Patient advocacy--an important part of the daily work of the expert nurse.

Over the past two decades, patient advocacy has been recognized as a part of nursing. For the most part, the issue has been treated by means of theoretical reasoning and case studies. Narratives describing lived experiences of nursing by expert nurses from Sweden were analyzed in this study. The nurses were identified by their superiors as expert nurses, as having a special gift, a "green thumb" for nursing. One third of the narratives concerned patient advocacy situations. The analysis of the narratives showed that the patient advocacy situation is composed of the following elements: a powerless patient, a problem concerning the patient's own will or what is good for him or her, and an adversary. Further, it includes a trigger situation, and a prompt decision and action by the nurse. The nurse acts out of conviction, accepts an additional work load, and takes the risk of being punished.