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2013 Instructors Manual for Policy and Politics in Nursing and Healthcare, 6e

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Mason: Policy & Politics in Nursing and Health Care, 6th Edition Introduction to Instructor's Manual Alma Dixon This manual is designed to guide and support faculty who are responsible for teaching courses for undergraduate nursing students about policy and politics. Although students will be focused on developing their skills as novice clinicians, it is vital they also recognize the roles policy and politics play in patient care, the health system, and human health. Learning about policy and politics will draw students’ attention to many issues in the health system and to learn about how they can play a role in addressing problems. Major problems that exist today include: • The unsustainable high cost of care • Health care and medical errors • Inadequate access to care • The shortage of nursing faculty needed to prepare an adequate nursing workforce • An insufficient primary care and public health workforce • Significant disparities in access to care • An inadequate focus on prevention of disease • An economy in recession Learning Outcomes The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) includes a policy as an essential part of nursing curriculum through Essential V (Healthcare Policy, Finance, and Regulatory Environments). The following outcomes are suggested as guideposts for course activities. If you are able to determine that these learning outcomes were met in prior courses, your task as the instructor will be to reinforce prior knowledge. Upon completion of this course, the student will be able to: 1. Demonstrate basic knowledge of health care policy, finance, and regulatory environments, including local, state, national, and global health care trends. 2. Describe how health care is organized and financed, including the implications of business principles, such as system cost factors. 3. Compare the benefits and limitations of the major forms of reimbursement on the delivery of health care services. 4. Examine legislative and regulatory processes relevant to the provision of health care. 5. Describe state and national statutes, rules, and regulations that authorize and define professional nursing practice. 6. Explore the impact of sociocultural, economic, legal, and political factors influencing health care delivery and practice.

Introduction

7. Examine the roles and responsibilities of regulatory agencies and their effect on patient care quality, workplace safety, and the scope of nursing and other health care professionals’ practice. 8. Discuss the implications of health care policy on issues of access, equity, affordability, and social justice in health care delivery. 9. Use an ethical framework to evaluate the impact of social policies on health care, especially for vulnerable populations. 10. Articulate through a nursing perspective issues concerning health care delivery to decision makers within health care organizations and other political arenas. 11. Participate as a nursing professional in political processes and grassroots legislative efforts to influence health care policy. 12. Advocate for patients and the nursing profession. This manual is designed to be used with Policy & Politics in Nursing and Health Care (6th edition). Some chapters are noted to be as Highly Recommended reading for all students. These are the core chapters that address foundational content in policy and politics. Some chapters are noted to be Suggested; these contain important content and can be assigned based on the overall design of the course. Other chapters are identified as Optional; these may be assigned based on individual student interest and learning needs. The learning outcomes and teaching strategies are designed for specific units instead of individual chapters. This allows instructors to focus on the broader concepts that will enable students to apply the knowledge to their clinical experiences and theory learned in prior nursing courses. Throughout this manual, the emphasis is on application of knowledge rather than memorization of content. Therefore, chapters entitled “Taking Action” have educational strategies specifically designed to encourage students to select an area of interest and apply the skills learned to their clinical practice, experience, and knowledge. Each unit contains Websites that both instructors and students may use to complete assignments and keep abreast of the changes in a rapidly evolving health care system. Policy & Politics in Nursing and Health Care (6th edition) is designed for use across nursing curricula from undergraduate education to graduate preparation at the Master’s and Doctorate levels. This manual begins the process by suggesting teaching strategies that lay the foundation for future study for students who will pursue advanced degrees. For students who do not advance their education, it suggests educational approaches that expose them to the major challenges that nurses have always embraced, and that is to effect change for patients by exercising our single and collective voices on behalf of the most vulnerable and often disenfranchised members of our society. References American Association of Colleges of Nursing. (2008, October 20). The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington DC: American Association of Colleges of Nursing.

