The Role of a Nurse as an Advocate to the Client - Term Paper Example

Nursing Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Instructor Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Introduction Advocacy in nursing on behalf of the client has become a very essential of nursing today, even though it is not properly understood and thus less utilized (Allinson & Apfel 2010, p 5). Based on the evidence about the lack of certainty about the role of a nurse as an advocate to the client, the aim of this paper is to discuss nursing advocacy as relates to the nurse’s role. It particularly expounds on the relationship of advocacy to autonomy, the continuum of advocacy within the clinical environment and the actual and potential costs of advocacy. The essay also discusses nursing advocacy and the law together with the codes of conduct and ethics that pertain nurses in advocacy. The Role of the Nurse in Advocacy The role of the nurse in advocating for the rights of the patients is considered paramount to nursing. A nurse is a person who looks after another or gives advice to another as defined in the Webster’s dictionary. On the other hand, to advocate for something is to plead for the cause of another, defend, recommend or propose (Concise Oxford Dictionary 2004). From the above definitions, it gives a clear understanding that nursing advocacy involves the nurse defending or arguing on behalf of the patient. Nurses have assumed it as being ethical to nursing standards and also an exercise of moral judgement (Bu & Jezewski 2007). Nursing advocacy is a fairly new concept in the field of nursing but continues to take root. Essentially, it became a recognized component of nursing in the early 1980’s (Hanks, 2008, p. 469) and is a moral obligation bestowed upon the nurses. Nurses were considered to be most appropriate for the role of an advocate for the patients because of they have enough direct patient contact time in the course of treatment (Hanks 2010, p. 255). The other health care professionals are not in as much contact with the patients like the nurses. With the ever changing hospital settings, it has become inevitable that nurses must take up the role of a patient advocate (Hanks 2010). At times, resources are not equally distributed among the patients and some practitioners may not make informed choices about the care and treatment options they give to their patients (Johnstone 2008). Moreover, some ethical issues may arise in clinical care settings that may harm patients physically, mentally and even spiritually (Johnstone 2008). In many of such situations, nurses may decide to take a stand, either individually or as a group in order to champion for the rights of the patients. It is here that advocacy arises (Johnstone 2008). However, a nurse may need to put in place several considerations before engaging in advocacy (Johnstone 2008). Most of these decisions carry either a moral or ethical dimension. When a person falls ill for instance, they tend to fail in making their own decisions (Vaartio et al. 2009 p 340 ).Time and again, they will need a nurse to be by their side and stand-up for them when they are unable. It is therefore very important that a nurse be equipped with the skills and information to provide the required support (Vaartio et al. 2009, p 342). One of the skills is autonomy in being a nurse advocate (Vaartio 2008). Through several studies, the success of a nursing advocate is cultivated through education, learning, teaching and adequate practice. These influence the nurse’s ability to be an effective advocate for the patient, including achieving autonomy and independence (Vaartio 2008). If a nurse is confident and sure of themselves, they will be less resistant to advocating for the rights of the patient. It also depends on the nurse’s feelings about their inner self (Hanks 2010). Notably, positive inner feelings and courage may trigger the nurse to be a strong advocate for the client (Allinson & Apfel 2010). If the client is vulnerable, it also gives the nurse a feeling of moral obligation which will trigger the nurse to act as an advocate on behalf of the patient (Bu & Jezewski 2007). The relationship between nursing advocacy and autonomy is that the nurse must be able to act independently as the voice of the patient. As an advocate, they assume the role of protecting the rights of the patients and bridging the gap between the different arms of the health care system thereby limiting any chances of inequities that may occur (Vaartio et al. , 2009). Good nursing advocacy carries a good sense of professional autonomy (Vaartio 2008). Advocacy, in stressing on the autonomy of nursing professionals focuses on the individual nurse’s skills and characteristics. In order for a nurse to be an efficient advocate, there is need for adequate professional training, enough clinical experiences and professional competence (Vaartio 2008 p 15). Ethical and good interactional skills also give rise to autonomy in nursing advocacy as nurses will have to take account of ethical principles, moral values and professional standards. Nurses, as autonomous and independent professionals, must be able to stand together on issues that affect their patients and equally demand