D025 Final Exam: Advocacy for Policy Change in Community Health

D025 Final Exam: Advocacy for Policy Change in Community Health

Student Name

Western Governors University

D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

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Date

Advocating for Policy Change to Improve Community Health Outcomes

Advocacy involves leveraging education, professional experience, and one’s position to champion the rights and needs of others. It is a fundamental skill instilled early in nursing education and remains a core responsibility throughout a nurse’s career. While nurses effectively advocate for individual patients in acute care settings by ensuring optimal treatment and care, broader advocacy in community health—particularly preventive care—is often overlooked. Advanced professional nurses (APNs) play a critical role in advocating for systemic policy changes that can improve health outcomes on a community level.

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Advanced Professional Nurse as Advocate

There are two primary distinctions in how an advanced professional nurse advocates for an at-risk community population versus an individual patient in clinical practice:

Aspect	Community Advocacy	Clinical Practice Advocacy
Level of Care Focus	Preventive care through policy change	Secondary and tertiary care for acute illness
Collaborative Partners	Local leaders and policymakers	Interprofessional healthcare team (doctors, nurses, pharmacists, therapists)
Scope of Impact	Indirect impact on community health outcomes	Direct impact on individual patient outcomes

When advocating at the community level, the APN concentrates on prevention by influencing policies that affect the whole population. Conversely, clinical advocacy focuses on treating individual health issues and ensuring comprehensive care. Collaboration at the community level requires working with legislators and local stakeholders to pass relevant policies, while clinical advocacy involves coordination among healthcare professionals to optimize patient care (Nickitas et al., 2018; Bondurant & Armstrong, 2016).

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Interprofessional Collaboration

Effective community advocacy by APNs requires teamwork within an Advocacy Action Team (AAT). An AAT consists of professionals united to champion the rights and services of marginalized groups. Interprofessional collaboration is vital to the success of such teams, with two evidence-based strategies supporting this collaboration:

1. Establishing Guidelines and a Shared Purpose: Clear definitions of roles, responsibilities, and common goals ensure each member understands their part and works towards a unified objective (Sims, Hewitt, & Harris, 2015).

2. Critical Reflection on Progress: Regular, unbiased evaluations of the team’s progress identify what is effective and what obstacles exist. This ongoing reflection allows the team to adapt plans, innovate solutions, and optimize resource use (Sims et al., 2015).

These strategies promote cohesion and keep the team aligned, even when facing resistance or challenges.

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Data-Driven Health Issue: Smoking in Winnebago County

According to County Health Rankings and Roadmaps (2021), Winnebago County is among Illinois’ least healthy counties, with adult smoking rates at 21%, significantly higher than Illinois’ and the national average of 16%. Smoking in adulthood is the identified health issue requiring intervention in this community.

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Characteristics of the At-Risk Population

The population most at risk comprises uneducated adults, largely due to factors rooted in childhood, such as:

Characteristic	Winnebago County Data	U.S. National Data
High School Diploma Rate	88% of adults	94% of adults
Some College Completion Rate	59% of adults	73% of adults
Childhood Poverty Rate	27% of children	10% of children

Lower educational attainment and childhood poverty substantially increase the likelihood of adult smoking (Gagne, Frohlich, & Quesnel-Vallee, 2020).

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Social Determinant of Health (SDOH)

A critical social determinant related to smoking prevalence in Winnebago County is limited access to education for children, particularly those living in poverty. Healthy People 2030 (n.d.) highlights that children in impoverished households have higher dropout rates, which increases their risk of becoming adult smokers. Therefore, improving educational access during childhood is key to breaking this cycle.

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Current Policy and Its Limitations

Winnebago County’s existing Tobacco Free and Smoke Free Environment Policy (2014) restricts tobacco use near buildings and indoors, reflecting compliance with Illinois state laws. While this policy protects current non-smokers and reduces exposure to secondhand smoke, it lacks preventative measures targeting the root causes of adult smoking, such as limited educational access linked to poverty.

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Policy Proposal: Extended Early Childhood Program

To tackle limited educational access, the proposed policy aims to implement an Extended Early Childhood Program that addresses the socioeconomic needs of children living in poverty. Research shows that children from low socioeconomic backgrounds often require additional educational support to succeed and are less likely to graduate from high school (Healthy People 2020, n.d.). This program would provide early interventions designed to increase graduation rates and ultimately reduce future smoking rates.

