Advocacy and Exercising Moral Judgement - Literature review Example

Advocacy and exercising moral judgment Name of the Student: Name of the Instructor: Name of the course: Code of the course: Submission date: Advocacy and exercising moral judgment Introduction The concept of advocacy in the realms of law can be perceived to trace its roots in the 14th C French word ‘advocacie’ which refers to pleading for or supporting. The core role of advocacy in the legal undertakings emanated whereby lawyers represented their clients in courts and engaged in verbal activities geared towards persuasion and justified arguments (Jugessur & Iles, 188). The concept of advocacy has thus gained increased prominence in the health and social care contexts with elevated relevance in issues related to poverty, disability and the status of the minority among other issues. This fact is supported by Jugessur and Iles (187) who determined that in the recent decades, client advocacy, which is done alongside rights and empowerment has evolved into becoming an integral concept in the realms of policies and healthcare reforms across diverse countries in the globe. Consequently, as a central concept in the practice of international nursing dominated extensively by nursing concepts and theories from western countries, advocacy has gained elevated eminence in Europe, America and the Asian-Pacific region with the rights of clients being underpinned in both legislations as well as healthcare reform policies. Majority of these reforms are profound reflections of a change of the clients’ rights in regard to the modern efforts aimed at consumer pre-eminence and empowerment (Jugessur & Iles, 188). Against this background, this paper will focus on the context of advocacy on behalf of the client as part of the role of the nurse. This is against the call by the International Council of Nurses encouraging nurses across all the countries in the world to make profound efforts to promote advocacy as one of their chief roles. The context of advocacy in nursing Hanks (469) cited that advocacy in nursing is a moderately new concept that was initially initiated in the 1970s and became a renowned constituent of the practices in nursing in the 1980s. The primary rationale behind its increasing prominence is founded on the fact that nurses are perceived as being in a suitable niche for the advocates’ role based on their elevated amount of time that they are usually in direct contact with the patients when juxtaposed with other professionals in healthcare (Hanks, 255). In the wider healthcare, the concept of advocacy is viewed to be exclusively associated with vulnerable clients who as a result of their ill health have inadequate capacity to express their concerns to the healthcare professionals. Nonetheless, it is imperative to be cognizant of the fact that the most considerable justifications behind the demand for advocacy in nursing vary between different countries. For instance, in the UK, advocacy has been perceived as being necessary based on the detrimental errors made by the professionals in the healthcare sector culminating in serious lack of confidence in this system. On the other hand, nursing advocacy in the US has been as a result of combined of factors mostly emanating from the failure of the healthcare system to fully meet the needs of the patients and a robust emphasis on human rights (Jugessur & Iles, 190). Thus, the overtime transformations in the healthcare sector across different countries has seen the increased necessity for nurses to engage in advocacy, either individually or collectively in order to comprehensively address matters which are endowed with extensive ethical and moral significance. The relationship between advocacy and autonomy The concepts of advocacy and autonomy in the realms of nursing have been perceived to have an inherent relationship. Autonomy in the nursing profession can be perceived in two folds; firstly, the autonomy of the nurses themselves and secondly, the autonomy of the patients. Both of these approaches have extensive impact in shaping the course, magnitude and direction of advocacy in nursing. To begin with, the context of autonomy best epitomized by the fact that the hierarchy of power, particular roles and responsibilities as specified for the nurses, fear, fatigue and burn-out, frustrations, inadequate professional autonomy and the overall atmosphere of secrecy in the healthcare sector has been credited for making the undertakings of advocacy among the nurses very difficult and in some cases practically impossible. This is despite the robust moral and ethical pressure for the nurses to engage in advocacy (Yliopisto, 17). The above phenomenon has been credited for the large numbers of nurses leaving the healthcare sector based on a deep sense of professional, ethical and moral distress as well as the inherent inadequacy of support from the organizational level and a sense of poor autonomy capacity at their professional undertakings (Yliopisto, 9). In other words, for there to be effectiveness and efficiency in the efforts aimed advocacy by nurses towards increased equality in the allocation of resource, equal treatment of patients as well as adequate adherence to the basic human rights of the patients, there is also a need for increased advocacy on the nursing profession. Thus, it is imperative for the nurses to gain a comprehensive understanding and can adequately validate their scope of practice in healthcare. This is based on the fact that this greatly determines their level of professional autonomy in the wider healthcare sector and in the larger society. Therefore, if the nurses are to gain increased success in empowering their patients, they ought to first empower themselves in the