⚖️410: Policy Flashcards
Define policy
A statement of direction resulting from a decision-making process that applies reason, evidence, and values in public or private settings.
Found at multiple levels.
Macro-level policies
National or provincial
Ex. Senators, MPs, ministry of health
Meso-level policies
Regional or institutional policies.
Ex. Hospital CEOs, nurse executives, advanced practice nurses (APNs)
Micro-level policies
Local or unit-based. Clinical programs.
Ex. Department directors, nurses, APNs, nurse managers
Public policy
- Often enacted at a government level.
- Clusters of issues
“Upstream” = addresses social, economic, political, environmental problems causing issue to intervene.
Downstream = addresses issues that are already there and trying to mitigate them.
What were the main reasons in the consolidation of the LHiNs into five geographical regions?
- Eliminating “hallway medicine”, reducing costs, and promoting efficiency
- Reduction of funding for public health
Neoliberal period of public policy in Canada
Hallstrom, 2016
- Reduction of public investments in social resources and structures in favour of privatization
- Concern about gov’t spending
- Reliance on private citizens to manage their own social and health endeavours
What are the two broad groups of health policy?
- Policies directly related to health of population
2. Policies related to the provision of healthcare
Healthy public policy
- Positive impact on the social, economic, and environmental determinants of health
- Intersection of political perspectives/values and its influence on health policy
- Ideally “healthy” defined by research
What are barriers to nurses participating in policy advocacy?
- Unaware of how to influence policy
- Sense that it’s not their job
- High work demands
- Political apathy
- Belief things “never change”
What’s at stake if nurses don’t participate in policy advocacy?
- Perpetuate powerlessness
- Demoralization and frustration
- Decisions made without our input that affect our practice
What are risks of participating in policy advocacy?
- May not lead to change you want
- Putting yourself out there
- Revealing your political or ideological orientation
- Political backlash of those who oppose
What are Malone’s (2005) ten framework questions for assessing policy environment? 🌟
- What is the problem with the current policy?
- Who and how many are affected by this policy?
- Who makes the decisions another the policy?
- What is the process around making policy decisions?
- What possible solutions could be proposed?
- At what level is the problem most effectively addressed?
- What are the ethical arguments involved?
- What are the obstacles to policy intervention?
- What resources are available to support policy intervention?
- How can I get involved in policy intervention/advocacy?
Voluntary ending of a persons life definition
A person makes a conscious decision to End their life and asks for help to do so
Non-voluntary ending of a persons life
A person is unable to give their consent to treatment and another person makes the decision on their behalf.
Passively ending a persons life
The act of intentionally causing someone’s death by withholding or withdrawing treatment, food, or fluids that is necessary to maintain life.
MAID policy adoption
- June 2012, BC Supreme Court declares laws against physician-assisted death were UNCONSTITUTIONAL because they discriminated against people with physical disabilities.
The MAID policy (Bill C-14)
- The administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death.
- The prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer to cause their own death.
- Amends the criminal code
- Specifies eligibility criteria and safeguards
What are the eligibility criteria for MAID?
- At least 18 years
- Capable of making decisions about their health
- Voluntarily request medical assistance in dying
- Give informed consent to receive MAiD after being made aware of additional treatments to relieve suffering
- Eligible to receive Canadian Medicare
- Have a grievous and irremediable medical condition.
What are the 4 stages in the policy cycle? (Villeneuve, 2017)
- Getting to the policy agenda
- Moving into action
- Implementation and change
- Policy evaluation and revision
What are the 14 stages in the policy cycle? (Villeneuve, 2017)
- Values and beliefs
- Problems or issues emerge
- Knowledge development
- Public awareness
- Political engagement
- Stakeholder activation
- Policy deliberation
- Policy adoption
- Preparing for change
- Managing change
- Reinforcing change
- Evaluate content
- Evaluate implementation
- Evaluate impact
In the policy adoption stage of the policy cycle, what is the most important factor to consider?
