Using Evidence-Based Research in Advocacy (graded)

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Chamberlain College of Nursing NR- 506 Health Care Policy
Using Evidence-Based Research in Advocacy (graded)
Consider your chosen policy priority. How can you use evidence-based research to demonstrate the relationship of nursing practice to outcomes in your policy priority?
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from
? Chapter 10: Communication and Conflict Management in Health Policy
? Chapter 13: Using Research to Advance Health and Social Policies for Children
? Chapter 51: TAKING ACTION: Influencing Policy Through an Appointment to the San Francisco Health Commission
? Chapter 69: TAKING ACTION: A Nurse Practitioner’s Activist Efforts in Nevada
? Chapter 72: Interest Groups in Health Care Policy and Politics
? Chapter 73: Current Issues in Nursing Associations
? Chapter 75: Coalitions: A Powerful Political Strategy
? Chapter 76: TAKING ACTION: The Nursing Community Builds a Unified Voice
? Chapter 90: TAKING ACTION: Reefer Madness: The Clash of Science, Politics, and Medical Marijuana
Teitelbaum, J. & Wilensky, S. (2017 ). Essentials of health policy and law (3rd ed.). Retrieved from
? Chapter 14: The Art of Structuring and Writing a Health Policy Analysis
Goodman, T. (2014). The future of nursing: An opportunity for advocacy. AORN Journal, 99(6), 668-671 doi: 10.1016/j.aorn.2014.03.004 link to article
Nannini, A. & Crocker, S. (2010). Translating evidence from systematic reviews for policy makers. Journal of Gerontological Nursing, 36(6), 22-26. doi: 10.3928/00989134-20100504-02 link to article

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This week, the course content will focus on the various elements impacting policy priorities, plans for implementation of those policies, the relevant stakeholders, and evaluation of results once the policy is implemented. Coalitions will be examined in terms of their functions and purposes, as well as the power of special interest groups. The value of research and its application to the political process will be explored. Conflict management and working effectively in the context of nursing specialty associations will also be discussed.
Coalitions: One Very Powerful Approach
A coalition is composed of individuals and/or groups that are combined into one organization that has leadership and structure. The purpose is to combine efforts for change. In other words, there is a common interest in influencing or changing public or social policy. This change can target concerns at the local level (i.e. removing an abandon building for safety reasons), state (i.e. requiring motorcycle riders to wear helmets) or federal level (i.e. national effort to prevent abuse of the elderly). Benefits to forming a coalition include the pooling of resources, increasing communication among interested parties and sustaining the energy to that the identified goal can be achieved. However, within a coalition problems can occur.
Have you ever been a member of a coalition? If so, what were the strengths? What were the weaknesses? Was the coalition’s mission based on specific objectives or an ongoing mission? Consider the success of the ongoing civil rights Rainbow Coalition or the various state nurse workforce coalitions. Coalitions can be made up of members of different groups coming together for a singular purpose, or they can be (as in the case of the state nurse workforce coalitions) subtypes within the same group, unifying for a singular purpose. A professional organization may also function as a coalition. Can you think of a professional nursing organizational with a specific health policy agenda?
Another component of an effective coalition is the use of scenario planning in order to consider all approaches and the possible consequences involved in meeting their goal. Scenario planning is a sort of “what-if” strategy. This technique allows for flexibility with various trends that may arise out of a given issue. The coalition brainstorms all possible approaches in meeting their goal and designs various contingency plans for dealing with issues that may arise.
Coalitions are groups of diverse people, and therefore, operate using a group process. It is important that strong leadership and a carefully organized structure be in place in order to maximize productivity and minimize conflict. It’s also critical to consider funding and promotion issues; money and visibility are so important! Both formative and summative evaluations of the coalition’s progress assist with keeping it on track and measuring effectiveness.
Pitfalls involved in coalitions result from a failure in tending to the elements that can make them highly effective. Ineffective leadership, lack of a clearly articulated goal and plan, lack of structure and organization, lack of resources, and having membership that just fails to click can all lead to a lack of overall success. Being proactive in meeting these challenges head-on greatly increases the coalition’s chances of meeting its goal.
The textbook lists several web resources for coalition-building and maintenance. As you progress in your professional development, consider getting involved in a coalition or building one of your own. The best place to begin, as with most things, is with education. By taking this course and getting directly involved in the political process, you are learning about and interacting with healthcare policy issues of your choice and passion. Building networks by active involvement is what coalitions are all about.
Determining Priorities
When considering healthcare problems/issues, it is important to remember that resources are limited and that priorities need to be established. One of the most common considerations is to determine the cost and resulting benefits. Part of cost is to consider individual responsibility?what responsibilities does one have for own health? What is the role of government at the local, state and federal levels in assisting individuals with their health and healthcare. The following criteria merit consideration:
? Social and geographical equity
? Quality
? Cost-effectiveness
? Democracy and consumer influence
Coalitions and individuals have a significant role at each of the above areas. Consider the role that an individual may have in cost-effectiveness??Is this CT scan needed when an x-ray be as effective?? Consider geographical equity??Should federal funding for an urban adult day care center be provided when rural areas of the state do not receive similar funding??
