Chapter 13: Policy Making and Community
Organize the following stages in the policy process in the order they should be considered. A) Policy Adoption B) Policy Evaluation C) Policy Formulation D) Policy Implementation
C) Policy Formulation A) Policy Adoption D) Policy Implementation B) Policy Evaluation feedback: The order of the stages in the policy process is formulation, adoption, implementation, and evaluation.
Which of the following statements about advocacy and lobbying and the influence of both on policy are true? Select all that apply. a. Advocacy can be defined as pleading the case of another or championing a cause. b. Lobbying is the act of influencing legislators. c. Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. d. Policy and politics are not related to each other. e. Public policy is a rational process.
a. Advocacy can be defined as pleading the case of another or championing a cause. b. Lobbying is the act of influencing legislators. c. Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. feedback: Advocacy can be defined as pleading the case of another or championing a cause. Lobbying is the act of influencing legislators. Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. Policy and politics go hand in hand; neither exists without the other. Public policy is not a rational process.
Which of the following would be important for a politically involved nurse to do? Select all that apply. a. Communicate ideas effectively b. Get to know local representatives c. Avoid involvement with community boards d. Be firm and unyielding in approach e. Stay current about health care issues
a. Communicate ideas effectively b. Get to know local representatives e. Stay current about health care issues feedback: The politically involved nurse should aim to accomplish three primary goals: (1) generate support for one's views by communicating ideas effectively and getting to know and influence representatives at local, state, and national levels; (2) create professional legitimacy by keeping abreast of current issues in health care and nursing and becoming involved in professional nursing organizations, community boards or committees, or political office at the local, state or national level; and (3) resolve conflict and effectively negotiate and compromise.
The community health nurse is reviewing how managed care today has changed from its initial proposal. Which of the following would the nurse identify as an important change? a. Current emphasis on cost containment b. Focus on choosing a practitioner c. Expansion in types of care provided d. Increase in nonprofit agencies
a. Current emphasis on cost containment feedback: Managed care has evolved and the emphasis has shifted from prevention to cost containment. Reductions in reimbursement particularly for disadvantaged patients (e.g., those covered under Medicaid and Medicare), reductions in the choice of practitioners, and limitations on the types of care available transformed this system as originally envisioned. Most managed care today is for profit, setting up a dichotomy between the insured and the owners/investors.
A community health nurse identifies a problem of increased infant mortality with adolescent pregnancies. The nurse decides to address this problem with a health policy. The nurse is engaging in which stage of the policy process? a. Formulation b. Adoption c. Implementation d. Evaluation
a. Formulation feedback: Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Implementation follows adoption and occurs when the policy is put to use. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.
When developing a teaching plan for a class that describes health policy, which of the following would the instructor include as an example of a regulatory health policy? a. Licensure of health professionals b. Federal subsidies for nursing education c. Benefits for needy groups d. Allocating resources among groups
a. Licensure of health professionals feedback: Regulatory health policy regulates or licenses services or people providing services in the community. Distributive health policy subsidizes nursing education, benefits the needy, and allocates resources among and between groups.
A community health nurse integrates understanding of power and empowerment when working with clients by demonstrating which of the following? a. Partnership with clients b. Hierarchical relationship c. Authority over clients d. Client autonomy
a. Partnership with clients feedback: The various definitions of empowerment and the expansion of the definition of health, which now includes the social, political, and economic determinants of health, have changed our thinking on how best to interact with the communities we serve. This also suggests a change in the relationship between professionals and communities; a change from the customary hierarchical patient/provider relationship to one of a partnership.
13. Which of the following statements about power and empowerment are true accurate? Select all that apply. a. Power is the ability to act or produce an effect and possess control, authority, or influence over others. b. Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. c. if power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. d. All of the power belongs to the legislators. e. Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.
a. Power is the ability to act or produce an effect and possess control, authority, or influence over others. b. Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. c. if power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. e. Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities. feedback: Power is the ability to act or produce an effect and possess control, authority, or influence over others. Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. Professionals hold the power and authority by virtue of their place in the bureaucracy. Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.
