Patient advocacy and advance care planning in the acute hospital setting.
OBJECTIVE
The aim of this study was to explain the role of patient advocacy in the Advance Care Planning (ACP-ing) process. Nurses rate prolonging the dying process with inappropriate measures as their most disturbing ethical issue and protecting patients' rights to be of great concern (Johnston et al 2002). Paradoxically ethical codes assume nurses have the autonomy to uphold patients' health-care choices. Advance Directives (AD) designed to improve end-of-life care are poorly taken up and acute hospitals are generally not geared for the few they receive. The Respecting Patient Choices Program (RPCP) improves AD utilisation through providing a supportive framework for ACP-ing and primarily equipping nurses as RPC consultants. Assisting patients with this process requires attributes consistent with patient advocacy arising out of nursing's most basic tenet, the care of others.


METHODS
Likert Scales survey administered pre and six months post-intervention to pilot and control groups, with coinciding focus groups.


METHODS
Selected wards in an acute care public hospital in South Australia.


METHODS
Nurses on the palliative care, respiratory, renal and colo-rectal pilot wards and the haem-oncology, coronary care, cardiology and neurology/geriatric control wards.


METHODS
The RPCP during the 2004-2005 South Australian pilot of the (RPCP).


RESULTS
The organisational endorsement of ACP-ing gave nurses the autonomy to be patient advocates with respect to end-of-life care, reconciling clinical practice to their code of ethics and easing distress about prolonging the dying process inappropriately.


RESULTS
Statistically significant survey results in the post-intervention group showed nurses experienced: encouragement to ensure patients could make informed choices about their end-of-life treatment (84%); the ability to uphold these wishes in practice (73%); and job satisfaction from delivering appropriate end-of-life care (67%); compared to approximately half (42-55%) of respondents in the pre-intervention and control groups. Focus group participants shared that it used to be hard to advocate for patients, but now they could act legitimately and felt ethically comfortable about ensuing end-of-life-care.


CONCLUSIONS
Findings suggested patient advocacy, fostered by the supportive RPC environment, effectuates the ACP-ing process. It is recommended that the RPCP should be recognised and developed as integral to promoting quality end-of-life assurance and associated job satisfaction.
The Queen Elizabeth Hospital, Adelaide, South Australia, Australia. camseal@chariot.net.au
Marion
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Seal
D000208:Acute Disease / Q000451:nursing; D032722:Advance Care Planning / Q000941:ethics / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D032781:Codes of Ethics; D004645:Empathy; D017144:Focus Groups; D006379:Helping Behavior; D006779:Hospitals, Public; D006801:Humans; D007588:Job Satisfaction; D024802:Nurse's Role / Q000523:psychology; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000941:ethics / Q000458:organization & administration* / Q000523:psychology; D010344:Patient Advocacy / Q000193:education / Q000941:ethics / Q000523:psychology; D010865:Pilot Projects; D017009:Professional Autonomy; D011446:Prospective Studies; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D011788:Quality of Life / Q000523:psychology; D013021:South Australia; D011795:Surveys and Questionnaires