Policy analysis and advocacy in nursing education: the Nursing Education Council of British Columbia framework

Academic nursing leaders play a crucial role in the policy context for nursing education. Effectiveness in this role requires that they work together in presenting nursing education issues from a position of strength, informed by a critical analysis of policy pertaining to the delivery of quality nursing education and scholarship. We describe a collective process of dialog and critical analysis whereby nurse leaders in one Canadian province addressed pressing policy issues facing governments, nursing programs, faculty, and students. Consensus among academic nurse leaders, formalized through the development of a policy action framework, has enabled us to take a stand, at times highly contested, in the politicized arena of the nursing shortage. We present the components of a policy action framework for nursing education and share examples of how we have used a critical approach to analyze and frame policy issues in nursing education for inclusion on policy agendas. We believe our work has influenced provincial and national thinking about policy in nursing education is the foundation of our conclusion that political presence and shared strategy among academic nursing leaders is undeniably critical in the global context of nursing today.     

The road less traveled: nursing advocacy at the policy level

A frequent observation made about nursing advocacy at the policy level is its absence-or at least its invisibility. Yet there is a persistent belief that nurses will participate in advocacy at the societal level in matters of health. Although gaps exist in our knowledge about how to advocate at the policy level, the authors suggest that a number of other factors contribute to the disconnect between what nurses are expected to do in terms of policy advocacy and what they actually do. There are two main purposes in this article: to review the epistemological foundations of advocacy in nursing, and to present a discussion of other factors that limit our participation in policy advocacy. The authors discuss challenges within the discipline, in the practice context, and at the interface of the worlds of policy and nursing practice. The article concludes with a discussion of possible strategies for moving forward.     

Global standards for professional nursing education: The time is now

A well-educated, professional nursing workforce is essential to good health care outcomes. Although nursing education is being strengthened globally, considerable diversity persists in the level and standards of nursing education both within and across countries. An international framework of guidelines for nursing education has, therefore, been developed to promote greater international consistency and high-quality nursing education globally.The purpose of this paper is to discuss the multinational methodology used to develop a global framework for professional nursing education and the policy implications of this framework in guiding the harmonization of nursing education demanded by the State of the World's Nursing 2020 (WHO, 2020a) call to action. The framework includes the underpinning assumption that nurses be prepared at the baccalaureate level and three pillars of global expectations targeting: a) learning outcomes for graduating preservice nursing students; b) standards for nursing programs, and c) standards for educational institutions delivering nursing programs.The Global Pillars Framework reflects international best practices, but the guidelines are adaptable across socio-cultural contexts facilitating the integration of locally relevant education. As 2020 has been declared the Year of the Nurse and Midwife globally, the ground has been laid for the next evolution in the education of the nursing workforce globally.     

Policy analysis: a framework for nurse managers

The lack of involvement of nurses in the policy process is an issue of concern which has resulted in calls for nurses to become more active in this area of activity. However, what is often less clear is precisely how this can be done. This paper presents a template for policy analysis which can be used by nurse managers. The nature of policy and policy analysis is explored to provide a broad context for the discussion and the need for managers and nurse managers in particular to be 'policy competent' is established, as a prerequisite for effective management. There is also an examination of policy analysis in nursing which demonstrates why a range of approaches to the analysis of policy is needed. Based on this, a particular framework for policy analysis which can be used by nurse managers is presented. The overall purpose of the paper is to encourage debate in this area and contribute to the development of a specific tool for policy analysis that may help ensure a nursing management perspective informs policy formation and implementation.     

政策工具视角下国内护理卫生政策的文本分析

目的 研究1978年—2020年护理卫生政策中政策工具使用情况,探讨现有政策工具的分布情况及框架结构,为后续政策的制定及落实提供参考。方法 基于Rothwell&Zegveld构建的政策工具分析框架,采用内容分析法,构建X维度（基本政策工具）及Y维度（政策发展阶段）的二维分析框架,对现有护理卫生政策文本进行编码整理和量化分析。结果 最终纳入24篇政策文件,共整理378条政策分析条目。X维度中,供给型、需求型、环境型政策工具所占比例分别为24.60%、14.02%、61.38%。Y维度中,萌芽探索期、补充完善期、成熟提升期政策工具占比分别为23.02%、31.75%、45.24%。结论 目前国内护理卫生政策工具总体使用不协调,供给型政策工具较关注人才培养,科技研究和信息化建设有待增加;需求型政策工具应用较少,缺乏有效拉动作用;环境型政策工具使用过于频繁,内部工具比例有待调整。建议可进一步把握护理卫生政策演化的规律性,提升政策实施的实效性,强化政策组合的整体性。     