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Impact of the Policy on Health Outcomes

Implementing an Extended Early Childhood Program is expected to:

• Directly improve education access for children.

• Lower high school dropout rates.

• Reduce adult smoking prevalence in the long term.

Early childhood education programs have demonstrated positive effects on physical and mental health in adulthood, as supported by the Carolina Abecedarian Project, which found participants were less likely to smoke as adults (Healthy People 2020, n.d.).

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Ensuring Equitable Distribution of Resources

The policy will include a diversity clause guaranteeing non-discrimination based on race, color, religion, sexual orientation, gender identity, or disability. A diversity board will monitor program admissions to ensure fair access based on need, not favoritism. If spaces are unfilled by certain groups, the board will allocate those spots to applicants demonstrating the greatest need.

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Ethical Considerations

This policy aligns with the American Nurses Association (ANA) Code of Ethics:

Provision	Description
Provision 7.3	Nurses must engage in community advocacy and policy development (ANA, 2015).
Provision 8.2	Nurses have a duty to address social determinants by collaborating with leaders and legislators.

By promoting policy reform targeting education access, APNs fulfill their ethical obligation to advocate for community health (ANA, 2015).

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Potential Barriers

Key challenges to policy implementation include:

• Financial Constraints: Winnebago County’s limited budget necessitates securing grants or external funding.

• Stakeholder Resistance: Differing priorities among decision-makers may slow progress.

Overcoming these barriers requires strategic collaboration and communication with key stakeholders.

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Policy Maker Identification

Jude Makulec, President of the Winnebago County School Board, is identified as a crucial policy influencer. Due to their role in overseeing education, Makulec has the authority and connections necessary to advance the Extended Early Childhood Program.

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Strategic Next Steps for Advocacy

To strengthen their advocacy efforts, an APN should:

• Join professional nursing advocacy organizations (e.g., National League for Nursing, American Association of Colleges of Nursing) to stay informed about national policy trends.

• Engage actively with local community leaders, keeping abreast of social determinants and health issues.

• Continuously develop interprofessional collaboration skills such as effective communication, active listening, and reflective practice to enhance advocacy effectiveness.

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Conclusion

Advanced professional nurses have a vital role in advocating beyond individual patient care by engaging with communities and policymakers to promote health equity. Through collaborative efforts and targeted policy reforms like the Extended Early Childhood Program, APNs can influence social determinants and improve health outcomes on a broad scale. Advocacy, as outlined in the ANA Code of Ethics, is fundamental to nursing practice and essential for fostering healthier communities.

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References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/coe-view-only

Bondurant, P.G., & Armstrong, L. (2016). Nurses: Leading change and transforming care – expert opinion. Newborn & Infant Nursing Reviews, 16(3), 155-160. https://doi.org/10.1053/j.nainr.2016.07.004

County Health Rankings & Roadmaps. (2021). Winnebago (WB). https://www.countyhealthrankings.org/app/illinois/2021/rankings/winnebago/county/outcomes/overall/snapshot

Gagne, T., Frohlich, K.L., & Quesnel-Vallee, A. (2020). The role of education and other transition milestones in the progression of social inequalities in cigarette smoking between the ages of 18 and 25: Evidence from the Canadian national population health survey. Addictive Behaviors, 109. https://doi.org/10.1016/j.addbeh.2020.106476

Healthy People 2020. (n.d.). Early childhood development and education. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/early-childhood-development-and-education

Healthy People 2030. Education access and quality. https://health.gov/healthypeople/objectives-and-data/browse-objectives/education-access-and-quality

Nickitas, D. M., Middaugh, D. J., & Feeg, V. (2018). Policy and politics for nurses and other health professionals: Advocacy and action (3rd ed.). Jones & Bartlett Learning. https://ebookcentral.proquest.com/lib/westerngovernors-ebooks/reader.action?docID=5504726&ppg=25

Sims, S., Hewitt, G., & Harris, R. (2015). Evidence of a shared purpose, critical reflection, innovation and leadership in interprofessional healthcare teams: A realist synthesis. Journal of Interprofessional Care, 29(3), 209–215. https://doi.org/10.3109/13561820.2014.941459

Winnebago County. (2014). Tobacco free and smoke free environment policy. https://wincoil.us/media/90326/winnebago_county_tobacco_use_policy_revised_3_2014.pdf