What Is Advocacy? Concept, Evolution And Barriers Of Advocacy

Advocacy has been defined as the process of helping the cause of, speaking, or writing in favour of a person or group as well as interceding on behalf of the person. (Segens Medical Dictionary 2012). According to Segens Medical Dictionary 2012, advocacy provides information and acts as a tool to provide self-empowerment for patient’s health and social care as well as helping patients obtain needed services.

Evolution of advocacy

The active support of a cause is advocacy and therefore advocacy can be understood as standing up as well as speaking out for a moral good, voicing out your concerns in relation to disadvantaged or vulnerable people and collaborating individuals or groups who need support utilizing their preferences and rights (Influence through advocacy: Raising awareness, advancing change, 2020).

There has been lack of certainty and also debate about what is the clear meaning of advocacy, which is as a result of lack of universal agreement which evolves from recent and debatable history of advocacy in the social health care sector and the role of people who works in the fields as an advocate (Advocacy Skills for Health and Social Care Professionals, 2020 Neil Bateman).

Negarandeh et al., 2020 also stated that advocacy over the recent two decades has been a topic of much debate in the nursing profession, and this crucial role has been embraced by nurses even though it is often limited in practice. Patient or nursing advocacy is one of the enhanced procedures that has been highlighted by nursing organizations around the world. This procedure is a relatively new idea, but its first movement began in the Florence Nightingale’s era (Shirmohammad Davoodvand, 2020).

Florence Nightingale advocated for patients in the Crimean war to have better hospital condition and for the nurses to also have better education. She advocated for improvement in health conditions and better care for the sick and vulnerable by influencing government, policymakers, physicians, and philanthropists (influence through advocacy: Raising awareness, advancing change, 2020). Nurses are the leading advocates for patients and therefore act as a link between the patient and the health care system and therefore patient advocacy is seen as an exceptionally important roles of nurses (Shirmohammad Davoodvand, 2020).

The skill needed in nursing to be a successful advocate who supports a cause or interest on one’s own behalf or that of another, requires skills such as problem solving, communication, influence and collaboration (Advocating for Nurses and Nursing, 2020).

Advocacy is important in safeguarding individuals who are vulnerable and has been discriminated against , speaking up for individuals who are unable to speak for themselves, empowering individuals by helping them express their own needs and make informed decisions, enable individuals to also access information, understand their option and also to express their views, wishes and feelings , and lastly actively help supports individuals to make informed choices.(2020)

Shirmohammad Davoodvand, 2020) indicated that there are patient or clients who are vulnerable and have faced various degrees of damage and therefore there are various opportunities for nursing in enforcing patient advocacy and this turns the nursing profession into the most reliable profession regarding patient advocacy.

According to Voiceability, advocacy plays an important part in preventing abuse by helping people to know about their rights and be confident in promoting them. Advocacy is therefore key in detecting and reporting abuse and those who advocate for people provides a trusted point of contact to divulge allegation of abuse and therefore their presence in hospitals and care homes , as well as their understanding of norms and training helps to deal with allegations or observations of abuse.

Communication in advocacy

Nurses advocates for the community and they are also communicators and coordinators within team and therefore communications skills for nurses are important. (Sibiya 2018)

Communication has been defined by Sibiya 2018 as exchanging information between people through sending and receiving which can be achieved through speaking, writing, or using any other medium. Sibiya 2018 state that clear communication enables information to be transmitted effectively between people and for nurses to be successful communication skills are important. Also, nurses interact with people of various educational, cultural, and social background and therefore interaction must be done in an effective, caring, and professional manner, particularly when interaction with patients and their families.

According to kourkouta and Papathanasiou 2020, there are three foundational skills that are needed in communication and these are; Communication without words or non-verbal communication , which is an ongoing process which is embodied by facial expressions, gestures , postures and physical barriers which includes distance from the speaker. Also listening is also a skill needed in communication which involves concentration of attention and utilizing all the senses for perception of verbal and non-verbal messages which is produced by the patient and the lastly personal relations is another foundational skill in communication which is obvious by kindness, compassion and care ,nurses therefore can develop good personal relations which gives nurses the ability to ask questions with kindness and provide information that does not scare and that also shows interest and create a feeling of acceptance trust and pleasant-sounding relationship, particularly in a modern multicultural society.

The process of communication has several barriers such as language, psychological, emotional, physical, and cultural and so on, and this can lead to misunderstanding and failure of communication (Barriers of Communication: Types of Barriers to Effective Communication 2020).