Mason: Policy & Politics in Nursing and Health Care, 6th Edition Orientation Class to Policy and Politics in Nursing and Health Care Alma Dixon The following is an activity that can be used to stimulate students’ early thinking about political activity and engagement. Directions: Distribute the Checklist (Table 1-1) to students. Direct them to complete the checklist individually. Divide the class in groups and have them discuss the following, based on their checklist responses. 1. Do you consider yourself to be politically active? Why or why not? 2. Do you feel that you are knowledgeable of the political process? 3. Should nurses be politically active? Why or why not? 4. How can nurses make a difference in the health of their patients and the public by shaping policy? 5. What do you hope to learn during this course? A recorder may be appointed to take notes so that students can compare their views from the beginning of the course to their views at the end of the course.

Orientation Class

Engagement and Political Voice Checklist For each item, check the box that applies Never to you. For the item on vote registration, use the “Yes” or “No” boxes. I work to solve community problems I volunteer regularly for an environmental group I volunteer regularly for a civic or community organization I volunteer regularly for any other organization I belong or donated money to any group or organization Besides donating money, I help raise money for charitable causes

Sometimes

Always

Yes

I have registered to vote I vote in elections (regular voting) I volunteer for a political campaign or candidate I encourage others to vote I wear a campaign button or have a sticker on my vehicle I volunteer for a candidate, work or contribute money to a political party, or an organization that supports candidates I contacted/visit public officials I contact a newspaper or magazine I contact a radio or television news show I protest I sign an e-mail petition I sign a written petition I boycott companies I buy something to support the values of a company Adapted from Dahl, I., Hoy, A., Meisel, W. (Eds. of the Corella and Bertram F. Bonner Foundation.) (2006). From community service to political action: A student call for civic engagement. Princeton NJ: The Bonner Foundation.

Mason: Policy & Politics in Nursing and Health Care, 6th Edition UNIT 1: INTRODUCTION TO POLICY AND POLITICS IN NURSING AND HEALTH CARE Alma Dixon Highly Recommended Chapters: Chapter 1: A Framework for Action in Policy and Politics Chapter 2: A Historical Perspective on Policy, Politics, and Nursing Chapter 3: Learning the Ropes of Policy, Politics, and Advocacy Chapter 4: Taking Action: How I Learned the Ropes of Policy and Politics Chapter 7: The Policy Process Chapter 8: Political Analysis and Strategies Chapter 11: Communication Skills for Success in Policy and Politics Suggested Chapters: Chapter 5: Advocacy in Nursing and Health Care Chapter 9: Health Policy, Politics, and Professional Ethics Chapter 12: Conflict Management in Health Care: The Tipping Point Arrives Optional Chapters: Chapter 6: A Primer on Political Philosophy Chapter 7: The Policy Process Chapter 10: Using the Power of Media to Influence Health Policy and Politics UNIT OVERVIEW: The content in Unit 1 may not have been presented in other nursing courses; therefore, it is fundamental to understanding policy and politics and the role that a baccalaureate prepared graduate nurse may play. It begins with an overview of the new Patient Protection and Affordable Care Act (PPACA) and its potential to reform the health care system and how health care is delivered. It also contains the review of various types of policies and the forces that shape health policy. The components of the often maligned, but critical political skill behaviors are also presented as well as the actions inherent in policy analysis, advocacy, and political activism. The “Framework for Action,” which was first introduced in Political Action Handbook for Nurses: Changing the Workplace, Government, Organizations and Community (Mason & Talbott, 1985) is expanded and updated to focus on the current spheres of influence, namely, the community, the workforce and workplace, the government, and the associations and interest groups. The historical perspective on policy, politics, and nursing lays the foundation for students to understand the role of nurses’ activism to advance the profession as well as health care. In addition, the unit describes how the formation of the professional associations placed nursing as a strong force in addressing the social and political reforms affecting society in the 1800s. The beginning tension between nursing and the advancement of women in society is also

