Patient advocacy

Answer

Part 1 Q2

Patient advocacy is an exceptionally vital component of contemporary nursing practice involving situations where nurses work on behalf of patient to sustain the quality of care to advance protection of patient's rights. It is a requisite of nursing practice that each nurse demonstrates advocacy in the healing environment, and NMC Code 2018 provides guidelines professional nurses are expected to uphold as part of enhancing patient advocacy (Nursing and Midwifery Council 2018, p.13). The NMC code 2018 bottom line aims to promote nursing practices prioritizing people, focusing on effectiveness, safety preservation, advancement of professionalism, and trust in the healing environment an idea that is supported by Snelling (2017) who advances need for the UK to revise standards for professional nursing practice to ensure efficacy. Snelling (2017, p. 17) assessment of the need for standard revision in the UK reflects the evolution of nursing advocacy and how practices should be aligned with current requirements.

Nursing advocacy is a multifaceted aspect in the healthcare environment and this implies that for nurses to achieve the outlines and standards of the NMC Code 2018, they have to understand all facets of care that promote the interest of patients (Nursing and Midwifery Council 2018, p.32). Fundamentally, the achievement of NMC code 2018 standards on nursing advocacy demands that nurses exercise care practices that ensure patient safety, give patients a voice, educate, double-check for errors, connect patients to resources, and protect the rights of patients (Ridley et al. 2018, p.3). In view of Ridley et al (2018, p.3) it will be established that safety of patients’ represents one of the critical dimensions nurses can use to promote advocacy and this entails monitoring treatment and discharge procedures in healthcare facilities besides making follow up in homecare treatment (David et al. 2015, p.3). It is the responsibility of a nurse advocate to ensure that all treatment and care practices in healthcare facilities or at home are constructed on premise of safety.

Nurse practice targeting to achieve the standards of patient advocacy must first establish the framework for assessing patients' needs. Haines et al (2018, p.1) argues that it is impossible to advocate for patients without understanding their concerns, values, and expected outcomes in the administration of treatments and according to Grant et al (2019) nurse advocacy assess the needs of patients focusing on family settings, availability of healthcare resources, and potential risks in the care environment. Observations of clinical practices relative to advocacy suggest that developing therapeutic relations with patients remains crucial in advancing the interests and personal values of patients (Gerber 2018, p.56). In essence, effective nurse advocacy must underscore frameworks for understanding the patient's level of awareness, cognitive function, and how they know their rights. It is a demonstration of how well patients understand diagnoses, prognoses, and treatment options and whether or not they align to personal values (Gerber 2018, p.56).

The roadmap to the achievement of effective advocacy entails identifying the patient's unique goals in the process of receiving care. According to Gerber (2018, p.55), advocacy must prioritize the development of partnership between patients, healthcare professions, and families as part of empowering patients in the decision-making process. In view of patient goals and expected outcomes of treatment options, effective advocacy involves nurses taking central roles in translating hospital policies and clinical information to patients, providing information on different treatment options, and empowering patients' assertiveness when it comes to expressing concerns about treatment options (Pecanac & Schwarz, 2018). In the identification of patients' unique goals, nurses will be able to practice advocacy by following a directive from patients, refrain from imposing their opinions on the patient, and promoting acceptance of patient's informed choices (Nsiah et al. 2017, p.1124).

Although patient advocacy has picked momentum in the modern nursing practice, it is essential to understand that there are significant barriers both in society and in the professional practice of nursing undermining the achievement of full potential (Dadzie & Aziato 2020). One professional issue that often emerges when it comes to advocacy involves the jurisdiction of authority between nurses and doctors.  Nurses play critical roles in providing care, but patients typically perceive doctors as the ultimate authority on medical decisions (Dadzie & Aziato, 2020). This poses significant challenges to nurse advocacy as patients would view nurses' decisions as counterproductive to a higher authority, the doctors. Another critical issue that comes up involves the family's roles in the caregiving process (Doody et al.2017, p.3). In most occasions, nurse advocacy is deemed to be challenging the wishes of family members. Yet, the priority setting of advocacy puts patients' interests first (Nsiah et al. 2020, p. 655). Sometimes the decision of a patient may appear contradictory to societal values and expectations. It is the nurse's role to explain to the family what such decisions entail and how beneficial they will be to the patient.

