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Diversity, Equity, and Inclusion

Patient Advocacy Takes Tapping Into Your Strengths

Forge strong relationships with your patients, so you can know what they need

By Barry Bottino
hen she teaches nursing students about advocating for patients, Katie Chargualaf, PhD, RN, CMSRN, will request that they see things through the eyes of a patient.
After a recent class discussion about patients who experience traumas and barriers that prevent them from leaving the hospital sooner, Chargualaf shared how one of her students cared for one such patient during a clinical rotation.
“I sat down with the student and said, ‘Put yourself in this patient’s shoes,’” said Chargualaf, an assistant professor at the University of South Carolina Aiken School of Nursing. “A young man experienced a trauma. Life isn’t going the way he thought. How would you feel about that?”
The student mentioned feeling angry and frustrated.
“I said, ‘Exactly. What can we do, as nurses, to move past that barrier of frustration and shutting down to show him what he’s capable of to help him move toward getting out of the hospital?’” Chargualaf said.
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By the end of the clinical day, the student had the patient out of bed, walking and, best of all, smiling.
“I turned to the student and said, ‘That’s what you did,’” Chargualaf recalled.

Being a strong patient advocate can be a powerful experience, and nurses are uniquely positioned in healthcare to thrive in that role.
“We have a number of skills and a lot of knowledge that can really benefit people,” said author and oncology nurse Alene Nitzky, PhD, RN, OCN. “Patient advocacy can be done anywhere. It’s not just in terms of when a person is a patient in a hospital.”
Nurses also spend the most time with patients, which helps build a trusting relationship, said Chargualaf.

How To Advocate for Patients

To ensure nurses are advocating for patients, they should start with what they’re best at, advised Nitzky, author of “Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care.”
“You need to use your own strengths to be an advocate, whatever those strengths are,” she said.
That could be as a speaker, a writer, or connecting with community members and resources to benefit patients. Nurses can also use their healthcare knowledge to advocate for political, social, and public health issues.
“You’re an educator, and by educating people you are advocating for them,” Nitzky said. “Nurses are really able to be advocates for anyone. Anything we do from day to day has an impact on our health and the health of greater society.”
Tammy Turner, BSN, MA, RN, Perinatal Nurse Manager at MLK Community Healthcare in Los Angeles, encourages nurses to use the time spent with patients to build trust and listen.
“It’s very important to learn how to be mindful when interacting with patients,” she said. “Really take the time to listen to what the patient is expressing. Helping patients to be able to have their own voices and express what they desire is key. Those relationships will hopefully lead to better outcomes.”

Advocacy Around the Clock

Turner and her nursing team in Los Angeles have been a model for strong patient advocacy.
The community hospital’s 12.7% C-section rate is nearly half that of the statewide average and has resulted in back-to-back years of being recognized on the Cal Hospital Compare Maternity Honor Roll for its success.
At the center of the program is a “patient-centered” goal.
“We’re very in tune with listening to patients and what they want their birth experience to be,” Turner said.
At the hospital, nurse-midwives are teamed with a laborist who is an obstetrician for 24-hour shifts, ensuring that “we have a doctor and a midwife on service 24/7 in the house,” she said.
The hospital focuses on not hurrying patients through a delivery.
“We’re able to work with our patients, and there’s no set time frame,” Turner said. “There’s no rush. Our midwives are very dedicated to trying different positions for delivery. They also use labor assist items like a yoga ball or a peanut ball. That’s the complement that the midwife brings to what we do.”
The low C-section rate is a source of pride for Turner and her team, who don’t meet many of their patients until they are ready to deliver.
Most of the prenatal care occurs at outlying clinics, so the hospital has developed a prenatal class called “Your First 48” to discuss what happens from the time the baby is born to when a patient leaves the hospital. These classes are held at the clinics and online during the COVID-19 pandemic.
The hospital also created a perinatal community liaison position to work directly with the clinics by building relationships and providing education for pregnant women.
Along with working directly with the clinics where its patients begin their prenatal care, Turner said her team has strong relationships with birthing centers and welcomes any patient who has a doula.
“If [the patient] can trust that we’re going to do the right things, that we’re going to keep you informed, that we’re going to give you the space to make an informed decision, and then to respect your choice … that’s what leads to better outcomes,” Turner said.

Rewards Are Plentiful

Chargualaf views the rewards of being a strong patient advocate similar to being an educator.
“It’s similar to a teacher in a classroom, and you see the students’ light bulbs go on when they get it,” she said. “Transfer that over to the patient care side. When you see the patient do things you’ve been working with them to do to achieve those outcomes, it’s rewarding.”
Helping a patient improve, according to Chargualaf, can lead them to do things they couldn’t when they were ill.
It’s similar to a teacher in a classroom, and you see the students’ light bulbs go on when they get it. Transfer that over to the patient care side. When you see the patient do things you’ve been working with them to do to achieve those outcomes, it’s rewarding.
— Katie Chargualaf, PhD, RN
For some, that means helping them attend a child’s wedding, traveling, or doing everyday things that previously weren’t possible.
As an oncology nurse, Nitzky said the rewards are clear for patients with good and bad outcomes.
“It’s the relationships you form,” she said. “I’ve gotten to know a lot of cancer survivors over the years. Knowing people and seeing them do well is awesome.”
For those whose cancers return or who die from the disease, Nitzky also feels rewarded.
“Knowing you did everything you could while they were alive to improve their lives or the quality of their families’ lives, that’s really important too,” she said.
Chargualaf encourages nurses to consider all the rewards of advocating for patients and not to look at it as a task.
“Don’t let it be daunting,” she said. “You can, as a single nurse, create the change you want to see.”
Barry Bottino is a freelance writer.