Study Notes on Patient, Subordinate, Workplace, & Professional Advocacy

PATIENT, SUBORDINATE, WORKPLACE, & PROFESSIONAL ADVOCACY

Chapter 6

Surgery Involvement

Definition of Advocate

  • Advocate (Entry 1 of 2):

    1. One who pleads the cause of another.

    2. One who defends or maintains a cause.

    3. One who supports or promotes the interests of a cause.

  • Advocate (Entry 2 of 2):

    • Transitive Verb: To support or argue for (a cause, policy, etc.); to plead in favor of.

    • Intransitive Verb: To act as an advocate for someone or something—e.g., a tradition of advocating for the equality and civil rights of all people (Merriam-Webster.com, n.d.).

Nurses as Advocates

  • Role of Nurses in Advocacy:

    • To help others grow and self-actualize, critical to nursing leadership.

    • Considered one of the most vital and basic roles of nursing.

  • Forms/Actions of Advocacy:

    1. Informing others of their rights.

    2. Ensuring patients have enough information to make decisions.

    3. Protecting and defending beliefs for oneself and others.

    4. Speaking on behalf of patients unable to advocate for themselves.

  • Methods of Advocacy:

    • Aiding others in making informed decisions.

    • Acting as an intermediary within the environmental context.

    • Directly intervening on behalf of individuals when necessary.

Nursing Values Central to Advocacy

  • Display 6.3:

    1. Each individual has a right to autonomy in deciding the most appropriate health-care actions.

    2. Individuals have the right to hold personal values affecting health-care decisions.

    3. All individuals should have access to necessary information for informed decision-making.

    4. Nurses must act on behalf of patients unable to advocate for themselves.

    5. Empowering patients and subordinates to make independent decisions is central to advocacy.

Engagement in Health Care

  • Key Points on Engagement:

    • Engagement improves population health, enhances patient experience, and lowers costs.

    • It exists on a continuum of partnership between individuals and service providers.

  • Strategies for Patient & Family Engagement:

    1. Invite patients and family members to act as advisors.

    2. Facilitate communication among patients, families, and health-care professionals from admission onwards.

    3. Ensure safe continuity of care through nurse bedside reports at shift changes.

    4. Involve patients and families in discharge planning throughout hospitalization.

Entry Points for User Engagement

  • Individual Level: Increase patient and family knowledge about care expectations.

  • Health-care Team Level: Promote shared understanding of patient-provider expectations.

  • Organizational Level: Encourage patient and family integration in hospital operations.

  • Community Level: Focus on community health improvements beyond hospital settings.

Common Areas Requiring Nurse-Patient Advocacy 1

  1. End-of-life decisions.

  2. Technological advancements in healthcare.

  3. Changes in health-care reimbursements.

  4. Access to health care.

  5. Transitions in health care.

  6. Provider-patient conflicts regarding expectations.

  7. Withholding information or misinformation to patients.

  8. Insurance issues: authorizations, denials, and delays.

  9. Medical errors.

Common Areas Requiring Nurse-Patient Advocacy 2

  1. Patient information disclosure (privacy and confidentiality).

  2. Grievances and appeal processes.

  3. Cultural and ethnic sensitivity.

  4. Respect for patient dignity.

  5. Inadequate consent processes.

  6. Incompetent health-care providers.

  7. Complex social issues, including AIDS, teenage pregnancy, violence, and poverty.

  8. Issues related to the aging population.

Patient Rights

  • Patient’s Bill of Rights:

    • Boosts patient confidence in the U.S. health-care system.

    • Emphasizes strong patient-provider relationships.

    • Outlines rights and responsibilities for patients and providers.

  • Federal Protections:

    • Protects privacy and provides access to medical records.

  • Patient Protection and Affordable Care Act of 2010:

    • Eliminated lifetime coverage limits.

    • Allowed choice of physician within plans.

    • Extended coverage for children up to age 26.

    • Restricted lack of coverage due to application errors.

  • Health Insurance Portability and Accountability Act of 1996:

    • Established health information privacy and security guidelines.

  • Genetic Information Nondiscrimination Act (GINA):

    • Prohibits discrimination by health insurers/employers based on genetic information.