UNIT 1

reviewed in tandem with the discriminatory practices inherent in society and nursing during the early 1900s. The impact of public health nursing as a vehicle to address the problems associated with urbanization, industrialization, and immigration is reviewed as well as the relationship between the suffrage movement, organized nursing, and modern nursing. In practice, the baccalaureate prepared graduate is expected to advocate for vulnerable populations. This unit contains detailed information on advocacy in nursing that can be applied to the clinical setting. A case study is provided to illustrate the material that was presented. RELEVANCE FOR STUDENTS: This unit provides the content to either introduce or broaden understanding of the complexities of the United States health care system and the need for fundamental changes in the way resources are allocated. It supplies the historical context of nursing in shaping policy and the transforming changes that will result from the enactment of health care reform. This information is important as students learn about the roles they will play as nurses and as concerned citizens. LEARNING OBJECTIVES 1. Identify the impact of the Patient Protection and Affordable Care Act (PPACA) on health care reform. 2. Explain how values and politics shape health policy. 3. Identify the components of political skill and the implications for nurses. 4. Explain how policy analysis, advocacy, interest groups, lobbyists, and the media play a role in health care and nursing. 5. Describe the Framework for Action including the spheres of influence (the community, the workforce and workplace, the government, and the associations and interest groups). 6. Discuss the present and historical application of nursing as “a metaphor for the struggle for equality of women.” 7. Explain how political activism has influenced the profession of nursing and the delivery of health care. 8. Identify the steps in political analysis and how they may be applied to an issue in the workplace or how to advocate for clients. 9. Identify the communication skills needed to be effective in professional and political arenas. TEACHING STRATEGIES The spheres of influence provide a practical framework to organize teaching strategies that will enable students to learn about political action through application of knowledge. Therefore the strategies are organized around the community, the workforce and workplace, the government, and associations and interest groups. Depending on the student evaluation system used, faculty may consider allocating specific points for each step within each assignment. In addition, criteria with suggested point allocations are provided to assist in the evaluation.

UNIT 1

Sphere of Influence 1: The Community Small Group Assignment Purpose: To provide students with experience in influencing policy at the community level. Instructions: Divide the class into groups of 4 to 6 with instructions that each group should complete the same task. Vignette Provided to Students: You are completing a clinical rotation in a small community agency that provides services to pregnant women or women with children under the age of 3 in an urban area of the southern United States. The racial composition of the community is 78.1% white, 9.6 % African American, 8.0% Hispanic, 0.3% American Indian/Alaska Native, 2.0% Asian, and 2.0% other. In 2009, 110,800 women of childbearing age resided in the county with 5,300 total births. Recently you and your fellow students learned that current statistics for the county reveal that from 2006 to 2008, the infant mortality (number of deaths per 1000 live births) rate was 8.2%; an increase from 6.5% in 2005-2007. For African Americans, the rates were 10.0% in 2005 to 2007 and increased to 14.4% in 2006 to 2008. The local Healthy Start agency confirms that these data are accurate for the community. In fact, based on a review of deaths by the coroner, in the last year, the major causes of neonatal and infant demise were low birth weight, babies sleeping in bed with an adult (roll over/unintentional deaths), and SIDS. Task: You and your classmates decide to take action. With the assistance of the staff from the agency and your nursing faculty, you decide to develop a community awareness campaign. The Assignment: 1. Name your campaign. 2. Identify community partners to help with your campaign. 3. Identify the stakeholders. 4. Name the resources you will need. 5. Establish a task list. 6. Assign responsibilities. 7. Define a timeline. 8. Describe an evaluation process. Evaluation Criteria You will be evaluated on: 1. Your ability to creatively engage the interest of the community by the name of the campaign………………………………………………………………………10 points 2. Your understanding of the community partners and stakeholders needed to ensure success of your campaign…………………..………………………30 points 3. Your ability to cite the extent of the resources needed and the time frame to develop the community awareness campaign………….…………………20 points 4. Your knowledge of the steps involved in evaluating the success of your campaign or what is needed to improve in the future……………………………..40 points

UNIT 1

Sphere of Influence 2: The Workforce and Workplace: Small Group or Individual Writing Assignment Purpose: To provide the experience for students to develop a policy that impacts the workforce or the workplace. Instructions: Students select a current problem, for example, the inability of the profession to establish the BSN as a minimum requirement for entry into practice, or the shortage of nurses in the United States. Using the “Steps of a Political Analysis” found in Box 8-1 as a guide, complete the following assignment: 1. Identifying and analyzing the problem 2. Outlining and analyzing proposed solutions 3. Understanding the background of the issue: its history and previous attempts to address the problem 4. Locating the political setting and structures involved 5. Evaluating the stakeholders 6. Conducting a values assessment 7. Recognizing the resources (both financial and human) needed to reach the intended goals 8. Analyzing the power bases

1. 2. 3. 4. 5. 6. 7. 8. 9.

