In Part I we discussed the essential need for having or being an advocate when you or a loved one is in the hospital. An advocate can operate long distance via phone, but in person is best and may even be necessary.

Here are some of the roles I found extremely useful for an advocate to know and perform:

• Ask if there is a hospitalist in charge of the patient. If so, this is the person in charge of overseeing the patient’s entire case and hopefully, coordinating tests, procedures and medications given. If not, then the admitting doctor is in overall charge, but s/he may not be present or reachable. In this case, step in as the “hospitalist” to oversee everything that is prescribed — tests, procedures and medications alike.
• Know that the admitting doctor is generally the discharging doctor. This is not necessarily the same doctor but could be another member of the same clinic or association sharing their specialty.
• Talk to the nurse in charge of the patient. Know that this nurse changes daily and nightly, though it’s possible over the weekend for them to repeat once. Do not be afraid to do this! It’s generally true that the squeaky wheel gets the most grease, and in this case, you want the best care possible. Explain the patient’s history to each new doctor and nurse. Stay courteous and respectful.
• Talk directly to the doctor if possible (you will need the patient’s permission given to the doctor and possibly a power of attorney depending on what is discussed and your relationship with the patient). Do not be afraid to talk with the doctors! They often find your input helpful, and can give you very useful information and an understanding of why they are taking a certain treatment approach. Be respectful but firm in any requests. Explain the patient’s history to each new doctor and nurse.
• Ask questions. Explore such issues as the doctor’s or nurse’s approach, reasoning for their chosen treatment plan, any possible side effects of recommended drugs, and ask them to explain any tests or procedures you do not understand.
• Take a personal interest in the nurses, doctors, practitioners and people at the nurse’s station. Know their names, find out if they have children, and so on. Many are actually into health food or other shared interests so may be more interested in your patient as a result.
• Research the medications given. They may change daily as new doctors on shifts try something different without knowledge of the patient’s tolerance or history. Particularly, research diseases, treatments and drug side effects or interactions. This will enable you to ask the right questions, make informed decisions and troubleshoot.
• Research any proposed tests or procedures. As in the case of prescribing new medications, each doctor may schedule new tests that might not be appropriate or needed.  
• Facilitate joint decisions. Help the patient decide whether or not they want to take a particular medicine or undergo a certain test or procedure. If the patient can’t be involved in such decisions, then the advocate takes their place (if they have power of health attorney or are accepted as a family member).
• Bring things from home to make the patient comfortable such as a bathrobe and slippers, comforter, shawl, books, music, and other items.
• To help the patient get rest, close the door and post a sign such as, “Do Not Disturb Until ____” and list the chosen hour. Discuss this with the nurses first so they support you in this and can schedule the vitals check accordingly. Give windows of availability so practitioners can plan on it. If needed, sit outside the door yourself and deny entrance firmly but kindly.
• When the patient is awake, keep the door open so people know they may come to perform their tasks during that time. However, realize that a doctor will come in when they wish, regardless of the sign!
• Know that medications often must be given or vitals taken at particular times so consider this when making plans and arranging sleep hours.
• Request vitals to be taken every six hours instead of four if this is possible for your patient. Nurses are generally willing to accommodate this.
• In the evenings it’s often possible for certain therapies to be skipped or vitals postponed so the person can sleep. Check into this and request it.
• Keep cell phone ringers off and text instead.
• Monitor visitors. Ask for people to visit during particular hours, to respect the sign on the door, and ask them to bring what’s needed to support the patient and advocate. Ask them to stay only for a certain amount of time or to do beneficial things with the patient such as read to them, massage their feet or play requested music. Suggest they leave something to “prolong” their stay and presence such as a card, flowers, stuffed animals, book, or something else the patient enjoys.
• Request frequent patient cleaning, changing of sheets and clothes and other services. If your person is less available so they can rest, some of these less “vital” duties are often forgotten or passed over, so ask for them when needed and desired, knowing you may have to wait.
• Be patient. There are other patients with needs, too, sometimes in emergency, and so nurses might not be available exactly when you want.
• Be considerate. Health care providers in hospitals work exceedingly long hours and in high-stress situations, plus they really do have your patient’s best interests at heart. Know that most hospitals have their practitioners work 12-hour shifts several days in a row, which can be wearing indeed!
• Don’t hesitate to massage the patient’s hands, feet, legs, and arms. Ask permission first, but generally touch is missing in western medicine (except for prodding and poking that is!). Most people love just having their feet held and touch is very healing in itself.
• Ask if you can use herbs or other alternative therapies. In a hospital the doctors will generally say they don’t want to know about it, meaning you can proceed, but they can’t legally tell you yes.
• If you plan on giving herbs, know that people in critical or acute conditions usually respond well to herbs. But think simple – single herbs or small formulas. Make them into a tea with hot water (get this from the cafeteria or bring in a thermos) and give in teaspoon doses. In acute conditions, often a formula works quickly with one dose and then is not needed again as the condition changes. Be sure to re-assess the condition before administering herbs.

There are other considerations for hospital stays. One is about being your own advocate. The other two take serious consideration. If you choose to use one or both, I highly recommend you prepare them now so they are available if and when needed. One is a Living Will; the other, a DNR (Do Not Resuscitate order).

Be Your Own Advocate!

The only time I suggest being your own advocate is during non-hospital medical appointments and procedures. If you find yourself in the hospital without an advocate, certainly be assertive for your own needs as you are able. Perhaps even carry this list with you and let the hospital staff know which of these are your specific desires.

Living Will

A Living Will is a legal document that lists a person’s wishes and provides directives about the course of treatment to be followed by health care providers and caregivers. It is sometimes referred to as an advance directive, health care directive, or a physician’s directive. A Living Will may include orders regarding the use or refusal of life-prolonging medical treatments such as tubes, ventilators, and other medical devices. As well, it may specify what actions should be taken should the person no longer be able to make decisions due to illness or incapacity. As well, it may appoint someone to make such decisions on their behalf. An example of a Living Will statement could be: “If I suffer an incurable, irreversible illness, disease, or condition that my attending physician determines is terminal, I direct that life-sustaining measures, which would serve only to prolong my dying, be withheld or discontinued.”

DNR

If desired, also have on hand a pre-prepared DNR. This is a legal order that states, “Do Not Resuscitate” but allow for natural death. It’s generally used in such situations as a heart attack, stopping breathing or advanced cardiac support.

Find Your Advocate Now

I suggest you line up advocates for yourself now. Choose people you trust, who will be there for you no matter what, who have your best interests at heart and who care for you. Then give them this list so they have it on hand if ever needed in the future. I also suggest you determine whom you are willing to be an advocate for and discuss that with them now. Be prepared. If you are admitted to the hospital, have your advocate called and if possible, take this advocate list with you along with any Living Will and/or DNR. Line it up with your siblings, children and friends ahead of time. Carry their phone numbers with you. Have the most important people know about any Living Will and/or DNR you have and give them copies. As well, tell your doctors ahead of time and give them copies. If you are an advocate for someone, be sure that you are notified when they enter the hospital. If you can’t be available, find someone else who can care for them. Ask if they have a Living Will or DNR and act according to their wishes. The better prepared you are for an unforeseen hospital visit, the better your chances of recovery and a swift discharge, or that for whom you are advocating. I know all of this may seem intense, nitpicky and too serious, yet it could save your life or the life of a loved one. May you be prepared with this information and may you never need to use it!