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This is MSN in nursing course "Health care policy" Discussion

This is MSN in nursing course "Health care policy"

Discussion thread: The Four Spheres of Political Action in Nursing


Please discuss the four spheres of political action in nursing. In addition, please develop a brief argument sharing how these spheres are interconnected and overlapping by applying an example from your practice.



Policy Making, Healthcare and Professional Nursing










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Welcome to the first week of healthcare policy! During this


first week, the focus is on types of policies and their


relationship to healthcare policy. Next there will be a review


of the relationship of values to politics and consideration of


political action spheres applied to nursing. It also is important


to examine the history of policy development and policy


making in nursing. Finally, ethical principles will be


considered in relationship to healthcare policy.


As you begin this course, notice that the conclusions of


several chapters in the textbook contain special features,


such as Vignettes, Policy Spotlights, and Taking


Action. Some of these features are assigned as reading that


serve to provide specific life examples of the topics


discussed in the individual chapters. Take a look at the


contents of these special features, whether assigned or not,


and you may see that some apply directly to your chosen


policy priority. The assigned journal articles further enhance


the content of the readings and lesson. The many websites


for various professional organizations found in the



Webliography will help you with tracking various policy


issues, and they will list important contact information, as


well as examples of position statements and briefs. Finally,


the video links provide presentation examples and ideas, as


well as the video clips that give you a broad understanding


of healthcare policy issues impacting the United States and


the global community.


When you think about policy, and especially healthcare


policy, what comes to mind? It is important to remember that


healthcare is a multifaceted system that is highly convoluted


with many interrelated elements. Changing a policy in one


area may have intentional or unintentional impact upon other


areas. For example, changing access to healthcare may


result in the need for additional advanced practice nurses or


could overwhelm already crowded emergency departments.


Consider possible changes to our American healthcare


policies with new leadership in Washington D. C. In addition,


consider the impact of new policies upon nursing practice in


your community, state, and country, as well as the global





Policy and Healthcare Policy


It is important to consider a basic definition of policy when


embarking upon any discussion of policy in general and


healthcare policy in particular. Policy is a defined course of


action identified by individuals or groups in order to resolve a


concern. Although this represents a fairly broad definition of


policy, it is important to realize that policies can change, and


in fact must change as situations or concerns change.


Consider for a minute an example of a positive and negative


policy you have experienced and its consequences. Public


policies are specific because they are identified and


enforced by public or governmental officials. For example,


requiring specific immunizations of school age children can


come from local school district officials or state government



or even both. Healthcare policies have far-reaching effects.


Consider the ripples that emerge when a pebble is dropped


into a pool of standing water. When the pebble is dropped


into the water, small ripples begin developing around where


the pebble was dropped, and a series of larger ripples


follows with an increasingly wider radius. Consider the wide


reaching impact if the minimum age for Medicare coverage


was raised to 70 years of age! What if the policy was


lowered to 60 years of age?


As noted earlier, healthcare is a complex, convoluted system


that must adapt to changes. The crisis facing the healthcare


system currently are very different from the 1960?s. Take a


minute and identify three current healthcare crisis or


concerns and then compare to the list noted below.



The Question


Identify three healthcare crisis or concerns.



Your Answer












Compare Answers


With limited resources and higher costs, all parts of our


current healthcare system are being severely stressed. In


order for the system as a whole to survive, nurses must


become more involved within healthcare policy making.


Since you realize how important it is for nurses to become


actively involved within healthcare policy making, the only


thing to now consider is what level or sphere of influence


should you be involved at?




Think of an example of how you might get involved at each


of the following levels:




Government (local, state, federal)


Associations and interest groups


Community (local school district)



What would a discussion on policy be without a discussion


about politics? Politics, being a neutral term, refers to the


process of influencing the allocation of scarce resources


(Mason, Gardner, Outlaw, & O'Grady, 2016). Therefore,


politics involves conflicting values and limited resources.


Is it any wonder that the very word?politics?often sparks


such powerful emotions? It is easy to confuse personal


values with facts. Everyone feels passionate about their own


values, attitudes, and beliefs, particularly when they have


had an up close and personal experience with an issue. In


fact some say that politics is the power of influence. Mason


et al. (2016) have identified forces that shape policy. These


are noted in the Figure: 1-1 Forces that Shape Policy.


