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HEALTH CARE ENVIRONMENT

DEFINITION OF HEALTH

According to WHO, “Health is a state of complete physical, mental and social well being
and not merely the absence of disease or infirmity.”
The health of an individual as an integrated system with in the context of the
environment is termed holistic health.

Environmental Health refers to the state of all substances, forces and conditions in an
individual's surroundings that may exert an influence on health and well being.

When environmental conditions are favorable, health status is enhanced. However

adverse biological, chemical, physical and sociological forces in the environment,
separately or in combination may disrupts healthy life-style and impede a person's ability to
cope with environmental stimuli.

FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY OF

NURSING

The core concept that is most reflective of nightingale’s writings is that of

environment. Although she tends to emphasize the physical more than the psychological or
social environment, this needs to be viewed in the context of her time and her activities as a
nurse leader in a war-torn environment.

The environment is viewed as all the external conditions and influences affecting
the life and development of an organism and capable of preventing, suppressing or
contributing to disease or death. Nightingale’s writing speaks of providing such things as
ventilation, clean air and water, cleanliness and warmth, so the reparative process that
nature has instituted will not be hindered

Medical practice is not viewed as a curative process but as having the function of
assisting nature. Thus, nursing is also a non-curative practice in which the patient is put in
the best condition for nature to act. This condition was seen by her as enhanced by
providing an environment conducive to health promotion.

At this point, it is helpful to think of a patient who has had surgery and relate what
Nightingale proposes. Medicine is seen as functioning to remove the diseased part, whereas
nursing places the patient in an environment in which nature can assist post operative
patient to reach their optimal health condition.

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NIGHTINGALE’S ENVIRONMENTAL CONCEPTS

MAJOR AREAS OF CONCENTRATION EXAMPLES

1. Ventilation Fresh air, which is of primary
importance, can be achieved through open
windows. An outlet is needed for impure air.
Drafts caused by open windows and doors
are to be avoided.

2. Light Second only to the need for fresh air

is the value of light. Beds should be placed
in such a position as to allow the patient to
see out the window – the sky and sunlight.

3. Warmth Guarding against the loss of vital heat is

essential to the patient’s recovery. Chilling
is to be avoided. Hot bottles and drinks
should be used to restore lost heat.

4. Effluvia (smells) Sewer air is to be avoided and care

is needed to get rid of noxious body odor
caused by disease. Fumigations and
disinfectants should not be used but the
offensive substance removed.

5. Noise Intermittent sudden noise causes

greater excitement than continuous noise,
especially during patient’s first sleep.
Whispering, or discussing a patient’s
condition just outside his or her room is
cruel.

To Nightingale the environment of the patient was quite encompassing. Although

she did not specifically distinguish among the physical, social or psychological
environments as such, she speaks of all three in the practice of nursing.

VIEW OF THE THEORY CREATED BY NIGHTINGALE

The key point is diagrammed in the center of the triangle- patient condition and
nature. Here the thrust of environment is on the patient and nature functioning together to
allow the reparative process to occur. The three components – physical, social and
psychological – need to be viewed as interrelating rather than a separate distinct part.

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PHYSICAL
ENVIRONMENT
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0920ce1600040000002d010000030000000000PSYCHOLOGICAL
SOCIAL
ENVIRONMENT
ENVIRONMENT

PHYSICAL ENVIRONMENT – The basic environmental components are physical in

nature and relate to such things as ventilation and warmth. These basic factors affect one’s
approach to all other aspects of the environment.
A patient’s bed must be clean, aired, warm, dry and free from odor. One should provide an
environment in which patient can be easily cared for by others or self. The entire room
should be well ventilated.

PSYCHOLOGICAL ENVIRONMENT – the effect of mind on the body was fairly well
accepted in Nightingale’s time. Nightingale recognized that a negative environment could
cause physical stress thereby affecting the patient’s emotional climate. Therefore emphasis
on placed on offering the patient a variety of activities to keep his or her mind stimulated.
Communication – Communication with the patient is viewed in the context of the total
environment. Communication should not be hurried. When speaking with patients, it is
important to sit down in front of them. The place one communicates with the physician and
family about the patient is in the context of environment of the patient.
Advice – One should not encourage the sick by false hopes and advice about their illness.
Rather the emphasis here is on communicating about the world around them that they miss
or about good news that visitors can share. Again, patients are viewed in the context of
their total environment.

