Ethics Narrative Commentary
By Martha Jurchak, PhD, RN
Director, Ethics Service
In this narrative, Diane illustrates how patient advocacy is grounded in knowing the patient. Diane’s commitment to being Mrs. F’s primary nurse, daily caring for her and managing the system for the patient and family are examples of this advocacy. She ensured that Mrs. F’s family received the information they needed to understand Mrs. F’s condition (e.g. “..making sure the family talked to all the big players”). This knowledge is what provided Diane with the courage and confidence to step forward to ask the hard questions, listen to the answers and advocate for the patient’s perspective to her colleagues on the treatment team and to Mrs. F’s family.
Can we deliver good nursing care without knowing the patient? I would argue we can’t. Knowing the patient grounds advocacy in the patient’s own values. Without knowing the patient, attempts at advocacy are based on either our projections of patient wishes, what we have decided is in the patient’s best interests or even what we may think is good for the patient. True patient advocacy requires that we know what the patient wants for himself or herself and that we speak from that perspective. There may be times when deep value differences between patients and caregivers can move us to abstain from a patient’s care on the grounds of moral objection or an affront to personal conscience, though this is a rare exception.
How do we uncover what the patient wants? While it is tempting to answer by saying “Just ask,” anyone who has cared for patients with life-threatening illness knows that uncovering what a patient wants can be achieved with clarity and confidence only by knowing them. This requires time in length and quality, attention and intention of interaction on the part of the nurse. As a result of this attention, patients reveal themselves through the trust that develops from this caring interaction.