DNP 840 Topic 4 Discussion Question Two
DNP 840 Topic 4 Discussion Question Two
How does a doctorally prepared advanced practice nurse advocate for patients as well as the nursing profession? Is there a symbiotic relationship between the two goals? How is advocacy advanced effectively?
Patient advocacy in nursing is a relatively modern idea (1), but its first movements originated in Florence Nightingale’s era (2). It is of such importance that it has entered the moral codes of nursing institutions (1, 3). The need for justice is among the basic human needs (4) and nurses, more than anyone else, are in contact with patients and their problems (5); therefore, they can provide justice for the
patients better than anyone else (6). Nurses are the first advocates of patients (7), and are the link between the patient and the health care system (8).Patient advocacy is one of the extremely important roles of the nurses (9–12).
The patient or client is vulnerable and has experienced varying degrees of damage (13). Therefore, many opportunities arise in nursing for the enforcement of patient advocacy, which has turned the nursing profession into the most reliable profession regarding patient advocacy. Through the appropriate performance of this role, the trust and respect of the community toward the nurses will increase (7). Nevertheless, even when they have effectively performed their role, complications such as fear, anger, frustration, hopelessness, and a sense of separation from their peers are experienced (1, 9). However, effective advocacy improves the quality of patient care and enriches the nursing profession. Thus, the failure to play this role effectively may detract from the richness of this profession (14) and result in nurses leaving their profession (15).
Advocacy is generally described as defending the rights and property of others (3). In nursing, it has been defined as being a patient representative, defending the patient’s rights and universal rights, protecting the interests of the patient, contributing to decision-making and supporting the patient’s decisions (3, 11, 16), ethical-centered skills for the ‘professional self’(17), and ‘being a voice for the vulnerable (3, 18). Negarandeh et al. defined the dimensions of patient advocacy in Iranian nurses as informing and educating, valuing and respecting, and physical, emotional, and financial support, protecting and representing the patient, and continuity of care (13). However, providing a single definition for the term is difficult (8, 11).
Today, patient advocacy has taken a wider range of dimensions. For example, Ware et al. stated that protecting patients against unethical and illegal acts was only a part of patient advocacy (12). Mahlin stated that although supporting the patient is a major goal, the broader problems of patient advocacy cannot be resolved through this method, and the patient’s advocate should address the systematic problems of care and administrative institutions (19). In support of this claim, Maryland and Gonzalez stated that nurses, in addition to within hospitals, should support patients and their families in other social environments including economic, educational and research, healthcare delivery, and legislative environments, regarding their access to health care, cost control, and health care quality (8). Protection of clients in clinical trials (20), supporting of organ donation volunteers, and protection of the fundamental rights and welfare of patients are also added to this category (16).
Patient advocacy is an ideal in the nursing practice (21). It is reliant upon many factors, including social relationships, human interactions (22), and moral distress and its side effects. However, many aspects of this concept have not been identified (23). Many studies have referred to the failure to define and explain the concept of nursing advocacy and their results were not in agreement (8, 10). These ambiguous interpretations of patient advocacy impose a number of problems on the nursing practice (21). Considering nurses’ lack of knowledge on patient advocacy in nursing and its irreparable consequences, it is necessary to train nurses on patient advocacy (9, 11).
In addition, few Iranian studies have addressed this issue. Jafari Manesh et al. in their descriptive-comparative study found that this perception was higher in the patents than the nurses and higher in the nurses than the physicians, but they did not address the topic of patient advocacy itself (24). Negarandeh et al., through the grounded theory, explored the dimensions of patient advocacy in Iranian nurses (13). So the present study is part of a greater qualitative study and its results differed in some ways from the results of previous studies especially in terms of empathy. Thus, this topic requires further qualitative exploration. The aim of this study was to better clarify nursing advocacy among Iranian nurses through a qualitative study.