SOCIAL ENVIRONMENT – Observation of the social environment, especially as related

to specific data collections relating to illness, is essential to preventing disease. Thus, each
nurse must use observational powers in dealing with specific cases rather than be
comfortable with data addressing the ‘average’ patient. The patient’s total environment not
only includes the patient’s home or hospital room but the total community influencing that
specific environment.

ENVIRONMENTAL HEALTH HAZARDS

It falls into 4 general categories;
•Biological

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•Physical
•Chemical
•Psychosocial

BIOLOGICAL - Disease producing infectious agents in the environment that are

capable of entering the human body such as viruses, bacteria or other micro-organisms are
environmental hazards of biological nature. Transmission by direct contact, contaminated
water, vectors (rodents and arthropods such as flies, mosquitoes, fleas, ticks, mites)

CHEMICAL - These include toxic agents such as polychlorinated biphenyls (PCBs),

asbestos, lead and pesticides such as insecticides (DDT, hydrocarbons), herbicides and
rodenticides, industrial waste, emissions
From motor vehicles. Results of experimental studies with animals indicate that these
chemicals cause severe chronic health problems, thus posing a serious threat to human
health.

PHYSICAL - Natural disasters such as earthquakes, volcanoes and accidents, noise, heat,
vibration, radiations, insects, rodents and certain type of equipment fall into the category of
physical hazards.
For e.g. air temperature and humidity may be adversely affected in industries that use blast
furnaces, laundry equipment contributing to health problems such as respiratory disorders,
dermatitis, GI disturbances and eye inflammation.

PSYCHOSOCIAL - Many of the stressors violence, stress, substance abuse and

dependence are known threat to health of individuals, families and communities.
Additionally feelings of well-being may be altered by factors such as high level of noise,
overcrowding or isolation, lack of adequate sources or opportunities for economic
advancement.

ENVIRONMENTAL INFLUENCES ON HEALTH

•TOXIC AGENTS
1. ASBESTOES - It has been linked to diseases such as lung and GI cancer and
mesothelioma.
2. LEAD - Lead biologically interferes with blood formation often resulting in anemia. It
can also cause kidney damage, birth defects, injury to the CNS, poor memory, hair loss,
hypertension, mental retardation, convulsions, coma and death.
3. PESTICIDES - Pesticide residues are contact poisons and tend to accumulate in fatty
tissues in living organisms and remain in the body indefinitely.

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•AIR POLLUTION
The effects of air pollution on the health of individuals depend on the chemical
properties of the pollutant and size of particle, which in turn affects the site of deposition in
the respiratory tract, adverse health effects from air pollution may range from mild to
severe. For e.g. mild irritation of respiratory tract can occur when larger particles are
entrapped in the upper respiratory tree. On the other hand, severe respiratory problems and
even asphyxiation may occur as a result of direct absorption of a pollutant such as carbon
monoxide, from the alveoli into the blood. The risk of developing cancer or a chronic
pulmonary disease increases with prolonged exposure to air pollutants.

•WATER POLLUTION
The most pressing health problems related to water quality involve contamination
of waterways with the microbial pathogens found in human body wastes, a problem
directly related to lack of or faulty sewage disposal facilities. Swimming facilities such as
swimming pools, hot tubs and natural bathing areas like lakes, rivers and ponds are
sometimes dangerously polluted and provide a medium to vectors to flourish.

•NOISE POLLUTION
It can be defined as any unwanted or undesirable sound in the environment. Its
effects can range from mildly annoying to psychologically and physically debilitating. The
most severe health problem resulting from noise pollution is temporary or permanent
hearing loss. It also affects an individual's psychological and physical health because it
disrupts communication, sleep, leisure and work activities.

•ACCIDENTS
Unintentional injuries like due to falls, drowning and fires kill more than 100,000
people each year and incapacitate millions of others with many lifelong disabilities. Of
these approx. 46,000 deaths are motor vehicle related injuries.

