Identify the clinical practice issue you would like to see on your organization’s systematic agenda What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?

Post a cohesive response that addresses the following: 1.In the first line of your posting, identify the clinical practice issue you would like to see on your organization’s systematic agenda.

2. What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?

A key aspect of the policy process is agenda setting. How do topics get on that agenda? Agenda setting requires the support of stakeholders to move the issue forward. In this week’s media presentation, Dr. Kathleen White outlines the policy process and discusses how to move issues into the policy arena through agenda setting. The ultimate goal is to gain the attention of leadership whether at the organizational, local, state, national, or international level.

To prepare:

Review this week’s media presentation, focusing on the insights shared by Dr. White and Dr. Stanley on agenda setting and identification of stakeholders.
Brainstorm clinical practice issues that you believe are worthy of being on your organization’s systematic agenda.- See transcript below
Who are the stakeholders who would be interested in this clinical practice issue?

RESOURCES
Required Readings
Hyder, A., Syed, S., Puvanachandra, P., Bloom, G., Sundaram, S., Mahmood, S., … Peters, D. (2010). Stakeholder analysis for health research: case studies from low- and middle-income countries. Public Health, 124(3), 159–166.

This study demonstrates how the engagement of stakeholders in research and policy making can assist in the successful implementation of policy proposals. The authors propose that by engaging stakeholders, researchers and policy makers are provided with multiple perspectives on proposed policies, which can lead to greater success with policy adoption and implementation.

Lavis, J. N., Permanand, G., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy & Systems, Health Research Policy & Systems, 71–79.

The purpose of a policy brief is to communicate an issue clearly and definitively to policy makers. The authors of this article propose an outline for policy briefs and also stress the importance of using research when creating a policy brief.

Lowery, B. (2009). Obesity, bariatric nursing, and the policy process: The connecting points for patient advocacy. Bariatric Nursing & Surgical Patient Care, 4(2), 133-138.

This article provides an example of nurse involvement in policy making by examining a bariatric nursing issue. The author stresses that nurses, in their patient-advocacy role, have a responsibility to be involved in the health care policy process.

Moore, K. (2006). How can basic research on children and families be useful for the policy process? Merrill-Palmer Quarterly, 52(2), 365–375.

Institute of Medicine. (2010). Report brief: The future of nursing: Leading change, advancing health.

Introduced in Week 2, this IOM report highlights four key recommendations in its proposal for the future directions of the nursing profession. These recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking.

National Center for Policy Analysis (2010). Ideas changing the world: Free-market health care policy. Retrieved from http://www.ncpathinktank.org/healthcare

The NCPA is a nonprofit, nonpartisan organization that promotes private sector solutions to public policy issues.

Required Media
Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Agenda setting and the policy process. Baltimore: Author.

Note: The approximate length of this media piece is 17 minutes.

Dr. Kathleen White and Dr. Joan Stanley share their insights into agenda setting and how issues are moved forward into the policy process.

Accessible player
Optional Resources
Barnes, M., Hanson, C., Novilla, L., Meacham, A., McIntyre, E., & Erickson, B. (2008). Analysis of media agenda setting during and after Hurricane Katrina: Implications for emergency preparedness, disaster response, and disaster policy. American Journal of Public Health, 98(4), 604–610.

Jennings, C. (2002). The power of the policy brief. Policy, Politics & Nursing Practice, 3(3), 261–263. doi: 10.1177/152715440200300310

Neumann, P. J., Palmer, J. A., Daniels, N., Quigley, K., Gold, M. R., & Chao, S. (2008). A strategic plan for integrating cost-effectiveness analysis into the US health care system. American Journal of Managed Care, 14(4), 185-188.

Plan, Policy, Procedure Relationship Diagram. (n.d.). Retrieved from http://www.informationsecurityintel.com/docs/Fig.%204.3.pdf

MEDIA Transcript :
NARRATOR: How do policy makers and health care professionals identify issues to address through policy?
DR. KATHLEEN WHITE: You can kind of see how something moves from being on a systematic just discussion agenda to a more formal agenda where a solution is actually chosen and the problem begins to be solved.
NARRATOR: And what influences these decisions?
DR. KATHLEEN WHITE: What’s most important to your organization or to your state in choosing to adopt a policy among the alternatives? Is it gonna be cost? Is it going to be the public good? Is it going to be some other type of outcome that you might have? Is it gonna be just simply feasibility?