How can nursing fulfill the potential to transform nursing and take the power to influence policy development? Select all that apply. a. Practicing to the full extent of their education and training b. Achieving higher levels of education and training through an improved education system that promotes seamless academic progression c. Act as full partners, with physicians and other health professionals, in redesigning health care in the United States d. Improve data collection and an improved information infrastructure to ultimately influence effective workplace planning and policy making e. Most nurses are already involved in the regulatory framework development.
a. Practicing to the full extent of their education and training b. Achieving higher levels of education and training through an improved education system that promotes seamless academic progression c. Act as full partners, with physicians and other health professionals, in redesigning health care in the United States d. Improve data collection and an improved information infrastructure to ultimately influence effective workplace planning and policy making feedback: The four key messages from The Future of Nursing: Leading Change, Advancing Health include the following: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. It is not yet true that most nurses are already involved in the regulatory framework development.
Which of the following statements reflect progress in public policy that can be attributed to professional nursing organizations? Select all that apply. a. Professional nursing organizations have elevated nursing professionalism. b. Professional nursing organizations have given voice to the inequalities that affect our society. c. Professional nursing organizations have developed the paradigms that influence and affect public health. d. Nursing is regarded as a major player in Washington when discussing health care policy. e. Professional nursing organizations have a long and consistent relationship with public policy.
a. Professional nursing organizations have elevated nursing professionalism. b. Professional nursing organizations have given voice to the inequalities that affect our society. c. Professional nursing organizations have developed the paradigms that influence and affect public health. feedback: Professional nursing organizations have elevated nursing professionalism, have given voice to the inequalities that affect our society, and have developed the paradigms that influence and affect public health. Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be fully realized.
Community health nurses are attending an in-service program about health policy. Which of the following would the nurses expect to be included in the description? a. Reflection of a community's values b. Creation for several influential people c. Development by those outside of the community d. Indication of needs of the community's poor
a. Reflection of a community's values feedback: Health policy should reflect a community's values and should not only be created for certain groups such as the influential or the poor. It needs to come from the people within the community and be for all of them.
Which of the following is an example of a distributive health policy? a. Reporting of communicable disease b. Federal funds for nursing education c. Medicare d. Arms control agreement
b. Federal funds for nursing education feedback: Distributive health policy promotes nongovernmental activities that are thought to be beneficial to society as a whole. An example of a distributive policy is the Nurse Training Act, Title VIII of the Public Health Service Act, which was established in 1965 and provided federal subsidies for nursing education in an effort to address the need for a more nurses. Reporting of communicable diseases and arms control agreement are examples of regulatory health policy at the national and international levels respectively. Medicare is an example of a redistributive health policy.
Which of the following statements about special interest groups and policy making are true? Select all that apply. a. Others will be persuaded by facts alone. b. Power is wielded by special interest groups, business, and industry. c. Nurses need to provide input to policy circles through advocacy. d. Nurses need to provide leadership at decision-making tables. e. There are power struggles behind all legislation and health care regulation.
b. Power is wielded by special interest groups, business, and industry. c. Nurses need to provide input to policy circles through advocacy. d. Nurses need to provide leadership at decision-making tables. e. There are power struggles behind all legislation and health care regulation. feedback: Nurses need to provide input to policy circles through advocacy and leadership at decision-making tables. It is naïve to believe that others will be persuaded by facts alone. Power is wielded by special interest groups, business, and industry. There are power struggles behind all legislation and health care regulation.
When describing public health nursing to a group of community health nurses, which of the following would be identified as its foundation? a. Social marketing b. Social justice c. Social disparities d. Advocacy
b. Social justice feedback: The concept of social justice is seen as the very foundation of public health nursing. Social marketing is the means to influence behavior of target populations for program development. Addressing social disparities or inequalities are one component of public health nursing. Advocacy involves pleading the case of another and pursuing influencing outcomes.
Which is the best way for any nurse to advocate for change and exert power? a. Pursuing an advanced degree b. Running for state congressional seat c. Actively participating in a professional nursing organization d. Becoming a member of a local not-for-profit agency board of directors
c. Actively participating in a professional nursing organization feedback: A major way in which nurses have been successful with advocacy is through membership in their professional organization. Influencing policy may be achieved by obtaining advanced education, which would be helpful in pursuing higher level positions, and political office whether at the local or state level. Influencing policy is not the same as advocating.
