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An exploration of advocacy models and the moral orientation of nurses

Brenda E. McNamara Millette, University of Massachusetts Amherst


Advocacy has been identified as a key function of the professional nurse. This study was designed to explore and describe nurses' preferences regarding three advocacy models. The relationship of advocacy preference to demographic factors and the moral orientation of selected subjects was also explored. Phase one of this study identified participant's preference for client, physician, or institutional advocacy in three ways. Nurses (N = 222, out of 500) ranked and rated the models and responded to a case. The first two hypotheses predicted that nurses would prefer client advocacy and that those with this preference would most likely be older women with more education in a management position in a community setting. In phase two, hypotheses three and four predicted that nurses preferring client advocacy would express a moral orientation of caring and that the nurse preferring the institutional advocate model would express a moral orientation of justice. Twenty-four subjects were interviewed, twelve subjects from each category: institutional and client advocacy. The results were analyzed for moral orientation using Gilligan's protocol. Gilligan's model of moral development and orientation framed the interpretation of the subject's reported moral dilemmas. The majority of the respondents ranked and rated client advocacy as preferred. However, most subjects selected a response to the case which was an institutional advocate's response. Staff nurses expressed more disagreement with both institutional and physician advocacy than nurse managers did. Nurses from the hospital setting most often preferred the responses of the institutional advocate. Eleven of the interview subjects labeled "client advocates" expressed one of the caring orientations and were more likely to be inactive staff nurses. Five of the interview subjects labeled "institutional advocates" expressed a "mostly justice" orientation and were likely to be active nurse managers. Six others expressed one of the caring orientations. From these findings it appears that though client advocacy may be preferred conceptually, implementation in practice may require clarification and investigation. It also appears that the caring orientation is readily apparent in the "client advocates." The ramifications of the moral orientation of nurses in practice and the effect of orientation on nurses' ethical dilemmas need to be investigated further.

Subject Area


Recommended Citation

Millette, Brenda E. McNamara, "An exploration of advocacy models and the moral orientation of nurses" (1989). Doctoral Dissertations Available from Proquest. AAI8917382.