C159-POLICY, POLITICS, AND GLOBAL HEALTH PERFORMANCE ASSESSMENT

Course mentors Dr. Ami Bhatt

Dr. Connie Diaz

Dr. Dana Hill

NursingUUT2@wgu.edu

For this assessment, you will actively participate in policy development and implementation in order to advocate for policies that improve the health of the public and/or the nursing profession. •You will utilize both a top-down and a bottom-up approach, bringing the nursing perspective to policy makers and stakeholders. •You will identify the values and ethical perspectives that underpin your position and develop criteria to evaluate the success of your work. •By the conclusion of the assessment, you will have a policy brief that can be sent to decision makers and a plan to work with an organization/community to promote policy change at the local level. •The purpose of this task is to ensure that a nurse who is a leader in the community can use policy as an intervention to advocate for change.

THE OBJECTIVE OF THE PERFORMANCE ASSESSMENT

DEMONSTRATING COMPETENCIES

• In the first section of your paper (Part A), you’ll write about how this issue impacts nursing and/or on patient outcomes. You’ll analyze the issue and provide rationale for why this is an important issue.

• Part B asks you to develop a policy brief for the top-down approach (a formal policy set by an authority that can require compliance). Generally, this would be through a rule-making board, regulatory organization, or legal (legislative) process at the local, state, or national level.

• Part C of the paper asks you to consider a community-based participatory (or bottom-up) approach. You’ll select a group to collaborate with to positively impact the issue from the ground-level. The group might be through a coalition within your healthcare system, a group of nurses from your state nurses’ association, or another professional or community group, who come together to collaborate on an approach to address the selected health issue.

• In the final part of your paper (Part D) you’ll discuss strengths and challenges of both the top-down and bottom-up approach. You’ll make a recommendation for which approach you believe would be the most effective to implement a positive change on this issue.

HOW DO I SELECT A TOPIC?

• As defined in the task directions, the topic for your paper should be a policy “that improves the health of the public and/or the nursing profession” (from the task instructions). You can select any topic that impacts health or nursing as long as you can address all of the elements of the rubric. The topic you select should be something that you’re interested in, because you’ll spend quite a bit of time researching the issue from different perspectives.

• Topics might include a focus on policy to impact public health issues such as childhood obesity, school health, communicable diseases, unintentional injuries, reproductive health, or any health issue you think could be positively affected by a change in policy. Nursing profession issues might include staffing ratios, minimum education levels, required continued education, mandated overtime, etc.

• Your formal policy proposal could be at the local level (such as a city-county ordinance), the state or federal legislative level (a law), or at the level of a regulatory organization such as a School Board, Department of Health, OSHA, CMS, etc. .

TOP DOWN APPROACH

• The top-down approach is one in which a person, governmental entity, or regulatory agency (an authority) sets a policy and expects compliance. It is an authoritarian approach.

• You should understand the steps necessary to formalize policy from the top-down approach. What are the steps to get a bill into law?

• If you are proposing a regulatory change, what steps are needed to have a policy approved? Does the agency require public hearings? Or board approval?

DECISION MAKER

• The decision maker should be a specific person. This is someone who can endorse the policy and move the policy forward through the formal approval process.

• To identify a decision maker, analyze the proposed policy. Why would this person receive the policy brief and why does it require their attention?

• What challenges might the decision maker face in gaining formal approval? (i.e. are there groups that might oppose the policy? Are there budget challenges? )

• What are the options and alternatives for the decision maker? What alternative policies should be considered to address the issue? Why are you recommending your proposed policy as the best option? What steps should the decision maker take from here?

• Propose a persuasive course of action for the decision maker- How can the challenges be addressed during the policy making process?

THE FINANCIAL IMPACT

• In this section, you will discuss what financial impact this policy will have on healthcare organizations or community. What is the financial impact on this policy issue specifically?

• Will the financial impact affect the health care system positively or negatively? Will it be worth pursuing?

• How will funding effect the policy? Is the funding available? If not, where will the money come from?

EVALUATION OF WORK

• Evaluation of the process for each approach is a bit different. In the top-down approach you might evaluate the multiple steps that need to be achieved for the proposal to become a formal policy. For example, did the decision maker agree to move the policy forward? What was the next step – was it successful?

• When you evaluate the CBPR (bottom-up) approach, you might evaluate the number of people who attend meetings, the active participation, and the success of the collaboration to design an intervention that all parties agree to.

• In both approaches, the evaluation should also include the longer-term outcomes – what would you see and how would you measure change as result of the policy?

BOTTOM UP APPROACH

• The “bottom-up” approach, or the Community Based Participatory approach, is an approach where those who are impacted by the issue, usually the stakeholders, collaborate to design interventions (rather than being told what to do by formal policy). Examples of bottom up initiatives include Meals on Wheels, Mothers Against Drunk Driving, etc. The bottom up approach is community-based.

• Both approaches can be effective to implement change. In the Policy paper, you’re asked to discuss both types of approaches. The ultimate desired outcomes for each approach are the same – to positively impact the health issue.

CREATE A PLAN

• Identify an organization or community- this can be a professional association, community group, a local organization committed to the issue, etc.

• Identify why this organization or community is interested in your topic. This needs to be supported with evidence, such as media-newspapers, magazines ,discussions, policy briefs., etc.

• Does the group’s goal align with your goal? How do you know?

• Discuss how three CBPR (Community-Based Participatory Research) principles could be used in your collaborative work with the group.

• What is your plan to approach and collaborate with the organization/community group? Specifically HOW will you do this?

• Discuss the key elements of evaluating how your collaborative group will incorporate the CBPR principles that you’ll use to achieve your goals.

ANALYSIS

• What are the strengths of the top down and bottom up approaches?

• What are the weaknesses of the top down and bottom up approaches?

• Which approach may be more effective for this policy issue? Why?

OTHER TIPS

• Create a heading in your paper for each section of the rubric

• Be sure to read the rubric carefully and address the criteria specifically and concisely.

• Analyze how your values and goals correlate to your topic

• When choosing a topic, consider a topic you are passionate about

• Think in terms of advocacy. As a nursing leader, how will you convince others that your issue is important and deserves attention? How can you use evidence to support the need for this policy change?