Nurses' political involvement: responsibility versus privilege.

Nursing apathy toward participation in the political process is pandemic. Never more so than today has the profession needed a strong united stand within the political arena. Political involvement encompasses being knowledgeable about issues, laws, and health policy. Barriers to political activism are thought to encompass several spectra including heavy workloads, feelings of powerlessness, time constraints, sex issues, and lack of understanding of a complex political process. The implementation of a political role for a nurse is based on three levels of commitment including survival, success, and significance. Survival includes individual involvement within communities. Success accepts challenges in addressing injustices especially within the health-care arena. Significant involvement uses visionary nurses toward the betterment of the nurse profession. Strategies for involvement include political awareness, incorporation of course/program expectations on both undergraduate and graduate levels and teamwork. As patient advocates, nurses cannot continue to be spectators in the political arena.     

Shaping the future of practice through political activity: how nurses can influence health care policy.

1. The scope of professional nursing practice obligates the individual nurse to make participation in public policy formulation part of their professional work. Helping to shape the health and welfare of our communities and the nation fulfills part of nursing's contract with America's citizens. 2. Nurses have valuable, special knowledge and skills which "fit" very well with political involvement and policy making activities. 3. Occupational and environmental health nurses have a special responsibility to influence public policies that affect America's work force by using the five Cs of political action to enable effective involvement. 4. Nursing's professional associations act as advocates for nursing's unique interests and causes. Nurses who join and become active in associations such as AAOHN and ANA are instrumental in protecting the profession of nursing and ensuring that health care issues are at the top of the political agenda at all government levels.     

Nurses speaking up for mothers and children: 25 years of public policy involvement

Public policy decisions directly affect the health care of women and children and also affect the practice of maternal and child nursing. The past quarter century has seen a shift in nursing involvement in the public policy process. Heightened awareness of the collective power of nurses, greater independence of the nursing profession, the increasing capability for generating research to guide the formulation of public policy, and nurses' better understanding of the political process have all contributed to the increasing influence of our nation's 2.6 million nurses. The passage of several significant pieces of legislation, such as expansions of the Medicaid program for pregnant women and children in the late 1980s, have opened up new opportunities for nurses to further shape the nation's health care agenda for women and children. Nurses can and should become more involved with the policy-making process at local, state, and national levels to assure that decisions are made that benefit this important population group. Leadership in the public policy arena will give nurses the best opportunities for putting forth the agendas that will accomplish these goals.     

The nursing experience of helping an elderly stroke patient with feelings of powerlessness via life review method

This report describes the nursing experience of using the life review approach to help an elderly stroke patient reduce his feelings of powerlessness. The nursing care lasted between March 14th and May 24th, 2006. In the study of the nursing process, the author uses Gordon's assessment tools to gather subjective and objective information to establish the nursing problems, including activity intolerance, swallowing impairment, high risk of falling down, and powerlessness. Aiming at the nursing problem of powerlessness, the author makes use of the oral history method to conduct a life review of the client. Through the process of life reviewing, the client expressed acceptance of his life, reduced his feelings of powerlessness, and achieved the integration of his ego with his life. This case report might serve as a reference in guiding nurses to provide appropriate nursing interventions in helping clients with similar problems to obtain inner peace and reduce their feelings of powerlessness.     

Ten attitudes and behaviors necessary to overcome powerlessness

Many nurses feel powerless, and the nursing profession as a whole has not been able to influence the health care industry as it could have. Nursing must overcome its long history of powerlessness and the present health care situaton demands that we do. This article describes changes in attitudes and behaviors that are necessary in order for individual nurses and the profession to become powerful.     

Nursing and politics: a South African perspective

The purpose of this paper is to provide a general introduction to politics, and to describe some political changes which have affected the rendering of multidisciplinary health care services in the Republic of South Africa since 1994. Political issues which will be addressed include: changed provincial borders; opening up of the Republic of South Africa's international borders; increased emphasis on primary health care services; enhanced international involvement of the Republic of South Africa; changes in the statutory bodies governing the nursing profession; and changed legislation affecting health care workers. Political know-how is essential for professional survival. Unless nurses in the Republic of South Africa collaborate proactively as a united group representing the largest proportion of health care professionals in the country, the nursing profession and nursing education might become irrelevant to the political realities of the country and its people. Unless nurses can succeed in engaging in successful political debates and in negotiating their rights, they might become an increasingly voiceless, faceless and powerless female profession in the Republic of South Africa. However, politically knowledgeable nurses may help to ensure that the people will get the nurses and the nursing care they deserve, whilst the nurses will enjoy the benefits to which they are entitled, including market-related salaries.     

