Friday, 29 March 2013

My Biggest Lesson: Advocacy by Carly Pain





            After being in Ghana for almost two months now, it is difficult to say what my biggest lesson has been because there have been so many! Having to choose just one, I believe that my biggest lesson has been the importance of the nursing role of patient advocacy. There have been numerous times during my stay here where I have witnessed the need for a patient advocate or have been the advocate myself.

            As I am sure you can imagine, hospitals in Ghana are much different from hospitals in Canada. Saying this, I would like to stress that the differences are not all negative. In fact, there are many tips from Ghanaian hospitals that Canadian hospitals could pick up on, such as maternal and pediatric health information booklets.

One difference that has been prominent for me is the variation in family-centred care. For example, on multiple occasions I witnessed husbands being shooed away when they tried to accompany their partners to their postnatal appointments. Sometimes the husbands were simply yelled at by the nurses for attending. However this is not universal; family-centred care was promoted at one of the polyclinics that offered priority appointments to the babies who had both their mother and father present. We observed how beneficial it is for nurses to adjust their practice and effectively advocate for maternal patients. Not only does this advocacy involve the father in the pregnancy, but it also helps to form a bond between the mother and the baby.

            In other instances, I have had the opportunity to advocate for the patients. Primarily, this has been teaching staff members’ best practice techniques during patient care in a variety of settings. These settings include pediatric emergency, maternity, and the female outpatient department. One instance that stands out for me involved a one-month-old premature twin boy. He visited the neonatal intensive care unit (NICU) for a dressing change for a wound caused by an infected intravenous line. The neonate was still very small for his age and was still quite vulnerable to infection. The nurse informed me that she was going to leave the open wound uncovered to save on resources. Shocked, I told her that it would be best to cover the wound as leaving at open would only increase his risk for infection. This would subsequently lead to more resources being spent on treating the worsened infection. Much to my surprise, the nurse listened to what I had to say and covered up the wound. After reflecting on the day, I realized that one of the most important roles of my job as a nurse is to ensure that patients are receiving the best possible care and guaranteeing that the best practice is made known in unclear situations.

            In Canada I have had many opportunities to advocate for patients. One of the most important aspects of care in my daily nursing practice is focusing on precautions to prevent pressure ulcers. Patients often cannot move themselves or speak for themselves when they have remained in the same position for a long period of time. Consequently, there are high rates of pressure ulcers on the unit I work on. In order to prevent this, I make it part of my everyday nursing care to turn the patients minimum every two hours, apply pressure relief boots, and keep their skin dry. On a busy day, I often witness these preventative measures being overlooked and hear the phrase “it’s good enough for now” or “I’ll try and do it later.” Unfortunately the voices of patients in need are often not heard. It is our role as a nurse to advocate for them, to make their voices heard.

            I think that the importance of advocating for patients in Canada is often overlooked in part due to the availability of resources – we often place other aspects of care at higher priorities. After working in settings with an astonishing lack of resources, it became apparent that advocating for patients is something that must be practiced and enforced by nurses worldwide. 

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