Transcript The Nurse as Patient Advocate

The Nurse as Patient Advocate
Ellen Bernal
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.
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.
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.
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.
The covenant model
• Instead of focusing only on the patientProfessional 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.”
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.