CHAPTER 10 RESEARCH AS A POLITICAL AND POLICY TOOL.pptx

RESEARCH AS A POLITICAL AND POLICY TOOL CHAPTER 10  S O W H AT I S P O L I C Y ? Research is a powerful tool in politics and policymaking, playing an increasingly influential role in crafting political messages and policy declarations in nursing and health care. Polic...

RESEARCH AS A POLITICAL AND POLICY TOOL CHAPTER 10  S O W H AT I S P O L I C Y ? Research is a powerful tool in politics and policymaking, playing an increasingly influential role in crafting political messages and policy declarations in nursing and health care. Policy is usually considered as formal rules set by Congress, state legislatures, or agencies at city, county, state, or federal levels. However, it is also made by private entities such as clinics, hospitals, nursing schools, insurance companies, and insurance companies. Policymakers in both private and public venues look to evidence to inform decisions. Research alone is not responsible for producing policy. As the players change, so do considerations about research, how best to use findings, and what research question to ask. This can be seen as the political ecology of policymaking, which encompasses the subtle and sometimes overt influences surrounding the making of any policy. Policymakers in both private and public venues look to evidence to inform decisions. W H AT I S R E S E A RC H W H E N I T C O M E S T O P O L I C Y ? Research in policymaking involves both quantitative and qualitative methodologies, including systematic reviews and meta-analyses. These reviews distill and analyze quantitative data from existing literature, providing a summary of evidence for advocates and policymakers. Data mining, which involves analyzing data from large data sets, is a long-standing relationship between data and healthcare policymaking. Secondary data is challenging but rewarding due to its vast scope. Other sources of data contribute to the policymaking process, such as reports from expert panels, foundations, and research agencies. Op-ed pieces by experts and position papers generated by legislative staff can also be powerful. Advocates should be open to sources when looking for evidence to support or oppose a policy position. W H AT I S R E S E A RC H W H E N I T C O M E S T O P O L I C Y ? C O N T.. To maintain focus on policy issues, policy briefs should be short, identify the problem and solution, and provide strategies recognizing both evidence and the context in which policymakers act. Narrative storytelling, which tells a pertinent story to bring the issue to life, is also important in the process. Research indicates that narrative provides cognitive and emotional content, which are fundamental aspects of human thinking when forming opinions. T H E C H E M I S T RY B E T W E E N R E S E A RC H AND POLICYMAKING Research plays a crucial role in policymaking, illuminating problems and guiding policymakers. Nursing has a long history of influencing policy through data collection, from Nightingale's Crimean data to American midwives' practice data. Today, healthcare research examines the interconnected aspects of care delivery, providers, procedures, patients, families, cultures, and reimbursement. This has led to a growing recognition of the role of advanced practice nursing by non-nurse researchers. U S I N G R E S E A R C H T O C R E AT E , I N F O R M , A N D S H A P E P O L I C Y. Research is crucial in health services, particularly in the context of advancing nurse practitioner (NP) full practice authority. The Institute of Medicine's 2011 report, The Future of Nursing: Leading Change, Advancing Health, exemplifies strategic thinking in this regard. The report summarizes the position of nursing in the U.S. health system and addresses the barriers nursing faces in implementing the full effect of the profession's capacity. Health services researchers sought to amplify the IOM report message by focusing on questions policymakers might have about NP qualifications to step into full leadership within the healthcare system. U S I N G R E S E A R C H T O C R E AT E , I N F O R M , A N D S H A P E P O L I C Y. C O N T.. The evolution of research related to NP full practice authority is detailed in a timeline from 2011 to 2018. The Institute of Medicine's 2011 report recommends full, unrestricted practice for all U.S. NPs. Since then, numerous studies have been published, examining the efficacy, safety, and acceptance of NPs, policy implications of unrestricted NP practice, and the impact of various policies regulating practice and payment for NPs on clinical practice. As of 2018, nine additional states have granted full practice authority to NPs, and the U.S. Department of Veterans Affairs amended its regulations to permit full practice authority for NPs effective in 2017. RESEARCH AND POLITICAL WILL The issue of gun violence has been a contentious topic for years, with policymakers often failing to take action due to the lack of research and political will. The Sandy Hook Elementary School shooting in 2012, where 20 students and 6 teachers were killed, was a significant event that led to a series of mass shootings and subsequent policy changes. However, the response to these events has remained stagnant, with no national policy initiatives. The Parkland Florida teen survivors' #NeverAgain movement has reframed the discussion away from the perspective of current elected officials who continue to support the National Rifle Association (NRA) and maintain focus on the tragic deaths of mass-shooting victims. The #NeverAgain movement has influenced change in their state, leading to policies banning bump stocks, imposing waiting periods, raising the minimum age to buy a gun, and allowing law enforcement to remove weapons from those with mental illness posing concern. Additionally, businesses such as Delta Airlines, MetLife, and Dick’s Sporting Goods have publicly cut ties with the NRA. The constraint to