NURS 4105 – Advocacy Through Healthcare Policy Essay

NURS 4105 – Advocacy Through Healthcare Policy Essay

The government of USA Policy on the use of marijuana as a medicinal plant establish several legal frameworks for ensuring the rightful use of marijuana for medical purposes which therefore enhances the patients to obtain actual authorizations to carry out the processing of marijuana for medical purposes. The Policy was developed back in the early 1960s with the aim of legalizing the use of marijuana as a medicinal plant in California. Though several government agencies have refuted the use of marijuana as a medicinal plant, this Policy is aimed at ensuring that the use marijuana in the USA treatment programs is of profound benefits to the patients. The main element of this policy in the USA is to ensure that physicians only prescribe marijuana for medical purposes and nothing else thus limiting cases of drug abuse. The policy is cost effective as it allows only specified groups of individuals with prior authorization from the physicians to use marijuana for medical purposes thus limiting the expenses of costly access to marijuana as a medicinal plant. The policy is of profound importance thus enhancing safety mainly through ensuring that physicians act in the best interest of their patients and also demonstrates professional competence while carrying out their medical duties. The main aim of this essay is to determine the effectiveness of Medical Marijuana Policy in the USA as well as determining its shortcomings in ensuring appropriate use of marijuana as a medicinal plant (Sallum, 2016). NURS 4105 – Advocacy Through Healthcare Policy Essay

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General provisions of the Policy

To provide full support for the above policy, the policy lays down procedures and guidelines which must be followed to ensure that the patient who receives marijuana prescription is actually for the right purposes. This policy provides that physicians must fully comply with the ultimate expectations set out in the drug prescription policy before prescribing marijuana to any patient. The physician must comply with other policies in close relations to drug prescription which include policies on dispensing drugs as well as telemedicine policies (Washburn, 2017). The Policy highlights that before prescription of marijuana as medicine, physicians, therefore, must always practice their profession within the boundaries of their knowledge, judgment, and skills. This aspect, therefore, implies that the policy hinders physicians and other healthcare providers from carrying out treatments or prescriptions which are beyond their limits of operations as well as beyond the scope of their clinical capabilities. It is important to note that this Policy provides that medical practitioners are not obligated to provide prescriptions on marijuana if they do not understand the ultimate impact of marijuana on patients’ health. NURS 4105 – Advocacy Through Healthcare Policy Essay

The Policy also highlights the kind of patients to be subjected to marijuana treatments which makes adolescents at a greater risk of exposure to marijuana. When physicians prescribe marijuana to patients below the age of 25 it becomes a major problem that the policy depicts and provides that children, adolescents as well as young adults should not be subjects of marijuana treatments because of the high risks of marijuana-related harms such as suicidal ideation, illegal use of the drug, disorders resulting from the use of cannabis and long-term cognitive impairment (Washburn, 2017). The Policy thus provides that due to such extensive effects of marijuana on the young adults, adolescents, and children, it should never be prescribed to any patient below the age of 25years unless other therapeutic interventions fail to alleviate the patient’s symptoms. This aspect thus highlights that physicians and other medical professionals should ensure that the use of marijuana as medicine should be of more benefits to the patients than harm. NURS 4105 – Advocacy Through Healthcare Policy Essay

Contributions of the Policy

The Policy makes extensive contributions to healthcare, nursing and health outcomes.It enables health professionals to act in the best interest of their patients. The Policy enables medical professionals to act and perform their duties in respect to patients consent in the use of marijuana as another form of providing therapeutic treatments. It is always important that patients consent is got during the use of marijuana as a form of treatments. Most patients with broader knowledge of the side effects of marijuana may fail to comply with marijuana form of medical therapy. The Policy hence clearly provides the need for patients’ consent while providing certain treatments. Similarly, the Policy enables healthcare providers to demonstrate professional competence while providing quality healthcare services, it also enables medical professionals to appropriately maintain their medical knowledge and clinical skills for effective prescriptions. Such skills enable the healthcare professionals to provide the best prescriptions in regards to the use of marijuana as a method of treatment only to a specific patient whose consents have been acquired (Eddy, 2010). NURS 4105 – Advocacy Through Healthcare Policy Essay

On the other hand, the Policy enables physicians to effectively collaborate with each other in terms of providing quality healthcare services thus improving the outcome of medical interventions. Through effective collaborations, patients’ care is thus enhanced increasing knowledge on appropriate prescriptions (Rabin ski, 2016). The Policy also enables the nursing teams and other medical professionals to appropriately manage conflict of interest through provisions of guidelines and procedures that enable health professionals to work together in ensuring patients’ safeties. The policy also states the government requirements of all healthcare providers in regards to appropriate prescriptions of marijuana for medical purposes. NURS 4105 – Advocacy Through Healthcare Policy Essay

