Shaping Health Policy
Through Nursing Research
American Association of Colleges
of Nursing
October 28, 2007
IOM / ANF / AAN
Distinguished Nurse Scholar
Program
2006-2007
Ada Sue Hinshaw PhD, RN, FAAN
Professor, School of Nursing
University of Michigan
Science Shaping Health Policy
When are science and research most
valuable for health policy makers?
When are science and research least
likely to be used in policy-making?
What are the characteristics of research
that facilitate health policy makers use of
the information?
What are the facilitating factors and
barriers to the use of research in policy?
What is Health Policy?
Authoritative principles and decisions
making up social programs of institutions,
associations and / or local, state, national
and international governments—intended
to direct health-related actions, behaviors
and / or resource distribution
Science Shapes Health Policy:
One of Many Factors
Health Policy Cycle Model:
From Talk to Action
(Shamian, 2003)
Moving Between Two Cultures--Policymakers on Researchers:
– They take forever to answer simple
questions, then late with results
– This stuff they write-can’t understand it
– Work in “ivory towers”-produce unintelligible
recommendations
– Always hedging-can’t get a straight answer
– Don’t answer the questions I thought I ask
Policy Makers on Researchers: (cont’d)
Why make such ridiculous assumptions?
They have biases, like everybody
It takes a long time to educate them—then
they go off and research something else
Take little responsibility for the implications
of their findings
I don’t trust them
(Helms, 2007)
Researchers on Policy Makers:
Don’t ask researchable questions
Don’t accept uncertainty or realize that
reducing uncertainty costs money
Don’t appreciate the influence of “publish
or perish” on my life
Want unrealistic turn-around for results
Researchers on Policy Makers: (cont’d)
Expect me to drop everything and deliver
results for policy input
Want “bottom line” answers to take them off
the policy hook
Can’t be trusted with results; they may
misinterpret or misuse my results
(Helms, 2007)
IOM / AAN / ANF Scholar Study:
Science Shaping Health Policy
Purpose:
To explore how science shapes health
policy and more specifically how nursing
research shapes health policy
General Questions:
Science Shaping Health Policy
When in the policy making process, are
science and research most useful?
What characteristics of the science or
research make it most useful?
When are science and research least
likely to be useful in policy making?
Interviewed 15 well known, recognized
health policy influencers in Washington
DC area who are leaders of organizations
with health policy agendas
When are science and
research most valuable for
policy making?
Policy Influencers Suggest:
Time of disagreement-to resolve conflict
and “save face”
Times of chaos—need to solve a major
problem and provide direction
Substantiation for a previously held
position
When there is a “window of opportunity” or
policy receptor for the results
Helpful Characteristics of Research:
Credibility of research
Information is clearly presented in
understandable lay terms
Data is provided in quantitative mode
Results give clear suggestions for
actions to be considered
Findings are framed in a policy context
When are science and
research least likely to be
used in policy making?
Policy Influencers Suggest:
Information does not address critical
public health issues
Not a “window of opportunity” for the
information
Times when strong values and beliefs
are held by policy makers
Hidden agendas in policy situation
Specific Questions re.
Nursing Research Shaping Health Policy
An Exploratory Study
Semi-structured phone interviews of 23
Principal Investigators funded on
Competing Continuation awards by NIH /
NINR. Stratified random sample of 32
from 109 such awards from 1986 to 2006.
Sample response rate= 72%.
Specific Nursing Research Questions:
(cont’d)
Content analysis of responses by
question for recurring themes. Themes
determined by frequency of responses
PIs ask their perception of the level of
influence their research had on shaping
health policy on a 1 to 5 scale with 5
being high. Perceived high influence was
3-5 with 16 PIs. Perceived low influence
was 1-2 with 7 PIs
Presentation focuses on:
Nurse PI’s responses to four questions:
– Characteristics of their nursing research that
facilitated shaping health policy?
– External factors that assisted their nursing
research in influencing health policy?
– Barriers that limited their nursing research
shaping health policy?
– Ways the PI’s nursing research has shaped
health policy?
