Nursing World Conferences 2019

Leadership Message

Patient advocacy in nursing

With the ever changing, uncertain healthcare system, nurses must remain diligent as advocates for patients and families. Advocacy is not a new role in nursing. Since the early development of the nursing profession, Florence Nightingale incorporated the role of advocating for both patients and nurses. Throughout her career she advocated for optimal care and a safe work environment while confronted by multiple obstacles. Understanding what advocacy is, the role in nursing and key strategies are critical to ensuring optimal patient outcomes.

What is advocacy?

An “Advocate” is defined as one that pleads the cause of another or one that supports or promotes the interest of another. The Code of Ethics set forth by the American Nurses Association (ANA) outlines the ethical obligations of all registered nurses regarding patient advocacy. The Code of Ethics states, the nurse promotes, advocates for and protects the rights, health, and safety of the patient.

Role in nursing

Patient advocacy is a key role within nursing and is an ethical obligation, which goes beyond the basic definition of advocate. Nurses are frequently in the forefront in matters of patient advocacy. There are several issues the nurse must advocate for which include, promoting access to quality evidence-based care for all patients, regardless of age, ethnicity, socioeconomic class or personal attributes. In addition, advocating for patient safety across the continuum is critical in the current fragmented healthcare system. Patients are often seen by multiple healthcare providers and through communication and coordination of care, nurses can facilitate patient safety. Nurses must also inform and educate patients and families regarding their diagnosis, care and treatment in a manner that is meaningful. Sharing of information allows the patient to make informed decisions regarding their care. Finally, advocacy is supporting patients and families in their care decisions. Patients maintain the right of self-determination and only they can say what is best for them. This requires the nurse to support patients in an objective manner. Support may be in the form of speaking on behalf of the patient and/or facilitating communication with other professions and the healthcare system.

Barriers to patient advocacy may exist and can vary from individual to organizational, and beyond. There is no single solution to address patient barriers. However, nurses must seek to resolve the barriers when possible to promote optimal outcomes.

Advocacy strategies

Several strategies may be incorporated to facilitate patient advocacy as follows:

• 1.Maintain a patient-centered focus
• 2.Establish a therapeutic relationship with the patient and/or family
• 3.Clearly identify and understand the issue
• 4.Encourage patient self advocacy
• 5.Foster interaction and collaboration with the patient, family and other team members
• 6.Maintain effective communication
• 7.Identify organizational leaders who can facilitate resolution
• 8.Be familiar with the bureaucracy of the organization and/or healthcare system, and question ineffective policies
• 9.Pursue professional development on patient advocacy
• 10.Become actively involved in professional nursing organizations to advocate for patient care issues

Summary

Nurses are in a key position to observe both the positives and negatives of the current healthcare system and recognize the shortcomings. As a patient advocate, nurses have the opportunity to make a significant difference in the lives of patients and their families every day. Similar to Nightingale, all nurses must uphold the idea that safe, quality, evidence-based patient care is a basic human right that all patients should receive.

Nursing World Conferences 2019
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World Nursing Congress 2019 | 53rd World Congress on Nursing and Healthcare

Avoid untruths in your nursing documentation

A reader submitted a question about nurse managers in a home health agency documenting the start and stop times for IV infusions. The nurse managers did not administer the IVs. The reason this practice occurred was so the nurse managers could be paid for the infusions.

A long-standing, essential principle of nursing documentation is that it be truthful and accurate. Moreover, you as a nurse are responsible for your own documentation. If you document for another, you must alert the reader of that fact by indicating you are doing so for the identified nurse (by name) and then signing your name after the notation.

If these legal and ethical standards are not met, the documentation that takes place is considered false, untrue, misleading and deceitful.

Backdated documentation is cause for concern

How much of a delay occurs due to this practice is one concern. The other is how the nurse manager is indicating the start and stop dates in the record.

Are the entries backdated? In other words, if an IV was stopped on Wednesday, Jan. 12, is the entry dated as such even though the documentation took place on Jan. 16, or is it entered on the day the nurse manager actually documents the stop date, indicating it as a “late entry” or as an “addition to the notation” pursuant to the agency’s documentation policies?

Another instance of legal inaccuracy is if the nurse manager backdates the notation. If, on the other hand, the nurse manager dates the start and stop dates truthfully but indicates the actual date of the entry as well, that is legally acceptable.

It may not be acceptable, however, for the insurance company who is paying for those IVs, whether its Medicare, Medicaid or a private insurance company.

As a result, not only is the nurse manager falsifying the record, the practice may result in a non-payment by the insurance company for the IV because it was not documented timely.

Payments also can be problematic

One last legal problem raised by the reader’s question is that the nurse managers were falsely documenting so they could be paid for the infusion.

Does this statement mean the nurse managers personally were being paid as a result of their visit and documentation? Or does it mean the agency was being paid for the visit? Unclear, to be sure, but still troubling.

It is important that as a nurse license you never falsify nursing documentation or any document in relation to your nursing practice.

