Nursing Advocacy - Essay Example

Introduction The origin of advocacy is the Latin word advocatus, which means one who is called to support another. An advocate is a person who speaksin support of another. If the nurses are required to act as advocate of their clients, this means literally that they are ethically required to advocate or to speak or write for a cause or issue related to their parents. This quality of the nurses is known as advocacy, and current literature means the process of advocating by this term. Relevant nursing literature has indicated that there are certain important themes related to advocacy (Brechin and Brown, 2000, p17). As evident in the study by Malik (1997), advocacy has been a traditional role with ethical implications applicable for nursing practice. In any healthcare team, nurses have maximal contact time with the patient, and their practice centres not only the biological issues, also the psychosocial aspect of health which is person-centred. Therefore, their interactions with the patients would also examine the individual aspects (Malik 1997). Thus within the healthcare team, nurses are in the best position to practice advocacy. For the part that the nurses play in patient care, their knowledge in advocacy is natural, and quite often the client interest is so prominent in any healthcare scenario, nurses and clients may become partners in advocacy (Baldwin, 2003). However, this does not mean only the nurses need to practice advocacy, it is the ethical license for all varieties of health care professionals. It can be very easy to understand, the role of nurses as advocates is lightened much if all other professionals act with awareness of the need for advocacy (Brechin and Brown, 2000, p 23). However, it is a fact that anything implemented in practice is not 100% fool-proof. It is a must that even the best of practice would have some negative and unacceptable implications. This has led to the controversy as to whether nurses should act as client advocates. In the literature there are indications that in any case scenario where advocacy is implemented, there may be conflicts between legal, ethical, and professional issues. Acting as an advocate for a client definitely enhances the therapeutic relationship between the nurse and the client, which in itself may be an indicator of access to healthcare (Brechin and Brown, 2000, p 37). However, unlimited advocacy always has it adverse effects. In this assignment, the advantages and disadvantages of nursing acting as advocates of their clients will be critically examined, and issues related to nursing practice will be critically reviewed in order to update knowledge and to examine its congruence to the theoretical framework. The prime duty of the nurses is to maintain professional standards in practice. While doing that within the ethical framework, the health and safety of these patients must be ensured first. Concomitantly, the rights of the patients need to be protected. The nurse's role here is to promote, advocate, and strive to protect all these. This means nurses must advocate for the appropriate healthcare environment with provision for auditory and physical privacy. This could ensure confidentiality which is a basic right of the patients (Breeding & Turner, 2002). Theoretically speaking, advocacy needs skills such as necessary for standard nursing practice. To be able to advocate the cause of the client, the nurse needs to have capability of attentive listening, problem solving, decision making, negotiating and bargaining, ability to resolve conflicts with requisite extent of perseverance (Giddings, 2005a). All these, in turn, are possible only with the nurse's verbal and nonverbal communication. There are certain other traits of a nurse, which make her the best advocate for her client. Chafey and colleagues (1998) indicated that these traits are being empathetic, nurturing, ethical, objective, and assertive (Chafey et al., 1998). Luther (2000) indicated that along with these the attributes of self-awareness, open-mindedness, a broad knowledge base, self-confidence, and cultural competence are also necessary. It is to be noted that by ensuring standards of care, the nurses through their advocacy for clients would promote and ensure quality of healthcare delivery system and professional competence (Luther 2000). This means while advocating their patients' causes their main objective would be to ensure the most efficient and state of the art care (Greggs-McQuilkin 2002). While it is acknowledged that advocacy is integral to good and standard nursing practice, and there is evident proof in literature that is is still relevant to profession. However, often administrative evils create barriers to its implementation. It is often expected that nurses will extend the scope of professional advocacy beyond the individual levels to the community and social levels as far as health is concerned. Peculiarly, advocacy is often absent at the policy level, whereas it is expected to be a logical extension of patient level advocacy (Carney, 2004). This creates a conflict, and sometimes nurses even though well intentioned and willing to implement the principles of advocacy at all levels, often fail to exercise these principles in actual practice. Indeed, there are many barriers present in the healthcare environment that make advocating difficult. Short staffing, knowledge deficits, power differentials, fatigue, fear, and lack of support are a few of them (Brechin and Brown, 2000, p 64). When the nurse advocates for patients, if the organisational hierarchy does not support it at policy levels, often she is misinterpreted. The nurses' loyalty to the organisation may be questioned since advocacy may be needed out of a conflict of interests between those of the patients and the hospitals. The ethically sound nurse advocating her