NSG 130 - Caring & Advocacy

Strategies for Stress Reduction and Time Management: Professional

Select employment thoughtfully Compare your values to the agency's mission Know your competencies and make a match Participate in policy development opportunities Join committees that contribute to governance Participate in organizational structure to target problematic job and role design Use negotiation skills Seek win-win resolutions to conflict Manage your role positively Network with colleagues Communicate clearly Support excellence in practice Be a self-advocate; use positive self-talk Develop good delegation skills Participate in support groups

Sister simone roach: caring as the human mode of being

She stated that caring is the human mode of being. She also discussed how people in healthcare professions care for others not because they are required to do so by their jobs, but because they are human beings, and this trait of caring is intrinsic to all humans. Caring is the underlying concept that forms the basis of what nurses do each and every day.

Creativity

Vision of how nursing can be and making it better •nursing requires thinking reflectively, critically and imaginatively to create healing environments and enhance care-giving practices. It requires the nurse to develop the qualities of envisioning, risk-taking, openness and resourcefulness. Creativity results in integrating new insights into existing nursing knowledge and awareness. It creates the potential for the nurse to individualize care and embrace change.

Do Not Resuscitate (DNR)

a type of advance directive that instructs medical professionals not to perform CPR if a person's heartbeat or breathing stops.

Advocacy

can also be defined as protecting and defending what one believes in for both self and others.

Nursing Values Central to Advocacy emphasize

caring, autonomy, respect, and empowerment.

Nurses who practice person-centered care are

committed to developing professional relationships based on respect and mutual trust. This holistic approach, which is consistent with theories based on human caring, seeks to promote humanism, health, and quality of living.

Advocacy

defined as the protection and support of another's rights

Conscience

directs moral, ethical, and legal decision making •It motivates us to increase the knowledge and skills needed to respond appropriately to moral, ethical and legal issues face by one and others. It directs us to adhere to the standards of professional nursing practice. It directs us to respond to social injustices. It is the increased awareness of local, national and global health concerns and current trends in health care that affect all ages and populations. It is the sense of accountability, responsibility and leadership for patient care.

Advocacy is

ever-changing, because the patients expectations change

Mindfulness promotes

healing as you pause, focus on the present, and listen. Stopping to focus on your breathing before walking into a patient encounter helps you to focus your mind and allows you to then be more centered and more fully present with the patient.

Power of Attorney (POA)

legal document in which one person appoints another person to act as an agent on his or her behalf

Compassion fatigue

loss of satisfaction from providing good patient care

As a nurse, you must be alert to early signs of fatigue, as well as compassion fatigue:

loss of satisfaction from providing good patient care and burnout.

Commitment

maintain and elevating the standards and obligations of the nursing profession and assuring the delivery of excellence in nursing care. the loyal endeavor to devote ourselves to the welfare of patients. It assures that caring will be part of every nurse patient interaction. It is a conscious effort to grow within the nursing profession through dedication to continuing education, life-long learning, and becoming more skilled, socially conscious, ethical, politically competent and caring

*Not all individuals want to make their own treatment decisions and nurses should

not violate the spirt of autonomy by forcing the decision-making role on anyone. Nurses sometimes advocate for patients by helping them delegate decisions to a preferred decision maker whom they trust.*

The role of advocacy is increasingly important because

patient's changing expectations and demands, and because in our increasingly market-driven health care economy there are no guarantees that the health care system will work to secure patient safety and health.

Nurse may also serve as intermediaries between

patients and the medical profession Pg. 113 - Fundamentals Text, nurse ethicist Patricia Murphy.

Managers also must advocate for patients

regarding distribution of resources and the use of technology. The advances in science and limits of financial resources have created new problems and ethical dilemmas. For example, although diagnosis-related groupings may have eased the strain on government fiscal resources, they have created ethical problems, such as patient dumping, premature patient discharge, and inequality of care.

