King Saud university Collage of nursing Master program Nursing administration 1430-1431 Special Problems in Clinical

1. King Saud universityCollage of nursingMaster programNursing administration 1430-1431Special Problems in Clinical Specialization (NUR 574 )Prepared by : Ohood AlharthiSupervised by : Dr.Fatma M.Baddar

2. Advocate

3. Outlines: The definition of advocacy. The key elements of Advocacy. The types of advocacy. How to be an effective advocator. The functions of advocacy group. Becoming an advocate. The Barriers to advocacy. The Advocacy facilitators.

4. Outlines: The principles of advocacy. The objectives of advocacy. The patient advocate. The Patient Advocacy Within the Health Care Community. The Nursing and patient advocacy. The common Areas Requiring Nurse–PatientAdvocacy. Leadership Roles and Management FunctionsAssociated with Advocacy.

5. Outlines: The management Functions. The Nursing Values Central to Advocacy. How Would You Proceed advocacy? The subordinate advocacy. How Can You Best Advocate? The summary. The references.

6. Introduction Advocacy—helping others to grow and fulfill their potential—is a critically important leadership role. Nurse leader–managers often find themselves in the role of advocate for their patients, subordinates, and the profession. The actions of an advocate are to inform others of their rights and to ascertain that they have sufficient information on which to base their decisions. The term advocacy actually comes from the Latin word advocates, which means “one summoned to give evidence’’ (Blais, Hayes, Kozier, Erb, 2002, p. 61). The goals then of the advocate are to inform, enhance autonomy, and respect the decisions of others. There are nursing values central to advocacy. These values emphasize caring, autonomy, respect, and empowerment

7. The definition of advocacy: Advocacy is speaking, acting and writing with minimal conflict of interest on behalf of the sincerely perceived interests of a disadvantaged person or group to promote, protect and defend their welfare and justice by: being on their side and no-one else's. being primarily concerned with their fundamental needs. remaining loyal and accountable to them in a way which is emphatic and vigorous and which is, or is likely to be, costly to the advocate or advocacy group.

8. The key elements of Advocacy : Functioning by speaking out, acting or writing. Minimal conflict of interest. Sincerely perceived interests. Promotion of person's welfare, well being and justice. Costs.

9. The types of advocacy: Individual Advocacy: Here the advocate concentrates their advocacy efforts on one or two people only. There are two common forms of individual advocacy: Informal advocacy: Parents, brothers and sisters, relatives, friends who take on advocacy roles are all examples of informal, individual advocacy. Voluntary community based organizations: that pay staff to advocate for individuals, is another form of individual advocacy.

10. The types of advocacy: 2)Systems Advocacy: This form of advocacy is primarily concerned with influencing and changing the system in ways that will benefit people with a disability as a group within society. Systems advocates will encourage changes to the law, government and service policies and community attitudes. Usually systems advocacy do not do individual advocacy. To do so can cause conflict around the use of resources, focus and purpose.

11. How to be an effective advocator: Choose your issues carefully. Send hand-written letters. Focus on building relationships with staff. Think strategically. Organize your work.

12. The functions of advocacy group: Give a voice to (misrepresented) citizen interests. Mobilize citizens to participate in the democratic process. Support the development of a culture of democracy. Assist in the development of better public policy. Ensure governments’ accountability to citizens.

13. Becoming an advocate: Nurses may act as advocates by either: helping others make informed decisions, by acting as an intermediary in the environment, or by directly intervening on behalf of others.

14. The Barriers to advocacy : Lack of Support. Limited communication. Lack of motivation. The Advocacy facilitators: The development of functional relationship. Recognizing and paying attention to and conditions of others. Knowledge and skills.

15. The principles of advocacy: Advocacy focuses on the individual needs and the rights and interests of people with disabilities. Advocacy has clear values based on social justice and full inclusion of people with disabilities as contributing and participating members of the community. Advocacy is about achieving justice. Advocacy is about achieving equity. All advocacy must attempt to minimize conflicts of interest.