Nurses and nursing staff are the fore front of communication and therefore assess, record and report on treatment and care, they handle information sensitively and confidentially, deal with complaints effectively and are duty bound to report things that they are concerned about (Principles of nursing practice Royal College of Nursing, 2020)

According to the Nursing and Midwifery Council (NMC 2018), nurses should be able to recognise when a person is at risk or need extra support and protection and take reasonable steps to safeguard them from abuse. Also, the need to use different range of communications skills and methods which include verbal , non- verbal and written to acquire and interpret and record their knowledge and understanding of peoples need, and also use technologies to support person-focussed care and enhance quality and safety.

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The nursing and midwifery council(2018) states that nurses must take into account different ways people communicate and the ability to recognise and respond effectively when a person find it hard to communicate and when language interpretation or other forms of communication support is needed and how to obtain the support.

Identification

Practitioners such as Nurses can identify and interrupt domestic abuse and this can be done by recognising the indicators of abuse and finding ways of supporting and referral for protection as needed. (Responding to Domestic Abuse: A Resource for Health Professionals, 2017

In the scenario in video 2 they Nurse was able to recognise some indications of signs of abuse such as marks on the arms of the patient, how nervous , afraid and hesitant she was and also the partner not allowing the patient to speak for herself, which is an indication of abuse.

According to the Department on health on Responding to Domestic Abuse: A Resource for Health Professionals, 2017 There are indicators to guide health professionals that a patient may be facing domestic abuse. Some of them are understated and therefore professionals must remain alert to these signs and respond appropriately. Some victims may drop hints in their interactions with health staff and their behaviours may also be telling. There is therefore the need for the health professional to listen, persist and enquire about the signs and cues.

Barrier for advocacy

The Video Scenario 2 – A close observation of the scene in scenario two highlights some of the key issues and challenges nurses are confronted with in their line of duty. The nurse was faced with 2 barriers of advocacy which was language and the presence of a spouse acting as a communication barrier for effective advocacy being utilized by the nurse to safeguard the patient who may be abused by her partner.

In my opinion the nurse could have ask the spouse to wait outside to enable her to examine the lady further with regards the bruises on her arm and potentially on other parts of her body. Also, that would have given her the chance to alert another member of staff to investigate the matter and get an interpreter to enable effective and clear communication between the patient and the nurse.

Beynon et al, 2012 did a study on barriers that healthcare professionals such as nurses faces in relation to asking about intimate partner violence and some barriers predominately described by nurses were language barriers and in the second scenario the nurse was not able to communicate with the lady because she did not speak English and the partner was speaking on behalf of the lady, also partner presence was also seen as a barrier because abusive partners tendency to stay by the woman side and nurses in the study also wrote that the partner presence made it challenging to interview the woman alone as depicted in the second scenario

Partner or spouse always attends appointments unnecessarily • the patient is submissive or afraid to speak in front of the partner or spouse. The partner or spouse is aggressive, dominant or over attentive, talking for the patient or refusing to leave the room (, Responding to Domestic Abuse: A Resource for Health Professionals, 2017)

People who insist on escorting their partners to appointment or speaking for their partner may seem to be caring and protective and this may be plausible , however, controlling their partners access to the nurse is part of the abuse as depicted in the second scenario and this support the need for advocacy. . Responding to Domestic Abuse: A Resource for Health Professionals, 2017

Intimate partner abuse is widespread and therefore victims often cannot or do not advocate for themselves and therefore the onus falls on nurses to be aware of these problems, be familiar with any risk factors, patterns of injury associated with intimate partner violence and understand how and to whom intimate partner violence should be reported.(2020)

Solution

Healthcare providers such as nurses can help by screening for domestic violence through documenting abuse in the patient medical record, through safeguarding evidence, providing medical advice, referrals and safety planning , showing sympathy and also compassion(Domestic Violence , Sexual violence , intimate partner Violence 20)

Only ever raise the issue of domestic abuse with a patient when you are alone with them in private and, if not, ask the escort to wait elsewhere

Privacy- Only ever raise the issue of domestic abuse with a patient when you are alone with them in private and, if not, ask the escort to wait elsewhere.

Using an interpreter Never use a relative or friend of the victim as an interpreter. Always use a professional interpreter, who has had domestic abuse training or an advocate from the local specialist domestic abuse agency. The interpreter needs to be the same gender as the victim and should sign a confidentiality agreement. Look at your patient and speak directly to them – not to the interpreter.

They need staff to follow up conversations in private, record details of behaviours, feelings and injuries seen and reported, and support them to act suitable for their organisation’s systems and local pathways(, Responding to Domestic Abuse: A Resource for Health Professionals, 2017)