HEALTH CARE ENVIRONMENT

Definition of Health:
According to W.H.O, Health is a state of complete physical, mental and social well being and not
merely an absence of disease or infirmity.

OR

The state of being free from illness or injury

The health of an individual as an integrated system within the context of the environment is teamed
holistic health.

Environmental Health:
It refers to the state of all substances, forces and conditions in an individual’s surroundings that may
exert an influence of 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.

Definition of Environment:
The environment is defined as the total external condition affecting the life and development of an
organism human behavior and society.

Types of Environment:
 Physical environment
 Psychological environment
 Psychosocial environment
 Biological environment

1.Physical Environment: The basic environment components are physical in nature and and relate to
such things as ventilation, light, effluvia (smell), noise, warmth. These basic factors affect one’s
approach to all other aspects of environment.

2.Psychological Environment: The effect of mind of the body was fairly well accepted that a
negative environment could cause physical stress thereby affecting the emotional climate. Therefore
emphasis is placed on offering the patient a variety of activities is placed on offering the patient a
variety of activities to keep his or her mind stimulated.

1
 3.Psycho Social Environment: The social environment related to specific data collections relating to
illness, is essential in preventing disease. The nurse must deal with specific cases rather than be
comfortable with data addressing the average patient. Many of the stressors violence, stress,
substance abuse and dependence are known threat to health. Well being may be altered by factors
such as high level of noise, overcrowding or isolation, lack of adequate surces or opportunities for
economic advancement.

4.Biological Environment: The biological environment is the universe of living things which
surrounds man including man himself. The living things are the viruses and other microbial agents,
insects, rodents, animals and plants. Most of the plants and animals are useful in maintaining the
ecosystem and thereby health of the people. There are some disease producing arthropods, insects,
microorganisms and domestic and wild animals.

FACTORS AFFECTING ENVIRONMENTAL HEALTH:

1. Population explosion: The rapid increase in our population is having harmful and unfavorable effect
on our environment. It is creating problems due to overcrowding, depletion of natural resources and
development of manmade resources by industrialization of manmade resources and development of
manmade resources by industrialization, green revolution, etc. increasing population is also creating
slum partially due to its natural growth and partially due to its migration from rural areas to urban
areas in search employment.
2. Industrialization: The industries have multiplied not only in magnitude but also in variety. All the
industries generate loss of waste products such as gases, effluents, solid matters, thermal waste, etc.
these wastes often are released directly into air, rivers, streams and drains on the lands which
deteriorate our environment and causes harmful effects on human health.
3. Urbanization: People from village migrate to towns and cities for employment, education, etc.
resulting in overcrowding and slums most of the time on unauthorized land. Tis situation not only
creates administrative problems but also adverse effects on environment and results in many physical,
mental and social health problems.
4. Modern agriculture practice: Chemical fertilizers are used to increase agriculture production for
meeting agricultural demands of ever increasing population, in addition insecticides are added and
sprayed to destroy pests and microorganisms. It also causes harmful effects of living organisms.
5. Deforestation: Deforestation refers to removing of forest. Deforestation is there because of wood
required by human being, demand on wood construction of houses, buildind, industries, dams, roads
and highways and expansion of land for cultivation. Deforestation also reduced the amount of
cultivation. Deforestation also reduces the amount of water being transferred from the ground to the
air because of reduced trees. This phenomenon is causing change in the climate. All these situations
have adverse effect on the environment health.
6. Radioactive substances: The radioactive substances are used in the laboratories, hospitals and power
plants, where nuclear bombs are manufactured. Some of the radioactive wastes from nuclear power
plants are discharged directly into the air and water and pollute these.

2
 7.Natural calamities: Natural calamities are grave disasters of misfortune of great magnitude
which occur by nature cause, disruption of the environment. These calamities include floods,
earthquakes, droughts, cyclones, volcanoes, landslides, avalanches and tidal waves in the seas.