While there are no easy answers in determining priorities, unless nurses participate in the discussion, their professional information and insight will not be available to the policymakers. So, the challenge to each NR506 student is not ?IF? you are going to become involved, but ?WHEN?.
The Importance of Research
Research is important in policy. Many think that powerful and conclusive research would greatly influence politics and policy making; unfortunately, that is not always the case. It is important to understand that most legislators are lay persons. Even when powerful, evidence-based research is clearly presented, it can be perceived as dry and muddy. Oftentimes, policymakers require some teaching about research and what comprises significant and accurate research results versus weak and inconclusive results. Research can be accurate and very significant, but if it represents information about subject matter that is not of interest (or counter to the interest) of the policymaker, it will be of little use. The very nature of the political process lends itself to manipulation, self-interest, and even deceit. Flawed studies have been promoted by individuals (both lobbyists and policymakers) with a specific political agenda. Consider these issues when studying policy and politics throughout this course.
Nurses can have a significant impact on policy by using research in a meaningful way, especially if research reinforces a true passion for a policy. Most often, nurses develop their passions out of experience; therefore, they have considerable knowledge not only about the issue but also the underlying politics involved. Nurses can use an issue to advocate for funding for research to support their issue, or they can use sound research data to recommend a course of action regarding their issue. For example, consider two health-related issues involving research that made an impact on the general public. The first issue involves the research published on Sudden Infant Death Syndrome (SIDS). Even though the research study had not yet been concluded, the preliminary results were significant enough to garner funding for a campaign to remind parents and caregivers to place infants on their backs while sleeping. That simple strategy proved to be so effective and easy to implement that the campaign was considered hugely successful.
The second research-related issue involves monthly breast self-exams. Funding for this campaign disappeared because research on the effectiveness of the campaign itself showed that the costs outweighed the efficacy of monthly breast self-exams. The assessment of the efficacy was based on research on breast self-exams, which revealed that a good number of tumors are in dense breast tissue and difficult to palpate.
Research, healthcare, and politics are a powerful combination, especially when the media is involved. For instance, in the past several years, pharmaceutical companies have been permitted to advertise on television. Pharmaceutical companies are especially powerful special interest groups. Consider the conflict of interest involved when healthcare practitioners and researchers for pharmaceutical companies are also involved, both directly and indirectly, with the Food and Drug Administration (FDA). When power, money, and influence are at stake, corruption can result. Who is funding the research? What are their ties to the regulating agency? Is it a case of the fox guarding the henhouse? How has the research data been presented to the general public? Keep in mind that most new research is not replicated and may prove troublesome in the future until further studies are conducted. It is a lot more difficult to correct public misconception and misperception (or remove a drug from the market) than it is to spark attention for a new and provocative study or drug. Often, the news media will hype interesting news on page one, but if a retraction later becomes necessary, it is deeply embedded in fine print somewhere in the back of the section.
Health services research is a category of research that deals with how care or service is practiced and how service is related to outcomes. Nothing is more powerful than research that demonstrates the difference that nurses make in promoting health and wellness. Nurses share basic things in common with our legislators: they too have children and aging parents; and they and their loved ones get sick or injured. Chances are that they also have friends and loved ones whose lives have been impacted by health-related issues. Personal and professional anecdotes are engaging and very powerful. Nurses would greatly benefit from educating the general public, as well as policymakers, about nursing. Nurses both conduct and utilize research, and thus have a unique perspective on both sides of the issue. Sadly, it is one of the best-kept public secrets.
Using research to look at nursing where the work happens demonstrates the relationship of nursing practice to outcomes. Ask yourself, where is the evidence to support this idea? How strong is the evidence? How can I use this evidence to get the importance of my policy-priority issue across to lay persons? This approach will shed more light on the use of best evidence in caring for patients at all levels of prevention. Packaging research in a policy context and the ability to convey it in a meaningful and compelling way will greatly advance the agenda of nursing.
Conflict Management
Conflict is a perceived threat to a social position, power, values, or resources. Conflict is expected in policy and politics and is a natural part of human interaction. Politics and conflict go hand-in-hand! Although dealing with conflict is never pleasant, it is a necessary part of productively interacting with others, especially when it comes to policy making issues. There are basically four types of conflict.
Intrapersonal (within oneself)
Interpersonal (between two persons)
Intergroup (between two or more groups)
Organizational (within an organization: between individuals or groups)
Roll your cursor over each item to view the type of conflict involved.
Conflict resolution involves negotiating toward a mutually acceptable agreement that can result in win-lose solutions (one person or group gets more of what they want), or preferably, win-win (both are satisfied). When it comes to policy and policy making, two win-win strategies that are especially effective are principled negotiation and collaboration.
