Running

head: THE ROLE OF PATIENT ADVOCACY 1

The Role of Patient Advocacy in Providing Respectable Patient Care

Lindsey M. Parker

James Madison University

The Role of Patient Advocacy in Providing Respectable Patient Care

One of the most professional roles of nursing involves being an advocate for all patients.

Nurses’ primary commitment is to the protection and well-being of their clients, yet when there

are contrasting ideals amongst physicians and patient surrogates it pins the nurse in a less than

ideal position. There can be power struggles amid nurses, physicians, and the family of patients

in terms of advocating for the client due to differing plans of action (Solomon, 2017). It is the

role of the nurse to establish patient comfort and encourage wellness, it is the ethical obligation

of the physician to do no harm, and it is an expectation that the surrogate acts in accordance with

the core interests of their loved one (Bayley, 2017).

Background

After assessing a stuporous, yet grimacing, patient alongside his registered nurse we

determined that his vitals and assessment findings were indicative of a dying individual. The

physician discussed comfort care options with the patient’s wife, especially advocating for

palliative sedation due to the lack of the analgesic effect of morphine for this patient. His stance

was that the patient would be in a restful state without pain and suffering, and that he would slip

peacefully into death. The wife became hysterical and accused the doctor of giving up on her

husband. She did not want her husband to be pharmacologically sedated and “appear lifeless”

prior to death. The debate between the wife and physician went on for ten minutes before the

nurse excused herself and me. Upon leaving the room the nurse rolled her eyes and made a

comment in which she blamed the patient and his family for his own pain because he “wasn’t

intelligent enough” to have an advanced directive in place or have discussed his wishes with his

wife, which led the nurse to being in this position.

This was the first clinical situation that has caused me moral distress. This constitutes as a

morally distressing situation because I knew the right action to take in regards of patient comfort,

which would be palliative sedation, yet was constrained from voicing my opinion in the matter. I

felt powerless and that my moral integrity was threatened because the patient under my care was

suffering within his final few hours, and I could do nothing about it. Despite the situation of not

being able to relieve my patient’s suffering, my distress intensified as I watched the nurse mock

and disrespect the patient and his family. I became angry at the nurse’s lack of advocating for his

needs while in the room. This led me to feel unsupported by the staff and uncomfortable in the

patient care I was taking part in. In reflection of this event, I should have alerted my clinical

instructor of the situation and gained insight on how to better cope with the external and internal

pressure I felt.

Methods and Findings

The eight key questions sponsored by JMU can be used to help clarify ethical versus

unethical judgments (The Madison Collaborative, 2013). This framework guides students

through decision-making processes ensuring that the outcome was decided upon based on ethics,

the individual’s morality, and logical reasoning. In the scenario presented the action in question

is the inappropriate verbal response and lack of action on the part of the nurse. Through

analyzing the event I will gain better insight as to how I can become a better advocate for my

own patients in the future.

A major component of fairness is to treat others with the same respect, equality, and care.

Fairness was not exhibited in the witnessed situation because the nurse took the focus off the

well-being of the patient and onto the inconvenience it was causing her. It is unfair to treat the

stuporous patient’s needs differently than others just because he was not prepared, nor can he
THE ROLE OF PATIENT ADVOCACY 4

speak up for himself. It was also unfair of me not to report the situation because, in doing so, I

did not advocate for the patient either.

The outcome of the nurse’s reaction may or may not have actually affected the patient.

The patient did not overhear the comment, and, regardless of the intervention the family decides

to take, the man is dying, so the choice will not affect him long-term. If the nurse would have

decided to advocate for the patient and support the family in their time of decision-making it

could have made a long-lasting impression on the family. Losing a loved one is a stressful and

sorrowful event, yet the nurse could have chosen to be the ray of light to help comfort the family

instead of abandoning them. I also could have taken extra steps to cause a more positive outcome

for the patient and his family.

It is our main responsibility as nurses to perform patient care, but we are also obligated to

recognize and seek help when unethical situations are presented. Whenever we have a

responsibility, it is correlated with a right of our patient (The Madison Collaborative, 2013). The

rights of the patient were jeopardized when the nurse stripped dignity and the basic entitlement

of respectable healthcare away from him. It is not lawful to treat a patient as if they do not have

any entitlements. This parallels with provision three of the American Nurses Association’s code

of ethics that states, “The nurse promotes, advocates for, and protects the rights, health, and

safety of the patient” (American Nurses Association, 2015). Regardless of the surrogate’s

decision, whether the nurse agrees or disagrees, according to this authority, it is the responsibility

of the nurse to fulfill her obligation to extend a supportive and comfortable environment for the

patient, as well as respect his rights and promote safety. I could have been more responsible by

reporting the situation to my professor.

I do not think that the concept of liberty should be used to help analyze the situation.

Although the nurse expressed her thoughts in accordance with the harm principle, and no one

was harmed, it was not professional or an ethical decision to share the negative thoughts.

I felt empathy for the family because they are trying to cope with a trying situation and

the nurse was not supportive of them, because they have decided to make a choice different from

the one she would have made. It is possible that with education about the pain process and

medications the family would have felt comfortable with choosing an alternative measure. The

nurse could have advocated and made a difference regarding her patient’s comfort

Nurses are continuously upheld as having the most trustworthy and ethical profession in

America (Jimenez, 2018). We are an authority figure and wealth of knowledge for families and

patients, yet when an ethical situation presents we should seek out other authorities, such as the

ANA Code of Ethics. I aspire to be a nurse of stellar character that shows integrity and upholds

my responsibilities to my profession and patients. I should begin forming these traits as a student

since character relates to ethical decision-making.

Conclusion

By applying the situation to the eight key questions I understood that it would be

unethical for the nurse to not advocate for and support the client, as well as giving subpar nursing

care, because she was frustrated by his lack of preparation. As a student, I was intimidated to

stand up to the nurse, but I could have voiced how we could still support him and try other

measures to decrease his pain, such as talking and singing to the patient, giving massages, and

wrapping him in warm blankets. I could have also been supportive of the family and let them

know that I respected their decision. The most responsible action I could have taken would have

been to report the incident to my clinical professor for her to review.

References

American Nurses Association (2015). Code of ethics with interpretative statements. Silver

Spring, MD. Retrieved from

http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/C

ode-of-Ethics-For-Nurses.html

Bayley, C. (2017). Managing conflicts between physicians and surrogates. Hastings Center

Report, 47(1): 20-23. Doi: 10.1002/hast.667

Jimenez, S. (2018). Nurses celebrate being members of most ethical profession. Retrieved from

https://www.nurse.com/blog/2018/01/15/nurses-celebrate-being-members-of-most-

ethical-profession/

Solomon, M. (2017). On patient well-being and professional authority. Hastings Center Report,

47(1): 26-27. Doi:10.1002/hast.668

The Madison Collaborative (2013). The eight key questions handbook. Harrisonburg, VA.

Retrieved from

https://www.jmu.edu/mc/Docs/131101%208KQ%20Handout%20Revision.pdf