Patient advocacy in the perioperative setting

AORN Journal,  August, 2005  by Heather J. Boyle

• E-mail
• Print
• Link

Advocacy is at the heart of nursing s professional commitment, and it plays an essential role when nurses are caring for patients and patients' family members. The term advocacy is commonly used in nursing literature and has many theoretical definitions. Dictionaries define advocacy as the act of pleading or arguing in favor of something, (1) or the giving of aid to a cause or the active support for a position. (2) In nursing literature, advocacy is described as an act of informing and supporting individuals so that they may make the best decisions possible for themselves. (3) It is a moral commitment to enhance a patient's autonomy (4) or an action taken to achieve goals on behalf of oneself or another. (5) Simply stated, advocacy is speaking up for someone who is unable to speak for himself or herself. (6) This article describes a qualitative study that was undertaken to define patient advocacy and perioperative nurses' role as advocates in the perioperative setting and to investigate perioperative nurses' perceptions of behaviors that represent advocacy in the perioperative setting.

NURSES AS ADVOCATES

The American Nurses Association's Code of Ethics for Nurses with Interpretive Statements states that as advocates, nurses must be alert to and take appropriate action regarding instances of incompetent, unethical, illegal, or impaired practice by any member of the health care team or system or any act on the part of others that places the rights or best interests of a patient in jeopardy. (7) Patients depend on nurses to help them find their way through the changing health care system. Nurses must do what they can to ensure that patients receive proper and safe care and must meet patients' physical, emotional, and cultural needs while complying with organizational policies and procedures; standards of practice; accrediting agency requirements; and relevant federal, state, and local regulations. One author depicts the nurse-as-patient-advocate as "a combination lawyer-theologian-psychologist-family counselor and dragon-slayer wrapped in a white uniform." (8 (p9))

Advocacy is a critical issue for surgical patients who are unconscious or sedated and unable to make decisions related to their care. One group of authors states that protecting patients from harm is the essence of the advocacy role of nurses, and it is a critical component for patients whose family members are not readily accessible and whose only possible advocate is the nurse. (9) This often is the case for patients who are in the OR, a restricted unit with no visiting hours.

The complexity of the perioperative environment frequently places the responsibility of patient advocacy on perioperative nurses, who face unique ethical and moral situations when caring for patients undergoing surgical procedures. (10) They must accept accountability for nursing actions that safeguard the rights of surgical patients. Perioperative nurses act as patient advocates by protecting patients, and they must be able to quickly and accurately identify advocacy issues and be ready to intervene on behalf of their patients.

THE PROBLEM

Many perioperative practice issues involve advocacy. These may include helping patients who are uninformed or have not given adequate consent for surgical procedures, confronting an incompetent colleague, pressing for more analgesia for a patient in pain, or prolonging life with extraordinary treatments or technology. Surgical patients can be compromised by stress, disease processes, and sedation or general anesthesia, and they trust that a perioperative nurse will advocate in their best interest to ensure their privacy, dignity, rights, and safety. (11)

Although the issue of advocacy has dominated discussions in nursing literature, there is little research on its definition, its role, or how it applies to nurses in the perioperative setting. The meaning and models are indeterminate, and the interpretation in the literature is unclear. (12) Experts provide no consistent definition or consensus about specific practices considered to be advocating practices. (9) Although nurses consider advocacy to be central to nursing practice, confusion still exists about the concept of advocacy and its role in professional practice. In addition, little empirical knowledge has been generated on the concept of advocacy and how it is taught or learned. (13)

PURPOSE OF THE STUDY

The purpose of this qualitative study was twofold. The first objective was to define patient advocacy and perioperative nurses' role as advocates in the perioperative setting. The second objective was to investigate perioperative nurses' perceptions of behaviors that represent advocacy in the perioperative setting. The researcher wanted to illuminate the roles and personal experiences of perioperative nurses advocating for the vulnerable surgical patient population and help define and promote knowledge and skills nurses need to advocate for patients in the perioperative setting.