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.     

Nursing diagnosis. Powerlessness in critical care patients

The critical care environment, with its fast-paced tempo, its vast technology, and its many invasive procedures, carries the potential for creating feelings of powerlessness within patients, their families, and even in the nurses who work there. This article examines the nursing diagnosis of powerlessness and its etiologic factors. The authors present a challenging case in which creative nursing techniques decrease powerlessness for a partially paralyzed and intubated patient.     

Ethical dilemmas and moral distress in oncology nursing practice

Although ethical values and principles guide oncology nursing practice, nurses often are challenged to fulfill every professional core duty and responsibility in their everyday practice. Nurses commonly encounter clinical situations that have ethical conflicts, and they often have difficulty recognizing and articulating them. Unresolved conflicts can cause feelings of frustration and powerlessness, which can lead to compromises in patient care, job dissatisfaction, disagreements among those in the healthcare team, and burnout. This article reviews the ethical principles and values individual nurses bring to their practice as well as those basic to the profession of nursing. This article also discusses ethical conflicts in oncology practice and describes how nurses, especially students and novice nurses, may react to such situations with moral uncertainty or distress. In addition, a process for analyzing and resolving ethical problems in clinical situations is outlined. Increasing awareness and dialogue about ethical issues is an important first step in the process. Additional resources in the clinical setting may encourage nurses to actively participate in ethical decision making and take deliberate action as moral agents.     

What are the sources of health policy that influence nursing practice?

This article seeks to fill a gap in the existing nursing literature by answering the question, "Where does health policy come from?" Nursing leaders agree that nurses should be involved in developing health policy, yet most nurses are not engaged. Many factors contribute to nurses' low rates of involvement, but the primary drivers is that nurses believe they lack the knowledge and skills to influence policy formulation. This article proposes a framework of the sources of health policy. We classify health policy sources as public, organizational, or professional, and provide examples. Nurses with a deeper understanding of the varied sources of health policy can enhance their political competence and more readily act in the policy domain.     

深圳市社区护士公共卫生护理知识掌握及需求情况的调查

目的对深圳市社区卫生服务中心,社区护士公共卫生护理知识掌握及需求情况进行调查,为社区公共卫生护理的发展定位与护士的培养提出方法和对策。方法采用问卷调查,随机整群抽取辖区33家社康中心150名护士作为调查对象,了解社区护士对公共卫生知识的掌握情况和培训需求的顺位。结果深圳市社区护士学历和职称偏低,掌握知识较少的为现场流行病学与统计的应用,社区公共卫生护理模式,最需要培训的是社区突发性公共卫生事件紧急救护,常见传染性疾病的预防与护理。结论社区护士对公共卫生护理知识缺乏,社区护理工作应均衡发展,根据社区护士对公共卫生护理知识不足及需求,有针对性加强培训。     

The moral leadership of the nursing profession.

As the largest group of professional workers in the health care field, nurses possess the numbers to command a key role among health professionals. It is, however, apparent that nurses must assume a more visible and vital leadership role in the delivery of health care if nursing is to remain a viable profession. Nursing's immediate goal must be to unite forces in an effort to bring about greater involvement of nurses in planning, delivering and assuming accountability for the nursing component of health services at all levels. The ease with which the profession is able to accomplish this goal is dependent upon the ability of nursing's leadership to evoke a sense of harmony and balance within the profession, while creating a dynamic image of nursing among other health professionals and the public. Today, there is a need for strong moral leadership in the nursing profession. In ‘moral leadership’ the power of the leader is used to work with the group as a whole, while guiding individual members towards satisfaction and self-fulfilment. A critical evaluation of the profession's leadership capabilities should begin with definitions of the role and responsibility of nurses for leadership in the professional association. By its very nature, the professional association stands as the leadership mechanism of the profession and, by working through the association, nursing leadership can unify nursing forces, implement plans aimed at involving more nurses in health planning activities, and facilitate the involvement of individual nurses in determining the conditions of employment under which they practise.     

Moral distress among Ugandan nurses providing HIV care: A critical ethnography

Background

The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa.

Aim

To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people.

Method

A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions.

Results

Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients’ wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues.

Conclusions

The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructure may result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public.     

Nursing shaping and influencing health and social care policy

Aim  This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.
Background  The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.
Methods  This paper critically reviews recent UK and USA literature and policy with relevance to nursing.
Results  Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.
Conclusions  Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.
Implications for Nursing Management  All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.     

