Patient advocacy has been claimed as a new role for professional nurses and many codes of ethics for nurses state that they act as patient advocates. Nursing education is faced with the challenge of preparing nurses for this role. In this article we describe the results of a study that considered the tendencies of a cohort of nursing students at the Kocaeli University School of Nursing to act as advocates and to respect patients’ rights, and how their capacities to do (...) so changed (or not) as a result of their nursing education. This longitudinal study used a questionnaire consisting of 10 statements relating to patient care. It was performed both at the start (1998) and at the end (2002) of the nursing training. At the beginning of their course 77 students participated; in the study. After four years, only 55 students participated, the reason for this drop in number being unknown. The questions asked nurses if patients should have: the right to receive health care; the right to participate in the decision-making process about their treatment; the right always to be told the truth; and the right to have access to their own medical records. They were also asked: if quality of life should be a criterion for discontinuing treatment; if patients have the right to die and the right to refuse treatment; if patients should be assisted to die or helped to undergo active euthanasia; and if severely disabled newborn babies should be allowed to die. The student nurses demonstrated considerable insight into contemporary nursing issues and were ready to act as patient advocates. Professional responsibility demands that good nurses advocate strongly for patients’ choices. (shrink)

In Israel, whistleblowing in the nursing profession has been largely ignored. This topic is neither part of the professional—ethical discourse nor a subject for research. Focusing on the divide between internal and external whistleblowing, this article presents a study that explores nurses’ willingness to disclose an act that could jeopardize the rights or safety of patients. Internal disclosure entails reporting wrongdoing to an authority within the organization. External disclosure involves reporting the offense to an outside agency, such as a professional (...) organization or the press. The study’s findings indicate that the nurse respondents viewed both the harmful misconduct of a colleague and that of a manager as being very serious. In such dilemmas the nurses reported a desire to correct the wrongdoing and a concomitant willingness to act. They were, however, much more likely to whistleblow internally rather than externally. This study revealed a pattern of nurses’ progressive retraction as the circle of disclosure widened. (shrink)

The purpose of this article is to examine whether patient/client autonomy is always compatible with the nurse’s role of advocacy. The author looks separately at the concepts of autonomy and advocacy, and considers them in relation to the reality of clinical practice from professional, ethical and legal perspectives. Considerable ambiguity is found regarding the legitimacy of claims of a unique function for nurses to act as patient advocates. To act as an advocate may put nurses at personal and professional risk. (...) It may also be deemed arrogant and insulting to other health care professionals. Patient autonomy can be seen as a subcategory of the right of every individual to self-determination, and as such is protected by law. However, it is questionable whether the traditionally paternalistic approach to health care provision truly respects the autonomous rights of each patient. The author considers examples and cases from the literature that resulted in professional and/or personal difficulties for the nurses involved, and also reflects on an incident from her own practice where a positive outcome was achieved that demonstrated compatibility between the concepts under consideration. (shrink)

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers’ agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical “coalfaces”.Virtue ethics, emphasising techniques promoting an agent’s character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we (...) argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing.The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development. (shrink)

Nursing is at the same time a vocation, a profession and a job. By nature, nursing is a moral endeavor, and being a ‘good nurse’ is an issue and an aspiration for professionals. The aim of our qualitative research project carried out with 18 nurse teachers at a university nursing school in Brazil was to identify the ethical image of nursing. In semistructured interviews the participants were asked to choose one of several pictures, to justify their choice and explain what (...) they meant by an ethical nurse. Five different perspectives were revealed: good nurses fulfill their duties correctly; they are proactive patient advocates; they are prepared and available to welcome others as persons; they are talented, competent, and carry out professional duties excellently; and they combine authority with power sharing in patient care. The results point to a transition phase from a historical introjection of religious values of obedience and service to a new sense of a secular, proactive, scientific and professional identity. (shrink)

Neither the corporate view of whistle blowers as tattle-tales and traitors, nor the more sympathethic understanding of them as tragic heroes battling corrupt or abused systems captures what is at stake in whistle blowing at its most distinctive. The courage, determination and sacrifice of the most ardent whistle blowers suggests that they only begin to be appreciated when they are seen as the saints of secular culture. Although some whistle blowers may be attempting to deflect attention from their own deficiencies (...) and others may be disgruntled employees, the most serious instances involve a level of moral sensitivity that approaches religious proportions that are baffling for a culture that has dispensed with sainthood. (shrink)

Advocacy has become an accepted and integral attribute of nursing practice. Despite this adoption of advocacy, confusion remains about the precise nature of the concept and how it should be enacted in practice. The aim of this study was to investigate general nurses’ perceptions of being patient advocates in Ireland and how they enact this role. These perceptions were compared with existing theory and research on advocacy in order to contribute to the knowledge base on the subject. An inductive, qualitative (...) approach was used for this study. Three focus group interviews with a total of 20 practising nurses were conducted with a sample representing different grades in a general hospital setting. Data analysis was carried out using elements of Strauss and Corbins’ approach to concept development. The findings indicate that the principal role of the nurse advocate is to act as an intermediary between the patient and the health care environment. The results highlight that advocacy did, however, result in nurses becoming involved in conflict and confrontation with others and that it could be detrimental to nurses both professionally and personally. It was also clear that when enacting advocacy, nurses distinguished between ‘clinical advocacy’ (acting directly for patients in the clinical environment) and organizational advocacy (acting on an organizational level for one or more patients). (shrink)

The systemic difficulties of health care in the USA have brought to light another issue in nurse—patient advocacy — those who require care yet have inadequate or non-existent access. Patient advocacy has focused on individual nurses who in turn advocate for individual patients, yet, while supporting individual patients is a worthy goal of patient advocacy, systemic problems cannot be adequately addressed in this way. The difficulties nurses face when advocating for patients is well documented in the nursing literature and I (...) argue that, through collective advocacy, professional nursing associations ought to extend the reach of individual nurses in order to address systemic problems in health care institutions and bureaucracies. (shrink)

