NURS 5050 – Policy and Advocacy for Improving Population Health 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. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

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 5050 – Policy and Advocacy for Improving Population Health 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 5050 – Policy and Advocacy for Improving Population Health 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 5050 – Policy and Advocacy for Improving Population Health 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 5050 – Policy and Advocacy for Improving Population Health 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 5050 – Policy and Advocacy for Improving Population Health 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 5050 – Policy and Advocacy for Improving Population Health 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.

The aspects of community and aggregate are closely connected and people tend to use the terms interchangeably. The best way to explain the difference between the two concepts is by examples to differentiate and get a clearer understanding of the difference between the two concepts. This paper will define aggregate and community giving a brief support from current literature. The paper will also examine and give the differences between the two terms plus describe and identify the chosen aggregate based on the health issue of heart disease. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

The Christoffel’s three stages of a conceptual framework for advocacy will be described. Then each stage as an aggregate selected is described.

Community and Aggregate Terms Defines
In community health care nursing, aggregate is defined as the whole population, which is being used to describe a given environment. The term aggregate is used to refer or define a group of people in a society who are believed to have similar or common problems and challenges in their life. These people should share similar characteristics and also they should be living in the same area. The group which is to be described should be suffering from the same medical or health care problem and should be in search of similar medication or health care services. Aggregate in nursing setting literally is defined as the entire, whole, or the sum of a given group with similar problems, (Nies & McEwen, 2010). NURS 5050 – Policy and Advocacy for Improving Population Health Essay

Differences Between Aggregate and Community
There are those people who use the term community when referring to aggregate. Aggregate and community are two different concepts but are closely connected. Community in nursing health care setting is used to refer to the general population in a given area. A community is the entire population that includes the sick and healthy population. When discussing about the aggregate, we refer to the population, which is experiencing a health condition along with those who are responsible of taking care of the group that are sick. The entire population that comprise of healthy and sick in the society is referred to as the community, (Stanhope & Lancaster, 2009).

Identified Aggregate and Description as a health Issue
There are those people who use the term community and the term aggregate to refer to the same thing or to mean something the same. There stand significant differences between the term community and the term aggregate. When we talk of aggregate, we are referring to a population, which has similar medical problems or challenges and live in the same region or geographical area. For the community, it’s the general population that involves the sick and those who are not sick. In this case, Adults suffering from heart disease in Illinois is an aggregate population that is used to define the current health care challenges. In the state of Illinois, specifically the Sangamon county community, evidence shows that heart disease is the number one reason for death of adults in the entire state of Illinois and in Sangamon county (Illinois Department of Public Health [IDPH], 2010). NURS 5050 – Policy and Advocacy for Improving Population Health Essay

Christoffel’s Three Stages of a Conceptual Framework for Advocacy Christoffel’s three stages for advocacy include information, strategy, and action. The stages take place concurrently. The first stage, information, includes naming, describing, and measuring the public health problem. The second stage, strategy, involves using the information in the first stage to develop a plan of action for the promotion of public health. The stage includes. This stage involves the communication of information to the public and health care professionals. Groups can then be assembled to focus on the issue and plan needed changes. Strategies can include public education messages, campaigns, and press conferences. This action may involve fund raising, persuading individuals to change their lives, and legislation involvement.

To achieve action, changes in mindsets, behaviors, and resource provision. Public health advocacy transpires at two levels: the individual/family level and in the larger community level (Christoffel, 2000). Advocacy that focuses on the interpersonal or intrapersonal level is frequently referred to as patient advocacy. Patient advocacy involves any “activity that benefits a patient” (Torrey, 2010). It can apply individual patient care, groups that develop policies, and legislation changes to improve the health care system for patients. There are many examples of patient advocacy organizations, which include government groups such as the Center for Disease Control, American Heart Association, and individual patient advocates who act as healthcare assistants (Torrey, 2010). NURS 5050 – Policy and Advocacy for Improving Population Health Essay

Applying Each Stage as an advocate for the Aggregate
The first stage in the Christoffel’s advocacy framework talks about the information factor. The information names, describes, and measures the public health problem. When discussing the issue of heart disease. This stage can be used to describe the disease process, the risk factors involved, and it’s complications. During this stage, the private sector or the government sector get involved so as to develop the research needed that can be used to measure the public health problem. Evidence shows that this stage is relevant simply because it assists develop all statistical information and results that are suitable in order to address the advocacy challenge. The first stage in Christoffel’s advocacy framework is to develop a research on heart disease within the society. This stage will help develop relevant information on the mortality rate related to heart disease and/or its complications (Christoffel, 2000).

