Policy Quiz 1 Review PDF

Quiz 1 Review [Chapter 1: Frameworks for action in policy and politics] **"Upstream factors"** - the broad range of issues, other than health care, that can undermine or promote health---aka "social determinants of health" - The key to reducing and eliminating health disparities, which...

Quiz 1 Review [Chapter 1: Frameworks for action in policy and politics] **"Upstream factors"** - the broad range of issues, other than health care, that can undermine or promote health---aka "social determinants of health" - The key to reducing and eliminating health disparities, which disproportionately affect racial and ethnic minorities, is to provide effective interventions that address upstream factors both from within and outside of health care systems. - How do they work?: Upstream factors create the conditions in which people live, work, and play. They influence health behaviors and outcomes indirectly through multiple pathways. By addressing these route causes, we can prevent health issues before they arise, rather than just treating symptoms. - Examples of upstream factors: - social inequities (class, race or ethnicity, gender and sexual orientation) - institutional inequalities (corporations and businesses, government agencies, education quality) - living conditions (housing quality, neighborhood safety, employment opportunities, income levels, access to healthcare) - Examples of how upstream factors are being addressed:     **Triple Aim of Value Based Healthcare System** 1. Improving population health 2. Improving patient experience of care 3. Reducing costs per capita   - Later modified to be the quadruple aim, adding the dimension of clinician and staff satisfaction in recognition that "care of the patient requires care of the provider" with goal to improve the health of populations and reduce health care costs. - Goal: by examining a health care delivery problem from all 4 dimensions, health care organizations and society can identify system problems and direct resources to activities that can have the greatest impact. - The Institute for Healthcare Improvement (IHI) identified these components of any approach seeking to achieve the Triple Aim to address the goal of creating a high-performing health care system but do not focus on geographic communities or social determinants per se: - A focus on individuals and families - A redesign of primary care services - Population health management - A cost-control platform - System integration and execution   **Policy Competencies for Nurses** 3 Main Elements: 1. Deep Knowledge: - Of both content and policy - Seek expertise from others - Anticipate focus, "What if?" - Know opposition and inoculate against it 2. Political antennae: - Continuously scan policy environment - Offer solutions that are not solely nursing focused -form coalitions -develop scenarios -listen deeply -no bridge-burning 3. Power: - Give useful expertise freely - Join APN organizations/develop partnerships - Bring sharp, evidence based focus - Bring nursing stories to policy arena - Develop effective relationships with EVERYONE - Educate the public (op-eds) [Chapter 14: Health policy, politics, and professional ethics] **Principles of bioethics:** 1. Autonomy: Respecting a patient's right to make their own healthcare decisions. For example, obtaining informed consent before surgery. 2. Beneficence: act so as to benefit; Promoting the well-being of patients. An example is providing pain relief to a patient in distress. 3. Justice: Fair distribution of healthcare resources. For example, ensuring all patients have equal access to life-saving treatments regardless of their background 4. Non-maleficence: "Do no harm." Ensuring treatments do not cause unnecessary harm. For instance, avoiding unnecessary procedures that could harm the patient. **Moral Agency:** - Moral character: cultivated dispositions that allow one to act as one believes one ought to act - Moral valuing: valuing in a conscious and critical way which squares with good moral character and ethical integrity; a commitment to patient well-being and a degree of altruism - Moral sensibility: the ability to recognize the moral moment when an ethical challenge presents - Moral responsiveness: the ability and willingness to respond to the ethical challenge - Ethical reasoning and discernment: knowledge of, and ability to use, sound theoretical and practical approaches to thinking through ethical challenges and to ultimately decide how best to respond to this particular challenge after identifying and weighing alternative courses of action - Moral accountability: the ability and willingness to accept responsibility for one's ethical behavior and to learn from the experiences of exercising moral agency - Transformative moral leadership: commitment and proven ability to create a culture that facilitates the exercise of moral agency, a culture in which individuals are supported in doing the right thing simply because it is the right thing to do [Chapter 6: A primary on political philosophy] **Political Ideologies:** - Political ideologies: a set of ideas about politics, all of which are related to one another and that modify and support each other; characterized by distinctive views on the organization and functioning of the state - 3 major political ideologies: liberalism, socialism, conservatism 1. **Liberalism:** - Individuals should be able to develop fully as individuals - Emphasizes individual rights and freedom of thought and expression (but not without limits) - Individuals have control over own bodies and minds, but not to extent of harming others - Democracy as ideal form of government, allowing everyone to participate and