Advocates must inform of their ______ and make sure they have _____.

rights enough information to make informed decisions

Caring means

that people, relationships, and things matter

Nurse must advocate for who?

themselves, their patients, subordinates, and their profession

Confidence

trust in one's ability to care for others •it is the belief that our skilled, professional presence can make a difference. Confidence is necessary to effectively implement the roles of the nurse as caregiver, teacher, counsellor, advocate, leader, manager and researcher. Confidence in our own ability to create caring environments serves as a catalyst for change. Confidence empowers both us and others to define and accomplish goals. Confidence is developed through the successful utilization of knowledge and experience.

Caring is viewed as

universal although there is no universally accepted definition of caring

ANA defines a healthy nurse as

•one who actively focuses on creating and maintain a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional well-being. Healthy nurses live life to the fullest capacity, across the wellness/illness continuum, as they become strong role models, advocates, and educators, personally, for their families, their communities and work environments, and ultimately for their patients.

Nurses as advocates must realize that they do not make ethical decisions for

•their patients. Instead, they facilitate their patient's own decision making. Nurses interpret findings for their patients, provide information to be considered, help them verbalize and organize their feelings, call in those people who should be involved in the decision making, and help patients assess all of their options. In this way, nurses advocate for the right of patients to make their own decisions concerning their health.

Nurses who value patient advocacy:

- Make sure that their loyalty to their employing institution or colleagues does not compromise their primary commitment to the patient. - Give priority to the good of the individual patient rather than to the good of society in general. - Carefully evaluate the competing claims of the patient's autonomy and the patient's well-being.

Patient Rights

-1998: Patient's Bill of Rights -2010: Patient Protection and Affordable Care Act

Watson's human caring theory - Major assumptions of the science of caring in nursing as follows:

1.Caring can only be effectively demonstrated and practiced interpersonally. 2.Caring consists of carative factors that result in the satisfaction of certain human needs. 3.Effective caring promotes health and individual or family growth. 4.Caring responses accept a person not only as he or she is now but as what he or she may become. 5.A caring environment offers the development of potential while allowing the person to choose the best action for himself or herself at a given time. 6.Caring is more "healthogenic" than is curing. The practice of caring integrates biophysical knowledge with knowledge of human behavior to generate or promote health and to provide ministrations to those who are ill. A science of caring is therefore complementary to the science of curing.

Nursing values central to advocacy

1.Each individual has a right to autonomy in deciding what course of action is most appropriate to meet his or her health-care goals. 2.Each individual has a right to hold personal values and to use these values in making health-care decisions. 3.All individuals should have access to the information they need to make informed decisions and choices. 4.The nurse must act on behalf of patients who are unable to advocate for themselves. 5.Empowerment of patient and subordinates to make decisions and take action on their own is the essence of advocacy.

Sister Simone Roach - Entailed in caring as the human mode of being are:

1.The capacity of the power to care. 2.The calling forth of this capacity. 3.Responsivity of being called to someone, something who/which matters. 4.The actualization of the capacity or the power to care. 5.The activity or performance of caring as manifested in specific caring behaviors.

Competence

Acquiring and using evidence-based scientific and humanistic knowledge. Reflected in the cognitive, affective and psychomotor domains of learning. It is the knowledge of the role of the nurse in the health care delivery systems of the hospital and the community.

Self-care

Any deliberate activity that we do to provide for our physical, mental, and spiritual well-being

Strategies for Stress Reduction and Time Management: Personal

Care for yourself Exercise regularly Have a healthy diet Get adequate sleep and rest Examine your lifestyle Build time for relaxation activities such as meditation and yoga Reflect on what has been helpful in the past Budget time according to priorities Develop new coping skills Let go of perfection Let go of the need to do it all Attend time-management workshop Attend assertiveness program Continue education to develop expertise in areas that give you satisfaction

Caring

Central to all helping professions and enables persons to create meaning in their lives.

Roach posed an interesting question during her work on caring. "What is a nurse actually doing when he/she is caring?"

Compassion, Competence, Conscience, Confidence, Commitment, Comportment, Creativity

Maslow's Hierarchy of Needs

Model developed by Abram Maslow that is used to explain human motivation. Physiological needs, safety needs, love and belonging needs, esteem needs, self-actualization

For example, a patient with terminal cancer tells his nurse that he wants to go home to die. The patient's family tells the nurse that they cannot care for him at home. What should the nurse do?

