1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Issues: A Call to Political Action Chapter 1

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B Rationale: These questions are making explicit the assumptions that you and others hold about the topic.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.