policy change, specifically related to gun law, lies in the policy issue of federal research dollars to study gun violence. There is limited research on gun violence despite the 30,000 deaths per year, the largest number of gun deaths in an industrialized nation. This lack of research initiative stems from the 1996 Congressional Appropriations Bill that states that the Centers for Disease Control and Prevention (CDC) cannot use funds that may result in data supporting the need for gun control. Physicians and health care professionals across the country initiated a public outcry campaign, #ThisIsOurLane, in response to the NRA implication that physicians should stay out of the gun control controversy. R E S E A R C H A N D P O L I T I C A L W I L L. C O N T.. To advance policy, there must be enough political will to devote attention, time, and effort to solve the problem, particularly when the problem is pervasive or long-standing. Research can help move difficult policy issues forward, as illustrated in Box 10.2. In conclusion, the issue of gun violence is a complex and multifaceted one that requires a combination of research and political will. Policymakers must be willing to take action to address the issue and ensure that the public health crisis resulting from gun violence is addressed. By focusing on research and political will, the United States can work towards addressing the pressing issue of gun violence and promoting responsible gun control policies. The Massachusetts response to the opioid crisis demonstrates how strategic use of data can inform policy conversations and sustain political will to tackle complex problems. Massachusetts enacted Chapter 55 of the Acts of 2015, providing analysis of multiple government data sets across various agencies in connection with opioid overdoses in Massachusetts. The legislative report detailed opioid use and overdose trends, providing recommendations to address the findings. Action plans from the Governor’s Opioid Addiction Working Group (2017; 2018) detailed how these annual legislative reports have informed policy decisions. R E S E A R C H A N D P O L I T I C A L W I L L. C O N T.... The interplay of research, political will, and policymaking is neither rational nor random. Policymakers often do not jump readily toward change due to powerful and well-funded stakeholders who oppose any change. Research, along with a compelling story, must engage legislators in advancing policy issues. In April 2014, CNN broke a story on long wait times for veterans within the Veteran’s Health Administration (VA) system, attributed veteran deaths to these wait times. The VA Office of Inspector General (2014) conducted a comprehensive review of veteran wait times and found clinically significant delays in access to care. In August 2014, Congress enacted H.R. 3230 (Veterans Access, Choice, and Accountability Act of 2014) to address access to care issues by establishing and funding the Choice Program. The RAND Corporation conducted an independent assessment of the VA health care system pursuant to the Veterans Access, Choice, and Accountability Act of 2014, which identified granting independent practice authority for all advanced practice registered nurses (APRNs) as one high- impact policy option for increasing access to care for veterans. R E S E A R C H A N D P O L I T I C A L W I L L. C O N T.... In May 2016, the VA proposed a rule that would grant APRNs full practice authority. During the comment period, the Federal Trade Commission submitted a memo in support of the proposed rule on grounds of improved access, cost containment, and expansion in innovation. In December 2016, the VA issued the final rule granting APRNs full practice authority to three APRN roles including nurse practitioners (NPs), concluding that standardization of full practice authority for APRNs would increase access and decrease wait times for veterans. Major policy change is most often incremental despite research supporting the change and frustrating those advocating for new policy. However, continued research validating the need for change, demonstrating positive effects of proposed policy changes, and the lack of negative impact are critical to build and be extremely effective in the long run. RESEARCH: NOT JUST FOR JOURNALS Research can be a powerful tool in shaping policy, not just in academic journals. Gray literature, which includes government reports, white papers, policy reports, and print and social media, offers current-event data that can direct the political climate, inspire advocacy groups, and serve as foundational platforms for transformative ideas. Negative-result data, often not published through traditional scholarly journals, can inform policy debates and issues. Artful dissemination in documentaries, such as Frontline's 2016 documentary Chasing Heroin and HBO's 2017 documentary Warning: This Drug May Kill You, can also influence policy context by engaging the public through visual and narrative data. Recent documentaries have explored various aspects of the opioid epidemic, highlighting the personal impact of addiction on individuals, families, and communities. RESEARCH: NOT JUST FOR JOURNALS C O N T.. With the opioid crisis in the public spotlight, other entities have taken action to curtail the problem, such as the CDC issuing guidelines for providers, insurers like Blue Cross Blue Shield implementing restrictions on coverage of opioid prescriptions, and some state legislatures enacting naloxone access laws. Nurses, at the frontlines of patient care and as the largest group of healthcare professionals, are strategically positioned to use research as a political and policy tool. They can make policymakers aware of the various types of research data available and help interpret research outcomes. Nursing's role in bringing the best health care research to the policy table matters to patients, policymakers, and the delivery of meaningful health care for all.