Health Care
Discuss what is meant by advocacy and how the communication strategies used in your chosen scenario either support or present a barrier to the concept of advocacy being utilized. ‘Critically review a range of communication strategies that can enable the development of therapeutic relationships
This assignment will discuss the concept of advocacy and its importance and relevance to developing therapeutic relationships in health care. It will discuss barriers to effective communication and how these can be an obstacle to delivering person-centred care and consequently impacting negatively on the individuals being cared for.
Person-centered care is care that is ‘personalised, coordinated, and enabling’ (The Health Foundation, 2020). It is care that treats people with ‘dignity, compassion and respect’ (The Health Foundation, 2020). One way to enable this is through empowering a person so that they have a voice and control over their care. Empowerment can begin with advocacy. Advocacy requires excellent communication skills, both spoken and unspoken as it will be impossible to advocate on behalf of an individual if their needs are not truly understood. When communication skills are used effectively, they can nurture trusting relationships in which individuals feel safe, cared for and respected. Once trust is established health care workers can begin to safeguard and promote the rights of vulnerable patients and ensure that all work towards delivering person-centered care and an increased quality of life.
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Nurses are viewed as ideal patient advocates due to their close proximity to patients and their skills, knowledge and expertise means that they are potentially in the best position to care, treat and advocate. The nursing and Midwifery code also states that nurses should ‘act as an advocate for the vulnerable’ . Graham (2012) notes that, nurses naturally care for their patient’s health and mental well being and so advocating is something that is inherent to nurses.
However, despite professional qualifications and experience, effective communication strategies are not always utilised resulting in neglect and negative health outcomes as were viewed in the short scenario.
John is a frail, elderly man who has been living in a residential care home since the death of his wife. He is awoken abruptly by a nurse who enters his room and draws the curtains harshly. There is no friendly acknowledgment and John who is clearly unwell and in some discomfort coughs. Another nurse enters the room and together they dress him and wheel him down to the dining room for breakfast with a urinary drainage bag in his lap. Both nurses showed a complete lack of sensitivity and empathy towards John and do nothing to conceal the bag and preserve his dignity. According to (Kim et al, 2004) the “empathetic communication skills of medical practitioners significantly and substantially influenced patient satisfaction and patient compliance”. Person centrered care should be empowering and driven by the person, however this was a dehumanizing experience that caused embarrassment and feelings of hopelessness.
In the clip the nurses are clearly on a busy schedule and facing conflicting demands on their time, which can lead to stress, poor communication with patients and an increased likelihood of work errors. Time constraints can have severe consequences for vulnerable groups such as the elderly who may already feel like a burden. John is instinctively aware of the demands when they receive a meeting reminder from a charge nurse. Demands on time will always exist but it is vital that care workers communicate clearly and sensitively so that vulnerable individuals do not feel neglected. John was not the focus of care provided which was clearly perfunctory.
Physical barriers such as noise, proximity to aids and body language can impact negatively on communication strategies. During the short time that the nurses were dressing John, they did not attempt any meaningful communication with him. They spoke animatedly with each other ignoring his multiple requests for his glasses. Their conversation drowned out his requests and it seemed like he was ‘getting in the way’ of their jobs. Had the nurses listened actively and responded appropriately, it would have helped to restore as sense of independence and self worth. Disempowering John by neglecting his pleas for his glasses, showed a complete disregard for his physical, social and emotional health. It resulted in him being unable to eat breakfast and as he was already unwell this could have serious implications on his health and well being. A worker in the dining area greeted him cheerfully, but then did not actively listen to what John had to say neglecting him and showing disregard to safeguarding. Had she sought clarification by pausing and listening to John she would have been able to empower him and enable his voice to be heard instead she made him feel silly and powerless.
Patients look for non verbal cues as a sign that they are being listened to; eye contact, a nod, a smile. In John’s case there were not any, as his care workers did not make eye contact and positioned themselves behind or besides him at all times. As John did not appear to have any connection with his care workers, it presents the serious issue of whether he would share any serious medical concerns with them. Research by (Montague et al 2018) revealed that ‘connectedness increased with social touch and eye contact’ This simple act of interpersonal communication can validate a person and provide a sense of worth when so often they feel as if the ‘are in the way’.
Observational skills are extremely important when working to develop therapeutic relationships particularly in settings such as care homes where patients may not be forthcoming with difficulties due to health, confidence or embarrassment. It provides health care workers an opportunity to gather useful information about patients, identify norms and routines so if something appeared out of the ordinary it could be investigated. Being able to identify these needs supports the facilitation of patient advocacy.