Opposing opinion on the Policy

In as much as the policy is of profound importance in ensuring effective drug prescriptions, limitations are also evident. The policy does not focus on the benefits of marijuana as a medicinal plant but only focuses on the negative effects. This is evident in the controlled use of marijuana as medicine to the only specific age of individuals lowering the chances of marijuana medicinal use even to the adolescents who may need it for chronic illnesses. It is therefore important that the use of medicinal marijuana should be as a way of preventing specific chronic illnesses rather than only focusing on its negative impacts. Through this, healthcare professionals are able to provide marijuana medical prescriptions without tight guidelines provided by the Policy.

It is evident that the use of Medical Marijuana Policy in the USA is of profound importance to both the patients and medical professionals when providing prescriptions. Therefore, the use of the Policy should be upheld by all medical professionals in order to provide quality healthcare services. The positive impacts of the policy over-weighs the negative impacts hence making the policy a major requirement in ensuring appropriateness in the prescriptions of marijuana as medicine.NURS 4105 – Advocacy Through Healthcare Policy Essay

Conclusion

In conclusion, Medical Marijuana Policy in the USA is of profound effect in enhancing the effectiveness of medical prescriptions as evident in ensuring that physicians act in accordance to their patients’ wants and the physicians also demonstrate high levels of competence in healthcare delivery. To increase the efficiency of the Policy both the benefits and detriments of marijuana should be incorporated into the policy rather than only focusing on the negative effects which shall increase broader understandings on the use of marijuana as medicine.Several studies about marijuana show that the contribution of the governmenttowards health and policy financing helps in controlling its use in the United States. The financing also comes from individuals and insurance companies who pay a certain amount to cover their medical expenses. The use of Marijuana for medication makes the governmentimplement these policies to help in regulating its use. It is however clear that the use of marijuana is prohibited in most countries in the world due to its adverse effects on the society. The plant has more negative effects on the users and those around them making it a major disaster if allowed to be used without government regulation. The policies help in enlightening the benefits of the plant andthus finances its production. The US government supports the use of the drug in cautious ways such as setting aside agencies and allocating funds to facilitate its growing and regulation of processing the pills. The use of the drug is however addictive and further sue can lead to health problems such as lung cancer and kidney problems. However, in my view, the use of marijuana for medication has more benefits especially to cancer patients who undergo a lot of pain during treatment thus the plant should be viewed as a drug. NURS 4105 – Advocacy Through Healthcare Policy Essay

References

Sallum, J., (2016). The Federal Ban on Medical Marijuana Was Not Lifted: Reason. Retrieved Feb 7^th, 2017.

Washburn, P., (2017). Public support for medical and recreational marijuana legalization hits-all time high: The Cannabist. Retrieved Nov. 19^th, 2017.

Eddy, M., (2010). Medical Marijuana: Review and Analysis of Federal-State Policies, Congressional Research Services.

Rabin ski, G., (2016). U.S Government Supplies Free Medical Cannabis to Select Patients. MassRoots. Retrieved April 22^nd, 2017.

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Nursing has essential concepts that are directed towards the development of knowledge relevant to taking care of patients. As from the previous studies in this course, it was put across that the metaparadigm is made up of four central concepts. These are health, environment, the patient, and nursing. This, therefore, means that the nurses a have a significant role that they play in the community. As nurses, we see health policy as something that can be shaped. This is because we understand better the needs of the patients and the community in general. Therefore, we are a natural choice that should always be included in the health policymaking.

It is true to say that the patient’s outcomes are a responsibility of the nurse. As noted from the previous courses and research work from other sources, the nurses educate the patients in a better manner. In addition to this, they also communicate effectively to them. All these contribute to success when the patient is discharged. Health policy will therefore directly impact the nursing roles more prominently. The nurses have assumed roles such as research, analysis, evaluation, policy development, and health policy advocacy. These roles have impacted the nurse directly in a manner that they can make a difference.

