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Enfermería Global

On-line version ISSN 1695-6141

Enferm. glob. vol.21 n.65 Murcia Jan. 2022  Epub Mar 28, 2022

https://dx.doi.org/10.6018/eglobal.455361 

Reviews

Nursing participation in Public Policies, why is it important? Integrative review of the literature

Mª Angélica Saldías Fernández1  , Denisse Parra-Giordano1  , Trinidad Martí Gutiérrez2 

1 Departamento de Enfermería Universidad de Chile. Santiago. Chile. drparra@uchile.cl

2 Centro de Investigaciones Biológicas Aplicadas. Chile

ABSTRACT:

Objective:

To analyze the scientific evidence available in the literature regarding the role of the political participation of the nursing profession.

Method:

Integrative literary review in six stages, in MEDLINE / PUBMED, ISI WEB OF SCIENCE, EBSCOHOST WEB, LILACS, and SCIELO databases 2010 - 2020 in English, Portuguese and Spanish languages, adjusted to PRISMA requirements. The data were summarized by thematic analysis.

Results:

From 75 texts, 23 were analyzed. 35% of the publications were made between 2010 to 2012, 48% are from the United States, 65% were obtained from PUBMED, and 26% are case studies. Two categories of work are obtained: Political participation of the nursing profession and Virtue and competences; Strategies and challenges to participate in PPs. Similarities are shown between both categories.

Conclusion:

Nursing has socio-political activism promoted by nurses in different contexts. To the extent that nursing professionals become aware of political involvement as an expression of socio-political knowledge, their participation favors the public policy process. It is an opportunity for change given their strategic position as referents of care of people in health systems.

Keywords: Nursing; Health Policy; Policy Making

INTRODUCTION

Public policies (PP) are the concrete and tangible expression of political actions. Nursing considers them as the choices of society through their rulers; their objective is to represent public affairs and the forms of granting the resources to achieve it. For this, ordinary people, professionals, or groups' political participation allows continuous improvement to the PP formulation process1.

The Adelaide declaration of 2010 (World Health Organization - WHO) opens the discussion. It proposes health in all policies, which highlights the work of the health sector and its importance in the development of PP. Also, as a strategy to achieve social, economic, and environmental development that favors the health and well-being of people. In this, professionals in the health sector, particularly nursing, have a fundamental role, given the skills acquired in their professional training, which undoubtedly contribute to formulating PP2,3.

In this context, the WHO since 2002 periodically published the "Strategic directions for strengthening nursing and midwifery"2, where, according to the historical context, it makes explicit the need for the participation of Nursing professionals in the definition of health PP, to make them more efficient and effective in achieving global health goals. The Situation of Nursing in the world 2020 report4) mentions the need to invest in nursing education, employment, and leadership, providing a vision and a plan for policies. Paradoxically, the International Year of Nursing and Midwifery Professionals 2020 coincided with the coronavirus pandemic5.

Nursing professionals represent 56% of the total health workforce in the world and develop both specific actions for caring for people and complementary activities to other health areas5; being evident the possession of diverse competencies to support the processes of formulation of PP in Nursing1)(2)(3)(5. Thus, supported by the pattern of socio-political knowledge of Nursing, they seek to respond to problems that arise in terms of access, quality of health care, and universal health coverage2)(3)(5.

The role of Nursing associated historically with caring for the health of individuals and communities, marked transversely by the political activism pioneered by Florence Nightingale in the 19th century. The act of caring is based on constructed human values. The political dimension, proper to the profession's action, always takes place in a historically determined context. In this way, Nursing has a fundamental role as an integral part of the collective work1.

Within the front-line workers, Nursing provides care addressing current social health challenges, such as emerging diseases, aging, sick and uninsured populations, increasing costs in plans and insurance, a shortage of providers, and the disconnection with political health and health reforms6. In this way, participation in the formulation of PP offers Nursing an opportunity to influence various socio-sanitary programs, which profoundly impact the provision of health and high-quality care practices in times of great current socio-sanitary crossroads5.

Thus, it would be favorable and advantageous for more nurses to be proactive developers of PP and implement them6. Nursing would have leadership and protagonist in the complex PP process by assuming an active role, strengthening the profession, and joint health.

