Nursing Issues: A Call to Political Action

1. Nursing Issues: A Call to Political Action Chapter 1

2. Objectives • Distinguish between problem solving and the process of issue articulation and resolution • Use a framework for the articulation and analysis of an issue • Describe strategies for addressing barriers and moving issues toward resolution

3. Significance for Nurses • Issues are best served by an approach that questions and interrogates the taken-for-granted view of the particular subject. • To articulate an issue fully means to consider the political, historical, social, and economic realities on and through which issues are constructed.

4. Significance for the Profession • The significance of clear articulation of issues for the profession goes beyond the individual nurse to include the organization of nurses and their ideas into a large collective. • To be effective in supporting political action within the profession, nurses need to speak in unison on issues and organize themselves to act provincially/territorially, nationally, and internationally. • The link between healthcare and political action is inseparable.

5. Quality of Healthcare: Four Elements • Standards of education and preparation for those entering the profession. • Quality of care provided by the practitioner—a quality closely associated with education and preparation. • Number of nurses available—a determination considered in modern times largely by the social and economic status the profession offers its members. • Milieu in which care is offered.

6. Nursing Practice as Political Action • The need for problem solving and decision-making abilities has been ingrained in the discipline of nursing since its inception. • Legislative changes in the scope of practice and in the code of ethics have contributed to the politicization of nursing practice. • Concurrent with their increasing social consciousness, nurse leaders experience an awareness of the limitations of approaching complex sociopolitical issues with short-term approaches to change.

7. Question • Questions such as “What is already known about this topic? Who has generated this knowledge? and What issue within this topic would you like to explore,” are asked when _________ the topic: • A) Articulating • B) Situating • C) Framing • D) Analyzing

8. Answer • B • Rationale: These questions are making explicit the assumptions that you and others hold about the topic.

9. Framing the Topic • An issue can be expressed as a dilemma, conundrum, question or series of questions, or simple statement. • Situating the topic: You situate the topic by making explicit the assumptions that you and others hold about the topic; an assumption is an idea that is held to be true without any support or substantiation. • A literature review is done with the intention to help establish the particular issue that you will address within the topic. • Articulating the issue: Once the issue is identified, you ask questions such as what, how, and why this is an issue.

10. Analyzing the Issue • Some issues call for a particular approach to analysis, but most issues benefit from more than one approach. • Historical analysis: Brings us the opportunity to reopen our nursing and healthcare history; more than a return to the history recorded but can be seen as an occasion to excavate the historical understandings that have been silenced, diminished, or erased. • Ethical and legal analysis of the issue: The code of ethics itself provides a framework for an ethical analysis of issues for nurses’ professional relationships with individuals, families, and other health professionals.

11. Analyzing the Issue (cont.) • Social and cultural analysis: Every issue develops in a societal context that shapes the issue and influences the possibilities for resolution. • An analysis of the social and cultural context explores the prevailing attitudes, the values and priorities, and the privileging dominant culture. • Political analysis: Asks questions that explore the location of power and influence within particular issues; in other words, whose knowledge, whose voice, is able to influence either the barriers or the strategies for resolution.

12. Analyzing the Issue (cont.) • Critical feminist analysis: Asks questions that challenge the taken-for-granted assumptions of gender that are prevalent in society; the intention is not to privilege the position of gender over others but to question the way in which notions of gender have been attached to issues affecting nurses/clients/others in the health system. • Economic analysis: The discourses we hear and repeat are replete with the language of economic restraint, efficiency and cost-effectiveness, and scarcity of resources.

13. Barriers to Resolution • Once barriers are identified, there may be an increased opportunity for resolution through mediation, collaboration, or negotiation • Limited accessibility to resources • Issues are not clearly understood • Irresolvable differences between participants • Power inequities between parties invested in the issue • Lack of tolerance for multiple views and unconscious resistance to change

14. Question Is the following statement true or false? • To maximize the amount of support, it is important to enlist the assistance of as many people as possible who are affected by the issue.

15. Answer • True • Rationale: A greater response and resolution can be anticipated if the affected parties are unified in their efforts to address the specific issue.

16. Devising Strategies for Resolution • After an issue relevant to the profession of nursing or healthcare is articulated and analyzed, multiple strategies can be implemented to address and resolve the issue: • Lobbying • Preparation of written resolutions for presentations • Establishment of a letter-writing campaign • Involvement of the news media through letters and articles

17. Summary • Articulation of an issue involves selecting the particular issue from a topic of interest. • The nature of the issue is articulated by asking questions, such as “Who are the participants in this issue? What makes this a nursing issue? Who first raised this issue and why?” • Beliefs and assumptions inform an understanding of the issue, and the importance of articulating these assumptions is the first step of issue analysis. • Identifying barriers to the resolution is an important step to moving toward a resolution.