Your inability to practice nursing with an unencumbered license is but one ramification if you do so. Another consequence is that your veracity will be severely compromised, a result that will follow you for the rest of your professional life.

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Contact us at worldnursing@conferenceint.com

53rd World Congress on Nursing & Health Care

Nursing Conferences Australia

The Opioid Crisis and the Role of the Nurse

In the United States, it is now unavoidable to see or hear news about the #opioid crisis. Pain is a common occurrence with patients, whether it is acute or chronic. It is estimated that approximately 25 million adults in the United State suffer from chronic pain on a daily basis, and about 126 million adults experience recurrence of pain. Today there are an estimated two million adults who have an #opioid use or misuse disorder, which may or may not be a result of prescriptions for pain management (St. Marie, Arnstein, & Zimmer, 2018). Illicit use of opioids is also a factor with opioid abuse, including non medical use and diversion. Statistics of dependence and drug overdose deaths have been on an upward trend, and it is truly alarming (American Nurses Association [ANA], 2018).

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#Nurses are at the forefront of patient care, and have the unique ability to assist during this time of national urgency. Nursing practice, including advanced practice, can contribute to improving patient outcomes. Pain management is essential, and nurses should be educated on all aspects of this important issue.

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Pain assessment includes much more than just asking about a number; it should include history, physical, and biopsychosocial assessment strategies. Interventions for #pain_management should include multiple modalities, such as pharmacological and non-pharmacological strategies. Multidisciplinary teams must be involved in #pain_management, with inclusion of the patient and family as part of the team. Patient and family education includes information about setting appropriate goals for #pain_management, available treatments and resources, and risks of opioid use.

Prescription monitoring is important for identifying opioid misuse. #Nurses and advanced nurses can assist in prevention and early recognition of opioid abuse. Appropriate interventions can assist with recovery for individuals suffering from this issue. #Nurses must also be aware that there is a risk of undertreating pain, and must advocate for appropriate management strategies (ANA, 2018; St. Marie, Arnstein, & Zimmer, 2018). For more information on #pain_management, refer to courses available through RN.com.

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NMC considers compulsory preceptorship and longer courses for midwives

The Nursing and Midwifery Council is also exploring the idea of increasing the length of the midwifery degree, which is currently three years.

The changes are being considered as part of the NMC’s latest overhaul of its standards of proficiency for #midwives and for pre-registration #midwifery education courses.

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A “recurring theme” that occurred during the wide-ranging engagement on the proposals was whether the current length of the #midwifery course and the approach to preceptorship were sufficient to properly prepare students for the modern challenges of the job.

Dr Geraldine Walters, director of education standards at the NMC, told #Nursing Times that some people believed newly qualified #midwives were entering the world of work with “competence but not confidence” and they needed extra support.

The regulator has now commissioned audit firm KPMG to gather evidence to help inform its decision.

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Members of the public will also be asked for their views as part of the upcoming consultation of the new “future midwife” education and proficiency standards.

The NMC made clear that it may not make any changes to the length of the course or preceptorship if the evidence did not support it.

Dr Walters said: “There’s a question here that we are bound to look into, but we don’t know what the answer is. So we have to try and get a consensus through consultation and we want to do some work to try and inform that better first.”

Mandating preceptorship would require new legislation, Dr Walters said.

She added that some may believe this option to be too “bureaucratic” and employers could implement good preceptorship programmes without being forced to by law.

Currently, organisations are advised to offer newly qualified #practitioners a period of extra support to help them make the transition from student to professional and embed their practical skills.

NHS Employers claims preceptorship can help enhance patient care and experience, improve recruitment and retention, reduce sickness absence and boost confidence and morale among staff.

However, the quality of programmes varies across the country and some organisations will not offer any preceptorship at all.

Dr Walters said: “Most organisations… say there should be a period of preceptorship, but some organisations will do it much better than others, some organisations won’t do it at all.

“There’s lots of evidence that says if you do do it, you will have less turnover,” she said. “So, what some people think is that we need to put it in our legislation to make sure it happens, where others are saying no.”

She added: “It’s really about is this our role or not, and we are hoping that the exploratory work and the consultation will throw a bit of light on that.”

If it is decided that preceptorship should be mandated for midwives, the NMC would also have to consider making it compulsory for #nurses.

Dr Walters told Nursing Times: “I think if it came to light that it was thought to be necessary for midwives then we would have to open the box and say do you think it’s necessary for #nurses as well.”

Carmel Lloyd, head of education and learning at the Royal College of Midwives, said the preferred option for the RCM would be for the course to be extended, but for the fourth year to be used for “clinical training”.

Ms Lloyd said more information was needed on how compulsory preceptorship would be enforced.

She added: “A period of preceptorship is currently recommended by the DH, NMC, NHS Employers, professional bodies/trade unions etc – all have statements/guidelines in relation to preceptorship, yet it doesn’t happen in practice and there is considerable variability in terms of what this looks like (length and content) as well as quality.

“We need greater clarity than we have the moment with regard to what this option might look like in reality and in particular whose responsibility it would be to ensure it is mandatory,” Ms Lloyd said.

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