CHAPTER 6

LEARNING EXERCISE 6.1

Values and Advocacy
How important a role do you believe advocacy to be in nursing? Do you believe that your
willingness to assume this role is a learned value? Were the values of caring and service
emphasized in your family and/or community when you were growing up? Have you identified
any role models in nursing who actively advocate for patients, subordinates, or the profession?
What strategies might you use as a new nurse to impart the need for advocacy to your peers and
to the student nurses who work with you?
Answer: The importance of advocacy in nursing is that it promotes a patient-center care since
the goal of advocacy in patient care is to uplift the rights of the individual, I believe that the
willingness to assume this role is a learned value, not everyone promotes the right of the patient
in their continuum of care, in takes time to possess this value of patient first type of care and
hence, why I think that advocacy is a learned value.

LEARNING EXERCISE 6.2

Culture and Decisions
You are a staff nurse on a medical unit. One of your patients, Mr. Dau, is a 56-year-old Hmong
immigrant to the United States. He has lived in the United States for 4 years and became a
citizen 2 years ago. His English is marginal, although he understands more than he can verbalize.
He was admitted to the hospital with sepsis resulting from urinary tract infection. His condition
is now stable. Today, Mr. Dau’s physician informed him that his computed tomography scan
shows a large tumor in his prostate. The physician wants to do immediate follow-up testing and
surgical resection of the tumor to relieve his symptoms of hesitancy and urinary retention.
Although the tumor is probably cancerous, the physician believes that it will respond well to
traditional oncology treatments. The expectation is that Mr. Dau should recover fully. One hour
later, when you go in to check on Mr. Dau, you find him sitting on his bed with his suitcase
packed, waiting for a ride home. He informs you that he is checking out of the hospital. He states
that he believes he can make himself better at home with herbs and through prayers by the
Hmong shaman. He concludes by telling you, “If I am meant to die, there is little anyone can
do.” When you reaffirm the hopeful prognosis reported by his physician that morning, Mr. Dau
says, “The doctor is just trying to give me false hope. I need to go home and prepare for my
death.”
ASSIGNMENT:
What should you do? How can you best advocate for this patient? Is the problem a lack of
information? How does culture play a role in the patient’s decision? Does a lack of
understanding on this patient’s part justify paternalism?
Answer: I The utilization of paternalism for this patient is not justified because the patient is still
not in a state where he cannot decide on his own, on what kind of care that he will receive.

LEARNING EXERCISE 6.3

Advocating for a Transgender Patient
You are the charge nurse on a medical unit. Today, during walking rounds, a male-to-female
transgender patient tells you that she hears the staff whispering and making fun of her in the
hallway outside her room. She says this is hurtful and that although the staff may lack clarity
about her gender identity, she does not, and that becoming a woman is all she ever wanted. She
said that friends who have come to visit her have also been made to feel uncomfortable.
ASSIGNMENT:
1. How best can you advocate for this patient?
Answer: I can best advocate for this patient by letting the institution announce that the
workplace is promoting the respect on all the individuals preferred gender identity, regardless of
what their roles are in the institute, may they be a patient or a staff there. Through this I will
make sure that all workforce in the hospital will acknowledge that all individuals have preference
on how they want to be identified.
LEARNING EXERCISE 6.4
How Can You Best Advocate?
You are a unit supervisor in a skilled nursing facility. One of your aides, Martha
Greenwald, recently reported that she suffered a “back strain” several weeks ago when she was
lifting an elderly patient. She did not report the injury at the time because she did not think it was
serious. Indeed, she finished the remainder of her shift and has performed all of her normal work
duties since that time.
Today, Martha reports that she has just left her physician’s office and that he has advised
her to take 4 to 6 weeks off from work to fully recover from her injury. He has also prescribed
physical therapy and electrical nerve stimulation for the chronic pain. Martha is a relatively new
employee, so she has not yet accrued enough sick leave to cover her absence. She asks you to
complete the paperwork for her absence and the cost of her treatments to be covered as a work-
related injury.
When you contact the workers’ compensation case manager for your facility, she states
that the claim will be investigated; however, with no written or verbal report of the injury at the
time it occurred, there is great likelihood that the claim will be rejected.
ASSIGNMENT:
How best can you advocate for this subordinate?
Answer: I would ensure that the workplace that I am working is both conducive and safe not
only for the patient, but also to my subordinates. To ensure that the standard of safe workplace is
really achieved I will raise this concern to the higher authorities so that my plans can be
reviewed and approved quickly in order for incidence such as what happened to Martha will not
occur again under my watch.

LEARNING EXERCISE 6.5

Write It Down. What Would You Change?
List five things that you would like to change about nursing or the health-care system. Prioritize
the changes that you have identified. Write a one-page essay about the change that you believe is
most needed. Identify the strategies that you could use individually and collectively as a
profession to make the change happen. Be sure that you are realistic about the time, energy, and
fiscal resources you have to implement your plan.
Answer: The things that I would like to change about nursing or the health-care system are:
1. Conducive nurse-patient ratio for every staff nurse in order to promote stress-free and
safe environment.
2. Embracing the new technological advancement made in the health-care system.
3. More emphasis to data privacy and push to digital information rather than the traditional
handwritten information.
4. Policies and regulations to increase the salary compensation of health care workers.
5. Change the system of provocation of experienced nurses on the novice/beginner nurses,
especially in assigning of work per seniority.

