Nurses: An integral Part of Advocacy

Vulnerability is the core condition that requires patient advocacy. Vulnerability caused by illnesses as well as risks natural in the healthcare industry, demand advocacy action for patients and their respective families. So who provides this advocacy and how?

           

For many decades the expression ‘advocacy’ has described patient-nurse relationships. Thus advocacy has become an obligation, a key nursing role. Many models for advocacy in nursing are derived from philosophical writings of Curtin LL, The nurse as advocate: a philosophical foundation for nursing, and Gadow S., Existential advocacy: philosophical foundation of nursing. Both authors base advocacy models on “patients’ right to self-determination” and “nurses’ role in assisting patients to exercise this right.” Soon after, more practical models stated that patients must be allowed to make informed decisions and that the role of the advocate was to provide patients with necessary information and support their choices.  However advocacy also consists of the relationship that exists between patients, nurses, and other healthcare professionals present in the environment.

           

Although many models have been constructed regarding the role of a patient advocate, they all vary in their own interpretation of advocacy in the nursing practice. This unclear definition and lack of consensus concerning the true meaning of advocacy, what it involves, demands research; research that will help achieve a well-rounded definition of advocacy while simultaneously considering the perspectives of individual societies on advocacy.

In 2008 a study was conducted in a university hospital in Tehran, Iran in order to gain more information on advocacy in an Iranian society. According to Ahmadi et al, authors of The Meaning of Patient Advocacy for Iranian Nurses, approximately 24 nurses working in various wards in the hospital such as neonatal intensive care, oncology, ophthalmology, and more were recruited for interviewing. The interviews encompassed a broad question, ‘could you describe one of your working shifts?’, and continued as nurses were also asked to describe their experience with patient advocacy. Each interview lasted for about 40-75 minutes. The results of the experiment showed five primary categories Iranian nurses considered part of their role as advocates. These categories were:

• Informing and educating

• Valuing and respecting

• Supporting physically, emotionally and financially

• Protecting and representing

• Promoting continuity of care

Additionally, data analysis indicated that nurses believe their patients lack appropriate knowledge about their medical condition, its diagnosis, services available to them and their families etc.

Granted that numerous studies such as the one described above have been conducted in order to reach an agreement on the definition of advocacy, further research is needed to better understand the nature, risks, and types of advocacy. This understanding is crucial for nurses as patient advocacy continues to become an integral part of their practice.

Introduction to Patient Advocacy

Advocacy is defined as “the act or process of pleading for, supporting, or recommending.” Consequently, patient advocacy would be defined as “the act or process of pleading for, supporting, or recommending [advice] to a patient.” Knowing that advocacy is the process, the means by which a patient is supported, it is important to ask why they are needed. The necessity for patient advocacy rises when due to illness an individual’s self-rule, in other words autonomy, and the ability to make sound decisions are affected. Unable to take crucial decisions in their health care, patients are left vulnerable in the complex system and often fall through the cracks. For example Suzanne C. Beyea, author of Patient Advocacy Nurses Keeping Patients Safe, states an advocate is most needed when a patient is undergoing surgery or is too ill to function as his or her own advocate. She presents a scenario in which a patient discovers his bone tissue had been removed during a surgery even though he had explicitly spoken to his physician not to remove any bone. Once this patient was sedated and in surgery, no one served as his advocate and his wishes were ignored.  Similarly, many other clinicians independently decide what is in the best favor of their patient instead of cumulatively considering the desires of their patients. Thus patient advocates plead for and support the choices of patients. In addition, the American Hospital Association has put forth a document entitled Patient’s Bill of Rights in which it clearly states that “activities must be conducted with an overriding concern for the patient, and above all, the recognition of his dignity as a human being." However, patients are not the only ones who need advocates. According to Kathryn Schroeter, author of Ethics in Perioperative Practice Patient Advocacy, patient’s family members also need an advocate throughout the perioperative time. Oftentimes family members are highly dependent on their patient’s health care provider, placing complete trust in their decision making. Advocates for family members make sure the family’s concerns, voices, and preferences are heard and abided by alongside the decisions of the physician.

After establishing what is patient advocacy and why patient advocates are needed, it is important to question and explore who is able to become an advocate and how, what ethical issues stem from patient advocacy, and what sort of political issues surface as well. Furthermore how do institutions such as clinics, hospitals, and advocacy centers deal with patient advocacy. In the upcoming weeks these aspects of patient advocacy will be discussed in further detail.