Ch 6: Patient, Subordinate, and Professional Advocacy

Which statement regarding the responsibility of a manager in advocacy is accurate?

A) Advocacy is a management function and not a leadership role

B) Managers advocate only as needed to meet organizational goals

C) Managers should advocate for patients as well as subordinates

D) Professional advocacy is not a primary concern for most managers

C: Managers should advocate for patients as well as subordinates

Feedback: Advocacy is helping others to grow and self-actualize. The manager must be an advocate for patients, subordinates, and the nursing profession. The remaining

statements are not accurate descriptions of the manager's role as advocate.

How is the action of advocacy described?

A) Informing others of their rights and making certain they have sufficient information to make decisions

B) Learning about the need for a decision and then making a good decision for other people

C) Supporting an individual's right to make a decision even when they do not have accurate information

D) Protecting the rights of patients in accordance with the law

Ans: A. Informing others of their rights and making certain they have sufficient information to make decisions

Feedback: The advocate informs others of their rights and makes certain they have sufficient information to make decisions. The remaining options are incorrect when describing the action associated with advocacy.

Even after a lengthy discussion concerning the ramifications, a patient wants to leave the hospital against medical advice (AMA). What would the nurse do in the role of patient advocate?

A) Encourage the patient to wait until morning to leave the hospital

B) Ask family members to help talk the patient out of the decision

C) Call the security guard to escort the patient off hospital property

D) Make sure the patient has appropriate follow-up appointments

Ans: D. Make sure the patient has appropriate follow-up appointments

Feedback: As advocate for this patient, you have made sure he is informed of the ramifications of leaving AMA; however, it is a patient's right to refuse treatment. The other options fail

to recognize the patient's right to make autonomous choices.

Which statement about a national Patient Bill of Rights is accurate?

A) Not yet been enacted by the federal government

B) Became the law of the land

C) Became legally binding in every state

D) Has not been beneficial to patients

Ans: A. Not yet been enacted by the federal government

Feedback: Although there has been significant progress in the field of patient rights since 1960, there is still no comprehensive federal legislation directed at the granting and protection of patient rights.

Who plays a primary role in ensuring that workers have reasonable, working schedules?

A) Unions

B) Top administrators

C) Managers

D) Federal government

Ans: C. Managers

Feedback: In workplace advocacy, the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates. The other

options play a role in such situations but the manager has the primary responsibility.

Which situation is a reality for whistle-blowers?

A) Retaliation against them is illegal

B) Fellow workers are supportive of them

C) Federal and State law protects them

D) They are often afraid to speak out

Ans: D. They are often afraid to speak out

Feedback: Although whistle-blower protection has been advocated for at the federal level and has been passed in some states, many employees are reluctant to report unsafe conditions for fear of retaliation. Nurses should check with their state association to assess the status of whistle-blower protection in their state. Retaliation and resentment still exist against these individuals in many situations.

Which statement is true regarding political action committees (PACs)?

A) They attempt to persuade legislators to vote in a particular way

B) They are comprised of volunteers who are interested in politics

C) Their focus is the passage of specific pieces of legislature

D) They appear to have little influence with law makers

Ans: A. They attempt to persuade legislators to vote in a particular way

Feedback: PACs of the Congress of Industrial Organizations attempt to persuade legislators to vote in a particular way. Lobbyists of the PAC may be members of a group interested in a particular law or paid agents of the group that wants a specific bill passed or defeated. Currently, PACs appear to have a significant amount of influence on law makers and the

legislative process.

Which factor has the greatest influence on a legislator?

A) Form letters from group members

B) Individual phone calls from constituents

C) Meeting with a strong collective political group

D) A personal visit by an individual constituent

Ans: C. Meeting with a strong collective political group

Feedback: Legislators and policy makers generally are more willing to deal with a group rather than individuals; thus, joining and supporting professional organizations allow nurses to become active in lobbying for a stronger nurse practice act or for the creation or

expansion of advanced nursing roles.

Which strategies would demonstrate an understanding of effective preparation for a television interview to discuss issues affecting nursing today? Select all that apply

A) Be focused on key points.

B) Introduce statistics that support the key points

C) Repeat key points several times during the interview

D) Provide background material related to the key points

Ans: A, B, C, D

Feedback:

The best strategies for a television interview are to be prepared and to stick to three or

four key points that will drive home your message, and repeat them during the

interview. Concentrating on popular points is not necessarily where the focus should be

directed.