Although Nursing began the path to achieve participation in the process and formulation of PP, it is a priority to develop a body of knowledge that strengthens the role of political participation as an expression of the pattern of socio-political understanding of the profession. Build forms of thought long-term strategy for the profession and motivate Nursing professionals to develop the political role that corresponds to them, as a strategy to expand social participation and contribute to humanized health and a more sustainable society.

In this context, the development of this research is necessary, which aims to analyze the scientific evidence available in the literature regarding the role of political participation in the nursing profession. To synthesize the evidence that supports the contribution of Nursing to the public policy process and build new knowledge in this matter that can help future investigative procedures.

METHODOLOGY

This study corresponds to a six-step integrative review of the literature. This type of reviews makes it possible to summarize a large amount of information regarding the subject under discussion, using various studies7.

Following the methodological path: 1) identifying the problem 2) determination of search strategy and determination of inclusion and exclusion criteria 3) definition of the information to be extracted from the selected studies/categorization of studies. 4) evaluate the studies included in the integrative review 5) interpretation of study results 6) presentation of the review/knowledge synthesis7.

The integrative review was guided by the question: What should be the Political Role that the nursing professional performs in the creation, implementation, and evaluation of PP between 2010 and 2020?

Regarding the eligibility criteria:

- Inclusion criteria (CI): scientific journal; full text online; the relationship between Nursing and politics or public policies or formulation of public policies; political analysis articles - critics, literature reviews, process evaluation studies, qualitative studies, and case studies.

- Exclusion criteria (CE): incomplete articles; Articles in a language other than Spanish, English, Portuguese; no relations between nursing with politics, articles with other health professionals studied.

The search for studies following search strategy was used: NURSING and HEALTH POLICY and POLICY FORMULATION, in English, Portuguese and Spanish, between 2010 and 2020. The databases were used: MEDLINE / PUBMED; ISI WEB OF SCIENCE, EBSCOHOST WEB, LILACS, and SCIELO. Search period: March - April 2020.

For data selection, modified PRISMA (Figure 1) was used to delimit the final texts and present them 8. Step 1: articles published from 2010 to 2020. Step 2: the title and abstract of the articles were read in detail, items of interest were selected according to CI and CE. Step 3: the texts were read in full, grouping the texts into two thematic areas 1) political participation of the nursing professional in PP, characteristics, and virtues; 2) strategies and Challenges regarding participation in PP. Finally, a Thematic analysis of Minayo9 was carried out, categorizing the findings with a qualitative synthesis and a narrative of the results.

Figure 1:  PRISMA flow Chart summarizing the study selection process 

RESULTS

Characterization of the studies

Of 75 documents found, 43 met the search criteria. Finally, 23 completed criteria (Figure 1) are presented in Tables 1, 2, and 3.

The descriptive analysis highlights 35% of the publications were made in the period from 2010 to 2012; 48% were carried out in the United States; 65% were obtained from PUBMED, and 26% are case studies. (Table 2) both categories highlight the interest of the research community in presenting the background of the value of Nursing in the different PP processes and the strategies necessary to apprehend this new knowledge to face the unique challenges that underlie current socio-sanitary dynamics. (Table 3)

Table 1:  Analysis matrix of selected articles. 

Source: self-made.

Table 2:  Qualitative - descriptive synthesis of the texts. 

Source: self-made.

Table 3:  Thematic axes emerged from the analysis 

Source: self-made.

DISCUSSION

When analyzing the scientific production on political participation and Nursing, the interest of the research community in presenting the background of the value of Nursing in the different PP processes stands out. Similarly, the strategies necessary to apprehend knowledge that allow us to face the new challenges that underlie current socio-sanitary dynamics are also highlighted. In this way, the conquest of spaces for political participation and the consolidation of the socio-political knowledge pattern from a continuous learning process and professional practice will favor the change and substantive improvements of the current socio-sanitary dynamics3.

Professional virtues and competencies to enhance the political participation of the nursing professional

Due to its historical and social importance, nursing's generalized insertion in the spaces for the production of individual and collective attention and the pattern of socio-political knowledge is it's own. It constitutes a social practice that can advance to compose forces capable of mobilizing broader social change3.

This profession characterizes by a high social benefit and its high contribution to healthcare quality and cost, outlining itself as safe, effective, patient-centered, timely, efficient, and equiTable16,19. Nurses who possess a high educational standard can "read the world" 23 and have specialized experience in essential topics of broad interest. Nurses are trusted by the public and recognized as major players in healthcare1.