District continence nurses’ experiences of their continence service in primary health care

hägglund d . (2009) Journal of Nursing Management  18, 225–233
District continence nurses’ experiences of their continence service in primary health care Aim The aim of the present study was to describe district continence nurses’ experiences of providing continence services in primary care. Background It has been stated that there is too little research on the experiences of district care nurses who provide continence services. Method Twenty-two district continence nurses answered a written questionnaire containing three open-ended main questions. A qualitative content analysis method was used to analyse the texts. Results The district continence nurses’ feelings of maintaining their professionalism were promoted by scheduled patient encounters, patients who participate in assessment of urinary incontinence (UI) and functioning teamwork. The opposite situation, nurses’ feelings of having a lesser degree of professionalism, was associated with not having scheduled patient appointments, patients not participating in assessment of UI and lack of teamwork. Conclusions The district continence nurses lacked the authority to start nurse-led continence clinics because of the lack of collaborative teamwork, an organization that did not enable nurse-led scheduled appointments and nurses’ limited view of their own profession. Implications for nursing management Primary health care managers and policy-makers need to provide an environment that enables interprofessional collaboration so that nurses’ skills can be used to advance patient services; such initiatives could enable district continence nurses to reach their full potential.     

Toward Redefining Public Health Nursing in Canada: Challenges for Education

Faced with a recent shift from a hospital-based to a community-based health care system, Canadian public health nurses are being challenged to redefine their roles. To empower these nurses to respond effectively, it is imperative that the profession be reclarified as a specialty with a distinct philosophy and mission. Nursing education is key to facilitate this process, and public health nursing educators must lead the way. Certain barriers hinder the response of public health nursing education, and four areas are suggested in which efforts to advance public health nursing may be best directed.     

The application in public health nursing of the employee empowerment model and relevant considerations

Empowerment, rooted in the black civil rights and other civic movements of the 1960s, has greatly impacted thought and theories on health promotion activities, management strategies, and educational reform. Public health nurses are vital facilitators to the introduction and implementation of the empowerment concept in the health care field. Employee empowerment, based on the concept of empowerment, comprises the two domains of ability and power, which may be assessed through psychological and organizational empowerment. This article illustrates the employee empowerment model, the combination of cognitive empowerment model, and its application in public health nursing. The empowering process includes confirming feelings of powerlessness during the dialogue phase; empowerment education and organizational dialogue during the development phase; and collective action for goal-setting during the action phase. This paper also notes issues that should be considered related to model implementation, including new technology of old paradigm, the risk for more disempowered status, and an appropriate methodology for research paradigms. The employee empowerment model presented in this paper may be used as a guide to design empowerment education curricula for public health nurses.     

Shared governance--nurses making a difference

AIM: This paper aims to describe how shared governance can be successfully integrated into existing management structures in a large medical directorate. It will show how the shared governance philosophy can lead to the creation of a culture where nurses feel important and valued and also consider its use as a foundation for the implementation of the nursing strategy. BACKGROUND: The hospital adopted shared governance in 1995 with the setting up of councils led by staff nurses. Shared governance advocates claim it broadens involvement of clinically-based nurses in the process of change through devolved decision-making thereby enhancing clinical practice and increasing staff moral and self-esteem. Key issues Shared governance is a cultural change that will develop the leadership and management skills of all grades of staff. Shared governance is not a quick fix for the profession; involvement of all staff needs time, persistence, determination and a strong commitment to training and development. CONCLUSION: The national nursing strategy puts nurses in a position to positively influence health care for the advantage of patients, however, for nurses to grasp this opportunity cultural change is required. This practical example of shared governance demonstrates how it can be used to create a proactive culture, focused on improving patient care. The nurturing and developing of clinically-based nurses provides them with the knowledge and skills to challenge the status quo and lead change. Thus, shared governance is an excellent foundation from which to develop the nursing strategy.     

The need for nursing leadership in uncertain times

Background The world today is changing and being affected by advances in technology and communication, as well as changes in the political, economic, demographic and social environment. These changes also effect the delivery of health care services.
Aim A review of the literature was conducted to examine how the profession of nursing can ensure that it is involved in shaping the health care system of the future.
Key Issues to Emerge The nursing profession requires leadership which empowers nurses, enabling them to lead the profession into the next millennium. Pressures for change in health care delivery make the move from bureaucratic management to effective leadership essential. Development of an appropriate model of leadership will ensure that nurses play a pivotal role in the process of change.
Conclusion Transformational leadership is the model that will assist nursing to develop into an empowered profession with the potential to be a dominant voice in reshaping the health care system of the future.