Leadership and Contemporary Nursing Strategies in Promoting Healthcare Policy, Study Guides, Projects, Research of Leadership and Team Management

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Week 7: Leadership and Contemporary Nursing

Strategies in Promoting Healthcare Policy

Introduction

By now you should have a good understanding of the components of a healthcare policy analysis with subsequent recommendations for change to make a positive impact upon the health of your community and nation. We have covered much material related to the role of nursing in policy making, policy analysis, health care economics, legal concerns relating to public health, ethics and the right to health care, and advocating for populations as leaders in public health. This week we will further examine the role of nurses as leaders in developing and promoting policy. We will look at the impact of networking with the community in promoting the holistic health of our nation. We will also target contemporary concernsin healthcare that will likely play key factors in policymaking today and tomorrow.

Nurses as Leaders in Healthcare Policymaking

It is very important that nurses play a key role in healthcare policymaking as they are at the grassroots level of understanding patient needs and best outcomes of care on a daily moment-to- moment basis. Of all healthcare professionals it is nursing who is most at the patient's side and in tune to patient needs. Hence, as a profession, nursing brings its caring experience as both art and science to the policy table. In addition, nursing must also continue to ensure that their professional input is an integral part of what occurs in healthcare policymaking as a standard of maintaining a position of autonomy in practice. As a profession and discipline we must continue to respect the power of policymaking and speaking in one voice.

Roads to Nurse Leadership in

Healthcare Policy

The roads to nurse leadership in healthcare policy are varied but key factors cited below are foundational for success in this area (Doody & Doody, 2012):

Environment

It is important as a policy maker to pay attention to what is going on around you. From environmental physical conditions to public opinions to state of the milieu (home turf). Some are more obvious than others. Nurse leaders as policymakers should recognize that all these factors play into the feasibility and success of any policy.

Communication Skills

Be aware as a nurse leader in policymaking that non-verbal skills are probably some of your most important talents. Of note, listening is not only an art but a key driver in policy making. Listening lets your constituents know they have been heard and that you are interested in what they have to say; it indicates caring.

Type of Leader

A transformational leader uses personal strength and power to motivate others to meet their goals. That the leader can be trusted seems key to the followers (Doody & Doody, 2012). This leads to followers acting to sustain the greater good rather than serving their own interests.

Shared Governance and Joint Decision Making

Nurse leaders in healthcare policy should foster teamwork (posited in professional organizations and coalitions) as the nature of healthcare policy takes place within a network of patients, professionals, politicians, and organizations. A focus on shared governance and teamwork is a sound leadership strategy in such a complicated milieu (Doody & Doody, 2012).

Evidence-Based Practice

Healthcare policy is effective (most persuasive) when based on research or active public (patient) opinion.

Diversity

Nurse Healthcare Policy Leaders are most effective as policymakers when they pay attention to diversity needs of the public and/or the people they work with or serve. Consensus is often one of the easiest ways to begin to approach diversity.

Week 7: Upstream Thinking

Upstream Thinking

Upstream thinking is a newer method to comprehensively consider the social, economic, and environmental origins of health problems of populations (Auerbach, 2015). Consider the classic analogy by Ashton and Seymour (1988) regarding the metaphor of rescue workers along a fast- moving river to explain manifestations of upstream thinking. A Community in Crisis Watch the following video. It depicts a community in crisis. People are experiencing severe GI symptoms; a primary reason for local hospitalizations. Cases of cholera are also being reported.

A Community in Crisis

Can you answer this? Using principles of Upstream Thinking select a priority community health threat. Develop a healthcare policy to remedy this situation. The cemetery is too close to the water supply. The rain and local flooding make this situation worse. Healthcare policy: Relocate the cemetery in community planning. "Every so often a drowning person is swept along side. The lifesaver dives in to the rescue, retrieves the 'patient' and resuscitates them. Just as they have finished another casualty appears alongside. So busy and involved are the lifesavers in all of this rescue work that they have no time to walk upstream and see why it is that so many people are falling into the river." Here, the metaphor is used to argue that what is needed among healthcare workers is more "upstream" thinking that would reorient the health care system towards addressing and preventing causes of disease and disability.