Nurses are often involved as an intermediary between the patient and their family, especially when the patient and family have conflicting ideas about the management of health care situations. •As the advocate, the nurse recognizes the rights of both the patient and his family. The nurse then works to help find a solution that benefits both the patient and the family. By informing the family of the availability of home care and hospice, the nurse gives them information that may help satisfy the patient's desire for a dignified death. Nurses have resources available to help these patients, so they can arrange referrals from other health care workers, such as social workers, to achieve the desired outcomes.

Compassion

To be with another in their suffering •It is empathy and sensitivity to human pain and joy that allows one to enter into the experience of another. It is the understanding of whom that person truly is for whom one is caring. Compassion is an essential component of the nurse-patient relationship.

Patient Protection and Affordable Care Act in 2010

A new Patient's Bill of Rights was established to give new patient protections in dealing with insurance companies. These protections, which phased in between 2010 and 2014, included the elimination of annual and lifetime coverage limits, provided for choice of physician from a plan's network, allowed children to get health insurance in spite of existing medical conditions, allowed children to stay on a parent's policy until age 26 years if they met other requirements, and restricted health insurance companies from being able to rescind (take back) health coverage because of honest mistakes on insurance applications.

Ways a nurse can be an advocate:

A post-operative client states he is unable to void in the urinal in bed. The client believes if he stands, he will be able to void. The nurse assists the client to a standing position. This is the nurse advocating for the right of their patient to make their own decision concerning his health/treatment as long as it did not pose a significant safety risk to the patient.

Controlling patient choices vs assisting patient choices

It is important for the patient advocate to be able to differentiate between controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom).

Roach Constructs of caring

Ontological, Anthropological, Ontical, Epistemological, Pedegogical

Advocating for social justice

Patients with special advocacy needs include those who are uninformed about their rights and opportunities, those with sensory impairment, those who do not speak English well or at all, the very young and the older adult, those who are seriously ill, those who are mentally or emotionally impaired, those with physical disabilities, and those who lack adequate financial or human resources.

Preventing Burnout

Personal goal setting - Long and shory term goals Problem indentification - What is causing the stress? Problem-solving strategies - Table 2-3 Time management skills - Proper delegation

Comportment

Professional presentation of nurses. •the professional presentation of us as nurses to others in behaviour, attitude, appearance, dress and language that communicate a caring presence. It includes the need for self-awareness, awareness of impact of self on others, and accepting responsibility for our actions. This extends to responsibility for the healthcare environment and the behavior of others who contribute to it.

Empowerment

The ability to effectively motivate and mobilize self and others to accomplish positive outcomes in nursing practice and work environment.

Altruism

The belief in or practice of disinterested and selfless concern for the well-being of others. Also, the helping behavior that is done without direct benefit for the person helping.

Integrity

The dictionary defines integrity as the quality of being honest and having strong moral principles, moral uprightness. At the core of the concept, integrity means that you are truthful and honest in your intent with or without others around.

Subordinate and workplace advocacy

•According to Standard 7 of the ANA Nursing Administration: Scope and Standards of Practice suggests that nurse administrators should advocate for other health-care providers (including subordinates) as well as patients, especially when this is related to health and safety. •Workplace advocacy is a critical role that managers assume to promote subordinate advocacy The manager assures the work environment is both safe and conducive to professional and personal growth for subordinates. •Managers must recognize what subordinates are striving for and the goals and values that subordinates consider appropriate. The leader-manager should be able to guide subordinates toward actualization while defending their right to autonomy. To help nurses deal with ethical dilemmas in their practice, nurse-managers should establish and utilize appropriate support groups, ethics committees, and channels for dealing with ethical problems.

