Role of Nurse as Patient

¶ … Role of Nurse as Patient Advocate

The role of nurses has dramatically changed even in the last twenty years. The nurse is increasingly seen as a professional who acts as an advocate for patients. Within the filed of nursing, standards, language and expectations have evolved to help better meet the needs of patients and to better utilize the unique role of the nurse as a clients medical and psychosocial confidant. As the individual who is likely to spend the greatest amount of one on one time with the patient the nurse is important in the whole delivery system, as a source of advocacy and voice for patient impaired by disease or treatment. In this work the role of the nurse as the patient advocate in the field of psychology treatment is explored through two seminal works on the role of the nurse as advocate for the mentally ill patient.

The nurse-client-relationship has for some decades been considered the cornerstone of psychiatric nursing (Peplau, 1952; Tudor, 1970; Lego, 1980; Lego, 1996; Hummelvoll, 1984; Hummelvoll, Nordby, & Sundmoen, 1988). In nursing research and practice the nurse-client relationship is a central theme (Kim, 1987). Peplau (1962) argues that the nurse-patient relationship is the crux of psychiatric nursing. (Hummelvoll, 1996, p. 12)

It seems that within he field of medicine there is no greater need for advocacy for the patient than when their disease process impairs their ability to advocate for themselves.

The nurse is in the best position to act in this role, helping patients with impaired cognitive abilities to express their needs and feelings to better adapt care to a holistic model. A nurse may be able to find out, long before a physician, when and why a patient is or is not compliant with care models. The patient may have personal complaints about the side effects of medications or other treatments which might be expressed to a nurse, through either symptom observance or direct communication.

The nurse-client-alliance model (NCA), based on a humanistic-existential view, can stimulate insight and understanding of people with psychiatric sufferings, through a specific nursing care plan. NCA is necessary for a holistic-existential approach to most clients. (Hummelvoll, 1996, p. 12)

In psychiatric care the nurse client relationship has often been thought of as the most beneficial to successful care, as the nurse and client discuss and interact during periods of everyday living which might hinder or enhance the life of the patient.

A the nurse-patient relationship as the specific interpersonal relationship that evolves between a nurse and a patient. This is a relation.".. In which recurring difficulties of everyday life arise" (1952, p. xi). The nurse uses knowledge and the nurse-patient relationship as a therapeutic tool, to promote the growth and well-being of the client. Peplau holds that this relationship "is both educative and therapeutic" (p. 9); and it evolves through a process with interlocking and overlapping phases, including orientation, identification, exploitation, and resolution. (Hummelvoll, 1996, p. 13)

The professional relationship that the client has with the nurse is often one of the most fundamental of all the relationships the client has in his or her life. The nurse can act as an advocate between the client and other health care professional as well as an advocate for the client with his or her own family. The holistic needs of the client are often met through this and other relationships, when they are strong, consistent and productive.

A an authentic caring relationship between clients and nurses. This relationship stimulates mutual empowerment and helps the client pass through the conglomerate of not easily accessible helping systems in the United States. The purpose of this reciprocal and chosen partnership is to increase the client's safety and quality of life. Here too, empowerment is a means to better health, with the nurse acting as the client's advocate, avoiding the kind of "herding" that Kendall rejects. (Hummelvoll, 1996, p. 11)

The issue of ethics is central to the nurses ability to provide services for a client as his or her advocate and in one article the psych nurse's ability to base decisions on ethical grounds for the greater goods of the client is explored, and within the work the role of nurse as patient advocate is explored, though secondarily through the language of the article. Though issues become much more complicated when involuntary procedures are concerned nurses rely on experience, not excluding the experience with the patients themselves as a guide. Without the role of advocate these decisions would be much harder to make.

If a psychiatric nurse is a patient advocate, as the American Nurses Association Code of Ethics (ANA, 2000) requires, when may she place a patient on an involuntary hold? When is the nurse justified in medicating a psychotic patient against his or her will? When does the nurse declare the situation calls for the "last resort" (ANA, 1999) and place a threatening patient in seclusion and/or restraints? The answer to these questions is, "It depends." Every time a psychiatric nurse implements an involuntary procedure, that nurse makes an ethical decision. Psychiatric nurses make such decisions daily when caring for the seriously mentally ill. (Vuckovich 2000, p. 111)