Today the concept of patient advocacy can be treated by different people in various ways. Still, there is a general tendency today, when there are major health care debates, to reduce this role to some typical images of a man on TV asking about your feelings after visiting the hospital the last time (Reece, 2011). But if this concept is considered in its true primary interpretation, it turns out to be very simple: it is first of all support of patients, and there is no one better to do it than nurses in the hospitals.
In fact, everything that a nurse does can be put into the term of patient advocacy. The whole system of support lies on their shoulders (Reece, 2011). In all the aspects of patients being in the hospitals nurses help them – from following a patient from registration to his ward, assessing the health state and providing emotional support to translation of the words doctors say into ‘normal’ people’s language (as opposed to the medical language they speak). With the help of nurses patients can feel safe and relaxed, and not only they, but their relatives as well, because nurses often act as supporters of the patient’s visitors as well.
Given the above described situation, it is possible to make a conclusion that patient advocacy is the basis for all the roles and functions a nurse performs, which is why it is necessary to pay attention to this aspect of this job (Willard, 1996). In this paper this question will be explained in detail. The history of this role development, the education peculiarities that are necessary to form a strong basis for patient advocacy, the steps that are necessary to take to be prepared for this role and the possible barriers that can become an obstacle to successful advocacy of patients will be described.
Historical Perspective of Patient Advocacy as a Role of Nurse
The issue of historical formation of the role of nurse as a patient advocate is researched by several authors. Mallik and Rafferty (2000), for instance, offer conceptual and philosophical ways of considering this role. They state this role was not formally recognized in the nursing literature until 1970s. In order to understand the development of this role, it is necessary to find out the information on the use and roots of the word ‘advocate’. From the Latin it can be translated as ‘to call’, while today in the legal sources it is interpreted as ‘to counsel’ or ‘to plead’. The words educating and counseling are often used when describing the roles of nurses. But it is also useful to consider the form of the word that is ‘agency’, which presupposes the use of a contract. Mallik (1998) emphasizes that such ‘contract’ can be offered by a nurse, but at the same time not requested by the patient.
There are various conditions that contribute to the need for advocacy that patients can feel. Among them there are complexity of the language doctors and medical staff use, vulnerability that is caused by the illness, and other aspects. According to Mallik (1998), several factors define the advocacy role of nurses – the patient-nurse relationships and the moral values that lie in the basis of the nursing profession.
On the whole, there can be traced broad and often different perspectives on the historical development of this role. Apart from description in legal and ethical frameworks, it is often described as a philosophical ground of the nursing practice. In order to better understand this issue, it is necessary to find out what barriers there exist for patient advocacy and how this process can be facilitated.
Barriers to Patient Advocacy
Among the barriers that are noted by nurses there is a lack of motivation. It is explained as working in the conditions when the rest of the staff is working with reluctance, and the management fails to create such an environment when devoted and inspired patient advocacy can be practiced. The nurses can see that their colleagues work not as diligently as them, but get the same appreciation from the management. In such situation nurses can decide not to dedicate the same amount of effort to their work, and consequently the role of patient advocate cannot be properly realized.
Another important barrier to patient advocacy is powerlessness. In particular, it is concerned with such situations when there is some neglect that happens in the team, but it is not a common practice to discuss such instances at work, which is why the same situations can repeat again and again. As a result, nurses feel powerless and cannot properly advocate the patients.
Lack of support from managers is also defined as an obstacle. In particular, nurses often feel that they don’t get any support for their advocacy initiatives from managers. Among the arguments presented by nurses there are often such claims as “To be effective advocator, it is necessary to be supported” (Gaylord & Grace, 1995). To properly perform the function and support patients, the nurses need support themselves.
There is also lack of law among the barriers. Nurses report that even if there is legal support of this role, on practice they don’t know about such and don’t see it. If there were better developed and clear statements considering this aspect of their practice, it would have been much easier for them to properly perform this role.
The system of physicians leading that is now widely practiced in the hospitals is also a barrier to advocacy. It results in the fact that nurses have to do advocacy in a concealed manner, as sometimes it can be regarded as violation of the physician’s instructions (Willard, 1996). Thus, as the advocacy role lies so greatly on the nurses, this system should change to such an extent that it can be performed in open manner and supported at all the levels.
An important factor that creates barriers to advocacy is the risk related to executing this role. There are certainly risks related to this issue, and the most important problem here is that nurses have no one to complain to, which can be regarded as a subproblem of the lack of support issue.
The problem of the lack of communication is also an important obstacle on the way to successful patient advocacy. In particular, it is said that in order to be proper advocates, it is necessary to communicate with the patient, to know his/her situation and be aware of many additional aspects. Still, the shortage in the nursing staff and the increasing number of patients results in the lack of time that nurses experience, which makes effective communication with patients practically impossible.
