The Centers for Disease Control and Prevention defines policy as a law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions. I believe the assessment, planning and implementation of new policy in the profession of nursing must be done in collaboration with other organizations, advocates, and leaders if we are to make lasting impact. Furthermore, multidisciplinary formulation of future clinical practice guidelines and diversity initiatives are critical to the development of emerging nurse scientists.
Nursing science and policy are intricately linked. Research says that our social determinants of health are directly linked to our lived experiences, which inform the development of policy. Furthermore, nursing science deals with the interactions between people and the effects of their lived experiences on their health. Traditionally, nursing science research falls into the categories of clinical and evidenced-based; it also includes the assessment, planning, and implementation of research into clinical practice.
I am of the opinion that it will be important for future nursing science policy-makers to be open to a multidisciplinary form of decision-making. Informed and inclusive decision-making has always led to more effective policy-making. In regards to health inequities, nursing has missed the mark on the scope and depth of cultural research, which has affected the scale of nursing science.
Historically, rights and privileges have been granted to some and not to others based on race, income, education, and other differences — for example, slavery, segregation, and immigration. All of these are accompanied by exclusionary policies that have undermined the health of those excluded. It is clear that the undertones of bias and discrimination have had a lasting impression on all aspects of care, including nursing, through our current health policies. This is why cultural competence and health literacy are vital to nursing research.
Cultural competence in health and health literacy are important when creating and designing health policy. As we experience growing change in demographics, the healthcare system has a unique obligation to implement culturally competent services, and the policies needed to solidify those services. As I continue the work of helping bridge the gaps of health inequity, I am positive that a culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities.
According to research, African Americans, Latinos, and Asian Americans are more likely than Whites to report that they believe they would have received better care if they had been of a different race or ethnicity. This also extends to language: the Office for Civil Rights published “Title VI Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency.”
Diversity and inclusion in decision-making around health policy is critical for long-term change.
It has been discussed that one of the best strategies for bridging the gap of health disparities is diversity and inclusion. But unfortunately, many such programs and initiatives have, and continue to fail. It has been reported that even after adjusting for factors like insurance status, income, age, and disease conditions, minorities tend to receive lower quality of care than Whites do. I believe the lack of diversity in healthcare professionals is a major factor in this outcome.
Brought on by COVID-19, the emergence of what I call “pandemic policy” has forced healthcare organizations to take a closer look at the mass of evidence that supports long-standing health inequities. Diversity and inclusion in policy entails a fundamental shift in the discourse on minority health, from conversations to experiences aimed at diminishing or eliminating disparities.
The implementation of diversity in the role of the nurse scientist is key establishing more equitable policy in medicine and health research. In doing so, we explicitly cast a culturally competent scientific gaze on setting parameters for policy change in healthcare.
Many nurse leaders don’t recognize public policy as a critical element in shaping immediate opportunities for nurse professionals; on the other hand, they think of policy as a construct best left to politicians.
I contend that nurses, nurse scientists, nurse educators, and nurse practitioners would benefit from considering public policy through the lens of diversity, culturally competent science, and medicine. My rationalization is (a) that public policy is not an intervention, but drives development and implementation; and (b) that understanding public policy processes is necessary to build the potential to influence policy change.
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