The Four Spheres of Political Action in Nursing

1
1-Please discuss the four spheres of political action in nursing.
2- in addition, please develop a brief argument sharing how these spheres are
interconnected and overlapping by applying an example from your practice. 
3- What are some ethical considerations here?

Policy and Healthcare

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 web resource section will help you with tracking various policy concerns,
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
concerns 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.

Person-Centered Care
Person-Centered Care
This course, NR 506, will employ the person-centered care model in order to foster
population health (McCormack & McCance, 2017). Population health and healthcare
policy focus on the holistic care and well-being of all individuals within a population
group. The consideration of all dimensions of healthcare align with the needs of society,
healthcare organizations and each individual's specific healthcare needs. Cultural
humility as well as individual's beliefs and values are added to the comprehensive
analysis of population needs and the development of healthcare policies. Advanced
care nurses are empowered to advocate for the healthcare needs of populations to
promote safety and positive health outcomes.

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?

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 a concern. 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 concerns. 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 concerns 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.

Applying the Principles

From the list of current health crisis or concerns 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 concerns, 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, administrators, politicians, doctors, nurses, and so forth—bring
their own professional ethics to bear on the concern at hand. Professional ethics evolve
in certain conditions.
1. Recognition of a social need for a particular type of professional, so there is a
purpose for a professional ethic
2. The expected conduct of the professional
3. 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 concerns
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 concerns in healthcare, as well as media influence on the
concerns. 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 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 concern 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.

ummary

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 concerns
related to policy making and policy decisions.

Prepare for the Assignment

Within this course, you are required to identify a healthcare concern  that is of great
importance to you. Once you have completed background research on the concern ,
you will identify a healthcare policy that addresses the situation and present it face to
face to an elected official.
 
 References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Silver Spring, MD: Nursebooks, Inc.
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (2016). Policy & politics in nursing
and healthcare (7th ed.). Retrieved from http://online.vitalsource.com (Links to an
external site.)
McCormack, B. & McCance, T. (2017). Person-centered practice in nursing and health care:
Theory and practice (2nd ed.). Chichester: West Sussex: Wiley-Blackwell.

Week, COs, and

Readings
Topics

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (2016). Policy & politics
in nursing and healthcare (7th ed.). Retrieved from
https://bookshelf.vitalsource.com

 Chapter 1: Frameworks for Action in Policy and Politics

Week 1  Chapter 2: A Historical Perspective on Policy, Politics and Nursing
 Chapter 3: Advocacy in Nursing and Health Care
COs 1 and 3  Chapter 6: A Primer on Political Philosophy 
 Chapter 15: Health Policy, Politics, and Professional Ethics
Policymaking,
Healthcare and
Gambardella, L.C. (2011). Nursing and politics: Strange bedfellows or compatible
Professional partners in practice? Building a passion for political action. Nursing News,
Nursing 35(2), 13. link to article
Nault, D.S. (2012). Nurses and public policy. The Michigan Nurse, 85(1), 13-20.
Nursing World., "Advocacy resources tools" retrieved
from http://www.nursingworld.org/AdvocacyResourcesTools