Advocacy in nursing and midwifery PDF

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Exam number: 72026

Question: Discuss your professional responsibility and strategies you can use to advocate for persons in your care. Your answer should make reference to challenges that may be encountered in practice.

Advocacy is defined as any action that speaks in favour of, argues for a case, defends or pleads on behalf of others. There are different types of advocacy: selfadvocacy, individual advocacy and systems advocacy. In nursing and midwifery, the most relevant type would be individual advocacy, focused on the role of a person in advocating for someone individually. In midwifery practice for example, the role of the midwife is focused on both promoting and protecting the interests of women. Advocacy was first introduced to professional codes of conduct in the 1970s and nursing and midwifery literature over the past thirty years has identified a number of advocacy models, primarily based on showing sensitivity towards other beings, supporting their right to self-determination, respecting their autonomy, fighting for social justice and protecting patients against unethical procedures, amongst many others. Research has been carried out to look at midwives and nurses’ perceptions of their role as advocates as well as ways in which advocacy can be promoted through education and training so it can be increasingly incorporated to the care provided in hospitals and community settings. This essay will be focusing on the strategies that can be used to achieve this and all the limitations and challenges nurses and midwives are faced with in practice, that often prevent them from fulfilling their roles as advocates. A study carried out by Davoodvand et al (2016) consisted of a series of interviews that sought to look at the nature of the relationships between nurses and their patients and what the nurses felt was their responsibility towards them. The participants argued that through understanding the expectations and feelings of their patients they had the ability to improve their relationships with them. Compassion is an essential quality that a nurse or midwife should possess in order to be able to provide effective care. Nurses who are compassionate tend to develop a feeling of closeness towards their patients, leading them to defend them like they would themselves or a loved one. Therefore, it is considered an important factor involved in advocacy. The nurses’ responsibility towards protecting the patient is mainly focused on preventing them from being harmed. For this reason, the nurses’

obligation towards the patient also involves safeguarding from inadequate healthcare provided by other healthcare team members. This was explored in a concept analysis of patient advocacy by Abbasinia et al (2019). They looked at how hospitalised patients are exposed to medical errors or misconducts and how in fact, in the past, patient advocacy was mostly defined by tracking medical records and providing information. It wasn’t until 2001 that other elements such as maintaining patient privacy, confronting inappropriate rules or policies and identifying and correcting inequalities in the delivery of health services were added to the concept definition. Patients are not only vulnerable to potential errors in the health system, but some of them might have lost their independence and are unable to make their own decisions due to illiteracy, lack of knowledge in health issues or their current physical or psychological condition. These patients are a clear example of the need for advocacy in the system, as they will need someone to speak for them, defend them and protect them from harm since they are unable to do it for themselves. Abbasinia et al (2019) also looked at how patient advocacy has effects on both nurses and patients. For patients, it supposes an improvement in safety and quality of care, an increase in collaboration among their families and the healthcare team, and as a result, an improvement in public health. For nurses, there are positive and negative consequences. Nurses experience a sense of being worthwhile, increased job motivation and satisfaction. However, it can also have negative effects as it can create conflicts with other members of the healthcare team since when playing the role of advocates, they may be placed against their colleagues and even their superiors. This can be considered one of the main challenges patient advocacy is faced with. Other important limitations would include time shortages, limited communication, physician dominance and lack of institutional support. These concepts are very relevant in midwifery practice, and this is explored in a study carried out by Hadjigeorgiou et al (2014) on midwives’ perceptions of their role as advocates for normal childbirth. Advocacy in midwifery is a fundamental aspect as it mainly revolves around the promotion of physiological childbirth, which is at the core of the midwifery philosophy. This study looked at the barriers midwives encounter when trying to advocate for women. Midwives struggle to advocate for women due to the power of obstetricians, accepted practices of routine intervention and lack of support for normal birthing within the system. The extent to which midwives are able to resist medical intervention depends on the authoritarianism of some doctors in