In a similar manner, public health is influenced by numerous elements—some are local (i.e. outbreak of influenza) while some are more distance or upstream (i.e. state regulations of healthcare access). If only local elements impacting public health are consider, the long term impact from more far reaching elements maybe neglected (Kelly, 2014). Seeing beyond the local, to consider broader health elements such as incomes, education, social supports and housing will allow investment into long term elements that impact quality of life and therefore public health (Kelly, 2014). Identification of "upstream" elements impacting upon the health of communities and neighborhoods may be a contemporary approach used in policymaking by Nurse Leaders as a means to promote the health of our nation. Healthcare Policy and Communities Learning about and becoming a part of one's community is the best starting place for nurse-advocacy efforts, either individually or as a member of a nursing organization. The baccalaureate nursing curriculum requires that nurses take theory and clinical courses in community-health nursing with the intent to get nurses involved in their communities. The nursing process forms the foundation to gain an understanding of the concerns affecting communities and the individuals living in them. Exactly what is a community? A community is an environment with physical, social, economic, and political factors that is more than simply a neighborhood or a place because it is sustained by public policies. The quality of resources available and accessible within any given community directly affects the health of those living within it. Moreover, The Developing Healthy People initiative of 2020 (United States Department of Health and Human Services [USDHHS, 2010]) aims to decrease health disparities and promote health in the community setting. This initiative places nurses in key policymaking positions within their communities. What kinds of resources and infrastructure are essential for healthy communities? A look at communities that have endured some type of disaster leads to an understanding of the critical importance of basic infrastructure. When H1N1 struck many communities at pandemic levels in 2009, what types of community resources were lacking or absent? Consider childcare, transportation, social support, sanitation, health, education, fire, and police services in this pandemic situation. In addition, other important structures in a community, such as civic opportunities, help to build a sense of community and cohesion. The Big Brothers organization is an example of a successful civic organization. Efforts to promote healthcare professionals and services support the communities in which those professionals serve and live. Community bonds are part of a nation's heritage;

strong resources in a community build healthy families, communities, and nations. Primary-care nursing activities are geared toward helping patients maintain and improve health while preventing future illnesses. These services are provided within the community rather than in a hospital setting. The role for nurses in primary care and community-based care focuses on community action. This encompasses developing the community members' skills (train the trainer), building supportive environments, and creating health-oriented public policies. Partnerships are important in communities. Community partnerships for health include initial embedding within the community in order to identify the community health workers who can act as catalysts in setting up basic services. Community health workers are leaders within the community who have the trust of community members, an important consideration in communities made up of ethnic groups. Many times, predominately ethnic communities are more effectively approached by a member of the particular ethnic group. Community health workers (also known as outreach advisors and workers) work to empower members of the community to develop plans based on identified needs and to implement solutions appropriate for their specific needs. Nursing policy advocacy efforts must be aimed at local, state, and national levels in order to effectively set up services that can endure. Nurses can strategically position themselves within communities as members of that community and act as liaisons between policymakers and community health workers. Within the community, nurses can work with groups of patients (such as women with children or adolescents) to identify health priorities and provide primary healthcare services. It is through this sense of shared community membership that nurses gain trust and support. It only makes sense to approach any healthcare-related problem from within one's own community and to approach healthcare from health promotion and prevention levels rather than after illness has already occurred. Nurses need to focus on the whole of the community, especially at the outset, rather than merely concentrating on pieces within it. Policies that nurses can partner to impact within communities include the following. ● Housing ● Food ● Labor ● Aging ● Environmental ● Social ● Educational ● Safety The following case study illustrates the interrelationships involved in community health concerns and levels of public policy making appropriate for nurse advocates.

Case Study—School X The company proposing to install the vending machines is contributing a sizable donation to the school and providing free t-shirts with the company logo for all school children. Most members of the board are excited about the contribution monies from this company and are focused on the immediate uses and possibilities this money represents. As a nurse leader, what strategies will you adopt within this community in order to highlight healthcare concerns in this situation? Assume your own children attend this school. How might you use community health workers in your advocacy efforts? How would you plan your presentation to this school board? What alternatives to the vending machines and their food items can you propose, and what are the implications of each alternative?

The Question

The United States Department of Health and Human Services (USDHHS) prioritizes two initiatives in the document Healthy People 2010 that directly impact nursing's policy making and advocacy efforts, particularly in communities. What are those two initiatives and why are they important?

Your Answer

The two initiatives are to (1) decrease disparities and (2) emphasize health promotion. These two are priorities because they address the inequity of healthcare and access to healthcare among individuals and groups of individuals. Emphasizing health promotion strategies shifts the focus from illness care to healthcare. Illness can be prevented and costs significantly decreased. Compare Answers How do the Healthy People 2020 priorities relate to the above case study? As you reflect upon this case study, recall what you have learned about research and evidence- based practice. Remember when we discussed research and healthcare-policy campaigns and the Back to Sleep campaign for SIDS? Instead of waiting for the best possible evidence, the best available evidence was immediately put into a campaign to get the message out about this simple yet highly effective lifesaving strategy. Do we need to do the same thing for the epidemic of childhood obesity? The evidence demonstrates that both society and appropriate organizations must implement strategies to get kids physically active, decrease the intake of junk food,

promote breastfeeding, decrease television time, and engage children in services to enhance and support these basic measures. These strategies can be implemented while the research is ongoing, using results of implementing the strategy to generate further research. Lobbying efforts need to focus on both the actual problem, as well as continued research to address it and all its consequences. Remember last week's lesson and the discussion about media influences? Consider the ethics involved in healthcare policies. In addition, consider hidden agendas, stakeholders, and incentives that line the pockets of the stakeholders. Can morality be legislated? Can personal responsibility be legislated?

