4 Client Advocacy and Patient Safety

Center the client in care

Client advocacy means helping protect a person’s safety, dignity, rights, and access to appropriate care. An advocate may be the client, a family member or chosen support person, or a healthcare professional. Advocacy involves listening to the client, clarifying concerns, sharing relevant information with the care team, and helping resolve barriers. It does not mean making decisions for a client who can make their own decisions.

Respect the client’s right to receive understandable information, take part in care planning, and accept or refuse treatment. Ask whom the client wants involved, and follow applicable rules for representatives and decision-making. A disagreement with a client’s preference calls for a respectful explanation of options and risks, not disregard for the client’s voice.

Shared decision-making brings together clinical evidence and the care team’s expertise with the client’s values, goals, and circumstances.

Speak up about safety

Raise safety concerns promptly, clearly, and respectfully. Describe specific observations rather than assigning blame: explain what you noticed, why it may be unsafe, and what action or clarification is needed. For example: “I’m concerned that the new weakness is a change from this morning. Could we reassess the client before discharge?”

TeamSTEPPS tools can help when a concern is not resolved:

• Assertive statement: State the concern, explain the safety problem, suggest an action, and confirm agreement.

• CUS: Say, “I am concerned,” “I am uncomfortable,” and, if needed, “This is a safety issue.”

• Two-Challenge Rule: If the first concern is not acknowledged, restate it clearly. If it remains unresolved, use the organization’s escalation or chain-of-command process. For immediate danger, act according to emergency procedures and your role.

Listen when someone else speaks up, acknowledge the concern, and clarify the next step. After an event or near miss, report it through the appropriate process and document objective facts according to policy. Documentation supports continuity and review, but it does not replace urgent communication.

Support preferences and access

Ask what matters to the client, including goals, routines, cultural or spiritual considerations, preferred supports, and concerns about treatment or discharge. Confirm understanding in plain language and use teach-back. Include preferences in handoffs and care plans so the whole team can act on them.

Notice and address barriers to care. Barriers may include language differences, communication or mobility disabilities, transportation, cost, difficulty arranging follow-up, or lack of needed equipment. With the client’s permission, coordinate with appropriate team members, such as nursing, the prescriber, pharmacy, social work, case management, interpreters, or community services. Follow up to check whether the connection worked.

When a client has limited English proficiency, arrange qualified language assistance when needed for meaningful communication. Do not assume conversational English is enough for complex health information. For communication disabilities, ask the person what works for them and arrange appropriate aids or services, such as a qualified sign-language interpreter or accessible written information. Speak directly to the client, not only to an interpreter or companion.

Apply advocacy to discharge planning

A client says they do not understand the discharge instructions and cannot get to the follow-up appointment. The nurse pauses discharge teaching, checks understanding without blame, and asks what support the client prefers. The nurse arranges an interpreter if needed, alerts the care team, and works with case management to explore feasible follow-up and transportation options.

The team confirms the plan with the client, communicates it in the handoff, and documents the actions taken. This response combines clear communication, attention to the client’s preferences, coordination across the team, and follow-up on whether the plan is workable.