16. The principles of advocacy: Advocacy remains loyal and accountable to the consumer at all times. Advocacy involves support, information, training and education, but DOES NOT involve personal care support, transport or the provision of similar services. Advocacy is about achieving the best possible outcomes for all parties concerned.

17. The objectives of advocacy : Prevent abuse, discrimination or negligent treatment of people with a disability. Promote and enhance the rights of people with a disability. Encourage people with a disability to make informed choices. Increase economic and social participation for people with a disability in the community. Assist vulnerable people with a disability to participate equitably in community life.

18. The objectives of advocacy : Increase the knowledge and understanding of people with a disability, their families and careers about the rights of people with a disability. Improve communication between people with a disability and other members of the community. Recognize, value and include families and careers, wherever possible and appropriate, in the support system for people with a disability.

19. The patient advocate: A patient advocate: acts as a liaison between patients and Health Care Providers to help improve or maintain a high quality of health care for the patients. The terms patient advocate and patient advocacy have a broad range of usage and may be applied to the actions of many different individuals and organizations. The patient advocate may be an individual or an organization. Patient advocacy organizations are often non-profit and focus on one aspect of health care or a specific disease.

20. The Patient Advocacy Within the Health Care Community : Some hospitals, health insurance companies, and other health care organizations employ people specifically to assume this role. Within hospitals, the person may have the title Patient Representative. The role of Patient Advocate is frequently assumed by nurses, social workers, and other health care providers. However, there are clearly potential problems when a professional may be in conflict between the interest of the patient and the interests of the advocates employer.

21. The Nursing and patient advocacy: Patient advocacy is fundamental to nursing. The American Nurses Association (ANA) includes advocacy in its definition of nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

22. The Nursing and patient advocacy: Advocacy in nursing finds its theoretical basis in nursing ethics. For instance, the ANA's Code of Ethics for Nurses includes language relating to patient advocacy: The nurse's primary commitment is to the patient, whether an individual, family, group, or community. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

23. The common Areas Requiring Nurse–PatientAdvocacy: 1. End of life decisions. 2. Technological advances. 3. Healthcare reimbursement. 4. Access to health care. 5. Provider–patient conflicts regarding expectations and desired outcomes. 6. Withholding of information or blatant lying to patients. 7. Insurance authorizations, denials, and delays in coverage. 8. Medical errors. 9. Patient information disclosure (privacy and confidentiality). 10. Patient grievance and appeals processes. 11. Cultural and ethnic diversity and sensitivity. 12. Respect for patient dignity. 13. Informed consent. 14. Incompetent healthcare providers. 15. Complex social problems including AIDS, teenage pregnancy, violence, poverty. 16. Aging population.

24. Leadership Roles and Management FunctionsAssociated with Advocacy: 1. Creates a climate where advocacy and its associated risk-taking are valued. 2. Seeks fairness and justice for individuals who are unable to advocate for themselves. 3. Seeks to strengthen patient and subordinate support systems to encourage autonomous, well-informed decision making. 4. Influences others by providing information necessary to empower them to act autonomously.

25. Leadership Roles and Management FunctionsAssociated with Advocacy: 5. Assertively advocates on behalf of patients and subordinates when an intermediary is necessary. 6. Participates in professional nursing organizations and other groups that seek to advance the profession of nursing. 7. Role models proactive involvement in healthcare policy through both formal and informal interactions with the media and legislative representatives.

26.  The management Functions: 1. Gives subordinates and patients adequate information to make informed decisions. 2. Assures that provider’s rights and values do not infringe upon patient’s rights and values. 3. Seeks appropriate consultation when advocacy results in intrapersonal or interpersonal conflict. 4. Promotes and protects the workplace safety and health of subordinates and patients. 5. Encourages subordinates to bring forth concerns about the employment setting and seeks impunity for whistleblowers. 6. Demonstrates the skills needed to interact appropriately with the media and legislators regarding nursing and healthcare issues. 7. Is aware of current legislative efforts affecting nursing practice and organizational and unit management.