•SOCIAL AND HAZARDOUS WASTES

Wastes are being generated at an alarming rate. The amount of solid waste
continues to soar, partly as a result of today's ‘Throwaway' attitude where many products
are used once and then discarded. In addition to solid wastes, the disposal of hazardous
waste is a critical issue.
EMERGING ENVIRONMENTAL ISSUES

A. MAJOR ISSUES
Seven major environmental issues which will directly or indirectly affect health have been
identified;

1. POPULATION - There was little change in population growth rates by the year
2000.The estimated world population by the end of century will be 6.3 billion.

2. FOOD PRODUCTION - Worldwide food production is projected to increase by 90%

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between 1970 &2000.However, the largest increase of food will occur in richer countries
and the countries of Middle East. Africa and Southern Asia will continue to have
inadequate amount of food for their people,

3. NATURAL RESOURCES - Non fuel resources appear sufficient to meet demands

through the year 2000, but discoveries and investments will be needed to maintain reserves.

4. WATER - Shortages will become more severe, over pumping of ground water, poor
land use practices and pollution of existing water supplies will reduce the availability of
water at a time of rising need.

5. FORESTS - Loss of forests will continue over the next 20 years.

6. WILD LIFE - Rates of extinction will increase sharply resulting in loss of hundreds of
thousands of species, especially in the tropical forest regions.

7. POLLUTION - Increased emissions of carbon dioxide and chlorofluorocarbons in the

atmosphere are threatening to alter the world's climate and upper atmosphere significantly
by 2050. Acid rain from the burning of fossil fuels is affecting increasingly wider areas
with damage to lakes, soil and crops.

B. GLOBAL WARMING
As a result of increased burning of fossil fuels, deforestation and the production
of certain synthetic chemicals, there is dramatic increase in heat trapping gases in the
atmosphere. Carbon dioxide is the major offender, allowing energy from the sun to pass
through, while absorbing radiation from the earth and creating a planetary hothouse.

NASA (National Aeronautics and Space Administration) has reported that the
atmospheric ozone layer, which protects life from harmful ultraviolet radiations, has begun
to thin globally. As ozone layer diminishes in the upper atmosphere, the earth receives
more ultraviolet radiations, which promotes skin cancers and cataracts and depresses the
human immune system.

C. ACID RAIN
Acid rain is caused by emission of sulphur dioxide and nitrogen oxides. Nitrogen
oxides, formed when fuel is burnt at high temperature, come principally from motor vehicle
exhaust, electric utilities and industrial boilers that burn coal or oil. Once released into the
atmosphere, these compounds can be carried long distances by prevailing winds until they
return to the earth as acidic rain, snow, fog or dust. Fish and wildlife suffer harm, lakes are
contaminated, buildings and statues deteriorate and people experience health problems such
as respiratory impairment.

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THE ENVIRONMENTAL PROTECTION AGENCY (EPA)

Legislation establishing regulations and policy occurs at national level. The EPA is an
independent agency formed to coordinate environmental programs related to air and water
pollution, solid and hazardous waste management, noise, public water supplies, pesticides
and radiation. The agency also administers the municipal sewage treatment construction
grant program authorized by congress in the 1972 Clean Water Act.

HEALTH ECONOMICS

Economics represents the study of allocating scarce resources among

competing needs. Allocating resources refers to how each good produced is distributed to
its consumers. Simply stated, economics becomes the intellectual liaison between nature
and technology on the SUPPLY side & the preferences and desires of consumers and
overall society on the DEMAND side.
The economics involved with health care is important on both sides of the
SUPPLY-DEMAND equation. Economics provides a systematic mechanism to obtain
information about the availability, potential and results of health care system. Also,
economics can be used to trace relationships among the health of the population, the size
and productivity of work force, and the demand for health care.

ECONOMIC INDICATORS OF HEALTH CARE

1. CONSUMER PRICE INDEX (CPI) - CPI measures the average changes in prices of
all types of consumer goods and services purchased by urban wage earners and clerical
workers. This index is computed monthly by the Federal Government.

