The proposed mid-range theory may be useful in guiding advocacy practice in nursing and in guiding research in the advocacy area. The proposed theory needs to be furthered refined and tested in the future.

More education related to ADs is needed and could be administered through in-service classes or continuing education. Nurses' responses indicated that they need more time to assist patients with completing ADs. This is difficult in the current practice environment but must be recognized as critically important.

Nurses' patient advocacy can influence patient outcomes. There is a lack of reliable and valid instruments on patient advocacy. The purpose of this study was to develop an instrument to measure nurses' attitudes toward patient advocacy. Bu and Jezewski's theory of patient advocacy and Fishbein and Ajzen's definition of attitude were used to guide the development and evaluation of the scale. Seven experts evaluated scale content validity. Two samples (N = 200; N = 2,500) were randomly selected from the Oncology Nursing Society membership to allow us to examine psychometric properties of the scale. The scale possessed satisfactory psychometric properties.