Ethical issues are also common in the practice of patient advocacy. In most situations in the advocacy practice, nurses are forced to make difficult treatment choices (Nsiah et al. 2020, p. 655). For instance, some treatment options may come with adverse side effects, and it is the discretion of the nurse to reconcile the need for treatment or the desire to keep the patient comfortable. Additionally, factors such as ineffective communication and interpersonal relationship, financial difficulties, religious and cultural beliefs have been identified as significant in challenging patient advocacy (Nsiah et al. 2020, p. 653). 

Part 1 Q3

Recent developments in healthcare express satisfaction and the need to strengthen inter-professional working. The dynamic nature of the healthcare environment demands that professionals harness frameworks that allow collaboration to improve outcomes. Observing healthcare institutions that have strong backgrounds on inter-professional working indicates several positives, including improved patient outcomes, fewer preventable errors, reduced cost of healthcare, increased efficiency, and quality of care coupled with enhanced relations between disciplines (Reeves et al. 2017).

The role of inter-professional working in advancing partnerships in the overall care environment, perhaps, is better demonstrated in the fight against mental illnesses. Previous observations suggest that dealing with conditions requires multiple approaches, especially regarding access to testing and primary care (Karam et al. 2018, p.70). Provision of testing frameworks, education on prevention, and primary care requires social worker, health educators, and other clinical services work in collaboration (Karam et al. 2018, p.70). The ideation of a collaborative approach in providing care for mental ill patients underlines that professionals will receive on the job training on how to better outcomes trough inter-professional working (Pinto et al. 2018, p.479). In a study conducted by the University of Michigan, the findings affirm that collaborative practices do encourage partnership between patients and different professionals and improve access to primary care for patients (Löffler et al. 2017, p.224).

Partnerships between social workers, clinical professions, and insurance partners remain critical in the process of advancing better healthcare outcomes. Observations indicate that vulnerable patients, especially those with chronic conditions, may not seek care due to the stigma in the healthcare system, distrust of care providers, and lack of information regarding insurance or treatment options. However, with the implementation of inter-professional working approaches, such patients receive sufficient information concerning treatment options and recommendations on insurance plans that meet their financial needs (Löffler et al. 2017, p.224). The issue of stigma in healthcare, particularly for mental patients, continues to cause havoc when it comes to access to care, which can be addressed with inter-professional working (Tsakitzidis et al. 2016, p.16). This may involve the roles of social workers providing psychological support to patients while also educating clinical professions on how to address the psychological needs of vulnerable patients better. 

According to the World Health Organization (WHO), inter-professional working in the healthcare environment must reflect interconnection and coordination of care between nurses, pharmacists, social workers, physicians, and other disciplines to achieve higher-order patient outcomes Manolakis and Skelton (2010). It is a facet of care that improves learning and respecting different professional perspectives in the process of patient care. Studies have established the contribution of inter-professional collaboration in the healthcare environment, especially involving nurses and physicians (Karam et al. 2018, p.70). According to Manolakis and Skelton (2010), cooperation in the care environment improves patient outcomes, quality of care, and optimization of cost- reduction in the cost of care. The focus of work through the lens of collaborations between professions significantly reduces inefficiencies in patient care. As Manolakis and Skelton (2010) observe, it means that evaluations and treatment options are conducted with an integrative approach. It underscores the need to focus on the needs of the patient rather than the specific diagnosis or treatment option.

Current practice in healthcare systems emphasizes the need for the adoption of patient-centered care, which advances the idea of listening, informing, and involving patients in their care. The Institute of Medicine recognizes that the fundamentalism of contemporary care lies in how physicians, nurses, and pharmacists customize diagnosis, prognosis, and treatment options to patient needs (WHO 2013). It entails the provision of care that is respectful of, responsive to individual patient preferences, values, and needs. In patient-centered care, patient values guide all clinical decisions, elements in care promoted by inter-professional working. Inter-professional working allows physicians and nurses to share their assessment of treatment options and to enhance approaches towards the identification of common goals for the benefit of patients (Karam et al. 2018, p.70).