The second stage in Christoffel’s advocacy framework is the stage of strategy. Having collected relevant information about the problem of health care issue, the second stage helps work on the information so as to understand the problem completely. In this stage, the central idea is to get results that will help come up with some strategies on how to approach the health problem. Experts in respective fields translate the research findings so that proper results are developed to develop a plan of action (Christoffel, 2011). NURS 5050 – Policy and Advocacy for Improving Population Health Essay

The third stage in Christoffel’s advocacy framework is the stage of action. Strategies, which are developed in the second stage on how to handle the health issue are implemented and monitored in the final stage of Christoffel’s advocacy framework (Christoffel, 2011). It is alleged that when strategies in stage two are implemented and monitored they provide the best results in respect to the health care environment, (Stanhope & Lancaster, 2009). Public health messages on the news and posters can help educate the community about heart disease. There are also local physicians who provide free learning seminars on specific diseases. Raising funds to help with campaign measures can also be implemented during this stage. Legislation can be educated on the health issue to convince policy makers to get involved. The main part of this stage is action. The goal is to influence people to change specific habits that will reduce the risk of developing heart disease. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

Conclusion
The aspects of community and aggregate are closely connected, and in most cases a lot of people tend to use them interchangeably. These two terms are used interchangeably, but they have different meanings. There are those people who use the term community and the term aggregate to refer to the same thing or to mean something the same. There stand significant differences between the term community and the term aggregate. Aggregate is the populations that has similar health problems and are seeking similar health care services, but the community is the entire population that carries the sick and the healthy. The use of Christoffel’s advocacy framework helps solve a problem in accordance.

References:
Christoffel, K. (2011). Public health Advocacy: Process and Product. American Journal of Public Health Illinois Department of Public Health. (2010). Leading causes of death, Illinois, 2010. Retrieved from http://www.idph.state.il.us/health/bdmd/leadingdeaths10.htm Nies, M. (Mary Albrecht), & McEwen, M. (2010). Community/public health nursing: promoting the health of populations. Elsevier/Saunders Stanhope, M., & Lancaster, J. (2009). Foundations of nursing in the community: community-oriented practice. Mosby/Elsevier. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

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. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

of speaking, fighting, and standing up for their patients (Hanks, 2007).

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).

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 5050 – Policy and Advocacy for Improving Population Health 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 5050 – Policy and Advocacy for Improving Population Health 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. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

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.

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 5050 – Policy and Advocacy for Improving Population Health Essay

This case appears to demonstrate the concept of patient advocacy.   However, when examined closely, the trauma patient may have felt that P.B. did not provide kindness, compassion, and congruity of care when failing to return to his bedside after stating that she would. Unknown to the patient, P.B.’s responsibilities as a charge nurse kept her busy for the rest of the shift, and in fact, P.B. explained the transfer of nursing care to the

patient’s mother.   However, the patient’s mother left the department while the patient was asleep, and no explanation was ever made to effectively relieve the patient’s feeling of desertion.   This exemplar may simply be a demonstration of a nurse who is very busy with patient care rather than the absence of patient advocacy.

Contrary Case

Using the scenario provided above, the contrary case example involves P.B. as she has just arrived to work as the Emergency Department charge nurse for the evening shift.   A trauma victim has been transported into the emergency bay, and he is suffering paralysis due to a spinal cord injury.   The victim is 24-year-old male, appears extremely frightened, and is in pain.   As the charge nurse, P.B. does not typically have individual patients assigned to her, and this is no exception.   However, the nurse assigned to the patient asks P.B. to contact the patient’s mother and to stay with the patient until his anxiety and pain have lessened.   P.B. calls the number provided on the patient’s chart, and asks the patient’s father to immediately come to the Emergency Department, relaying that he should contact the victim’s mother as well.   Following the phone call, P.B. stays with the patient for a short time, but does not provide any comfort measures; instead, P.B. frequently leaves the patient’s bedside, avoids speaking with patient, and denies any knowledge of his condition when asked. NURS 5050 – Policy and Advocacy for Improving Population Health Essay

for updates by the patient.

The above nurse does not demonstrate the core attributes identified when a nurse is successful in the role of patient advocate.   The nurse fails to act as a patient protector from fear or to represent and safeguard the patient’s rights and autonomy through contacting the inappropriate family member.   Further, the nurse does not attempt to exude kindness, humanity, or supporter-of-patient’s needs by frequently leaving his bedside and failing to offer reassurance or education regarding the patient’s injuries.   This is clearly not the concept of a patient advocate role.

Identification of Antecedents

Antecedents are those incidents or events in place prior to the occurrence of the concept being researched (Walker & Avant, 2011).   Antecedents of patient advocacy occur at all levels of the healthcare system, and appeal for nurses to advocate for patients.   Advocacy for patients stems from a need to protect a vulnerable population that loses power to represent or defend itself (Hank, 2007).   Vulnerable patients are the most frequently mentioned situation demanding nurses’ advocacy actions (Bu & Jezewski, 2006).   Populations of vulnerable people include groups or individuals who cannot fully embody and defend their own rights, needs, welfares and wishes, are unable to make suitable choices, or unable to carry out their choices (Bu & Jezewski, 2006).  NURS 5050 – Policy and Advocacy for Improving Population Health Essay