Evaluation Criteria You will be evaluated on your ability to complete the following tasks according to points designated: Identify and analyze the problem…………………………………………..10 points Outline and analyze proposed solutions………………………………….10 points Explain the background of the issue including its history and previous attempts to address the problem…………………………………………………………..10 points Identify the entities that have jurisdiction over the problem………………10 points Identify the stakeholders and their potential roles in addressing the problem…10 points Name the inherent values that need to be assessed………………………10 points Determine the resources, both financial and human, needed to bring the issue forward and to reach a resolution……………………………………………...10 points Analyze the power bases……………………………………………………….10 points Design a plan of action based on your political analysis…………………….20 points

Sphere of Influence 3: The Government Writing Assignment Purpose: To provide the opportunity for students to practice influencing policy by communicating with a legislator about a current health problem. Instructions: Have students complete the following steps: 1. Select a current health problem that is being debated at the national and/or state level (e.g., the proliferation of “pill mills” and pain clinics), and state why it is of interest. 2. Identify a legislator (state or federal) and state why that person is the appropriate one to contact. 3. Draft a letter to the legislator including the proper salutation.

UNIT 1

4. Introduce yourself and your reason for writing. 5. State concisely what you understand to be the current socioeconomic, political, and ethical issues surrounding the problem. 6. Discuss the implications of the problem for nursing or nursing practice. 7. Make a clear request for action. 8. Request a response. Evaluation Criteria You will be evaluated on the following criteria: 1. Identification and description of a current health problem………………20 points 2. Identification of a legislator and the reason for your selection…………………………………………………………………20 points 3. Preparation of a concise letter that cites the current socioeconomic, political, and ethical issues surrounding the problem as well as the implications of the problem for nursing or nursing practice………….30 points 4. Your ability to determine an appropriate action and make a request for that action ………………………………………………………………………30 points Sphere of Influence 4: Associations and Interest Groups Writing Assignment Purpose: To provide the opportunity for students to become familiar with different nursing associations. Instructions: Have students complete the following steps: 1. Choose a nursing association. 2. List the mission and purpose of the association 3. How is it governed? 4. What is the legislative agenda of the association? 5. How is that agenda developed? Is the membership involved? 6. How is the agenda communicated to the membership? 7. Does it partner with any coalitions? 8. Does the partnership influence policy on a national or state level? If yes, how? 9. When you graduate will you join the association? If yes, why? If no, why not?……………………. Evaluation Criteria After you have selected a nursing association, you will be evaluated on your ability to answer the following: 1. 2. 3. 4. 5. 6. 7.

What is the mission and purpose of the association?................10 points How is it governed? ...................................................................10 points What is the legislative agenda of the association? ...................10 points How is that agenda developed? ................................................15 points Is the membership involved?........................................................5 points How is the agenda communicated to the membership?...............5 points Does it partner with any coalitions?.............................................10 points

UNIT 1

8. Does the partnership influence policy on a national or state level? If yes, how? ........15 points 9. When you graduate, will you join the association? If yes, why? If no, why not? 20 points Optional Assignment Writing Assignment Purpose: To provide the opportunity for students to select an area of interest in policy and politics and apply the knowledge to their clinical practice, experience, and knowledge. Instructions: Students may select a chapter and answer the following: 1. Why did you select this case study? 2. How does it relate to what you understand or have learned about policy and politics in nursing and health care? 3. How does it relate to your current clinical practice? Give at least one specific example. 4. How does it relate to what you hope to accomplish in nursing practice? Evaluation Criteria You will be evaluated on your ability to apply the knowledge from the chapters in Unit 1: Introduction to Policy & Politics in Nursing & Health Care by answering the following questions: 1. Why did you select the case study “Taking Action: Advocacy in Nursing and Health Care?”………………………………………………………………….20 points 2. How does it relate to what you understand or have learned about policy and politics in nursing and health care?...............................................................30 points 3. How does it relate to your current clinical practice?..................................25 points 4. How does it relate to what you hope to accomplish in nursing practice?..….25 points