Advocacy is essential to nursing and can offer a nursing student the privilege to do good (beneficence), which is one of the key biomedical ethical principles (Beauchamp and Childress, 2013). However, whether nursing students can function successfully in this role in practice has been questioned (Hanks, 2008).
The concept involves actively ensuring that a patient's rights, choices and causes are defended and involves acting or intervening in the patient's best interest. It is speaking on behalf of those who cannot communicate or empowering patients to speak for themselves and make informed choices (Spence, 2011).
For nursing students, advocacy presents a good opportunity to use communication skills, knowledge of professional values and the Nursing and Midwifery Council (NMC) (2018) code of conduct. If nursing students play their roles judiciously, they can make a positive and lasting impact on patients' lives. Nurses interact more with patients than any other health professionals and are more involved in day-to-day care. Patients are more likely to confide in nurses, giving access to privileged and sensitive information that doctors or other health professionals may not have. Therefore, it is incumbent on nurses to fulfil their role as advocate professionally and be committed to addressing patients' needs and concerns.
In many cases, nursing students avoid acting as patient advocate until they have qualified as staff nurses (Hanks, 2008). Students may encounter more barriers than staff nurses when advocating for patients, which can be attributed to fear of consequences, an unsupportive work environment, labelling and lack of courage (Gazarian et al, 2014). Consequently, the teaching of nursing ethics should be prioritised to promote the practice of patient advocacy.
While on placement, I looked after a patient diagnosed with cholecystitis, an inflammation of the gallbladder. After examination by the doctor, she was prescribed some analgesia/opioids, intravenous fluids and antibiotics. However, she stated that the pain in her abdominal area remained severe and she looked exhausted. It became necessary for me to carry out a set of physiological observations: some of her vital signs were within normal range. However, she had a raised pulse rate of 102 and a slightly raised body temperature, which may have been due to her pain. This was reported to the staff nurse in charge of her care.
While completing the ward round chart, I noticed that the patient was very emotional and I took the time to ask what the problem was. She explained that her pain was unbearable, but the doctor had asked her to be discharged despite her high, irregular pulse rate. She complained that her early discharge was due to a shortage of bed space and she was scared and upset at being discharged in that condition.
After listening to her concerns, I said I would relay these to the staff nurse, who suggested that I mention them to the doctor. Initially, I was hesitant, but my knowledge of the implications of abnormal vital signs such as tachycardia and pyrexia gave me the impetus to advocate for the patient. Tachycardia due to anxiety may be harmless but, if the heart beats too fast, it may not pump blood effectively to the rest of the body, which can deprive the organs and tissues of oxygen causing symptoms such as shortness of breath and dizziness (Boateng, 2013).
I was hoping that the patient would remain in hospital overnight for further examinations, but she was discharged a few hours later. Despite this, I found that my advocacy had influenced the outcome because the doctor had reviewed the patient's symptoms. Before the decision was made to discharge, she was prescribed a weak opioid pain relief medication to facilitate mobilisation. I believe that my patient felt valued and respected because she was listened to and provided with both physical and emotional support while ensuring her safety (NMC, 2018).
On reflection, this experience further strengthens the importance of advocating for patients and empowering them to advocate for themselves, even if the desired outcome is not always achieved. It has strengthened my resolve to improve patients' care in any way I can, and to value my role beyond bedside nursing.
In addition, the reality of bed shortages in the NHS was an eye opener because this puts health professionals in a difficult situation when it comes to making decisions regarding whom to admit and whom to discharge. The event has continued to shape my professional values and confirms that, embedded in true nursing, is the courage to advocate for patients. This is consistent with the NMC (2018)Code, which mandates nurses to advocate for patients and be courageous in challenging poor practices.
Finally, my experience reinforces that advocacy can be learnt and practised before formal qualification. Engaging in continuous personal development will build confidence, competence and position students to deliver effectively on this objective. Trusts can also create a safe, conducive and enabling work environment where students can advocate without fear of retribution (Altun and Ersoy, 2003).