7007.1.1 : Organization and Financing Healthcare

The graduate analyzes the organization of healthcare delivery and financing systems in the United States and other nations.

7007.1.2 : Policy Process

The graduate analyzes the historical, economic, and political factors that affect healthcare policy development and the impact of those policies on healthcare cost, quality, and access.

7007.1.3 : Effects of Legal and Regulatory Policies

The graduate analyzes the effect of major legal and regulatory policies on nursing practice, healthcare delivery, and health outcomes for individual, families, and communities.

7007.1.4 : Ethical Theories Applied to Nurses’ Policy Positions

The graduate analyzes the values that drive policies.

7007.1.5 : Advocate for Policies That Improve the Health of the Public and the Profession of Nursing

The graduate analyzes strategies that healthcare advocates use to affect policies with the goal of improving the public health and the profession of nursing.

INTRODUCTION


For this assessment, you will be required to develop and thoroughly analyze a public policy in order to advocate for one that improves the health of the public and/or the nursing profession globally (local, state, national, or international). To do this, you will reflect on several aspects of being a policy maker within the nursing position. A few things to consider are:

•   Why did you select the health or nursing profession policy issue?

•   How does this issue affect nursing practice, healthcare delivery, and health outcomes for individual, families, and/or communities?

•   What are the values and the ethical positions that underpin your perspectives?

•   What are the criteria you will use to evaluate the success (outcomes) of your proposed policy change?


By using both a top-down and a bottom-up approach, you will analyze and bring the nursing perspective to policy makers and stakeholders. Identifying the values and ethical perspectives that underpin your position, you will develop criteria to evaluate the success of your work. This will lead to a created a policy brief that can be sent to decision makers and created a plan to work with an organization/community to promote policy change at the local level.

To guide you to your conclusion, using nursing research to support your position is vital. This should include principles of community-based participatory research (CBPR).

REQUIREMENTS


Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

Professional Communications is a required aspect to pass this task. Completion of a spell check and grammar check prior to submitting your final work is strongly recommended.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. 

Note: Your submission may take the form of an essay, multimedia presentation, etc. Be sure to cover each prompt in sufficient detail and support no matter what form you use.

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.

Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

File Restrictions

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-PA Task Rubric Tips-

Section Criterion Course Instructor Tips

Section A: Policy Proposal In this section, the candidate (i.e. student) will explain why the issue/problem is important and provide the rationale for your policy (or bill) proposal. (Video: Quick tips on setting up your paper and APA – 5:01) Download the APA template here: APA Template.docx This section serves as a brief introduction to your paper. In a few sentences, describe the problem you are trying to solve. Then clearly state your policy (or bill) idea in a very detailed sentence or two.

A1. Public Policy Issue The candidate provides a plausible analysis, with substantial detail, of a health or nursing profession public policy issue that impacts a group of people and requires a policy change. The policy (or bill) proposal must have an impact that is larger than one organization (not hospital policy). Typically it should be a state or national policy (or bill), but sometimes city, or county will also work.

A1a. Issue selection The candidate provides a logical discussion, with substantial detail, of why the public policy issue was selected. In about a paragraph , write about why you selected this issue. Why is it a problem for your community, your state, or the nation?

A1b. Issue Relevance The candidate provides a logical discussion, with substantial support, of the relevance of this public policy issue to health or the nursing profession, using 2 pieces of academically appropriate literature from the last five years. In a few paragraphs (2 – 4), write about why this issue is important. Why should this issue be addressed as a public policy or law? Be sure to use at least two citations from academically appropriate literature. (Appendix A describes how to identify academically appropriate literature)

A1c.

Financial Impact

The candidate provides an accurate description, with substantial detail, of the financial impact of the public policy on an organization or on a community. Discuss what types of things would cost money (and time and effort) and then discuss the positive impact the policy would have on healthcare. For example, if your policy (or bill) idea is to improve staffing, you can discuss how it would cost money to hire more nurses; however, the positive financial impact, over time, would be: reduced turnover, improved job satisfaction, and better patient outcomes. As a result, money will be saved and reimbursements will increase.

