Abstract
BACKGROUND: Advocacy is a professional nursing responsibility [1,2], and refers to speaking up or empowering marginalised individuals or groups [3]. Nursing advocacy requires "tending" to the needs of the community in which care occurs [4], thereby addressing the social determinants of health [5]. In 2025, the International Council of Nurses (ICN) redefined nursing with a call to extend advocacy beyond individual needs [4]. There is, however, a dearth of frameworks grounded in nursing practice that guide nurses in initiating and sustaining advocacy initiatives across the health system. This study therefore sought to describe the diverse strategies used in nurse-led advocacy to develop a conceptual model for change from bedside to the system level.
METHODS: Descriptive qualitative design was used to describe how nurse-led advocacy is manifested in the stories of RCN-UK “Nurse of the Year” (2016-2023) awardees. Framework Method [6] involving familiarisation, identification of a thematic framework, indexing, charting, and mapping and interpretation were applied to synthesise nurse-led key advocacy dimensions.
RESULTS: The analysis resulted in the development of The TRIL Nurse Advocacy Model, a novel conceptual framework that posits that nurse-led advocacy comprises of three interconnected pillars: Transformative action, Relational co-design and Institutional Legacy. Transformative action highlights the nurses’ capacity for crises-responsive innovation, and revisioning practice standards. Relational co-design underscores the importance of cross-sector partnership, community-led empowerment and workforce inspiration, while the Institutional Legacy pillar emphasises the critical role of policy and resource formalisation, and sustainable system integration in ensuring lasting impact. The model also recognises the reality of a Context of Barriers which indicates the need for strategic navigation to overcome systemic resistance, creating sustainable healthcare outcomes.
Notes
References:
[1] Gaylord N, Grace P. Nursing advocacy: an ethic of practice. Nurs Ethics. 1995;2:8-11. doi:10.1177/096973309500200103.
[2] Košir M. A growing need for advocacy skills and knowledge in promoting population health and well-being. Int J Alcohol Drug Res. 2024;12:S71-5. doi:10.7895/ijadr.463.
[3] Cullerton K, Donnet T, Lee A, Gallegos D. Effective advocacy strategies for influencing government nutrition policy: a conceptual model. Int J Behav Nutr Phys Act. 2018;15:1-11. doi:10.1186/s12966-018-0716-y.
[4] International Council of Nurses. The ICN code of ethics for nurses. Revised 2021 ed. Geneva: ICN; 2021.
[5] World Health Organization. Social determinants of health [Internet]. Geneva: WHO; 2025 [cited 2025 Nov 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health
[6] Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117. doi:10.1186/1471-2288-13-117.
Sigma Membership
Chi Omicron
Lead Author Affiliation
University of Cape Coast, Cape Coast, Ghana
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Descriptive/Correlational
Research Approach
Qualitative Research
Keywords:
Policy and Advocacy, Global Leadership, Nursing Role, Patient Advocacy, Health Policy, Nurse-Patient Relations, Nurse Advocates
Recommended Citation
Abraham, Susanna Aba; Osei Berchie, Gifty; Anumel, Benjamin Kofi; Druye, Andrews Adjei; and Bosomtwe-Duker, Diana, "The TRIL Nurse Advocacy Model: A Practice-Grounded Framework for Sustainable Health System Change" (2026). International Nursing Research Congress (INRC). 46.
https://www.sigmarepository.org/inrc/2026/presentations_2026/46
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-24
The TRIL Nurse Advocacy Model: A Practice-Grounded Framework for Sustainable Health System Change
Toronto, Ontario, Canada
BACKGROUND: Advocacy is a professional nursing responsibility [1,2], and refers to speaking up or empowering marginalised individuals or groups [3]. Nursing advocacy requires "tending" to the needs of the community in which care occurs [4], thereby addressing the social determinants of health [5]. In 2025, the International Council of Nurses (ICN) redefined nursing with a call to extend advocacy beyond individual needs [4]. There is, however, a dearth of frameworks grounded in nursing practice that guide nurses in initiating and sustaining advocacy initiatives across the health system. This study therefore sought to describe the diverse strategies used in nurse-led advocacy to develop a conceptual model for change from bedside to the system level.
METHODS: Descriptive qualitative design was used to describe how nurse-led advocacy is manifested in the stories of RCN-UK “Nurse of the Year” (2016-2023) awardees. Framework Method [6] involving familiarisation, identification of a thematic framework, indexing, charting, and mapping and interpretation were applied to synthesise nurse-led key advocacy dimensions.
RESULTS: The analysis resulted in the development of The TRIL Nurse Advocacy Model, a novel conceptual framework that posits that nurse-led advocacy comprises of three interconnected pillars: Transformative action, Relational co-design and Institutional Legacy. Transformative action highlights the nurses’ capacity for crises-responsive innovation, and revisioning practice standards. Relational co-design underscores the importance of cross-sector partnership, community-led empowerment and workforce inspiration, while the Institutional Legacy pillar emphasises the critical role of policy and resource formalisation, and sustainable system integration in ensuring lasting impact. The model also recognises the reality of a Context of Barriers which indicates the need for strategic navigation to overcome systemic resistance, creating sustainable healthcare outcomes.
Description
The study presents the development of the TRIL Nurse Advocacy Model; a framework grounded in nursing practice. Descriptive qualitative design and Framework Method were applied to analyse seven initiatives of the RCN-UK "Nurse of the Year" awardees (2016-2023). Findings revealed three pillars; Transformative Action, Relational Co-design and Institutional Legacy, and a Context of Barriers nurses must navigate. The model provides a structured approach for nursing practice, education and research.