Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Patient Advocacy by Nurses - Past, Present and Future

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Patient Advocacy by Nurses - Past, Present and Future

Article excerpt

Introduction

Over the past four decades, patient advocacy has become central to nursing's professional identity. Nursing regulatory and professional organizations explicitly and implicitly include advocacy activities as part of codes of conduct and ethics. Advocacy is seen by the International Council of Nurses (ICN) as central to nurses' contribution to the development of strong and resilient healthcare systems, thereby contributing to achieving the United Nations Sustainable Development Goals (SDG) (ICN, 2016). In order to facilitate this, nurses need to advocate for the populations who they work with, in particular those most vulnerable and at risk; advocate for the development of a strong nursing workforce; and contribute to the development of policy that supports the SDG goal 3 of ensuring healthy lives and promoting well-being for all at all ages (ICN, 2016). The importance of advocacy is also highlighted in other areas: for example, pain management (Ware, Bruckenthal, Davis, & O'Conner-Von, 2011), cultural safety (Ronnebaum & Schmer, 2015), mental health (Jugessur & Iles, 2009), end of life care (McSteen & Peden-McAlpine, 2006) and patient engagement (Guglielmi et al., 2014). The importance of acting as a patient advocate is impressed upon nurses as part of their nursing education, and research indicates that that the majority of nurses see patient advocacy as part of their core responsibilities (Barlem et al., 2015). There have been many attempts to define, explain and describe patient advocacy (Mallik, 1997); however, certainty about the concept, its meaning and its implications for nursing practice remains elusive (Sorensen & Iedema, 2007). There are concerns that while nurses know they are supposed to advocate for patients, they are less clear about what patient advocacy is and how to carry out this role (MacDonald, 2007). There appears to be a divide between the ideals expressed in nursing codes, and the reality, where nurses often struggle to put effective patient advocacy into action (Kalaitzidis & Jewell, 2015).

Historical background

Most accounts of patient advocacy have situated its rise to prominence within nursing as part of a series of profound changes that occurred in Western society and culture in the 1960s and 1970s. Central to these changes were the women's and civil rights movements, whose critiques of the power relations in society that subjugated women and minority groups were significant both for healthcare and for nursing as a profession (Mallik & Rafferty, 2000; Snowball, 1996). Rising consumerism in the West was also crucial to patient advocacy because of the increased emphasis upon the power of consumer choice (Hewitt, 2002). These developments were linked to deeper cultural shifts in the second half of the twentieth century; an increasing emphasis upon the primacy of individual autonomy and self-determination in Western cultures resulted in a greater focus upon the elucidation of individual rights in a variety of domains, including health (Schroeter, 2000). This rights-based focus was crucial to the conception of a need for patient advocacy; patient rights, particularly the right to self-determination, were seen to require active protection.

Within healthcare, developments in technology not only enhanced the ability to keep people alive for longer, but also increased the complexities of the ethical decisions that patients and healthcare professionals faced (Bu & Jezewski, 2007; Snowball, 1996). At the same time, the authority of modern bio-medicine was challenged by critics who questioned the increasing influence it had over the human body from birth to death (Illich, 1977). Through this maelstrom of rapid social and cultural change, the nursing profession sought to define a new role for itself, no longer as the handmaiden of medicine, but as a separate profession with its own set of aims and principles, coalescing around a more holistic concept of patient-centred care (Hewitt, 2002). …

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