A2. Personal Values The candidate provides a plausible analysis, with substantial detail, of how the candidate’s values impact the candidate’s position on the public policy issue. Discuss how your own personal/professional values relate to this policy (or bill) idea. [Why are you passionate about this topic]. You may write in 1st person language in this section and in other sections that ask you for your perspective.

A2a. Ethical Principle or Theory The candidate provides a logical discussion, with substantial detail, of the ethical principle or theory that underpins the candidate’s perspective. In about a paragraph, discuss an ethical principle or theory that could apply to your policy (or bill) topic. You can find a list of nursing ethical principles and theories.

Section B: The Top-Down

Approach to Policy Advocacy In this section, the candidate (i.e. the student) will discuss your plan for going directly to a decision-maker and asking them to pass a mandate (a bill, regulation, ordinance, etc.) for policy change or passing of a law. (Video: Quick tips on the Top-Down Policy Advocacy Process – 7:11)

B1. Decision-Maker

The candidate identifies the appropriate decision maker (name and title) who will receive the policy brief. Select a decision-maker for the proposed policy (or bill). You must identify a real name and actual title of the person who has either influence or authority to set policy. For more guidance view the video clip (linked above).

B1a. Explanation The candidate provides a logical explanation, with substantial detail, of why the public policy requires the decision maker’s attention, using substantial relevant nursing research from the last five years to support the position. Describe why this policy (or bill) is important (summarize the main points from Part A). Then explain why the decision-maker is a good fit for the proposed policy (or bill). Be sure to use at least two nursing research articles to support why this policy idea is important. (Appendix A describes how to determine if the article is research and also how to investigate authorship)

B2. Challenges The candidate provides a logical discussion, with substantial detail, of the main challenges of addressing the selected public policy issue. Discuss some of the challenges you think the decision-maker may face in trying to get the policy implemented or the bill passed into law. These are often objections raised by lobbyists, groups, and members of the public. To brainstorm potential challenges, ask yourself, “why isn’t this idea already a policy or law?”

B3. Options/Interventions The candidate provides a logical discussion, with substantial detail, of the primary options and/or interventions for the decision maker, including why they are tangible. Anticipate choices the decision-maker will have related to taking on your proposal. The first option to consider is that the decision-maker may decide to leave things as they are (the status quo). If the decision-maker would decline to move forward, what would the outcome be? Also explain why they might choose this option (think politics). A second option could be that the decision-maker accepts the proposal with some modifications or compromise. A third option for the decision-maker is to adopt and support the policy (or bill) proposal and carry it forward through the change process. Students must cover all three options.

B4. Course of Action The candidate provides an appropriate proposal, with substantial support, for a persuasive course of action for the decision maker, including ways to avoid the challenges identified in part B2. Discuss the challenges of the decision maker that you discussed in B2 from their perspective. How would the decision maker address each of these challenges in a persuasive way? Keep in mind that your decision maker may or may not be a legislator depending on your policy. If they are a legislator you will want to keep in mind that he or she might be making these persuasive discussions during the debate portion of the bill of the legislative process. If not a legislator the decision maker would likely be making these persuasive discussions during a meeting of members of the deciding committee (school board, nursing board, etc). Legislative example: The general public and other lawmakers may not understand the health risks and importance of vaccines. Persuasive action: The decision-maker could invite the State Epidemiologist to the public committee hearing to present testimony about risks of disease and benefit of immunizations. The emphasis is on the action of the decision-maker to persuade, not on what you do. Keep in mind the timeliness of action. The decision-maker can describe what has been done or share evidence to support their opinion that the bill should pass, but they will not conduct research or provide expert testimony.

Non legislative example: The general public and other school board committee members might not understand the importance of decreasing child obesity in their county. Persuasive action: the decision maker could invite a nutritionist to a meeting to discuss the importance of a healthy diet and exercise in preventing and reducing childhood obesity rates. Again the emphasis is on the action of the decision-maker to persuade.

B5. Success of Policy Brief The candidate provides a logical discussion, with substantial detail, of how the candidate will evaluate the success of the policy brief (a top-down approach). Anticipate what success will look like at each stage in the process and what you would like to see as the long term outcome of your policy or bill change. Process successes for the top-down approach happen at each stage of the policy (or bill) process. For example, if you are trying to get a bill passed, your first success is when a legislator agrees to sponsor a bill, the next success is when the bill passes committee hearings, etc. Long-term success describes what happens after your policy or law is implemented. After your policy (or law) passes, what would be different? What is your SMART goal? For example, if we were changing childhood immunization requirements, a long term success might look like this: “One year after the new immunization law is passed, the incidence of vaccine-preventable illnesses decreases by 20%”.

