NURS 6050 Week 10 Discussion – Walden

Global Nursing Issues

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Two Strategies for Challenges

​Volunteering in third world countries is one to help with global health issues. Organizations must understand what motivates people to volunteer and continually give back to ...

Advocating for Global Health

       ​Nurses must be involved in policy decisions. A team of healthcare professionals can …

Discussion Week 10 Nurs 6050 Policy and Advocacy Essay.

Development of a Health Advocacy Campaign

Breast cancer is the second leading cause of death for women in the United States (Morrison, 2012). Breast cancer needs to be detected earlier so that effective treatments can begin sooner. Earlier health screening would reduce mortality (Morrison, 2012). There are many women who have limited access to appropriate breast health screening due to not having health insurance, having a low income or being from an ethnically diverse background. This paper will discuss the factors that have caused success in health advocacy programs aimed at ethnically diverse women and will link those successful interventions with current laws and regulations that impact the advocacy efforts in breast cancer.Further, I will discuss ethical dilemmas faced by breast cancer advocacy programs connecting those dilemmas to the American Nurses Association (ANA) Code of Ethics in order to direct effective nursing action

Breast Cancer Screening for Ethnically Diverse Women

The incidence of screening in ethnically diverse women is much lower than in Caucasian women (Morrison, 2012). Women from ethnically diverse backgrounds have several challenges that make accessing breast cancer screening more difficult for them. These challenges include “low socio-economic status, lack of health insurance, having no regular source of care, and being a member of an ethnic minority group.” (Morrison, 2012, p. 3216) Language barriers are associated with being a member of an ethnically diverse group (Sadler, Beerman, Lee, Hung, Nguyen, Cho, & Huang, 2012). These challenges combine reducing the likelihood that women from diverse ethnic groups will have appropriate breast cancer screening. The lack of screening contributes to the increasing mortality rate for women of diverse ethnic backgrounds (Sadler et al., 2012). Several ethnic groups have mortality rates rising more quickly than for the general population (Sadler et al., 2012). Interventions are needed to increase the compliance of ethnically diverse women in relation to breast cancer screening in order to reduce this increasing mortality.

Successful Health Advocacy Programs

The literature discusses some successful breast cancer advocacy programs that have been undertaken around the country. One study completed by Morrison, (2012) focussed on women attending a local health clinic. The study participants watched a video discussing breast selfexamination. They were then given additional educational materials written in their primary language. These materials discussed various issues around breast cancer screening such as knowing their risk, having screening, knowing what is normal and abnormal in their breasts and making healthier choices (Morrison, 2012). The study results demonstrated that these interventions dramatically raised the percentage of women who had a mammogram within 12 months after their participation in this program (Morrison, 2012). A few study participants were diagnosed with breast cancer following their mammograms thus demonstrating the need for increased compliance with the screening.

A second study focussed on reaching Asian American women from four Asian ethnic groups (Chinese, Korean, Vietnamese and Filipino) (Sadler et al., 2012). The researchers sent university students to Asian grocery stores to meet women and discuss breast cancer screening or prostate screening with them. The women were randomly placed in either the breast cancer screening education or prostate screening education groups. The women were then sent educational materials in their own language at two weeks and six weeks after their grocery store meeting. The women also received two telephone calls at four weeks and eight weeks after their grocery store meeting to reinforce the importance of breast cancer screening, to provide details on where free mammograms could be accessed and to answer questions (Sadler et al., 2012).

The breast cancer screening educational materials increased the number of women who booked a mammogram within two months in comparison to their counterparts in the prostate screening education group. Those in the prostate screening education group were educated about the importance of cancer screening but didn’t apply that to their own breast health (Sadler et al., 2012).

The attributes that made both of these programs successful were several. First of all, these programs personally accessed women. They were not cold calling women requesting their participation. This face to face introduction both of these studies cultivated a feeling of investment in the participants and was believed to be a contributing factor in the increased rates of mammogram (Morrison, 2012; Sadler et al., 2012). Secondly, the women received multiple follow up contacts (Morrison, 2012; Sadler et al., 2012). This allowed for the importance of having a mammogram to be reinforced to them. The follow up contacts also served as a reminder of where free mammograms could be completed, thus reiterating to women of a lower socio-economic status that they could have the screening for free (Morrison, 2012). Lastly, the follow up contacts were done in a variety of forms and the written educational materials were in the primary language of the women participating whenever possible (Morrison, 2012; Sadler et al, 2012). This allows for greater comprehension of the material which would then bring about greater compliance with seeking out screening.

