The advocacy process in Canadian community health nursing: A collaborative ethnography.

Abstract

To shed light on the process of advocacy in the context of community health nursing, through a methodology inspired by the epistemologies of the South. We conducted a collaborative ethnography in a community health centre in Canada. de Sousa Santos' epistemologies of the South, a typology of advocacy and main themes from historic research informed the methodology. Data were collected between 2016 and 2018 through 420 h of fieldwork observations and three group discussions, including a collective process to co-construct interpretations with participants. Twenty-one nurses participated in the study. Nurses had sufficient work flexibility to practice advocacy actions focused on individuals and groups. They also engaged in attempts at policy reform in the form of defending access to appropriate care and changing the mode of care organization. However, these were curbed by bureaucracy and administrative rules, resulting in the eventual dismissal of health promotion actions and experiences of moral distress. Despite the political climate of their work environment impeding social justice agendas, nurses' advocacy practices showed a persistence of moral values and ideals in coherence with the regional nursing legacy. Acting at the organizational level and involving field nurses in decision making are potential avenues for increasing policy advocacy efficacy. Examining contexts through another epistemic lens and methods of research drawing on history and anthropology has shed light on a process of advocacy. This research shows that organizations need to equip themselves with mechanisms to promote the sharing of realities between nurses, thereby building collective advocacy. The research adheres to the EQUATOR guidelines with SRQR and COREQ methods. No patient or public contribution.