Patient Advocacy and the Affordable Care Act: The Growing Need for Nurses to Be Culturally Aware

Abstract

The nurse-patient relationship is centered on patient advocacy. Patient advocacy is essential in providing individualized care and improving health outcomes. With the recent implementation of the Affordable Care Act, the patient advocacy concept requires further exploration. Published literature involving patient advocacy's history, uses, definition, past analyses and nursing perceptions were examined. Outcomes of this literature review lead to further examining patient advocacy and how it is applied to culturally diverse patient populations, patient advocacy in nursing curricula and related research. Overall study results indicate that patient advocacy is associated with enhanced health encounters that include nurses presenting patients with understandable healthcare options and supporting patients with their healthcare preference. Although, this review identified positive outcomes of patient advocacy, nursing research must be directed toward creating a patient advocacy definition and measuring advocacy from a patient's perspective. There is also a need for nursing leaders to consider placing a higher emphasis on cultural awareness research and education due to an increased rate of culturally diverse patients now seeking care through the Affordable Care Act.

Patient Advocacy History, Evolution and Impact on Health

“…In the 14 th century the Ming Dynasty has the first mention of a government ombudsman -"one who acts on behalf of another" [3]. Later in the 1920's nurses played a key role in promoting the rights of patients in their Code of Ethics [4], and during WWII Great Britain established a Citizen Advice Bureau. But it wasn't until the 1970's that a formalized patient advocacy program development emerged in healthcare [3].…”

“…In 1926, the ANA, presented a nursing Code of Ethics that established the goals, values and obligations of this profession. The Code of Ethics includes nine provisions; particular to this research is provision three that includes the statement: The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the Juniper Online Journal of Public Health patient [4]. While patient advocacy groups, in their current form, began from the early days of cancer research and treatment in the 1950's, one, if not the best-known, example comes from the very roots of patient engagement in the HIV/AIDS grassroots advocacy of the 1980s.…”

Patient Advocacy at the APRN Level: A Direction for the Future

“…It is these critical advocacy responsibilities that transcend all levels of nursing, including that of advanced practice. Although the advocacy duty is explicit historically, there has been a lack of clarity for a definition of patient advocacy for the profession (Cole, Wellard, & Mummery, ; Ronnebaum & Schmer, ) and the term needs to be differentiated from advocacy for the profession of nursing (Hanks, ).…”

“…Although the preponderance of advocacy literature has been focused on individual patients, this focus has been criticized for not producing systemic change (Mahlin, ). In the United States, the advent of the Affordable Care Act has brought a compelling reason for nursing to focus on the new array of healthcare options available to patients (Ronnebaum & Schmer, ) and for nursing to adapt existing advocacy actions to the new healthcare arena (Walker et al., ). This focus may be of particular importance to the APRN engaged in the primary care setting with patients seeking access to health care.…”

“…As mentioned previously, APRN practice is differentiated from RN practice in that APRN practice includes advanced assessment, diagnosis, and treatment of patient health conditions that include prescribing medications, ordering diagnostic tests, and directing medical management. In this advanced role, APRNs face challenging circumstances related to patient treatment issues, patient insurance coverage and limitations, healthcare bureaucracy, and ensuring that healthcare resources are available to patients (Ronnebaum & Schmer, ). The APRN is now being placed in a role of advocacy in an increasingly changing healthcare environment, particularly in helping patients to access healthcare resources and navigate healthcare systems, thus reducing healthcare disparities (Schroedl, ).…”