At the root of both of these approaches lies the ability of participants to focus on problem solving. Each participant must also separate the issue from the other individual involved to demonstrate mutual respect and valuing of the other person, along with empathetic understanding of a differing viewpoint and the desire to come to a deeper understanding of the issue. Finding common ground in a conflict tends to help the resolution process by uniting the participants, as does finding mutual benefits. It is essential to explore conflict and avoid toxic behaviors that will hinder the process of policy. Brainstorming alternatives is also important, as is the use of objective criteria. In this way, egos and positions are removed from the equation. When one considers working in coalitions, conflict resolution skills are essential.
It is important to understand that effective conflict management and resolution is a lifelong process. As with any useful skill, it must be practiced regularly. The payoff for becoming adept at this skill is huge for a nurse policymaker. Proper management of conflict is essential to advance policy agenda.
Special Interest Groups
Interest groups in the United States today number in the thousands and represent both for-profit sector and nonprofit groups. They are classified according to structure, focus, type of benefit, and goals and mission, although some types fall into more than one category. Often, the development of one type of special interest group (American Cancer Society) spawns the creation of an opposing group (Tobacco Research Council) and thus strikes a balance between the two. Some of the strongest political alliances formed are also the oldest. These powerful alliances are made up of three entities: a congressional committee or subcommittee, the special interest group, and a federal agency. In this way, all three support and benefit from each other. Can you think of an example in the area of healthcare?
Interest groups exist because people come together for
? solidarity (strength in numbers);
? purposive benefits; and
? material benefits.
The strategy of interest groups involves direct lobbying or political action committee (PAC) contributions (direct strategies), or it can also include indirect or outside strategies, such as those that target public opinion. In the information age, the Internet has proven an invaluable (and initially underestimated by some politicians) tool in the hands of some special interest groups. Take a look at examples of interest groups listed in your textbook. Are you surprised to learn that you are a member of a special interest group? We, as nurses, are all represented by the American Nurses Association (ANA), whether or not we are members.
The strength and power of interest groups lie in information; information is what allows the various types of interest groups to lobby and influence lawmakers and public opinion. Interest groups collect information to support their agendas, structure the data to enhance their agenda, and ensure that the policymakers (and the general public via media) are exposed to that information. No matter the amount of money contributed to a given campaign, the evidence shows that the access to the candidate and the visibility provided by contributions prove the most valuable. In other words, the key factor is that your group contributes enough money to get you in the door. Now you have the ear of the lawmaker and can tell your story and make your proposals to influence policy making.
Interest groups vary in form, mission, structure, and type. Interest groups are unpredictable because they use varying strategies at different times and are especially active between election cycles, because political parties are active during elections. Do you feel that interest groups are positive or negative forces in the political process? Are they really representative of the average person in society, or are they elitist? How do you feel about your own interest group? Are you knowledgeable about the ANA, its focus, and how contributions are spent? How does that money help you, your practice, and your clients? Attempts have been made in recent years to monitor and regulate political contributions made by special interest groups. Both hard money (donations made directly to the candidate) and soft money (party-building activities) are regulated in terms of amount allowed by campaign finance laws. Still, as mentioned previously, the world of politics involves competition for scarce resources, which opens the door for corruption. Monies coming from contributors outside the United States have added a new layer of problems regarding enforcement of regulations on political campaign finance.
Nursing Action and Nursing Specialty Associations
Do you belong to your state or national nurses association? Do you belong to a specialty nurses association? At this time, how politically active are you? Consider that there are over 100 nursing specialty groups, each with its own agenda and political goals. Consider, too, that less than 10% (even though the organization represents and benefits every nurse in the United States) of nurses are members in their state nurse’s association of the American Nurses Association (ANA). Lastly, consider the fact that nursing has long been crippled by the fragmentation in the various levels of nursing practice and education, which gives the profession less political power.
Your Healthcare Issue
Let’s discuss your policy issue. What are your strategies for action? Do you have a passion for a particular policy-priority issue? Do you feel like you have a solid understanding of the issue? Can you identify the stakeholders involved? Do you have a basic plan in mind and evidence that it is a relevant and needed policy/revision/adaptation? Have you considered the support (including financial) needed to implement the plan? Who else needs to be involved, and to what extent? Who are the key policymakers involved? Are you sure that they are interested in your issue and/or serve on the appropriate committee? Is this a local, state, national, or even a global issue? How can you get prepared? Have you considered how to be more visible? Have you thought about unintended consequences?
As now is the time to focus on how to approach the appropriate policymaker/legislator(s) about your chosen issue, you may want to check websites for state and local governments, various school boards, and nursing organizations (including your specialty) websites. These sources will keep you informed about current hot topics and where they are in the political process. Do not forget?timing is everything in politics! You can make a difference!
This week’s lesson has both informed and enlightened you regarding healthcare policy priorities and background information relative to the process of policy making. You are now prepared to determine a public policy-priority issue and follow through with advocacy efforts. Next week’s lesson will represent an overview of legislation and regulation with a focus on the communication issues involved. As should be clear to you at this point, communication is crucial to the entire political process at every level. Start brainstorming and putting together your policy priority and plan. Let your passion and experience lead you to learning and participating in healthcare policy!

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