Patient advocacy has been an essential part of nursing since Florence Nightingale's work during the Crimean War, though she never used the term itself. Even so, her activism for healthcare reform and efforts in making conditions in British military hospitals better for soldiers resulted in a model of advocacy that has been used in nursing ever since.
Depending on where you look, the definition of "advocacy" can vary. In the dictionary, advocacy is defined as the act or process of supporting a cause or proposal: the act or process of advocating.
In its Code of Ethics with Interpretive Statements (Provision 3), the American Nurses Association (ANA) offers its own definition of nurse advocacy, stating, "The nurse promotes, advocates for, and protects the rights, health, and safety of the patient."
In an attempt to provide a comprehensive and clear definition of patient advocacy as a concept, a group of researchers, in their study, "Patient advocacy in nursing: A concept analysis," reviewed 46 articles and two books published between 1850 and 2016 related to patient advocacy. The researchers used Rodgers' evolutionary concept analysis that is an "inductive method in which the development of a concept is examined over time." Because the definition has developed over time, the researchers used this approach in their study.
Identified attributes of patient advocacy in nursing
Five major attributes were identified by the researchers:
- Safeguarding
- Apprising
- Valuing
- Mediating
- Championing social justice in the provision of health care
The evolution of these five attributes indicated that, until the year 2000, they included the act of nurses tracking medical errors, maintaining patient individualization and humanity, promoting patient self-control, being the patient's voice, enabling patients to make decisions freely, suggesting alternatives to health care, and protecting patients from incompetency or misconduct of workers or members of the healthcare team.
From 2001 until 2016, additional attributes of nurses were added to the definition of patient advocacy. They were maintaining patient privacy, confronting inappropriate rules or policies in the healthcare system, and identifying and correcting inequalities in the delivery of health services.
Patient advocacy does not happen in a vacuum. It is a dynamic concept.
Thus, the researchers identified precursors that helped support its development and very existence. The review of articles and books revealed individual and work-related qualities that nurses contributed to patient advocacy, including professional knowledge and skills, independence, work motivation, and the ability to interact with patients and other healthcare team members.
The outcomes of advocacy
The study clearly indicated that advocacy has effects on both patients and nurses alike. Patients were able to develop a sense of self-determination and empowerment and were the benefactors of improved patient safety and quality of care, to name just a few.
For nurses, the results include experiencing a sense of feeling worthwhile, enhancement of their public image/reputation, and job satisfaction.
Nurses did experience some negative outcomes, however. Identified negative results included moral distress or dilemmas, being labeled as troublemakers, and feelings of isolation and frustration.
Implications for you
This study is a very interesting one. I suggest all nurses read the entire report to get an in-depth view of patient advocacy and its growth over the years included in the report. The analysis raises many points to consider. Would you describe advocacy differently than it is in the review? Have you or your colleagues experienced any of the identified benefits that were identified? Have you faced any of the negative outcomes identified by these authors?
If you are a nurse researcher delving into the behaviors or characteristics of patient advocacy, this report would be interesting to you and could be a research project you may want to consider taking on to answer some important questions. For example, how is advocacy different in psychiatric mental health nursing as compared to maternal child health? How is patient advocacy the same in these selected specialties of nursing practice? How do nurses successfully teach patient advocacy? Should it be a special course or included in all courses of the nursing education program?
Questions also arise as to how patient advocacy will continue to progress as health problems change in the future. Issues such as access to care, healthcare for incarcerated individuals, and possible adjustments to Medicare are just a few of the current healthcare concerns that might change how advocacy looks in the years to come.
Nurses are critical players as patient advocates. You are, in fact, the last line of defense when a patient's wishes are not adhered to, as I discussed in my blog, "Advocate for patients by adhering to advance directives". Your critical role is also important in the legislative process. Proposed bills that improve patient care for all patients who cannot speak for themselves require your voice be heard, so such bills become law.
Take these related courses:
Ethics for Nurses (1 contact hr) Healthcare professionals are held to high standards of moral character and an expectation to be patient advocates. This innate drive to do "what is right," arguably a prerequisite for pursuing a career in patient care, is rooted in history, law, clinical education, and current daily practice. What do we do when this line is blurred, and no clear answer appears to all involved parties? This course seeks to give the nurse understanding of past, present, and future practices of ethical decision-making in the acute care setting as well as how to manage instances when our own values and judgement do not align with that of the patient, family, or care team.
Protect Yourself: Know Your Nurse Practice Act (1 contact hr) Nurses have an obligation to keep abreast of current issues related to the regulation of the practice of nursing not only in their respective states but also across the nation, especially when their nursing practice crosses state borders. Because the practice of nursing is a right granted by a state to protect those who need nursing care, nurses have a duty to patients to practice in a safe, competent, and responsible manner. This course outlines information about nurse practice acts and how they affect nursing practice.