Theories of caring - core value encompassing

•Altruism •Autonomy •Human dignity •Integrity •Social justice

Human dignity

•An individual's sense of self-worth and self-respect. In a healthcare environment, human dignity is more focused on aspects of privacy, respect, and autonomy. Part of a nurse's advocacy role is preserving human dignity throughout the continuum of care. Being sensitive to the patient's demographic and special circumstances is critical to preserve that human dignity. Ask: How can we do that? Answer: maintaining modesty when possible, lowering your voice when asking personal questions, getting down to their "level" to present "talking down to them", if a caretaker is present, not ignoring the patient and talking exclusively to the caregiver, include the patient, etc. With older patients, the path to preserving human dignity involves respectful communication, even when it takes more time. What are some big barriers to preserving human dignity? Time and adequate staffing are probably the biggest barriers nurses face when it comes to preserving patient dignity. When you're rushed, you may not take enough time to address each patient as an individual. Burnout may also hamper your efforts to be an effective patient advocate.

Application and significance of caring in nursing

•Caring is the core and basic foundation for nursing practice. (skills, techniques, specialized language are the "trim"). •Caring is the vehicle through which nurses interact with patients and assist them to cope with suffering, to find meaning in their experiences, to promote health and wellness and to die with dignity. •Caring is an action that nurtures; action that fosters growth, recovery, health and protection of those who are vulnerable. Caring is the empowering of those for whom care is given (Roach, 1997). •Caring is the framework through which we as nurses implement the art and science of professional practice.

The International Association of Human Caring (IAHC) members believe that:

•Caring is the human mode of being. •Caring is the essence of nursing and the moral imperative that guides nursing praxis (education, practice, and research). •Caring is both spiritual and human consciousness that connects and transforms everything in the universe. •Caring in nursing is action and competencies that aim toward the good and welfare of others. •Caring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity. •Care is culturally diverse and universal, and provides the broadest and most important means to study and explain nursing knowledge and nursing care practices.

Jean Watson

•Defines caring as a science and her operational definition of caring science as an evolving philosophical ethical-epistemic field of study that is grounded in the discipline of nursing and informed by related fields. Caring is also the moral ideal of nursing whereby the end is protection, enhancement, and preservation of human dignity

Common areas requiring nurse-patient advocacy

•End of life decisions •Technological advances •Health-care reimbursement •Access to health care •Provider-patient conflicts regarding expectations and desired outcomes •Withholding of information or blatant lying to patients •Insurance authorizations, denials, and delays in coverage •Medical errors •Patient information disclosure (privacy and confidentiality) •Patient grievance and appeals process •Culture and ethnic diversity and sensitivity •Respect for patient dignity •Inadequate consents •Incompetent health-care providers •Complex social problems including AIDS, teenage pregnancy, violence and poverty

How nurses can act as advocates

•Helping others make informed decisions. •Acting as intermediaries in the environment. •Directly intervening on behalf of others. •Advocating for social justice.

Caring theories

•Jean Watson: Theory of Human Care •Sister Simone Roach: Caring - the Human Mode of Being •Marilyn Ray: Theory of Bureaucratic Caring

Caring encounters are demonstrated by:

•Knowing the patient •Nursing presence •Empowering the client •Compassion •Competence

Autonomy

•Patients are able to make independent decisions. Nurses can not, and should not, influence the patient's choice. Examples of nurses demonstrating this include obtaining informed consent from the patient for treatment, accepting the situation when a patient refuses a medication, and maintaining confidentiality.

Self care for the professional nurse

•Self care builds self-esteem and helps oneself grow and actualize. •Healthy self-care practices include: •Stress reduction training •Use of relaxation techniques (such as: guided imagery, meditation, storytelling, music therapy, yoga) •Time management •Assertiveness training •Work-life balance measures •Meditation or mindfulness-based practices.

Patient's Bill of Rights in 1998

•This document had three key goals: (a) to help patients feel more confident in the US health-care system, (b) to stress the importance of a strong relationship between patients and their health-care providers, and (c) to stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and health-care providers (American Cancer Society, 2019).

Social justice

•best represented as the guide in the nursing practice. It is expressed in the professional nursing codes (ANA). The Code is a social contract, built on the core promise of nursing: to provide and advocate for self, quality care for all patients and communities. In the discipline of population health in particular, ensuring social justice can be one of the most challenging facets of establishing care. Providing sound care to all patients regardless of their finances, insurance coverage or social status.