DEVELOPMENT 5
Health Advocacy Campaign

The public health issue to be addressed is ensuring that ethnically diverse women have the same access to breast health screening as Caucasian women. Attending to this issue will address the higher healthcare costs associated with treating breast cancer found at later stages and will work towards ensuring lower mortality in ethnically diverse women. The proposed policy solution is to make free breast cancer screening available across the country for all women regardless of their socio-economic circumstances. Access to breast health screening needs to be addressed nationally because despite increases in coverage initiated in the Affordable Care Act, there are still many women who have little to no access to free breast health screening (American Cancer Association, 2014). The main objective to be implemented in this policy is that every state would have several health clinics providing free mammograms to all women over the age of 40.

Information about this policy change would need to be conveyed to many stakeholders.

In the case of this new policy these some stakeholders would include: women’s groups, state and federal politicians, national cancer advocacy groups, hospitals and health centers, private insurance companies and women in the general population would all have to be informed in the changes in coverage. Informing women in the general population of this policy change would be of great importance. The targeted population needs to engage in the policy change in order for it to be successful (Smart, 2013). Getting this information out to this high number of stakeholders would be challenging and would involve a comprehensive media campaign. The use of print media, press releases, television, radio and online interviews would be some of the strategies used to inform stakeholders about the proposed change.

DEVELOPMENT 6
Legal Considerations

This proposed policy change could be enacted thorough an amendment to the Affordable Care Act. The Affordable Care Act mandated that health insurance companies provide mammography to women over the age of forty without charge if their health plan was initiated on or after August 1, 2012 (American Cancer Society, 2014). This leaves many women still without access to this free service. Many states also have laws affecting the ability of women to access free mammography. Utah remains the only state in America that still has no provision for women to access free mammograms (American Cancer Society, 2014). Other states have some limited access, but nothing that provides universal access to mammograms for women over the age of forty (American Cancer Society, 2014).

Support for this policy change would be elicited by initiation of a grassroots campaign to lobby lawmakers to make this change a reality. Grassroots campaigns can be very effective in bringing about policy changes (Lanier, 2013). The grassroots campaign would be made up of women, including nurses, that are passionate about ensuring that all women over the age of forty receive a yearly mammogram. A successful lobbying campaign relies on unity between members, effective outreach and the correct timing in order to be successful (Lanier, 2013).

Some interventions to be instituted by the campaign members would be to hand out flyers and other educational materials, meet with local politicians, participate in local media interviews, organize and participate in local town hall meetings to ensure that the message about the proposed policy change could be heard. Gaining support from the public can exert much pressure onto those they elected to office (Lanier, 2013). If sufficient finances were available a professional lobbyist may be hired to provide greater access to state and federal politicians and other high-powered decision makers. This would be an important strategy towards success as professional lobbyists are often seen to be experts on issues by politicians (Lanier, 2013).

Money plays a large role in lobbying lawmakers for change in existing laws. Nurses and grassroots campaign members would need to ensure that funding was being directed to political candidates that supported the proposed policy change. Discussing money and its influence is often uncomfortable for nurses however, if this policy change is to be successful money will have to be directed purposefully (Lanier, 2013).

Several legal obstacles to this policy change can be anticipated. To provide universal access to free mammography for women over forty in the United States laws in each state would need to be amended along with the proposed amendment to the Affordable Care Act. This would take considerable time and patience. In order to effect change on this scale grassroots lobbyists would be needed in each state. These grassroots lobbyists could develop and maintain relationships with local political candidates, keep the issue in front of the public, and remain current with the status of the legislation in that state. In addition, relationships with national contacts would be developed that could elicit results in multiple locations (Lanier, 2013).

Cultivating changes to a national law like the Affordable Care Act is out of the scope of a grassroots campaign. More sophisticated lobbying skills would be required in order to advocate for this change in such substantial national legislation. In order to bring about the amended change to the Affordable Care Act, a professional lobbyist would be required. The professional lobbyist would have the national contacts necessary to influence politicians in Washington (Lanier, 2013).