Week 7: Population Health and Safety

Population Health

Population health is a newer term that should not be confused with public health. Population health refers to the health outcomes that focus on a group of individuals. The size of the population or group can vary from small (i.e. a rural community of 200 individuals) to a hug group (i.e. all of the residents of an entire country). When evaluating the health of a population group it is important to consider all of the conditions and factors that may influence health. A few of these are identified to include, but are not limited to: ● Available medical care ● Demonstrating public health actions ● Demonstrating self-care actions ● Factors associated with the environment. No matter which of the above factors are being evaluated the key to population health is advocacy and polices that result in decreased health disparities. Population health is a progressive community oriented effort to focus care on health promotion, prevention, and treatment services targeted at patient populations (age, diagnosis, consumer

needs, etc.). Healthcare needs are based on a holistic community assessment of services and infrastructures available to the patient. Prevention, curative, and rehabilitative services would be available as needed with the basic goal of keeping the patient out of the hospital and stable at home. Population health as we shall see in the following discussion takes on the persona of consumer needs and preferences for healthcare. Related to population health is safety. Safety Using a very broad explanation, safety refers to being protected with goal being to prevent danger, risk, and/or injury. Hazards are to be limited or controlled as much as possible so that either the risk level is acceptable or eliminated. When discussing safety, there are numerous types or areas that can be the focus. The following are a limited number of examples: ● Occupational/work place safety ● Patient safety ● Environmental safety ● Biological hazards safety ● Nuclear safety ● Eye safety ● Fire safety The study of safety is concerned with two major elements which are noted to be:

1. Behaviors related to injury and/or incident prevention
2. Behaviors that foster a desirable safety culture and related actions All of these topics are related to the consumer or the user of healthcare. Consumer Considerations The Patient as consumer of services will be a key player in the future of Population Health as a service model of care. Nurse Leaders wishing to implement progressive policymaking that positively impacts upon the public should reflect on the following (Health Forum, 2015): ● Future successes of population health will call for consumer friendly hospitals and adjunct health services that reflect the

consumer's mindset (for example even terminology will likely be more patient friendly; consider "health home" instead of "nursing home"); ● Patients as consumers want convenient access to healthcare and a constellation of services in some sort of systematic user friendly way that they can use (for example easy connections to adjunct services such as outpatient pharmacy, home medical equipment, and mobile diagnostic screening units, outpatient rehabilitation services, etc.); ● User friendly informatics (can the older population use the admission electronic keyboard?); ● Quality transitional care models from hospital to home must be in place (look at admission and discharge processes and home care as well as hospice services); ● Consumer engagement over the lifetime in terms of shared decision making and shared plans of care (what qualities of service provoke consumer loyalty?); ● Family engagement in terms of shared decision making and shared plans of care; ● Wellness focus (weight reduction and smoking cessation, for example); and a ● Patient education focus (a self-care focus with new dimensions and definitions of health that continue to be shaped by technology and advances in medicine as well as a public expanding consciousness of self).

Week 7: Summary a

Summary

The content in this lesson was designed to empower you to be a more effective nurse leader in healthcare policymaking. An awareness of the opportunities of networking with the community is a good step in this process. It is also good to remember that utilization of upstream thinking and consideration of consumer preferences when developing healthcare models of service delivery may provide rich ground for policymaking. Next week, the focus will be on examining nursing and healthcare policy in the global context as we wrap up this course. The international community will be the canvas for understanding how policy and policy making come together in a larger sense and how all aspects of healthcare and healthcare policy are interrelated to some extent.

References

Ashton, J., & Seymour, H. (1988). The new public health. Philadelphia: Open University Press. Auerbach, J. 2015. Creating a diversified portfolio of population health measures within payment and healthcare reform. AJPH 105 (3), 427-431.

Butterfield, P. (2002). Upstream reflections on environmental health: An abbreviated history and framework for action. Advanced Nursing Science, 25 (1), 32-49. Doody O. & Doody, C. (2012). Transformational leadership in nursing practice. British Journal of Nursing, 21 (20), 1212-1218. U.S. Department of Health and Human Services (USDHHS). (2010). Healthy people 2020. Retrieved from http://www.healthypeople.gov