A Political Action Framework for Nurses
C. Avolio March 2011
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At the end of the learning session the nurse
will be able to:
Discuss the importance of political activity
Define advocacy and community
Discuss the morale, ethical role of the RN in
relation to addressing health, health policy
and nursing for individuals and populations
Identify determinants of health pertinent in
the Windsor/Essex community
Begin to develop a personal position
statement on a health issue of concern
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Nurses have first hand knowledge of health
and social disparities
Responsibility to address social, economic
and political issues that impact health
Advocacy is a core value of nursing
Nurses possess the right skills;
communication, decision making, problem
solving and critical thinking
Use of the nursing process-assess, plan,
implement and evaluate our actions
RNAO “Framework for political action” 2006
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Not sure how to utilize our skills in the
political arena
Language of policy and legislation is
complicated
Lack basic education to prepare us for
political action
Power struggles-history
Image of nursing-caring profession. Does
this conflict with the aggressiveness of
politics?
Work-life balance
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Political science not a mandatory course in
undergraduate studies
Most graduate programs have core courses
in population health
Limited research about the contents and
delivery method
Moral education Gehrke, 2008, p. 54
Nurses have called for educational
preparation in policy advocacy, and
beginning research suggests that
educational preparation enhances
competencies in political advocacy.
Reutter & Duncan, 2002
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“The act or process of advocating or
supporting; one that pleads the case of
another” Webster Dictionary, 1998
”A combination of individual and social
actions designed to gain political and
community support for a particular goal”.
WHO, 2005
“Pertains to both clinical situations on behalf
of patients and social circumstances on
behalf of the general public.” Beu, 2005
Advocacy is identified as a core value
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throughout the Standard of Practice
Guidelines:
Therapeutic Nurse-Client Relationship
Professional Standards
Informed Consent
Ethics
Leadership
www.cno.org
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Florence Nightingale-linked health to social
and economic inequalities. Reduced
mortality rates of British soldiers, addressed
poor sanitation, overcrowding, ventilation
and the welfare state.
Lillian Wald-Founder of the public health
nursing, lobbied for improved social
conditions for the poor, introduced both
school and rural nursing, addressed child
labour and welfare issues.
Falk-Rafael, 2005
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“Health policy advocacy is an
important part of nurses’ health
promotion role, and it is considered
an aspect of sociopolitical caring.”
Primomo, (2007, p. 263)
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“A group who share common characteristics, but
may not interact with one another.” McKay & Segall,
1983
“Persons who reside in an area, space and time,
which includes a community history and
environment and purpose.”
Shamansky &
Peaznecker, 1981
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“Shared interests, ethnicity, sexual orientation, or
occupation.” Fellin, 2001
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“A social unit where people come together
politically to make changes.” Parker, 1994
As cited in Glanz, Rimer & Viswanath, (2008)
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The health of those in the Erie-St. Clair region is
affected by:
Smoking, alcohol misuse, lack of physical activity,
poor nutrition/diet and obesity. All greater than
the Ontario average
Significantly high incidence of chronic diseases;
cardiovascular, cerebrovascular, diabetes,
hypertension, COPD and arthritis
Greater than average rate of hospitalization, years
of life lost and death due to tumours and
circulatory disease
Low income, high cost of medications
http://www.esclhinihsp2.ca/mha/mha.html; retrieved March 2011
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Over 408,000 residents
High senior population, decreased number of
25-39 years
Slightly more females than males
Many lone parent families, predominantly
female with an average income of 31,000
Culturally diverse, immigration and visible
minorities
Most residents have a high school diploma or
less
Unemployment rate is 9.5%
Statistics Canada, Windsor Essex Census 2006
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Healthy public policy is aimed at
achieving equity and can positively
affect many of the determinants of
health.
Reutter & Duncan, 2002
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Income and social status
Social support networks
Education
Employment and working conditions
Social environments
Physical environments
Personal health practices/coping skills
Healthy child development
Biology and genetic endowment
Health services
Gender
Culture
Pangman & Pangman, 2010 p. 67-8
Health inequalities are the differences,
variations and disparities in the health
attainments of individuals and groups.