Triggers for nursing policy action: Getting to the critical point to solving “ordinary problems” in nursing

Two “ordinary problem” policy issues are analyzed, with the examination of how nurses, individually and organizationally, collaborated and advocated to address these issues by triggering local, state, and national action by stakeholders. Ultimately, the policy process through which nurses arrived at a Critical Point that triggered policy-based action to resolve these “ordinary problems” is presented. The first nursing issue is the national nursing shortage of 1966, which led to political action by members of the American Nurses Association, with policy implications focused on increasing the salary of the newly graduated nurse. The second nursing issue is that of needle-stick injuries experienced by health-care workers with analysis of the actions of individual nurses and nursing organizations’ stakeholders that triggered the development of state and federal laws, regulations, and policies that protect health-care workers from these injuries. Common filters affecting triggers for policy action are integrated throughout the policy dialogue.     

Development of the nursing process through action research

Implementation of the nursing process in practical nursing can be achieved in accordance with the principles of action research. A pre-requisite of the action research is a knowledge of the basic principles and the component areas of the nursing process, and of the opportunities for applying the nursing process to practical work. The documentation of the nursing of the patient is one clear object in which the model of the nursing process takes concrete shape. Another prominent form of action is the analysis of the content of the nursing, and on the basis of this framework the needs of individual patients can be determined and evaluated. Important methods in action research are consulting and work guidance. The researcher, together with the workers, endeavours to develop the work of nursing and to seek opportunities and methods to carry out the nursing process model.     

Health care policy development: a critical analysis model

This article describes a phased approach for teaching baccalaureate nursing students critical analysis of health care policy, including refinement of existing policy or the foundation to create new policy. Central to this approach is the application of an innovative framework, the Grand View Critical Analysis Model, which was designed to provide a conceptual base for the authentic learning experience. Students come to know the interconnectedness and the importance of the model, which includes issue selection and four phases: policy focus, colleagueship analysis, evidence-based practice analysis, and policy analysis and development.     

Distilling the Antecedents and Enabling Dynamics of Leader Moral Courage: A Framework to Guide Action

Intelligent, robust and courageous nursing leadership is essential in all areas of nursing, including mental health. However, in the nursing leadership literature, the theoretical discourse regarding how leaders recognise the need for action and make the choice to act with moral purpose is currently limited. Little has been written about the cognitions, capabilities and contextual factors that enable leader courage. In particular, the interplay between leader values and actions that are characterised as good or moral remains underexplored in the nursing leadership literature. In this article, through a discursive literature synthesis we seek to distill a more detailed understanding of leader moral courage; specifically, what factors contribute to leaders’ ability to act with moral courage, what factors impede such action, and what factors do leaders need to foster within themselves and others to enable action that is driven by moral courage. From the analysis, we distilled a multi-level framework that identifies a range of individual characteristics and capabilities, and enabling contextual factors that underpin leader moral courage. The framework suggests leader moral courage is more complex than often posited in theories of leadership, as it comprises elements that shape moral thought and conduct. Given the complexity and challenges of nursing work, the framework for moral action derived from our analysis provides insight and suggestions for strengthening individual and group capacity to assist nurse leaders and mental health nurses to act with integrity and courage.     

Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections

AIMS: This paper sets out to examine critically aspects of curriculum policy related to preregistration nursing education in the Republic of Ireland. BACKGROUND: Following a period of industrial unrest concerned with pay, promotional opportunities and conditions of employment amongst nurses and midwives in the Republic of Ireland, a Commission on Nursing was established in March 1997. Along with a series on recommendations pertaining to the role and the professional development of nurses and midwives, the final report of the Commission on Nursing contained recommendations on the educational preparation of nurses. Specifically, the Commission recommended that the future framework for preregistration nursing education in the Republic of Ireland be based on a 4-year degree programme, fully integrated into higher education. As a means of giving effect to this recommendation, the Commission also recommended the establishment of a Nursing Education Forum, whose task it was to develop a strategic framework for the introduction of the proposed preregistration nursing degree programme. The Forum published its final report in October 2000 and this report constituted the most explicit statement of official policy on the nursing curriculum in the Republic of Ireland. DESIGN: The paper constitutes a critical analysis of selected aspects of the report of the Nursing Education Forum, in the light of scholarly literature on curriculum philosophy and curriculum policy. SUMMARY OF CONTENT: The paper considers some of the implications for curriculum development and design arising out of the recommendations of the Nursing Education Forum. Among a list of core principles underpinning curriculum regulation and design, the report included the principle of 'eclecticism'. The paper considers this principle with reference to nursing epistemology, pedagogical practice and curriculum policy, and seeks to challenge some of the assumptions underlying this principle. CONCLUSIONS: The epistemological identity and the structural integrity of primary forms of knowledge in the preregistration curriculum need to be maintained if students are to develop their knowledge and understanding of nursing science.     