What statement is true concerning nurses as a political body?

A) They are very committed to both their profession and the political process

B) Many are active members of the American Nurses Association (ANA)

C) Their primary focus is to speak out on consumer health-related issues

D) They have not yet recognized the full potential of political activity

Ans: D. They have not yet recognized the full potential of political activity

Feedback: As a whole, the nursing profession has not yet recognized the full potential of collective political activity. Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes. The remaining options are not true of nurses in general.

Which leadership role is associated with advocacy?

A) Create a climate where advocacy and its associated risk-taking are valued

B) Give subordinates and patients adequate information to make informed decisions

C) Ensure that rights and values of patients supersede those of the health-care providers

D) Seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict

Ans: A. Create a climate where advocacy and its associated risk-taking are valued

Feedback: A leadership role associated with advocacy is to create a climate where advocacy and its associated risk-taking are valued. Management functions include the following: give subordinates and patients adequate information to make informed decisions; ensure that rights and values of patients supersede those of the health-care providers; and seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict.

Which management function is associated with advocacy?

A) Awareness of current legislative efforts affecting nursing practice and organizational and unit management

B) Role modeling proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives

C) Participation in professional nursing organizations and other groups that seek to advance the profession of nursing

D) Assertively advocating on behalf of patients and subordinates when an intermediary is necessary

Ans: A. Awareness of current legislative efforts affecting nursing practice and organizational and unit management

Feedback: A management function associated with advocacy is awareness of current legislative efforts affecting nursing practice and organizational and unit management. Leadership roles include the following: role models' proactive involvement in health-care policy

through both formal and informal interactions with the media and legislative

representatives; participates in professional nursing organizations and other groups that

seek to advance the profession of nursing; assertively advocate on behalf of patients and

subordinates when an intermediary is necessary.

How can nurses act as advocates? Select all that apply.

A) Helping others make informed decisions

B) Directly intervening on behalf of others

C) Providing consent to treat for the cognitively impaired patients

D) Making health-care decisions for those who are not able to do so

Ans: A, B

Helping others make informed decisions

Directly intervening on behalf of others

Feedback:

Nurses may act as advocates by either helping others make informed decisions, by acting as intermediary in the environment, or by directly intervening on behalf of others.

Advocates do not make decisions or provide consent but rather educate patients so they can be informed.

Which characteristic associated with being a patient increases the need for advocacy?

Select all that apply.

A) Loss of physical freedom as a result of extended hospitalizations

B) Decreased independence due to physical or psychosocial limitations

C) Physical or psychosocial limitations negatively impacted autonomy

D) Illness tends to make an individual more vulnerable to unethical activities

Ans: A, B, C, D

Feedback:

Patient advocacy is necessary because disease almost always results in decreased

independence, loss of freedom, and interference with the ability to make choices

autonomously. In addition, aging, as well as physical, mental, or social disability may

make individuals more vulnerable and in need of advocacy. It is not true that cognitive

function is impaired as a result of chronic and/or acute illness.

Which are common areas requiring nurse patient advocacy? Select all that apply.

A) Securing patient consents

B) Preventing medication errors

C) Facilitating access to health-care services

D) Respect for patient dignity and cultural values

Ans: A, B, C, D

Feedback:

Common areas requiring nurseñpatient advocacy include inadequate patient consents;

medical errors; access to health care; and respect for patient dignity and cultural values.

While hospitalization is expensive, education on this subject is not considered a nursing

advocacy role.

Which intervention demonstrates that the nurse-manager is to advocate for patients in common areas of concern? Select all that apply.

A) Staffing a unit with sufficient care providers

B) Orienting staff to safely use a new patient lift

C) Providing an in-service on culturally meeting end-of-life needs

D) Arranging for patient consultations with members of the financial office

Ans: A, B, C, D

Feedback:

Common areas for managers to advocate for patients include distribution of resources;

use of technology; end-of-life decisions; and health-care reimbursement. While

aesthetics is an important consideration, it is not a common area for managers to act as

advocators

Whose rights do the legislative controls of nursing practice primarily protect?

A) Patients

B) Subordinates

C) Managers

D) Administrators

Ans: A. Patients

Feedback: The legislative controls of nursing practice primarily protect the rights of patients. Protection of those identified by the other options while important is the primary focus of the nursing practice legislative bodies.

Patients were often denied basic human rights until when?

