NR 506 Global Policy Reform Discussion

From reading the article, it reinforced the concept that simply having a policy in place does not mean it is being executed to its fullest potential (Kohl et al., 2016). Issues that are prevalent in one area of the world might not be common in another part of the world; this possibility will have to be considered when developing a global policy (Kohl et al., 2016). No matter the location, any action that a nurse takes must always be with the patient in mind. The nurse must evaluate aspects of the patient’s life that might make him different from the patient right next door with the same medical problem. As nurses we should be able to think on our feet and be flexible when it comes to our solutions for the patient. One treatment we might think is the best in reality might not be a suitable option for a particular patient.

From this course, I have learned the importance that nursing has in the political area. Nurses have a tendency to think they are just products of the system and are told what to do. On the contrary, nurses hold much more power than they realize. We are patient advocates, so we have a duty to change the system if we do not agree with it. We are problem solvers in our daily practice; this skill is vital for public policy. Through this course, I feel I have developed more confidence in feeling capable to speak to someone in policymaking or administration about an issue. We have a responsibility to ourselves and the people we care for to be lifelong learners, and I will try to implement this concept into my own practice one day. We are entrusted to give the patient the best possible care that we can provide. To accomplish this objective, we must strive to better our practice while always safeguarding the rights and integrity of our patients.

References

Kohl, H.W., Craig, C. L., Lambert, E.V., Inoue, S., Alkandari, J.R., Leetonngin, G., & Kahlmeier, K. (2012). The pandemic of physical inactivity: Global action for public health. The Lancet, 380(9838), 294-305. doi:http://dx.doi.org/10.1016/S0140-6736(12)60898-8.

One-to-one nursing provides direct services to patients in need, but one-to one direct nursing has little impact or influence on changing community healthcare goals or healthcare systems and policies. Thinking about community and population health needs calls for nurses to get involved with public policy advocacy. Public policy advocacy has more of a direct influence on implementing community healthcare goals and creating policies that benefit all patient groups.Nurses who train to become public policy health advocates put themselves in unique positions to take on roles as lobbyists for specific health causes, help draft legislation for a needed health policy, speak at conferences, become liaisons for coalitions, even start grass roots health policy organizations and join forces with more established organizations that advocate similar causes. Public policy advocacy is a great way to get community health issues heard on a grand scale to influence system change (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). However, public policy advocacy is not the best method to provide direct services to individual population members in need (Arabi et al., 2014). Only root causes of the issue will be addressed, such as reviewing the legality and constitutionality of laws and ordinances (Arabi et al., 2014). Both one-to-one nursing and public policy advocacy are effective in their own way.

Reference:

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3), 315–322. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

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As an advanced practice nurse, it is crucial that we have the ability to make informed decisions on nursing practices. Obtaining research and gaining knowledge about the topic is a crucial part of making these decisions. Many times, the research that is done is not necessarily the most recent or the best practice. We need to be sure that the research being done is the best available (Oxman, A. (2016). Patient outcomes depend on the current practices and can improve when we discover what has worked well and what has not worked well. In the article, there were multiple steps when gaining information about physical inactivity. First, activity must be measured and then a guide can be made. We then need to take a step back and decide what is needed to help this move forward. This goes for any topic. While researching about my policy issue, it took time to figure what the goal was and the steps to get there. It is a one step at a time kind of deal, which makes it much more difficult (Kohl et al, 2012).

When thinking about my upcoming practicums, I believe that this process will help me take a step back and think about the issues that we face in healthcare and also how we can help make change. I have learned that when finding a problem, research and communication can go a long way.

References

Kohl, H.W., Craig, C.L., Lambert, E.V., Inoue, S., Alkandari, J.R., Leetonngin, G. & Kahlmeier, K. (2012). The pandemic of physical inactivity: Global action for the public health. The Lancet, 380(9838), 294-305.

Oxman, A. (2016). GRADE evidence to decision frameworks: a systematic and transparent approach to making well informed healthcare choices. The bmj, 28(1), 353.