As an advocate for social change, I would begin by developing a bedside way of communication to the patient. My philosophy will be highly personalized and focused on compassion and empathy. All these will be tailored to the patient. As a result, I know there will be a more considerable success achieved in the form of healthier and happier patients. I believe that the personalized care will be a more significant tool for me as an advocate for change. NURS 4105 – Advocacy Through Healthcare Policy Essay

Nurses are highly skilled and trained professionals who take care of the sick. They educate patients, families, communities and populations on wellness and healthy living as well as health approaches to any chronic or current disease process and treatment. Moreover, nurses are entrusted with the duty of performing treatment and procedures as prescribed by physicians, physician assistants and nurse practitioners. Pattillo (2011) notes that a nurse is full of compassion for her fellow human beings; they possess good communication skills and good listening skills. They are required to report the progress of their patients to physicians, keep patient records, chart all patients’ observations, do the teaching procedures for patients and document communications with their patients. The nature and duties of nurses depict them as health care providers that are closest to patients and their families. They are therefore endowed with the task of advocating for the rights of patients within health care institutions. This paper discusses nurses as advocates for the patients, giving reasons why advocacy for patients’ rights should be incorporated into the nursing practice.

Nurses are better placed as advocates of patients because they are constantly interacting with patients, thus making it easy for patients to trust them and confide in them. Pattillo (2011)

describes a wide range of activities performed by nurses, which extend to the wider community. Nursing involves collaborative care of communities, individuals of all ages, groups and families; both sick and healthy (Pattillo, 2011). Nurses prevent illnesses, promote health, and care for the disabled, the ill and the dying people placed under their care. Moreover, they are advocates for promotion of safe environment, health education, research participation in shaping health policy as well as systems and patient management (Pattillo, 2011). NURS 4105 – Advocacy Through Healthcare Policy Essay

Marquis & Huston (2009) observe that nurses are the first health care professionals to recognize situations which are not in the best interest of patients and to report these situations to persons that could effect change. They identify and take action or report things such as questionable drug order to the physician or report an incompetent health care provider to a nursing supervisor; thus advocating for the rights of the patient (Marquis & Huston, 2009).

The American Nursing Associations Code requires nurses to be advocates of patients by reporting cases of patient abuse, including known or suspected cases of emotional, physical or sexual abuse because they constitute unprofessional conduct and form basis for disciplinary action against the culprits (Marquis & Huston, 2009). In the event that the nurse is not satisfied with how a reported case is handled to protect interest of the patient, the Code provides for nurses to pursue the case further within appropriate reporting channel and outside the agency (Marquis & Huston, 2009). According to Marquis & Huston (2009), the policy for board of registered nurses warns that reporting duties are responsibilities of individual nurses and supervisors or administrators are not required to impede or inhibit the process or subject the reporting nurse to any sanction for making the report. Nurses are further advised to follow guidelines developed by the board of registered nurses concerning content of patient abuse course in identifying abuse cases that require action to protect the rights of their patients (Marquis & Huston, 2009). NURS 4105 – Advocacy Through Healthcare Policy Essay

Nursing advocacy plays a key role in observing safety of patients during their encounters with health care system; especially when the patient is too ill to serve his own advocate or when the patient is undergoing surgery and anesthesia. Marquis & Huston (2009) highlight that during situations of surgery, the circulating nurse must serve as the patient’s advocate, speaking for the patient and protecting patient’s wishes throughout the process. The nurse is required by the nursing code to support the cause or proposal as a result of patient’s vulnerability. Nurses serve as patients advocate by advocating improved health care practices that relate to control of infections and patient care environments as well as access to care. Marquis & Huston (2009) note that each encounter that the nurse has with his patient presents an opportunity for the nurse to serve as the advocate for the patient. NURS 4105 – Advocacy Through Healthcare Policy Essay

Giving voice to patients in situations where patients decide to give their full trust to health care provider or when the patients are hesitant to speak their mind is an advocacy role of nurses to their patients. Goldberg (2011) reiterates that in such situations, nurses should encourage patients to voice their wishes and provide care that focuses on meeting patients’ specific wishes. In addition, nurses should ensure that the safest procedures are observed for patients during care provision. As advocates for the patients, nurses are required to limit traffic in operating suite or delay the beginning of a surgery procedure until correct instructions are provided (Goldberg, 2011). This not only eliminates carelessness but also protects the well being of patient throughout the process. Furthermore, Goldberg (2011) embraces the importance of nnurses in the preoperative arena who play a critical role by care environment monitoring, provision of safe care for the patient and promotion of best practices for prevention and control of infection. The nurse as an advocate for the patient must intervene in situations where patient’s safety is compromised like in cases where a physician does not routinely wash his hands before touching a patient or physicians who regularly violate sterile technique and ignores other practice standards. The code stipulates for nurses to recognize and address practice patterns that put patient at risk in order to protect the rights and well being of the patient. NURS 4105 – Advocacy Through Healthcare Policy Essay