their interactions with them and the degree to which they have the confidence to resist it. Medicalisation of childbirth is also presented as a huge barrier for advocacy. However, it is also a big issue preventing midwives from carrying out their jobs effectively. A study by Bradfield et al (2019) focused on being ‘with woman’ as the identifying characteristic of midwifery care, which is interlinked with advocacy, since both concepts revolve around providing care that is respectful of the woman’s wishes and needs. Advocating for women also requires midwives to acknowledge all the possible factors that may have an impact on the woman such as hospital policies and other practitioners. This is relevant because midwives themselves are often faced with a dilemma between prioritising the needs of the woman or those of the institution they work for. This again, can be linked to the medicalisation of childbirth, normalisation of intervention and the treatment of childbirth like a condition that needs to be cured. Even when they want to stand up to their colleagues, midwives might feel they are unable to voice such disagreements due to their inferior position within the hospital hierarchy and might end up choosing to benefit the organisation rather than ensuring the woman has the best possible birth experience. A solution to this problem could be moving the care provided in hospitals into the community since if midwives do not work for an organisation, they are only accountable to the women in their care. Several studies have compared the roles of midwives within hospitals or other big organisations to those working in the community, since despite having the same obligations as advocates, they are able to exercise their roles in very different ways. An example for this would be the study carried out by Finlay & Sandal in 2009, in which they conducted interviews with midwives from an NHS hospital and midwives working with a community midwifery service. Those working in the hospital claimed they were often influenced by the tendency of hospitals to ensure that their workers act according to hospital policies and protocols, focusing on efficiency and avoiding emotional engagement. Midwives struggled to maintain their ability to treat each woman individually due to time pressures and staff shortages, hence compromising advocacy. Some midwives even claimed to skip questions or fail to explain some procedures better in order to get through appointments quicker. This proves that even when midwives attempted to provide good maternity care, the structure of the system was restrictive and there was an overall lack of support from the organisation. Lack of continuity of care also made it difficult for the midwives to act as advocates. Participants argued there is no incentive to act as an advocate in

the absence of responsibility, and because of this, women tend to miss out on needed information that could help them make important choices throughout their pregnancy. It is also easier to advocate for someone you have had a chance to establish a relationship with, and standard care midwives claimed that because they never got the chance to get to know each woman individually, they did not feel like they were responsible for them. In contrast, midwives working in the community described their role and experiences very differently. Midwives working in the community are generally more flexible since they are able to manage their own time and because they do not have to respond to an organisation, they tend to prioritise the needs of the women over the needs of the service. In the community, it is easier to promote continuity of care as midwives can focus on a woman throughout the course of her pregnancy and get to establish a trusting relationship which makes them more able to help the women make choices and feel supported. An increased personal obligation makes midwives more likely to advocate for the women in their care and as a result, improve their experience. Similar concepts were explored in a study carried out by Stevens et al in 2011, which compared the roles of midwives and doulas in Australia. Midwives reported the system is medically dominated and because of this, they feel like they are unable provide woman-focused care. Decreased staffing and lack of continuity of care were also mentioned as factors that are making it impossible for them to advocate for women or fulfil their roles. On the other hand, doulas are not bound by the system, are contactable 24 hours a day and are able to give women the power of choice during birth, empowering and encouraging them. Midwives believe doulas are reducing their role to obstetric nurses and are overstepping their boundaries since they can’t be made accountable for birthing outcomes as they are not registered members of the healthcare system. They feel disadvantaged because they don’t get the same opportunities to build a relationship with women. However, a rise in the use of doulas can only be explained through the lack of satisfaction of women with the way in which the maternity care system is currently organised, as increasing numbers of Australian women feel they are given little to no choice in birth. Doulas can be considered better advocates in the current system because of their freedom to provide choices for women without any agendas or responsibilities towards the organisations they work for. A shift in medically dominated to woman-centred care seems to be the only way to improve maternity care provided in hospitals, as well as the overall experience of pregnancy

and birth. Despite all the barriers to patient advocacy related to problems rooted in the way the system works, there are ways in which advocacy can be enhanced in the future and research has proven education to be one of the main solutions. In a study by Thompson et al (2019), student midwives discussed their educational needs as advocates, and all agreed that having opportunities to see how midwives advocate for physiological birth in their interactions with women and other practitioners was essential for them to note which behaviours to incorporate to their practice. They also stated that working in ways that allowed time to be with woman in a patient manner were deemed essential to developing their skills in women-centred care. Knowing this, investing in training and educational programmes focused on advocacy seems to be the perfect strategy to ensure it is at the core of efficient nursing and midwifery practice. The research outlined in this essay has offered evidence for all of the ways in which advocacy is essential to quality care, as well as the issues practitioners encounter in their roles as advocates. Increased medicalisation of the system with the development of new technologies and normalisation of intervention often prevents nurses and midwives from connecting with their patients and establishing a relationship of trust. In midwifery, continuity of care and promotion of the physiology of birth are crucial to ensuring midwives are able to advocate for women. Despite the flaws in the system, educational programmes should invest in training nurses and midwives to advocate for their patients and always put them first rather than prioritising the needs of the organisation they work for. Putting strategies in place so that they feel supported to do so by the healthcare system seems to be the only way to ensure nurses and midwives can provide the individualised care each patient needs so that we can all enjoy the benefits going forward....