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Policy, Politics, and Global Health Trends Task Requirements: A.  Prepare your reflection essay (suggested length of no more than of 3 pages) of the values and ethics of a public policy issue by doing the following: 1.  Analyze a health or nursing profession public policy issue that impacts a group of people and requires a policy change. a.  Discuss why you selected this public policy issue.   Note: If you select a local policy, be sure your discussion reflects how the policy will affect more than a single unit, department, or organization.   b.  Discuss the relevance of the public policy issue to the health or the nursing profession, using two pieces of academically appropriate literature from the last five years. c.  Describe the financial impact of the public policy on an organization or on a community. 2.  Analyze how your values impact your position on the public policy issue. a.  Discuss the ethical principle (e.g., autonomy, beneficence, non-maleficence, justice) or theory that underpins your perspective.   B.  Develop a policy brief (suggested length of no more than 6 pages) for the public policy issue discussed in part A in which you do the following: 1.  Identify the decision maker (name and title) who will receive the policy brief. a.  Explain why the public policy issue requires the decision maker’s attention, using relevant nursing research from the last five years to support your position. 2.  Discuss the main challenges of addressing the selected public policy issue. 3.  Discuss the primary options and/or interventions for the decision maker, including why they are tangible. 4.  Propose a persuasive course of action for the decision maker, including ways to avoid the challenges identified in part B2. 5.  Discuss how you will evaluate the success of your policy brief (top-down approach).   C.  Create a plan (suggested length of no more than 3 pages) for working with an organization or a community to address the public policy issue analyzed in part A by doing the following: 1.  Identify an organization or community that has expressed interest in your selected health or nursing profession public policy issue. a.  Summarize evidence supporting why the organization or community has expressed interest in the selected public policy issue. 2.  Identify three CBPR principles you could use to work with the organization or community to address a policy change for the public policy issue. a.  Explain how you could approach and collaborate with the organization or community. b.  Discuss how the goal of the community or organization aligns with your goal for the selected public policy issue. c.  Discuss the action steps that need to be taken to achieve your goal from part C2b. d.  Discuss the possible roles/responsibilities of the community or organization members, including problem- solving and capacity-building roles. e.  Discuss key elements of developing a collaborative evaluation plan, using CBPR principles. f.  Discuss how you will evaluate the success of your community or organization plan (bottom-up approach).   D.  Analyze (suggested length of 1 page) the strengths and challenges of the top-down and bottom-up approaches in achieving policy change(s) to support your selected public policy issue by doing the following: 1.  Discuss the strengths of each approach to implement change for the selected public policy issue. 2.  Discuss the challenges of each approach to implement change for the selected public policy issue. 3.  Discuss which approach you would recommend as the most effective to address the selected public policy issue.   E.  When you use sources, include all in-text citations and references in APA format. *I WILL ATTACH A SAMPLE PAPER THAT WILL MAKE THINGS A LOT EASIER

SAMPLE PAPER

Decreasing Violence on Nurses

Student

University

C159: Policy, Politics, And Global Health Trends

Date

Decreasing Violence on Nurses

This paper will propose a new state policy and evaluate what goes into that proposal. An analysis of this nursing practice issue will be followed by a proposal to advocate for change in this area from both a top-down and bottom-up approach. This paper will examine the proposal’s relevance, financial impact, and challenges.

Policy Proposal

 The purpose of this new policy is to decrease workplace violence against nurses in hospitals. “Workplace violence is defined as any act or threat of physical violence, harassment, intimidation, or other threatening, disruptive behavior that occurs at the work site” (Flynn, 2019, p. 25). Workplace violence in healthcare can be decreased if healthcare facilities will have a plan in place for the prevention of this kind of violence. 

A1. Public Policy Issue

 According to one study, of the 25,000 workplace assaults reported each year, 75% of those involve healthcare workers (The Joint Commission, 2019). Between 2005 and 2014, there was a 110% increase in violence against healthcare workers (Flynn, 2019). According to Flynn (2019), 50% of physical assaults and 80% of verbal abuse do not get reported.  According to Ming (2019), “the rate of violence and abuse towards health workers was four times higher than that towards other occupational groups” (p. 1). Homicide is the second leading reason for workplace death amongst home health aides and nursing aides. The percentage of violent incidents is a significant health priority by the World Health Organization (WHO) and the International Council of Nurses (Ming, 2019).