Healthcare institutions with discrepancies when it comes to implementation of inter-professional working often encounter challenges in relationships and job satisfaction. According to MacLean et al. (2014, p.457). Every health professions have unique subcultures, knowledge base, and philosophies that can be impacted by power structures negatively. Incorporation of inter-professional working acknowledges that everyone has a role to play in the care of patients, creating a sense of community and boosting professions' morale. Ideally, integrating inter-professional working constitutes bringing together different aspects of skills to better outcomes of care (MacLean et al. 2014, p.457). The WHO observes that inter-professional care contributes to a reduction in inefficiencies and the scope of medical errors. Professional bodies like the American Nursing Association and American Medical Associations are empowered to conduct non-statutory services with a common goal when healthcare institutions foster inter-professional work.

Part 2 – Transcript Analysis Q1

The relative increase in demand for patient-centered care implies that nurses have to demonstrate effectiveness in communication to ensure that treatment options reflect the patient's unique needs (Drahošová and Jarošová 2016, p.453). Through effective communication, it is possible to foster clinical decisions in the view of patient values, requirements, and preferences, elements that are unfortunately missing in the conversation between Mr. Dhes and the nurse in the scenario given. Implementation of effective patient-nurse communication allows patients to convey their fears and concerns to nurses and helps them to make a correct nursing diagnosis (Haley et al. 2017, p.13). It is essential for a nurse in practice to establish awareness of cues that may signal what a patient needs. Ideally, the patient expresses multiple cues, either subtly or overtly. In the case of Mr. Dhes, the missing cues include the nurse's inability to recognize that the patient wants to talk about his medical conditions rather than his religious affiliation. The nurse insists on talking about Mr. Dhes religiosity despite the patient's expression of the need to focus on the surgery's medical concerns. In another instant, the nurse fails to recognize Mr. Dhes aggression when talking about do not attempt resuscitation (DNAR). It is evident that the patient does not understand what it entails, but the nurse fails to explain to him efficiently. The conversation could have been more productive if the nurse paid attention to communication cues to read what Mr. Dhes wanted the conversation to focus on.

Nurses must exercise listening skills to improve the productivity of communication with patients. In this scenario, the application of active listening skills from the nurse could have saved time and promote an amicable understanding of the medical condition at hand besides improving the patient's knowledge of surgery outcomes (Haley et al. 2017, p.11). Practical application of active listening skills in the conversation could have advanced the nurse's ability to recognize the perspectives and feelings of Mr. Dhes besides appreciating the fact that he did not need to understand all the medical requirements. The nurse demonstrates a lack of respect for the patient, occasionally interrupting him, which implies communication breakdown. It delineates the patient from expressing his views on treatment options (Drahošová and Jarošová 2016, p.457).. Additionally, the use of active listening skills could have played a central role in allowing the nurse to observe Mr. Dhe's body language, which is critical in giving and an extra level of understanding (Haley et al. 2017, p.14). Active listeners tend to induce minimal interruptions in conversations, qualities required in the practice of nursing.

Part 2 Q2

Cases of discrimination remain prominent in the practice of nursing despite significant improvements in ensuring fairness and equality in care. Prejudice in nursing disqualifies the Equality Act. It describes situations or instances where healthcare or care providers treat patients differently or worse than others for specific reasons such as gender, age, race, religious affiliation, and socioeconomic status (Turan et al., 2017, p.3435). The interaction between Mr. Dhes and the nurse highlights several instances of discrimination, and one of them involves age. It is a concern in general healthcare practices that age discrimination cases are on the rise, where older people receive poor access to healthcare and social service compared to other patients.

The nurse's attitude, when describing the use of DNAR to Mr. Dhes, reflect the intensity of age discrimination in the healthcare system. The nurse seems to suggest that the patient, due to his old age, would not require resuscitation if something goes wrong in the surgery, a clear indication of discrimination based on age. The nurse sentiments on the patient's comments about his blood pressure measurement further portray discrimination based on age. Additionally, aspects of racial and religious discrimination appear in the nurse attitude as she seems to suggest that Poles are better than Muslims. The nurse's initial mistreatment may have been informed by the understanding that the patient is a Muslim.

All forms of discrimination in healthcare have adverse implications for patient outcomes. Discrimination has the potential to trigger loss of self-esteem, and patients may experience negative self-identity an aspect assessed by Turan et al (2017, p.3431). Observations of biases based on race and class regarding access to healthcare indicate that it contributes to depression among patients besides the fact that it dilutes the quality of service received by patients. Discrimination implies that nurses pay little attention to patients' preferences, needs, and values, possibly exposing them to clinical decisions that infringe their rights (Turan et al. 2017, p.3431).

