Principles of patient advocacy

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Andrew, a 17-year-old, is a talented baseball player. He plays 3rd base for a local high school and has a great batting average. Because Andrew is so accomplished, he is hoping for a full athletic scholarship to the state university. He plans to pursue a degree in engineering or computer science. He is the oldest of three children. He is active in his church and community. His father works two part-time jobs and his mother is unemployed.

Today Andrew is practicing with the high school baseball team. A baseball hits him in his head. He falls to the ground and becomes non-responsive.

The baseball coach calls an ambulance and Andrew is taken to the local emergency room. In the emergency room, Andrew is non-responsive and his breathing is labored necessitating intubation. He has a large laceration on his back because of the fall. He is stabilized and transferred to the medical intensive care unit (MICU). The hospitalist managing the MICU admits Andrew and immediately orders an interprofessional care team consultation.

Address of the following question regarding this case and provide evidence to support it from our course materials or outside readings in your main posts. Respond to one or more other student’s main post.

Andrew’s family is having a great deal of difficulty dealing with Andrew’s condition. They are told that he needs further tests. One is to determine whether his brain is still functioning. As you apply the principles of patient advocacy keep in mind Andrew’s outcome could be good or not so good and the family is struggling. How would you use advocacy in this situation for Andrew, family, friends, and care providers?

Sample Solution

As a patient advocate, I would use the principles of advocacy in this situation by actively listening to Andrew’s family members and providing them with support and information. This could include covering topics such as their rights as guardians or caregivers, the importance of informed consent for testing and treatment decisions, and potential resources available to help manage different aspects of Andrew’s condition. Additionally, I would aim to communicate any updates regarding Andrew’s tests results in an efficient yet compassionate manner so that everyone involved is aware of what is happening at all times (Kurtzman et al., 2018).

In order to create a safe space for discussion between friends, family members and care providers regarding the best course of action for Andrew going forward – one where decisions are made collaboratively instead – it may be helpful to bring together everyone involved in regular meetings or virtual conference calls as needed (Peckham & Siewers-Pickard, 2020). During these sessions it can be beneficial to provide education around ethical considerations related not just to individual decision making but also how they interact with one another since various stakeholders will likely have differing perspectives on what is considered “best” which must be taken into account when determining overall care plans.

Ultimately, regardless of whether the outcome turns out good or bad – both possibilities should be discussed openly among those involved so that everyone can come away from the experience of feeling supported either way (González-Fernández & Moreta-Castillo, 2019). As a patient advocate then, my role would encompass doing whatever I can to make such conversations happen more frequently while helping ensure each party remains aware about his/her respective rights throughout this process.

As humans, we continuously seek out things that can produce pleasurable feelings. One of the few ways to attain this feeling of euphoria or pleasure is by consumption of chemical substances. However, continuous consumption of these substances can lead to development of dependence towards them and this is more commonly known as addiction. Currently, the cost of social and economic impacts due to drugs of abuse addiction sums up to more than $740 billion annually (National Institute on Drug Abuse, 2017). Despite this, the clear neurophysiological mechanisms underlying development and progression of addiction is still unknown.

Addiction can be defined as repeated self-administration of alcohol or other drugs (AOD’s) despite knowledge of adverse medical and social consequences and attempts to abstain from AOD use (Robert & Koob, 1997). Initial intake of drug may be due influenced by genetic, psychosocial or environmental factors however, subsequent doses is most probably caused by action on drug on the brain to induce the drug-seeking behaviour. Addiction is comprised of three stages which are ‘binge/intoxication’, ‘withdrawal/negative affect’, and ‘preoccupation/anticipation’ as seen in Figure 1 (Koob &Volkow, 2010).

Figure 1. The Three stages of addiction and brain areas each stage associates with (Herman & Roberto, 2015)

‘Binge/intoxication’ refers to the consistent intake of drug after initial dose which may cause decrease in dopamine release after each intake due to sensitization. This will then lead to ‘withdrawal/negative affect’ stage where absence of drug will cause a decrease in dopamine causing anxious and restless feelings resulting in the craving or ‘preoccupation/anticipation’ stage. Two major factors known to modulate these behavioural changes are reinforcement where a stimulus increases the chance of response and neuroadaptation, the process by which neuronal structures change in response to drug exposure. Modulation of these factors motivates initial response to a drug and formation of long-term craving however, relapse is thought to be caused by permanent neuroadaptations that will cause discomfort during withdrawal (Robert & Koob, 1997)

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