A1a. Issue Selection

            The reason for selecting this issue is because in the past two weeks at my current place of employment, there have been four physical assaults that resulted in injury. All four of these assaults were on nurses by patients in the Emergency Room (ER). Over the last year, I have heard multiple news reports of assaults on healthcare workers. Of the 25,000 workplace assaults reported each year, 75% of those involve healthcare workers (The Joint Commission, 2019). I believe that healthcare facilities are so focused on patient satisfaction because of government reimbursement and regulation that healthcare workers’ safety has been neglected and compromised in the process. Violence on healthcare workers has been ignored and even tolerated, and it is time to look after the healthcare worker’s safety.

A1b. Issue Relevance

This issue is relevant because healthcare workers should feel safe at work.

Healthcare workers are being abused at alarming rates (Flynn, 2019). The percentage of violent incidents is a significant health priority by the World Health Organization (WHO) and the International Council of Nurses (Ming, 2019). With the recent 110% increase in assaults on healthcare workers, something must be done to protect healthcare workers from violence at work. California and Illinois both have recently passed legislation that requires programs to be put in place in healthcare settings to address the prevention of workplace violence (Flynn, 2019). Homicide is the second leading reason for workplace death amongst home health aides and nursing aides (Ming, 2019). In my state of North Carolina, there is a bill being proposed that makes it a felony to assault a healthcare worker. While this addresses the aftermath of an assault, there needs to be a policy in place to help prevent assaults from happening. The most effective means to stop workplace violence must focus on prevention. 

A1c. Financial Impact

            There is a financial responsibility for implementing this proposed public policy. There will be costs involved because it will take time developing this public policy, developing education materials, and training healthcare workers and agencies. Other costs that may be involved with this policy change will depend on the recommendations made to increase safety such as more security officers and more healthcare staff. Over time this upgraded public policy about health care worker safety will reduce turnover rates, improve job satisfaction and decrease workers’ compensation claims due to healthcare violence. 

A2. Personal Values

            Over the last few weeks, there have been multiple assaults in the ER where I am employed. I have recently seen a coworker beat in the head by a behavioral health patient until security could help her. This is unacceptable in any workplace regardless of the situation. Healthcare workers deserve to be taken care of at work regardless of patient satisfaction. My mother and sister are nurses, my niece is a nurse and two of my three children plan to be nurses. Safety at work is an essential part of a good work environment for everyone.

A2a. Ethical Principle

            The ethical principle for this public policy is nonmaleficence. Nonmaleficence is avoiding harm or hurt (American Nurses Association [ANA], 2015). Although this ethical principle is primarily preventing harm to patients, it can apply to healthcare workers as well. Healthcare facilities should be held responsible for keeping their staff safe as well as the patients in their care. This new public policy will promote nonmaleficence. 

The Top-Down Approach to Policy Advocacy

B1. Decision Maker

            It is important to identify a decision-maker who has the influence or authority to receive the policy brief when using the top-down approach to policy advocacy. One chair in the NC House is Representative Donna McDowell White. Representative White is one of four chairpersons in the House Standing Committee for Health. There are thirty committee members that work alongside the four chairpersons.

B1a. Explanation

 The reason why this issue is relevant is that healthcare workers should feel safe at work. Healthcare workers are being abused at alarming rates (Flynn, 2019).  While there is a focus on the consequences of assaulting healthcare workers in NC, there needs to be a focus on the prevention of assaults on healthcare workers. One study found that healthcare workers felt that workplace violence was a normal part of the job and said that it happened daily. One result of daily healthcare violence is that healthcare workers have a high tolerance for aggression (Morphet, Griffiths, Beattie, & Innes, 2019).

Representative Donna McDowell White is in the perfect position for putting forth the proposed policy for health care worker safety. She is a registered nurse and has her hand in many health and nursing policies in NC. She was the primary sponsor of the Board of Nursing technical changes policy and the need for additional funds for school nurses in NC.

B2. Challenges

            There are always challenges when addressing a new public policy issue. Everyone has their opinion on how policies should work or be implemented. The biggest challenge the decision-maker may face in trying to implement this new policy is the cost of the implementation. Healthcare facilities may be resistant to the proposed public policy because it will cost them more money. Some may feel it is not an important policy and not see the need for it. Another challenge that the decision-maker may face is opposition from the public. The public may feel as though healthcare facilities will not treat them appropriately if they are looking out for their employees first.  

B3. Options

            One option for the decision-maker is not follow through with the new proposed policy. If the decision-maker declines to move forward with the proposed policy, then healthcare workers will continue to be abused at high rates. The decision-maker may choose this route if they do not have enough support behind the policy. Another option for the decision-maker is to follow through with the proposed policy with some modifications. The final option would be for the decision-maker to follow through with the proposed policy. This final option would be the best option for healthcare workers and their safety. 

