The Nurse as Patient Advocate

1. The Nurse as Patient Advocate Ellen Bernal

2. Nurses role historically • Florence Nightingale and the military model • Hierarchical: Nurses’ duty is to obey physicians and maintain order in the hospital. • Unquestioning loyalty to physician and hospital even in the face of wrongdoing.

3. Advocacy model • Developed as Nursing was pursuing its own sense of professional identity, separate from duties to physicians and institutions. • Advocacy as the protection of patients’ rights and interests. • This model recognizes that patients’ rights are undermined by institutional practices and unequal power structures.

4. Advocacy model • Nurses have a duty to empower patients, both directly by supporting patient autonomy and indirectly by working to changes practices that disempower patients. • Examples – Mitchell (p.42) nurse forced to follow inconsistent (?) order given re 2 patients re resuscitation. • Leah Curtin (p.42) MD withholding info from patient re diagnosis of cancer. Nurse informs.

5. Bernal’s critique of advocacy model • It continues the old view of nurses as the guardians of morality. • It portrays nurses as adopting whatever values the patient supports and portrays relationships between patients and professionals/institutions as adversarial and manipulative. • It neglects important moral considerations besides patient autonomy (i.e. just distribution of resources). • Finally, the advocacy model places too much focus on patient autonomy since much of the patient’s experience involves suffering and vulnerability and requires the consideration of third party interests.

6. The covenant model • Instead of focusing only on the patient-Professional relationship, the covenant model looks at the nursing profession’s duties as a whole. • Nurses are indebted to society for their training and professional benefits. Society is indebted to nurses for their work. This “mutual indebtedness” creates an exchange of promises. • The nurse “is given freedom to practice by the public” on the basis of the nurse’s “promise to remain faithful to the ideal of service.”

7. Covenant model • While advocacy is part of a nurse’s role, so is the duty to respond to the patient’s preferred view of their relationship and to the “wider variety of needs occasioned by illness and health care.” • Bernal sees the covenant model as more consistent with the goal of cooperation amongst all health professionals.