Table 1
Characteristics of Nursing Research Shaping
Health Policy
Addresses major public health issue
Research of interest to multiple disciplines &
audiences – e.g. federal / state agencies &
industry
Interdisciplinary team of investigators with
multiple bodies of knowledge – enriches
results
Table 1
Characteristics of Nursing Research Shaping
Health Policy (cont.)
Research focused on clients (patients),
families & communities – tracing important
safety outcomes
Research integrates complexity of health
issues, e.g. focuses on merger of biobehavioral concepts & indicators
Table 2
Factors that Facilitate Nursing Research
Shaping Health Policy
Based in strong supportive research
university environments
Partnered with multiple disciplines – visibility
and access to diverse networks for
dissemination
Timeliness of research in informing major
health issue – “window of opportunity”
Strong visibility by public & colleagues
through media attention, marketing,
Congressional testimony, etc.
Table 3
Barriers to Nursing Research Shaping Health
Policy
•L
Lack
of Congressional interest – No “window
a
of
c opportunity”
k
Research
not focused on major health
concerns
o
f
Lack
of economic outcomes – Need
“reasonable” benefit / cost estimates
Lack of visibility of research to broader public
& policymakers
Table 4
Ways of Shaping Health Policy Through
Nursing Research
(In Frequency Order)
Informed local practice
– Acute Care Organizations
Informed national health guidelines and
standards; e.g.
– NQF documents
– CA pain guidelines
– Ambulatory guidelines for UI
Shaped health science policy
Table 4 (cont...)
Ways of Shaping Health Policy Through
Nursing Research
Shaped national health policy; e.g. federal
agencies, Congressional testimony, IOM
citations
Informed state health policy
Informed international health policy
– Shaped national practice safety alerts;
e.g. UK, Australia
Broad Themes:
Need for education of Principal
Investigators in terms of health policy
Need for a “Broker” system for moving
research into health policy
Examples:
Nursing research shaping health
policy at multiple levels; institutional,
state, national and international.
Proper Placement of a Gastric
Tube: pH as an Indicator
(Metheny, 2001)
Purpose:
To assess the proper placement of
feeding tubes by measuring the pH
of secretions aspirated from the
tube
Results:
70% gastric secretions in pH range of
0 to 5
99% respiratory secretions are a pH of
7 or more
Recommended: Test for correct
placement using a pH of 0 to 4
Practice and Institutional Health
Policy Influence:
Recommended pH test adopted as new
standard:
– In practice policies in health care
agencies
– In clinical textbooks for nursing
Urinary Incontinence:
Improving Control
(Dougherty and colleagues, 2002)
(Sampselle and colleagues, 2000)
(Jirovec and Temple, 2001)
Behavioral Interventions:
Pelvic Muscle Training
Biofeedback
Scheduled Voiding
Bladder Training
Nursing interventions
advanced to prevention
strategies.
Practice and Professional
Association National Policy:
Translation study with behavioral
strategies conducted in 21 ambulatory
women’s health clinics
Taught over 900 women post childbirth
the prevention strategies
Strategies built into agency practice
policies and sponsored by the
professional association
Challenge:
With older women and men the
behavioral strategies are less
effective.
Use of scheduled voiding requires
caregiver-time intensive so often not
practiced.
End of Life Care:
Reducing Family Stress
(Tilden and colleagues, 2001)
Purpose:
Increase family control through
advanced directives and decrease
family stress
Results:
Significantly less family stress and
more comfort with grieving when
advanced directives completed prior
to end-of-life
Health Policy Implications
Incorporated in RWJ Foundation “Last
Acts” campaign
– “You can Lift a burden from those
you love—use advanced directives”
– Results part of Oregon Report Card:
Improving Care of the Dying
Nurse Staffing and Patient
Outcomes
(Aiken & colleagues, 2002)
(Needleman & colleagues, 2002)
Nurse Staffing and Patient
Outcomes:
Over 81 studies document positive
patient and nurse outcomes with
adequate nurse staffing and positive
work environments.
(IOM, 2004)
Practice and Policy
Implications:
Built into ANA Credentialing process
for Magnet Hospitals
Used to develop state legislation on
nurse/patient ratios
Quoted extensively in IOM reports on
positive work environments for nurses
and patient safety
Moving Between Two Cultures!