The author, Donna M. Nickitas, learned early in her nursing career that professional nursing was more than clinical practice and involved important areas that were essential to the status of the profession, such as the need for advanced education, licensure issues, scope of practice, and health care policy. She learned that nurses were engaged in frontline health care but could also be involved in economic, political, and policy debates around issues of health and health care. Nickitas also appreciated how her core values of family, faith, and preserving the dignity of others aligned her with the values and ethics of nursing. She was intrigued by the many overall facets of health care and the need to understand health and public policy. She have advocated for health care policy that addresses issues of social justice and equity in health care as she realized that nurses are potent influencers in policy formation.
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Long credited as a pioneer of public health nursing in America, Lillian D. Wald personified the attributes of exemplary leadership in a way that transformed not only the nursing profession but society as a whole. The same leadership attributes of taking risks and challenging rules would later characterize her approach to health care and societal reform. Just as she was influenced by the Progressive Movement and the increasing role of women in achieving social justice, Wald was also significantly impacted by the public health movement. One of the revolutionary characteristics of the settlement house movement was that many of the most important leadership roles were filled by women, in an era when women were still excluded from leadership roles in business and government. As an exemplary nurse leader, Wald’s approach was aspirational, broad, and visionary. Wald’s broad view of health included standing up for social fairness.
At the advanced level of practice, the public/community health nurse is required to make shifts in thinking. Two major components of the shifts are: from the individual and family to the community, population, or systems level; and from treatment of disease to prevention of disease and injury and health promotion. This chapter provides a foundation for practice that challenges the nurse to orient toward health, prevention, and nursing. Foundations of advanced public/community health nursing practice include nursing philosophy, nursing concepts, and nursing knowledge. Although it shares foundations of practice with all fields of nursing, public/community health nursing is especially concerned with equity and social justice issues of healthcare delivery. Guiding concepts for advanced public/community health nursing practice are numerous. The concepts that are central to advanced practice in public/community health nursing include nursing, public health, primary prevention, health promotion, population focus, community, autonomy, and interdisciplinary practice.
Healthcare reform initiatives that address payment and delivery transformation have created a new landscape within the U.S. healthcare system. Nurses are being asked to assume new and enhanced roles in the delivery of care. Successful changes that ultimately benefit patients can be achieved through effective policy and advocacy, however. Nurses are in a unique position to influence policy makers because they comprise a sizeable and trusted voice. The proximity of nurses to their patients makes them a knowledgeable resource for policy makers. Further, the profession’s social justice underpinnings establish a clear duty to patients who can provide nurses with strong motivation to act. This chapter is designed to review fundamentals of public policy development so nurses engaged in advanced nursing practice can appreciate how to best advocate beyond the patient’s bedside into the greater healthcare reform environment in ways that positively impact delivery systems and patients within the United States.
This chapter provides an overview of the concept of advocacy, the nurse’s advocacy roles, and expectations of society and the profession regarding advocacy. The American Nurses Association’s Code of Ethics for Nurses is used as a framework to describe the application of advocacy. In addition, the chapter identifies competencies for advocacy, resources for becoming an advocate, and advocacy arenas. It uses advocacy exemplars to illustrate the various possible outcomes of nurses’ advocacy efforts. Investigate advocacy as a means to improve the safety and quality of healthcare delivery. The chapter demonstrates the competencies needed to be an advocate in different healthcare settings and describes the relationship of social justice and ethics to the work of advocacy. It then discusses the public’s view of nursing in healthcare advocacy and identifies the barriers that can impact the success or failure of advocacy.
Telehealth is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status”. In today’s healthcare environment, telehealth is usually operationalized by the Advanced Practice Registered Nurses (
APRNs) as the use of live video conferencing, store-and-forward information exchange, and the use and interpretation of wearable device data. It is therefore important that APRNsunderstand telehealth practice and the policy and ethical implications of using telehealth as a part of new practice patterns. This chapter outlines the history of telehealth, a conceptual framework for its growth, and application of its use for APRNs. It uses the nursing code of ethics; Autonomy, Beneficence, Justice, and Non-Maleficence. One should also reflect on the driving purpose for starting a telehealth initiative whether they be to correct inequity or to become an entrepreneur.