As a care-based disciplinary profession, nurses are in a unique position to advocate for patients and their families19, identify public health problems20, and find solutions from the work they do19.

They can intensely develop political savvy as a vital aspect of the Nursing profession related to political participation. It includes understanding the legislative and public policy process, knowledge, and political skills necessary to advocate for people and communities, knowing who the policymakers are and how to communicate with them. Therefore, awareness of this role is the first step to improve the capacity of nurses to support government policies and have active participation in the political process21.

Involve Nursing in developing global health policies is vital to ensure the scaling up of effective health programs and sound global health12. For this reason, participating in political matters given their understanding of the implications of normative, legislative, and organizational changes in the health environment19 and territories24. It would require three strategies to influence the political process further: developing an in-depth knowledge of political subsystems, the construction of networks based on a democratic spirit, and participation in the policy area for extended periods 15.

Nurses can participate throughout the policy formulation cycle, promoting policies based on scientific evidence obtained from big data17 and empirical evidence obtained from clinical experience26. It has given the understanding of more significant human aspects and impacts of proposed and existing policies at all health levels1.

In this sense, it is necessary to work expansively on an approach beyond professional aspirations and advocate more for their work's political relevance than individual benefits19. The authors highlight the dialogue exercise16,19 and the visibility of their work27 through the use of social networks and communications1. Could improve the ability of nurses to advocate in the political-legislative sphere for its populations of interest and, in turn, achieve the objective of improving the health outcomes of the communities26.

Strategies and challenges to participate in politics and the development of PP

The authors position Nursing as one of the key professions in fulfilling the Global Health goals, thus playing a significant role in achieving universal access to health and the sustainable development of communities26,27.

To effectively exert influence on PP, the authors reinforce the idea that nursing contributes to society's benefit by considering the context as an opportunity for visibility and expression, change and transformation3.

Based on the socio-political pattern, Nursing will find a way to advance and guarantee the profession3. However, it requires a regulatory framework that supports professional and union functions15. Also, continuing education for exposing concepts of policy formulation12)(15)(18)(21)(26)(27)(29; raising awareness of political issues and developing political savvy, a sense of self-efficacy regarding participation in the political process12)(15)(29; development of leadership and decision-making skills11)(14)(27; communication, collaboration, and consensus(59that challenges the ideological assumptions that drive superior policies, advocate for comprehensive reforms and reduce the vast and growing inequalities in education, income, and health between citizens and communities23.

In times of significant changes in the management of PP, in which Nursing faces different political points of view, it is necessary to use empirical knowledge as a fundamental guide in combination with ethical and moral judgment to support the planning and implementation of public policies23. In this sense, according to the authors, it is necessary to coordinate actions or coalitions between nursing congregations, groups, and interprofessional work12 to establish an interdisciplinary regime with institutions, unions, and/or politicians who share the same concerns and have close objectives for the development of uniform and unified solutions in the face of windows of opportunity17,18. At the same time, work to construct scientific evidence that allows strengthening the professional work3. Other authors also emphasize the use of technologies and the mass media to give testimony, actively communicate the perspective of Nursing and participate in social dialogue in the face of public events1.

Likewise, professional training in public policies is essential to contribute to collective work1. Other studies expose the training of lobbyist nurses22, communicators1, knowledge intermediaries that connect science and society through the construction of networks, facilitating opportunities between producers and users of knowledge27. And also as storytellers to support the public policy formulation process, taking into consideration various practical and innovative approaches to bridge the gap between research and policy formulation25.

However, its impact on society challenges leadership development barriers and participation in political processes27. Lack of support (bureaucratic walls), resources, and time for nurses to develop the role in their workplaces stand out. Some passivity, lack of coalitions, and ignorance in political matters are also revealed29.

Therefore, to the extent that Nursing professionals become aware of the knowledge of the context and the opportunities offered by politics as a mediator of changes, this pattern of experience will become an enhancer of nursing practice and research3.

FINAL THOUGHTS

In "the year of Nursing," it is a priority to highlight the role carried out by these professionals towards the achievement of health, well-being, and the achievement of sustainable development objectives. The development of this review allowed us to analyze the evidence available in the literature on the nursing profession's political participation. To synthesize the evidence that supports the contribution of Nursing to the public policy process to build new knowledge in this matter and, at the same time, promote future research processes.

