families and community members through education, facilitating access to health and social services, and actively engaging key decision makers to support and enact policies to improve community health outcomes.
Concept analysis approach: The eight-step concept analysis methodology by Walker and Avant (2010) was used. The steps are as follows: 1) Select a concept 2) Determine the purpose of the analysis 3) Identify all uses of the concept that you can discover 4) Determine the defining attributes 5) Identify a model case 6) Identify additional cases 7) Identify antecedents and consequences 8) Define empirical referents. A broad inquiry into the literature was undertaken using the search terms, “advocacy and community health nursing.” Databases searched include PubMed, CINAHL, Scopus, and Psych INFO. Inclusion criteria were: 1) Articles were full texts 2) Articles were written in English 3) Articles were published between 1994 and 2014. 43 articles were used after crossing out duplicates. In addition, older classic articles and books, websites and gray literature were used to gather information on theories and broader uses of the concept.
Linking the concept to nursing practice: CHN advocacy finds its theoretical base in nursing ethics, including the American Nurses Association and the International Council of Nurses’ Code of Ethics, which emphasize promotion and protection of health and safety. The health care landscape in the U.S. is changing due to factors such as the changing demographic trends, implementation of the Affordable Care Act, and early discharges from hospitals to community settings. Community health nurses are encountering more complex health and social issues from high-risk vulnerable populations. Advocacy for upstream community-based interventions is therefore central to community health nursing roles. This analysis outlines the critical attributes of CHN advocacy and provides nurses with a clearer understanding of what the concept is or is not, and what actions lead to or do not lead to advocacy. The analysis is grounded in theory and provides nurse clinicians, educators and researchers with a framework to guide their advocacy work in communities. It also provides a template that could be used to challenge or critique advocacy within community health nursing practice and research.
Conclusion: This analysis contributes to the advancement of knowledge of the concept of CHN advocacy by articulating an operational definition that is derived from theoretical foundations. Furthermore, the analysis provides some conceptual clarity for nurses to improve their research and practice.