Ethics in Healthcare Policy Making (graded)

Ethics in Healthcare Policy Making (graded)

A wave of pandemic illness can host a variety of ethical considerations. Please apply the importance of ethics to the process of policy making regarding pandemic outbreak and other future pandemic issues.
D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from http://online.vitalsource.com
• Chapter 1: Frameworks for Action in Policy and Politics
• Chapter 2: A Historical Perspective on Policy, Politics and Nursing
• Chapter 3: Advocacy in Nursing and Health Care
• Chapter 6: A Primer on Political Philosophy
• Chapter 15: Health Policy, Politics, and Professional Ethics
Gambardella, L.C. (2011). Nursing and politics: Strange bedfellows or compatible partners in practice Building a passion for political action. Nursing News, 35(2), 13. link to article
Nault, D.S. (2012). Nurses and public policy. The Michigan Nurse, 85(1), 13-20. link to article
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks, Inc.
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from http://online.vitalsource.com
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introduction
Welcome to the first week of healthcare policy! During this first week, the focus is on types of policies and their relationship to healthcare policy. Next there will be a review of the relationship of values to politics and consideration of political action spheres applied to nursing. It also is important to examine the history of policy development and policy making in nursing. Finally, ethical principles will be considered in relationship to healthcare policy.
As you begin this course, notice that the conclusions of several chapters in the textbook contain special features, such as Vignettes, Policy Spotlights, and Taking Action. Some of these features are assigned as reading that serve to provide specific life examples of the topics discussed in the individual chapters. Take a look at the contents of these special features, whether assigned or not, and you may see that some apply directly to your chosen policy priority. The assigned journal articles further enhance the content of the readings and lesson. The many websites for various professional organizations found in the Webliography will help you with tracking various policy issues, and they will list important contact information, as well as examples of position statements and briefs. Finally, the video links provide presentation examples and ideas, as well as the video clips that give you a broad understanding of healthcare policy issues impacting the United States and the global community.
When you think about policy, and especially healthcare policy, what comes to mind It is important to remember that healthcare is a multifaceted system that is highly convoluted with many interrelated elements. Changing a policy in one area may have intentional or unintentional impact upon other areas. For example, changing access to healthcare may result in the need for additional advanced practice nurses or could overwhelm already crowded emergency departments. Consider possible changes to our American healthcare policies with new leadership in Washington D. C. In addition, consider the impact of new policies upon nursing practice in your community, state, and country, as well as the global community.
Policy and Healthcare Policy
It is important to consider a basic definition of policy when embarking upon any discussion of policy in general and healthcare policy in particular. Policy is a defined course of action identified by individuals or groups in order to resolve a concern. Although this represents a fairly broad definition of policy, it is important to realize that policies can change, and in fact must change as situations or concerns change.
Consider for a minute an example of a positive and negative policy you have experienced and its consequences. Public policies are specific because they are identified and enforced by public or governmental officials. For example, requiring specific immunizations of school age children can come from local school district officials or state government or even both. Healthcare policies have far-reaching effects. Consider the ripples that emerge when a pebble is dropped into a pool of standing water. When the pebble is dropped into the water, small ripples begin developing around where the pebble was dropped, and a series of larger ripples follows with an increasingly wider radius. Consider the wide reaching impact if the minimum age for Medicare coverage was raised to 70 years of age! What if the policy was lowered to 60 years of age
As noted earlier, healthcare is a complex, convoluted system that must adapt to changes. The crisis facing the healthcare system currently are very different from the 1960’s. Take a minute and identify three current healthcare crisis or concerns and then compare to the list noted below.
With limited resources and higher costs, all parts of our current healthcare system are being severely stressed. In order for the system as a whole to survive, nurses must become more involved within healthcare policy making.
Since you realize how important it is for nurses to become actively involved within healthcare policy making, the only thing to now consider is what level or sphere of influence should you be involved at
Reflection
Think of an example of how you might get involved at each of the following levels:
• Workplace/workforce
• Government (local, state, federal)
• Associations and interest groups
• Community (local school district)
What would a discussion on policy be without a discussion about politics Politics, being a neutral term, refers to the process of influencing the allocation of scarce resources (Mason, Gardner, Outlaw, & O’Grady, 2016). Therefore, politics involves conflicting values and limited resources.