Public health nursing: the generalist in a specialized environment

In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role. Key factors were the subtle forces operating in the public health environment that constrain the public health nurse generalist role. Based on conflicts that arose in implementing the model, implications for public health nursing practice are in opportunities to influence policy at health department and other levels and responsibility for assuring professional practice.     

Education for advanced nursing practice: an evolving framework

This paper presents and critiques a framework for advanced health care practice. The framework is a set of professional attributes which underpin the delivery of an inter-disciplinary postgraduate course in the United Kingdom (UK). It enables students to review and develop knowledge and skills required to lead and advance nursing and health care practice. The framework is reviewed in relation to UK policy discussion on advanced or higher levels of practice. Brief comparisons are made with international concepts and literature on advanced nursing practice. The potential contribution of this framework to nursing practice and education is discussed. In particular, the framework provides a degree of clarity and coherence in specifying the nature and scope of advanced and higher level practice in the UK.     

A framework for portfolio development in postgraduate nursing practice

Aims and objectives. The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. Background. This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. Design and method. An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the ‘taking action’ phase of a first action research cycle. Results. In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. Conclusion. The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. Relevance to clinical practice. Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning.     

Innovations in community health nursing: Examples from practice

Cusack L, Smith M, Byrnes T. International Journal of Nursing Practice 1997; 3: 133–136
Innovations in community health nursing: Examples from practice
The Ottawa Charter for Health Promotion is cited internationally as an appropriate conceptual framework for healthcare service delivery yet the literature reveals minimal evidence of nursing services interpreting and applying the Ottawa Charter strategies into nursing practice. Nurses with the community services of Noarlunga Health Services and the Drug and Alcohol Services Council of South Australia, however, do use the strategies to plan and implement their services. The Ottawa Charter strategies of developing personal skills; creating supportive environments; strengthening community action; building healthy public policy; and re-orienting services in the interest of health can be used as a tool to assist nurses to identify the purpose of their interventions and select a comprehensive range of nursing actions which address the needs of individuals while acknowledging the broader determinants of health. This article presents a nursing analysis of the Charter and provides examples of how the strategies are used to influence nursing practice in both organizations. The examples provided from the two different nursing services also demonstrate the adaptability and relevance of the strategies to diverse community nursing practice settings.     

Planning for change: developing a policy framework for nursing labour markets

This article examines key aspects of change in European nursing labour markets, and highlights an integrated policy framework intended to improve nurse recruitment, retention and utilization in European health care. Health care is labour intensive. Staffing costs are often a major focus of the health sector. There is a tendency for staffing to be regarded as part of the 'problem' of cost containment, and staffing costs are often a major focus of health sector reform. This report argues that it is more appropriate to regard staffing in general, and nurses in particular, as part of the solution to improving quality, access and cost of care. The major elements in nurse workforce planning are discussed, and the need for planning to be integrated with service delivery is emphasized. With projected increases in the demand for healthcare, and concern about staff shortages, policy attention across Europe and in other countries must focus on improving the methods of recruiting, retaining and utilizing nursing resources. A policy-based framework for sustained improvement is presented, based on five areas of action: improve 'conventional' recruitment; improve recruitment from 'non-conventional' sources; identify and apply incentives to improve staff retention and motivation; improve staff deployment; and improve utilization/skill mix.     

The concept of priority as it relates to a community mental health team

This article illustrates how a concept clarification exercise can provide evidence to inform local policy development. Based on the framework developed in Walker and Avant's (1995) concept clarification theory, the concept of priority is examined in the context of a team of community mental health nurses. Themes of risk, multidisciplinary working, resources, and nursing role are identified as key areas for consideration, and the difficulties existing between government policy directives towards the severely mentally ill and health promotion are discussed. The article highlights how nursing theory can integrate the concept analysis of priority in planning client care. This is presented using Peplau's (1952) model as a guide to further enhance meaning of generated priorities to nursing practice.