Stacey Ludlow
Peer #1
Stacey Ludlow
Patient advocacy is the most important aspect of our duty as professional nurses. Patients often present in a condition in which they are unable to advocate for themselves, and it is the nurse’s role to fulfill this need. The Institute of Medicine outlined six factors that influence patient outcomes: safety, effectiveness, patient centered, timely, efficient and equitable (Hilbet, 2018). By consistently incorporating these tenets and utilizing evidence-based care practices, nurses continually improve care.
We must always address our patients’ needs according to their individual and unique needs, taking into account culture, environment, and spiritual diversity. Because we are often faced with broadly diverse views, nurses can find themselves morally and ethically conflicted when addressing individual patient needs (Luca et al., 2021). According to a 2021 study, nurses were found to feel the need to advocate more assertively for patients who were particularly vulnerable. These patients were those who were especially weak or frail, whose families were failing to include the patient in medical decisions, patients who were unable to express their wishes, and also they felt the need to advocate as a team with other disciplines (Luca et al., 2021). While we should certainly maintain sensitivity in practice and advocate for all our patients, we have must always hold ourselves accountable to those who cannot advocate for themselves.
My advocacy story is about a personal experience. Several years ago, my father had a massive stroke that left him with left hemiplegia and cognitive changes. He eventually regained his speech, and was able to live at home with his significant other, but he had several complications which eventually led to the decision to place him on hospice care two years after his stroke. His S.O. was very caring, but had no prior healthcare experience. My sister and I lived in different states and were comfortable with his S.O. making medical decisions, and she and his doctor eventually made the decision to stop tube feedings, and other invasive interventions. I went to see him during this time, and his S.O. was attentive, and concerned about his pain level. She crushed a lortab, mixed it in water and pushed it with a syringe into his mouth. Violent coughing ensued. I gently told her that he should not be taking oral meds, that he was aspirating and it was essentially tortuous. I checked his PEG tube for placement, and it seemed fine, so I contacted the hospice nurse for clarification. She told me that because we had decided to discontinue fluids and nutrition, that the med should be given that way, that even if he didn’t actually swallow the meds, they would be absorbed buccally. When I asked about the use of the PEG tube because he was violently coughing, she told me that if we used it and gave him fluids, we would be “prolonging the inevitable”. After several phone calls, and conversations about proper administration of P.O. meds, and appropriate treatment of patients with dysphagia, his pain meds were changed to roxanol drops. Eventually, he passed away peacefully and comfortably at home.
This taught me several things about advocacy. I spoke with the agency and formally complained about the lack of professionalism and empathy and basic care. I was grateful for my nursing knowledge, and have thought of this incident often in my practice. Any patient who falls under my care will never experience this situation, and I share this story often when training new nurses. We are advocates by nature in this profession, and often that advocacy can be utilized for our own families as well as those for whom we provide care.
Resources:
Helbig, J. (2018). Professional engagement. In Grand Canyon University (Eds.), Dynamics in nursing: Art and science of professional practice. https://lc.gcumedia.com/nrs430v/dynamics-in-nursingart-and-science-of-professional-practice/v1.1/#/chapter/5
Luca, C. E., Cavicchioli, A., & Bianchi, M. (2021). Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study. SAGE Open Nursing, 7, 1-13.
Peer #2
Kelly Beeman
The importance of advocacy in patient care is exponential. Patients need someone that is willing to speak up for them if something is not right, and not all patients have family to be there for them or have family that know when to speak up. Patient advocacy is standing up for the patients’ rights and/or getting them the care that the nurse is aware they need (Helbig, 2018). Patient advocacy can also include “stopping the line,” if a medication is ordered that is wrong or maybe the surgeon is fixing to cut the wrong arm of a patient. There are many ways in which the nurse can be the patient’s advocate, including, empowering the patient’s own voice (Knippa, Makic, Cohu, Rader, 2021). My example as an advocate for my patient is receiving a call to place a PICC line on a patient who is receiving no vesicants, but the nurses are unable to place a peripheral IV and because of this, they asked the doctor to order a PICC line. PICC lines are great but should not be ordered lightly as there are, of course, certain risks and it is rather invasive if a peripheral IV would suffice. I am able to use an ultrasound to place peripheral IV’s as well, so as the patients advocate, I would definitely recommend a simple peripheral IV, letting the attending physician know that this patient does not qualify for a PICC and it’s not recommended. Anytime that a less invasive line can be used, it is my job as the patient’s advocate to speak up and recommend that line. It is in the patient’s best interest to be as less invasive as possible when at the hospital, and sometimes this gets overlooked. Nurses are at the best position to be a patient advocate as they are seeing the doctors’ orders and generally know what is going on with their patient. Advocacy becomes easier as you gain experience as a nurse, but it is important even as a young nurse to speak up and ask questions if you see something that doesn’t seem right, and in the long run the rest of the medical team will thank you, for potentially stopping harm to a patient.
REFERENCE
Knippa, Sara. Makic, Mary Beth Flynn. Cohu, Emily. Rader, Cheryl. (August, 2021). Advocacy for patient’s voice. Critical Care Nurse, 41(4), 71-75.
Helbig, J. (2018). Professional engagement. In Grand Canyon University (Eds.), Dynamics in nursing: Art and science of professional practice. https://lc.gcumedia.com/nrs430v/dynamics-in-nursing- art-and-science-of-professional-practice/v1.1/#/chapter/5