patients' cause may be reprimanded due to the impression that she is merely a trouble maker. These outcomes may be morally disheartening, and in order to minimise these, the nurse must be familiar with the organizational structure, lines of authority, job descriptions, ethics committee, grievance procedures, and disciplinary processes where she works. These situations may have tremendous professional implications, but one theme is clear, the nurse must have a very sound communication skill in order to be able to encounter these problems effectively (Brechin and Brown, 2000, p 73). The nurse as an advocate of patients' cause, debate has always been there as to whether the nurses need to practice advocacy at all. While some authors consider advocacy to be integral component of nursing practice, since conceptually it is the philosophic foundation or the crux of ideals involved in nursing practice, some authors strongly recommend against it. They have also raised questions about its appropriateness in the context of healthcare due to the fact that this contradicts autonomy in that paternalistic attitudes are favoured by these. Moreover bias to self on the part of nurses cannot be totally eliminated. Some authors have noted in the place of advocacy, the nurses may foster self-serving professional motivations in the name of advocacy for clients. Moreover, a patient needing advocacy is presupposed to be vulnerable, and in a really hostile context, some professionally unjust responses may be instigated against the already vulnerable client (Giddings, 2005b). Although literature has not been able to indicate what the nurse should do in a particular situation involving a client where his rights need to be protected, his values need to be preserved, and his personhood needs to be defended, there is no clear-cut guideline regarding the actions of the nurses (Chapman, 2001). These can have many implications. For example protection of rights of a client gives a primarily legal understanding of advocacy. This does not necessarily mean that the nurse is professionally qualified enough to plead for the cause of the client. All conceptual models of advocacy take clients' vulnerability in the practice scenario to be primarily significant. Therefore factors that are compromising the interests of the clients are perceived to be essentially detrimental to the goals of the clients. The nurse is supposed to advance these rights on behalf of the client in the context of the care team (Davenport-Ennis et al., 2002). Although it may appear discouraging, advocacy has several positive implications on practice, its standards, and client experiences. The nurse advocacy on preservation of values of the clients actually focuses on empowerment and enablement. This also ensures the client is paid due regard in the clinical decision making. This also ensures that the client autonomy is exercised and preserved in the clinical decision making. This is evident in several day to day clinical scenarios (Dalyrymple, 2004). Taking into account the example of pain management, it is often noted that in most cases a multidisciplinary team decides the analgesic management schedule based on clinical criteria which frequently results in inadequate pain management. In such cases, the nurse's responsibility is to advocate for the patient to achieve a pain level satisfactory to the patient. The disagreement often occurs between the nurses and the physicians. Although the physician is traditionally known as a better judge of signs and symptoms of pain, the nurse has sole right to decide what level of pain would be tolerable for her client. In such situations drawing the notice of the treating physician is an act of advocacy, and although criticised severely, the nurse requesting a larger dose of pain medication is advocating the cause of the patient and is attempting to improve the patient experience. The nurse in a way is also advocating the cause of the institution who may enter into a liability issue for failure to treat the pain adequately. In this scenario, pain being a subjective symptom, patient's self-report is the single most important indicator of pain or pain relief. Therefore, it must be advocated that the patient must be involved in decision making. However, advocacy as a nursing ethical principle comes with its own share of knowledge that the nurse must master before advocating. It is important for the nurse to become familiar with the policies on pain management in the institution, particularly as they relate to lines of authority and accountability for pain management. The nurse then can refer to the assessment process to be used and the time frame for appropriate response by members of the healthcare team (Foley et al., 2002). It is evident that the nurses' advocacy in the context of the patients' involvement in decision making may be compromised by the temporary inability of the client to engage in decision making or by the paucity of knowledge. To be able to help the patient make informed decisions, it becomes imperative for the nurse to counsel and educate the patient so the patient can form his own decisions. This decisional counseling is only possible if the nurse has sound and clear knowledge about the client's condition, its interpretations based on the most recent evidence from literature, and a very effective skill in communication, all of which can successfully empower the client to make his own decision and influence his own care (Falk-Rafael, 2005). Some other model of advocacy has proposed a relational and existential model of advocacy. This contends that advocacy should be directed at exploring the true meaning of the client experiences on healthcare but at the same time this experience must be dominated by right to self-determination. The nurse in these states must behave as a part of the client, not just a professional assigned