The Concept Of Advocacy

Introduction

Advocacy is defined as the process of advocating or supporting a cause one believes in. When a nurse makes the decision to advocate for a client, then the patient and his or her best interests become the cause. This is especially true in cases where those seeking care are unable to make informed decisions about the care they receive due to their condition. The idea of advocacy allows the nurse to communicate with the client, the client's family, and medical team to ensure the needs of both the patient and family are met. Nurses use critical thinking and ethical theory to make decisions that they feel are in the best interest of their client. The nurse taking on the role of advocate is better prepared to provide the client specific care needed for each unique situation and has a stronger rapport with those involved than one who chooses not to advocate. This concept is important because it is the nurse, not the doctor, who is on hand meeting these needs while the client is seeking care. Advocacy provides nurses with a plethora of opportunities to ensure clients, and their families receive the best treatment available.

The Nurses Role in Advocacy

Advocacy in nursing, "has been a part of the ICN and ANA codes since the 1970s" (Butts, p.42). Nurses deal with unique situations on a daily basis, and it is a field where the work of nurses are never done. According to a favorite saying of Zeba Arif (2006), "Nursing is unique, nursing is 24/7" (p.1). The nurse wears many masks in terms of their roles in patient advocacy. Nursing is more than the ability to perform skills, and advocacy allows those in the field to showcase their abilities beyond a blood draw or injection. One of the most important roles the nurse assumes, is the role of listener. Listening to the client and their family is the crux of what nurse advocating is all about. According to Colleen Corish (2005), "Listening to patients, nurses help develop plans that are directed by clients, which nurses then put into action" (p. 478). This was not always the case when it came to delivering client care. Before the concept of patient advocacy, it was the physician and medical team who had discretion over the plan of care, with little input from the client or family. Nurses who listen are more inclined to gain the trust of clients and family, and will be more open to expressing their emotions and needs to the medical staff. Another key role in advocating for the patient is the ability to communicate with the client verbally and nonverbally to determine the needs they may or may not be expressing. Clients often have trouble understanding the ins and outs of the medical system. This could cause them to feel vulnerable which could allow them to be taken advantage by medical staff and even family. The ability to establish a good rapport with clients and family will allow all to take part in the process, and also allow the nurse to provide them with the information needed to keep them from feeling as if they are at a disadvantage to the system. Examples of this are obtaining implied consent for procedures and explaining them often many times to ensure the client's understanding, going over medications with clients before asking them to take it, verbally expressing the clients right to refuse treatment, and providing written information on the illness or issue the client has been admitted for. Another important roles nurses play in terms of patient advocacy is that of a defender. In cases where clients are incapacitated or unable to make decisions, it is the nurse who must ensure all care provided or not provided to the client is for his or her best interest. Examples of this include clients with mental disabilities, comatose clients, underage clients, and the elderly. The nurse is responsible for the lives of these clients, and must be able to note and address when they feel the clients rights are being infringed upon. It is when this occurs that according to Elizabeth Harrison nurses become mediators, negotiators, and spokespersons for their clients (p.134). The roles assumed by nurses performing as patient advocates continue in a cycle and according to Harrison is an, "ongoing process because the issue advocates address are usually not resolved through a one-time action" (p.135). Therefore practicing the skills necessary to better oneself as an advocate is essential to providing optimal care to clients and their families.

Difficulties in Advocating

Advocating for the needs of clients in the nursing profession is not always easy. There are situations where the ethical beliefs of the family, physicians, and nurse come into play and can become major setbacks in making the best decisions possible. An example of this is in the case of long-term coma patients. There are clients who do not wish to have any form of resuscitation and yet others who believe in sustaining life until the client dies on his or her own. This type of decision is extremely difficult for the family to make and often leads to major dysfunction. In this situation the nurse must be able to remove any bias they may have in regards