27. The Nursing Values Central to Advocacy: 1. Each individual has a right to autonomy in deciding what course of action is most appropriate to meet his or her healthcare goals. 2. Each individual has a right to hold personal values and to use those values in making their own healthcare decisions. 3. All individuals should have access to the information they need to make informed decisions and choices. 4. The nurse must act on behalf of patients who are unable to advocate for themselves. 5. Empowerment of patients and subordinates to make decisions and take action on their own is the essence of advocacy.

28. Situation How Would You Proceed advocacy: You are an RN case manager for a large insurance company. Hoda Ali is a 34-year-old mother of two small children. She was diagnosed with advanced, metastatic breast cancer six months ago. Traditional chemotherapy and radiation seem to have slowed the spread of the cancer, but the prognosis is not good. Hoda contacted you this morning to report that she has been in contact with a physician at one of the most innovative medical centers in the country. He told her that she might benefit from an experimental gene therapy treatment; however, she is ineligible for participation in the free clinical. trials since her cancer is so advanced. The cost for the treatment then is approximately $150,000. Hoda states that she does not have the financial resources to pay for the treatment and begs you “to do whatever you can,to get the insurance company to pay. Otherwise, she will die.” You know that your insurance company almost always disallows the cost of experimental treatments. You also know that even with the experimental treatment, Sheila’s probability of a cure is minimal. Assignment: Decide how you will proceed. How can you best advocate for this patient?

29. The subordinate advocacy: Nurse administrators should advocate for subordinates as well as patients. Subordinate advocacy is a neglected concept in management theory but an essential part of the leadership role. In this area of advocacy, the manager must help subordinates resolve ethical problems and live with the solutions at the unit level. Angelucci (2003) suggests that managers have an obligation to assist staff in dealing with ethical issues. She maintains that nurse–managers must advocate for their staff through the following steps: • Invite collaborative decision making. • Listen to staff needs. • Get to know staff personally. • Take time to understand the challenges faced by the staff in delivering care. • Face challenges and solve problems together. •

30. The subordinate advocacy: Another critical part of subordinate advocacy is workplace advocacy. In workplace advocacy, the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates. Occupational health and safety must be assured by interventions such as reducing worker exposure to needle sticks or blood and body fluids. Subordinates should also be able to have the expectation that their work hours and schedules will be reasonable, that staffing ratios will be adequate to support safe patient care, that wages will be fair and equitable, and that nurses will be allowed participation in organizational decision making. When these working conditions do not exist, managers must advocate to higher levels of the administrative hierarchy to correct the problems

31.  How Can You Best Advocate? You are a unit supervisor in a skilled nursing facility. One of your aides, Samira Hossein, recently reported that she suffered a “back strain” several weeks ago when she was lifting an elderly patient. She did not report the injury at the time because she did not think it was serious. Indeed, she finished the remainder of her shift and has performed all of her normal work duties since that time. Today, Martha reports that she has just left her physician’s office and that he has advised her to take four to six weeks off from work to fully recover from her injury. He has also prescribed physical therapy and electrical nerve stimulation for chronic pain. Martha is a relatively new employee, so she has not yet accrued enough sick leave to cover her absence. She asks you to complete the paperwork for her absence and the cost of her treatments to be covered as a work-related injury. When you contact the Worker’s Compensation case manager for your facility, you learn that the claim will be investigated; however, with no written or verbal report of the injury at the time it occurred, that there is great likelihood the claim will be rejected. Assignment: How best can you advocate for this subordinate?

32. The summary: Advocacy is defined as the process of advocating or supporting a cause one believes in. When a nurse makes the decision to advocate for a client, then the patient and his or her best interests become the cause. This is especially true in cases where those seeking care are unable to make informed decisions about the care they receive due to their condition.

33. The references: http://www.nursingworld.org/gova/federal/gfederal.htm. http://www.ana.org/about/honaward/staff.htm. Foley, B. J., Minick, M.P., & Kee, C.C. (2002). How nurses learn advocacy. Journal of Nursing Scholarship, 34(2), 181–186. Gonzalez, R. (1999). ANA advocates more diversity in nursing. American Journal of Nursing, 99(11), 24.