Dear UofT blog,
I still can’t believe that over a month has passed since attending the 2019 Canadian Nursing Students’ Association (CNSA) National Conference! From meeting students across the country to hearing about both their experiences and initiatives, it was a memorable event to say in the least and is a time that I will cherish as conducive for much self-reflection and growth. In a snapshot, this blog post aims to explore some of the breakout session topics, with focus placed on the “Policy and Politics, A Nurse’s Role”. Of note, the later-mentioned policy creation cycle is based upon the Public Policy Models and Their Usefulness in Public Health: The Stages Model (National Collaborating Centre for Healthy Public Policy, 2013).
As front-line clinicians, nurses are highly qualified individuals that are familiar with the needs, struggles and gaps in care that their patient/client populations face. They are also familiar with the systemic forces currently in place that may impede or impair abilities to seek equitable care. As such, they are primely positioned to strongly advocate for policy changes in provincial and territorial governments. Generalized into the following cycle, change can be brought about by:
Agenda Formation -> Policy Formation -> Implementation -> Policy Evaluation -> Reflection.
Preparing and Implementing Change
1. Agenda Formation: For what, and why do we require change?
- Major actions: Identification of issue(s). Research and data collection on the gravity of the issues(s), and how they specifically affect the pertinent population(s).
2. Policy Formation: What current policies in place allow for incorporation of applicable intervention(s)? What are the advantages/disadvantages that will come from alteration?
- Major actions: Identification of current policies in place that may lend themselves to applicable change. Identification of those individuals that can advocate for change (e.g. experts and/or researchers in relevant fields, MPPs, etc.). Assessment of effects on pertinent population(s) by the current policy, as well as proposed policy. Estimation of potential costs that come with a new policy change.
3. Implementation: What is happening now that the new policy has been implemented?
- Major actions: Agreements made between stakeholders associated with policy-creation on how to best adopt and deliver the new policy. Research is taken to identify and assess factors that affect its implementation, including but not limited to: resource allocation and budgets, administrative frameworks and/or teams for its oversight, and expectations.
4. Policy Evaluation: Is the new policy effective?
- Major actions: Development and use of continuous data collection and monitoring systems to assess as to how the implemented policy is affecting the pertinent population(s), as well as any and all unintentional/unforeseen effects. Evaluations may include questions on how efficient the current framework/oversight is, if the policy is producing the intended effects, and whether any unintended effects may be attended to.
5. Reflection: Does the new policy need to be revisited to be improved? What was learned and can be done differently for next time?
- Major actions: Identification of barriers encountered to the change that had been implemented, important considerations brought to light during the policy’s implementation and evaluation, whether the policy is working as intended to, as well as questions of sustainability.
On a Smaller Scale
This framework was originally presented in a way that highlighted political empowerment and action in provincial and territorial government discussions. That being said, I noted that this reflection cycle can transcend Parliament to places closer to home, inclusive of workplaces and clinical placement sites. Applicable to this is the world of quality improvement; which, despite misconceptions of being a heavy task, can be worked through simply with a pen and paper. Unless otherwise stated, information provided is based upon the Quality Improvement Guide by Health Quality Ontario (Health Quality Ontario, 2012).
In healthcare, quality improvement can be described as a systematic framework used to improve the delivery of care to accessing services. The Similar to the cycle of policy formation, quality improvement can be described through the following:
Aim + Measure + Change -> Plan -> Do -> Check -> Act
1. Aim + Measure + Change
- Major actions (Aim): Identification of issue(s) and an intervention desired to be implemented to improve it.
- Major actions (Measure): Identification/development of a monitoring system to understand whether improvement has been brought as a function of the implemented intervention.
- Major actions (Change): Reflection and identification of other changes that may be included to result in further improvement.
- Major actions: Creation of an agenda inclusive of goals, predicted results, and features of involvement (who, what, where, and how) for the implementation. Decision on data to be collected.
- Major actions: Implementation of the intervention and of monitoring of its adoption (e.g. observations including effects, problems encountered, unintended effects, etc.)
- Major actions: Utilization of the monitoring system to determine effectiveness of intervention. Comparison to predicted results and expectations. Discussion on team learning and experiences.
- Major actions: Reflection on the implemented change and whether there are areas for improvement that can be included in its next evolution. If there are no issues, the intervention can be maintained as a permanent intervention (until otherwise noted).
Quality improvement is a process you might already be engaging in – in its simplest essence, it is act of studying a process and advocating for its change to bring about efficacies that will benefit staff and those accessing services. An example of this could be implementing a new communication strategy to better relay information to the interprofessional team, after noting areas of improvement with the previous or lack thereof. It is also the use of RNAO’s best-practice guidelines. At the CNSA National Conference, this process was highly utilized by many students in their search for improved accessibility, equity, and population-based interventions. For example, a group of nursing students from British Columbia contributing to harm-reduction by way of the creation of peer-led naloxone teaching within their community, where opioid overdoses were higher than their surrounding city and provincial counterparts!
I am thankful to have attended this conference and hope that my blog post has offered some insight into how you, as nursing students and future nurses can bring about measurable change at both the provincial/territorial level as well as in your workplaces and clinical placement sites. Below, I will list some resources that you may look into should you be interested! Thank you to the University of Toronto for funding this highly memorable and thought-provoking experience.
1st year student
Benoit, F. (2013). Public Policy Models and Their Usefulness in Public Health: The Stages Model. Montréal, Québec: National Collaborating Centre for Healthy Public Policy.
Health Quality Ontario. (2012). Quality Improvement Guide. Toronto: Queen's Printer for Ontario.