Discrimination in healthcare access impact assumes a multifaceted approach, including contributing towards the development of negative behavior among individuals. Studies suggest that people who experience discriminatory services in healthcare facilities may change their behavior, which involves adopting criminal mindsets as part of airing out frustrations. Discrimination, further implies that people are subjected to restrictive opportunities when it comes to treatment options, possibly risking lives. Medical errors also increase in situations where the discriminatory approach to service is adopted by nurses (Turan et al. 2017, p.3439).

Part 2 Q3

Disempowerment refers to situations where individuals or groups of people feel less powerful or confident in themselves and would occur partly due to discrimination (Cerezo et al. 2016, p.667). Nurses and patients must establish the ground for empowerment, a crucial component in the healing environment (Regan et al. 2016, p.56). Empowered patients can effectively motivate and mobilize themselves to have positivity on treatment options. Empowerment builds the mental strength of a patient to over the pain and suffering of their conditions and contributes to positive patient outcomes in an overall sense of nursing practice (Castro et al. 2016, p.1931).

In the scenario of Mr. Dhes, however, the nurse fails to understand the role of patient empowerment in enhancing positive results. The nurse acts at the detriment of the patient by disempowering him through actions such as invalidating his awareness of the medical condition (Candace et al. 2019, p.8). The nurse calls the patient silly instead of explaining to him what DNAR means, driving the notion that aged patients do not have option resuscitation when surgery fails. Mr. Dhes expressed positivity regarding routine 5miles runs, but the nurse's expression and attitude appear discouraging. The nurse also disregards the patient's knowledge about blood pressure, suggesting that the patient could have diabetes.

Patient disempowerment in the healthcare setting is exceptionally adverse to patients and the quality of care (Candace et al. 2019, p.4). It crushes a patient's self-esteem and may subject them to a crisis of self-identity, issues that can generate to trigger mental illnesses such as depression. Nurses need to keep patient's mentality positive to reduce the risks of depression (Castro et al., 2016, p.1929). Current practice in nursing fosters patient-centered care, and that means patients need to develop an awareness of their conditions, an element undermined by disempowerment. Patients with low self-esteem are less assertive in expressing their wishes in clinical decisions. That means care outcomes would not reflect the preferences, values, and unique needs of patients (Candace et al. 2019, p.7). Further, disempowerment can push patients to make life-risking decisions such as failing to adhere to treatment plans while it also possible that disempowered patients can be violent to caregivers. Generally, disempowering impacts both a patient and caregivers negatively, increasing the risk of violence against nurses.

Part 2 Q4

It is crucial to healthcare that patients receive treatment or procedures through consent. It is legally binding that all clinical practices take place with full knowledge of the patient; that's the patient must consent after understanding the risks, benefits, and alternative treatment to their conditions (Tingle 2017, p.119). Consent is an essential aspect of nursing. It plays a part in promoting patient autonomy, creates trust and confidence in medical professionals, and reduces the risk of unnecessary litigation claims based on wrong assumptions concerning appropriate care (Main et al. 2017, p.29).

The interaction between Mr. Dhes and the nurse demonstrates infringement of the patient's right to consent. The nurse opens the conversation with a predetermined assumption that the patient would not need resuscitation if things go wrong. Part of patient consent involves taking the patient through steps of benefits and risks associated with the treatment plan. These elements appear futile based on the interaction between the nurse and Mr. Dhes. There are no elements of the patient receiving sufficient information regarding the operation. Mr. Dhes does not consent to diabetic and blood pressure tests in addition to the fact that the nurse uses the wrong arm.

The nurse could have managed these issues by clearly articulating to the patient the risks of the surgery and why resuscitation would be needed. It would have been necessary for the patient to understand that the operation is for the overall benefit of his health despite the possibilities of risks (Tingle 2017, p.118). On the issue of diabetes and blood pressure tests, the nurse also ought to have explained to the patient why the tests were vital to the success of the surgery. It is the fundamental right of a patient to receive informed consent before any medical treatments and operations (Tingle 2017, p.118). Mr. Dhes scenario presents a perfect example of instances where litigation issues can arise subject to poor handling of consent (Main et al. 2017, p.29). The nurse's actions can attract unnecessary legal claims, and the hospital may be required to compensate the patient.