However, compromise and alternative solutions must be part


of the political process in order for a system to survive.



Professional Nursing?s History of


Healthcare Policy Making


As nurses, we have been consistently judged as one of the


most trusted professions. Strong nurse leaders, such as


Lillian Wald, Margaret Sanger, and Lavinia Dock, worked


tirelessly to promote health and change the lives of millions


of people in this country. Yet, their actions occurred in spite


of being women at a time in our history when women's roles


were those of homemaker and mother without the right to


vote! Oftentimes, these women were persecuted and even


risked jail in order to pursue their agendas of public health,


social welfare, and community service.


Professional nursing as we know it today was started by


Florence Nightingale in the mid-1800s. Her well known


healthcare policy work in the Crimean War reduced the


death rate at one hospital from 42% to 2%. The healthcare


policies that she implemented focused on sanitation and


environmental controls. She opened the nurse-training


program in England with the intention to promote health, as



well as the autonomy of nursing and women. When


Nightingale's model was first applied to schools in the United


States a few years later, the intent was the same. It is her


work to change healthcare policy at the workplace/workforce


level that resulted in her recognition.


Nurse leaders at this time fully realized that their mission of


public health and professional autonomy needed the


strength found only in organizing. If they remained isolated


and alone in their work, they were essentially powerless


against the forces of entrenched medical groups and


hospital boards. The founding editor of the American Journal


of Nursing, Sophia Palmer, specifically used the journal as a


means of enlightening nurses (women) about the importance


of policy and politics. Nurse leaders, such as Isabel


Hampton Robb, organized nurses and began to take control


of the training schools within hospitals so that students


would receive the type of education Nightingale had


intended, instead of the hard-labor model that had evolved.


Within the public-health sector in the early 1900s, nurse


leaders in the United States worked to improve appalling


sanitary conditions, especially in poor urban areas. Lillian


Wald organized a group of nurses living within the


community they served and focused on community health


issues. Today, it is difficult to imagine the social conditions of


that time: Sanitation was nonexistent, overcrowding was


rampant, and poverty was pervasive. Often, it was the


women and children who bore the brunt of the lack of even


the most basic healthcare. Margaret Sanger fought to


promote access to birth control education, fully


understanding and using political strategies in advocating for


women's health. Lavinia Dock worked to organize nurses


and involve them in the suffrage movement, realizing that


this political action would significantly strengthen nursing's


voice in all areas of healthcare policy. Appealing to nurses as


women and citing the social plight of underfed school



children in New York, Dock noted that this translated into the


political power to change not only that situation but countless


others that affect the health and social conditions of all




Out of the efforts of these women came health and social


policies that transformed the quality and quantity of life in


this country, and the ripple effect impacted the global


community, as well. Consider each of these and other nurse


leaders from history in terms of the four spheres of political


action and political development. These women understood


the critical importance of politics and policy making and the


impact of policy on their advocacy agendas. Their focus was


on the political process, and their goal was to impact health


promotion and wellness in order to prevent illness, rather


than simply treating what already existed. In this way, they


understood that they could help far more people and


promote the health of generations to come.


Throughout the intervening decades, nurse leaders in all


areas of nursing followed in the footsteps of early activists


and learned from their strategies. Ponder the fact that nurses


have a significant way to go in terms of nursing leadership in


the government sphere. What do you think needs to change


or improve in order for nurses to get more politically active in


the government sphere? Will you be an active participant at


this level? How can you move in this general direction?



Ethics and Healthcare Policy


One cannot possibly discuss politics and policy making


without first reviewing the basics of ethics. Healthcare policy


ethics is one of the most hotly debated and hard-fought


issues in politics, especially here in the United States. With


the rising costs and limited resources involved in healthcare


services in this country, ethical problems and dilemmas


appear on every horizon. When discussing ethics and


healthcare policy, it is good to review basic ethical principles



Review the ethical principles and see a description of each.











The obligation of healthcare provides to provide assistance


to those individuals who are in need.