express views freely - Government protections against abuse of power 2. **Socialism:** - Government should protect workers for negative situations and conditions - Equality regardless of role or status - Economy supports the good of all - Concept of a common good - Lack of individual ownership - Lack of privatization - Centralized government in control 3. **Conservatism:** - Historically: Those in power have responsibility to help those not in power - Contemporary form: Opposes rapid and fundamental change but advocates for decreased federal involvement in all matters, reduced tax burden, traditional social values, and transfer of authority to the geographic states - Preference for tradition, stability, and structure - Patterns of power that are predictable [Chapter 7: The policy process] **Advocacy:** - The role of nurses in advocacy is 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. - For many nurses, advocating for fairness and equity is an application of patient advocacy, especially when human rights and health disparities are at stake. - What lesson can be drawn from history regarding nursing's advocacy role?: Advocacy has been a fundamental aspect of nursing throughout history. - What is the evolution of nursing's advocacy role?: From passive recipients to active agents of change - What are the models of nursing advocacy discussed in the text?: activist and collaborative - How can nurses overcome barriers to advocacy?: By developing political competence and leadership skills - What is the importance of lived experience in advocacy?: It provides insight into patients' perspectives and needs - How can nurses prepare for their role as advocates?: By developing advocacy competencies and staying informed about healthcare policy issues **Longest's Policy Cycle Model (3 Phases):** 1. A policy formulation phase (development of legislation): - includes all the activities that are involved in policymaking, including those activities that inform the legislators - It is in this phase that nurses can serve as a knowledge source to legislators in helping to frame problems by bringing nursing stories and patient narratives to illustrate how health problems play out with individual constituents/populations. - The most effective time to influence legislation is before it is drafted, so that nurses can help to frame the issues to align with their desire for policy outcomes that are patient centered. 2. A policy implementation phase (rulemaking -- operation): - comprises the rule-making phase of policy development - the legislative branch passes the law to the executive branch which is charged with implementation - the writing of the rules after legislation is passed is a crucial and often overlooked aspect of policymaking 3. A policy modification phase (feedback): - Allows all previous decisions to be revisited and modified - Almost all policies have unintended consequences which is why many stakeholders seek to modify policies continuously [Chapter 39: An overview of legislative and regulatory process] **Introduction of a bill to congress:** - How does a bill become a law in the legislative process?: It undergoes multiple readings and debates before being signed by the president - Only a member of either the House or Senate can introduce or sponsor a bill - Every bill introduced in Congress faces a 2 year deadline; it must pass into law by then or die by default - How can nurses influence the introduction of bills into congress?: As constituents and as members of professional associations that lobby Congress, they can call attention to problems in funding health care, such as the need for expanded services for uninsured children or to increase reimbursement for nursing services - Identifying the appropriate sponsor to introduce a bill is critical to its success - A committee can handle a bill in what way?: 1. Approve a bill with out without amendments 2. Rewrite or revise the bill, and report it out to the full House or Senate 3. Report it unfavorably (i.e. allow the bill to be considered by the full House but with a recommendation that it be rejected) 4. Take no action, which kills the bill **Floor procedures in the US House and US Senate:** - Floor procedures in the US House - Rules of adoption: Each new Congress adopts its own rules, which are often based on the previous Congress's rules with any necessary amendments - Debate and voting: Bills and resolutions are debated on the House floor. Members can offer amendments, which are debated and voted on. - Committee of the Whole: This is a mechanism that allows the House to operate with a lower quorum and more flexible debate rules. It is used to consider and amend bills before they are voted on by the full House. - Voting methods: Cotes can be taken by voice, division, or recorded vote (electronically). - Floor procedures in the US Senate - Bringing a Bill to the Floor: To consider a bill, the Senate must first agree to bring it up, typically through a unanimous consent request or by voting to adopt a motion to proceed. - Debate: Once a bill is on the floor, Senators can debate it. The length and nature of the debate can vary. For instance, debates can be extended indefinitely through a filibuster unless a cloture motion is passed to end the debate. - Amendments: Senators may propose amendments to the bill. These amendments can be debated and must be voted on before the final vote on the bill - Voting: After debate and amendments, the Senate votes on the bill. This can be a voice vote, a division vote, or a roll call vote, depending on the circumstances - Final Passage: If the bill passes, it is sent to the House of Representatives (if it originated in the Senate) or