Jacqueline Switzer (Switzer, 1994) writes that at its foundation government is called to protect and extend civil rights. It is assumed that this should be the foundation of policy development. This calls into question some basic terminology: what are ‘civil rights’ and what is ‘policy’?
The terms ‘human rights’ and ‘civil rights’ are often used interchangeably; particular to health care, the phrase ‘human rights’ is more broadly applied. Within the United Nations framework is a Committee on Economic, Social and Cultural Rights that translates these innate human rights into more specific obligations for each country. Both the World Health Organization and the United States committee agree that these rights are universal and each state has a responsibility to uphold these rights for its citizens. The Universal Declaration of Human Rights (1948) included thirty articles detailing what ‘human rights’ consists of. These included freedom from torture, freedom from slavery, the right to live safely and without fear among many others. This is often the foundation of policy making. The World Health Organization has recently included palliative care services within its consideration of human rights (Callaway & Krueger, 2014).
In its most naïve and basic form, policy is a fulfillment of each state’s obligation to uphold human rights. Switzer (1994) asserts that policies are generally a reflection of the current cultural values and attitudes. She continues that policy making is often a predictable, logical and sequential process. We might liken this to the nursing process. Consider the following example:
Assessment– – – A review of the current situation: Our population is aging rapidly. Healthcare spending in the final years of life is tremendous and yet people still do not receive the care they are seeking. The evidence demonstrates that palliative care provides high quality and cost-effective services for those with serious illness.
Diagnosis– – – Not everyone who desires palliative care has services available: Despite the known value of palliative care services, access to this intervention is limited in small and rural communities.
Planning– – – Palliative care services should be equally available in rural communities as it is in more metropolitan areas. Local, state and federal policy should protect the right to these services for its citizens. Consider development of a policy to subsidize development of palliative care programs in rural areas. A bill is placed on the ballot and the voters chose whether this would be a valuable allocation of their tax money.
Implementation– – – State governments allot funding for development of palliative care programs in hospitals with less than 100 beds. These services are extended to the rural community.
Evaluation– – – Were the funds used appropriately? Did this program increase the value and quality of care provided? Where patients and communities satisfied with the outcome? Further recommendations and modifications to the program… Begin to assess the situation again.
This is very rudimentary example of how policy making may follow a logical sequence, similar to the nursing process. Successful policy development and implementation requires that the problem, the policy and the politics of the times align (Kingdon, 2010).
Kingdon (2010) writes that in policy development there is a ‘window’ in which policy making can be successful. It is possible that for palliative care that ‘window’ or timeframe of opportunity is now.
References
The American Nurses Association (2015). The nursing process. Retrieved from http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html
Callaway, M. and Krueger, S. (2014). A global victory for palliative care. Open Society Foundations. Retrieved from http://www.opensocietyfoundations.org/voices/global-victory-palliative-care
Switzer, J. V. (1994). Disabled policymaking/disabled policy. In Disabled rights: American disability policy and the fight for equality (pp.12-29). Washington DC: Georgetown University Press.
United Nations (1948). The universal declaration of human rights. Retrieved from http://www.ohchr.org/Documents/Publications/ABCannexesen.pdf
the value of palliative care 
You did a very good job at describing the process of health policy making within the focus of your blog topic. It has been my experience that palliative care is a service that is underutilized and misunderstood. The palliative care provider that rounds at my hospital is phenomenal and has the ability to discuss end-of-life decisions in such a way that patients feel comfortable with that stage. It is interesting that palliative care is different that hospice, as I have understood it. However, most providers and patients are uneducated on what palliative care actually is and thus, I feel it is definitely underutilized. Furthermore, I agree with you that now is the time to address this issue as the bulk of our population, the baby-boomers, are aging and getting to that point where palliative care should be an option. Also, with the number of co-morbidities and cancers that affect so many of the population, having a better understanding of palliative care would be influential. What do you suggest is the first step to addressing this issue?
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The example of how the nursing process can influence health policy development was great! I agree that there is a window or time-frame during which a health policy can be successful. People are not interested in issues of yesterday, let alone the past. People want up-to-the-minute news flashes and want to follow the trendiest social media feeds. That being said, however, I do think that palliative care’s window or time-frame has not fully lapsed. Healthcare is only going to become more expensive and policy-makers will seek solutions, such as palliative care, that are evidence-based and cost-effective. The notion of having the problem and policy align at exactly the right time is exactly the reason why it is so important for nurses to continually take a political stand on the issues near and dear to their hearts.
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What has been the involvement of nurse practitioners in policy making for palliative care services in California? JHM
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