NARRATOR: Dr. Kathleen White and Dr. Joan Stanley describe aspects of agenda setting and the policy process and explain how DNP-prepared nurses can become involved.
DR. JOAN STANLEY: It’s a long process, and that it’s not just a one-time deal. It’s a stepwise process.
DR. KATHLEEN WHITE: It’s a good question to think about how issues get on the public agenda. And probably the best way to start talking about that is, you know, with the classic theory on agenda setting. And it was really written back
actually in the 1970s by two political scientists, Cobb and Elder, and they put forth the fact that they’re really kind of two types of agendas that we have at the public level. And the first one is what they call the systematic level. And this is really where we just have discussions, and there are lots of things at that discussion level. And so I’m sure any one of you can think of things that right now are hot, if you will, hot on the agenda. And so we’re talking about them, but we’re not really yet implementing legislation or rulemaking or taking it to any kind of a formal level. But when you talk about what they refer to as the governmental or sometimes institutional–so again, thinking about two different levels of agenda setting–this is really the level of agenda setting where you feel obliged to take care of a problem, and hence, either write a policy, develop a regulation or write a law in order to take care of a problem.
DR. KATHLEEN WHITE: Examples of things that would be on, I think, on the systematic agenda right now are things like maybe primary care medical home. Some people might argue that that’s already moved to a level where we’re writing
policy. But I would say that we’re probably talking a lot, and so pilots are running, and we’re looking at best practices and trying to figure out how we wanna move with that kind of thing. Another one is obesity, dealing with obesity in the public level. There’s a lot of discussions. How are we gonna take care of that as a major health problem that affects a lot of the chronic care that we, as Americans, are facing as we age? And seeing many more obese children in our families and in our schools and how we might deal with that in more of a realm that would be formal policy? So if you think back to smoking cessation, that was on the systematic agenda for years and years. And now we’ve taken that further, and we’ve written both institutional and governmental policies that are dealing with getting Americans to stop smoking. We have workplace cessation programs where smoking is not allowed. First, it wasn’t allowed by patients. Then, it wasn’t allowed by staff. And now, many organizations are even saying, you can’t even smoke on our campus. Governmental-wise, smoking cessation, we prevent smoking in many public places, in a lot of regions of the country. But you can kind of see how something moves from being on a systematic just discussion agenda to a more formal agenda where a solution is actually chosen, and the problem begins to be solved. We’re certainly nowhere solving the smoking issue or obesity in this country yet, but we’re moving in those directions.
DR. KATHLEEN WHITE: I think future DNP–is doctorally prepared nurse– are going to approach problems either in your organization or at some other level of policymaking that you get involved in. And so think about how do things get on your agenda? I mean, maybe right now, it’s catheter-associated bloodstream infections. How are you dealing with that in your organizations, the catheter-associated urinary tract infections, as two huge practice issues that we’re all dealing with in infection control? And so when you think about how those became, I think, systematically discussed and now policies and procedures and quality improvement processes being written about them. But if you think about
them getting on the agenda and think about how the agenda then drives the policy process, I’m just gonna briefly review what I think are the important four steps in the policy process.
DR. KATHLEEN WHITE: The first one is policy formulation. And so it’s, again, where you’re starting to think about, what are my alternatives? What are we going to do to take care of that problem that’s on the agenda? The second stage
is policy adoption where you then have made a decision among alternatives. And so when you think about some of your policy analysis frameworks, they will help you to decide about criteria for making decisions among those alternatives. So what’s most important to your organization or to your state in choosing to adopt a policy among the alternatives? Is it gonna be cost? Is it going to be the public good? Is it going to be some other type of outcome that you might have? Is it gonna be just simply feasibility? Can we get this policy up and running versus one that would be very hard? Is it gonna deal with stakeholders? So think about all of those criteria for evaluation as you begin to make your decision, and that’s the policy adoption phase.
