Exploring the Conditions and Strategies That Lead Nurses to Advocate for Elderly Cancer Patients in the Perioperative Intensive Care Unit: A Qualitative Study.

Background/Objectives: Elderly cancer patients in perioperative intensive care units represent a highly vulnerable population due to complex medical needs and physiological challenges. In these high-pressure settings, nurses play a crucial role as patient advocates to ensure well-being and person-centered care. However, there is limited understanding of how nurses operationalize this advocacy role for this specific patient group. This study aimed to explore the conditions and strategies guiding nurses in advocating for elderly cancer patients in perioperative ICU contexts. Methods: Using a Grounded Theory approach, six nurses with direct experience in caring for elderly cancer patients in an oncology institution were recruited. Data were collected via in-depth semi-structured interviews, participant observation, and field notes. Analysis followed the constant comparative method and was supported by MAXQDA software to systematically identify codes, dimensions, and categories, highlighting essential elements of nursing advocacy. Results: Advocacy emerged as a central nursing function, serving both practical and ethical imperatives. Conditions activating advocacy included patients' complex vulnerability, threatening dignity, mitigated by the family's anchoring role. Institutional barriers, such as professional devaluation and staffing shortages, often hindered advocacy, resulting in moments of "failure to advocate." Strategies formed a dynamic process: beginning with in-depth knowledge, progressing through communication mediation, and culminating in direct action. Conclusions: This study contributes to the development of a data-driven theory that deepens the understanding of nursing advocacy in perioperative intensive care for elderly cancer patients, offering valuable implications for practice, education, and policy development, ultimately supporting optimized care delivery and improved patient outcomes.