Right to Die Movement

  • Importance for advocates to distinguish between patient choice autonomy and assisting in decision-making.

  • Physician-Assisted Suicide (PAS): Gaining traction in the U.S., with 10 states allowing it plus Washington D.C.

  • Leaders must ensure patient rights, which include privacy and personal liberty as guaranteed by the Constitution.

Subordinate & Workplace Advocacy

  • Subordinate Advocacy: Essential leadership role as suggested by ANA for nurse administrators to advocate for healthcare providers and patients.

  • Need to foster empowerment and proactive leadership within healthcare settings while minimizing barriers.

  • Workplace Advocacy: Includes ensuring policies meet safety regulations (OSHA), addressing job dissatisfaction, and ensuring staff awareness of policies/procedures.

Suggestions for Promoting Subordinate Advocacy

  1. Facilitate collaborative decision making.

  2. Attentively listen to staff needs.

  3. Build personal relationships with staff.

  4. Understand care delivery challenges faced by staff.

  5. Collaborate to overcome challenges.

  6. Provide needed support to staff.

  7. Promote shared governance and transparency.

  8. Empower staff and enhance nurse autonomy.

Whistleblowing in Advocacy

  • Types of Whistleblowing:

    • Internal: Reporting misconduct within the organization.

    • External: Reporting to media or officials outside the organization.

  • Best Practices for Whistleblowing:

    • Should not be the initial solution; first attempt to resolve through other means.

    • Document all attempts to address issues and provide objective facts.

Professional Advocacy

  • Professional Commitment: Necessitates questioning and addressing issues within the profession.

  • The nurse’s commitment to advocate for the profession involves elevating the profession through questioning and problem-solving.

  • Importance of advocating for collective professional needs across various contexts.

Advocacy for the Nursing Profession

  • Skills Include:

    • Service through teaching, mentoring, peer review, and community service.

    • Knowledge dissemination is essential (ANA, 2001).

Legislative and Public Policy Advocacy

  • Nurses should collectively influence policy makers by participating in nursing associations and Political Action Committees (PACs).

  • Methods of Advocacy Include:

    • Direct communication (in person, calls, emails).

    • Writing effective letters to legislators focusing on a single issue clearly and with respect.

Nursing and the Media

  • Nurses are frontline providers but are often underrepresented in media narratives despite public trust in their professional opinions.

  • Opportunities should be sought for media appearances to share health-care perspectives.

Tips for Interacting With the Media

  1. Establish proactive communication with media outlets.

  2. Attend media training and practice interviews.

  3. Dress professionally during interviews.

  4. Respect and meet reporters' deadlines.

  5. Prepare key facts and limit to key messages (2-3 points).

  6. Avoid jargon, speak confidently, and clarify expertise boundaries.

  7. Maintain professionalism; avoid inflammatory issues.

Integrating Advocacy in Leadership and Management Roles

Managerial Role:

  • Recognizes patient needs and fosters a respectful work culture.

  • Advocates for subordinate needs and concerns to enact positive changes.

  • Facilitates open discussion around ethical dilemmas and concerns while maintaining positive public relations.

Leadership Role:

  • Advocates for patients even when it conflicts with institutional goals.

  • Models support for different patient choices and participates in public education regarding health policies.

Questions

  1. True or False: Nurses can advocate by directly intervening on behalf of others.

    • Answer: True.

    • Rationale: Nurses sometimes must directly intervene on patients' behalf.

  2. True or False: Reporting offenses to one's boss is external whistleblowing.

    • Answer: False.

    • Rationale: This is internal whistleblowing; external involves outside reporting.

  3. How can nurses advance the nursing profession? (Select all that apply)

    • Options: Learn about sociopolitical issues; Participate in professional organizations.

    • Answer: Select learning about sociopolitical issues AND participating in professional organizations.

    • Rationale: Participation in the social framework is essential for advancement.

  4. What should one not do when writing a letter to a legislator?

    • Option D: Compose a letter over two pages.

    • Answer: D. Should be succinct and directed, ideally not over one page.

  5. True or False: Nurses should avoid exposure in media.

    • Answer: False.

    • Rationale: It is beneficial to engage with media opportunities.