The Requirement for Nurses - Term Paper Example

Client Advocacy in Nursing Introduction Nursing often involves dealing with problems which are of a moral or ethical nature. Two essential constituents of nursing ethics are: respect for autonomy and the nurse as patient’s advocate. These are based on the requirement for nurses to avoid imposing one’s own belief on others and to develop the role of advocate (Rumbold, 1999). Client advocacy along with accountability, collaboration, and caring are the moral concepts that form the foundation for nurses’ ethical and principled decision making. Advocacy which refers to the active support of an important cause, can be defined in the nursing context as a legal concept for the nurse’s role in relation to a patient’s human and moral rights within the healthcare system. Advocacy is also the ideal expressed in nursing in the assistance of clients in the exercise of self-determination; or it may be interpreted as the moral concept that defines how nurses view their responsibilities to the patient (Bishop & Scudder, 2001). Thesis Statement: The purpose of this paper is to define and examine the issues of client advocacy with respect to nursing, relate the concept of client advocacy with ideas of care, cure and nursing practice, and determine how client advocacy, nursing practice and moral theory are interrelated. Discussion Both ethics and morals in nursing refer to “the general area of the rights and wrongs in theory and practice, of human behavior” (Rumbold, 1999: 2). Since theoretical and practical problems combine together in nursing, it is essential that a framework for decision making has to include practical problems. Moral theory in nursing is distinctive and is not related to traditional medical ethics derived from the Hippocratic tradition. The concept of ethics or morals in nursing focuses on human actions, their effects and the value of those actions. A moral framework helps to formulate answers to questions, deal with issues and dilemmas to consequently guide actions. Client Advocacy in Nursing The concept of advocacy has long been an intrinsic part of nursing. The two important concepts of client advocacy are courage and heroism. Advocacy is also the means by which the nurse participates with the patient in determining the meaning that the experience of illness, suffering or dying has for that individual. The ethical principles of fidelity and respect for human dignity form the basis of the advocacy concept. As an important aspect of nurse ethics and primary ethical responsibilities, it also includes what nurses do to protect human dignity, privacy, preference and well-being of the patient (Bishop & Scudder, 2001). Client advocacy in circumstances such as mental health care nursing includes the process of acting on behalf of the client when he or she cannot do so. This includes “ensuring privacy and dignity, promoting informed consent, preventing unnecessary examinations and procedures, accessing needed services and benefits, and ensuring safety from abuse and exploitation by a health professional or authority figure. Further, state Nurse Practice Acts include the nurse’s legal responsibility to report unethical conduct and violations of limits by other healthcare providers (Hitchcock et al, 2002). Towards the client’s best interests, for keeping the client safe, the nurse may not advocate for the client’s autonomy or right to self-determination, and may directly oppose the client’s wishes. An example is the support of involuntary hospitalization for a suicidal client. Some critics regard this as paternalism and non-conformity with the true purpose of advocacy. Additionally, they do not consider advocacy as a role exclusive to nursing, but also relevant to the work of physicians, social workers and other healthcare professionals (Videbeck, 2007). Client Advocacy in Relation to Care, Cure and Nursing Practice Client advocacy has two main goals: client independence and system improvement. By making the client more independent and capable of self-care, the nurse encourages the client to be an active participant in individual health care. The client should be central to the care process, and feel supported in decisions. For this reason, the nurse increases the client’s understanding of the services that are available in the healthcare system, the purposes of those services, and the ways of accessing those services. As a client advocate, the nurse facilitates both client and healthcare system acceptance of active participation from client as well as social groups, in health care decisions that affect them. The second goal of advocacy to improve the system, is to make it more sensitive and useful to the needs of the individual or group (Hitchcock et al, 2002). Related to client advocacy and its goal of client independence and self-care, is the concept of nursing care which refers to “those assistive, supportive or facilitative acts for another individual or group with evident or anticipated needs” to alleviate or improve a human condition (Leninger, 1984: 4). Care is central to nursing and is the unifying and essential core that underlies nursing practice. The importance of care as the essence of nursing has not received the same degree of attention as the importance of cure that is related to physician’s skills. Dramatic medical cures are highlighted by the media, rather than nursing care in the alleviation of illnesses and diseases. The limited emphasis on care is concurrent with the “cultural, social, political and professional factors” which