B4. Course of Action

            The course of action will be persuasion. Representative White will need to persuade members of the House to agree on the need for this new public policy. One way to avoid the challenges she may face in getting the public policy passed is to provide the members with the evidence that there is a problem with healthcare violence. She will need to demonstrate how healthcare violence has increased by 110% in recent years. A member of the law enforcement community that has been involved with investigating healthcare violence can speak on behalf of the need for this new public policy.  An administrator from a large hospital in NC can speak to the House on how the policy will not affect the quality of patient care but will only add to the safety of healthcare workers. And, thereby, this policy will actually increase the quality of patient care.

B5. Success of the Policy Brief

            The evaluation of the success of the policy brief will be seen initially when the policy is passed. Police reports will be reviewed six months after the implementation of the new public policy and compared to the six months before implementation. Surveys will go out to nurses in NC hospitals to determine if they feel safer in their workplace after the public policy is passed. The long-term success can be seen if one year after the new public policy is passed, the incidence of violence on healthcare workers will decrease by 20% in the state of NC. 

The Bottom-Up Approach to Policy Advocacy

C1. Identified Organization or Community          

            The North Carolina Nurses Association is the best organization to rally behind this proposed public policy.  

C1a. Summary of Expressed Interest

            The North Carolina Nurses Association advocates for nurses. “The North Carolina Nurses Association serves the changing needs of its members, addresses nursing issues, and advocates for the health and well-being of all people” (North Carolina Nurses Association, n.d., para. 1). This organization is an advocate for the nursing profession. The NC Political Action Committee (PAC) is part of the North Carolina Nurses Association. The NC PAC helps assure that nurses’ voices are being heard by candidates running for statewide office (North Carolina Nurses Association, n.d.).

C2. Community-Based Participatory Research

            There are three Community-Based Participatory Research (CBPR) principles that will work to address this new public policy change. The first principle involves systems development using a cyclical and iterative process. The second principle disseminates results to all partners and involves them in the wider dissemination of results. The third CBPR involves a long-term process and commitment to sustainability (Isreal, et al., 2010).

C2a. Approach and Collaboration

            Collaboration is needed when proposing a new public policy. An email will be sent to the NC Nurses Association to ask for their support on the policy. Their email address is noted on their website. I will ask to come and speak at an upcoming NC Nurses Association meeting to plead my case for support of the policy. All the attendees of the meeting will get handouts with information about the proposed policy and how to contact me with any questions that may arise.

C2b. Goal Alignment

            There is a goal alignment between mine and the NC Nurses Association in this proposed policy. The final goal for passing this public policy is to make the workplace safer for nurses. We both want to advocate for NC nurses’ safety. Part of the philosophy of the NC Nurses Association is to ensure that nurses have voices in NC. The NC Nurses Association works as an ally to protect and promote the issues that matter to nurses in NC, such as nurses’ safety (North Carolina Nurses Association, n.d.). 

C2c. Action Steps

            The first action step to achieve the stated goal is to gain support from stakeholders. A town hall meeting will be held to educate other healthcare workers about this issue. A sub-committee will then be organized to work on the research needed to support the issue. The final action step is to propose the new public policy to a decision-maker who can move the policy forward to a formal change. 

C2d. Roles and Responsibilities

Role/Title
Responsibilities
Problem-Solving
Capacity-Building

MSN, RN- Manager of ER
Facilitator of the meetings Goal setting Recruitment
Will address administration with any concerns they may have regarding the proposed policy
Collaboration and information sharing between administration and organizations  

BSN, RN, ER Nurse Educator
Organize a town hall meeting  Provide education to staff regarding the proposed public policy
Address concerns from staff regarding the proposed policy
  Workforce/professional development programs 

BSN, RN, Nurse Researcher
Address the financial impact of the proposed public policy
Will look at ways to decrease costs in implementing the proposed policy
  Resource allocation   Sanctions/incentives for compliance

C2e. Key Elements of Evaluation Plan

            The first CBPR principle we selected to use is systems development using a cyclical and iterative process. Our group will use the iterative process principle for the repetition of procedures to create a sequence of outcomes that we desire. This principle applies to the evaluation plan because evaluation is an on-going process. The second CBPR principle we selected to use disseminates results to all partners and involves them in the wider dissemination of results. Our group will use this principle by doing being transparent with the issue and involving as many people who are interested in the proposed policy as possible. This principle applies to the evaluation plan because it allows for people to ask questions about the proposed policy. The third CBPR principle we selected involves a long-term process and commitment to sustainability. Our group will use this principle by showing other healthcare workers that their safety matters, and we are committed to making the workplace a safer place.  This principle applies to the evaluation plan because it allows for the enforcement of the outcomes of the CBPR process (Isreal, et al., 2010).

