Diffusion of the concept of patient advocacy

To examine the growth and diffusion through the USA and UK literature of nurses claims to patient advocacy.

A bibliometric analysis of articles cited under the key descriptor "patient advocacy" in the International Nursing Index (INI) was undertaken. Analysis included output in 5-year accumulations from 1976 to 1995, and was focused on quantity of output and exposition of concerns through interpretation of the titles. Citation mapping was undertaken to trace dominant influences in the diffusion process.

Titles and countries of origin of the journal along with year of publication were organized into a database to provide quantitative material on comparative output from the USA and the UK. Citation profiles of key influencing authors were examined.

A role in patient advocacy was proposed in the American nursing literature in the late 1970s and in the British literature a decade later. Support for the role was evident in its use in professional organizations and schools. The pattern of dissemination illustrates the influence of American nursing on the professional role of nurses in the UK.

On the basis of a stages model for diffusion of an innovation, patient advocacy has reached only preliminary stages of acceptance as an innovation in nursing.