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Nursing Role in Patient Advocacy in Research

Dr Lorna Bennett SRN HV FWT MSc DLSHTM DProf Clinical Service Manager Haemoglobinopathies ­ NHS Islington 7th October 2009

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Tuesday, 20 October 2009

Definition and Scope of Advocacy

Alison P Smith in Patient Advocacy: roles for nurses and leaders Nursing Economics, March ­April 2004 What is patient advocacy? Is it Is it Is it s a nurse running down the hall to grab a physician who was unaware of a family in need for information? Is it the CNO implementing a patient safety programme? These examples tie into the role of a patient advocate in the broadest definition in some way, BUT are often referred to as exemplary acts `above and beyond the call of duty'..

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Tuesday, 20 October 2009

Definition and Scope of Advocacy

The literature made reference to various forms of advocacy: Sylvia M, Kubach A et al (2004) A holistic model of advocacy..... Ethical Legal Political Spiritual Substitutive Advocacy as complementary therapy or in facilitating the use of this Fraser J (2008) `Practice Integrity' provides an insight into the obligation to advocate for children, young people and their families.

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Tuesday, 20 October 2009

Definition and Scope of Advocacy

The literature made reference to various forms of advocacy continues:

Alison P Smith (2004) Advocacy from a Public Harm & Public Policy perspective - reporting on bad practices or situations where patients lives are at risk Eg: `Nurse accused of killing nine patients over the course of 16 years in Pennsylvania and New Jersey...investigation revealed a long history of job hopping, questionable discharges and psychiatric issues.' Tahan HA (2005) Essentials of Advocacy in Case Management: Generally advocacy aims to promote or reinforce a change in one's life or environment, in program or service, and in policy or legislation. In health care delivery, these activities focus on health conditions, health care resources, and the needs of the patients and the public.

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Tuesday, 20 October 2009

Definition and Scope of Advocacy ­ Patient perspective What is patient advocacy from a patient perspective? Evidence from a public poll conducted by Swedish Covenant Hospital in Illinois (Smith A. 2004) where responders...... Agreed compassion played an important role in the healing process (95%) Believed that compassion hastens or is necessary for healing (over 80%) Described compassionate as treating people with dignity (84%); showing concerns for questions (70%); keeping you informed (69%); respecting cultural/ racial/religious needs (62%)

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Tuesday, 20 October 2009

Definition and Scope of Advocacy What is patient advocacy from a patient perspective? The degree of consensus around these beliefs suggests that these behaviour should be standard of care and not instances of `exceptional care'. This view is reinforced by the United Kingdom Central Council (UKCC) for Nursing Midwifery and Health visiting which states that advocacy forms an integral part of the nurse's duty to patients. Negarandeh R, Oskouie F et al (2006) Found that nurses in their study believed that patient advocacy was one of the primary roles of the nurse

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Tuesday, 20 October 2009

Advocacy Conditions

Conditions contributing to the need for advocacy (Allison P. Smith): The vulnerability created by the illness Complexity of the health care systems Risk for loss of basic human rights through informed consent and self ­ determination Mallik M. (1997) Advocacy in nursing, A review of the literature Factors that predispose and /or prescribe the role of nurses as patient advocates Underlying moral values system of the nursing profession and the nurse-patient relationship; nurses have knowledge to advocate; are in the best position in the health care team; nurses and patients can be partners in advocacy

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Tuesday, 20 October 2009

Advocacy Conditions

Features central to advocacy by Willard C (1996) Nurse's role as patient advocate: obligation or imposition? ·Patients rights and interests in health care ·The moral status of patient autonomy ·Obligations owed to patients by nurses ·The work of independent advocacy schemes Suggests that literature tends to confuse advocacy with beneficence which dilates the significance of advocacy in health care

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Tuesday, 20 October 2009

Advocacy Tensions

More extreme arguments position nurses as the best or the only people to serve as advocates BUT most experts would agree that nurses do not claim a monopoly on the role of patient advocate. Positioning nurses as the sole patient advocate places undue strain on multidisciplinary relationships Advocating for patients can involve risks ranging from humiliation to job termination There is the risk of confronting another party who could be the doctor, family member or system Permission may be required from patients to advocate on their behalf A common view point highlights the need to distinguish advocates as a distinct profession, as an independent third party from the patient for neutrality

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Tuesday, 20 October 2009

Advocacy Tensions

A common view point highlights the need to distinguish advocates as a distinct profession, as an independent third party from the patient for neutrality When nurses advocate for patients, they face certain risks and obstacles associated with the settings within which they work. Therefore, there was always the possibility that attempts to advocate for a patient can fail, and that nurses can experience many barriers when addressing the rights, choices, or welfare of their patients. Very relevant in the development of sickle cell and thalassaemia community services in the UK-Evidence of Nursing Advocacy refs. Include STAC, Anionwu E and Atkin Karl (2001) The Politics of Sickle Cell and Thalassaemia

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Tuesday, 20 October 2009

Advocacy Practice Guidelines

Minnesota Nurses Association (2003) Position Statement Advocacy ­ prepared d to assist nurses in the role of advocate at an individual, organisational and community/policy level Advocacy at the individual level include: Promote the expert role of nurses as advocates Promote increasing the knowledge of research-based nursing practice to enhance patient / client education and outcomes Promote cultural sensitivity and literacy of nurses to become expert in communicating with persons from diverse cultures Expand the ability of nurses to effectively communicate complex issues and concerns on behalf of patient populations

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Tuesday, 20 October 2009

Advocacy Practice Guidelines Promote increasing the knowledge of nurses in the legal, ethical and professional practice standards Promote the nurses' ability to reflect on their personal beliefs, values, attitudes and behaviour which may affect their role as an advocate Promote the preparation of nurses for expanded roles of co-ordination in the management of acute and chronic care and in the promotion of health and the prevention of disease Promote the education of nurses to recognise the physical and emotional limits of effective advocacy Promote the confidence and security of healthy individual nurses who care for themselves while securing reasonable working conditions

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Tuesday, 20 October 2009

Advocacy Practice Guidelines

Organisational land community level: Promote the discussion of ethical and emotional value conflicts inherent in the current health care delivery system bringing issues to the appropriate body in the facility Promote safe and secure health care environments that support effective advocacy for patients and families Promote the recruitment of individuals from diverse cultures into nursing and actively support these nurses in their workplace Promote community standards and policy initiatives designed to protect the health of the public in such areas as access to immunisations; safe staffing in health care facilities and collection of data on defined measures of quality in health care facilities

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Tuesday, 20 October 2009

SUMMARY

· Role of advocacy is considered to be integral to nursing practice · However structures and support at organisational level is important to prevent tensions emerging from advocacy activities · Literature review was not undertaken for comparing advocacy in other health care systems nor in respect to population variation · Te literature was not reviewed to explore potential differences in advocacy among professionals of different backgrounds

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Tuesday, 20 October 2009

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