Is it any wonder that the very word—politics—often sparks such powerful emotions It is easy to confuse personal values with facts. Everyone feels passionate about their own values, attitudes, and beliefs, particularly when they have had an up close and personal experience with an issue. In fact some say that politics is the power of influence. Mason et al. (2016) have identified forces that shape policy. These are noted in the Figure: 1-1 Forces that Shape Policy.
However, compromise and alternative solutions must be part of the political process in order for a system to survive.
Professional Nursing’s History of Healthcare Policy Making
As nurses, we have been consistently judged as one of the most trusted professions. Strong nurse leaders, such as Lillian Wald, Margaret Sanger, and Lavinia Dock, worked tirelessly to promote health and change the lives of millions of people in this country. Yet, their actions occurred in spite of being women at a time in our history when women’s roles were those of homemaker and mother without the right to vote! Oftentimes, these women were persecuted and even risked jail in order to pursue their agendas of public health, social welfare, and community service.
Professional nursing as we know it today was started by Florence Nightingale in the mid-1800s. Her well known healthcare policy work in the Crimean War reduced the death rate at one hospital from 42% to 2%. The healthcare policies that she implemented focused on sanitation and environmental controls. She opened the nurse-training program in England with the intention to promote health, as well as the autonomy of nursing and women. When Nightingale’s model was first applied to schools in the United States a few years later, the intent was the same. It is her work to change healthcare policy at the workplace/workforce level that resulted in her recognition.
Nurse leaders at this time fully realized that their mission of public health and professional autonomy needed the strength found only in organizing. If they remained isolated and alone in their work, they were essentially powerless against the forces of entrenched medical groups and hospital boards. The founding editor of the American Journal of Nursing, Sophia Palmer, specifically used the journal as a means of enlightening nurses (women) about the importance of policy and politics. Nurse leaders, such as Isabel Hampton Robb, organized nurses and began to take control of the training schools within hospitals so that students would receive the type of education Nightingale had intended, instead of the hard-labor model that had evolved.
Within the public-health sector in the early 1900s, nurse leaders in the United States worked to improve appalling sanitary conditions, especially in poor urban areas. Lillian Wald organized a group of nurses living within the community they served and focused on community health issues. Today, it is difficult to imagine the social conditions of that time: Sanitation was nonexistent, overcrowding was rampant, and poverty was pervasive. Often, it was the women and children who bore the brunt of the lack of even the most basic healthcare. Margaret Sanger fought to promote access to birth control education, fully understanding and using political strategies in advocating for women’s health. Lavinia Dock worked to organize nurses and involve them in the suffrage movement, realizing that this political action would significantly strengthen nursing’s voice in all areas of healthcare policy. Appealing to nurses as women and citing the social plight of underfed school children in New York, Dock noted that this translated into the political power to change not only that situation but countless others that affect the health and social conditions of all individuals.
Out of the efforts of these women came health and social policies that transformed the quality and quantity of life in this country, and the ripple effect impacted the global community, as well. Consider each of these and other nurse leaders from history in terms of the four spheres of political action and political development. These women understood the critical importance of politics and policy making and the impact of policy on their advocacy agendas. Their focus was on the political process, and their goal was to impact health promotion and wellness in order to prevent illness, rather than simply treating what already existed. In this way, they understood that they could help far more people and promote the health of generations to come.
Throughout the intervening decades, nurse leaders in all areas of nursing followed in the footsteps of early activists and learned from their strategies. Ponder the fact that nurses have a significant way to go in terms of nursing leadership in the government sphere. What do you think needs to change or improve in order for nurses to get more politically active in the government sphere Will you be an active participant at this level How can you move in this general direction
Ethics and Healthcare Policy
One cannot possibly discuss politics and policy making without first reviewing the basics of ethics. Healthcare policy ethics is one of the most hotly debated and hard-fought issues in politics, especially here in the United States. With the rising costs and limited resources involved in healthcare services in this country, ethical problems and dilemmas appear on every horizon. When discussing ethics and healthcare policy, it is good to review basic ethical principles
Review the ethical principles and see a description of each.