Besides acting as advocates for patients, nurses also act as advocates for family members of the patient. Goldberg (2011) points out that positive results have been achieved through advocacy in situations where patients are very ill and at point of death; where upon request of family members to be with the patients, nurses have respected these wishes and allowed family members to be with the patient. In such situations, death conditions have been reversed with the patient’s condition improving drastically upon seeing family members. Patient’s advocacy guarantees safety and protection of patients from preventable harm as patients and their family members depend on nurses to detect and address potential safety issues (Goldberg, 2011). NURS 4105 – Advocacy Through Healthcare Policy Essay

Nurses as advocates for patients face numerous challenges in their daily advocacy duties. Goldberg (2011) observes that some physicians may not respond or listen to nurses in a timely manner as a result of competing priorities for nurse attention and efforts, thus placing tasks before advocacy. Additionally, hierarchical and institutional constraints frequently limit nurses from role as advocates of patients; placing patient’s safety at risk. People who espouse advocacy for patients are of the opinion that nurses should achieve higher professional autonomy for rights of patients to be fully protected in hospital settings. Goldberg (2011) regrets that while medical ethics rarely addresses the freedom of physicians to establish professional relationships with patients, nursing ethics must deal with continuous challenges to freedom of practice, especially in hospital settings.

The intertwining of professional and ethical concerns, with the principles such as rights of patient and autonomy being considered in the same context as professional freedom to practice is quite challenging and places nurses at an awkward position. However, it is clear that the primary obligation of a nurse is to the patients, but not to physicians or hierarchies in health care facilities. This has gained prominence and wide acceptance within the profession. The American Nursing Associations Code requires nurses to be always alert as client’s advocates by taking necessary action on any situations of unethical, illegal or incompetent practices originating from health care system, members of health care team or actions that violate patient’s best interest. This has overtaken sections of previous code that mandated nurses to be obedient to physicians’ orders and observe high level of confidence in physicians. In addition, putting nurses as advocates for the patients has led to shift of nurses’ perceptions of their primary allegiance from physicians and hospitals to patients. However, advocacy for patients may be a complex issue, especially when patients are unwilling to express their preferences or are afraid to say what they want because they believe it will alienate their physician. Sometimes disagreements may arise between choices and also the nurse may find other care professionals indifferent or opposed to wish of his patient. These reasons and others make advocating for patients a complex activity. NURS 4105 – Advocacy Through Healthcare Policy Essay

In conclusion, nurses as advocates for patients have been embraced in most health care institutions. Advocacy for patients guarantees safety and protection for patients, especially in situations where patients are too ill or during surgery. Health care professionals should therefore respect the role of nurses as advocates for patients by providing adequate support and cooperation in order to attain this goal.

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The purpose of this concept analysis is to identify, focus, and refine how patient advocacy is perceived by professional nurses in the nursing community. This paper will follow the Walker and Advant (2011) method of concept analysis to identify the concept of patient advocacy from existing literature with the aim to analyze and provide clarity and direction for enhancement of advocacy in nursing. Further, steps will include the process of identifying attributes of the concept, describing all model cases selected, identifying antecedents and consequences regarding the concept, and lastly, identifying examples of empirical referents of the concept (Walker & Avant, 2011).

Identification of Concept and Aim of Analysis

Patients often have an inadequate knowledge of illness and medicine, yet they desire more control over their personal healthcare. In many healthcare settings, patient care is unpredictable and patient’s right to self-determine and quality-of-life has a tendency to be ignored (Bu & Jezewski, 2006). Advocacy is understood as the act of pleading for, supporting, or recommending (Webster’s Online Dictionary, n.d.). Moreover, the concept most often noted in literature as a component of nursing advocacy involves acting on behalf of patients, including nurses’ activities

of speaking, fighting, and standing up for their patients (Hanks, 2007).NURS 4105 – Advocacy Through Healthcare Policy Essay

Nurses are in a unique position to support their patient’s interests in the re-establishment of health and well-being through patient advocacy. However, due to the limited number of quantitative empirical studies of patient advocacy in nursing, the definition of patient advocacy is not consistent, and many nurses have a limited view of what patient advocacy is and how to perform the challenging task of protecting and supporting patient’s rights. (Bu & Jezewski, 2006). The aim of this analysis is to clarify, define, and refine the concept of patient advocacy in order to expand understanding of this concept in nursing practice.