C2f. Community/Organization Plan

            The first action step to achieve the stated goal is to gain support from stakeholders. A town hall meeting will be held to educate other healthcare workers about this issue. To evaluate the effectiveness of this step a count of how many people came to the meeting and how many agreed to support the proposed policy will be tallied. The second step is to organize a sub-committee that will work on the research needed to support the issue. To evaluate the effectiveness of this step the sub-committee will bring forth evidence-based research that can be used to support the proposed policy.  The final action step is to propose the new public policy to a decision-maker who can move the policy forward to a formal change. To evaluate the effectiveness of this final step would be to see the proposed public policy passed. 

Evaluate the Effectiveness of the Two Different Approaches

D1. Strengths of Each Approach

            One strength of the top-down approach is that there is a reduced risk involved in the decision-making method when lower-level employees are not in the equation. Another strength of the top-down approach is that decisions can be made more quickly due to strong management being involved with the top-down approach. One strength in the bottom-up approach is that employees are more likely to want to be involved and take ownership of the issue at hand. 

Another strength of the bottom-up approach is that ideas can be shared from multiple viewpoints, which can lead to quicker solutions (Eby, 2018).

D2. Challenges of Each Approach

            One challenge of the top-down approach is that employees may not feel as though they are important in the process of the proposed policy. Another challenge of the top-down approach is limited creativity. With not having a variety of employees involved in the approach to implement a change, there will not be as many ideas. One challenge of the bottom-up approach is the policy may take longer to come to initiate. It can take some time to get the administration involved in a proposed policy if they were not initially involved. Another challenge of the bottom-up approach is that the employees working on the project can be taken away from their everyday tasks that must be done (Eby, 2018).

D3. Most Effective Approach

            The bottom-up approach is the most effective approach to use when addressing a proposed public policy change. Although it may take a little more time to use the bottom-up approach, the benefits will be seen in the long run because there will be more buy-in. Lower-level employees are the ones working in the trenches and involved in the everyday workflow. It is important to have these people involved in the process of public policy change so they can have a say in new policies since they are directly impacted by these policies. 

References

American Nurses Association. (2015). Code of Ethics with interpretive statements. Retrieved 

from: https://www.nursingworld.org/coe-view-only

Eby, K. (2018). Which management style is right for you: Top-down or bottom-up approach?

Retrieved  from https://www.smartsheet.com/top-down-bottom-up-approach

Flynn, J. (2019). Workplace violence prevention: Liability recommendations. Journal of Legal 

Nurse Consulting, 30(2), 24–29. Retrieved from http://search.ebscohost.com.wgu.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=136971107&site=eds-live&scope=site  

Isreal, B., Coombe, C., Chezum, R., Schulz, A., McGranaghan, R., Lichtenstein, R., . . . Burris, 

A. (2010). Community-based participatory research: A capacity-building approach for policy advocacy aimed at eliminating health disparities. American Journal of Public Health, 100(11), 2094-2102. doi:https://doi.org/10.2105/ajph.2009.170506

Morphet, J., Griffiths, D., Beattie, J., & Innes, K. (2019). Managers’ experiences of prevention 

and management of workplace violence against health care staff: A descriptive exploratory study. Journal of Nursing Management (John Wiley & Sons, Inc.), 27(4), 781–791. https://doi-org.wgu.idm.oclc.org/10.1111/jonm.12761

North Carolina Nurses Association (n.d.). About NCNA.

Retrieved from https://www.ncnurses.org/about-ncna/about-ncna/

Ming, J.-L., Huang, H.-M., Hung, S.-P., Chang, C.-I., Hsu, Y.-S., Tzeng, Y.-M., … Hsu, T.-F.

(2019). Using simulation training to promote nurses’ effective handling of workplace violence: A quasi-experimental study. International Journal of Environmental Research and Public Health, 16(19). https://doi.org/10.3390/ijerph16193648

The Joint Commission (2019).  Workplace violence in health care settings. The Source 17(5), 10.

Retrieved from http://search.ebscohost.com.wgu.idm.oclc.org/login.aspx?direct=true&db=heh&AN=136010686&site=eds-live&scope=site  

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