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Applying the Principles
From the list of current health crisis or issues that you developed earlier in the lesson—consider one identified crisis and apply the four ethical principles to it.
When faced with an ethical dilemma, nurses understand that it is helpful to use an ethical decision-making model for examining various approaches.
Oftentimes, nurses think they are faced with an ethical dilemma, only to realize that after obtaining more information, no actual dilemma exists. As you consider potential policy-priority issues, take a minute to apply an ethical-decision model. Nurses face ethical problems every day, but an ethical dilemma places an ethical problem on a much higher level, calling for firm action and decision making.
Over the past several years, there have been many politically charged ethical dilemmas in the news. Ethical dilemmas abound in politics and policy making because of the nature of competition for scarce resources. Various professionals involved in ethical dilemmas—journalists, administrators, politicians, doctors, nurses, and so forth—bring their own professional ethics to bear on the issue at hand. Professional ethics evolve in certain conditions.

1. Recognition of a social need for a particular type of professional, so there is a purpose for a professional ethic
2. The expected conduct of the professional
3. The outcomes and skills expected in the professional’s practice
   As you think about a specific ethical dilemma debated in the media, consider the professionals involved and their particular professional ethics. Think about issues with health such as the possible epidemic with the H1N1 virus. This situation represented a politically charged true ethical dilemma in terms of healthcare distribution and allocation of vaccines. In addition, there were possible ethical considerations with the distribution of H1N1 antiviral medications. Lastly, some hospitals had scarce resources in terms of availability of hospital beds for the treatment of H1N1 patients and other patients needing care. These decisions all involve application of ethical principles for decision making.
   It is important to remember professional codes of ethics when encountering similar ethical dilemmas and issues in healthcare, as well as media influence on the issues. We will explore media influence on healthcare in detail in Week 6 by looking at various professionals with their own codes of ethics, as well as their own political agendas. Consider the media’s influence and impact on policy, such as policies involved with the H1N1 epidemic. Refresh your memory by performing a search on current H1N1 policy and prepare for the discussion question. As you search about H1N1 policy, consider the impact of reporting or bias expressed in some of the media accounts of the epidemic of H1N1. Keep the H1N1 policy in mind when the course focuses on the media’s impact in policy making in Week 6.
   As a nurse, what are your professional ethics Take some time to review the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2015). The code establishes an ethical framework that applies to all nurses regardless of role or educational level. Contained within the code are nine provisions that summarize basic values and commitments of the nurse, including duty and loyalty that extend beyond direct patient care. The principles of distributive justice should also be applied in the ethical decision-making model. Based on your personal experience dealing with various ethical dilemmas, consider the following.
   • To each the same thing
   • To each according to his or her need
   • To each according to his or her ability to compete in the open marketplace
   • To each according to his or her merits
   Most RNs have discharged patients from the hospital who have been sent home before they were ready. In fact, not only were they being discharged far too soon, but it was also clear that they lacked adequate support or resources at home. Have you seen suicidal patients denied admission or discharged within 24 hours of admission What about the lack of community resources An ever-increasing number of people are unable to access even the most basic of healthcare services. The issue here is one of limited resources versus costs. What happens when people are not provided basic healthcare What can nurses do about this situation How can you as an individual nurse with a graduate degree help to make life better This course provides the opportunity to embrace the political sophistication and leadership stages of political development.
   Summary
   Where the profession of nursing stand today does compared to those nurse leaders of yesteryear in terms of actually making health promotion and wellness our main focus How many lives did efforts of early leaders save Is your practice a subset of medicine and the illness model, or is it about wellness, health promotion, and prevention It is important that nurses remain active in policies and healthcare policy. How can YOU become active
   Next week, the focus involves a closer look at the U.S. healthcare system and issues related to policy making and policy decisions.

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