2. HOSPITAL STATUS - Admissions, Cost per inpatient day, Length of stay, Outpatient
visits, Occupation rates and Staffed beds indicate consumption and cost of consumption for
hospital care.

3. NATIONAL HEALTH EXPENDITURE - It includes both public and private

expenditures for personal health care, medical research, the construction of medical
facilities, program administration, insurance costs and Government sponsored public health
programs.

4. PERSONAL CONSUMPTION EXPENDITURE (PCE) - PCE represents private

payments for medical care.

5. PERSONAL HEALTH CARE EXPENDITURE (PHCE) - It indicates expenditures

for consumers whether insured or not. Included are expenses for non-prescribed drugs and

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medicines, household supplies and other items not covered by insurance.

6. PROFESSIONAL STATUS -
• OFFICE VISITS- indicate the number of office calls consumers make to a physician.

• PHYSICIAN FEE reflects charges for office and other physician visits.

• SURGICAL CHARGES indicate the fee for common surgical procedures and
emergency medical procedures.

ECONOMIC CONCEPTS IN HEALTH CARE

The three basic concepts of SUPPLY, DEMAND & COST are intricately related
in economics.

The SUPPLY of health care refers to the amount of resources currently available for
delivering health services. Resources include health care facilities, manpower and
financing. Supply levels are constantly changing because of technological discoveries,
costs for services, consumer demands, and effect of Government regulations.

The DEMAND for health care refers to the amount and type of health care the consumer
requires and is willing to purchase. (Feldstein, 1983). The demand level revolves around
consumer needs and desires, costs of health care, treatment selections ordered by health
care providers, and general societal needs.

The COST of health care refers to the amount a provider pays to produce health related
goods and services, as well as the amount a consumer pays to purchase these goods and
services. Factors influencing the cost of health care are numerous, ranging from consumer
demands to advancements in medical technology to the nation’s economy

PLANNING PROCESS
PLANNING is a process of analyzing and understanding a system,
formulating its goals and objectives, assessing its capabilities, designing alternative courses
of action or plans for the purposes of achieving these goals and objectives, evaluating the
effectiveness of these plans, choosing the preferred plan, initiating the necessary action for
its implementation and monitoring the system to ensure the implementation of the plan and
its desired effect on the system.

HEALTH PLANNING is an orderly process of defining community

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health problems, identifying correct needs and surveying the resources to meet them,
establishing priority goals that are realistic and feasible and projecting administrative action
to accomplish the purpose of the proposed programme.

CHARACTERISTICS OF PLANNING

1. Planning is essential for all the job. Planning leads to more effective and rapid
achievement because everyone involved is clear about what is to be done, how, when and
why.
2. Good planning should focus on the purpose i.e. every programme including health
programme has their own purpose or objectives e.g. RCH programme.
3. Although planning is a continuous process, there should be a provision for flexibility to
some extent according to changes due to event or situation.
4. Planning should not be based on high ideals and be blind to social and political
conditions in the environment.
5. Planning of health programmes must be precise in its objectives, scope and the nature.
6. Planning should be documented because it serves as a blue-print for implementation.

STEPS OF PLANNING PROCESS

•Analysis of the health situation.

•Establishment of objectives and goals.
•Assessment of resources.
•Fixing priorities.
•Write up the formulated plan.
•Programming and implementation.
•Evaluation.

PLANNING CYCLE
Planning cycle may be considered in Eight steps as follows;

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0920ce1600040000002d010000030000000000

POLICIES

INTRODUCTION

A policy is an established course of action determined to achieve a desired outcome.

Government and institutions create policies to achieve their missions. However, policy
development and implementation are not limited to Government and institutions. Any
health care providing agency, professional organization, non profit organization or family
may make policies for members to follow. Policy formation takes place at many levels in
society at family, community, institution, state, national and international level. Policies
can be major or minor.

DEFINITIONS

POLICY is defined as principles that govern actions directed towards given ends;
policy statements set forth a plan, direction or goal for action.

Policies may be laws, regulations or guidelines that govern behavior in the public
arena, such as in Government or in the private arena such as in workplaces, schools,
organizations and communities.