A) 1940s

B) 1950s

C) 1960s

D) 1970s

Ans: C. 1960s

Feedback: Until the 1960s patients had few rights; in fact, patients before then often were denied basic human rights. Conditions improved by the 1970s.

The Patient's Bill of Rights established by which body has the most legal authority?

A) A health-care organization

B) A professional medical organization

C) A regulation professional nursing organization

D) A specific state

Ans: D. A specific state

Feedback: A bill of rights that has become law or state regulation has the most legal authority because it provides the patient with legal recourse. A bill of rights issued by health-care organization and professional associations is not legally binding but may influence federal or state funding and certainly should be considered professionally binding.

Which standard of the American Nurses Association (ANA) Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients?

A) II

B) III

C) IV

D) V

Ans: D. V

Feedback: Standard V of the ANA Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients. This issue is not addressed in the other options.

Which nursing intervention demonstrates attention to the nursing values central to patient advocacy? Select all that apply.

A) Assuring the patient that their wishes will be respected regarding the care they receive

B) Identifying the patient's religious dietary practices when discussing a prescribed diet

C) Answering the patient's questions regarding the alternatives to a proposed procedure

D) Suggesting to a patient that a social services consult would help with discharge needs

Ans: A, B, C, D

Feedback:

The nursing values central to advocacy emphasize caring, autonomy, respect, and

empowerment. While appropriate, comforting a patient is not an act of advocacy in this

situation.

Which strategy demonstrates an understanding of the management's role as advocate for their subordinates? Select all that apply.

A) Staff representatives on all unit committees

B) Monthly brown bag lunches with the staff

C) Requests revising criteria for granting a leave of absence

D) Working with primary care providers to expand standing nursing orders

Ans: A, B, C, D

Feedback:

The following are suggestions for creating an environment that promotes subordinate

advocacy: Invite collaborative decision making; get to know staff personally; ìgo to batî

for staff when needed; and promote nurse autonomy. Rather than anticipating

educational needs, the manager advocates by asking for and then respecting their

suggestions by planning accordingly.

Managerial advocacy has resulted in which profession of nursing characteristics? Select all that apply.

A) Ethical code

B) Legal recognition

C) Nurse Practice Acts

D) Professional licensing

Ans: A, B, C, D

Feedback:

Managers must be advocates for the nursing profession. It was nurses who pushed for

accountability through state nurse practice acts and state licensing. Nurse-leaders

collaborated on defining the profession, achieving legal recognition of the profession

and establishing a culture for professional nursing which has continued to the present

time. Advocating for professional nursing is a leadership role. Professional issues are

always ethical issues. When nurses find a discrepancy between their perceived role and

society's expectations, they have a responsibility to advocate for the profession. This

includes speaking out on consumer issues, continuing and expanding attempts to

influence legislation, and increasing membership on governmental health policy-making

boards and councils. Only then will nurses be able to influence the tremendous problems

facing society today.

Which statement correctly identifies the composition of a letter to a legislator? Select all that apply.

A) Identify yourself as a constituent in the first paragraph

B) State your reason for writing in the second paragraph

C) Sign the letter and include your contact information

D) Address the legislator by title

Ans: A, C, D

Feedback:

Personal letters are more influential than formal letters, and the tone should be formal

but polite. The letter should also be concise (not more than one page). Be sure to address

the legislator properly by title. Establish your credibility early in the letter as both a

constituent and a health-care expert. State your reason for writing the letter in the first

paragraph, and refer to the specific bill that you are writing about. Then, state your

position on the issue and give personal examples as necessary to support your position.

Offer your assistance as a resource person for additional information. Sign the letter,

including your name and contact information. Remember to be persistent, and write

legislators repeatedly who are undecided on an issue. Display 6.5 displays a format

common to letters written to legislators.

A nurse-manager has been asked to write an article for the newspaper addressing a health-care issue of local concern. Which statement demonstrates the nurse understandings the appropriate way to response to such a request? Select all that apply.

A) I'll include the latest data on the subject.

B) When will you need to have the final draft of my article?

C) Are you comfortable with me focusing on 3 key points related to this topic?

D) That isn't my field of expertise but I will contact a peer with that knowledge.

Ans: A, B, C, D

Feedback:

Tips of effective interaction with the media include respecting and meeting their

deadlines, having key facts ready to include, limiting key points to two or three, and not

being afraid to say you lack that specific expertise. One should assume, until proven

otherwise, that the reporter will be fair and accurate in his/her reporting.