Health Policy and Advocacy at the Local, State, and National Level+ Ethics Flashcards
Nurses who select the community as their area of practice must be especially aware of the impact of:
government, law, and health policy on nursing, health, and the communities in which they practice.
__ changes over time and influence the health care system
Government, law, and political action
pending legislation, not law yet
bill
public health policy for nursing practice:
State nurse practice acts fall under the umbrella of public health policy because they are designed to protect the public as the recipients of nursing care.
A nurse’s scope of practice is included in public health policy.
For the nurses, public health policy affects their personal lives as well as their professional role of advocacy.
Changing public health policy does fall within the scope of nursing practice in that nurses are responsible for identifying, interpreting, and implementing public health laws, regulations, and policies.
the federal agency that has a strong influence on public health activities at state and local level
US Department of Health and Human Services (USDHHS)
pieces of US Department of Health and Human Services (USDHHS)
The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration
things that changes government priority
wars, economic instability, and political differences between parties all shaped the government’s role
develop regulations that implement policies formulated by Congress and provide a significant amount of funding to state and territorial health agencies
federal public health agencies
funding is given to state and territorial health agencies to:
Provide public health services
Survey the nation’s health status and health needs
Set practice standards
Provide expertise that facilitates evidence-based practices
Coordinate public health activities that cross state lines
Support health services research
role of state public health agencies
responsible for monitoring health status and enforcing laws and regulations that protect and improve the public’s health
state public health agencies distribute federal and state funds:
to local public health agencies to implement programs at the community level
examples of state programs:
communicable disease programs
maternal and child health programs
chronic disease prevention programs
injury prevention programs
state public health agencies are responsible for monitoring:
health status and enforcing laws and regulations that protect and improve the public’s health; they do not provide essential public health programs to the community.
roles of local public health agencies
Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community
goal of local public health agencies
to safeguard the public’s health and to improve the community’s health status
example of local public health agencies
A nurse is working at a local health department would likely be providing leadership in planning community health screenings, disseminate health information, provide essential public health services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community.
The majority of local, state, and federal agencies are involved in:
Collecting and analyzing vital statistics
Providing health education and information to the population served
Receiving reports about and investigating and controlling communicable diseases
Protecting the environment to reduce the risk to health
Providing some health services to particular populations at risk or with limited access to care
Planning for and responding to natural and human-made disasters and emergencies
Identifying public health problems for at-risk and high-risk populations
Conducting community assessments to identify community assets and gaps
Partnering with other organizations to develop and implement responses to identified public health concerns
purpose of the Affordable Care Act
Meant to reduce health disparities by increasing access to health insurance so that people could better access healthcare services.
AFA allows children to stay on their parents insurance until:
age 26
does not allow insurance companies to drop people because they have a diagnosis requiring expensive care, and helps others to be able to get the care they need with insurance coverage for their needs.
the law and healthcare
Your state board of nursing governs your nursing license.
State boards of nursing govern each state’s Nurse Practice Act which determines your scope of practice.
North Carolina is a “compact state.”
what is scope of practice
involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers (Nurse Practice Act, Licensure).
what is professional negligence?
Failure to follow scope of practice and licensure can result in professional negligence (or malpractice): An act (or a failure to act) that leads to injury of a client
the nurse’s role in the policy process
Nurses need to be involved in the policy process and understand the importance of involvement in nursing to the clients they serve
For most professional nurses, action is the policy arena comes most easily and naturally through participation in nursing organizations, such as the State Nurses Association, Association of Community Health Nursing Educators (ACHNE), or the Association of Public Health Nurses (APHN).
Nursing advocacy is important! Government and policy have a large impact on nursing and health.
Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care. You also need to know how people can access services so you can help.
examples of nursing in policy process
A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance.
ethical struggle for nurses
Nurses struggle with the rights of individuals and families versus the rights of local groups within a community.
ethical issue examples
COVID-19 pandemic
Medication access
Vaccination
struggling with ethical issues can lead to:
moral distress – can be hard to know the right thing to do
Moral problems when the right thing to do is unclear. Example: Allocating limited resources among needy populations.
ethical dilemmas
the part of ethics that focuses on the process of how ethical decisions are made
ethical decision making
When is it ok to breech client confidentiality?
Only if the nurse suspects abuse. Then, who do you breech confidentiality to? Supervisor, child protective services, adult protective services, etc.
