NR554 Week 3 Discussion, Building Research Locally; Supporting Research Nationally

Building Research Locally; Supporting Research Nationally NAME Chamberlain College of Nursing NR 554: Nurse Leader and Healthcare Policy DATE Nursing leaders are often presented with problems and issues, some that are departmental and organizationally focused, and others that have wide national impact. Consider the different levels of challenge for the nursing leader that move from local to state to national health policy agenda. Consider one project, either one that is local OR one that has national implications, that created policy change and was implemented in your organization. What are the greatest challenges on the project for the leader within the context of healthcare policy and use of evidence support? Building Research Locally; Supporting Research Nationally Smoking and tobacco use are significant risk factors for a variety of chronic disorders such as stroke, lung cancer, and coronary heart disease. According to the CDC, cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure (2017). Approximately 13 years ago a common scene at the Cleveland Clinic and many other neighboring hospitals was to see a group of employees in scrubs stand on the front lawns of hospitals smoking, only to return inside shortly to take care of patients suffering from tobacco-related diseases. On November 2006, voters approved the indoor smoking ban making Ohio the first Midwestern state and the first tobacco-growing state to enact such a ban (Ohio Department of Health, 2008). Ohio also became the 12th state to protect all workers and the public from exposure to secondhand smoke in workplaces and public places. The Cleveland Clinic's campuses went smoke-free in July 2005. In September 2007, the Cleveland Clinic's non-smoking hiring policy went into effect and in July 2008 the organization began offering free tobacco cessation courses and a two-month supply of nicotine patches for workers in its employee health plan. Healthcare professionals in positions of leadership can get involved in the policymaking process–supporting comprehensive tobacco control measures that go beyond the availability of cessation to include smoke-free workplaces, a campaign to prevent youth from taking up tobacco, and funding for tobacco control programs. Enforcing smoking bans can be difficult, especially for large hospitals with sprawling campuses like the Cleveland Clinic. One challenge the nurse leader may experience while working with other healthcare professionals and executives to develop and implement a smoking ban is the lack of knowledge about tobacco control because tobacco control has not traditionally been a part of nursing practice. Research has shown that tobacco-related content in nursing schools is minimal. A survey of nursing schools in four Asian countries (China, Japan, Korea, and the Philippines) revealed that 92% included content on health risks of smoking and 49% did not provide smoking cessation content (Sarna, Danao, Chan, Shin, Baldago, Endo, Minegishi, & Wewers, 2006). Oncology Nursing Society (ONS) acknowledges, “there is a need to improve nursing curricula about the health effects of tobacco use and exposure to secondhand smoke, prevention of tobacco use, and science-based strategies for tobacco dependence treatment, as well as clinical practice opportunities, to ensure that all nurses are competent in providing evidence-based cessation interventions” (2008). Nursing leaders and frontline nurses should be provided with educational opportunities and continuing professional education regarding tobacco control and delivery of evidence-based cessation interventions. Another challenge the nurse leader may experience while developing and implementing a smoking ban is limited nursing research. Nursing research in the area of tobacco control and tobacco dependence treatment can contribute significantly to developing interventions for all persons who smoke, but more efforts and support are needed to enhance the science in this area (ONS, 2008). Nurses have the opportunity to develop research on tobacco use prevalence and cessation needs of nurses as well as on the effectiveness of nurse interventions in different settings The final challenge is the continued tobacco consumption among health professionals (World Health Organization, 2005). Health professionals who consume tobacco themselves are often less likely to engage in tobacco control programs than their non-tobacco-using counterparts. Nursing leaders should advocate for access to smoking cessation, reimbursement for tobacco cessation treatment, and advocate for a tobacco-free workplace. Nurses and those entering the profession should become non-smoking role models for their own health and the health of their patients. If nurses want to advocate for better healthcare, it is essential that they learn how to influence the policy-making process and participate in the implementation of smoke-free healthcare facilities and influence tobacco control policies. Nurses also have the opportunity to join other professional organizations to promote tobacco control advocacy and policy. References Centers for Disease Control and Prevention. (2017). Smoking and tobacco use. Retrieved from Ohio Department of Health. (2008). Smoke-free workplace program. Retrieved from