Strategies for Nurse Advocacy

Advocacy on behalf of the elderly is a skilled activity requiring knowledge of physical, psychological, spiritual, and social aspects of aging in addition to ethical knowledge or knowledge of what constitutes a "good" in health care. For the nurse, the "good" concerns promotion of the well-being of elderly persons, recognizing that this well-being may occur in the context of chronic illness. Promoting the "good" in regards to access to care requires recognizing barriers.

Extensive and appropriate data-gathering permits nurses to isolate ethical problems, initiate appropriate action on an elderly patient's behalf, or enable patients to get the health care they need. Individual patients may encounter several obstacles in accessing care. Some are relatively easy to redress, others may require a variety of types of assistance. For these reasons, it has been argued that advocacy actions may be required on different levels (Grace, 2001). There is a professional responsibility to try and meet a patient's needs on an individual level, but there is also a social responsibility to participate in improving systems that have proved inadequate to meet the needs of one's population of concern. This is especially true if the same problems keep recurring because the underlying cause of them remains. Provisions 6 - 9 of the American Nurses Association (ANA) Code of Ethics for Nurses (2001) outline this responsibility.

In part, a nurse's responsibility to address practice problems at a higher level, including social or political activism, stems from the idea that it is nurses (along with physicians and allied health care providers) who are in the best position to recognize obstacles to care experienced by their patients, as well as to propose solutions. It is a societal expectation of the health profession that they publicize system-wide shortcomings and act to try and remedy them (Ballou, 2000; Crandall, 1990; Grace, 2001; Newton, 1988).

The advocacy role of the nurse on behalf of the elderly patient also includes promoting their well-being and assisting them in the exercise of their basic moral and legal rights. Elderly patients may be individuals or groups. The ethical obligation of advocacy represents the profession's commitment to those in need of its services. Because activity may be needed both on an individual level and in addressing underlying societal problems that block nursing's professional purposes, the nurse has broad advocacy responsibilities.