impact the focus on cure (Leninger, 1984: 3). More funds are granted for research as well as practice of cure rather than care. The reasons for greater importance given to cure in contrast to that given to care is believed to be because cure is traditionally associated with medical treatment which receives public recognition. The public and the media tends to reinforce new methods of cure using the latest technology, diagnostic tools and physical modes of treatment. Such new methods of cure generally receive high payoffs and recognition both nationally and internationally. On the other hand, important nursing practices involving compassion, support and provision of comfort are not recognized and valued as equally by the public, as the physician cure practices. Besides the issue of recognition, there are other perspectives to care, cure, and nursing practice (Leninger, 1984: 4). It is crucial that research on nursing care should be given public emphasis in order to clearly explain the essential attributes of care for “human growth, development, healing processes, and survival” (Leninger, 1984: 4). Increased research on care as an essential aspect of nursing theory, practice and teaching has the potential to revolutionize the quality of health services in the world. Palliative care in the case of conditions such as terminal illnesses may at times be proactive, causing a lack of focus on nursing care alone. Here there may be a dilemma of whether to treat the patient palliatively with the sole aim of making the client comfortable, or to treat more aggressively towards remission or as close to cure as possible. The decision may not be straightforward, and may involve movement between different modes of treatment and care. Treatment that is carried out with the purpose of effecting a cure is different from treatment that is directed towards palliation, and in “either case care may be compromised along the way” (Melia, 2004: 67). The overall aims of palliation are the same as those of care. However, in aggressive methods of palliation such as radical surgery carried out for remission or cure, the purpose is to alleviate the symptoms of cancer. Here focusing excessively on cure or a palliative treatment could undermine a more care-oriented approach to the patient. Hence, palliative treatments or care should be judged on the basis of individual circumstances, rather than comparing some measures more favorably to others. Aggressive or excessively proactive palliation could resemble an intensive approach to cure, however there would be no cure in terminal illnesses. In such circumstances, the interrelationship between care, cure and nursing practices used for providing comfort to the patient has significant connotations in client advocacy (Melia, 2004). The Interrelationship Between Client Advocacy, Nursing Practice and Moral Theory Client advocacy is an ethic of nursing practice. It is not only the defence of the encroachment or violation of client rights. The concept emerges from a philosophy of nursing in which nursing practice is the support of a patient, which he/ she may use to promote his or her well-being as understood by that individual (Gaylord, 1995). Thus, moral theory is integral to client advocacy which is important to nursing practice. The scope of advocacy in nursing, with the terms’s legal origins is based on its attention to both individual and societal needs. Nurses have additional responsibilities both individually and collectively to remove obstacles to the services considered necessary for fulfilling the client’s requirements. The concept of advocacy as an ideal of practice requires the nurse to carry out actions that are to be performed beyond the required or expected degree at great risk to self, and perhaps without meeting with success. Further, many of the problems that appear unresolved do not involve difficult decisions about morally correct action. On the other hand, the nurse though aware of the right course of action, is prevented from accomplishing this by institutional obstacles which can rarely be overcome by the efforts of single individuals (Grace, 2001). Hence, client advocacy may be regarded both as actions taken to advance the purposes of nursing on behalf of the individual patients, as well as actions taken to expose and resolve underlying problems which are integral to institutions, policy making, and the healthcare delivery system. The term client advocacy includes clarifying the problems nursing has experienced in relating to an ideal of advocacy that has been conceptualized in several unclear ways, and in some instances has seemed to make compulsory the risky actions that are beyond the requirement expected of individual nurses. Nursing that is focused on promoting the profession’s goals related to both individuals and to a society made up of those individuals, gives rise to client advocacy. This ideal of client advocacy has implications for nursing education, research including philosophical research, and nursing practice. Advocacy as a practice ideal relates to moral theory and ethics in nursing practice (Grace, 2001). Research on nurses’ experiences with advocacy indicate that there are significant themes related to the factors that influence the application of advocacy in nursing practice. The evidence reveals that the essential characteristics and context of relationships play an important role in influencing the undertaking of advocacy. Thus, relational ethics forms an important basis for furthering understanding of the concept of advocacy. Advocacy is