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This is MSN in nursing course "Health care policy"

Discussion thread: The Four Spheres of Political Action in Nursing

Question:

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.


Lesson

 

Policy Making, Healthcare and Professional Nursing

 


 

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Introduction

 

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

 

community.

 


 

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

 


 

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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?

 

Reflection

 

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

 

of the following levels:

 

Workplace/workforce

 

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

 

individuals.

 

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.

 


 

Flashcards

 

Print

 

Shuffle

 

Beneficence

 

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

 

making.

 

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,

 


 

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2

 

3

 


 

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

 

practice

 

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.

 


 

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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

 

marketplace

 

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

 

development.

 


 

Summary

 

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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