Oncology Nursing Society. (2008). ONS: Nursing leadership in global and domestic tobacco control. Oncology Nursing Forum, 35(5), 745-747. Retrieved from Sarna, L., Danao, L., Chan, S., Shin, S., Baldago, L., Endo, E., Minegishi, H., & Wewers, M., (2006). Tobacco control curricula content in baccalaureate nursing programs in four Asian nations. Nursing Outlook, 54(6), 334–344. doi: 10.1016/ok.2006.09.005. World Health Organization, (2005). The role of health professionals in tobacco control. Retrieved from Response to Peer: Mayrelis, I was intrigued by your post regarding the role of transformational leadership in healthcare policy. Leadership at the meso-level utilizes transformational methods to aid in implementing organizational changes. Strong leadership is critical if the vision of a transformed health care system is to be realized. To be influential, nurses must see themselves as professionals with the capacity and responsibility to influence current and future healthcare delivery systems. According to Payne and Briscoe (2010), “there is a need for leaders to develop other leaders; thus, the purpose of fostering enhancement of others is to provide a firm foundation for emerging and growing leaders for the future”. Additionally, fostering the development of other involves inspiring others regarding the shared vision, allowing others to perform, and leading as an example which eventually results in significant work done as well as building and sustaining of confidence with followers. To use our power and influence effectively, nurse leaders involved in healthcare policy need to develop an awareness of the legislative process and hone their working knowledge of the political arena. Any nurse can influence policy and politics at the local, state, and federal levels. Nurse leaders in healthcare policy arena understood the consequences of the social, political and economic factors on the health and well-being of the public. Nurses leaders can continue to make an important contribution to planning and decision-making, and to the development of appropriate and effective public, health and nursing policy on all levels. Reference Payne, D., & Briscoe, D. (2010). Engage others. Book two of five LEADS booklets. Victoria: Canadian College of Health Leaders, Canadian Health Leadership Network and Leaders for Life. Response to Professor and Student: Opioid Epidemic: decreasing the amounts of opioids given to the patients for pain control. Dr. Fildes and Penny, Opioid addiction is a public health emergency. There has been a mismanagement of chronic pain for patients by healthcare professionals for many years. A large part is a result of prescribing powerful drugs as a quick solution to mask pain rather than treat its underlying causes, thus fueling the opioid crisis. Within the past year, I have witnessed a drastic shift in patient care in the emergency room when physicians are ordering and prescribing narcotic medication for acute and chronic pain. In the past physicians would order Dilaudid, Morphine, Percocet, or Vicodin without hesitation. Now, I see fewer opioids being ordered, even for acute pain, and more Tylenol with Ibuprofen, Fentanyl or smaller doses of Dilaudid or Morphine. I do agree with Dr. Fildes that patients suffering from chronic pain are in need of compassionate, whole-person, and effective approaches to controlling their pain. People with chronic pain need treatment approaches that take into account individual differences in susceptibility for pain and response to treatment, as well as improved access to treatments that take into account their preferences and are in accord with the best evidence on safety and effectiveness. The CDC acknowledges “clinicians should consider the full range of therapeutic options for the treatment of chronic pain.” (2016). The Food and Drug Administration recommends the use of nonpharmacologic therapies in managing pain, particularly musculoskeletal pain and chronic pain (2017). An integrative approach to treat pain includes the appropriate combination of drugs with complementary and non-pharmacologic methods such as acupuncture, mind-body methods, yoga, massage, and manipulation that can ease patients’ suffering without making them addicted to opioids. Summary Week 3 In this week’s lesson, I’ve learned that a number of major health policy directives have been important in shaping healthcare decisions and professional programs. Many major national health policy directives are shaped by research and research is sometimes influenced by the evidence needed for health policy decisions. Nurse scientist and nurse researchers are poised to build the scientific foundation for improving clinical practice and influencing policy. Nurse leaders in healthcare policy need to engage as full partners with other professions in research, analysis, development, and advocacy of health policy at all levels. Healthcare policy nurses must envision themselves as leaders in the policy-making process and seek out new stakeholders who share their goals. Reference Dowell, D., Haegerich, T.M., & Chou, R. (2016). CDC Guideline for prescribing opioids for chronic pain — United States, 2016. Retrieved from Food and Drug Administration. (2017). FDA education blueprint for health care providers involved in the management or support of patients with pain. Retrieved from