DEVELOPMENT 8

Lastly, as this process would be long and time consuming keeping the public interested in the policy change would also be an obstacle. Ensuring that the grassroots campaign members in each state kept the issue in the media would be essential. This would involve extensive time and money in order to present the issue repeatedly to the public. Accessing support from national female advocacy groups and cancer advocacy groups would be vital. These advocacy groups have access to media funding beyond what the grassroots campaign could provide. Partnering with these groups could make the difference in ensuring continued public interest.

Ethical Dilemmas

There are several ethical challenges around providing universal mammography to ethnically diverse women. Firstly, the situation as it stands does not give low income, ethnically diverse women any choices around breast health screening. They either have coverage or they do not. Leaving the situation as it is perpetuates paternalism (one making decisions on behalf of another) and does not advocate for changing the future health of ethnically diverse women.

Nurses have an obligation to reduce paternalism and to advocate for our patients (Zomorodi, & Foley, 2009). One major factor contributing to this is the language barriers that are in place for many of these women. Having limited understanding of the language prevents them from comprehending mainstream media and previously developed educational materials (Sadler et al., 2009). Nurses have an obligation to advocate for our patients that do not have a voice.

Therefore, health teaching for these women needs to be developed to increase their understanding around disease processes, treatment options and prognosis. Secondly, nurses have an obligation to ensure that healthcare dollars are being spent in the most appropriate ways. Many women from ethnically diverse backgrounds live in poverty and do not have access to comprehensive health insurance plans (Morrison, 2012). Diagnosing breast cancer when it is in a late stage of progression is more expensive for the healthcare system as more advanced treatment is needed for a longer duration. Often the diagnosis occurs too late and these women experience much higher mortality rates than their Caucasian peers (Sadler et al., 2009). There will most certainly be a debate around cost versus benefit of spending health care dollars on this population. As many of these women have low income jobs they are not perceived to have the same amount of benefit to American society as other groups. However, nurses have a role in assuring that social and economic inequities in health care are addressed (Leviton, Rhodes, & Chang, 2011).

Development of ethical decision-making has not progressed as thoroughly in nursing practice as has other concepts (Pavlish, Brown-Saltzman, Hersh, Shirk, & Rounkle, 2011). Nurses need assistance in understanding how to navigate ethical dilemmas. In order for the Registered Nurse to make sense of ethical dilemmas presented to them an understanding the American Nurses Association (ANA) Code of Ethics is mandatory. Several provisions in the code are applicable to the ethics around this proposed policy change. Provision seven in the ANA Code of Ethics links the practice of each individual nurse with changing health policy and developing professional practice standards (Drought & Epstein, 2008). Nurses need to understand that their practice is linked to changing health policy. Nurses need to be aware of changing health policies and practice standards. They need to ensure that in their care of patients they are following those policies and standards. Provision eight of the ANA Code of Ethics discusses that Registered Nurses have an obligation to ensure that care is provided to populations of ethnic diversity both in this country and around the world. It highlights the need for removing the focus off of the individual and placing it on communities and population groups (Silva, 2008).

Considering this advocacy campaign, provision eight is of great importance. It guides the Registered Nurse to advocate for ethnically diverse women who have little voice to change their circumstances. These women often find themselves living in poverty, without access to health insurance. They are dying at higher rates than their Caucasian peers with the same illness and Registered Nurses can change this situation. Provision nine outlines that Registered Nurses have an obligation to work towards social reform in America (Fowler, 2008). Linking this to the breast health screening advocacy program is obvious. Nurses have an obligation when they observe inequities in society to develop changes to address those inequities (Fowler, 2008).

The success of the Affordable Care Act is necessary for this advocacy program to move forward. If states do not enact the reforms in this legislation, there will be further delays to implementing universal no-cost breast health screening for all women over forty. In order for this legislation to be successful, each state needs to work at implementing the new reforms as mandated within it (Knickman & Kovner, 2011).

Conclusion

Ensuring that nursing is monitoring the health of all citizens is a mandate presented in the ANA Code of Ethics. Nurses cannot sit back and watch underserved populations continue to have reduced access to health services. Nurses have an obligation to investigate disparities in health care. Once observed, nurses must take action to improve access to quality care (Fowler, 2008). In this paper, a health advocacy campaign was proposed that addressed the lack of access to free breast health screening for ethnically diverse women over the age of forty. The paper discussed the legal and ethical issues that surround appropriate access to universal no-cost breast health screening for this population. If the current inaction around this issue continues, many women will die needlessly.