with care responsibilities. The nurse's participation as a whole with the patient in these processes based on the relationship that the nurse develops may ensure adequate advocacy (Evans, 1999). In reality however the nurse often holds an intermediate position between the healthcare team and the patients. As a result, they are exposed to both the perspectives leading to unique knowledge from these practice scenarios. This unique knowledge, if the nurse intends to, can be used to create a negotiated understanding between these different perspectives, which should be aimed at the benefit of the client. In that sense, this process of negotiation must be executed in a very articulate manner so the nurse does not lose her position in the care team yet play the advocate of her client (Brechin and Brown, 2000, p 79). One can understand how resources may play important roles in implementation of such advocacy. Advocacy must be a customised process in the context of the clinical scenario. The nurse must gain some unique knowledge about the patient and his care, which will motivate her to advocate for her client if there is a lapse (Grace, 2001). This needs research, academic knowledge, knowledge about the policies prevalent in the organisation, and treatment and care framework. In most of the cases, the practice scenario is different. Resources and time both are limited. An overburdened nurse has merely any time for such though processes where independent thinking out of the traditional measures may provide a ground for advocacy (Estabrooks et al., 2005). Advocacy is always disadvantageous unless the nurse is prepared enough to be an advocate. The issues will be discovered only through a time-consuming process of relationship building. A thorough understanding of the client condition is only feasible if the nurse can corroborate clinical condition with the theories and evidence. Over the top of that, the nurse must be skillful enough to present these issues to the concerned to lead to a change in practice. Otherwise advocacy would be just a fruitless exercise with all the probabilities that the nurse is projected as undisciplined within the organisation and the care team (Greggs-McQuilkin, 2002). This means that straight thinking in nursing advocacy is very elusive. It is nowhere indicated what are the expectations from the nurses who advocate their patients' causes. It is very difficult to imagine what would be expressions or actions of the nurses who develop a therapeutic yet personal relationship with their clients. In this context, the concept of social justice relevant to nursing advocacy can be examined. Even in the developed systems of health care, there are still disparities and marginalisation. Nursing advocacy is required to insist on change. Policies play important roles to facilitate nurse advocates' roles (Griepp, 2002). This means also a role beyond the healthcare setting, where the nurses are needed to encompass care which would tend the meet the needs and rights of the families and patients, both. The nurses' advocacy efforts may then intend to influence changes in the relationships and structures within the healthcare systems leading to help of the downtrodden. In an hostile system, this may be viewed as criminal, and the system's response to these advocate nurses and their patients may tend to marginalise them. In such situations, the nurses may start believing that if anything is wrong, it is their personal belief system. They may start considering their moral systems to be inconsistent with the prevalent values in the care context. There is chance in such scenarios for the nurses to bend or distort policies for the cause of their patients leading to surreptitious or subversive forms of advocacy which in all cases are contraindicated (Halpern, 2002). Conclusion As indicated in this essay, advocacy on the part of the nurses in the practice scenario has its own advantages. Advocacy strengthens the other ethical principles of clinical practice such as autonomy, empowerment, and person-centred care. Although this presupposes the patient to be vulnerable and promotes a paternalistic attitude, this may foster quality and standard of care. The patient's involvement in care processes makes the care outcomes and experiences very satisfactory for the patient and the family. Although advocacy is based on basic moral principles of care in nursing, there is hardly any policy guideline to suggest the nursing actions to promote advocacy. This leads to a situation where the nurses determine their own actions which may lead to disadvantages for the patient and nurse both. Through the critical analysis of the theoretical frameworks for nursing advocacy, it is evident that if the nurse aspires to update her knowledge about the patient's condition, knows how to remain in the organisational framework, desires to update evidence from research, and is skilled in communication, advocacy may really be a tool for quality assurance in nursing care. References Baldwin, M. A. (2003). Patient advocacy: Aconcept analysis. Nursing Standard, 17(21), 33-39. Brechin A. and Brown., E. (2000) (eds.) Critical Practice in Health and Social Care. Sage: London. Breeding, J., & Turner, D. (2002). Registered nurses' lived experience of advocacy within a critical care unit: A phenomenological study. Australian Critical Care, 15(3), 110-117. Carney, M. (2004). Perceptions of professional clinicians and nonclinicians on their involvement in strategic planning in healthcare management: Implications for interdisciplinary involvement. Nursing and Health Sciences, 6, 321-328. 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Advocacy-the cornerstone of professional nursing. ORLHead and Neck Nursing, 18(4), 4-5. Mallik, M. (1997). Advocacy in nursing-a review of the literature. Journal of Advanced Nursing, 25(1), 130-138. Read More