Problematising autonomy and advocacy in nursing

Cole, Clare; Wellard, Sally; Mummery, Jane

doi:10.1177/0969733013511362

Cited by 63 publications

(73 citation statements)

References 30 publications

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“…[2][3][4] Therefore, the actions of nurses related to patient advocacy can be defined as an integral part of their effort to promote the interests of patients, ensuring they are aware of their rights and have access to information when making decisions, as well as defending their rights, and helping them to access health care and ensuring quality health care. 1,[5][6][7][8][9] Moreover, the role of nursing in patient advocacy reveals in its essence a direct relationship with the moral sphere; patient advocacy is an essential activity of the nursing field. Many barriers, however, are faced by nurses, impeding them from satisfactorily fulfilling this role in accordance with their ideals.…”

Section: Introductionmentioning

confidence: 99%

Advocacia Do Paciente Na Enfermagem: Barreiras, Facilitadores E Possíveis Implicações

Tomaschewski-Barlem

Lunardi

Barlem

et al. 2017

Texto contexto - enferm.

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Objective: to promote reflection upon the barriers, facilitators and potential implications of patient advocacy on the part of nurses.Results: this reflection results from a thorough reading of the international literature addressing patient advocacy along with Brazilian and international studies addressing moral distress and its relationship with patient advocacy.Conclusion: the barriers imposed on patient advocacy are well-known and such constraints are based on the organizational structure of health institutions and power relationships established between doctors and nurses, challenging and discouraging nurses from acting in accordance with their knowledge and conscience, often leading to a condition known as moral distress.DESCRIPTORS: Health advocacy. Nursing. Nursing ethics. ADVOCACIA DO PACIENTE NA ENFERMAGEM: BARREIRAS, FACILITADORES E POSSÍVEIS IMPLICAÇÕES RESUMOObjetivo: realizar uma reflexão acerca das barreiras, facilitadores e possíveis implicações do exercício da advocacia do paciente pelos enfermeiros.Resultados: essa reflexão resulta de uma leitura minuciosa da literatura internacional acerca da advocacia do paciente, acrescida de estudos nacionais e internacionais acerca do sofrimento moral e suas relações com o exercício da advocacia.Conclusão: as barreiras diante do exercício da advocacia do paciente são notórias, pautando-se na própria estrutura organizacional das instituições de saúde e nas relações de poder entre equipes médica e de enfermagem, desafiando e desencorajando os enfermeiros a agirem de acordo com seus conhecimentos e consciências, implicando, muitas vezes, em situações reconhecidas como de sofrimento moral. DESCRITORES:Advocacia em saúde. Enfermagem. Ética em enfermagem.http://dx.doi.org/10.1590/0104-07072017000100014Texto Contexto Enferm, 2017; 26(3):e0100014Tomaschewski-Barlem JG, Lunardi VL, Barlem ELD, Silveira RS, Ramos AM, Piexak DR 2/7 DEFENSA DEL PACIENTE EN ENFERMERÍA: BARRERAS, FACILITADORES Y LAS POSIBLES IMPLICACIONES RESUMENObjetivo: realizar una reflexión sobre las barreras, facilitadores y las posibles consecuencias del ejercicio de la defensa de los pacientes por enfermeras.Resultados: esta reflexión resulta de una lectura exhaustiva de la literatura internacional en defensa de los pacientes, como estudios nacionales e internacionales acerca de la angustia moral y su relación con la práctica de la defensa de los pacientes.Conclusión: los obstáculos al ejercicio de la defensa de los pacientes son notorios, basándose en la estructura organizativa de las instituciones de salud y de las relaciones de poder entre los equipos de médicos y enfermeros, desafiando y desencorajando los enfermeras para actuar de acuerdo con sus conocimientos y conciencia, resultando a menudo en situaciones consideradas como sufrimiento moral. DESCRIPTORES:Defensa de la salud. Enfermería. Ética en enfermería.

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Section: Introductionmentioning

confidence: 99%

Advocacia Do Paciente Na Enfermagem: Barreiras, Facilitadores E Possíveis Implicações

Tomaschewski-Barlem

Lunardi

Barlem

et al. 2017

Texto contexto - enferm.