Which of the following effects of a health system in disarray have the most direct influence for a public health nurse at this present time? a. The United States is often touted as having the best health care system in the world. b. Fewer jobs for nurses c. Crisis in public health related to underfunding and underappreciation of the core functions of public health leading to substantial reduction in public health programs d. Changes in the Medicare payment system
c. Crisis in public health related to underfunding and underappreciation of the core functions of public health leading to substantial reduction in public health programs feedback: Currently, there is serious underfunding and underappreciation of the core functions of public health, which has led to massive layoffs of staff and substantial reduction in public health programs. The United States is often touted as having the best health care system in the world. However, this may be in question related to the expense of our current health problems and the lack of benefit to the health of all Americans. There is currently a serious nursing shortage that is projected to only get worse in the coming decades. There are changes in the Medicare payment system and this does affect health care in general but most public health programs do not receive Medicare support.
A group of community health nurses are discussing health care policy in the United States. Which of the following reflects the consensus view? a. Market forces should solve the problem. b. The government should assume responsibility. c. Health care policy needs to change. d. Health care policy is flawed but adequate.
c. Health care policy needs to change. feedback: Most people agree that health care policy in the United States must change, but there is little agreement among policy makers and citizens about how this should occur. Some believe market forces should be allowed to work this problem out; others believe the government should assume responsibility. Health care policy is not viewed as being adequate.
A community health nurse is involved in assessing the community's capacity to define strategies to enhance compliance with a policy. The nurse is working in which stage of the policy process? a. Formulation b. Adoption c. Implementation d. Evaluation
c. Implementation feedback: Implementation of health policy occurs when an individual, group, or community puts the policy into use. It involves overt behavior changes as the policy is put into nursing practice. As an implementer, the community health nurse assesses the capacity of the community to formulate and define strategies that will enhance the community's compliance with the policy. Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.
Which stage in the policy process is exemplified by the activities of identifying the health problem and/or using a goal-oriented approach? a. Policy adoption b. Policy evaluation c. Policy formulation d. Policy implementation
c. Policy formulation feedback: Policy formulation involves identifying goals, problems, and potential solutions. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy implementation follows adoption and occurs when the policy is put to use. Policy evaluation compares policy outcomes or effects with the intended or desired effects.
When involved in the policy process, the community health nurse must keep in mind that which of the following should be the strongest influence? a. Social conditions b. Political conditions c. Public need d. Health planning
c. Public need feedback: The social and political conditions that affect policy formulation are limitless, but public need and public demand should be the strongest influences. Health planning may be an approach to policy formulation.
After a class on nursing and political activism, which statement by the nursing student would indicate that the teaching was successful? a. "Nurses have just now become increasingly active in the political arena." b. "Nurses are the smallest group of providers with the largest voice." c. "Nurses are considered major political players in Washington." d. "The ANA provides nurses with a collective political voice."
d. "The ANA provides nurses with a collective political voice." feedback: A professional nursing association such as the ANA builds a collective voice for nurses. Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be realized. Nursing also is not thought of as a major player in Washington when discussing health care policy.
When analyzing health policy, which question would be most important for the community health nurse to ask? a. "How much does it cost?" b. "What is the result?" c. "Why is it in place?" d. "Who benefits from it?"
d. "Who benefits from it?" feedback: When analyzing policy, nurses need to answer two general questions: Who benefits from this policy? and who loses from this policy? Whether the policy should be advocated by the community as a whole depends on the degree to which the policy benefits the community without being detrimental to individuals or the country. Cost, results, and reasons why are not key elements to address in policy analysis.
Which of the following statements about professional organizations and public policy is the most accurate? a. Professional organizations increase polarization and cause a group to be more united and strong. b. Professional organizations encourage selfishness and self-interest. c. Professional organizations focus solely on "protecting their turf." d. A united voice on public policy is more powerful than individuals pleading with legislators.
d. A united voice on public policy is more powerful than individuals pleading with legislators. feedback: A united voice on public policy is more powerful than individuals pleading with legislators. The other statements about professional organizations are not true. They do not increase polarization and if they did, it would not cause the group to be more united and strong. Professional organizations do not increase selfishness and self-interest, and professional nursing organizations do not focus solely on "protecting their turf."
When engaging in the policy process, which of the following would the community health nurse do last? a. Define the problem b. Gather information c. Look for alternatives d. Choose the approach
d. Choose the approach feedback: Policy analysis involves the following sequential steps: define the problem, information gathering, looking for alternatives to the approach, and choose the most appropriate approach.