When considering guidelines for different patient populations, there should be guidelines based on different factors, such as: age, physical health, and current condition. My policy priority issue was childhood obesity so most of my research was based on a younger patient population. Older adults, age sixty-five an older need about two hours and thirty minutes of aerobic activity each week (Centers for Disease Control and Prevention, 2015). This could include activities such as brisk walking and swimming. A patient with impaired physical health needs, such as rheumatoid arthritis may not be able to tolerate this amount of exercise do to physical limitations. Therefore, their health plan may need to be adjusted based on what they can tolerate comfortably. Maybe, swimming would be a better choice for them. An example of current conditional state would be pregnancy. Woman that exercise before they become pregnant can continue to exercise at their same prepregnant rate. But woman that are not conditioned to exercise before pregnancy should limit their exercise gradually and continue aerobic activities such as walking, yoga, or swimming (Centers for Disease Control and Prevention, 2015).

Centers for Disease Control and Prevention. (2015). Retrieved from https://www.cdc.govLinks to an external site.

I think all nursing students should do as you have done and take a step back to think about the healthcare issues affecting the people in this country and abroad. This allows us to see what areas of nursing we are needed in the most and what areas interest us. I found an excellent journal that will help nurses stay informed about health policy reforms and issues. The Policy, Politics, & Nursing Practice (PPNP) is a peer-reviewed journal that publishes articles and studies on the multiple relationships between nursing and health policy. PPNPdiscusses relevant policy issues for nurses in a broad variety of roles and settings. Two recent journal articles that have caught my attention are “Exploring nurse leaders’ policy participation within the context of a nursing conceptual framework” and “An integrative review of bullying and lateral violence among nurses in magnet organizations.” As a future nursing leader, my goal is to address real issues in nursing practice, and the first article explains how important nursing leaders are to influencing policy and building a consensus for priority skills and knowledge useful in policy efforts (Waddell, Adams, & Fawcett, 2018). The themes in this article inform nurses about learning objectives for nursing education and suggest preparation for developing the knowledge, skills, and persistence nurses need to interact with public officials (Waddell et al., 2018)

Reference: Waddell, A., Adams, J. M., & Fawcett, J. (2018). Exploring nurse leaders’ policy participation within the context of a nursing conceptual framework. Policy, Politics, and Nursing Practice. Retrieved from https://doi.org/10.1177/1527154418762578

This class has made me feel more empowered, especially during this current political climate. Nurses have a loud and respected voice and we can make so many positive changes by making ourselves heard. Our healthcare system is in desperate need of change … the costs are increasing exponentially. Acute care patients are sicker for various reasons, but one of the major reasons is lack of access to quality healthcare for management of chronic illnesses. One way that nurses can be at the forefront of positively influencing our healthcare system and potentially driving down costs is staying involved in healthcare policy and planning.

Promotion of health lifestyle changes would have an enormous impact on the healthcare system. If people were to take better care of themselves, get up and moving, eat healthier, quit smoking, excessive drinking and drugs, etc …, the issues could be managed. Nurses are in a prime position to get changes implemented locally, nationally and globally. People hear us, they admire us and they respect us! To make informed decisions in my future practice, I will make sure to keep up-to-date with current best evidence, engage in conferences and take advantage of educational opportunities.

This weeks article offered great ideas about how to tackle a public health issue globally. I was shocked to read that physical inactivity is the 4^th leading cause of death worldwide (Kohl et al., 2012). This issue is considered a pandemic and it has to be a priority and it has to be approached collaboratively in order to have a chance to make positive changes. There are many other areas of concern that have required global action, such as promoting health diets, alcohol and smoking cessation.

One thing that this class has taught me is that a great deal of patience is needed to approach the healthcare policy arena. A lot of work goes into pinpointing the issue, researching what has and has not been done, forming a plan then presenting it. Finding the right person(s) to present your work to can be just as challenging as gather all the data. It is a time consuming process but is so necessary.

This has been one of my favorite classes! I took it concurrently with NR505 Advanced Research Methods: EBP, and this session was no joke! The projects for this class, coupled with the cumulative 45 page research project in the other have kept me hopping. I have every intention of presenting my project for this class at the upcoming Town Council meeting in an effort to have it implemented. My goal is to convince the town council to mandate a policy that gives naloxone to the 15 law enforcement officers in the town where I live. The research that I found is solid and the need is urgent. I think it can happen. Kohl, H.W., Craig, C.L., Lambert, E.V., Inoue, S., Alkandari, J.R., Leetonngin, G. & Kahlmeier, K. (2010). The pandemic of physical inactivity: Global action for public health. The Lancet, 380(9838), 294-305. https://www.doi.org/10.1016/S0140-6736(12)60898-8Links to an external site.