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“…In a broader view, health advocacy may comprise different dimensions such as to communicate, inform, educate, protect, talk about, build sound relationship/link, and also keep the focus on social issues (8) through different actions developed by nurses on behalf of users and the community. In the FHS context, health advocacy is perceived as an integral part of the professional work of nurses to promote the users' wellbeing and empower them (9)(10) . Health advocacy is not limited to the user-nurse relationship.…”

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confidence: 99%

Health advocacy by nurses in the Family Health Strategy: barriers and facilitators

et al. 2018

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Objective: Identify the barriers and facilitators of health advocacy to users delivered by nurses from the Family Health Strategy. Method: Qualitative study carried out with nurses from the Family Health Strategy of a city in the south of Brazil. Study participants were 15 nurses, who were interviewed. The content of the interviews was recorded, transcribed and analyzed in the light of the discursive text analysis. Results: Two categories emerged, one about the lack of organization at the workplace, bureaucracy and limitations to professional work in health environments, and another about the facilitating aspects to exercise advocacy both individually and collectively. Conclusion: When nurses, provided with technical, scientifi c and relational knowledge, are empowered to make decisions, they are not only supported by other professionals at work but also develop actions of health advocacy to users, thus qualifying the care delivered. Descriptors: Health Advocacy; Primary Health Care; Nursing; Integrality in Health; Power. RESUMO Objetivo: Identifi car as barreiras e facilitadores da advocacia em saúde dos usuários por enfermeiros da Estratégia Saúde da Família. Método: Estudo qualitativo realizado com enfermeiros da Estratégia Saúde da Família em uma cidade no sul do Brasil. Participaram 15 enfermeiros mediante uso de entrevistas gravadas, transcritas e analisadas à luz da análise textual discursiva. Resultados: Emergiram duas categorias, uma discorrendo sobre a falta de organização do trabalho, da burocracia e das limitações para atuação profi ssional nos ambientes de saúde e outra sobre os aspectos facilitadores para o exercício da advocacia de forma individual e coletivamente. Conclusão: Quando o enfermeiro, imbuído dos saberes técnicos, científi cos e de relacionamento, desenvolve sua autonomia na tomada de decisões, além de contar com o apoio de outros profi ssionais no trabalho, consegue desenvolver ações de advocacia em saúde aos usuários e, assim, qualifi ca o cuidado prestado. Descritores: Advocacia em Saúde; Atenção Básica a Saúde; Enfermagem; Integralidade em Saúde; Poder. RESUMEN Objetivo: Identifi car las barreras y facilitadores de la acción política en salud de los usuarios por parte de enfermeros de Estrategia Salud de la Familia. Método: Estudio cualitativo realizado con enfermeros de Estrategia Salud de la Familia en ciudad del Sur de Brasil. Participaron 15 enfermeros mediante entrevistas grabadas, transcriptas y analizadas por análisis textual discursivo. Resultados: Surgieron dos categorías, una discurriendo sobre falta de organización del trabajo, la burocracia y las limitaciones de actuación profesional en ámbitos sanitarios, y otra sobre aspectos facilitadores para el ejercicio de la acción política de modo colectivo e individual. Conclusión: Cuando el enfermero, poseedor de conocimientos técnicos, científi cos y de relación, desarrolla su autonomía para toma de decisiones, contando con el apoyo de otros colegas profesionales. Consigue desarrollar acciones políticas en salud para...

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“…ambiguous for a profession which claims an advocacy role, and though the concept is problematic and contested [4,33], the notion of an unbiased advocate might be considered oxymoronic. It is simply unclear what 'objective' means in the context of professional nursing care.…”

Section: Four Clauses For Concern (1) Consent and Its Documentationmentioning

confidence: 99%

Can the revised UK code direct practice?

Snelling

2015

Nurs Ethics

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The Nursing and Midwifery Council, the United Kingdom regulator of nursing and midwifery has recently revised its professional code of practice. This paper begins by arguing that a professional code must be capable of sustaining close reading and of action guidance. Using four exemplar clauses it is argued that the new revised code does not met this purpose. First, I show that in setting out requirements for consent and documentation, the meaning of the relevant clause has changed significantly during the editing process so that a literal reading of the final document bears little relation to established professional practice. Second, I argue that the clause concerning the nature of professional relationships has also been altered during the editing process so that it is inconsistent with other professional groups and established accounts of the professional nurse-patient relationship. Third, I argue that the clause concerning disclosure of confidential information, which survived revision and editing with its meaning intact is nevertheless factually incorrect and inconsistent with UK law and authoritative guidance. Finally, fourth, I argue that use of the word 'inappropriate' is inappropriate as it amounts to meaningless circularity, discussed in relation to a clause on expressing personal beliefs. Taken together, these examples demonstrate that the Code is seriously flawed and does not fulfil its purpose. One way that simple prescriptive clauses in the Code can be usefully understood is through the provision of detailed guidance. I argue that the NMC has changed its position on its view of the value of guidance and has significantly reduced the amount of written guidance and advice is provides. The paper concludes by arguing that in order to meet its action directing function, further clarifying revision and the provision of detailed guidance is required.

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Problematising autonomy and advocacy in nursing

Cited by 63 publications

References 30 publications

Advocacia Do Paciente Na Enfermagem: Barreiras, Facilitadores E Possíveis Implicações

Advocacia Do Paciente Na Enfermagem: Barreiras, Facilitadores E Possíveis Implicações

Health advocacy by nurses in the Family Health Strategy: barriers and facilitators

Can the revised UK code direct practice?

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