Nurses: The ultimate patient advocates

What do a child admitted to the hospital for an appendectomy, a teenager being treated for a drug overdose in the emergency department and an elderly patient confused about the medication his physician prescribed have in common? They will all be cared for by a dedicated team of health care professionals who will advocate on their behalf. Integral members of that care team are nurses, a profession with a longstanding history of patient advocacy.

“By nature of the job, nurses often spend more time with patients and their families than other members of the medical health care team,” said Sharon Wilkerson, Ph.D., dean of the Texas A&M Health Science Center College of Nursing. “This provides more opportunity to get to know patients as individuals and to understand what is important to them, which is why the role of patient advocate aligns so well with the nursing profession.”

What is patient advocacy?

Long thought to be an ethical responsibility of the nursing profession, patient advocacy may be defined as providing holistic support in the context of a patient’s medical needs.

“As advocates, nurses will act on behalf of a patient who is unable or unwilling to act for themselves,” Wilkerson said. “Whether it is letting a physician know that a patient isn’t responding to a particular medication, or facilitating the patient’s desire to have a clergyman visit them, nurses care about what their patients care about.” This also means that patient advocacy includes facilitating a patient’s ability to fully participate as a partner in their own care.

“Nurses help empower patients by providing information, encouragement and assistance so they can engage in making decisions regarding their health care to the extent that they are able or interested in doing so,” Wilkerson said. “It may be that a patient needs support when asking loved ones to leave the hospital room so they can rest, or they may just need someone to help them understand their options.”

Patient advocacy is intertwined in nursing’s approach to patient care. As such, nurses integrate the prescribed treatment plan in caring for the total person—body, mind and spirit.

The medical care that nurses provide and their roles as patient advocates are critical to the health outcomes of all patients. And, it’s been this way for more than 150 years.

A little history

Florence Nightingale, an English nurse who is considered the founder of modern nursing, established the framework for patient advocacy as a result of her service to wounded British soldiers during the Crimean War (1853-1856).

Deplorable medical and sanitary conditions in military hospitals led to rampant infections and the spread of infectious diseases throughout the ranks of those serving during the war. An estimated 25,000 British, 100,000 French and up to one million Russian soldiers died during the war, with most dying not from battle injuries, but from preventable diseases.

Recognizing the heavy toll that disease was taking on British troops, Nightingale advocated for patients and worked to improve sanitation and nutrition within British military hospitals. Her efforts proved effective, and she is credited for significantly reducing the number of deaths among wounded soldiers.

After the war, Nightingale collected health statistics to evaluate the high death rates among soldiers. She used applied statistics to identify problems in the care that soldiers were given and then took her findings to the Royal Commission on the Health of the Army. Nightingale successfully advocated for better standards of care and for incorporating the use of relevant data to guide military medical practice and policy.

From advocating for better conditions for individual patients to working for health care reform, Nightingale became a model for patient advocacy, which has persisted throughout the history of professional nursing.

Modern nursing

Nursing has always been dedicated to preserving human dignity, patient equality and freedom from suffering. But, with our evolving cultural, economic and medical landscape, this presents some modern challenges.

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For example, what was once medicine by trial and error has been made more exact through advances in technology. And, the health care system has grown far beyond a single practitioner treating several generations of a family. We have a multitude of medical specialists, practice types and ways to deliver health care. While these developments have in many ways helped to advance medicine, they have also made nursing more complicated.

“We know that patients who are admitted to hospitals today are not only more seriously ill, but they also stay for shorter periods of time, which complicates both the patient’s treatment and recovery,” Wilkerson said. “And, many illnesses and injuries are now only treated on an out-patient basis, making it more difficult for nurses to get to know patients, to provide holistic care and to educate patients on recovery once they are discharged from the hospital.“

Advances in technology have helped in both diagnosing and treating medical conditions, but it can also create barriers in patient care.

“While technology provides important information, it also carries on its own conversation with nurses through various bursts of beeping, buzzing and dispensing data,” Wilkerson said. “Often, it is in direct competition to what the patient is trying to communicate to the nurse. So, we need to be careful not to allow technology to become the primary voice that our patients have.”

Navigating today’s health care system means understanding a patient’s diagnosis, being aware of second opinion options, considering the advantages and risks of relevant treatments, sorting through a vast array of insurance issues and addressing home recovery challenges.

As members of the health care team, nurses have a unique vantage point from which to advocate for their patients. Nurses see and seek to understand both the needs and the wants of their patients, and they have experience that helps patients throughout the process.

“Nursing is an intimate and privileged calling; patients are often at their most vulnerable state in life and they need someone who understands and cares about what they are going through,” Wilkerson said. “Patient advocacy provides continuity of care, serves as a checks and balances of our health care system and extends support for patients and their families; nurses are uniquely qualified to fill this important role.”