Full Answer Section

• 1. Facilitating Communication: The nurse recognizes the communication barrier between the family and the medical team. They proactively initiate a family meeting with the attending physician and other relevant team members (e.g., social worker, palliative care team).
  2. Presenting Observations and Concerns: During the meeting, the nurse articulates their objective observations of the patient’s declining status and suffering, and compassionately but firmly conveys the family’s concerns, questions, and wishes regarding continued aggressive treatment versus a shift towards comfort care.
  3. Ensuring Informed Decision-Making: The nurse ensures that the medical team explains the prognosis and treatment options clearly, in culturally sensitive language, and answers all family questions. They advocate for the family’s right to make informed decisions that align with their values and the patient’s best interest, even if that means a difficult conversation about transitioning to palliative care.
• Outcome: Through the nurse’s advocacy, the family feels empowered, their concerns are heard and addressed, and decisions about the patient’s care are made collaboratively, ultimately aligning with the patient’s comfort and dignity, even in the face of a challenging prognosis.

2. System-Level Advocacy for Policy or Practice Change

Beyond individual patients, nurses often identify recurring systemic issues that negatively impact patient care or the nursing profession and advocate for broader change.

• Example: A nurse working in a busy surgical ward in a hospital consistently observes that patients post-surgery are experiencing preventable complications (e.g., pressure injuries, medication errors due to rushed documentation) because of inadequate nurse-to-patient ratios, especially during night shifts. The nurses are frequently overwhelmed, unable to provide the ideal level of care.
• Discussion: The nurse, recognizing this as a systemic issue, decides to advocate for improved staffing policies.
  1. Data Collection and Documentation: The nurse begins to meticulously document instances where staffing levels directly contributed to negative patient outcomes or near misses. They encourage colleagues to do the same, collecting aggregate data that quantifies the problem (e.g., increased incidence of pressure injuries on understaffed shifts).
  2. Internal Channels: Initially, the nurse raises concerns through internal channels – to their nurse manager, unit council, and possibly the hospital’s quality improvement committee. They present the collected data and propose evidence-based solutions for appropriate staffing levels.
  3. Professional Organization Engagement: If internal efforts are insufficient, the nurse might engage with local or national nursing professional organizations (e.g., the Nurses Council of Kenya, or a regional nursing association). These organizations often lobby for legislation or policies that mandate safe staffing ratios based on patient acuity. The nurse’s data and personal experience can serve as powerful testimonials.
  4. Educating Stakeholders: The nurse might participate in awareness campaigns, educate hospital administrators about the link between staffing and patient outcomes (including financial implications of complications), or even speak to policymakers about the importance of nursing workload management.
• Outcome: Through this multi-pronged advocacy, the nurse contributes to a broader understanding of the issue. Depending on the scale of the advocacy, this could lead to the hospital implementing better staffing policies, or even contribute to a larger movement for legislative changes that establish minimum nurse-to-patient ratios, ultimately improving safety and quality of care for numerous patients across the system.

These examples illustrate that nursing advocacy is not just about speaking up; it’s about being informed, strategic, collaborative, and p