In this context, it is understood that Nursing, as defenders of quality, safety, and access to care, have a direct link with the defense of people, their families, and communities with a unique professional, ethical sense. However, for them to take their place at the decision-making Table and become deeply involved in the formulation of government policies and health reforms, they must develop the necessary knowledge, skills, and attitudes regarding public policy. In this sense, the significant historical burden that Nursing, its comprehensive representation in the health workforce. The high social esteem it has, and its extensive knowledge of current socio-sanitary dynamics give it great capacities to support and provide greater solidity. Consistency in public health policies and respond more efficiently to future health needs of the population.

Nursing constitutes a social practice that can advance to compose forces capable of mobilizing broader social changes. Undoubtedly, as Nursing sets its professional course by taking advantage of these windows of opportunity, it will have a constructive influence on human health and health equity worldwide.

REFERENCIAS

1. Myers CR. Promoting Population Health: Nurse Advocacy, Policy Making, and Use of Media. Nurs Clin. 2020;55(1):11-20. [ Links ]

2. Organization WH. Global strategic directions for strengthening nursing and midwifery 2016-2020. 2016 [citado 25 de septiembre de 2020]; Disponible en: https://www.who.int/hrh/nursing_midwifery/global-strategic-midwifery2016-2020.pdfLinks ]

3. Osorio Castaño JH. Patrón de conocimiento socio-político en enfermería: reflexiones conceptuales. Rev Cuid. 2016;7(2):1352-7. [ Links ]

4. World Health Organization. State of the world's nursing 2020: investing in education, jobs and leadership. 2020 [citado 25 de septiembre de 2020]; Disponible en: https://apps.who.int/iris/bitstream/handle/10665/331677/9789240003279-eng.pdfLinks ]

5. Cassiani SHDB, Jimenez EFM, Ferreira AU, Peduzzi M, Hernández CL. La situación de la enfermería en el mundo y la Región de las Américas en tiempos de la pandemia de COVID-19. Rev Panam Salud Pública [Internet]. 2020 [citado 17 de mayo de 2020];44. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213064/Links ]

6. Hassmiller SB. The future of nursing: Lessons in crafting successful policies. 2013 [citado 25 de septiembre de 2020];14(2):55-6. Disponible en: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1034.6705&rep=rep1&type=pdfLinks ]

7. Souza MT de, Silva MD da, Carvalho R de. Revisão integrativa: o que é e como fazer. Einstein São Paulo [Internet]. 2010 [citado 25 de septiembre de 2020];8(1):102-6. Disponible en: https://www.scielo.br/pdf/eins/v8n1/pt_1679-4508-eins-8-1-0102Links ]

8. Hutton B, Catala-Lopez F, Moher D. The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin Barc [Internet]. 2016 [citado 25 de septiembre de 2020];147(6):262-6. Disponible en: file:///C:/Users/denis/AppData/Local/Temp/the-prisma-statement-extension-for-systematic-reviews-incorporating-network-meta-analysis-prisma-nma.pdf [ Links ]

9. De Souza Minayo MC. O desafio do conhecimento. Pesquisa qualitativa em saúde. 13° edição. Hucitec: São Paulo; 2014. [ Links ]

10. Turale S, Kunaviktikul W. The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. Int Nurs Rev [Internet]. 2019 [citado 4 de octubre de 2020];66(3):302-4. Disponible en: https://onlinelibrary.wiley.com/doi/pdf/10.1111/inr.12550Links ]

11. Sullivan-Marx EM. Using ethical frameworks in times of transition and uncertainty. J Gerontol Nurs [Internet]. 2017 [citado 27 de septiembre de 2020];43(3):8-12. Disponible en: https://www.researchgate.net/profile/Eileen_Sullivan-Marx/publication/314143849_Using_Ethical_Frameworks_in_Times_of_Transition_and_Uncertainty/links/59dcfc974585158eaa08a432/Using-Ethical-Frameworks-in-Times-of-Transition-and-Uncertainty.pdfLinks ]

12. Gimbel S, Kohler P, Mitchell P, Emami A. Creating academic structures to promote nursing's role in global health policy. Int Nurs Rev [Internet]. 2017 [citado 27 de septiembre de 2020];64(1):117-25. Disponible en: https://onlinelibrary.wiley.com/doi/pdf/10.1111/inr.12338Links ]

