Explore a variety of issues related to advocacy and empowerment, and begin to develop a personal concept of the nurse's role in supporting users/carers to achieve independence

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Living within a Community: The nurse’s role module

(Module code: HCN06-1)

Learning Outcome: Explore a variety of issues related to advocacy and empowerment, and begin to develop a personal concept of the nurse’s role in supporting users/carers to achieve independence

by Martina Bazikova

       In this essay the writer will identify the importance of advocacy and empowerment and reflect upon her own application of these concepts within the field of learning-disability nursing.  Before researching this learning contract, the writer had little perception of advocacy and empowerment, nor their tremendous significance, despite several years’ experience working in nursing. It is within learning-disability nursing the benefits of both disciplines have been most strongly felt in recent times. Working on a practice placement caring for such patients, and principally on one individual case, detailed later, the writer has come to value them and to consider their increasing use in this field, as shown by the recent White Paper Valuing People (published in March 2001). This learning outcome was chosen for these reasons, and, having exploited these issues in practice, the writer has begun to appreciate the value of the perception of independence.

       The UKCC Code of Professional Conduct, first published in June 1992, states that nurses must “act always in such a manner as to promote and safeguard the interest and well-being of patients and clients”. It is clear that to fulfil this statement, these skills must be crucial to the nurse, especially in the context of community nursing.

       Empowerment is defined by Adams and Bromley (1998) as giving the client control over a situation and the interventions that are available. Put crudely, it enables people to recognise and feel their strengths, competencies and personal power and to exploit them through increased knowledge, control of practice and command of resources (Conway-Welch 1996). Its widespread use in the healthcare environment came about relatively recently. Previously, patients had been encouraged by the healthcare system to be compliant: to accept the power of the doctor and to do as instructed by them. The absence of empowerment best defines its importance: Payne and Walker (2000) cite research by Raps et al (1982) that demonstrated that any period of hospitalisation, however short, can lead to identifiable changes in cognition, behaviour and emotion. This research led the authors to believe that the quiescent and inanimate behaviour of the “good patient” may actually be the result of a concept called “learned helplessness”. With this hindsight, the significance of empowerment, then, cannot be exaggerated: it also helps diminish feelings of alienation; the loss of a sense of control over one’s life; and powerlessness, real or imagined (McNally 1997).

       Empowerment equips the user with the knowledge to make meaningful choices. It can also require the involvement of insightful and enabling family members and highly sensitive and skilled personnel (Brown, Brown and Bayer 1992).

       Adams and Bromley (1998) define advocacy as the promotion of the rights of another to be self-determining and autonomous. When the user is unable to speak for himself, the advocate speaks out or acts on behalf of the user, upholding their rights and best interests. The advocate should have a genuine commitment to delineate the needs and interests of the user as though they were their own (McNally 1997).  

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       Gates (1994) cites four variations of advocacy: legal advocacy, the representation of the user in a formal context, for instance a health-review tribunal; self-advocacy, where the individual or a group of individuals speak up for themselves, a form of empowerment; collective or class advocacy, the large organisations who speak for the interests and rights of a category of people; and citizen advocacy, the representation of the user’s interests by a competent advocate (eg a nurse).

       So what of the disadvantages for the nurse in acting as advocate? Castledine (1981, cited by ...

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