DR. KATHLEEN WHITE: The third phase then includes implementation. You’re gonna have to think about the context that you are implementing this policy in. So thinking about societal implications so–and that has to do with the community that you’re involved in. What are the internal and external factors that you might have to deal with it? It includes your organization’s culture, your organization’s leadership, and all of those kinds of activities that you need to plan for. How does your organization react to change? I mean, that’s a huge question that as you’re thinking about policy implementation. And how have policies been implemented in the past? Have you been successful moving the organization through the change stages? Where have you had problems in the past? And that’s what you wanna plan for as you think about that policy implementation phase. And what you do at an organizational level is very similar, just with the different level of stakeholders and leadership in a different kind of culture that you would at a state or a national level for planning, for implementation.
DR. KATHLEEN WHITE: Finally, last stage of the policy process is policy evaluation. And so what kind of measures or outcomes are you gonna be looking for? So think first about your strategies for implementation. And then think about outputs, what kind of deliverables will you have, how will you measure those, thinking about–I think outcomes at a couple of different intervals, you probably wanna think about short term, also intermediate, and then, longer term outcomes, and how might those be measured.
DR. JOAN STANLEY: Nurses obviously need to be involved in setting policy agenda, both at their institutional level, at their local and state and federal levels. The American Association of Colleges of Nursing and the National Organization
of Nurse Practitioner put out a proposal to bring Advanced Practice Nursing Organizations together to really look at regulation of advanced practice nursing. What was happening was individuals were graduating from programs, they
couldn’t get certified, they couldn’t get licensed, because that particular state did not recognize a particular specialty. So we started this initiative, and it became known as the consensus process. And there were 24 national APRN organizations that participated, that represented licensure, certification, accreditation and education.
DR. JOAN STANLEY: And in 2008, what we call the APRN Consensus Model was approved. It took four years of long dialog to reach consensus. And we are working with the various organizations that comprise what has now become
LACE, licensure, accreditation, certification and education, to implement it. But anybody that is connected to advanced practice education or practitioners should really become familiar with this new model, because it is the regulatory model of the future. State boards are working to implement and to pass licensing regulations and laws that reflect the model. The certifiers are making changes in their exams and their criteria to reflect the model, and accrediting bodies are implementing the model.
DR. JOAN STANLEY: I think the lesson learned is that it’s a long process, and that it’s not just a one-time deal. It’s a step-wise process. So, for example, when we attempted to get a law passed in Maryland that would cover the scope of
practice for nurse practitioners, this was back in ’78, I think, we eventually went through regulatory route, so that for several years, it’s mainly a lot of educating and educating and talking and explaining and collecting data. And I cannot stress how important that is one to have the data and to have your message very clear and to be consistent and just continually, you know, educate all stakeholders, bring in consumers, whoever is important to your message. It was a several-year
process to try and get legislation passed.
DR. JOAN STANLEY: I think we’re talking about many different kinds of policy and ways to influence. At the organizational level, for example, the credentialing process within an organization, there are policies that are set that who can achieve credentialing, who can admit patients, who can discharge patients, what decisions–guidelines for practice. I think DNP graduate should be very well equipped to, not only present the evidence to evaluate the outcomes, but to recommend new policies based on that evidence about what guidelines and how they should practice and how others should practice, and work within inter professional committees within their facility, whether it’s an inpatient or an outpatient. So that’s one example of a type of policy, the credentialing process committees. Hospitals and other facilities do have credentialing committees and review committees. Nurses should not just sit back and let somebody else decide, you know, what those policies and criteria are, particularly individuals who are in leadership positions and are familiar.
DR. JOAN STANLEY: DNP graduates are well-equipped, hopefully, to practice and make change within systems. That was one of the things that was identified, that was really needed by these new education programs, to look at how you
function within microsystems and mesosystems and macrosystems. That’s all important for making policy changes. One of the issues at a local level that has come up: Many local areas over the last 10 years have really done emergency
preparedness policy. That’s a great example of where nurses–frequently, funding has come down from the federal level to the state level to the local level and its

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