possible only when there is recognition and valuing of patient rights, and identification when advocacy is required (MacDonald, 2006). Patients’ right to self-determination is often a source of moral contention, since this basic right is limited because of their low levels of knowledge of their health issues and inexperience with the healthcare system. For clients to have true autonomy over healthcare decisions, they need to acquire the information and understanding to make an informed choice, by exercising the freedom of making a choice based on their own values, beliefs and personal circumstances (Beauchamp & Childress, 2001). According to Gadow (1990: 46), “advocacy not only safeguards but contributes positively to the exercise of self-determination”. It is the initiative to help clients become clear about what they want in a situation, to assist them in perceiving and clarifying their values, and examining available options based on those values. As an essential element in advocating for self-determination, advocacy involves participation of the entire self, with feeling of emotion in relating fully to a patient’s situation and perspective. Thus, it is clear that a high level of understanding of patients’ experiences is vital for nurses to assist patients to clarify the way they see their situation, and thus the types of decisions they wish to make. Relational ethics focuses on the role of relational context or the experience of relationships in influencing moral choices. The significance of relational context on the enactment of advocacy is best understood when seen in the context of moral theories that influence nursing ethics (Bergum, 2004). Analyzing the facts of the client’s situation by applying ethical principles can be useful for the nurse advocate for considering competitive perspectives, but moral considerations may be insufficiently addressed by using principle ethics. Moral theory underlines the subjective experience of the interpersonal relationship between nurses and patients and influences the former’s emotional attunement to patient’s unique experience and situation (Rodney et al, 2002). Relational ethics provides a meaningful perspective to study client advocacy in nursing practice. Impact of the concepts of rights and justice which form an ethical basis should also be included in informing nurses’ advocacy choices. Rodney et al (2002) recommend nurse education on the relational context of nursing practice. This is because nurses require special knowledge to navigate effectively through the complexity of relational features characteristic of moral issues in practice. Nurses’ everyday moral issues in practice based on grounded theory, indicates a need for greater emphasis in nurse education on the nature of the various relationships nurses encounter in practice. The way advocacy may best be applied in patient-care situations would be better understood by careful examination of the unique dynamic and interpersonal characteristics of relationships in nursing practice (Woods, 1999). Conclusion This paper has highlighted issues of client advocacy with respect to nursing, examined the concept of client advocacy with ideas of care, cure and nursing practice, and determined how client advocacy, nursing practice and moral theory are interrelated. The application of advocacy in nursing practice is complex, based on moral theory. The philosophy of relational ethics forms an important basis for greater understanding of the concept of advocacy, emphasizing the contextual elements of relationships. Further research on advocacy which is a moral obligation in nursing practice is required. As the role of nurses evolves with respect to direct patient-care, research could reveal new insights about the particular nature of advocacy in nursing practice (MacDonald, 2006). References Beauchamp, T.L. & Childress, J.F. (2001). Principles of biomedical ethics, 5th Edition. New York: Oxford University Press. Bergum, V. (2004). Relational ethics in nursing. In J.L. Storch, P. Rodney & R. Starzomski. (Eds.). Toward a moral horizon: nursing ethics for leadership and practice. Toronto: Pearson Education Canada Inc: pp.485-503. Bishop, A.H. & Scudder, J.R. (2001). Nursing ethics. Canada: Jones & Bartlett Publishers. Gadow, S. (1990). Existential advocacy: philosophical foundations of nursing. In T. Pence & J. Cantrall (Eds.). Ethics in nursing: an anthology. New York: National League for Nursing: pp.41-51. Gaylord, N. (1995). Nursing advocacy: an ethic of practice. Nursing Ethics, 2(1): 11-18. Grace, P.J. (2001). Professional advocacy: widening the scope of accountability. Nursing Philosophy, 2: 151-162. Hitchcock, J.E., Schubert, P.E. & Thomas, S.A. (2002). Community health nursing: caring in action. The United States of America: Thomas Delmar Learning. Leninger, M.M. (1984). Care: the essence of nursing and health. Michigan: Wayne State University Press. Melia, K.M. (2004). Health care ethics. California: Sage Publications Limited. Rodney, P., Varcoe, C., Storch, J.L., McPherson, G., Mahoney, K., Brown, H., Pauly, B. & Starzomski, R. (2002). Navigating towards a moral horizon: a multisite qualitative study of ethical practice in nursing. Canadian Journal of Nursing Research, 34(3): 75-102. Rumbold, G. (1999). Ethics in nursing practice. The United States of America: Elsevier Health Sciences. Videbeck, S.L. (2007). Psychiatric-mental health nursing. Philadelphia: Lippincott, Williams & Wilkins. Woods, M. (1999). A nursing ethic: the moral voice of experienced nurses. Nursing Ethics, 6: 423-433. Read More