The nature of advocacy vs. paternalism in nursing: clarifying the 'thin line'.
OBJECTIVE
This paper is an exploration of the concepts of advocacy and paternalism in nursing and discusses the thin line between the two.


BACKGROUND
Nurses are involved in care more than any other healthcare professionals and they play a central role in advocating for patients and families. It is difficult to obtain a clear definition of advocacy, yet the concepts of advocacy and paternalism must be compared, contrasted, and discussed extensively. In many situations, only a thin line distinguishes advocacy from paternalism.


METHODS
A literature search was conducted using PubMed and CINAHL databases (2000-2008) as well as a library catalogue for texts.


CONCLUSIONS
Four case stories were described in order to discuss the 'thin line' between advocacy and paternalism and develop communication strategies to eliminate ambiguity. Weighing the ethical principles of beneficence and autonomy helps to clarify advocacy and paternalism and provides an avenue for discussion among nurses practicing in a variety of settings.


CONCLUSIONS
Advocacy and paternalism should be discussed at interdisciplinary rounds, and taken into consideration when making patient care decisions. It is difficult to clarify advocacy vs. paternalism, but strategies such as knowing the patient, clarifying information, and educating all involved are initial steps in distinguishing advocacy from paternalism.


CONCLUSIONS
Truly 'knowing' patients, their life experiences, values, beliefs and wishes can help clarify the 'thin line' and gain a grasp of these difficult to distinguish theoretical concepts.
Zomorodi
Meg
M
School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA. meg_zomorodi@unc.edu
Foley
Barbara Jo
BJ
D000293:Adolescent; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007400:Interprofessional Relations; D008297:Male; D024802:Nurse's Role; D009723:Nurse-Patient Relations / Q000941:ethics; D015399:Nursing Research; D026706:Paternalism / Q000941:ethics*; D010344:Patient Advocacy / Q000941:ethics*; D026684:Personal Autonomy