Policies are essential opportunities for nurses to take ownership of advocacy. This completely updated third edition provides a hands-on approach to help nurses across a variety of settings to develop health policy competencies for managing an ever-changing health and uncertain policy arena. Four major units provide a framework for the authors approach as the chapters of the book take the reader on a journey through all the steps of the policy-making process. Leadership, ethical, and social justice principles are unifying concepts integrated across chapters. Throughout each new or revised chapter, policy development is exemplified from the grand scale of global or national to the local level. The authors believe that policymaking at all these levels is essential. Often, however, the interplay between levels is not always recognized or acknowledged. The key features of each chapter covers specific aspects of the policy-making process including learning objectives, an introduction, policy challenge and solutions, policies on the scene, key concepts, future implications, summary, learning activities, and e-resources. These features in each of the 15 chapters have been thoroughly revised. Each chapter introduces a key aspect of the policy-making process framing the important details for the reader. The Policy Challenge presents a particular dilemma or issue in policy with a Policy Solution illustrating the outcome at the end of the chapter. Policies on the Scene provide short vignettes about the policy journeys of nurse leaders and aspiring policy activists. Implications for the Future describe projected developments in nursing and healthcare that have the potential to influence policy. Key Concepts aid learning by taking readers through the steps of the policy process to enhance their policy skills. The Learning Activities are designed to enhance critical thinking. E-Resources reflect key information from a variety of sources important for policy savvy nurses.
This chapter imagines a far more equitable world than the one we live in today. Advancing these report recommendations will require everyone to come together and make advancing health equity the top priority during the next decade. The nation’s health inequities emanate from a 400-year legacy of slavery, segregation, and structural racism-and have been exacerbated by the pandemic. No single profession or sector can dismantle health inequities, but every sector working together with a shared goal can make substantial progress in advancing health equity. Nurses must think broadly and form or join multisector partnerships with groups who have long sought to advance health equity, including social justice organizations, community groups, consumer advocacy organizations, faith-based organizations, and others. Health systems need to be involved, too. The nursing field must address injustices within its own profession and prioritize nurse well-being.
The criminalization of HIV nondisclosure creates disadvantages for and promotes discrimination toward people living with HIV/AIDS (PLWHA) and may therefore be considered a threat to social justice. Despite the fact that HIV is now considered a chronic manageable condition, criminalization continues to mark it as exceptional in regard to other sexually transmitted infections. This chapter reviews key criminal cases from the United States, Canada, the UK, and Australia to better illustrate the shifting legal context and to demonstrate the injustices these proceedings inflict upon PLWHA. Critically examining the outcomes of the criminalization of HIV nondisclosure is required not only by governmental agencies, but also by healthcare and nursing professionals working on the frontlines of HIV/AIDS care. The goal of public health is to empower people to practice safer sex, get routine testing to learn their HIV status and if positive, and to comply with treatment.
As Americans, we are adept at living in a state of contradiction. We live in a racialized society where yes, indeed, race matters. Race is the first thing we see when encountering another person. In fact, we immediately categorize people into racial groups. Yet, we have been socialized not to talk about race and were taught not to talk about race in polite conversation. Moreover, when we do talk about race, discomfort, defensiveness, and frustration often prevail, with comments surfacing such as: get over it, it happened 400 years ago, that’s in the past, we had a Black president, I don’t see color, or you are too sensitive, and the conversation shuts down. To eliminate health disparities and achieve health equity we must connect our past to our present and grow comfortable with conversations about race, racism, and racial justice. This chapter helps to move the dialogue from frightening, feared, difficult, and sensitive to necessary, meaningful, and productive.
Fast Facts About Diversity, Equity, and Inclusion in Nursing:Building Competencies for an Antiracism Practice
This nursing handbook introduces and defines key terms about race and racism for nurses, nursing students, and nurse educators. It addresses how race and racism act as structural and core social determinants of health and propel health inequities. It moves beyond a focus on multicultural approaches for understanding inequity toward a recognition of the broader impact that both systemic and structural racism have had on inequality in health and life opportunities. Through a social justice lens, the book underscores how nurses, as frontline health professionals, need to understand racism as a factor behind these inequities and its significance to their working environment and nursing practice.
In concise chapters with brief paragraphs and bulleted information, this practical handbook offers strategies for how to productively engage in a dialogue about race and racism. It considers the history of racism in the United States and then breaks down how it operates at structural, institutional, and individual levels. Case studies illustrate such concepts as microaggressions, implicit bias, power, privilege, and intersectionality in order to foster understanding and provide opportunities for both self-reflection and collective conversation.