My husband, like so many of our patients, was in pain, overwhelmed, and in denial. Of course, NOTHING would have happened without my consistent presence to translate, clarify, repeat, and advocate for my husband. I could barely follow all of this confusion, dates, times, preparations, follow-up. I have finally returned to work. When my husband appeared for his most recent exam, everyone asked, "Where is your nurse?" Irony to be sure. I was often angry, yet knew that it would be counterproductive to show it. I was not as successful with the patient.
Despite my frustration, I recognize that we are among the fortunate. We are well educated, intelligent, healthy people with excellent health insurance, outstanding physicians and facilities available to us. I am very aware of pathophysiology, medications, and treatments. I am a pleasant, agreeable person. Yet, overall, I felt that I was either expected to perform miracles in the way of communication or I was in the way. Not once did I feel useful or appreciated. The reality was that my husband was very ill and unable to think clearly. I cannot conceive of how anyone could have maneuvered our health care "system" on his own. Swimming through a maze as an outpatient!!
Tate, RN, states that not advocating on a patient's behalf is a deviation from the standard of care (Tate, 2005). Yet, as she notes, far too many nurses have never learned or practiced this critical skill. She states, "I believe that no hospitalized patient should have to advocate for himself-ever. Nor should any family member or significant other ever be expected to have to have to advocate on behalf of their hospitalized loved one. This is a nursing responsibility" (Tate).
As a nurse educator for many years, I have reflected on my family's experience and the lonely road of advocacy. I understand that advocacy must be taught. At my institution, the notion of advocacy may only be included in Health and Human Caring class or referred to at times in nursing classes. Learning about advocacy best occurs by observing other nurses or through experience.
Advocacy is a skill based upon a body of knowledge. Yet, the concept does not appear in the educational literature to the degree that it should. Among the current foundational resources available to nursing faculty, "advocacy" is hardy mentioned at all. In 2009, based on the Institute of Medicine competencies, Quality and Safety Education for Nurses (QSEN) faculty and a National Advisory Board defined the Knowledge, Skills, and Attitudes (KSAs) necessary to continuously improve the quality and safety of health care systems. These KSAs are to be developed in Nursing Pre-licensure, Transition to Practice, and Continuing Education programs.
Advocacy is mentioned in the first of six categories, "Patient-centered care", defined as "recognizing the patient or designee as a source of control and full partner" in providing compassionate and coordinated care based on respect of patients' preferences, values, and needs. This implies seeing "through the patient's eyes." Exploring ethical and legal implications of patient-centered care is another knowledge expectation.
Of the four Major Client Needs categories of the 2010 NCLEX test plan, the first is "Safe and Effective Care Environment", enhancing care delivery to protect clients and health care personnel. One subcategory is "advocacy". Advocacy should be implicit if not salient in ALL NCLEX categories.
Too often competing priorities, the hurry to complete tasks, or to complete documentation, take precedence over advocacy. Yet, advocacy is an ethic of practice and integral to a philosophy of nursing rooted in caring. Heightened nurse advocacy contributes to making the health care system less intimidating, makes the journey of patient and families less lonely, and improves the image of nursing.
About the Author: Rye Huber has taught beginning nursing students in medical-surgical nursing, skills, and health assessment in Samuel Merritt's BSN, ABSN, and ELMSN programs. Her focus is gerontology and her doctorate is in Philosophy and Religion. Rye's passion is being in the hospital with students and their patients and finds it thrilling to participate in the students' growth.
ANA Social Policy Statement. 2nd Ed. Retrieved from www.QSEN.org, 2003 Code of Ethics for Nurses.
"The Nurse's Role in Ethics and Human Rights: Protecting and Promoting Individual Worth, Dignity, and Human Rights in Practice Settings" ANA Policy Statement. Retrieved from http://www.nursingworld/MainMenuCategories/HealthcareandPolicyIssues, June 14, 2010.
ANA Position Paper, "Workplace Advocacy" retrieved from /ANA Position...6/6/2011
Beyea, Suzanne C. "Patient Advocacy. Nurses keeping patients safe." AORN Journal, May 2005.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Johnson, J., Mitchell, P. et al (2007). Quality and Safety Education for nurses. Nursing Outlook, 55(3) 122-131.
Ellis,J., and Hartley, C. (2008). Managing and Coordinating Nursing Care (5th Ed.). Philedelphia, Lippincott.
Foley, B.J., M.P. Minnick, C.C. McKee "How Nurses Learn Advocacy" Journal of Nursing Scholarship 34 no.2 (2002) 181-186.
Institute of Medicine. Health professions education: A bridge to quality. Washington, DC: National Academies Press; 2003.
Malik, M, "Advocacy in Nursing-A Review of the Literature," Journal of Advanced Nursing 25 Jan 1997;25 (1) 130-138.
National Council of State Boards of Nursing, 2010 NCLEX-RN Detailed Test Plan for the Educator, Chicago, Illinois
Scandanavian Journal of Caring Science 2006 September 20 (30): 282-292.
Tate, RN. "Patient Advocacy: The Nurse's Responsibility". Topics in Advance Practice Nursing eJournal 8/2005;(2).