Card 1 of 4


View each term then click "Flip Card" to see the definition.



Previous Card


Flip Card


Next Card


Applying the Principles


From the list of current health crisis or issues that you


developed earlier in the lesson?consider one identified


crisis and apply the four ethical principles to it.


When faced with an ethical dilemma, nurses understand that


it is helpful to use an ethical decision-making model for


examining various approaches.


Oftentimes, nurses think they are faced with an ethical


dilemma, only to realize that after obtaining more


information, no actual dilemma exists. As you consider


potential policy-priority issues, take a minute to apply an


ethical-decision model. Nurses face ethical problems every


day, but an ethical dilemma places an ethical problem on a


much higher level, calling for firm action and decision




Over the past several years, there have been many


politically charged ethical dilemmas in the news. Ethical


dilemmas abound in politics and policy making because of


the nature of competition for scarce resources. Various


professionals involved in ethical dilemmas?journalists,










administrators, politicians, doctors, nurses, and so forth?


bring their own professional ethics to bear on the issue at


hand. Professional ethics evolve in certain conditions.


Recognition of a social need for a particular type of


professional, so there is a purpose for a professional ethic


The expected conduct of the professional


The outcomes and skills expected in the professional's




As you think about a specific ethical dilemma debated in the


media, consider the professionals involved and their


particular professional ethics. Think about issues with health


such as the possible epidemic with the H1N1 virus. This


situation represented a politically charged true ethical


dilemma in terms of healthcare distribution and allocation of


vaccines. In addition, there were possible ethical


considerations with the distribution of H1N1 antiviral


medications. Lastly, some hospitals had scarce resources in


terms of availability of hospital beds for the treatment of


H1N1 patients and other patients needing care. These


decisions all involve application of ethical principles for


decision making.


It is important to remember professional codes of ethics


when encountering similar ethical dilemmas and issues in


healthcare, as well as media influence on the issues. We will


explore media influence on healthcare in detail in Week 6 by


looking at various professionals with their own codes of


ethics, as well as their own political agendas. Consider the


media's influence and impact on policy, such as policies


involved with the H1N1 epidemic. Refresh your memory by


performing a search on current H1N1 policy and prepare for


the discussion question. As you search about H1N1 policy,


consider the impact of reporting or bias expressed in some


of the media accounts of the epidemic of H1N1. Keep the


H1N1 policy in mind when the course focuses on the media's


impact in policy making in Week 6.












As a nurse, what are your professional ethics? Take some


time to review the American Nurses Association (ANA) Code


of Ethics for Nurses with Interpretive Statements (2015). The


code establishes an ethical framework that applies to all


nurses regardless of role or educational level. Contained


within the code are nine provisions that summarize basic


values and commitments of the nurse, including duty and


loyalty that extend beyond direct patient care. The principles


of distributive justice should also be applied in the ethical


decision-making model. Based on your personal experience


dealing with various ethical dilemmas, consider the following.


To each the same thing


To each according to his or her need


To each according to his or her ability to compete in the open




To each according to his or her merits


Most RNs have discharged patients from the hospital who


have been sent home before they were ready. In fact, not


only were they being discharged far too soon, but it was also


clear that they lacked adequate support or resources at


home. Have you seen suicidal patients denied admission or


discharged within 24 hours of admission? What about the


lack of community resources? An ever-increasing number of


people are unable to access even the most basic of


healthcare services. The issue here is one of limited


resources versus costs. What happens when people are not


provided basic healthcare? What can nurses do about this


situation? How can you as an individual nurse with a


graduate degree help to make life better? This course


provides the opportunity to embrace the political


sophistication and leadership stages of political







Where does the profession of nursing stand today compared



to those nurse leaders of yesteryear in terms of actually


making health promotion and wellness our main focus? How


many lives did efforts of early leaders save? Is your practice


a subset of medicine and the illness model, or is it about


wellness, health promotion, and prevention? It is important


that nurses remain active in policies and healthcare policy.


How can YOU become active?


Next week, the focus involves a closer look at the U.S.


healthcare system and issues related to policy making and


policy decisions.




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