The Professional Role of the Nurse as an Advocate with Adult Patients

The paper critically reflects on the issues that pose conflict and the role of the nursing staff who are faced with an ethical dilemma. This is evaluated also with regard to how confidentiality applies in the nurse’s role as a professional as described by NHS (The ethical decision-making model as described by Burkhardt and Nathanial (2002) is also applied to the exemplary presented, to gain a better insight into the possible course of action. The portfolio concludes with an action plan that can be implemented based on reflective analysis.

Advocacy is defined as: “the process of befriending and where necessary, representing a patient, client, partner or protégé, in all matters where the nurse’s help is needed in order to protect the rights or promote the interests of that person” (cited by Frizell, 2005)

Mrs. A, 59 yr old widow, was admitted with shortness of breath and acute exacerbations of COPD. Doctors suggested Bipap treatment twice in the course of treatment but both the times Mrs. A was alert and she refused consent. The Professional Role of the Nurse as an Advocate with Adult Patients. The daughters were aware of this situation. When Mrs. A became unresponsive on the fourth day, the daughters agreed with the doctor and Mrs. A. was put on Bipap. As an advocate for Mrs. A, the student nurse, and her mentor felt that the treatment was ethically and legally inappropriate.
Ms. M, 28 yrs old separated female was admitted to A&E with severe abdominal pain. She was accompanied by her boyfriend and two children. A urine test confirmed pregnancy. Ms. M disclosed to the student nurse and the mentor that she was HIV positive but did not want this information passed on to her boyfriend. The mentor as the patient’s advocate tried to explain to Ms. M to confide in her partner since it was both ethical and legally binding. The mentor and the student nurse listened to Ms. M and tried to understand her situation and win her trust. But she still did not agree to disclose and the student and mentor were left in dilemma on the next steps.

According to the UK Department of Health (2008) high quality of care is protecting patients’ safety, treating them with dignity, respect, compassion, giving them choice, creating a safe environment, eliminating healthcare acquired infections and avoidable accidents. In practice, Nurses are required to undertake their professional duties based on best available evidence which ensures safe practice for both patients and Nurses and every other healthcare worker. Intervention should be therapeutic as opposed to being counterproductive and harmful to the patient, it is also essential that Nurses recognise the need to respect patient’s dignity, religious beliefs, sexual orientation, disability and race in a multi-ethnic context like the UK. Nurses are also expected to show a high level of empathy and compassion to the patients. The Professional Role of the Nurse as an Advocate with Adult Patients.

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High quality care means keeping patients informed about their care, ensuring their privacy is maintained by closing the curtains when patients are using commode or when providing personal hygiene, respecting patients by asking them how they will like to be addressed, individual, maximizing independence and assisting the patients to maintain confidence and a positive self-esteem

Trained nurses have various roles and responsibilities which can be defined as professionals boundaries within health care settings. These roles includes; “to promote and maintain health, to care for people when their health is negotiated, to assist recovery, to facilitate independence, to meet needs, to improve or to maintain wellbeing/quality of life” Royal College of Nursing (RCN, 2003).

The role of an adult nurse entails providing seamless care for adult patients aged 18 and above. Nurses are required to exercises a high level of professional proficiency at all times and practice within professional boundaries as stipulated by the Code of Ethics of the Nursing and Midwifery Council (NMC). The Nursing and Midwifery Council is a professional body which regulates the professional standards of nurse and midwives. Nursing students and staff nurses are bound by the code of conduct which ensures good practice. It is important that nurses are aware of their professional liabilities and their professional registration in good standing as failure to adhere to this may lead to loss of their registration. Nurses are required to understand the fundamental human right practice within its remit in terms of respecting individual patient’s opinion .RCN (2008).

The Human Right Act (1998) discuss that freedom of expression is the most fundamental attribute for people. In addition it stated that no one should be denied of the right to life and the freedom from torture and degrading treatment. This legislation implies that patients have the right to life and should be treated with respect and their dignity should always be maintained. For instance patients should have access to medical treatment or community care services, irrespective of their age, disability, gender or ethnic origin.