The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position. A nurse can only legally breech confidentiality when there is concern for harm to the patient or others.
ways to handle moral distress
-identify the types of situations that lead to distress
-communicate that concern to your manager and examine ways to work toward addressing the stressor
-seek support from colleagues
-seek support from ethics committees, social workers, and pastoral care among others
-be proactive and express one’s voice on matter that are ethically considering
Situations in which ethnic diversity can be judged in relationship to cultural standards:
Situations that place persons at direct risk of harm, whether psychological or physical
Situations in which cultural standards conflict with professional standards
Situations where the greater community’s values are jeopardized by values of a small culture within that community
Situations where community customs may cause mild offense or annoyance to other communities, but no major problems
ethics in assessment
competency in research, measurement, analysis, and dissemination techniques
beneficence and nonmaleficence
virtue ethics - importance of integrity
ethics and policy developmentq
Achieve public good
Service to others over service to self
What is ethical is also good policy
Moral leadership
ethics and assurance
All persons should receive essential personal health services
Providers should be competent to provide care and be available
Distributive/Social Justice
The ability to implement and carry out patient care goals by using your knowledge and skills.
autonomy
examples of autonomy
Your professional decision making, and carrying out nursing responsibilities as appropriate to your nursing role.
To do no harm. To provide safe, effective, and quality care.
nonmaleficence
examples of nonmaleficence
holding the administration of a medication when you assess signs of an adverse reaction to it, assessing the safety of a home healthcare client’s home environment, to provide quality care that is not influenced by personal bias
Fair and equal distribution of nursing care. To delivery equitable quality care to all patients without bias. To assure that quality healthcare is delivered to all people. **This is where nursing advocacy comes in.
justice
examples of justice
To advocate to your state legislature in the promotion of a bill that improves wifi and telehealth access for rural community members so they can be seen by specialists whose offices are in the city.
making sure that the patients best interests are considered while you work for the benefit of those in your care
beneficence
examples of beneficence
Comfort to a hospice patient, helping a patient learn how to self-manage their insulin, self-checking your personal biases so they do not negatively impact your care.
Keeping your commitment to provide consistent delivery of interventions so that all clients receive appropriate information, guidance, and quality skilled nursing care. This refers to loyalty to patient care and the trustworthiness you project when you do what you say you will do.
fidelity
examples of fidelity
Returning to check on your patient in 30
minutes, as you told them you would.
Staying at the patient’s bedside when you
assess that their end of life approaches,
Student nurses are expected to meet the
same standard of care as the professional
nurse.
The following items are examples of principles of ethical practice:
Interventions planned with respect for diverse cultures.
Confidentiality of health information.
Community collaboration to build trust.
what is advocacy
the application of information and resources (including finances, effort, and votes) to effect systemic changes that shape the way people in a community live
the act of pleading for or supporting a course of action on behalf of a person, group, or community.
the process of actively engaging in activities to change health policies and improve the health of populations.
equity and social justice
Work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all
example of health policy advocacy
The lawmakers, healthcare professionals, and civic leaders who worked together for many years advocating for the affordable care act to become law.
how to advocate when meeting with your legislative representative
Call and make appointment – state you would like to discuss ____legislation.
Introduce yourselves and state what you are there to talk about.
Bring some documentation and written summary to provide; support or objection statements from nursing organization.
Anticipate questions and challenges.
Conclude with what you want them to do.
Thank them for their time.
Follow-up with emailed thanks to whoever you met with.
what to say/write when advocating to legislation
Identify yourself, where you live, and state where you are a nursing student/working nurse.
State purpose your communication.
Summary of your support or objection to legislation of focus.
State rationale with references; cite nursing organization legislative opinions.
Conclude with what you want them to do.
Thank them for their time.
Email/mail Talking Points
nursing organizations’ “legislative agenda”
NLN Public Policy Priorities:
Nursing Education
Workforce Development
Equitable Access to Quality Health Care
Diversity and Inclusion
advocating class divided into 4 sections
each section will create either:
an elevator pitch meant for a lawmaker about a bill (pending legislation that is not law yet)
an elevator pitch meant for your hospital’s administrator about a problem issue you want to change
a talking points in support of a UNCG nursing policy or state bill
a talking points in opposition to a UNCG nursing policy or state bill
20 minutes
Groups present their advocacy statements