Policies are formalized procedures that are followed by persons responsible for
delivering Governmental or institutional services. (Stanhope, 1996)

HEALTH POLICY refers to the public or private rules, regulations, laws or

guidelines that relate to the pursuit of health and the delivery of health services.

IMPLIED AND EXPRESSED POLICIES

IMPLIED- Implied policies are neither written nor expressed verbally, have usually
developed over time and follow a precedent. For example a hospital may have an implied
policy that employees should be encouraged and supported in their activity in community,
regional and health care organizations.
EXPRESSED – Expressed policies are dineated verbally or in writing. Most organizations
have many written policies that are readily available to all people and promote consistency
of action. It may include a formal dress code, policy for sick leave or vacation time and
disciplinary procedures.

Before any action is taken, an issue should be put on the public agenda. Placing an
issue on the public agenda requires actions that bring a concern to the attention of the
policy makers and the public, people other than those affected by the situation are aware of
the issue and its consequences.

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POLICY DECISIONS

According to Mason, Leavitt, Chaffee, 2002

Policy decisions (e.g. laws or regulations) reflect the values and beliefs of those
making the decisions. As the values and beliefs change, so do policy decisions.

TYPES OF POLICIES

• DISTRIBUTIVE POLICIES – Distributive policies extend goods and services to

members of an organization, as well as distributing the costs of goods or services
amongst the members of organization. Examples include Government policies that
impact sending for welfare, public education, highways and public safety or a
professional organization’s policy on membership training.

• REGULATORY POLICIES – Regulatory policies limit the discretion of individuals

and agencies or otherwise complete certain types of behavior. These policies are
generally thought to be best applied in situations where good behavior can be easily
defined and bad behavior can be easily regulated and punished through fines.

• CONSTITUENT POLICIES – These create executive power entities or deal with laws.

• MISCELLANEOUS POLICIES – Policies are dynamic; they are not just static list of
goals or laws. Policy blueprints have to be implemented, often with unexpected results.
SOCIAL POLICIES are what happens ‘on the ground’ when they are implemented as
well as what happens at the decision making or legislative state.

OTHER TYPES OF POLICY

 DOMESTIC POLICY – It presents decisions, laws and programs made by

Government which are directly related to issues in the country.

 ECONOMIC POLICY – It refers to the actions that Governments take in the

economic field. It covers the systems for setting interest rates and Government
deficit as well as the labor market and many other areas of Government.

 EDUCATION POLICY – It refers to the collection of laws or rules that govern

the operation of education system. Education occurs in many forms for many
purposes through many institutions. Education policy can directly affect the
education people engage in at all levels.

 ENVIRONMENTAL POLICY – It is an action deliberately taken to manage

human activities with a view to prevent, reduce or mitigate harmful effects on

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nature and natural resources and ensuring that man made changes to the
environment do not have harmful effects on humans.

 HEALTH POLICY ANALYSIS – It is the process of assessing and choosing

among spending and resource alternatives that affect the health care system,
public health system.

 FOREIGN POLICY – It is also called the ‘INTERNATIONAL RELATIONS

POLICY’ is a set of goals outlining how the country will interact with other
countries economically, politically, socially and military.

 HUMAN RESOURCE POLICY – These are systems of codified decisions,

established by an organization, to support administrative personnel functions,
performance management, employee relations and resource planning.

 PUBLIC POLICY – It is the body of fundamental principles that underpin the

operation of legal systems in each state. This addresses the social, moral and
economic values that tie a society together, values that vary in different cultures
and change overtime.

 SOCIAL POLICY – It relates to guidelines for the changing, maintenance or

creation of living conditions that are conducive to human welfare. Thus social
policy is that part of public policy that has to do with social issues. Social policy
aims to improve human welfare and to meet human needs for education, health,
housing and social security.

IMPACT OF POLICY ON NURSING

•Public policy has significant impact on the practice of nursing. The ability of the individual
nurse to provide care is affected by public policy decisions.

•State licensure of a registered nurse (RN) derives from legislation that defines the scope of
nursing practice. The defined scope determines what a nurse legally can and cannot do.