The Mental Capacity Act (2005) was introduced to protect patients’ decision to refuse treatment. It also safeguards patients who may lack the mental capacity to make informed decisions by providing them with advocates to make decisions that are in their best interest.The Professional Role of the Nurse as an Advocate with Adult Patients.  It also aim to ensure that individuals are able to participate as much as possible in any decisions so that they feel that they have control of their own care (Hill and Seymour, 2010). In such situations, there should be effective communication between nurses and their patients which is essential to acquire a morally and legally valid consent.

In agreement, Dimond (2008) states that if a mentally capable adult is given treatment without consent, then the individual lawfully has the right to file a suit against the clinician for trespass in the civil courts. For instance, if an intervention is undertaking in the form of medication/injection to a patient without obtaining verbal or written consent from the patient, the Patient reserves the right to file a suit against the Nurse/the Hospital especially if the patient develops an adverse reaction towards such intervention.

Ethical theory is based upon four moral principles; autonomy, justice, beneficence and non-maleficence (Tingle and Cribb, 2007). Ethical principles need to be considered when providing care for patients’ in deciding how to act, health professionals ought to respect autonomy in the sense that patients’ choice and decision should be respected. For instance, patients who have the capacity to make decisions should be allowed to decide whatever they prefer. Melia (2004) supported this by stating that patients should be encouraged to make reasonable decisions based on their health and the sort of treatment being received.

Furthermore, Johnstone (2010) the principle of autonomy demands respect for body. Example of this in health care setting is nurses respecting a patient’s autonomy and allowing patient freedom of choice regarding treatment, For instance, a patient refused blood transfusion because of their religious belief. In this case where a blood transfusion is required to save the life of the patient, the patient must be informed and explain the consequences of refusing the blood transfusion and if he /she still refuse then nurses have to respect patient decision and choice. Ethics is a rule of conduct that is recognised in respect to a person’s or group personality or profession (Rumbold, 1999). The Professional Role of the Nurse as an Advocate with Adult Patients.

Ethics requires that health professionals must always put regulations into practice when dealing with patients. Patients’ needs to be treated fairly and equally, there should be no discrimination against any patient. If nurses treat patient unfairly without respecting his/hers autonomy and dignity, it means the nurse is not working according to professional ethics and the patient would feel he/she has been treated unethically or isolated.

Johnstone (2011) describes the principle of non-maleficence as a demand for a patient’s protection. Supported by Daniels (2004), who suggests that no harm should come to the patient either deliberately or not deliberately. In this case the nurse need to make sure patients are protected by making sure students are properly supervised when task are delegated to them. Maleficence also mean nurses should avoid causing patients injury or suffering when maintaining a competent practice level. Maintaining competency can also be done by reporting suspected abuse to prevent further victimization to protect patients.

Nurses’ serve as advocates for all patients by providing a high standard of practice and care at all times Nursing and Midwifery Council (NMC, 2008). The principle of beneficence seeks to do good for the patient and act in their best interest at all times (NMC, 2008). Similarly, Daniels (2010) suggests that nurses should provide care according to patient’s needs and abilities. In this case for a nurse to promote or support beneficence in nursing implies that nurses need to take actions to benefit patients and ease their well-being by raising beds’ side rails to prevent falling or harm.

NMC (2008) suggests that nurses must maintain appropriate professional boundaries in the relationships they have with patients. The status of nursing as a professional is important because it reflects the value society places on the work and the importance of the work to society. Maintaining patient’s confidentiality is important and is part of professional aspect of care. Service users’ requirements need to be met by respecting their values and wants, maintaining confidentiality and ensuring that their personal information are kept safe, maintaining dignity, asking for their consent before making a decision.

Nurses should recognise accepting patient’s personal contacts, may results in crossing boundary and breaching patient’s confidentiality. Muskin & Epstein (2009) suggests some client request continuous attention but unaware of their insatiable neediness. Therefore, it is the responsibility of the nurse to be cautious about form of professional relationship with a patient and explaining their commitment to confidentiality and what is expected of them as a nurse. College of Registered Nurses of British Columbia (CRNBC, 2004). The Professional Role of the Nurse as an Advocate with Adult Patients.