13. Thompson MR, Schwartz Barcott D. The role of the nurse scientist as a knowledge broker. J Nurs Scholarsh [Internet]. 2019 [citado 27 de septiembre de 2020];51(1):26-39. Disponible en: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/jnu.12439Links ]

14. Kuhlmann E, Larsen C. Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany. Health Policy. 2015;119(12):1636-44. [ Links ]

15. Duncan S, Thorne S, Rodney P. Evolving trends in nurse regulation: what are the policy impacts for nursing's social mandaté Nurs Inq. 2015;22(1):27-38. [ Links ]

16. Kurtzman ET. The contribution of nursing to high-value inpatient care. Policy Polit Nurs Pract. 2010;11(1):36-61. [ Links ]

17. Blumer L, Giblin C, Lemermeyer G, Kwan JA. Wisdom within: Unlocking the potential of big data for nursing regulators. Int Nurs Rev. 2017;64(1):77-82. [ Links ]

18. Eaton MK. Professional advocacy: Linking Virginia's story to public policy-making theory, learning from the past and applying it to our future. Policy Polit Nurs Pract. 2012;13(2):105-12. [ Links ]

19. Nault DS. Nurses and public policy. Mich Nurse. 2012;85(1):13-20. [ Links ]

20. Glasser S. Postpartum depression: a chronicle of health policy development. Isr J Psychiatry Relat Sci [Internet]. 2010 [citado 27 de septiembre de 2020];47(4):254. Disponible en: https://www.researchgate.net/profile/Saralee_Glasser/publication/49788504_Postpartum_Depression_A_Chronicle_of_Health_Policy_Development/links/0c96051d11d308bf3d000000/Postpartum-Depression-A-Chronicle-of-Health-Policy-Development.pdfLinks ]

21. Primomo J, Björling EA. Changes in political astuteness following nurse legislative day. Policy Polit Nurs Pract. 2013;14(2):97-108. [ Links ]

22. Gilson Sistrom M. Oregon's Senate Bill 560: practical policy lessons for nurse advocates. Policy Polit Nurs Pract. 2010;11(1):29-35. [ Links ]

23. SmithBattle L. Moving policies upstream to mitigate the social determinants of early childbearing. Public Health Nurs. 2012;29(5):444-54. [ Links ]

24. Fu W, Bao J, Meng J. Development of community nursing in Zhejiang Province, China: a report of the driving measures. Int Nurs Rev [Internet]. 2010 [citado 27 de septiembre de 2020];57(2):265-8. Disponible en: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1466-7657.2009.00787.xLinks ]

25. Fadlallah R, El-Jardali F, Nomier M, Hemadi N, Arif K, Langlois EV, et al. Using narratives to impact health policy-making: a systematic review. Health Res Policy Syst [Internet]. 2019 [citado 27 de septiembre de 2020];17(1):26. Disponible en: https://link.springer.com/article/10.1186/s12961-019-0423-4Links ]

26. Lewinski AA, Simmons LA. Nurse knowledge and engagement in health policy making: Findings from a pilot study. J Contin Educ Nurs. 2018;49(9):407-15. [ Links ]

27. Maaitah RA, AbuAlRub RF. Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage. Rev Lat Am Enfermagem [Internet]. 2017 [citado 27 de septiembre de 2020];25. Disponible en: https://www.scielo.br/scielo.php?pid=S0104-11692017000100300&script=sci_arttextLinks ]

28. SOUZA A, HEINEN H, AMESTOY S, MENDIETA M, PIRIZ M, HECK R. The nurses' work process of Primary Health Care and the National Politics of MedicinalPlants/Phytoterapies. Rev Bras Plantas Med [Internet]. 2016 [citado 4 de octubre de 2020];18(2):480-7. Disponible en: https://www.scielo.br/scielo.php?pid=S1516-05722016000200480&script=sci_arttextLinks ]

29. dos Santos AR. Educação Permanente em Saúde: construções de enfermeiros da Estratégia Saúde da Família. Rev Baiana Saúde Pública. 2015;38(3):708-24. [ Links ]

30. David HM, Bonetti OP, da Silva MR. Brazilian nursing and the democratization of health: notes on the National Policy of Popular Education in Health. Rev Bras Enferm. 2012;65(1):179-85. [ Links ]

Received: November 10, 2020; Accepted: March 03, 2021

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