TYPES OF POTENTIAL POLLUTANTS:

 Air pollution: The effects of air pollution on the health of 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 the site of deposition in the respiratory tract, adverse
health effects from air pollution may range from mild to serve.
 Effects of air pollution on health: Mild irritation of respiratory tract can occur when larger particles
are entrapped in the upper respiratory tract. 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 sewage disposal facilities. Swimming facilities such as swimming pools, hot tubs and
natural bathing areas like lakes, rivers and pond are sometimes dangerously polluted and provide a
medium to vectors to flourish. Water pollution causes various water borne diseases like dysentery,
typhoid and other health hazards.
 Land pollution: Like air and water, land is also a very important natural resources for all the living
organisms on the earth planet. Land is solid part of earth’s surface while soil is the upper layer of the
earth in which plants are grown. Thus soil is the upper part of the land. Often those two term (soil and
land) are used interchangeably inspite of the basic differences. About 40% of the land is covered by
desert. The rest of the land is used for making houses and buildings for various services ,
organizations and institutions, for agriculture and forests, for industrialization, urbanizations, roads
and highways railways, for monitoring etc. land abuse results in destruction of soil, soil erosion,
creation of dust bowls and deterioration of environment.
 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.
 Radioactive pollution: the presence of invisible ionizing radiations produced from radioactive
substances in the atmosphere, water, food etc. which are harmful refers to radioactive pollution. The
radioactive pollution of environment is due to advanced technology and modernization of man’s
activities. It includes radioactive pollution of atmosphere, water, soil and food. The radioactive
substances are very hazardous to all living organisms. It is becoming very important to understand
about it as it will help in creating awareness among the community people for taking precautionary
measures.

3
 Environment health hazard: It is state of events which has the potential to threaten the surrounding
natural environment and adversely affect people’s health. This term incorporates topics like pollution
and natural disasters such as stroms and earthquakes. Hazards can be categorized in five
types:
 Biological :disease producing infection agents in the environment that are capable of entering the
human body such as viruses, bacteria or other micro-organism are environmental hazards of
biological nature. Transmission by direct contact, contaminated water, vectors (rodents and
arthropods such as flies, mosquitoes, fleas, ticks and mites)
 Chemicals : These includes toxic agents such as polychlorinated biphenyls, asbestos, lead and
pesticides such as inesticides (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 equipments fall into the category of physical hazards.
For example : air temperature and humidity may be adversely affected in industries that use blast
furnaces, laundry equipment contributing to health such as respiratory disorders, dermatitis, GI
disturbances and even eye inflammation.
 Psychological : 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.

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 and the
preferences and desires of consumers and overall society on the demand equation.

Economics provides a systematic mechanism to obtain information about the availability, potential
and result of health care system.

ECONOMICS CONCEPT IN HEALTH CARE:

The three basic concepts of supply, demand and cost are intricately related in economics.

 Supply: 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.

4
 Demand : The demand for health care refers to the amount and type of health care refers to the
consumer requires and is willing to around consumer needs and desires,cost of health care, treatment
selections ordered by health care providers and general societal needs.
 Cost :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.

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 facilities, program administration, insurance costs and government sponsored public
health programmes.
4. Personal consumption expenditure (PCE) : PCE represents private payments for medical care.
5. Personal health care expenditure (PHCE) :It indicates expenditure for consumers whether insured
or not. Included are expenses for non-prescribed drugs and medicines, household supplies and other
items not covered by insurance.

CONSTRAINTS

Meaning :Restriction or limitation.

A constraint is something that plays the part of physical, social or financial restriction.

Types of constraints :
1. Cognitive constraints: One of the most common barriers to communicate is cognitive constraint.
Cognitive constraints are the way people view the world based on their culture. For example: people
in the united states might be inclined to feel superior to many cultures because of the power and
prevalence of U.S. culture since world war II. This might lead people to become angry if somebody
questions this superiority. However, cognitive constraints are created by the way people’s minds give
meaning to the world around them based on the knowledge and perceptions they have obtained.
These differ from culture to culture.
2. Behavior constraints : Behavioral constraints are another barrier to effective communication.
Behavior constraints are the ways people behave from different cultures. This can be as simple as eye
contact or how close you should be to somebody. In the united states, eye contact should be sporadic