Section C: The Bottom-up

Approach to Policy Advocacy In this part of the paper, the candidate (i.e. student) will describe a plan for working with a relevant stakeholder organization (such a professional or community organization) and developing a work-group to educate others about the issue and to advocate for a policy (or bill) change. (Video: Quick tips on the bottom-up approach – 4:29)

C1. Identified Organization or Community The candidate identifies an organization or community that has expressed interest in the selected health or nursing profession public policy issue. Identify an entity to serve as a collaborating organization. This organization will not do all the work but if they back your idea they can share resources, help you make connections, and lend their name to give your work-group credibility. (Video: Choosing and working with a collaborating organization – 9:35 )

C1a. Summary of Expressed

Interest The candidate provides a logical summary, with substantial detail, of evidence supporting why the organization or community has expressed interest in the selected public policy issue. How do you know this collaborating organization would be aligned with your policy (or bill) proposal idea? Do they have information on their website? Printed materials? Have they discussed this issue at conferences? Cite your source, such as the organization’s website address, monthly newsletter, or personal communications at a meeting.

C2. CBPR Principles The candidate accurately identifies 3 CBPR principles the candidate could use to work with the organization or community to address a policy change for the public policy issue. List three CBPR principles (Appendix B) that the work-group could apply in the advocacy process. You do not need to expand on the principles or explain your rationale in this section. That will come later in section C2E. (Video: CBPR in the bottom-up approach – 6:08) Find CBPR citation tips in Appendix D

C2a. Approach and

Collaboration The candidate provides a logical explanation, with substantial detail, of how the candidate could approach and collaborate with the organization or community. Describe exactly how you would approach the collaborating organization to discuss your policy (or bill) idea. Approach: Who would you contact? How would you ask for their support [via email, phone, etc.? Collaboration: How will you recruit contacts from that organization to work with you on the policy (or bill) change? This is where you begin to build your work-group for the bottom-up approach. Ideas for networking and collaboration: Present a poster at a conference, write something about your idea in an organizational newsletter or email, ask to speak at a regular meeting of members.

C2b. Goal Alignment The candidate provides a logical discussion, with substantial detail, of how the goal of the community or organization aligns with the Discuss how you know that the collaborating organization has a philosophy that would support your policy or bill. Have they done work with this issue before? Is there something in their mission or values

candidate’s goal for the selected public policy issue. statement that demonstrates goal alignment? Be sure to cite a source for this information.

C2c. Action

Steps The candidate provides a logical discussion, with substantial detail, of the action steps that need to be taken to achieve the candidate’s goal from part C2b. List 3-5 important action steps that the work-group will take to educate others about the issue, to advocate for your policy, and to gain support from stakeholders. Would you have a town hall meeting? Would you have a sub-committee of your work-group do some research on the subject? Would you arrange for meetings with other organizations or individuals who may be interested in supporting your idea? Remember that the last step in a successful policy (or bill) change would generally be presenting your proposal to a decision-maker who can move the policy (or bill) forward to a formal change.

C2d. Roles and

Responsibilities The candidate provides a logical discussion, with substantial detail, of the possible roles/responsibilities of community or organization members, including problem-solving and capacity-building roles. Identify 3 – 5 important roles for your work-group members. It helps to think about what you need the work-group to do. Then identify specific individuals to take on those functions. For example, someone will need to serve as the facilitator of your meetings; the MSN is often the best person to take on this role since the initial idea is yours. If you have planned a town hall meeting you may want to include a subject matter expert from your collaborating organization to lead the public session. Be sure to include the fact that some of these roles will be assumed by either members of your collaborating organization (C1) or people that you have met through networking within that organization. The important part is to identify what your work-group needs people to do in order to accomplish your goal, and then identify group members (by position or area of expertise) who have the knowledge, skills, or experience to take on those roles. For each role, be sure to include how that role will help the group meet your goal (getting the policy changed). You also need to identify how each role contributes to problem solving (addressing challenges) and capacity building. Additional Guidance in Appendix C (Video: Roles and Responsibilities 8:42)

