Viewpoint: Standing in the gap: How advocacy can ensuring a better outcome for patients

How a child in pain helps her mother understand the power of patient advocacy.

June 1, 2008
By: Claudia Stoffel, RN, MSN

Claudia Stoffel

According to Webster's dictionary, an advocate is one who pleads the cause of another. As both a nurse and a mother, I discovered firsthand the importance of the nurse's role as advocate for the client.

A long, painful night

My daughter has osteogenesis imperfecta, a congenital collagen disorder that causes her bones to bow and break easily. When she was three years old, one surgical procedure involved cutting the femur into pieces to correct the bow, then threading a rod through the newly straightened bone for internal stabilization. The surgeon put my daughter in a hip spica cast (from chest to foot), and explained that the anesthesiologist had placed a nerve block for pain control.

When the block wore off eight hours later, my daughter suddenly was in excruciating pain. The nurse gave her acetaminophen with codeine for the pain and diazepam for muscle spasms. Neither medication relieved her, and the large cast made repositioning for comfort nearly impossible.

I've worked on an acute care pediatric unit, so I've given these same pain meds to children for relief from fractures and other orthopedic problems. Maybe that—or the stress of the moment—is why I didn't question the nurse or ask her to contact the physician for more effective pain control.

Taking a stand

When morning arrived, so did the orthopedic resident and the nurse who would care for my daughter that day. I told the resident that the prescribed pain medication was not effective. His only suggestion was to give the medication every three hours instead of every four. But after he left, the nurse returned with a syringe and slowly injected a small dose of morphine sulfate into my daughter's IV line. She began to relax, and finally fell asleep. When she awoke, the oral medication was more effective.

The nurse had explained to the resident that all children need pain relief for proper healing, and that oral medication often is not adequate immediately after surgery. It was a small thing, but to a child in pain—and the mother who sat with her—her actions meant so very much. She taught me that being an advocate for the client means to "stand in the gap." I never will forget the nurse who saw my daughter's pain and stood in the gap between a child's need for pain relief and the need to educate the resident.

Speak out for patients

Advocacy means recognizing that all clients require individualized care. It may mean calling a physician to clarify orders or helping a doctor interpret a young child's pain.

I share this story with my nursing students to help them understand why they must "stand in the gap" for every client. Small acts of advocacy create life-changing experiences that never will be forgotten.