Existential Advocacy in Nursing Care: A Concept Analysis

Table 1

Existential advocacy literature matrix.

Title	Antecedents	Attributes	Consequences
Healing during existential moments: the “art” of nursing presence [14]	Nursing presence	Intersubjective nurse-patient relationship	Personal and professional satisfaction
	Nurse’s self-awareness, openness, flexibility, and willingness to embrace another’s situation	Therapeutic relationships	Increase patient satisfaction
	Nurse’s moral courage		Holistic care
A pluralist view of nursing ethics [30]	Ethical dilemma	Ethical practice grounded in relationships	Scope of EA may not be fully inclusive; therefore, patient ethical issues may not be fully addressed
		Determine patient’s unique meaning of health, illness, suffering, or dying
Clinical epistemology: a dialectic of nursing assessment [27]	Vulnerability	Holism	Revising a situation of vulnerability into one of safety
	Disengagement from subjectivity	Engagement	Relational narrative encompasses the particular and general nature of the patient’s situation
	Reduction-search for the “real” thing
Relational narrative: the postmodern turn in nursing ethics [28]	Subjective immersion	Attentive discernment and valuing of an individual as unique	Lack of meaninglessness
	Objective detachment	Care, respect, and personal responsiveness to the particular other	Relational narrative persons can coauthor an interpretation that may be more inhabitable than either of their individual narratives as they seek a new form of the good
Existential advocacy: philosophical foundations of nursing [3]	Sustained patient contact	Patient self-determination	Patient self-unity = lived body + object body
	Participation of the advocate as a unified individual	Holistic nurse engagement	Authentic decisions: decisions that are indeed one’s own express all that one believes critically about oneself and the world, and the entire complexity of one’s values
	Fellow-feeling: feeling the others’ feelings not just knowing it, nor judging that the other has it	Clarification of patient values	Lived objectness: nurses can assist the patient in recovering the objectified body at a new level
		Nurse mediates lived/object body duality
Nurses practice beyond simple advocacy to engage in relational narratives [31]	Nurse’s respect for patients’ unique experiences	Relational narratives allow persons to know the good they seek through their own accounts	Reaffirmation of personal values
	Nurse self-awareness		Awareness and exercise of the value of respect
	Respect for others requires that one tries to understand what it is for the other to live the life they live
Gadow’s contribution to our philosophical interpretation of nursing [4]	Patient self-determination	Intersubjective nurse relationship	Patient self-direction
	Patient request for advocacy		Determination of patients’ unique meaning which the experience of health, illness, suffering, or dying is to have for that individual
	Physical patient need or vulnerability	Mutual person-to-person relationships	Nursing truth: a truth that is born anew by the patient and professional together in each situation
Living as an oldest old in Rio de Janeiro: the lived experience told [23]	Patient as a unique human being	Patient self-determination	The patient determines meaning that guides self-determination
		Broad definition of autonomy: individuals may be dependent in one area while independent in others
		Holistic care	Existential care: the person providing care understands other persons’ subjective worlds and experiences union with them, such that the singularity of each of them emerges
		Intersubjectivity between nurse and patient
The role of advocacy in critical care nursing: a caring response to another [24]	Nurse’s moral alignment with the patient rather than the physician, next of kin, or hospital	Caring relationship: the nurse meets the private person behind the patient’s role	Ethical care
	Nurse’s courage
	Nurse’s cultural competence	Empowerment: educating with help and encouragement
	Nurse’s moral autonomy	Make room for interconnection to inform, translate, communicate, and collaborate
	Trusting environment
Existential caring in the family’s health experience: a proposed conceptualization [29]	Nurse-patient trust, fidelity, and sensitivity	Open-minded responsiveness to another’s needs as defined by the other	Nurse’s understanding of the family’s perspective enhances the context for moral agency
	Patient vulnerability	The ideal nature and purpose of the patient-nurse relationship guide caring
	Sense of professional obligation	Mutual interdependence in relationships	Ethical care
	Nurse confidence	Self-determination
Actualizing Gadow’s moral framework for nursing through research [25]	Patients and nurses freely decide the nature of their relationship	Protect patient self-determination	Patients feel autonomous motivation when practitioners bring more of their whole selves, interpersonal sensitivity, and respect for their patients
	Interpersonal care	Enhance patient subjectivity through advocacy
		Regarding the patient as a subject rather than as an object	Failure to honor patients’ self-determination led patients to feel practitioners had an “agenda” about smoking
Snapshots of experience: vignettes from a nursing home [26]	Nurse-patient relationship: the nurse must know the patient as a person	Relational care	Nurse-patient mutuality
		Individualized care
		Transpersonal nurse-patient relationship	Covenantal relationship (spontaneous and developed out of the process of the relationship, each relationship being different)
		Authenticity