As we continue the observance of Sepsis Awareness Month throughout September, we’d like to share a first-person account written by Cooper employee Jennifer Harbourt, MSN, RN, CEN. In addition to discussing her personal story, Jennifer shares the importance of being an advocate for patients. The story first appeared in Bridges, Cooper’s nursing newsletter.
Here is her story:
The Importance of Patient Advocacy
Jennifer Harbourt, MSN, RN, CEN
There is more to being a patient advocate than just answering questions or getting answers. Advocacy is a fundamental aspect of nursing practice. 1 In the 1960s and 1970s, the women’s and civil rights movements led to a greater focus on individual rights. Clarification regarding these new rights created a need for patient.2 By the early 1980s, nursing was beginning to be defined by its philosophical approaches to health, guiding patient advocacy to become a core component of nursing.2 The vision of being an advocate in nursing practice is different across the profession and is “not adequately defined.”3 The role of advocacy in nursing is still being developed, even today. I would like to share how my personal journey shaped my views on patient advocacy.
I was always aware that nurses were a huge part of patient advocacy. After all, nurses are the ones most often at the bedside, updating patients and families regarding status and monitoring the patient’s condition. But what exactly does being a patient advocate mean? My understanding was that a good patient advocate keeps the patient informed about care options and can answer or obtain answers to the patients’/families’ questions to assist them with decision-making. Recently, my expectations for a patient advocate have drastically changed.
My story starts on January 2, 2017. I have been an Emergency Department (ED)/Trauma Nurse for many years and a Clinical Educator at Cooper University Hospital for one and a half years. I was not shy in telling the staff at a local hospital we visited that I was an ED Nurse Educator. My husband and I had been completing in vitro fertilization (IVF) over the past four years. We were in the middle of our eighth IVF cycle when the pain started. Now, with a history of endometriosis, I was used to pain. I knew that I had an ovarian cyst and assumed it was the cause of my pain. At the recommendation of my fertility doctor, my husband took me to the local ED where I received a prescription for narcotics. In the past, this provided relief; but at this time it did not. I was informed that I needed to have surgery to drain the cyst and alleviate the pain.
I was prepared for the admission, but not for what followed. The fertility doctor consulted my obstetrician/gynecologist (OB/GYN) group to do the surgery, but because we were waiting to find out if I was pregnant, he was reluctant to immediately operate. Four pregnancy tests and two days later, it was determined that my beta HCG levels were negative and surgery was scheduled for the next day. The OB/GYN surgeon returned to speak to my husband with unexpected news: the cyst could not be visualized due to a massive infection. The team had no idea where it came from, as there were no signs or symptoms of an infection prior to the surgery. General Surgery was consulted during the operation, and they were able to irrigate the area. The original surgery would be rescheduled once the infection was treated.
Due to the high hospital census, I remained on the Observation Unit as an inpatient admission. Post-operatively, I was started on antibiotics, but my pain remained uncontrolled. I would awaken from a sound sleep, crying and unable to gain any relief with repositioning. This continued for 48 hours. During this time my vital signs changed significantly. I also started with a fever, but was not given an antipyretic. My nurse was new to practice and I voiced my concern about sepsis. I asked for IV fluid to help with my hypotension (systolic in the 80s), I asked for Tylenol, I told her that my vital signs indicated I was getting worse, not better. Her response: “Is that what they do at Cooper?” I was now scared. If my nurse did not understand I was in danger, that my condition was worsening, then who was going to help me?
The night shift nurse came in after report and I told her my concerns. She was able to obtain a Tylenol order, but it was a small dose and my fever was now 102.5F. She called for an additional 325mg, and then a miscommunication led to a 1000mg IV dose of Tylenol within the hour. I was still hypotensive, tachycardic, and tachypneic. A rapid response team (RRT) was called in the middle of the night; I begged for my husband to be called. I became hysterical thinking I would never leave the hospital or see my soon-to-be 2-year-old son again. I had a feeling of impending doom. I was moved to a post-operative unit where a second RRT was called. My doctors came in the next morning and told me if the pain and fevers continued, they would have no choice but to do an emergent open abdominal surgery that would land me in the ICU, intubated with an IV bag closure (leaving my incision open to allow for swelling). Luckily, a change in the antibiotics led to eventual improvement. Eight weeks later I had another surgery and was able to return to work on April 24, 2017. It has been a year since all of this has taken place, and I feel I am finally back to normal.
I stated earlier that being an advocate is more than keeping a patient informed about care options and answering questions. Being a patient advocate is about acting on behalf of the patient, safeguarding the patient from harm, and being a champion for the patient in this health care system.3 I learned from this entire process that I had to be my own advocate. My nurse was not able to be my advocate, she was not able to find the answers I needed, and I could not tell you if she even knew what she was seeing. The problem with being your own advocate is you need to have a background in health care and understand what is happening. I could do this because I was alert and aware of the changes occurring and I had a health care background. What if the night nurse had the same actions as the day nurse? What happens to your patients who are not alert, not aware, not educated? “If the need for effective patient advocacy is not recognized and applied, the effective healthcare would not be achieved.”4
As a clinical educator, I have the ability to mentor nurses in all stages of their careers. My goal is to provide nurses with the skills, knowledge, and resources to be great. I never knew how important the role of patient advocate was until I was a patient in need of an advocate. An advocate’s role includes keeping the patient informed about care options, answering or getting answers to questions, and being alert to the patient’s progression and trends to intervene when necessary. Being a patient advocate is about keeping the patient safe by staying current with evidence-based nursing practices, keeping your education relevant to your practice, and having a good foundation of basic nursing care. Advocacy is about anticipating your patient’s needs and acting in their best interest. Your patients, most likely, will not be an experienced health care provider from a university hospital; they will be people of any background who need a nurse to be their advocate.
If not you, then who?
Email comments to Jennifer Harbourt at harbourt-jennifer@cooperhealth.edu.
References
- American Nurses Association. (2010). Scope and standards of practice (p. 20). Silver Spring, MD: Nursebooks.
- Water, T., Ford, K., Spence, D. and Rasmussen, S. (2016). Patient advocacy by nurses – past, present and future. Contemporary Nurse, 52(6), 696-709. doi:10.1080/10376178.2016.1235981
- Agom, D. A., Joy, C. A., Ominyi, J. N. and Simon, N. O. (2015). Concept analysis of patients’ advocacy: The nursing perspective. International Journal of Nursing Didactics, 5(3), 1-4. doi:10.15520/ijnd.2015.vol5.iss03.67.01-04
- Grace, P. (2001). Professional advocacy: Widening the scope of accountability. Nursing Philosophy, 2(2), 151-162. doi.org/10.1046/j.1466-769X.2001.00048.