Policy Definitions

Policy Definitions

Policy is authoritative decision making (Stimpson & Hanley, 1991) related to choices about goals and priorities of the policymaking body. Generally, policies are constructed as a set of regulations (public policy), practice standards (workplace), governance mandates (organizations), ethical behavior (research), and ordinances (communities) that direct individuals, groups, organizations, and systems toward the desired behaviors and goals.

Health Policy is the authoritative decisions made in the legislative, judicial, or executive branches of government that are intended to direct or influence the actions, behaviors, and decisions of others (Longest, 2010, p.5).

Health Determinants include the physical environment in which people live and work, people’s behaviors, people’s biology, social factors, and health services (Longest, 2010 p. 2).

Policy analysis is the investigation of an issue including the background, purpose, content, and effects of various options within a policy context and their relevant social, economic, and political factors (Dye, 1992).

Stakeholders are those directly impacted by specific policy decisions and who may be involved in the policymaking process.

Advocacy is a role, often performed by nurses, that works to promote or protect rights, values, access, interests, and equality in health care. Much of the policy process involves advocating for policy on behalf of patients and public health.

Public interest is a fascinating dynamic relevant to the development of public policy and is particularly important to influencing policy agendas at the community and broader policy levels. Taft and Nana (2008) have classified the sources of health policy within three domains. The first is professional, such as the need for standards and guidelines for practice. The second is organizational, which should be consistent with the needs of health care purchasers (employers), payers (insurers), and suppliers (health systems and providers). The third relates to the community stakeholders (patients and consumers) and public sources, including special interest groups and government entities.

Whatever the source, public awareness is often necessary for political action to take place and for the policy process to be initiated. For example, trends associated with health behaviors, such as the increased rates of childhood obesity, drunk driving, smoking, or gun violence, either gradual or resulting from a crisis situation, can all shift public perception and open the policy debate. Research 62consistently shows that a wide range of social and economic factors affect health although this broader causality is not well understood by the public. An opinion survey probing public opinion determined that most respondents think access to care and behaviors are most important. Far fewer respondents considered broader social determinants such as income, safe housing, race, and ethnicity to be important factors impacting a person’s health status (Robert & Booske, 2011). This gap in public understanding adds to the confusion and politi­cization of health policy in developing solutions that fun­damentally impact a person’s health status. As public knowledge increases, however, trends become increasingly objectionable to some mem­bers of society, which propels them to seek solutions. The rate of deaths caused by drunk driving, for example, resulted in strict nationwide drunk driving laws, and research on the impact of second-hand smoking led to the near universal ban on smoking in shared open spaces.

When people have a strong sense that the status quo is unacceptable, they begin to organize in a predicable fashion, leading to actions such as coalition forming or the establishment of a nonprofit organization. To move policy agendas forward, organizations must mature and build the resources needed to be effective in the policy realm.

Interest groups can stimulate a shift from interest in a policy solution to action wherein people work collectively to find solutions. Unions, trade associations, and political action committees are such examples. Professional nursing organizations serve as an interest group for nurses, not only to explore issues about the advancement of nursing but also to focus on societal issues such as the need for health reform, informing the public of emerging diseases and health threats, and the consequences of health disparities

Identifying and framing a problem is the first step, but it is also necessary to identify potential solutions. For example, concerns were raised in Washington state about the ability of insured workers to access health care in rural areas. This resulted in a delay in workers returning to work as well as insufficient reporting of injuries. Because nurse practitioners had been restricted in performing some of the functions related to certifying worker disability compensation, worker access to these providers was underused. As a result, the Washington State legislature enacted a pilot program to allow nurse practitioners (NPs) to expand their scope of practice to include serving as attending providers for injured workers. Despite some stakeholder concerns, the evidence concerning NP competency in undertaking this service was positive and subsequent analysis of the pilot program established that it was not only effective, it was also efficient in terms of use of resources (Sears & Hogg-Johnson, 2009). A policy intervention that will solve the problem is dependent on a 63thorough understanding of the problem itself as well as viable, evidence-based policy options.

Fairness and equity is a primary value driver that inspires nurses to participate in the policy process. Fawcett and Russell (2001) consider the equity of a policy as the extent to which it allows the benefits and burdens of nursing practice to be equally distributed to all; in particular, equal access to health services. For many nurses, advocating for fairness and equity is an application of patient advocacy, especially when human rights and health disparities are at stake. As noted in Chapter 1, social determinants of health illustrate that, in addition to individual choices, there are important environmental factors beyond the control of the individual that require collective action if health and health care are to be accessible for all (Dorfman, Wallack, & Woodruff, 2005).

Political viability is a further issue that must be considered. Policy that is considered desirable to both politicians and stakeholders will have the best chance of passage by a policymaking body. For example, public concerns about health effects from exposure to second-hand smoke have been communicated to policymakers many times. Although policymakers may want to take action to protect the public from tobacco smoke in public places, the pressure from tobacco companies for policymakers not to act has been equally powerful. As a result, public policy related to second-hand smoking languished for years in many states. However, when local communities in these states changed their ordinances to restrict smoking in public, there was increased pressure on state legislators to take action.