•Regulations that are developed to implement legislation also affect practicing nurses and
their work environments. For e.g., the rules for administering and documenting the
administration of narcotic drugs are promulgated by a regulatory agency of the Federal
Government, the Federal Drug Administration, under the department of Health and Human
Services. The way in which such regulations are written can greatly affect nurse's ability to
practice. If nurses do not actively participate in developing regulations, policy outcomes
are likely to restrict rather than enhance nursing authority for regulated activities.

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SPHERES OF NURSING INFLUENCE

The nurse has an opportunity to make an impact on policies in four aspects of

influence as identified by Talbott and Mason (1988). These spheres are;

• Government
• Organizations
• Workplace
• Community

Since the community encompasses the other three spheres, only Government,
organizations, and workplace will be discussed here.

GOVERNMENT – Laws, with their accompanying rules and regulations, control nursing
practice and health care.
 Nurses have been more involved in federal and state Governments, although local
Governments provide many health care services.
 Local Governments control school health programs, local public hospitals and home
and community health care.
 In general, the nurse first must be a registered voter.
 Nurses can join collective actions by working with PACs (Political Action
Committees). These committees support deserving candidates who support nursing
and health care issues.
 Most states have state nurses association PACs for state and local candidates.

WORKPLACE – Over 66% of nurses work in hospitals and should be influential in

setting hospital policies, especially regarding patient care. Nurses can influence how
quality care is delivered with controlled costs. Most hospitals currently require that many
non nursing tasks be done by nurses. Through collective action, nurses serving on
committees in the institution can help eliminate these tasks.
Nurse can even serve on the board of trustees of the institution. Nurses who
successfully practice the politics of change in their place of employment can influence the
type and quality of patient care.

ORGANIZATIONS – Important influences include professional organizations such as

ANA and many specialty organizations. The organizations work in coalitions with other
health groups to support or oppose issues. By joining and being active in a professional
organization, an individual nurse has access to a wider range of tools and information to
use in order to influence health care policies.

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POLITICAL PROCESS IN NURSING PROFESSION

POLITICS

Merriam Webster’s Collegiate Dictionary (1994) defines politics as ‘the art or

science concerned with guiding or influencing guiding policy’ and ‘the art or science of
winning and holding control over a government’.
Policies are the decisions; Politics is the influence of those decisions.

POLITICS AND NURSING

Broader issues affecting the nursing profession are political in nature. Issues of pay
equity, or equal pay for the work of comparable value are of concern to nurses, because
they have historically been underpaid for their services. One of the earliest case
demonstrating the inequality of nursing salaries involved public health nurses in Colorado.
They were paid considerably less than city tree trimmers and garbage collectors. The
nurses demanded just compensation for their work by demonstrating that nursing requires
more complex knowledge and is of greater value to society than these other occupations.
As a result of this suit, recognition of nurse’s low pay was brought to public
attention, this in turn mobilized public support for increasing nursing salaries. This is an
example of political action by nurses that resulted in both policy and professional
outcomes.
More recently, the nursing shortage has caused concern amongst the public that the
number of nurses available to provide care in hospital and other agencies is inadequate.
Nurses in California mobilized the public and other constituency groups to get the first
legislation requiring specific nurse to patient ratios passed in 1999.
Unfortunately nursing profession was not well organized politically during the time
of expanding health care capacity and access in the early 1960s. Times have changed.
Nurses have increased their political savvy. Through the efforts of American Nurses
Association (ANA), other professional organizations, constituent member associations,
political action committees (PACs), nurses are now participating much more effectively in
both Governmental and Electoral politics.

LEVELS OF POLITICS IN NURSING

Three levels of political involvement in which nurses can participate are as;
1. NURSE CITIZENS – A nurse citizen brings the perspectives of health care to the
voting booth, to public forums that advocate for health and human services. Nurses
tend to vote for candidates who advocate for improved health care. Here are some

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examples of how the nurse citizen can be politically active:

 Register to vote.
 Vote in every election.
 Keep informed about health care issues.
 Speak out when services on working conditions are inadequate.
 Join politically active nursing organizations.
 Join a political party.
Once nurses make a decision to become involved politically, they need to learn how to
get started. One of the best ways is to form a relationship with one or more policymakers.

