NR 506 Discussion The Four Spheres of Political Action in Nursing
NR 506 Discussion The Four Spheres of Political Action in Nursing
The four spheres of political actions in nursing are the workplace, government, community and professional organizations (Mason et al, 2012). Each one of the spheres has it’s own separate functions such as: the workplace focuses on issue, which affect jobs and patient care. Government addresses rules, laws, and manages regulations in nursing practice. Community involves issues that affect community well-being and lastly organizations which address concerns related to shaping nursing practice (Mason et al, 2012). Together the spheres can create change. Nurses are able to change policy making and improve issues in the community health systems (Mason et al, 2012).
When you start out in your new nursing career, it is vital to review the political policies and nursing policies in your organizations. Nurses don’t realize that we are already political our nursing practice is molded around governing bodies, ethical, professional, governmental standards, and healthcare itself (Bjornsdottir, 2009).
I believe in centered family care in our organization. Especially when a trauma has occurred and the outcome doesn’t look good. It is important for family to see that you have done everything you can to help their loved one. Nursing has the greatest power in this situation (Parker, 2013). We are responsible for being the patient’s advocate. In the workplace it is vital for the patient’s family to be at their child’s bedside when something critical is taking place. If not then the family is wondering what is being done on their child (Parker, 2013) when a family member becomes involved they know you have done your best even if the outcome is not good. We have an ethical responsibility to do everything we can to save someone’s life. Nurses have to remind surgeons and other physicians that families have a right to be with their loved ones (Parker, 2013). Physicians see families as a distraction and that they will be in the way, instead of seeing them as a positive and realizing the family needs to believe that we tried everything to save their child’s life. If not allowed in the room they decide what they think or don’t think you did for their loved one (Parker, 2013).
Some ethical problems one may face with not allowing patient centered care in your organization can be wait times in the emergency room. These extended wait times puts a patient and their families at risk for harm (CDC, 2014). The main reason for this is boarding of patient’s for lack of nurses to take care of patient’s inpatient. When boarded patient’s take up Ed resources which makes waiting times in the Ed waiting room increase to unsafe levels (CDC, 2014).
Bjornsdottir, K. (2009). The ethics and politics of home care. International journal of nursing studies, 46, 732-736. Retrieved from
Centers for Disease Control. (2014). Emergency department visits. Retrieved from http://www.cdc.gov/nchs/fastats/emergency-department.html (Links to an external site.)
Mason, D.J., Leavitt, J.K., & Chaffee, M.W. (2012). Policy and politics in nursing and health care. Retrieved from http://nursingandpolitics.blogspot.com/2012/12/asyou-are-learning-this-week-about.html (Links to an external site.)
McClelland, M., (March 6, 2015) “Ethics: Harm in the Emergency Department – Ethical Drivers for Change”: The Online Journal of Issues in Nursing 20, (2).
Parler, L. (2013). Family centered care: Aiming fro excellence exploring the past, present, and future. Vancouver general hospital. Retrieved from
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It actually is a standard of practice where I work. The nurses fought hard to make it a policy within our organization. Physicians were very reluctant and still need reminders at time to allow parents to be with their child when a tragedy occurs. The organization in which I work is a pediatric emergency room setting. We realized when the family was involved in an event that had a poor outcome family presence made a world of difference (ENA, 2010). The family that is involved in the decision making as much as they can be are more understanding when we can’t save their loved ones compared to ones that are outside our trauma room while their loved ones are being worked on (ENA, 2010). It makes a considerable amount of difference if they are watching you work on their child trying to save their life. When family is outside the room they seem to imagine what is going on and sometimes have doubts if the physician and nurses did everything possible. I believe in family presence and feel as though this may help with the loss of a loved one especially if there is extenuating circumstances.
Emergency Nurses Association. (2010). Position statement: Family presence at the bedside during invasive procedures and/or resuscitation. Retrieved from www.ena.org/SiteCollectionDocuments/Position%20Statements/Archived/FamilyPresence.pdf (Links to an external site.)
The organization has a standard of care for their organization of how patients and their families are to be treated and the fact that we now practice family centered care. We actually have a parent based counsel that meets once a month and discusses family centered care in our organization and what is working well and what we can focus on making better. Healthcare workers from each division are on that group also. I know that we take government insurance and with that we must provide great care and allow convenient access to quality and safe care (CQC, 2016). The government expects that you will be given good care and be able to be involved in the decision making of the care every step of the way (CQC, 2016). The government tracks hospital organization trough a website at www.cqc.org.uk , this website publishes details of how the hospital services regulates and meets government standards of quality and safety (CQC, 2016). In giving this care the community is aware and through thus we get more referrals. If for some reason we do not provide the quality of care and safest care required we could lose our funding (Hughes, 2011). The four spheres relate to each other and are intwined. We need all four spheres to work together to be complete and produce change (Hughes, 2011).
Hughes, R., (May 31, 2011) “Overview and Summary: Patient-Centered Care: Challenges and Rewards” . The Online Journal of Issues in Nursing, 16 (2).