Defining Attributes

According to much of the literature, defining attributes of patient advocacy involves a series of specific actions by nurses to protect, represent, and safeguard the patients’ rights, best interests, and values within the healthcare system (Bu & Jezewski, 2006). As well, safeguarding patient’s autonomy, acting on behalf of patients, and defending social justice in the delivery of health care are all core attributes of patient-care advocacy (Bu & Jezewski, 2006). The title of patient supporter and patient representative is also used frequently in research literature to describe the role of the nurse advocate (Hank, 2007). These attributes place patients at the center

of the of the healthcare system, emphasizing patients’ legal rights and well-being, and nurses’ humanity, kindness, and fairness in the delivery of health care (Bu & Jezewski, 2006). NURS 4105 – Advocacy Through Healthcare Policy Essay

Cases of Patient Advocacy

Cases of patient advocacy can be examples of several main factors that define and challenge the attributes that facilitate or hinder nurses as patient advocates. A model case is defined as “an example of the use of the concept that demonstrates all the defining attributes of the concept” (Walker & Avant, 2011, p. 163). In addition to the model case exemplar, the attributes of patient advocacy will be defined and challenged through case examples of borderline, related, and contrary cases. NURS 4105 – Advocacy Through Healthcare Policy Essay

Model Case

An example of a model case for patient advocacy involves a Registered Nurse who has been working as the charge nurse of a busy Emergency Department for 15 years. P.B. has just come on shift, when an air emergency vehicle lands on the helipad with a 22-year-old, male, trauma patient. The paramedic reports that the patient was involved in a two vehicle head-on collision, the patient was ejected from the vehicle, and that there is a possibility of a spinal cord injury. Immediately, the trauma team attends to any life-threatening injuries, while P.B. quietly and efficiently attends to the patient’s emotional and safety needs. She quickly determines that the patient would like his mother contacted

only, that he would like to know the extent of his injuries, and that he suffering a considerable amount of pain. After the patient’s primary care is complete, P.B. explains spinal shock to the patient, allows the previously-contacted mother to enter the Emergency Department, and carefully reviews the plan-of-care with both the patient and the mother. She then offers to contact further family as needed, and presents herself available for any further questions. Further, after administering ordered pain medications, P.B. is very astute with timed, follow-up, assessments regarding effective pain control. NURS 4105 – Advocacy Through Healthcare Policy Essay

The above nurse demonstrates the core attributes necessary when a nurse is successful in the role as patient advocate. The nurse acted as a patient protector from pain and fear, representing and safeguarding the patient’s rights and autonomy through contacting the appropriate family members, and addressing the patient’s pain with medication and personal reassessment of patient’s pain control. As well, the nurse showed kindness, fairness, and humility with congruity of care by personally providing the patient and the patient’s family with compassion and education regarding the patient’s injury and treatment.

Borderline Case

An example of a borderline case regarding the role of a nurse as a patient-advocator would involve the same scenario, but slightly different reactions from the above charge nurse.

As the helicopter lands and the patient’s life-threatening injuries are attended to by the trauma team, P.B. offers to contact the family members of the patient. The patient asks that only his mother be notified, that he is afraid, and that he is in tremendous pain. P.B. quickly reassures the patient that she will contact his mother, that being afraid is natural, and that as soon as she is given the order, she will provide the patient pain medicine. When the patient’s mother arrives in the Emergency Department, P.B. explains the nature of the patient’s injuries, assures the mother that her son is going to be fine, and then leaves the two alone to discuss their options for care.

The above example represents a borderline case due to the mid-range of appropriate reactions by the nurse attending the needs of a patient. The patient’s autonomy, privacy, and rights were safeguarded when the nurse contacted the appropriate family members. However, the nurse did not demonstrate effective fairness when assuring the patient and the patient’s mother that everything would be fine with regard to the patient’s injuries. Further, the nurse did not display kindness and compassion when leaving the patient and his mother alone without first determining that their educational and emotional needs were met. NURS 4105 – Advocacy Through Healthcare Policy Essay

Related Case

An example of a related case using the previous scenario involves a variance in the actions of the

charge nurse. P.B has just begun her role as charge nurse on the night shift in the Emergency Department. One of the trauma nurses has called in sick, and she is now required to provide care as a nurse on the trauma team as well as fulfill the role as charge nurse. Shortly after her shift begins, a 24-year-old, male, trauma victim arrives via air transport, and P.B. realizes that she will have to be the primary nurse on this patient’s case. The patient is quickly stabilized, but a spinal cord injury with possible paralysis is soon diagnosed by the trauma physician. The patient is very frightened, in pain, and requests that P.B. phone his mother. P.B. calmly assures the patient that she will contact his mother, administers ordered pain medication, and then assures the patient that she will return to check on him shortly. However, due to P.B.’s charge nurse status, she is needed in another trauma case and the 24-year-old trauma victim is replaced by another trauma nurse. NURS 4105 – Advocacy Through Healthcare Policy Essay

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