Purpose The purpose of this article is to assess the operation of the UK’s Public Interest Disclosure Act 1998 (PIDA 1998) during its first 10 years and to consider its implications for the whistleblowing process. Method The article sets the legislation into context by discussing the common law background. It then gives detailed consideration to the statutory provisions and how they have been interpreted by the courts and tribunals. Results In assessing the impact of the legislation’s approach to whistleblowing both (...) in the UK and elsewhere, the author draws upon empirical research. Conclusion The author concludes that PIDA 1998 has not adequately protected whistleblowers and makes 12 recommendations for change. Despite the European Commission’s acknowledgement that whistleblowers can play a part in the fight against corruption, the author notes that common standards for their protection still seem a long way off. (shrink)

The received account of whistleblowing, developed over the last quarter century, is identified with the work of Norman Bowie and Richard DeGeorge. Michael Davis has detailed three anomalies for the received view: the paradoxes of burden, missing harm and failure. In addition, he has proposed an alternative account of whistleblowing, viz., the Complicity Theory. This paper examines the Complicity Theory. The supposed anomalies rest on misunderstandings of the received view or misreadings of model cases of whistleblowing, for example, the Challenger (...) disaster and the Ford Pinto. Nevertheless, the Complicity Theory is important for as in science the contrast with alternative competing accounts often helps us better understand the received view. Several aspects of the received view are reviewed and strengthened through comparison with Complicity Theory, including why whistleblowing needs moral justification. Complicity Theory is also critiqued. The fundamental failure of Complicity Theory is its failure to explain why government and the public encourage and protect whistleblowers despite the possibility of considerable harm to the relevant company in reputation, lost jobs, and lost shareholder value. (shrink)

How a person perceives a wrongdoing being committed by a coworker will affect whether the incident is reported within the organization. A significant factor that may influence the decision to report a wrongdoing is the perceived intentionality of the wrongdoer. This study sought to examine if differences in perceptions of a wrongdoing could affect the disclosure of unethical behavior. Three hundred seventy-two registered nurses (N = 372) responded to a survey consisting of both intentional and unintentional wrongdoings that could occur (...) by a nurse. Results of a paired t-test were as predicted. More wide ranging revelations found that respondents were more likely to discuss the unintentional wrongdoings with the wrongdoer in lieu of officially reporting to an immediate supervisor, or a member of upper management. Discussion, limitations, and suggestions for future research are provided. (shrink)

How a person perceives a wrongdoing being committed by a coworker will affect whether the incident is reported within the organization. A significant factor that may influence the decision to report a wrongdoing is the perceived intentionality of the wrongdoer. This study sought to examine if differences in perceptions of a wrongdoing could affect the disclosure of unethical behavior. Three hundred seventy-two registered nurses (N = 372) responded to a survey consisting of both intentional and unintentional wrongdoings that could occur (...) by a nurse. Results of a paired t-test were as predicted. More wide ranging revelations found that respondents were more likely to discuss the unintentional wrongdoings with the wrongdoer in lieu of officially reporting to an immediate supervisor, or a member of upper management. Discussion, limitations, and suggestions for future research are provided. (shrink)

In nursing, the concept of advocacy is often understood in terms of reactive or proactive action aimed at protecting patients' legal or moral rights. However, advocacy activities have not often been researched in the context of everyday clinical nursing practice, at least from patients' point of view. This study investigated the implementation of nursing advocacy in the context of procedural pain care from the perspectives of both patients and nurses. The cross-sectional study was conducted on a cluster sample of surgical (...) otolaryngology patients (n = 405) and nurses (n = 118) from 12 hospital units in Finland. The data were obtained using an instrument specially designed for this purpose, and analysed statistically by descriptive and non-parametric methods. According to the results, patients and nurses have slightly different views about which dimensions of advocacy are implemented in procedural pain care. It seems that advocacy acts are chosen and implemented rather haphazardly, depending partly on how active patients are in expressing their wishes and interests and partly on nurses' empowerment. (shrink)

Nursing advocacy for patients is considered to be an essential component of nursing practice. This phenomenological qualitative pilot study explored registered nurses' lived experience of nursing advocacy with patients using a sample of three medical-surgical registered nurses. The guiding research questions were: (1) how do registered nurses practicing in the medical-surgical specialty area describe their experiences with nursing advocacy for their patients; and (2) what reflections on educational preparation for their professional roles do registered nurses identify as related to their (...) practices of nursing advocacy with their patients? Data analysis procedures were based on Moustakas' data analysis method, and Lincoln and Guba's criteria were applied for rigor. The emergent themes were: speaking out and speaking for patients; being compelled to act on unmet needs of patients; fulfillment and frustration; the patient is changed; primarily learned on the job; and confidence gained through practice. The findings increase the body of knowledge surrounding nursing advocacy as practiced by nurses. (shrink)

This pilot study had two purposes: (1) to review recent Japanese nursing literature on nursing advocacy; and (2) to obtain data from nurses on advocacy. For the second purpose, 24 nurses at a nursing college in Japan responded to a questionnaire. The concept of advocacy, taken from the West, has become an ethical ideal for Japanese nurses but one that they do not always understand, or, if they do, they find it difficult to fulfil. They cite nursing leadership support as (...) necessary to enacting this role. Discussion on the meaning of and the rationale for advocacy in a society where goodness or badness is relative to social situations and its impact may reveal two parallel but overlapping views of morality. Such a situation would not only influence notions of advocacy but also possibly render them more complex. (shrink)