to the President for signing into law (if it has already passed the House). - A unique feature of the Senate is the ability to filibuster. Unlike the House, Senate rules support the absence of time limits on how long senators can speak to an issue or to a Supreme Court confirmation. Therefore, the strategy of creating a filibuster---a prolonged speech that prevents action but is not technically illegal---can be used to prevent an issue from coming to a vote. [Chapter 38: How government works: what you need to know to influence the process] **US Cabinet Departments:** - Department of Health and Human Services: - the U.S. government\'s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves - incorporates the Office of the Secretary and 11 agencies that oversee more than 300 programs, responsible for the distribution of the 2nd largest portion of federal budget - Department of Defense: - U.S. military spending makes up the largest portion of the federal budget, and a large part of that money goes to health care - Provides care to all active duty military personnel, retirees, National Guard and Reserve members, and their families. - Department of Veterans Affairs: - oversees programs to provide health care and other services to U.S. military veterans and their families - manages the largest medical, nursing, and health professions training program in the U.S. - Department of Education: - provides billions of dollars in grants and loans for students to attend college and professional schools, including nursing - works with hospitals and other government agencies to provide incentives such as loan repayment programs - Department of Homeland Security: - Oversees emergency preparedness [Chapter 46: Nursing Licensure and regulation] **Licensure Board Responsibilities** - Nursing Boards: - The initial qualifications for licensure, continuing educational requirements, disciplinary procedures, complaint resolution processes, professional misconduct or unprofessional conduct definitions, mandatory reporting requirements, and specific scopes of practice are determined at the state level - Given their authority though state laws or administrative procedure acts - Health and human services and the center for Medicare and Medicaid services: - regulates issues such as civil rights, privacy, food and drug safety, the Medicaid and Medicare programs, health care fraud, medical research, technology standards, and tribal matters. - serves as the umbrella organization for such agencies as the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Office for Civil Rights, among others - Federal, State, and Local Law: - Public health codes are laws enacted at the local, state, or federal level to promote community health and safety. - address emergency preparedness, communicable diseases, environmental controls, use of health care facilities, staff credentials and competency, policies and procedures, mental health issues, food safety, and other elements related to nursing care. - These laws may be enforced by civil or criminal penalties. - Organizational Policy: - Nurses are responsible for being familiar with their employer's policies and procedures and to adhere to them. - They exist to provide standardization and consistency. **Nursing Licensure:** - Enhanced nursing licensure compact - a "mutual recognition model," allows RNs or LPN/LVNs to work across state lines in certain circumstances. - Nurses residing in compact member states, known as residency or home states, may practice in other compact member states, known as remote states. - Nursing practice must be compliant with the NPA and the nursing licensure compact administrative rules of each state. - Nurses must remain within the specific scope of practice in the state in which they are practicing (the state in which the patient is located). - Requirements for issuing and renewing nursing license: - In some jurisdictions, an initial professional license issued by a nursing board is valid for the licensee's lifetime. - The licensee must periodically register that license to continue practicing and meet the board's registration requirements to be issued a registration certificate. - Such requirements typically include continuing education, clinical practice, the absence of a criminal record, and continued good moral character. - The cyclical process of reregistering a license is commonly referred to as a renewal process. - In some states, licenses that have not been renewed can be categorized as null and void, and then are ineligible for renewal. Nurses must reapply for licensure in these jurisdictions. - Candidates for entry into nursing practice as an RN or LPN/LVN must apply for licensure to a BON and receive an Authorization to Test - must pass the National Council Licensure Exam (NCLEX-RN or NCLEX-PN) to be granted an initial licensure. [Chapter 57: The Contemporary Work Environment of Nursing] - **Harassment, Bullying, and Micro-aggression** - Harassment: offensive jokes, slurs, name calling, undue attention, physical assaults or threats, unwelcome touching, intimidation, mockery, insults etc. - Definitions of harassment vary between workplaces - Bullying: repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress - Microaggressions: forms of bullying, brief everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group - **Meeting needs of diverse workforce in contemporary environment** - Diversity, inclusion, culturally competent care, a multicultural workforce - Millennials (43% non-white) surpassed Boomers in 2019 for the largest US adult generation - **5 components of emotional intelligence** 1. Self-awareness 2. self-regulation 3. self-motivation 4. Social awareness 5. Empathy