Care Quality Commission. (2016). Retrieved from https://www.gwh.nhs.uk/media/147361/6436_cqc_hospitals.pdf (Links to an external site.)
When looking at the big picture in how the four spheres are connected in relation to this policy, depends on if we always follow through with following the policy set forth. On occasion when we don’t comply with the organizations policy in regards to family centered care cam become a big problem. The family has rights and when we don’t allow them access to being involved in their child’s care , legally we become responsible for our actions. When we change the policy to make the physician feel more comfortable and don’t think about the patient or parents rights this becomes an immediate ethical issue and may put yourself in a legal position. Thinking about the community we serve may become a problem also. Patient’s families like to talk and when they have a bad experience or don’t believe their child was treated fairly they seem to spread that all over. This could affect the organization negatively and patient’s families may choose to go else where for care. This not only affects the organization financially but legally also. If this should involve the government it may affect any funding the organization can ultimately receive. Insurance carriers may not want to continue contracts with this organization.
The four spheres of action can be linked to the idea of family centered care. The government is the ones who set the universal standards of healthcare. They are the ones who are in control of programs like Medicare, Medicaid, and WIC just to name a few. Since they are providing for these programs, they are going to set the expectation for what care is appropriate; if they do not think something is correct, then they will simply not pay. Hospitals are always having to keep this concept in mind, which is where the workplace comes into play. If a patient receives a pressure ulcer while in the hospital, the government will not pay for that treatment. They say the hospital is the cause, thus making the hospital be at a loss for that treatment. Interest groups for the medical professionals and for the organizations are also behind these movements because they want to help prevent these issues from arising. Lastly, the community has to do with the patients themselves. The government makes information about healthcare providing systems available to the patient from things like the rate of hospital inquired infections, amount of pressure ulcers, and success rates. The patient can then make their own decision on where to receive care. All four of these spheres do intertwine with one another.
I completely agree with your comment of the importance of having families involved in the patient’s care. Yes sometimes, in the moment, having families present can make our job more complicated, but ultimately it can be a very large help to us. We are strangers to the patient and only interact with them for a short time. The family members are the ones who are with the patient day in and day out; they are the ones who really know the patient. When the patient is not in our care, the families are the ones who are helping the patient maintain their health. They are the ones who know how a patient acts when they are really hurting or do not feel good. All healthcare workers need to keep in mind that the family can be one of our biggest supporters and helpers in caring for the patient. We, as the nurse, are usually going to be the middle man between the patient and family and the other healthcare workers. Even if it would be easier during a situation for the patient’s family to not be in the room, we must be an advocate for our patient and know that it is best for their own interest and the families.
I enjoyed reading your discussion post for this week. Your example of family centered care was presented well. It reminded me of my own workplace including our multidisciplinary rounds each morning. We encourage family members of our patients to be present for our rounds that take place each day. I work with four different intensivists, each of them having a different take on what family centered care means. It makes things difficult for some of our patients families who are there for more than one week when a new physician cares for them each week, there can be discrepancy in the way that family centered care is provided. Family centered care in intensive care units is something that although is beneficial for family members can also be frustrating for the nursing and physicians caring for those patents. We have struggled in my organization to make it a nice balance to include family members and involve them in care and decision making but also ensuring that the nurse and physicians are able to focus on the patient. Of Course, some families and patients this come easily and others there is not a happy medium to be found. When you speak of caring for pediatric patients I feel that the urgency for family centered care is greater.
. I connected with your post because I also work as a nurse in the Emergency Room and wait times have become a big problem for us over the past 5 or so years. The first 5-7 years I worked in the ER patients rarely had to wait more than 15-20 minutes. Since that time we have remodeled and expanded the amount of beds and many times we have wait times of 2-6 hours. You mentioned boarding patients and how this puts the patients in the waiting room at risk. I absolutely agree. I started my career on the floor and when our beds were full that was it, no more patients. In the ER the patients keep coming and every time we have to wait for a bed to open up for an admit hold we are delaying care of others who are sitting in the waiting room undiagnosed. One of our triage nurses sits at the front desk and registers patients and keeps track of people in the waiting room. That assignment can be the worst because half of your day is spent deflecting mean comments from people waiting. Many times we send ambulance patients to wait in the waiting room if they have a lower acuity complaint and are stable. In our ER we have advanced techs who work in triage with the nurses and if wait times are over an hour we order initial blood work, urine, and x-rays if necessary just to expedite the visit. This does help because many times patients have labs resulted by the time the Dr sees them and then further diagnostic testing can be decided on. So in addition to a full unit we are also medicating and getting labs and x-rays on waiting room patients. It’s difficult and dangerous. There have been policy changes over the years that attempt to open overflow units and move those ER patients who are waiting for beds over so we can make room for ambulances and waiting room patients. It’s really difficult when the census is high because everyone in the hospital feels it, but it’s important for policies within hospitals to have a plan to move boarded patients out quickly so those waiting can be evaluated.