The process of a bill becoming legislation
In the policy deliberation stage of the policy cycle, what is the most important factor(s) to consider?
- Feasibility
2. Wording and structure
In the political engagement stage of the policy cycle, what is the most important factor(s) to consider?
Understanding decision making structures
In the Preparing for change stage of the policy cycle, what is the most important factor(s) to consider?
Identify potential points of resistance
Direct lobbying
Directly engaging with decision maker.
Ex. Letters, meetings, petitions, etc
Indirect lobbying
Efforts to influence public opinion, which may influence policy makers later.
Ex. Social media, ads, etc
Grassroots lobbying
Mobilizing a committed group of people to influence the opinion of policy makers. Often have champion/advocate.
Includes both direct and indirect.
_______ involves experiential and reflexive learning so practitioners adopt good standards.
Practice
Managerialism
The standardization of everyday nursing practice
Moral ecology
Connection b/w an organization (structure/culture) and the ability of nursing to be a moral practice or the ability of nurses to practice in a moral way.
Can support or restrict. Organizations informally shape people’s moral action by providing background, area and field for moral practice.
Ex. Workload for nurse engagement
Ex. Educational and ethical supports
What are the major characteristics of clinical leadership?
- Clinical experts
- Challenge the status quo
- Reflect positive attitudes toward their profession
- Engages in reflective practice
- Supportive and approachable
- Acts as role model
- Collaborative learning
- A Knowledge source
- Interprets/critiques managerial agenda
- Translates vision fo institution into care delivery
- Strategic vision for frontline practice
Leadership is:
A process (involves interaction) whereby an individual influences a group (followers) to achieve a common goal (movement towards an end).
Why is leadership important for nursing?
- Coordination needed
2. Associates with better patient outcomes
Autocratic leadership
- Decisions are made for staff/followers
- Followers are not able to participate in decision making
- Staff are often unmotivated
Laissez-faire Leadership
- Leader takes a step back
- Important decisions left to staff with little to no direction
- Organization lacks direction
- Work may not be held accountable to operational processes
Transactional Leadership
- Providing rewards for meeting/exceeding expectations
- May offer negative feedback if standards not met
- Considered a “lower order” of leadership
- Bureaucratic leadership:
- maintains formal role
- follows organizational structures
- clarifies work tasks
Transformation al Leadership Theory (Finkelman and Kenner, 2016)
- Dominant leadership theory
- Create vision and mission statements
- “Human-capital-enhancing resource management style”
- Emphasizes positive environment
- Leader characteristics include confidence, self-directed, energetic, flexible, and committed
What are critiques of Transformation al Leadership Theory?
- Focused on heroic and distant leaders
- Idealize leader - follow without challenge
- Less attention to leader personal integrity
- Fails to address immoral leader behaviours
- Sexist stereotypes - often misses feminist perspective
What are the 6 types of power used in leadership?
- Coercive - based on punishment
- Reward
- Persuasive
- Referent - leader admired
- Expert - respected for expertise
- Informational - access and share info
Management
- Accomplishment of tasks/goals.
- Formal authority to direct work of employees.
- Takes responsibility for quality and cost of work
What are the 4 main functions of management?
- Planning
- Organizing
- Directing
- Controlling
What are the 3 types of Leaders in Nursing?
- Frontline Management
- Middle Management
- Nurse Executives
Shared Governance in nursing
Management approach and professional practice model
- Nursing staff are directly involved in decision making, particularly when affects their practice
- Decentralized leadership and autonomous decisions
- May include council structure
What are barriers to clinical leadership?
- Lack of confidence
- Resistance to change
- Clinician cynicism
- Perceptions of leadership as “other”
- Poor interdisciplinary relationships
What are the types of councils found in shared governance?
- Quality Council
- Education Council
- Research Council (apply best practice)
- Management Council
- Coordinating Council - facilitate and integrate activities of other councils