Examples:
Income
Gender
Disabled persons
New immigrants
Aboriginal persons
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Social justice is the degree of equality
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Smith (2005) as cited in Pangman & Pangman (2010)
of opportunity for health made
available by the political, social and
economic structures and values of a
society.
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Micro-level processes – Social structures that
lead to individual health or illness
Macro-level processes - Power relationships
and political ideology that dictate the quality
of social structures
Downstream carative processes-”directed
towards meeting needs of individuals and
families.”
Upstream processes-”influencing change in
societal structures and relations, by those
with power in society.”
(Raphael, Bryant & Rioux, 2009; Falk-Rafael, 2005)
Vision
 Risk takers
 Contacts with people in power and
positions of authority
 Sought to influence government
 Work collaboratively to achieve their
goals
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Beu, 2005
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Nursing expertise
Networking
Persuasion
Collective action
Broad perspective
Perseverance
Rains-Warner, 2003
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Communication
Credibility
Collective action
Collaboration
Cash
Leavitt as cited in Beu, 2005
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Are nurses morally obligated to respond to
the inequities that affect people and/or our
communities?
Reflect on your own personal/professional
values.
Political action can mobilize change
Identify a question or concern-something that is
important to your patients, community and SELF
 Assessment of the problem-evidence, research,
talk to nursing experts, call RNAO
 Plan your action-i.e. write a letter to your MP, call
the media, respond to an action alert, support
RNAO position statement
 Act-Have a colleague review your response,
important to act in a timely manner. Provide a
possible solution(s) that are congruent with
those that support positive health outcomes,
healthy public policy or support nursing roles.
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Evaluate-What is the response or outcome to
your action? Satisfied?
Reassess the need to act further, develop a
coalition, focus group, monitor progress, etc.
RNAO Political Framework-Taking Action!
(2006)
RNAO Political Framework-Taking Action!
(2006)
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http://www.cnanurses.ca/CNA/issues/matters/default_e.asp
x
http://www.rnao.org/Page.asp?PageID=1224
&SiteNodeID=117
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“Nurses who practice at the intersection of
public policy and personal lives, are,
therefore, ideally situated and morally
obligated to include political advocacy and
efforts to influence health public policy in
their practice. The health of the public and
future of the profession may depend on it.”
Falk-Rafael, 2005
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Following the presentation, in your opinion
does the RN have a commitment to act on
behalf of the community as a
community/political advocate?
Have you identified any areas within your
community or work environment that
requires action to improve the healthcare
delivery system and/or population health
through addressing the determinants of
health?
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Beu, B. (2005). Internship links practice and politics. Health policy issues, 81(2), 421422.
Canadian Nurses Association. Retrieved March 26, 2011. www.cna.ca
College of Nurses Standards of Practice. Retrieved March 26, 2011. www.cno.org
Falk-Rafael, A. (2005). Speaking Truth to Power: Nursing’s Legacy and Moral
Imperative. Advances in Nursing Science, 28(3), 212-223.
Gehrke, P.M. (2008). Civic Engagement and Nursing Education. Advances in
Nursing
Science, 31(1), 52-66.
Health Canada, www.gchc.on.ca
International Council of Nurses,
LHIN, ISHP 2, 2010
Primomo, J. (2007). Changes in political astuteness after a health systems and policy
course. Nurse Educator, 32(6), 260-264.
Rains Warner, J. (2003). A phenomenological approach to political competence: stories
of
nurse activists. Policy, Politics & Nursing Practice, 4(2), 135-143.
Raphael, D., Bryant, T., & Rioux, M. (2006). Staying Alive: critical perspectives on
health,
illness, and healthcare. Toronto, Canadian Scholars’ Press Inc.
RNAO (2006) Taking Action! Political Framework
Stats Canada retrieved March 26, 2011
World Health Organization (2005). “Introduction to Toolkit”. From Health Service
Planning and Policy Making: A Toolkit for Nurses and Midwives. p. 4