light of having the adequate opportunity of independently making choices in healthcare without being obliged by external pressure (Yliopisto, 9). On the other hand, Jugessur and Iles (190) revealed that to a great extent, the practice of nursing entails constant contact and interaction with people who are often characterized by the inability to apply their autonomy based on their extensive vulnerability which can be attributed to age, disability and illness. In this sense, the autonomy of patients is mostly alienated when they mentally ill and incapable of making rational decisions. In this case, the nurses are often perceived as an integral link or bond between these patients who are highly vulnerable and their families and the overall decision making process. This is through undertaking the role of advocacy aimed at optimizing the level of patients’ autonomy (Jugessur & Iles, 190). Thus, autonomy in the above context can be perceived to mean endowing the patients with adequate information in regard to the variety of choices and options that they have in relation to the care and treatment available and in the process having the capability of making rational decisions. In this case, the nurses play a vital role in ensuring that ethical and moral standards are upheld in the process of empowering the level of patients’ autonomy (Jugessur & Iles, 190). The role of the nurses in elevating the autonomy of patients has experienced immense prominence in nursing practice in the recent times. This fact is supported by Davies and Elwyn (315) who determined that promoting the autonomy of the patients has become central in different encounters in the delivery of health services. The above context is exemplified in the theory of ‘existential advocacy’ which is a philosophical model in the realms of nursing advocacy and concretely founded on the humanistic theory of nursing. Thus, this is often perceived as being integrated in the core roles and responsibilities in nursing whereby there is an intrinsic involvement of the nurses in terms of undertaking their designated mandate in partnership with the patients aimed at enhancing the level of autonomy among them (Jugessur & Iles, 190). Thus, the role of the nurses in enhancing the patients’ autonomy entails comprehensively explaining the medical information to them, assisting them in the process of analyzing and interpreting the alternatives and choices available to them and helping in explaining the beliefs, values and perspectives of the patient to other healthcare practitioners. Through this process, the patients are empowered into becoming more self-determining and are endowed with increased freedom and liberty to determine the eventual nature and course of the care that will be given to them (Jugessur & Iles, 191). Actual and potential costs of advocacy Majority of the nurses have in the recent past become mindful of the fact that individuals and collectives who are exposed to inequality in healthcare in relation to their socio-economic and political orientations have the rudimentary right of making formidable contributions to the policy making process on issues that affect the distribution of resource, mostly in healthcare (Murphy & Russell, 40). This can be perceived as a major contributor of increased advocacy in majority of the countries which are confronted by the challenges of inequality in the healthcare system. Nonetheless, there are extensive costs of advocacy in nursing both at the professional and personal level. This is based on the fact that advocacy entails speaking, fighting for and even standing up for the patient and in most cases, acting on behalf of a patient in case of violation of ethical or moral standards in the larger healthcare system. This often poses massive impacts on the nurses engaging in advocacy, both at the professional and personal level. At the professional level, Hanks (1) cited that majority of the nurses perceived the costs of nursing advocacy as a professional or career quandary or a risk taking process which is uncalled for. This is based on the fact that it can sometimes result in lowering of the nurse’s status and in some extreme cases culminate in punishment in case of the course of advocacy taking a wrong turn and jeopardizing the state of the healthcare system. This is epitomized in a situation whereby in case nursing advocacy results in an instance of violation of a patient’s rights leaking into the media and resulting in a marred reputation of the medical facility, this can go to the extent of costing the nurse his/her job. The above scenario represents a probable cost of nursing advocacy both to the individuals or collectives engaged in advocacy as well as different medical facilities. On the other hand, Jugessur and Iles (192) determined that in a case whereby a nurse is trying to promote the level of autonomy of the patient in helping him/her to make rational decisions in regard to the course of care that he/she will receive, there is a probability of conflict of interests and moral stands with other medical practitioners. This fact is supported by Johnstone (36) who cited that moral conflicts and disagreements often occur in the context of healthcare. In such a case conflicts of interest also arises between the right of the clients to autonomy and on the other hand the legal and professional duty and responsibility of the nurse to healthcare. For instance, if a nurse decides that it is in the best interest of the patient to utilize negotiation and persuasion of a mentally ill patient aimed at averting potential harm both to the patient and to the public, this can result to the nurse being accused of portraying a paternalistic behavior (Jugessur & Iles, 192). This can be attract sanctions and pose