for their rights (Hanks 2010 p 262). A collaborative relationship in the health care team gives the nurses and other practitioners a greater ability to advocate for and protect the interests of the patients. If this often happens there will be a greater likelihood that the interests of the patients are not threatened by other forces (Abood 2007). Thus, when the nurses collaborate, they educate each other about the rights and the interests of their patients, an element that gives them some sense of autonomy (Vaartio 2008, p 10). The continuum of advocacy within the clinical environments still takes place despite the much uncertainty that surrounds it. According to Vaartio, (2008 at p. 9), advocacy in nursing has continued to attract a lot of research, both empirical and theoretical. The Australian Nursing and Midwifery Accreditation Council believe that patient advocacy is an essential and integral component of the nursing practice. As such, the continuum of advocacy is not limited to the individual patient-nurse relationship but may extend a whole lot to address general societal concerns (Bu & Jezewski 2007). Moreover, the role of advocacy for patients by the nurses continues to grow because of the increasing awareness of the rights of the patients (Vaartio 2008, p 10). This places increasing demands on both the organizations and the physicians to provide care amounting to high standards of ethical and moral competence (Vaartio 2008, p 10). In other words, the nursing profession requires effective patient advocacy which must go on and on (Vaartio, 2008). It is therefore important that the nurses understand and demonstrate competence and high levels of moral judgement as a means of empowering their patients. This in turn can give the patients an opportunity to make their own choices and even sound decisions (Earp, French & Gilkey 2008, p 17). Time and again, advocacy activities have continued to take place in almost all clinical environments. These include activities like gathering information and learning about the personal needs and desires of the patients (Vaartio et al. 2009, p 355). It also entails activities such as educating, guiding, counselling and giving social support to the patients as well as promoting informed consent on behalf of the patient (Hanks 2008). Of paramount importance is that the nurses ought to continuously stand up for the rights of the patients, protect and defend their interests and even taking direct action by physically standing in their way in order to protect them (Vaartio, 2008). It is also determined by good therapeutic relationships between the nurses and the patients of which the nurse must strive very hard to establish. It is worth noting that nurses at times face certain barriers when advocating for their patients (Earp, French & Gilkey 2008). Most of these risks and obstacles are associated with the uncertainty of the clinical settings in which they work. Core to these barriers are environmental barriers such as time restraints (Bu & Jezewski 2007). Most nurses are forced to complete many tasks in limited time and sometimes cannot spare time for the patients even if they want to. Other challenges include budget austerity, lack of support for the nurses, lack of cooperation among the health care teams and legal risks (Shwartz 2012). Moreover, limited communication between the nurses and the patients limits the ability for nurses to fully advocate for the rights and interests of the patients (Vaartio, 2008). Nursing advocacy also comes with its costs. They can either be actual or potential and could affect a person personally or professionally (Johnstone 2008). In as much as there is inevitable need for the nurses to play the role of advocates for their patients, most of them are usually very reluctant because of the costs that are associated with it (Shwartz 2012). For instance, the implications of nursing advocacy has at times conflicted with legal advocacy and thereby threatening the profession (Shwartz 2012 p 37). Conflict has mostly arisen between what is expected of a nurse advocate and a legal advocate in situations where the patient is represented. The tension here is that there are always difficulties in distinguishing between what is actual representation and an assertion of what the advocate may believe to be in the best interests of the patient (Hanks 2010, p 257). In most cases, the nursing profession has been belittled and victimized where the legal advocates of the patients come in. It has created confusion between advocating for what the patient wants and defending the best interests of the patient (Shwartz 2012, p 38). At times, advocacy also necessitates stepping beyond the nurse’s ability to incur their own personal costs. This is because successful advocacy depends on the power, will, time, energy and resources to assume such a role (Abood 2007, p 3). Moreover, as nurses interact with the patients and their families, they are caught between the cross currents of cost constraints because of the need to provide quality care (Abood 2007, p 4). Because the health care system is not effectively meeting the needs of the patients, the nurse might at times be forced to come in and help thus incurring personal expenditure (Abood 2007). Nurses will also come face to face with issues that affect their patients in the course of advocating for their rights (Hanks, 2010). For example, a nurse may be forced to meet the food expenses of the patient, travelling costs, access to quality treatment as well as ensuring patient safety (Abood 2007). Some of these amenities are not fully catered for by the multidisciplinary health care system. It forces the nurse to intervene in such situations. The nurses have to move out of their comfort zones when they choose to take up the role of being an advocate for their patient (Allinson & Apfel 2010). It is also challenging and time consuming as they are fully engaged in battling for the scarce resources and defending the rights of their patients when they have been contravened (Abood 2007). By accepting this responsibility, the nurses take up the opportunity to make a difference by bringing into place a better health care system for the sake of their patients. It indeed requires zeal, commitment and patience (Abood 2007). Advocacy therefore, has its own costs and commitments. The Australian Nursing and Midwifery Council (ANMAC) (2007), has set up regulations and competency standards for nurses while engaging in the advocacy role. Their codes of conduct and ethics have laid down the regulations that pertain enrolled nurses and all other practitioners. They include the national competency standards that were first adopted in the early 1990’s and have been reviewed and revised since then. One of their descriptions of a nurse is one who assesses plans and implements nursing care in collaboration with other co-players in the health care team so as to achieve goals and favourable health outcomes (Australian Nursing and Midwifery Council 2007). Such goals and health outcomes for the patients include nursing advocacy. The competencies required of nurses by the ANMAC regulations are organised into different domains. One of them is the role of the nurse as an advocate for the patient. As such, this requires professional and competent practice which has been described in the regulations as entailing professional, legal and ethical responsibilities. In addition, the nurses are required to exhibit a clear demonstration of satisfactory knowledge base, accountability and protection of the patient’s rights and interests (Australian Nursing and Midwifery Council 2007). Under the regulations as well, there is the requirement that nurses ought to advocate for the rights and interests of their patients either individually or in groups whenever they feel that the rights are being overlooked and/or compromised (Hewitt 2009 p 39). In this way, they acknowledge the dignity, culture, beliefs, values and the rights of their patients. The nurses also need to be sensitive to the needs and the rights of the patient in which case they will then be able to advocate for their rights (Australian Nursing and Midwifery Council 2007). There are legal implications for the nurses in taking up the role of an advocate for the patients. Nursing advocacy and the law is also another area that has attracted much research in recent studies on the same. In legal terms, an advocate is one who pleads for the cause of another (Hewitt 2009 P 39). In the past, the concept of nursing advocacy was barely recognized by the laws and the courts were very reluctant to acknowledge the nurse as an autonomous advocate for the patient (Hewitt 2009 p 44). However, the legal reality is that the nurse has a potential of advocating for the patient by defending them, giving them information and allowing them to make informed choices about nursing care and treatment (Johnstone 2008). For instance in law, a nurse or doctor has the privilege of withholding information revealed by the patient by virtue of patient-doctor privilege (Bu & Jezewski 2007). Such like requirements are not to be overlooked if it is in the best interests of the patient. Moreover, the nurse has got no legal right to countermand the therapeutic relationship as this is contrary to professional practice (Shwartz 2012). Conclusion The concept of nursing advocacy and exercising moral judgement is a complex field though easy if understood. It is increasingly becoming an integral component of the nursing practice. Advocacy arises when health resources are not equally distributed, when no informed choices are made about the care and treatment that can be given to patients and when situations arise that may lead to the rights and interests of the patients to be overlooked and compromised (Johnstone 2008). As part of professional practice, the nurses will then consider out of moral and ethical requirements to stand up and champion for the rights of their patients. But before engaging in such activities, they must also reflect carefully on the outcomes and implications, an aspect that brings in the relationship of advocacy and the law. Conclusively, there are many benefits that nursing advocacy can provide to the patients. Once it has been established, it will prove to be a very important component of primary health care (Bu & Jezewski 2007, p 109). The role still remains more attached to the nurse. Abood, S. (2007). 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