Kozier (2008) expressed nurses are obligated to respect patient’s privacy and confidentiality needs. Patients must be able to trust that nurses will reveal details of their situations only as appropriate and will communicate on the information necessary to provide for healthcare. For example computerised patients records should not be shared with anyone to maintain confidentiality; this can be done by not giving unauthorised persons system security codes or giving the access to computer files.

Nurses are accountable for maintaining professional relationship with their patients ensuring the care of the patient is their first concern. Nurses are responsible in maintaining the same limitations with the patient’s relatives as with the patients. NMC the code (2008) states that, nurses must refuse any gifts or hospitality that may be seen as an attempt to gain preferential treatment and are required not to ask or accept loan from anyone in their care or their relatives. Professional boundaries can be stated as the limits that governs the relationship nurses have with patients which allows delivering safe and therapeutic connection between nurses and their patient’s. The relationship is based on trust, caring, professional intimacy and respect and involves the appropriate use of power (CNO, 2006).

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Therapeutic relationship can be defined as a relationship that is established between the nurse and the patient for the purpose of assisting the patient in their care (Neal, 2003). According to Chambers et al, (2005) a therapeutic relationship is said to be at the center of nursing work as the relationship that exists between nurses and patients can often provide the energy to motivate the nurse to continue with the patient’s treatment. It also allows nurses to understand and establish how the individuals are coping with their treatments. Furthermore, a good therapeutic relationship builds trust, as well as ensures that patients’ autonomy is respected. For example ensuring a patient’s privacy is maintained by closing the curtains when giving them personal care which is in accordance with the NMC (2008).

In addition, McHugh-Schuster (2000) states that communication plays an important role in positions of building a therapeutic relationship by involving patients in their treatment, allowing them to always ask questions, permitting them to express their feelings. Encouraging patients to express their opinion will also result in effective patient care and patients’ well-being, as it is important to actively listen to what patients are saying both verbally and non-verbally.

Betts (2002) expressed that communication is a symbolic representation of the thoughts and feelings of the sender which is decoded and interpreted. Communication skills are very essential in therapeutic relationships, a skilled nurse must demonstrate effective communication skills in order to promote patient care effectively, by doing this it will help the inter-professional team improve the standard of care given to a patient, it also allows a nurse to build trust, respect, and create an environment where inspired ideas, problem solving, affection, and caring can thrive.

There are many reasons as to why the professional nurse must have effective communication skills, for instance when explaining or discussing patients’ treatment, speaking with family members as well as other health professionals by clear and precise literature.The Professional Role of the Nurse as an Advocate with Adult Patients.  It is important for a nurse to acquire effective communication skills in order to promote patients’ health effectively (Casey & Wallis, 2011). There are diverse elements that make a good therapeutic relationship and it is important to know that therapeutic relationship is a formal relationship between the nurse and the patient. NMC (2008) suggests that nurses must maintain appropriate professional boundaries in the relationships they have with patients. We must also ensure that all aspects of the relationship focus exclusively upon the needs of the patient or client.

Empathy has been stated to be an important feature in therapeutic relationship and provides the ability to recognize and understand the patient’s feelings and point of view objectively (Chambers et al 2005). Hughes (2012) expressed that professionalism is about attaining the highest quality of care by maintaining standards and demonstrating good judgement and competence at all times are key factors of therapeutic relationship.

In conclusion, nurses need to provide high quality of care by following their policies and role descriptions. This is to equip them with the tools needed in order to deliver a good work ethic so that patients are cared for properly and enhancing their experience positively. Nurses need to maintain professional boundaries at all times in order to improve the quality of care being offered to patients while in the hospital or in their own home by respecting patients’ dignity and autonomy at all time. The Professional Role of the Nurse as an Advocate with Adult Patients.