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Advocacy

Advocacy. Helen Nicholson h.m.nicholson@leeds.ac.uk. Learning Objectives. Students will begin to… define Advocacy …and explore… the role of an Advocate the history of Advocacy the history of Advocacy in Nursing who needs an Advocate who should be an Advocate

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Advocacy

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  1. Advocacy Helen Nicholson h.m.nicholson@leeds.ac.uk

  2. Learning Objectives Students will begin to… • define Advocacy …and explore… • the role of an Advocate • the history of Advocacy • the history of Advocacy in Nursing • who needs an Advocate • who should be an Advocate • the desired outcomes of Advocacy • the reality in Nursing Helen Nicholson June 2004

  3. Definitions • From the Latin Advocatus “one who is summoned to give evidence” (Gates 1995) • “one who pleads the cause of another” (OED 1989) • “defending the rights of the vulnerable…or acting on behalf of those unable to assert their rights” (Thompson, Melia, Boyd 2000) Helen Nicholson June 2004

  4. LAW: The advocate is a lawyer who is consulted by a client before a case comes to court (Woodrow 1997) Ensuring responsibility in decision making Supporting decisions Objectivity Mediation Negotiation Assertiveness Knowledge Commitment Roles Helen Nicholson June 2004

  5. History • Civil rights 1960s • Larry Gostin 1968 • Independent advocacy groups for mental health • UK MIND • Advocacy Alliance 1982 Helen Nicholson June 2004

  6. The Need for Advocacy “The assumption that advocacy is required in healthcare implies that the process of becoming a patient results in a reduction of autonomy and that the patients rights or interests may not be respected” (Willard 1996) Helen Nicholson June 2004

  7. Autonomy • “…autonomy is a feature of persons and that (it) is a desirable quality to have” (Dworkin 1988) • From the Greek autos “self” and nomos “rule or law” • Decision making • Valued principle in ethics and law Helen Nicholson June 2004

  8. Moral Autonomy “An autonomous life is one that is directed in accordance with an individual’s own conception of what he (or she) wants to do in and with that life. Such an account requires us to think of autonomy as involving more than just the absence of constraints. A purely “negative” conception … leaves out the positive element of self-determination essential to an adequate account of autonomy.” (Young 1986) Helen Nicholson June 2004

  9. “the effort to help persons become clear about what they want to do by helping then discern and clarify their values in the situation, and, on the basis of that self-examination, to reach decisions which express their reaffirmed, perhaps recreated, complex of values.” (Gadow 1980) “informing the patient of his rights in a particular situation, making sure he has all the necessary information to make an informed decision, supporting him in the decision he makes, and protecting and safeguarding his interests.” (Clark 1988) Advocacy in Healthcare is… Helen Nicholson June 2004

  10. Empowerment Informing patients/ clients of their rights Supporting and protecting rights Partnership with the patient/ client Taking action on the part of the patient OUTCOMES Choice Justice Support Protection Access Satisfaction Advocacy in Healthcare involves… Helen Nicholson June 2004

  11. CAN BE AN ADVOCATE? Self Volunteer (citizen advocate) Trained advocate (paid) Peer (another client) Nurse Other healthcare worker? NEEDS AN ADVOCATE Who…? ? Helen Nicholson June 2004

  12. History in Nursing • “The ideal of advocacy as a nursing prerogative arises out of the uniqueness of the nurse-patient relationship” (Mallik & McHale 1995) • 1973 International Council of Nurses • UKCC 1989 “the practitioner will accept a role as advocate on behalf of his or her patients/ clients.” Helen Nicholson June 2004

  13. NMC Code of Conduct 2002 NURSE VALUES: • Accept and respect the right to decide • Relationship is democratic, collaborative partnership • Thoughts matter • Distributive justice and fairness • Is this the same as the “informing and enabling” role of the nurse? Helen Nicholson June 2004

  14. Perceptions of Advocacy “Advocacy occurs in a conflict situation where the patient’s request, patient’s fear, patient’s vulnerability or threats to the patient’s human rights provoke a response from the “advocacy sensitive nurse”. ” (Mallik 1997) “When attempts at advocacy were unsuccessful the nurses experienced intensified moral distress frustration and anger.” (Sundin-Huard & Fahy 1999) Helen Nicholson June 2004

  15. Advocacy in Nursing? • Rights advocates: moral or legal? • Beneficence advocates: doing good. What is in the patient’s best interest? • Autonomy advocates: plead in every case? (Allmark 2003) Helen Nicholson June 2004

  16. The Reality in Nursing? • Conflict of interests: security and confrontation • Conflict of interests: duty of care/ professional judgement • Limited authority • Individual characteristics Helen Nicholson June 2004

  17. Learning Objectives Reflect on your experiences in clinical practice and consider… • definitions of Advocacy • the role of an Advocate • the history of Advocacy • the history of Advocacy in Nursing • who needs an Advocate • who should be an Advocate • the desired outcomes of Advocacy • the reality in Nursing Helen Nicholson June 2004

  18. Question Can a nurse ever be a truly independent and effective patient advocate?

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