Nursing leadership in addressing health disparities through caring relationships

Healthcare Policy Formation

HEALTHCARE POLICY and FINANCE

The objective of this work is to review articles related to nursing and to outline the policy formation based on one of the approaches reviewed in the articles. This work will secondly discuss why the chosen process was the one chosen by this writer and will additionally provide a brief sample of how the writer of this work has participated in any phase of public policy formulation. The article chosen in this work as the model of policy formation is that which is related in the work of Gloria Smith (2007). This policy is formed upon the very core of nursing which is caring and specifically as related to 'relationships' or the treatment of others in the role of nursing and at its highest 'calling' to care.

II. FOUR DETERMINANTS of HEALTH DISPARITIES

Four determinants of health disparities are stated by Smith to include: (1) Discrimination; (2) Workplace and social status; (3) Income inequality; and (4) Systemic depletion of resources. (Smith, 2007; p. 288)

III. OUTCOMES of HEALTH DISPARITIES

Smith (2007) states that the outcomes of health disparities include: (1) avoidable suffering; (2) lost productivity; (3) discarded human resources. All of which effectively "...deny equal opportunity for health." (Smith, 2007, p. 288)

IV. CAPACITY of NURSING in REDUCTION of HEALTH DISPARITIES

Smith questions whether the capacity of nursing in leading the way to reduction in health disparities is "waning" or whether the simple fact is that nursing is not well-equipped or well-prepared for leadership in this area. Smith states that nursing inherently has a "moral obligation to address health disparities" and that this is true because "nursing and health disparities are inextricably linked by their very nature." (2007, p. 283) Nursing is a profession that focuses on caring "in its fullest and most elaborated and profound meaning - is absolutely central to theory and practice." (Smith, 2007, p. 283) Stated otherwise, when the caring stops, nursing is no longer nursing and "health disparities are, fundamentally, the result of lack of caring within society." (Smith, 2007, p. 284) Smith states that the question that should actually be addressed is not that of what "nursing can do about health disparities" but instead the question that needs to be answered is that of "what can nursing do about nursing." (2007, p. 284) Smith asks if "the desire to eliminate health disparities by rooting out the social disease underlying them inspire nursing to find itself again?" (2007, p. 284) Smith also asks if health disparities, being despicable and laden with shame can somehow, through the response of nursing, actually "serve a higher purpose" through "reawakening the caring" aspect of nursing? (2007, p. 284) Indeed, it is held by Smith that nursing "the premier profession for caring" may have very well "become contaminated...infected by a selfishness that is gaining ground, credence and sanction" within the society of today. (Smith, 2007) Smith holds that selfishness is a disease that "...in a mild form" results in a "loss of social capital and community engagement in the United States." (2007, p. 284) Smith notes that the work of Krugman (2002) states very candidly that "we live in the new Gilded Age where 13,000 richest families have almost as much income as the 20 million poorest households." (Smith, 2007, p. 285) Krugman additionally relates that data are "deliberately reported in dubious ways to conceal the reality. Shapiro (1987) is noted by Smith has having stated: "We now confront a moment in history when our unifying moral and political commitments are deteriorating and when our obsession with expanding individual freedoms outruns our concerns for their appropriate use." (2007, p. 285) Smith writes that irony exists in the knowledge that "health disparities appear to have crept up higher on the national agenda whereas the principle of 'mutuality' has been slipping down in the national conscience." (2007, p. 285) Smith relates that Duman (2002) provided a definition for the concept of 'mutuality' as: (1) committing ourselves to others - without the coercion of legal obligation; (2) maintaining human bonds - rather than eroding them; (3) serving the shared interests of the community - rather than only our own interests, and (4) placing our individuality voluntarily in the service of larger objectives." (Smith, 2007, p. 285) Smith states that it is quite true that what she has to relate "is likely not palatable or popular" however, there can be no progress made by nursing through maintaining a state of denial. Smith states the knowledge that she intends to convey concerning nursing are concerned with: (1) caring in nursing; (2) the underlying nature of health disparities; and (3) what nurses can do to bring caring to the forefront in both restoring the promise of the profession and fighting health disparities. (Smith, 2007, p. 285)

V. NURSING'S LOSS of CAPACITY for CARING

Smith (2007) states that when reflecting back over the 40 years spent in the nursing profession that what she views both "distresses and angers" her in that the nursing profession has become "so preoccupied with its own internal issues, its desire for improved status and nursing is the health profession best suited for leadership in reducing disparities." (p. 286)as nursing has made progress along status lines simultaneously, nursing has become "alienated from the needs of other oppressed groups." (Smith, 2007, p. 286) in fact, achievement in nursing of a higher status and a higher level of affluence has resulted in nursing becoming more akin to the oppressors trapped in a web of "our own desires." (Smith, 2007, p. 286)