(Video: Capacity building 2:41)

C2e. Key Elements of

Evaluation Plan The candidate provides a logical discussion, with substantial detail, of key elements of developing a collaborative evaluation plan, using CBPR principles. In a few sentences, discuss how you would use each of the three CBPR principles (C2) as you work with your work-group. Provide an example of how your group might use this principle in your work. Be sure to specifically address how the process will use the CBPR principles to plan for the evaluation, since there is no implementation required in this assignment. How might you use each principle to evaluate the effectiveness of your work-group? The details of the evaluation plan are in the next section (C2F) so here you just need to write about applying these principles to your plan. This might look like: The first CBPR principle we selected to use is _______. Our group will use this principle by doing ____________. This principle applies to the evaluation plan because ___________________________. Additional Resource for Explanation of CBPR Principles: http://www.policylink.org/sites/default/files/CBPR.pdf Tip: See video in C2

C2f. Community/

Organization Plan

The candidate provides a logical discussion, with substantial detail, of how the success of the community or organization plan will be evaluated (bottom-up approach). Describe how you will evaluate each of the action steps from C2c. For example, if you hold a town hall meeting, you might count how many people came to the meeting and how many agreed to support your policy idea. A long term success would be evidence of actual change that you expect to see if the policy is adopted. You just need to identify one indicator for long term success. (SMART goals are best!) Tip: See video in C2. For example, if you hold a town hall meeting, you might count how many people came to the meeting and how many agreed to support your policy idea. A long term success would be evidence of actual change that you expect to see if the policy is adopted. Look for the measurable outcome.You just need to identify one indicator for long term success. (SMART goals are best!)

Tip: See video in C2

Section D: Evaluating the

Effectiveness of the two

Approaches In this section, you’ll discuss the pros and cons of the top-down and bottom-up approaches to policy (or bill) advocacy.

D1. Strengths of Each

Approach The candidate provides a logical discussion, with substantial detail, of the strengths of each approach to implement change for the selected public policy issue. Describe at least 2 strengths of the top-down approach (the approach you developed in Part B) and 2 strengths of the bottom-up approach (the approach you discussed in Part C). Be sure to discuss how the strengths relate back to your policy.

D2. Challenges of Each

Approach The candidate provides a logical discussion, with substantial detail, of the challenges of each approach to implement change for the selected public policy issue. Describe at least 2 challenges (weaknesses/negatives) of the top-down approach, and 2 challenges of the bottom-up approach. Be sure to discuss how the challenges of each approach would relate to your policy.

D3. Most Effective Approach The candidate provides a logical discussion, with substantial detail, of which approach the candidate would recommend as the most effective to address the selected public policy issue. In about a paragraph, discuss which approach you would recommend, based on your analysis of each approach. Be sure to pick only one approach (either Top-down or Bottom-up) to recommend and provide your rationale for why you would recommend it.

E. Sources When the candidate uses sources, the candidate provides appropriate in-text citations and references with no readily detectable deviations from APA style, OR the candidate does not use sources. Double-check your paper for appropriate APA, especially in your citations and references. Be sure to check for spelling and grammatical errors. Be sure that you are citing the resources used both in-text and on the reference page. It is vital to your Turnitin score that you are paraphrasing (putting in your own words) what the references say. Citing a sources in not enough to prevent it from being triggered on the originality report. Ensure that your paper score is in the ‘green’ (less than 30%). (For some examples of common sources used in this course see Appendix D on page 15 of this document) (Video: Quick tips on setting up your paper and APA – 5:01)

policy: A standard, or mandate that is enacted with the intent of regulating a practice. For purposes of this assignment, the policy must be at the level of being endorsed by government or standard of practice that is regulated by an organization or industry. It must be larger than organizational policy and procedure or at a local level.

substantial: Ample; significant; considerable in importance; more than adequate

tangible: Capable of being perceived, realized, or appraised as substantially real

top-down approach: A process by which the candidate (student) designs a plan to approach a decision-maker with an idea for policy change. The student’s role is in convincing the decision-maker to agree to promote the policy. The active part of the policy change process is then done by the decision-maker, not the student or a community organization.

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