LEARNING EXERCISE 6.6

Realistic Advocacy for the Nursing Profession
Do you belong to your state nursing organization or student nursing organization? Why or why
not? Make a list of six other things that you could do to advocate for the profession. Be specific.
Is your list realistic in terms of your energy and commitment to nursing?
Answer: As of now, I am still not involved in any state nursing organization or student nursing
organization as I do not have the capacity and capability to function in both extracurricular
activity and studies. My list of six other things that I can do to advocate for the profession are:
1. A safe and beginner friendly environment that nurtures both student-learners and novice
nurse.
2. A Nurse-to-patient ratio be centralized so as to lessen the burden of the nursing
workforce.
3. Abolition of short-end contracts for new nurses.
4. A salary increase for nurses working 16 hours in a given week, plus incentives
 5. A workplace with technological advancement to minimize reliance on traditional way of
doing nursing
6. Involvement of the nursing profession in decision involving the health care as a whole.
LEARNING EXERCISE 6.7
Preparing for a Media Interview
You are the staffing coordinator for a medium-sized community hospital in California. Minimum
staffing ratios were implemented in January 2004. Although this has represented an even greater
challenge in terms of meeting your organization’s daily staffing needs, you believe that the
impetus behind the legislative mandate was sound. You also are a member of the state nursing
association that sponsored this legislation and wrote letters of support for its passage. The
hospital that employs you and the state hospital association fought unsuccessfully against the
passage of minimum staffing ratios.
The local newspaper contacted you this morning and wants to interview you about
staffing ratios in general as well as how these ratios are impacting the local hospital. You
approach your chief nursing officer, and she tells you to go ahead and do the interview if you
want but to remember that you are a representative of the hospital.
ASSIGNMENT:
Assume that you have agreed to participate in the interview.
1. How might you go about preparing for the interview?
Answer: Being self-aware and creating an overview of pertinent data in the area I plan to discuss
in the interview will help me prepare for this interview. Additionally, I will prepare for any
questions that might be asked of me so that I can respond to them without stuttering and
unnecessary pauses.
2. Identify three factual points that you can state during the interview as your sound bites. What
would be your primary points of emphasis?
Answer: The three factual points that I can state during the interview are:
1. The community hospital I am working is in need of additional staffing to promote quality
care to patients
2. New laws are needed to incentivize nursing professional to pursue and apply back to the
nursing profession.
3. The working condition that we are in, is not safe both to the patient and staff nurses due
to nursing staff shortage.
My primary points of emphasis in this interview will have to be a call to nurses to work
back on the profession in order to provide quality of care to the patients and that the legislative
authorities will shift their focus on the salary increase to motivate nurses.
3. Is there a way to reconcile the conflict between your personal feelings about staffing ratios and
those of your employer? How would you respond if asked directly by the reporter to comment
about whether staffing ratios are a good idea?
Answer: There is a way to reconcile the conflict between your personal feelings about staffing
ratios and those of my employer but it would require them to rethink their decisions because the
burden set to us is way too burdensome in our part. I would respond in a way that it articulates a
plead for them to also promote safety and well-being of being a nurse in this community
hospital.

LEARNING EXERCISE 6.8

Ethics and Advocacy
You are a new graduate staff nurse in a home health agency. One of your clients is a 23-year-old
man with acute schizophrenia who was just released from the local county, acute care, behavioral
health-care facility, following a 72-hour hold. He has no insurance. His family no longer has
contact with him, and he is unable to hold a permanent job. He is noncompliant in taking his
prescription drugs for schizophrenia. He is homeless and has been sleeping and eating
intermittently at the local homeless shelter; however, he was recently asked not to return because
he is increasingly agitated and, at times, violent. He calls you today and asks you “to help him
with the voices in his head.” You approach the senior registered nurse (RN) case manager in the
facility for help in identifying options for this individual to get the behavioral health-care
services that he needs. She suggests that you tell the patient to go to Maxwell’s Mini Mart, a
local convenience store, at 3 PM today and wait by the counter. Then she tells you that you
should contact the police at 2:55 PM and tell them that Maxwell’s Mini Mart is being robbed by
your patient so that he will be arrested. She states, “I do this with all of my uninsured mental
health patients, since the state Medicaid program offers only limited mental health services and
the “patients really have a chance of getting better.” She ends the conversation by saying, “I
know you are a new nurse and don’t understand how the real-world works, but the reality is that
this is the only way I can advocate for patients like this, and you need to do the same for your
patients.”
1. Will you follow the advice of the senior RN case manager?
Answer: I will not follow the advice of senior RN case manager in trying to falsely accuse the
patient of robbing a store even though it is not true, and that she thinks that this is the only way
for the patient to have his Medicaid compensation for his case as it is not ethically justifiable and
I am putting my patient in a situation where he might be falsely imprisoned because of an
incident that I made.
2. If not, how else can you advocate for this patient?
Answer: I would try to contact support groups and suitable mental institute to transfer the patient
so that he can get the best possible care for his current condition, and also, he will be surrounded
with people with the same problem and so it can create a welcoming environment that maybe
therapeutic to this patient.