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Learning Objective #1: describe advocacy as it relates to end-of-life nursing practice.

Learning Objective #2: discuss the study's research design, implementation, and results pertaining to nurses' perceptions of advocacy behaviors in end-of-life nursing care.

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Nurses advocate for patients in every practice setting and it is an inherent part of all professional nursing curricula. Nursing professionals are in key positions to support end-of-life care decisions and advocate for patients and families across all health care settings. The purpose of this comparative descriptive study was to describe nurses' perceptions of advocacy behaviors in end-of-life nursing practice. The novice to expert process and the seven domains of a caring practice helped to develop a clearer understanding of the power of advocacy (Benner, 1984) to assist the patient and family to overcome barriers impeding their end-of-life care. This study used a naturally occurring practice setting of three regional hospitals to describe the perceived advocacy practice behaviors in end-of-life nursing care among novice, experienced and expert nurses. The convenience sample consisted of 317 practicing nurses, with the majority reporting frequent contact with dying patients. Participants indicated considerable agreement with perceived advocacy behaviors in end-of-life nursing practice with no significant differences among novice, experienced and expert nurses. Despite the recent emphasis on end-of-life nursing education, practicing acute-care nurses report modest exposure to end-of-life training. The perception of hospital supports to advocacy practice was modest. Three substantial supports identified by the participants included nurse managers, co-workers and multi-disciplinary services. The study participants described considerable barriers to their advocacy practice including the physician, the patient's family and fear. This study added to the empirical data base and its findings were congruent with the literature in that the majority of nurse participants agreed that they practiced advocacy behaviors, despite the reported barriers. A cross-method triangulation served to strengthen internal validity by measuring the concept of advocacy from two approaches.