diabolical costs to the professional development of the nurse. At the personal level, Hanks (1) argued that even effective nursing advocacy is often associated with extensive feelings of anger, frustrations and can even go to the level of disrupting the relationship with other peers in the working environment with some peers being eventually labeled as disruptive. In such a case, advocacy in nursing can be viewed as resulting in disrupting personal relationship of the nurses with their peers. In addition, long-term exposure to anger, frustrations and distress in the advocacy process can culminate in ‘emotional imbalance’ of the nurses and they can lose commitment to their work or even abandon their jobs altogether. At a personal level, this can be detrimental to their socio-economic stability and even that of their dependents. This has been perceived as a very potential cost of advocacy mostly when there is an overall phenomenon of lack of organizational support in upholding the ethical and moral standards of the clients in the healthcare system. Guidance provided for nurses via the ANMACcompetencies and/or Codes of Conduct and Ethics It is imperative to be cognizant of the fact that the legal framework which shapes the nursing practice includes the civil requirements in common law as well as statute law and the provisions as embedded in the registration statutes, codes of conduct. This is not to forget other advice through registering authorities. In addition, there are the industrial prerequisites and sanctions and criminal sanctions (Iliffe, 78). For instance, in Australia, the nurses are bound by standards of conduct as entrenched in different documents published by the Australian Nursing and Midwifery Council (ANMC) (Johnstone, 1). There are several provisions which guide the advocacy of nurses in the ANMAC competencies and/or Codes of Conduct and Ethics. Firstly, according to ANMC (5), there is a provision which guides the practice of nurses in promoting the autonomy of patients which is directly related to advocacy as analyzed in a preceding section. This is whereby in a case where the nurse provide advice to the patient in regard to products or the overall care, they are permitted to offer a full explanation in regard to the merits and demerits of alternative care so that the patients are endowed with an ideal opportunity of making informed and rational choices. Nonetheless, the nurses are supposed to desist from engaging in acts geared towards exploitation, misrepresentation and misinformation with regard to the various products and the overall healthcare being offered to the patients in their advocacy and patients’ empowerment efforts (ANMC, 5). In addition, in situations whereby the patients who are under healthcare are unable to speak independently due to various factors such as age (for instance, children) or mental state, the nurses are permitted to ensure that the viewpoint of these patients is represented in an appropriate way through effective advocacy (ANMC, 5). Similarly, according to the College of Registered Nurses of Nova Scotia (11), the nurses are mandated with the role of coordinating the resources which are geared towards promoting quality healthcare to all the patients, for instance, human, educational and physical resources.This is a robust platform for the nurses to engage in extensive advocacy to ensure equality in healthcare systems. Moreover, there is a provision thatpermits the nurses to participate in as well as offer their support to the formulation as well as implementation of policies which are central in ensuring that the rights of the clients in the healthcare system are adequately respected in the course of care provision (College of Registered Nurses of Nova Scotia, 11). Thus, the eventual participation of the nurses in the policy making process places them in a favorable niche in their efforts of advocacy. Lastly, there is a provision that guides the nurse educators engaged in the advocacy process which states that the nurse educators are mandated with the role of promoting a learning environment which is central to the efforts of supporting client advocacy (College of Registered Nurses of Nova Scotia, 11). Thus, all these provisions in the code of conduct and ethics as well as ANMACcompetencies to some extent guide the advocacy process of nurses in different healthcare systems. Conclusion From the preceding discourse, it is evident that nursing advocacy has received elevated prominence in the recent years since it was instigated in the 1970. On the other hand, the concrete interconnection between advocacy and autonomy has been explored from the nurses’ perspective and the patients’ viewpoint. Nonetheless, it is also apparent from the analysis that nursing advocacy has extensive costs to individuals and collectives, both personally and professionally. Lastly, it was evident that there is some sought of guidance provided for nurses via the ANMACcompetencies and/or Codes of Conduct and Ethics in regard to advocacy and exercise of moral judgment by the nurses. Works cited Australian Nursing and Midwifery Council. Code of professional conduct for nurses in Australia. ANMC. 2008. Web. 02 October, 2012. College of Registered Nurses of Nova Scotia. 2012 Standards of Practice for Registered Nurses. CRNNS. 2011. Web. 02 October, 2012. 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Murphy, N. and Russell, Aquino. “Nurses Practice Beyond Simple Advocacy to Engage in Relational Narratives:Expanding Opportunities for Persons to Influence the Public Space.” The Open Nursing Journal, 2.1 (2008). 40-47 Yliopisto, Turun. “Nursing Advocacy:A concept clarificationin context of procedural pain care.” PhD thesis. University of Turku, Finland, 2008. Print. Read More