The original framework for Action had four spheres of influenced. The four spheres were: the workplace, the government, organizations, and the community (Chaffee, Leavitt, and Mason, 2014). The term workplace has been broadened to include the workforce now as well. Organization has been expanded upon as well to now include “associations and interest groups.”
Each of the four spheres are part of a broader and more complex system (Chaffee, Leavitt, and Mason, 2014). Nurses can be big influences within a community by identifying problems, forming strategies, and advocating for change (Chaffee, Leavitt, and Mason, 2014). Nurses can get involved in their community to have their voice be heard on issues involving nursing and healthcare.
As far as the workforce and workplace goes, there are several different settings a nurse can work in. Nurses can work in hospitals, clinics, schools, factories, etc. but they must all abide by certain laws and other factors that are set forth by their state or by their scope of practice.
As for the workplace and workforce, we as nurses must follow the same guidelines regardless of where we work. While our job descriptions can vary significantly depending on the type of nursing we practice, we must still only practice what is outlined within our scope of practice.
I do all of the new RN orientation at our hospital. One thing we have began to incorporate in our orientation is to have nurses familiarize themselves with the Illinois Nurse Practice Act to look at what is in our scope of practice as a nurse. I was very intrigued to find after years of nursing that I was not aware with certain things listed within.
Government- The government responds to and funds disasters. They also regulate much of healthcare, therefore how government views health policy is important because the government has a large influence over nursing practices.
With all of the regulations set forth by payers as well as CMS, it is necessary to follow the guidelines set forth by these agencies. One example within my practice that comes to mind is documentation. There are many different required fields of documentation that must be completed on each patient. VTE prophylaxis, immunization status, and sepsis screening are a few areas that must be addressed on each patient at the time of admission. Another thing that comes to mind is documentation on swing bed patients. Certain things that seem pretty small can actually be very important when it comes to receiving payment. For swing bed patients, it is necessary that the nurse or CNA charts the number of people required to assist the patient in getting out of bed. If the correct documentation is not completed, the entire stay can be seen as unnecessary and payment can be refused. I teach all nursing students and new employees how important a simple step of documenting the number of people it takes to transfer or ambulate a patient. As mentioned, this is a very simple step, but can mean a huge difference.
Nurses can also become involved in lobbying for what they believe in or in changes they think need to happen.
Organizations – There are many organizations within nursing. They work together for the good of their cause. Resources can be shared which can promote networking and can limit the amount of resources used by each organization. When organizations work together, they can be much stronger and have more opportunities. At our hospital, our CEO works with many local hospitals and organizations to build strong relationships so we can build off of one another. Working together can save time, money, and resources, and eliminate having multiple people researching the same information for potential changes.
Community- It is important for nurses to become involved in their community to help to promote change when needed, or to stand up for what is current if they feel no change is needed. Nurses can both volunteer and have paid positions where they work to influence policy and changes within policy.
I currently do not have any involvement in my community other than speaking to prospective students about nursing, but many people throughout history have voiced their concerns to promote a change.
As with anything, there can be ethical concerns. Some ethical concerns that would involve government, community, and organizations would be having an ulterior motive or any conflict of interest in what the nurse is promoting or how they are choosing to speak on certain topics. Like many things within politics, there is always a concern that someone is financially backing a person and that those people have a personal interest or have something to gain by their involvement. An example I can think of is I used to work with a physician who was the Medical Director of a local nursing home. He refused to send his patients to any nursing home other than the one he was the Medical director of. He worked with the community to promote this nursing home, but it all came back to the fact that he had personal involvement as well as financial gain from his involvement.
There can be a lot of ethical dilemmas within the workplace. Some can be as simple as the nurses and physicians not seeing eye to eye. Other ethical dilemmas could be the nurses feel like they have an inequitable workload (Bajwa, Hamid, Kanwal, Rhalid, and Mubarak, H. (2016). This is something that is especially on my mind right now. Our hospital census has been almost double what it normally is for almost four months. Nurses are feeling overworked and as if their workload is more than they can handle. There is constant talk of this. Many good nurses have left recently due to this complaint. One argument is that even with the increased census, the nurses still take much smaller patient loads than many of the neighboring hospitals are required to take. But because our nurses have been a little “spoiled” the last several years with a lower census, they now are not satisfied with a normal full patient load. The major dilemma becomes 1) are our patients being taken care of and 2) can how do we focus on being profitable while satisfying the nurses.
Chaffee, M., Leavitt, J., & Mason, D. (2014). Policy & Politics in nursing and health care. (Sixth Edition.) St. Louis, Missouri. Elselvier.
Bajwa, M., Hamid, S., Kanwal, R., Rhalid, S., & Mubarak, H. (2016). Ethical issues faced by nursing during nursing practice in District Layyah, Pakistan. Diversity & Equality in health care. Retrieved from: http://diversityhealthcare.imedpub.com/ethical-issues-faced-by-nurses-during-nursingpractice-in-district-layyah-pakistan.php?aid=10616