The Nurse as Advocate

1. Chronic care emphasizes the maintenance of function and prevention, while the current healthcare system is focused on curing and restoring Within the contrast of these conflicting agendas, the term �medical necessity� has become a focus of contention and frustration The Nurse as Advocate

2. Education is an important part of advocacy It is important to empower patients and families to become self-advocates Educate on the ramifications of insurance coverage Instruct how to frame an appeal Advise on how to engage healthcare team in the process The Nurse as Advocate

3. The Nurse as Advocate Spokesperson and advocate in negotiations with case managers and other decision makers Investigator and linkage to community programs Liaison to the pharmaceutical industry Innovator and developer of programs and services

4. Patient Receipt of Adequate Care Navigating private insurance, Medicare, Medicaid Prescriptions Long-term care Living wills Clinical trial participation

5. Patient Rights and Protection Americans with Disabilities Act (ADA) Health Insurance Portability and Accountability Act (HIPAA) Family and Medical Leave Act Healthcare proxies

6. Life Planning Advance directives Living will Healthcare proxies Power of attorney Trusts

7. ADA and Disability Rights Rights of the disabled Accessibility Reasonable accommodations A level playing field for the disabled Removal of obstacles to independence Dynamic legislation for the disabled

8. Tools of Advocacy Major issues affecting people with MS Patient rights legislation HIPAA�protection and confidentiality Expansion of health insurance coverage Broadening of Medicare/Medicaid Pharmaceutical assistance programs Long-term care costs Caregiver tax credits

9. Empowerment and MS Empowerment in MS can be defined as self-direction with an underpinning of hope Empowerment enables recognition of skills and resources It involves skill development, coping, mastery over the environment, and flexibility

10. Empowerment and Self-Efficacy Self-efficacy is the belief that one can achieve desired outcomes through behaviors Personal beliefs will affect effort, the length of perseverance, and the level of anxiety or depression Adherence and self-efficacy have been strongly linked

11. Promoting Self-Efficacy Mastery over the environment Vicarious experiences Persuasive information Enhancement of physical and psychological states

12. Empowerment by MS Nurses Facilitate goal setting Provide experiences with peers Provide ongoing affirmation/�cheerleading� Maximize wellness Encourage motivation Affirm the worth of each person

13. Patient Advocacy and Resources

14. Conclusions Information and knowledge are power Personal energy is power Nurses affect a broad spectrum of the healthcare industry Nurses function in positions that influence societal change and can influence the future of healthcare Nurses are a powerful voice of advocacy and empowerment