Empowerment as an alternative to traditional patient advocacy roles
- Authors: Cole, Clare , Mummery, Jane , Peck, Blake
- Date: 2022
- Type: Text , Journal article
- Relation: Nursing Ethics Vol. 29, no. 7-8 (2022), p. 1553-1561
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- Description: There has long been acceptance within healthcare that one of the roles that nurses fulfil is to do with patient advocacy. This has historically been positioned as part of the philosophical and inherent requirements of the nursing profession at large and is supported through shared conceptualisations of the nursing profession. Such conceptualisations are communicated to nursing professionals by way of first their education, and second their professional codes, guidelines and standards for practice. The focus on advocacy is further embedded within patient-centred care frameworks and concepts of the nurse–patient therapeutic relationship. Nurses have also been considered ideally placed to undertake the work of patient advocacy due to the 24/7 nature and intimacy of the care provided. What this means is that nurses are under the impression that that they must be an advocate for their patients through their nursing practice. However, for a fundamental concept of nursing, advocacy is poorly defined, and practices commonly associated with advocacy are undercut by the professionalisation of nursing and other constraints. In addition, nursing standards and frameworks of care are being actively reframed around ideas of empowerment which do not necessarily fit well with those of advocacy. This article thus suggests that it is time to recognise that the work of advocacy is no longer representative of what nurses (can) do in practice, and to explicitly reorient conceptualisations of nurse practice around empowerment. This article will further analyse what this may look like in practice. © The Author(s) 2022.
Problematising autonomy and advocacy in nursing
- Authors: Cole, Clare , Wellard, Sally , Mummery, Jane
- Date: 2014
- Type: Text , Journal article
- Relation: Nursing Ethics Vol. 21, no. 5 (2014), p. 576-582
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- Description: Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses' work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate. © The Author(s) 2014.
Implied consent and nursing practice : Ethical or convenient?
- Authors: Cole, Clare
- Date: 2012
- Type: Text , Journal article
- Relation: Nursing Ethics Vol. 19, no. 4 (2012), p. 550-557
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- Description: Nursing professionals in a variety of practice settings routinely use implied consent. This form of consent is used in place of or in conjunction with informed or explicit consent. This article looks at one aspect of a qualitative exploratory study conducted in a Day of Surgery Admission unit. This article focuses on the examination of nurses' understandings of implied consent and its use in patient care in nursing practice. Data were collected through one-on-one interviews and analysed using a thematic analysis. Nurses participating in this study revealed that they routinely used implied consent in their nursing practice. This article will look at whether implied consent supports or impedes a patient's autonomy. © The Author(s) 2012.
Advocates or corporates : constructions of clinical nursing practice in Australia with regards to the idealisation of advocacy and autonomy
- Authors: Cole, Clare
- Date: 2019
- Type: Text , Thesis , PhD
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- Description: Although the idealisation of nurses as advocates is popularised in nursing literature and supported within nursing frameworks, codes and standards, there has been little critical examination of these ideas within contemporary Australian healthcare settings and nursing practice. The Australian Healthcare system is a complicated system of interacting service providers and consumers. Institutions that regulate healthcare professionals and organisations normalise understandings of nursing and nursing practice, including conceptualisations of the importance of autonomy and advocacy and how each is to be supported and/or practised. This study used the perceptions of practising Registered Nurses (RNs) to examine the actualities of advocacy and support for autonomy as they are carried out within clinical practice, and to highlight, problematise and then analyse differences between the rhetoric and realities of practice. Firstly, a phenomenological lens, including an ethnographic model of observation, was used to thematically map and examine the RNs’ lived experience of their practice, paying particular attention to their conceptions of and responsibilities toward advocacy and autonomy. This thematic analysis brought to the fore a range of assumptions that, although clearly normative within nursing practice, are in evident tension with one other. These were then re-examined using a range of Michel Foucault’s concepts concerning the construction and maintenance of regimes of truth. Designed to unpack the operations of power and knowledge, and to make visible the techniques of disciplinarity and governmentality that inform and support them, an engagement of these concepts has allowed this thesis to critically examine the normative constructions and enactments of nursing practice with regards to ideas and practices concerning advocacy and autonomy. What this thesis provides is a detailed examination of the contrasting constructions of power and knowledge within nursing practice in relation to advocacy and autonomy, how and why these concepts have been operationalised within nursing practice, and how they could be re-visioned into the future.
- Description: Doctor of Philosophy
Professionalising care into compliance : the challenge for personalised care models
- Authors: Cole, Clare , Mummery, Jane , Peck, Blake
- Date: 2023
- Type: Text , Journal article
- Relation: Nursing Inquiry Vol. 30, no. 3 (2023), p.
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- Description: One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person-centred practice (PCP). Although the idealisation of nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient-centred care. © 2022 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.
Nursing assessment of older people who are in hospital : Exploring registered nurses' understanding of their assessment skills
- Authors: Penney, Wendy , Poulter, Nola , Cole, Clare , Wellard, Sally
- Date: 2016
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 52, no. 2-3 (2016), p. 313-325
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- Description: Background: Nurses worldwide are expected to take a leading role in caring for older people. Considerable literature dedicated to the range and application of assessment skills used by nurses vary. There is limited knowledge of registered nurses' (RNs) views of their assessment of older adults.Aim: The aim of this project was to explore RNs current perceptions of nursing assessment, and the core skills they identified as necessary.Design: A qualitative descriptive design study was conducted in three inpatient units in one regional hospital in Victoria.Method: Date were collected through participant observation of RNs (n = 13) followed by 1:1 semi-structured interviews. Data were analysed thematically.Conclusion: This research has illuminated that an ill-defined repertoire of skills was used by RNs when assessing older persons. Skills identified appeared to be based on years of personal-professional experience. Differences were noted between the descriptions nurses gave and what was observed during interactions with older persons.