Time constraints were also defined as a barrier to patient advocacy, as due to the reasons stated in the paragraph above it has become a real problem. Nurses have to attend to so many patients at one and the same time that it is simply not possible to be real advocates. When patients need a comforting conversation, or something else, nurses just don’t have time, because there are other patients waiting to take their medicine or being in more difficult states.
Taking the Steps to Establish Advocacy
There is a solution to the problems stated above – there are certain factors that can facilitate performance of this role. They will be presented in this section of the paper.
The first facilitator is paying attention to and recognizing patients’ conditions and needs. It means that nurses need comprehensive assessment of patient so as to understand the conditions and needs of each particular patient. It is clear that every person has some family history or other conditions that can influence success of the treatment. If nurses were aware of such factors, it would have become a perfect step towards effective advocacy of patients (Willard, 1996).
Another facilitator that can be distinguished is establishment of functional and effective patient-nurse relationship. If proper environment and conditions are provided for development of such relationship, patient advocacy becomes much easier for nurses. If they are motivated enough and start to really care about their patients, having enough time for it, patients can feel a lot safer and more comfortable.
Among the other facilitators there were defined certain personal characteristics of the nurses. The most important of them are responsibility and accountability. The rest of the important qualities were commitment to professional code of ethics, the conscious of the nurse and respect of patients. Thus, nurses should develop these characteristics to be real professionals in their field (Gaylord & Grace, 1995).
Physicians being colleagues in the role of executing the patient advocacy role instead of strict supervisors can also help considerably in facilitating this problem solution. It means that an approach of being a team in the matter of treating patient will be much more effective, than the one practiced today. It is also necessary for the nurses to develop more friendly relationships with physicians, as in this way their cooperation would have been much more effective.
Another important factor is the skills and knowledge of the nurse. The nurses believe that if they received better educational background on this issue, it would have been much easier to properly apply their knowledge on practice. Currently there are certain programs that allow nurses to get familiarized with the most important issues constituting patient advocacy, but there is no practical support of this theoretical background that they receive. Thus, when they encounter some similar problems on practice, they just don’t know what to do exactly, which results in improper advocacy and not as effective treatment as it could have been, given proper guidance and support.
On the basis of the above presented review of literature and studies in this field, it is possible to draw a conclusion that a role of nurses as patient advocates is very important and forms a basis of this profession. Still, there are certain barriers that don’t allow nurses to properly perform this function and become effective advocates for their patients. It’s clear that urgent measures have to be taken to change this situation for the better.
First of all, the problem of shortage of nurses has to be addressed and better supervision should be provided. The work of nurses should be organized in such a ways that they effectively work in a team and have enough time to help patients solve the problems that appear in the course of their stay at the hospital. It is also very important for managers to support nurses in this issue and provide proper motivation and encouragement for them (Reece, 2011). IT should become an obsolete situation when nurses decide to work not as diligently as they can just because their colleagues are treated in the same way, despite working not so hard. It is necessary to introduce effective systems of bonuses and provide better environment in the hospitals.
It is necessary to take into account all the risks associated with this role and create such conditions, in which nurses could have felt safer and secure, not being afraid to advocate patients. In order to realize it, it is necessary to provide proper legal background and make it known to all the nurses so as they could defend themselves in some difficult situations. The knowledge background should also be introduced in the educational establishments and appropriate practical skills should be developed (Reece, 2011).
At the same time, it is necessary for nurses not to focus too much on their role of patient advocates, and perceive it as a basis of their work that doesn’t limit the other functions, but instead makes the care about patient easier, more effective and much more pleasant for both the patient and the nurse. These changes are not hard to implement, but can bring great results on practice. Further studies should be also conducted to understand this issue better and find a way to introduce the necessary changes.
Gaylord N., & Grace, P. (1995). Nursing advocacy: an ethic of practice. Nursing Ethics, 2(1), 11-18.
Mallik, M. (1998). Advocacy in nursing: Perceptions and attitudes of the nursing elite in the United Kingdom. Journal of Advanced Nursing, 28(5), 1001-1012.
Mallik, M, & Rafferty, A.M. (2000). Diffusion of the concept of advocacy bioblimetric analysis. Journal of Nursing Scholarship, 32(4), 399-404.
Reece, D. (2011). A nurse is the ultimate patient advocate: A Nurse's Journal. Retrieved from http://www.cleveland.com/healthfit/index.ssf/2011/01/a_nurse_is_the_ultimate_patien.html
Willard, C. (1996). The nurse's role as patient advocate: obligation or imposition? Journal of Advanced Nursing, 24(1), 60–66.