One global healthcare issue that affects nursing internationally is the IV fluid shortage. Hurricane Maria in Puerto Rico caused a serious shortage in IV fluids, which are used both nationally and internationally in all hospitals. This has caused a global healthcare issue because IV fluids are a very important and a necessary part of patient care in hospitals everywhere. This became a nursing issue in the hospital I work in because IV fluids are constantly used in the emergency department. The nurses and physicians have had to be more aware of IV fluid use and find alternate methods of care when it was possible in order to reserve the use of IV fluids. Even nursing policies such as making certain medications had to be changed due to the fluid restrictions. This is an issue that started from the small nursing community in Puerto Rico getting hit by bad weather and leading to the fluid shortage. This example proves that all Healthcares’ are connected internationally. It has caused a great deal of controversy between the physicians and our Pharmacy team. Physicians feel that if they believe a pediatric patient requires a NSS bolus then they should be able to give it, even if there is storage. While nurses have become responsible to make sure if giving a NSS bolus is required that we utilize the smallest bag possible not to waste fluid.

This is such a big issue right now. After reading your post, it reminded me that I have been wanted to do a little research about what’s actually behind the shortage, it doesn’t seem possible that Puerto Rico is the only place that these manufacturers can produce fluids. Also, with all the money and political clout that pharmaceutical companies have, why aren’t they providing more aid to those poor people?

Anyway, in researching, I found out that Puerto Rico produces 44% of the IV-fluid supply (Patino et al., 2018). Even before Hurricane Maria, the U.S. has been facing various degrees of IV-fluid shortages because majority of the U.S. supply of fluids are produced by only 3 manufacturers and it’s production is highly regulated and complex (Patino et al., 2018).

This particular article highlighted one strategy that could help conserve the scarce fluids. Brigham and Women’s Hospital implemented an oral rehydration protocol that they use for patients with mild dehydration. They have an entire system set up that includes giving the patients 2 jugs full of their preferred fluid, straws, medicine cups and a timer so that they can keep on task with rehydrating themselves. They have even implemented an order set in their EHR (Patino et al., 2018). Sounds interesting, if not a ton or added work, but maybe necessary to make sure that we can have adequate IV-fluids for those who desperately need them.

Patino, A., Marsh, R., Nilles, E., Baugh, C., Rouhani, S., & Kayden, S. (2018). Facing the shortage of I.v. fluids – a hospital based oral rehydration strategy. The New England Journal of Medicine. https://www.doi.org/10.1056/NEJMp1801772

The concepts and practices I have learned in NR506 on healthcare systems, politics, and health policy has allowed me to bring into light how every nurses can use their professional experiences in healthcare to advocate for change in issues that are of great significance to the world. I never realized how impactful nurses can be in the providing changes for patients in safety, quality, and cost efficient healthcare.

According to Kohl et. al. (2012), available data suggest that “31% of the world’s population is not meeting the minimum recommendations for physical activity and, in 2009, the global prevalence of inactivity was 17%.” They are not making the minimum physical activity due to diet, urban living, and life style choices. For example, with being able to order everything through the internet such as item goods and groceries, people have reduced going outside to stores, further hindering physical activities.

To make informed decisions on nursing practice and patient outcomes on a global basis it is best to promote improvements of the health of populations, rather than individual behaviors. Lastly, we should drive our political, business, public health, and academic leaders to be aware of these global healthcare crisis to promptly advance regulatory and policy solutions so that the health of populations and the principle of the people will be guaranteed for prospective generations.

I will apply what I have learned in this course to my upcoming practicum by making changes through reaching out to the patients that I will see. Also, by reaching out to my legislators to make a transformation in healthcare reforms. Since it is our responsibility as future Nurse Practitioners to educate patients and the communities on the policies, global changes, and threats to health and security.

Nice to have met everyone and best wishes to you all.

Reference

Kohl, H.W., Craig, C. L., Lambert, E.V., Inoue, S., Alkandari, J.R., Leetonngin, G., & Kahlmeier, K. (2012). The pandemic of physical inactivity: Global action for public health. The Lancet, 380(9838), 294-305. doi: http://dx.doi.org/10.1016/S0140-6736(12)60898-8.

NR 506 Global Policy Reform Discussion