Discuss the importance of being aware of the potential need for advocacy within relationships in health care. Use relevant literature to comment on how and when advocacy can contribute to relationships in health care and the communication skills required to facilitate this.
Although the term advocacy appears to be a relatively new concept (40 years old), it is something that has always existed. Nurses such as Florence Nightingale were advocates who worked tirelessly to ensure that they acted in the best interests of their patients.
There is an abundance of research that shows the positives or the need for advocacy in health care such as (Black,2011) ‘who discovered hospital acquired infections increased due to nurses inability to advocate’ or (Kalaitzidis & Jewell, 2015) who stated that ‘safeguarding patients autonomy, acting on patients behalf and championing social justice in the provision of health care’ improved the safety and health outcomes of patients.
Illness can render the healthiest and most knowledgeable individuals vulnerable due to a lack of understanding, seriousness of illness and support. Therefore it should not be presumed that certain individuals will not benefit and advocacy should be a right for all. However, it is also accepted that the vulnerability experienced during illness is stronger for certain groups such as the elderly, individuals with disabilities and Special Educational Needs, individuals in care, those with mental health issues, serious illnesses and disease, and ethnic minorities to name a few. Reasons for vulnerability could include complex needs which require a multidisciplinary team to care for. An inability to look after ones interests, be unaware of the rights due to age or mental capacity. A lack of confidence due to barriers such as age, language and discrimination or to raise awareness about the needs, circumstances and opinions of the vulnerable. Many of these groups already face prejudices and stereotypes which are not always challenged by society.
Healthcare workers have made a commitment to be advocates for the vulnerable who will need the their right safeguarded...Despite this healthcare workers sometimes face conflicting priorities at work which mean that advocacy can sometimes be tricky to achieve. For example a lack of knowledge or training will significantly impact on the level of care that can be provided;
- Who is the best person to advocate- complex needs- consider needs- patient groups- support there. Signpost- communication..............all unwell are vulnerable- all have right to advocacy.-
- ‘ PHYSICIANS LEADING the system’ – obstacle to advocacy- do not question as unsure what will happen to them- sometimes done in concealed manner..resource allocation, equality of patient care (conflicts relating to policies and practises)- limit adcocacy
- Limited communication- time constraints
- Job security, management conflicts.......advocates strength comes from co workers peers (sellin, 1995)
- Limited by real or perceived constraits, societal norms, organisation culture...quote rRUSHTON
·Today it is important to be aware of the strengths and limitations of advocacy with in healthcare settings.
Conclusion
It is widely accepted that advocacy in healthcare settings has the ability to empower all patients at their most vulnerable and this paves the path for patient-centered care where a patient is given autonomy, respect and . Healthcare professionals such as nurses advocate for the vulnerable as it is interwoven with their job but also a key requirement. It is also inevitable that as advocacy needs become more complex for some and more demands are made of nurses time that it will be beneficial to signpost individuals to organisations who are more qualified in trems of resources, skills and knowledge to support patients.
- http://lightshopfilms.co.uk/port/if-you-dont-do-something-who-will/
- https://uwaterloo.ca/centre-for-teaching-excellence/teaching-resources/teaching-tips/communicating-students/telling/effective-communication-barriers-and-strategies
- https://participatorymedicine.org/journal/evidence/research/2013/08/14/nonverbal-interpersonal-interactions-in-clinical-encounters-and-patient-perceptions-of-empathy/
- Montague, E., Chen, P., Xu, J., Chewning, B. and Barrett, B., 2018. Nonverbal Interpersonal Interactions In Clinical Encounters And Patient Perceptions Of Empathy. [online] Journal of Participatory Medicine. Available at: [Accessed 30 March 2020].
- Sellin SC out on a limb: a qualitative study of patient advocacy in institutional nursing. Nursing Ethics 1995
- The Health Foundation, 2016. Person-Centered Care Made Simple- What Everyone Should Know About Person-Centered Care. [online] The Health Foundation, p.5. Available at: [Accessed 2 April 2020].
- Kim, S., Kaplowitz, S. and Johnston, M., 2004. The Effects of Physician Empathy on Patient Satisfaction and Compliance. Evaluation & the Health Professions, 27(3), pp.237-251. (Kim, Kaplowitz and Johnston, 2004)
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