Response to "Patient Advocacy - an Important Part of the Daily Work of the Expert Nurse"
Copp, Laurel Archer Rn, PhD, Faan, Scholarly Inquiry for Nursing Practice
To advocate is to speak on behalf of others, to plead in support of them (advocatus) (ad-vocare, or call). When the needful one or patient is wounded or susceptible to injury, s/he is vulnerable. In the hospital setting or health center in the community, the advocate by proximity, professional role, and privilege is most often the nurse.
The sensitive work of Segesten is a clarion call to patient advocacy. It should be not only a part of the role of expert nurses, but of all nurses regardless of credentials and/or status in the health care hierarchy. But it is the expert nurses (those identified by superiors as nurses with a "green thumb") who have insight and the confidence of their peers and superiors who may be in a position to advocate effectively; and these nurses may be instrumental in raising the consciousness of all nurses to the need for patient advocacy, a need that appears to be unrecognized or denied by many.
Through the eyes of Segesten, we see that in Sweden, "the need for patientadvocacy has mainly been recognized as an activity outside nursing" (p. 131). It is through analysis of narratives that the need for patient advocacy of various types and the need and willingness to respond to such needs by nurses are carefully documented.
WHAT IS ADVOCACY?
The need for advocacy exists in the presence of vulnerable patients - those who are ill, immature, unconscious, or incompetent, the frail elderly, and those who may be temporarily or permanently fragile. The advocate attempts to protect the weaker ones from adversaries. In health care settings, the adversary may be trauma and disease, and the vulnerable one may literally be bruised and bleeding. The adversary may be circumstances, such as pain, famine, crime, or suffering. Unfortunately, the adversary may also be one's fellow human beings.
Advocacy may be as informal as acknowledgement of the human condition or as formal as employing a process that will bring the unmet needs of the patient to those who have the inclination and power to cease exploitation and redress (set right, remedy, make up for, rectify) grievances.
Although patient advocacy doesn't necessarily require an adversary, the vignettes highlighted often identify one. Most commonly, the adversaries were other members of the team, namely peer nurses, social workers, physicians, family members, health insurance officers, and, of course, the faceless rules, routines, and policies of "the health care system." Regardless of the country or system of health care, these occurrences are common. Nurses reading the narratives nod in understanding and no doubt would be prepared to come forward with examples of their own.
WHO REQUIRES ADVOCACY?
Advocacy is predicated on some measure of human vulnerability, e.g., that of the patient, to which the fellow human, e.g., nurse, may respond empathetically. We advocate for one another. Often advocacy is "present tense - that is, here and now, and takes place when the nurse encounters and responds to suffering, anxiety, or agony of the human condition."
Vulnerability, however, may have a subtle and complex quality. Types of vulnerability may constitute a continuum; patients may be (Copp, 1986):
a. potentially vulnerable (in utero);
b. circumstantially vulnerable (poverty);
c. temporarily vulnerable (trauma);
d. episodically vulnerable (chronic illness);
e. permanently vulnerable (paraplegia);
f. inevitably vulnerable (aging and death).
Patients, as well as staff, may experience more than one type of vulnerability in a lifetime, and indeed, may experience more than one type of vulnerability simultaneously.
Besides those who receive health care, powerlessness can be experienced by the advocate in the face of confrontation with the adversary. Actually, the powerlessness is compounded - that of an ill patient, a fear filled family, and collusion of many non-risking health professionals, physicians, nurses, social workers, clergy, insurers, and policy makers. …