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Learning Objectives

By the end of this section, you will be able to:

  • Define the components of self-advocacy
  • Outline the strategies that a nurse can use to help promote self-advocacy for clients

Mental health clients enter treatment for various reasons, and it is important to remember that treatment is done with or alongside a client, not to a client. The goal is to work with the client in a collaborative fashion to achieve what they want and what they need, considering the client’s values and beliefs. Mental health recovery belongs to the client, not the nurse. The objective is to accompany the client on their journey.

Defining Self-Advocacy in Mental Health

In a mental health context, self-advocacy means the ability to speak for oneself, have full autonomy, and complete agency. Self-advocacy means expressing personal beliefs, and making needs known, toward meeting personal goals. Ways to enhance and encourage self-advocacy in clients include asking the client to identify what they want and what they need and collaborating with them and their family to achieve the goals the client sets. Self-advocacy according to Davis (2021) includes the following:

  • speaking up for yourself
  • making your own decisions
  • identifying support
  • knowing and owning your rights
  • using problem-solving skills
  • learning about self-determination
  • fighting for your independence
  • owning your actions and words
  • deciding what is suitable for you and going to get it

Self-advocacy can empower the individual, just as support and advocacy from others can promote empowerment. Empowerment is the ability to take the necessary action. For example, clients should feel empowered to ask questions if they feel unsure of something concerning decisions and treatment.

Knowing oneself is a fundamental part of self-advocacy (Disability Resource Center, 2019). The support and encouragement of nurses and family members can hasten the client’s ability to know who they are and begin the process of achieving self-advocacy. The ability to define their illnesses, strengths, and weaknesses is another important part of knowing their needs. The client is the best resource for their needs and accommodations they may require. As they evaluate previous experiences, they can identify what has worked and what has not. Knowing their individual needs can be an asset when conferring with nurses and other mental health-care professionals. Through identifying and putting into words the accommodations they may require, they are more likely to receive what they truly need.

National Alliance on Mental Illness (NAMI) advocate Tracie Noelle writes that mental health-care laws, government regulations, existing research, and standards compose a complex system for users to navigate (2016). Noelle endorses the following strategies for self-advocacy:

  • Participate in the wider community and speak up for mental health resources.
  • Strive for a balance between work and personal life.
  • Work with professional organizations and personal support systems.
  • Vote for political candidates who advocate for mental health needs and contact your representatives.

The Role of the Nurse in Promoting Self-Advocacy in Clients

Mental illness and other medical conditions share characteristics, such as chronicity, loss of control, and numerous treatment methodologies. Client advocacy is part of every nurse’s role. When nurses keep clients safe, find answers to clients’ questions, and bring clients’ concerns to those able to address the concerns, this is client advocacy. When nurses teach and role model these actions, this is the promotion of client self-advocacy. The role of the psychiatric-mental health nurse in promoting self-advocacy in clients is critical because clients are socially and legally vulnerable (Faleti, 2020).

Clinical Judgment Measurement Model

Applying the CJMM to Client Advocacy

Kimberly is a psychiatric nurse working in an inpatient psychiatric unit. She is assigned to care for Janet, a twenty-five-year-old female admitted voluntarily for treatment of severe depression and suicidal ideation. Janet has a history of trauma and has been struggling with feelings of hopelessness and worthlessness. Kimberly is responsible for providing therapeutic interventions and ensuring Janet’s safety during her hospitalization.

Kimberly uses the Clinical Judgment Measurement Model to advocate for Janet.

Recognize Cues Kimberly recognizes the cues indicating Janet’s distress, including her withdrawn demeanor, tearfulness, and expressions of hopelessness. She assesses Janet’s mental status and identifies potential risks to her safety, including the presence of suicidal ideation.
Analyze Cues Kimberly analyzes Janet’s behavior in the context of her psychiatric history and current symptoms. She considers the underlying factors contributing to Janet’s depression, such as past trauma, and recognizes the importance of providing a safe and supportive environment for her recovery.
Prioritize Hypotheses Kimberly prioritizes the need to address Janet’s suicidal ideation and provide emotional support and therapeutic interventions. She considers the potential consequences of untreated depression and suicidal thoughts, including the risk of self-harm or suicide.
Generate Solutions Kimberly develops a plan of care focused on suicide prevention and emotional support. She engages Janet in therapeutic communication, providing empathy, validation, and active listening. Kimberly collaborates with the treatment team to implement evidence-based interventions, such as cognitive behavioral therapy and medication management, tailored to Janet’s individual needs.
Take Action Kimberly takes proactive measures to ensure Janet’s safety and well-being. She conducts frequent suicide risk assessments, implements safety precautions, and maintains close observation of Janet’s behavior. Kimberly advocates for additional resources and support services to address Janet’s complex needs effectively.
Evaluate Outcome Kimberly evaluates the effectiveness of interventions by assessing Janet’s response to treatment, including changes in her mood, thoughts, and behaviors. She monitors for signs of improvement or worsening of symptoms and adjusts the plan of care accordingly. Kimberly communicates regularly with Janet and the treatment team to ensure ongoing collaboration and support.
Table 12.2 CJMM Model for Advocacy for Janet

Kimberly demonstrates effective client advocacy in psychiatric-mental health nursing by applying the Clinical Judgment Measurement Model. Through recognition of cues, analysis, prioritization, generation of solutions, action, and evaluation, Kimberly advocates for Janet’s safety, well-being, and recovery. By empowering, educating, supporting, collaborating with, and ensuring the safety of her client, Kimberly promotes compassionate and client-centered care in a psychiatric-mental health nursing situation.

Nurse as Educator

Client teaching may occur in formal or informal settings and may include instructions for significant life changes or simple tips for immediate change. The nurse’s first step is to determine what the client already knows about the subject, then what, and how they would like to learn.

When teaching self-advocacy, the nurse may suggest the client keep a list of their questions to ask the provider on rounds or the social worker in a team treatment meeting. The nurse can pose questions to the client such as, “What is most important to you about      ?” or “How do you think we could best help you with this?” Then, the nurse develops strategies with the client to have their needs met, such as, practicing with the client how they will present their questions or how they will access resources.

Nurse as Role Model

When nurses are observed by peers and coworkers encouraging clients to participate in their care, this has influence. Other caregivers may witness how the nurse encourages and assists the client to advocate for self and realize the positive impact this can have on outcomes of care.

During interactions with other professionals, the nurse may prompt the client, “Was there more you wanted to discuss today?” or “Did you have another question about your medication?” This provides an invitation for the client to speak for self and feel successful in having their own needs met.


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