2. NURSE ACTIVISTS – The nurse activist takes a more active role than the nurse
citizen. Nurse activists can make changes by:
 Joining politically active nursing organizations.
 Contacting a public official through letters, Emails or phone calls.
 Registering people to vote.
 Contributing money to a political campaign.
 Working in a campaign.
 Writing letters to the editor of local newspapers.
 Inviting legislators to visit the workplace.

3. NURSE POLITICIANS – Once the nurse realizes and experiences the empowerment
that can come from political activism, he or she may choose to run for office. No longer
satisfied to help others get elected, the nurse politician desires to develop the legislation,
not just influence it. Nurse politicians use their knowledge about people, their ability to
communicate effectively and their superb organizational skills in running for office. The
nurse politician can:
 Run for an elected office.
 Seek appointment to a regulatory agency.
 Be appointed to a governing board in the public or private sector.
 Use nursing expertise as a front line policymaker who can enhance health care
and the profession.

FLORENCE NIGHTINGALE, the founder of modern nursing was the first nurse
politician.

CURRENT POLITICAL ISSUES AFFECTING THE PRACTICE OF

PROFESSIONAL NURSING AND HEALTH CARE

1. The patient safety act of 1997

It aims to ensure safe patient care in hospital and other health care institutions. Each
health care institution would have to make the following information available to the
public:
 Number of RNs and UAP (Unlicensed Assistive Personal) providing direct
patient care.

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 The mean number of patients per RN who is providing direct patient care.
 Patients’ mortality rates.
 Number of adverse patient care incidents.
 Methods used to determine and adjust nursing personnel staffing levels
according to patient care needs.
2. The Genetic Information Nondiscrimination in Health Insurance Act of 1997
This legislative act would protect American consumers from being denied health care
insurance coverage based on high risk genetic information.
Advances in genetic research provide critical information for effective screening for
diseases for persons at high risk for terminal and chronic illnesses, especially cancer.
3. The HIV Prevention Act of 1997
It includes the following provisions;
• Mandatory HIV testing of all sex offenders.
• Mandatory partner notification of persons testing positive for HIV.
• Allowing health care professionals to perform HIV testing without informed
consent on any person undergoing an invasive medical procedure.

4. Victims of Abuse Protection Act of 1997

This bill would prohibit the use of information by insurers for refusing to ensure
persons or for charging higher premiums based on previous history of or high risk for
domestic violence. (Gonzales, 1997).
As client advocates, nurses must support any legislation that prohibits access to, or
increases the cost of health care for, any specified population.

5. The Telehealth Bill of 1997

Telehealth is the use of computer technology to link rural and underserved areas to
large medical centers. This bill would provide loan and grant funding to establish telehealth
networks in rural areas and renames the Joint Working Group on Telemedicine as the ‘Joint
Working Group on Telehealth.

6. Working Families and Flexibility Act

It has been introduced to assist parents meet family and work obligations. This bill
proposes that employers compensate hourly rate employees for overtime by offering them a
choice of overtime pay or compensatory time off at a rate of 1.5 times the hourly wage.
This bill would increase the flexibility of hourly waged employees.

CONCLUSION
This is to conclude that nurses need power commensurate with their knowledge and
expertise as the care givers closest to patient and proportionate to their numbers. They need
power and politics to provide competent, humanistic and affordable care to people and also
enormous decision making power with in the health care system for improve nursing
profession in health care and health policy.

BIBLIOGRAPHY

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 Kay Kittrell Chitty, “Professional nursing concepts & challenges, Ed 4th, Published
by Elsevier, pp- 580-598
 Susan Leddy, Mae Pepper J., “Conceptual Basis of Professional Nursing” Ed 4th,
Published by Lippincott, pp- 277, 290-292
 Joan Creasia L., Barbara Parker, “Conceptual foundations of Professional Nursing
Practice, Published by Mosby, pp- 107-125, 225-239
 BT Basavanthappa, “Nursing Administration,” Ed 1st, Published by Jaypee
Brothers, pp- 50-51
 George Julia B., “Nursing Theories The Base for Professional Nursing Practice,”
Ed 3rd, published by Appleton & Lange, pp- 32-36
 www.google.com

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