Like many of us, I’ve been told that I’m a great advocate for my patients. But what does this really mean? How does one articulate what nursing advocacy is? Is there a “magic formula” for being an advocate?
In my quest for an answer to this question, my first stop was the Oxford Nursing Dictionary. I’ll admit it, it’s been quite a while since I’d opened the book, so long that I had to track down a copy from one of my colleagues. Here’s their definition of “advocate” (Reference 1):
Advocate: 1. A practitioner, usually a nurse, who utilizes this role to promote and safeguard the well being and interests of his or her patients or clients by insuring they are aware of their rights and have access to information to make informed decisions. Advocacy in health care is an integral part of professional practice. 2. A person who acts as a proxy for or speaks on behalf of a patient who lacks capacity.
This seemed a bit unhelpful in terms of being a practical guide to how to be an advocate, so I conducted a brief search of the nursing literature and found a research article about advocacy that described a small study of a group of surgical patients and their nurses (Reference 2). Although the article was not related to patients with bone marrow failure disease, I see the article as equally applicable to our patient population.
The aim of this study was to “describe the way nursing advocacy was defined, activities that advocacy involves, and the way that advocacy is experienced.” As I read through this article, I was not surprised to find that there are quite a number of definitions of advocacy and that historically the concept of advocacy has been written about more than the activity of advocacy itself. Through interviews with patients and their nurses, the authors found that the respondents’ definitions of nursing advocacy fell into three general categories: Exceptional Care (going “above and beyond”); Individual Care (focusing on the specific needs of specific patients), and Continuous Care (sustained and ongoing responsibility for and attention to the patient).
What really caught my attention, though, was how advocacy was perceived as being pursued, or rather, what happens in advocacy situations. The following five categories of advocacy activities emerged from the participants’ responses to the researchers’ questions: Analyzing, Counselling, Responding, Shielding, and Whistleblowing. With the exception of “Whistleblowing,” I was struck by the remarkable similarity of these activities to the nursing process itself.
The authors of the study also concluded that there were some specific conditions that needed to be present for advocacy to exist: interpersonal dialogue, competence of the nurse, contextual sensitivity, and empowerment of the patient and of the nurse. The consequences of nurse advocacy included patient empowerment, professional development, and disagreement. As an experience, the study determined that nursing advocacy boils down to the rights of the patient and the duty of the nurse. The authors concluded that nursing advocacy requires an integration of professional responsibility and active commitment to take part in the continuous expression and support of patient’s needs and wishes.
As I reflect on my own practice, I consider my own level of responsibility and commitment. This afternoon, I received a surprise visit from one of my former patients. This young man, who does not live in the United States, happened to be visiting the Washington, D. C. area. He stopped by just to say hello to the staff members who had cared for him over 5 years ago, and to introduce us to his girlfriend. I couldn’t help but think about the impact that my colleagues and I must have had on this young man’s life. I recalled some of the overwhelming challenges that he had encountered just a few years ago. I believe that the commitment and responsibility that we showed this young man not only helped lead to a positive outcome, but also forged a connection that brought him back to see us today.
As I close, I would ask you to consider the following question:
How do you exemplify professional responsibility and commitment to your patients and their families, and what can you do to take it to the next level?
(1) Oxford Dictionary of Nursing, 6th Edition. (2014). Elizabeth A. Martin, Ed., Oxford University Press, Oxford.
(2) Vaartio H, Leino-Kilpi H, Salanterä S, Suominen T. (2006). Scand. J. Caring Sci. 20:282-92.