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Autor: anton 13 April 2011
Words: 1260 | Pages: 6
Running Head: CONCEPT ANALYSIS
Concept Analysis: Patient Advocacy
The purpose of this concept analysis is to clarify, define, and refine how patient advocacy is perceived in the nursing community. Much of the literature has attempted to define patient advocacy and emphasis its role within the nursing profession. This paper will discuss multiple definitions of patient advocacy from existing literature and refine them into two critical characteristics.
Concept Analysis: Patient Advocacy
(10%)I Ð’â€“ SELECTION OF CONCEPT
Patients often have a limited knowledge of illness and medicine, yet they desire more control over their healthcare. In many healthcare settings, patient care is inconsistent and "patients' quality of life and right to self-determination tend to be ignored" (Bu & Jezewski, 2006, p. 102). Nurses are in a unique position to "support and thereby advocate the patient's interests in the restoration of their health and well-being" (Marshall, 1994, p. 11). However, this is not always put into practice.
"The definition of patient advocacy is still confusing, and there is no consensus about its meaning among nurses and nurse authors" (Bu & Jezewski, 2006, p. 102). Today, many nurses have a limited view of what patient advocacy is and how to perform the challenging task of protecting and supporting patinets'rights. Greater clarity about the concept of patient advocacy is needed within the nursing field in order to improve practice.
(10%)II Ð’â€“ AIM OR PURPOSE OF THIS CONCEPT ANALYSIS
The aim of this paper is to clarify, define, and refine the concept of patient advocacy in order to expand its understanding in nursing practice.
(20%)III Ð’â€“ IDENTIFY ALL DEFINITIONS AND USES OF THE CONCEPT
A search of the literature reveals several different definitions of patient advocacy. Merriam-Webster's Online Dictionary defines advocacy as "the act or process of advocating or supporting; to promote the interests or cause of " and an advocate as "one that pleads the cause of another; one that supports or promotes the interests of another"(Merriam-Webster, 2006). Curtin's (1979) concept of advocacy is based on the nurse/patient relationship that forms from the common bond of humanity. The nurse must realize patient reactions and needs created by illness, which may threaten the integrity of the person (Bu & Jzewski, 2006, p103)(McSteen & Peden-McAlpine, 2006, p. 260). Gadow (1980) states that advocacy not only preserves, but also positively contributes to self-determination. "The effort to assist patients become clear about what they want in a situation, to assist them in discerning and clarifying their values and examining available options in light of those values" (MacDonald, 2007, p.120) Kohnke's (1982) definition of advocacy focuses on ensuring patient self-determination over decision-making (MacDonald, 2007, p. 120). Advocacy involves the nurse supplying patients with information needed to make appropriate choices and then supporting the decisions they make along with their right to make that decision (Bu & Jzewski, 2006, p103). Robinson (1985) thought advocacy involved allowing patients to make decisions without pressure and promote informed decision-making" (Baldwin, 2003, p. 35). Chafey et. al. (1998) indicated that the nurse-patient relationship is an important feature of advocacy. Teaching, informing, and supporting are activities of patient advocates. Lindahl and Sandman (1998) described patient advocacy as "building a caring relationship, carrying out a commitment, empowering, making room for and interconnecting, being a risk-taker and moral agent" (Bu & Jzewski, 2006, p. 106).
(20%)IV Ð’â€“ REFINING AND DEFINING ATTRIBUTES/CHARACTERISTICS OF THE CONCEPT
The defining attributes that occur consistently throughout the literature include:
Ð’â€¢ Therapeutic nurse/patient relationship that is formed to secure a patient's freedom and self-determination.
Ð’â€¢ Preserving the patients' right to self-determination. This represents a specific series of actions that preserve and respect patients' values, beliefs, and rights in healthcare situations. Actions that are taken to promote and protect patients' rights include teaching, informing, educating, caring, and supporting.
(20%)V Ð’â€“ APPLYING THE CONCEPT IN ACTUAL CASES
Case study example: A 29 year old male with a new diagnosis of an inoperable grade IV glioblastoma. He was offered the opportunity to participate in a trial involving a new chemotherapy that could possibly prolong his life. He confided to the nurse involved in his care that he was having difficulty deciding whether or not to participate due to the need for an extended hospital stay to more closely monitor treatment. He asked the nurse to help find more information about the drug.
1-Model case: The nurse contacted a helpline and obtained written information about the nature of the cancer and the drug. She also contacted an oncologist who provided the patient with additional information. The oncologist conveyed to the patient that the trial might be able to offer some "quality of life". Although due to the nature of the trial, what this involved could not be specified. The nurse discussed the information with the patient and made sure he had no more questions. The patient, in possession of the information the nurse had provided, decided to enter the trial.
2-Borderline case: The nurse contacted a helpline and obtained written information about the nature of the cancer and the drug. She gave the patient all the information and told him to "look it over". She stated, "I hope this information helps you to make a decision." The patient, not clearly understanding all the information the nurse gave him, sought out another healthcare professional to explain it better.
3-Contrary case: The nurse said, "I'll get you information when I get the chance. But if I were in your shoes I would just take the chemotherapy if it could help prolong your life." The nurse went on to care for her other patients forgetting to get information on the drug. The patient didn't want to bother the nurse so he didn't remind her. Because of the lack of information, the patient did not enter the trial.
4-Related case: The nurse obtained various phone numbers and web sites that contained information about the drug. She told the patient where the research library was and to "look over" all the information. She encouraged him to consider all of the information and make a decision. She told the patient that she would help to support his decision in any way that he needed.
(5%)VI Ð’â€“ SUMMARY
Patient advocacy is an essential part of nursing practice. If the need for advocacy is not appropriately recognized and applied, then proper healthcare will not be received. Much of patient advocacy is rooted in the recognition and valuing of patient rights, and the role of nurses as advocates for the interests and rights of individuals. A patients' rights to self-determination is often a source of moral debate, as patients' knowledge of health issues and experience with healthcare is often limited. "True autonomy over healthcare decisions requires patients to possess the information and understanding to make an informed choice, so that they can exercise the freedom of making a choice based on their own values, beliefs, and personal circumstances". (MacDonald, 2007, p. 124).
(5%)VII Ð’â€“ REFERENCE LIST
Baldwin, M.A. (2003). Patient advocacy: a concept analysis. Nursing Standard (Royal College of Nursing (Great Britain): 1987). 17(21), 33-39.
Bramlett, M.H., Gueldner, S.H. & Sowell, R.L. (1989). Consumer-centric advocacy: its connection to nursing frameworks. Nursing Science Quarterly. 3(4), 156-161.
Bu, X. & Jezewski, M.A. (2006). Developing a mid-range theory of patient advocacy through concept analysis. Journal of Advanced Nursing. 57(1), 101-110.
MacDonald, H. (2007). Relational ethics and advocacy in nursing: literature review. Journal of Advanced Nursing. 57(2), 119-126.
Marshall, C. (1994). The concept of advocacy. The British Journal of Theatre Nursing. 4(2), 11-13.
McSteen, K. & Peden-McAlpine, C. (2006). Nurse's role in ethically difficult care situations with dying patients. Journal of Hospice and Palliative Nursing. 8(5), 259-269.
Merriam-Webster. (2006). Advocacy. Merriam-Webster's Online Dictionary. Retrieved on February 8, 2007 from http://220.127.116.11/dictionary/advocacy