Levels Of Patient Advocacy

Advocacy Nurses have historically played a major role in advocacy dating back to Florence Nightingale (Nickitas, Maddaugh & Aries, 2016). The advocate role can be defined in several ways, and nurses have the ability to advocate to individuals, families, communities and populations. This paper will attempt to define advocacy and discuss the need for advocacy and identify potential barriers.
Patient Advocacy According to Hanks (2010), nurses define advocacy as “intervening on behalf of a patient within a system, resulting in nurses’ actions of speaking, fighting and standing up for patients” (pg.98). Nickitas, Maddaugh and Aries (2016), expanded on this definition by including language related to ethical nursing practices
and the need to protect and safeguard the patient and their rights. Advocacy is considered the central role of nursing and many national nursing organizations have included the role of patient advocate into their standards and codes of ethics. Choi (2015) identified three essential models for advocacy: Human Advocacy Model, Functional Advocacy Model and Existential Advocacy Model.
These models help define the three most important components of advocacy which include: developing humanistic relationships with patients to protect their interest and well-being, respecting patient values and helping patient through the decision making process and providing information to help empower patients to make decisions. Choi (2015) also categorized advocacy into proactive or reactive. As one would guess, proactive advocacy deals with possible future problems and reactive advocacy occurs when a patient’s rights or safety have been endangered. Choi (2015) also classified advocacy into two levels: macrosocial and microsocial. Macrosocial deals with health disparities and promoting policies in large populations, communities and the hospital environment whereas microsocial deals more at the individual or patient level. Most nurses practice advocacy on the microsocial level verses the macrosocial
level. The process of advocacy is very similar to the nursing process.
Both include the following steps: assessing, development of goals, implementation and evaluation. The assessment phase needs to focus on the situation, resources and risks involved. Next it is imperative to identify goals of advocacy and the goals need to be geared toward empowerment, safety and quality. In the planning and implementing stage, stakeholders are engaged to help plan and carry out actions of advocacy. Stakeholders may include but are not limited to: patients, families, other health care professionals, community leaders, state and national leaders. In the planning implementation phase it is important to form alliances and serve on committees. The last step of advocacy is evaluation and with any outcome, they will be either positive or negative. According to Nickitas, Maddaugh and Aries (2016), every nurse must be able to engage in the advocacy process in order to manage the emerging needs of a population and the nursing profession. In order to be an effective patient advocate, one must be assertive and a good communicator (Beyea, 2008). Other characteristics needed are flexibility, empathy, objectivity, self- motivation and professional commitment (Choi, 2015). Potential barriers of patient advocacy include the nurse’s personal values and beliefs, work environment or culture and level of education of the nurse. Nurses have the legal authority and the responsibility to act in the best interest
of their patients to ensure safe, quality care (Beyea, 2008). End of life care issues are a growing concern in healthcare today due to our aging population and the rise in health care cost. Often patients have very clear thoughts and ideas about end of life care but are reluctant to discuss these issues with their family or health care provider. Some health care providers are not comfortable with discussing end of life care issues with patient and families causing increased stress and poor satisfaction with patient care. As a care manager and a nurse, my job is to help educate patients and families on end of life care, assist with communication between all parties, empower the patient or family to make decision and assist with the decision process as needed. On a microsocial level, advocating for end of life care can occur between the patient and family, patient and healthcare provider and the family and healthcare provider. Broader advocacy would occur by educating the community on end of life care by providing them with the opportunity to understand and ask questions. This could be done by using social media outlets or offering educational sessions in the community. Some of the stakeholders my include, the local aging commission, local churches and pastors, local doctors, hospital administration, general public and local hospice or palliative care experts. Advocating for end of life care can help decrease health care cost, allow patient’s wishes to be carried out and decrease the quilt and burden of family members having to make these decision thus creating a better outcome for all involved.