Nursing is more than delivering care; it involves patient advocacy as well. Because they have the most direct interaction with patients, nurses are in the ideal position to advocate for each one on an individual basis. The American Nurses Association (ANA) stresses the importance of patient advocacy in its Code of Ethics and lists three core values that form its basis: preserving human dignity, patient equality, and freedom from suffering. This three-part blog series will address each of these core values in turn.
Equality is a much discussed concept, one that has historically been difficult to achieve in practice. It is a concept that is central to many ethical theories, and nursing ethics are no exception. The ANA’s Code of Ethics states that nurses must practice “with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” This means all nurses must set aside prejudice or personal bias to care for all patients with the same degree of professionalism, regardless of who that patient is. What’s more, recognizing and promoting patient equality is one of three core values that form the basis of nursing’s patient advocacy role.
In healthcare, patient equality comes down to two main themes: universal human value, and equal access to healthcare resources.
The theme of universal human value relates to the recognition that every life has value. It was highlighted dramatically in the Boston Globe’s coverage of the trauma nurses who cared for the Boston Marathon bombing suspect in 2013, including in this excerpt:
All of the nurses asked by supervisors to care for Tsarnaev agreed, the hospital said. The Globe interviewed seven of them, and all said that the ethical bedrock of their profession requires them to treat patients regardless of their personal history. They are sometimes called upon to nurse drunk drivers, prisoners, gang members, but this assignment was the ultimate test of Florence Nightingale’s founding ideals.
The Globe also reported that, “The nurses said they were proud of the care they provided the suspected bomber, whose condition steadily improved, and of their role in preparing him to face justice.”
These nurses were able to overcome their ambivalence about caring for the bombing suspect in order to do their jobs with skill, professionalism, and even compassion, as they provided comfort and pain relief in a difficult situation. They truly promoted the principle of patient equality, despite the circumstances.
The other side of patient equality has to do with our healthcare system itself, which is prone to disparities in the way care is delivered and who has access to high-quality care. According to the Institute of Medicine (IOM), “a large body of published research reveals that racial and ethnic minorities experience a lower quality of health services, and are less likely to receive even routine medical procedures than are White Americans.” The Centers for Disease Control and Prevention report on Health Disparities and Inequalities found that mortality rates from various chronic illnesses were all higher for certain minority populations. For example, while African-American women develop breast cancer at lower rates than white women, they are more likely to die from their disease. Disparities exist for ethnic populations due to factors that may include: social isolation, socioeconomic status, discrimination, language/cultural barriers, and environmental factors, among others.
Nurses have a long history of caring for underserved and vulnerable populations, and this should continue—but with a focus on practices that may help to end disparities. Cultural competency can go a long way in helping minority patients overcome barriers that stand in their way of receiving excellent care, particularly for nurse case managers and oncological nurse navigators, who are trained to look for and overcome barriers to care. Yet even bedside nurses can advocate for underserved patients in a myriad of ways. Ideally, every patient should receive the same quality of care regardless of ethnicity, religion, sexual orientation, education, or income.
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