Essentials for advanced professional nurse and professional roles (D025)

D025 ESSENTIALS OF ADVANCED NURSING ROLES AND INTERPROFESSIONAL PRACTICE Advocating for Policy Change to Improve Health Outcomes in the Community Advocating is the act of using education, experience, and position to speak out and stand up for the rights and services of others. The art of advocacy is taught early on in nursing colleges across the nation and is one of the primary responsibilities of a nurse. In the acute care setting, nurses advocate well ensuring the best possible care for patients, but on a larger scale, advocacy is often lost concerning preventative care in the community. It is the role of an advanced professional nurse to advocate for policy change to improve health outcomes in the community. Advanced Professional Nurse as Advocate There are two significant differences in how an advanced professional nurse advocates for an at-risk population in the community versus how an advanced professional nurse advocates for an individual patient in the clinical practice setting. The first significant difference is the level of care involved in advocacy. An advanced professional nurse advocates for an at- risk population in the community by focusing on preventative care and through policy change. In contrast, an advanced professional nurse advocates for an individual patient in the clinical practice setting by treating acute illness and ensuring the best possible secondary or tertiary care. The focus is on preventative care versus secondary or tertiary care. Another significant difference is who an advanced professional nurse is collaborating with to advocate. In the community, an advanced professional nurse advocates by proposing policy changes and collaborating with local leaders to ensure the policy changes pass through legislation (Nickitas et al., 2018). In the clinical practice setting, an advanced professional nurse advocates by collaborating with the patient’s individual interprofessional team of doctors, nurses, pharmacists, and therapies to ensure the best outcome (Bondurant & Armstrong, 2016). The difference is advocating for an individual versus advocating for an entire community. An advanced professional nurse has a direct impact on each patient when advocating, whereas advocating in the community results in an indirect impact with the goal of improving health outcomes for the whole. Interprofessional Collaboration In order for an advanced professional nurse to advocate on a larger scale, it is important to collaborate with an Advocacy Action Team (AAT). An AAT is a team of professionals that work together to speak out and stand up for the rights and services of others. Interprofessional collaboration is an essential component of an AAT to be efficient and successful. Two evidence- based strategies to promote interprofessional collaboration include establishing guidelines and a shared purpose and critically reflecting on the process (Sims et al., 2015). Establishing guidelines and a shared purpose ensures that roles and responsibilities are well defined, and that each team member is working towards a clearly set purpose, or end goal (Sims et al., 2015). A successful AAT works both individually and collaboratively within the guidelines to keep focus and ensure progress. The guidelines and purpose should be set by the team leader, but must be agreed upon by each team member. Keeping in mind the "why" behind the goal helps the AAT to stay focused and continue on, even through resistance and barriers. By critically reflecting on the progress, the AAT is able to measure what is working and any barriers. This should be a non-biased review that results in feedback that is usable to change or adapt the plan as needed. The AAT is then able to develop new, innovative ideas that not only help overcome barriers, but help to create more efficient processes that potentially decrease the resources needed and overall time it takes to complete the plan (Sims et al., 2015). Data Driven Health Issue According to County Health Rankings and Roadmaps (2021), Winnebago County is ranked as one of the least healthy counties in Illinois. Currently, adult smokers make up 21% of the population of Winnebago County (County Health Rankings and Roadmaps [CHR&R], 2021). This is a significantly higher percentage when compared to the rest of the population of Illinois and across the United States at 16% adult smokers (CHR&R, 2021). The data driven health issue in Winnebago County is identified as smoking in adulthood. Characteristics of the at-risk Population The at risk population identified in this analysis is uneducated adults. Two characteristics of uneducated adults stem from childhood including dropping out of high school and growing up in poverty. In Winnebago County, only 88% of adults have obtained a high school diploma compared to 94% across the United States (CHR&R, 2021). In addition, only 59% of adults have completed some college compared to 73% across the United States (CHR&R, 2021). In Winnebago County, 27% of children live in poverty compared to 10% across the United States (CHR&R, 2021). Dropping out of high school and growing up in poverty significantly increases the risk of smoking in adulthood (Gagne et al., 2020). Social Determinant of Health (SDOH) The social determinant of health (SDOH) identified for the health issue of smoking in adulthood is limited education access for children. According to Healthy People 2030 (n.d.), children living in poverty are more likely to drop out of high school, and dropping out of high school places a child at higher risk for smoking in adulthood. Currently, Winnebago County is filled with uneducated adults related to childhood poverty and dropping out of high school. In order to help prevent the new generation of adults from smoking, it is imperative Winnebago County increase and improve the education access to children. Current Policy Current policy provides limited support to prevent the new generation of adults from smoking, therefore does not adequately address the uneducated adult population or SDOH identified as limited education access for children. Due to the Smoke-Free Illinois Act and the Illinois Clean Indoor Air Act, Winnebago County created the Tobacco Free and Smoke Free Environment Policy (Winnebago County, 2014). This current policy prohibits any tobacco use close to buildings or indoors. This policy addresses current smokers, but does not provide any preventative measures. As identified above, dropping out of high school and growing up in poverty result in limited education access which leads to increased risk of smoking in adulthood. This current policy does not address the SDOH, therefore, does not adequately address smoking in adulthood. Policy Proposal In order to address the limited education access for children in Winnebago County, a policy to implement an Extended Early Childhood Program is proposed. An Extended Early Childhood Program would increase education access to children in poverty by addressing the daily socioeconomic needs. According to Healthy People 2020 (n.d.), children in low socioeconomic situations are more likely to require special education and are less likely to graduate high school. By ensuring children living in poverty have the services required to increase and improve education access, high school dropout rates will decrease thus reducing the amount of smokers in the next generation. Health Issue Impact The policy to implement an Extended Early Childhood Program will positively impact the health issue, smoking in adulthood, by directly influencing the social determinant of health, limited education access for children. Extended Early Childhood Programs have been shown to have a positive impact on the physical and mental health of adults (Healthy People 2020, n.d.). The Carolina Abecedarian Project found that adults who were enrolled in early education programs were less likely to use cigarettes as adults (Healthy People 2020, n.d.). Overall, increasing access to quality education plays a significant role in positively impacting future health outcomes and community health issues. Equitable Distribution of Resources In order to ensure equitable distribution of resources, the policy proposal will address diversity. The proposed policy will include a diversity clause that clearly states that the Extended Early Childhood Program will not discriminate against race, color, religion, sexual orientation, gender identity, or disability. Also as part of the policy, a diversity board will be in place to monitor the participants in the program and verify that entrance into the program is based on need, not favoritism. Part of the responsibilities of the diversity board will be to collect and analyze the data of applicants. To ensure resources are distributed equally and appropriately, a limited amount of spaces from each diversity group will be available and filled. In order to be a steward of the resources available, if there are no applicants from a particular diversity group, the diversity board would fill the open spaces based on the greatest need. Ethical Provisions The policy proposal upholds provision 7 and provision 8 from the American Nurses Association (ANA) Code of Ethics. Provision 7.3 states that nurses must contribute to the community by advocating for health initiatives through policy development (American Nurses Association [ANA], 2015). Provision 8.2 states that nurses have a responsibility to address social determinants of health by collaborating with leaders and legislators to ensure the advancement of the health and safety of the population (ANA, 2015). By collaborating with local leaders and legislators through policy reform and development, the advanced professional nurse contributes to and advocates for the health of the community. Advocating for a policy to implement an Extended Early Childhood Program directly impacts the limited education access for children thus upholding the ANA Code of Ethics. Barriers