5
 and people should stand at least three feet apart. In Europe, eye contact is considered “close to
staring”. And closeness can be defined by inches. It can also be as complex as how much information
one gives another while taking. In the united states, politeness and restraint is practiced, while in
Arab cultures, people often say what they mean. Every culture regulates its behavior differently.
3. Emotional constraints : the final culture barrier that blocks effective communication is emotional
constraints. Each culture has rules that tell us how emotional we can be in a situation. Italians are
generally open about their emotions, with hugs and kisses alternating between angry shouting and
gesturing. British people, however, are more reserved and keep their emotions close at hand. This can
cause problems when these approaches meet. The British may think Italians are rude in their
emotional wildness, while the Italians see the British as uptight. This varies in approach between
each culture.
4. Overcoming health system constraints : effective interventions exist for many priority health
problems in low income countries; prices are falling and increasing. However, progress towards
agreed health goals remains slow. There is increasing consensus that stronger health systems are key
to achieving improved health outcomes. There is much less agreement on quite how to strengthen
them. Part of the challenge is to get existing and emerging knowledge about more and less effective
strategies into practice. The evidence base also remains remarkably weak, partly because health-
system research has an image problem. The forthcoming ministerial summit on health research seeks
to help define a learning agenda for health systems, so that by 2015, substantial progress will have
been made to reducing the system constraints
Addressing the constraints
Parallel Approaches
As discussed above, programmes specific to a service or disease can work in more or less vertical
ways to achieve their goals. For example, several global initiatives are concerned with making good
quality pharmaceuticals available to health facilities in a timely and reliable manner. This goal might
be achieved through development of new and parallel pharmaceutical procurement and distribution
system, or by strengthening the exiting pharmaceutical management system to meet the needs of all
the specific initiatives. In practice, global initiatives and national programmes are using both
integrated and more vertical or parallel approaches to move their agendas forword. The primary
advantage of taking an intervention specific approach to strengthening of health systems is that it can
help maintain focus by targeting a ‘manageable chunk” of the system rather than taking on the whole.
Targeting particular health-system constraints to the achievement of health goals may also deliver
quicker returns than longer-term, broader, system-based intervention. However, although the formal
evidence base is limitd,19 there are many reports from experience that problems may arise when
several vertical, parallel subsystems are created within the broader health-care system. Parallel
approaches are likely to results in:
1.Duplication:Running parallel system for delivering drugs to health facilities will increase
transports cost, and increase the number of forms that health workers need to complete to secure their
durg supply.

6
 2.Distoration: Creation a separate cadre of better paid health workers for the specific tasks of a
programme may deplete staff from other functions and
\or demotivate staff from other key functions and or demotivate staff who do not benefits from higher
pay or better conditions.
3.Distruption: programmes often train health workers by taking away their jobs for several days or
week, leaving their posts vacant. This training to be uncoordinated across programmes, and may
results in the same worker receiving training courses in a year, with a substantial loss of services
being delivered.
4.Distractions: similarly, the specific and uncoordinated repoting requirement of donors can lead to
several forms being filled by a sole health worker for the problem, distracting them from more
productive uses of their time.
These problems suggest that even though globlal initiatives or national programmes are bound to
maintain a primary focus upon their own particular disease or intervention, there are few
circumstances when this focus should be pursused exclusively through the establishment of separate
parallel system. More rigorous assessment of the extent to which vertical versus more integrated
approaches contribute to sustained overall system strengthening- and in what circumstances-are
certainly needed.
Constraints of health planning:

 Lack of adequate health information system for planning, monitoring and for evaluation.

 Natural resistance to change.

 The relatively low priority often accorded to health by the political decision makers and the public.

 The frequency of government, political and administrative changes with concurrent changes in
commitment to support the plan.

 The imperfect state of the art planning i.e. the absence of trained health administrators and planners
particularly the lack of precise tool to measure need, demand, cost and benefit.

 The long time gap between planning and implementation particularly refers to the supply of
additional health, man power and enactment of necessary legislation.

 The division of health professionals into compartments and resultant lack of adequate inter
professional communication.

 The inflexibility of the educational system.

 Inefficient administrative practices that limit the flexibility of the budgets promote fragmented
programs and result in inappropriate personnel system.

 Inadequate coordination of planning between the various ministeries and departments concerned with
socioeconomic development.

7
 PLANNING PROCESS
Planning is a process of analyzing and understanding a system, formulating its goals and objectives,
assessing its capabilities, designing alternative course 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 :It is an orderly process of defining community 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 :
 Planning is essential for the entire entire job. Planning leads to more effective and rapid achievement
because everyone involved is clear about what is to be done, how, when and why.
 Good planning should focus on the purpose i.e. every programme including health programme has
their own purpose or objective e.g. RCH programme.
 Although planning is a continuous process, there should be a provision for flexibility to some extent
according to changes due to event or situation.
 Planning should not be based on high ideals and be blind to social and political conditions in the
environment.
 Planning of health programmes must be precise in its objectives, scope and nature.
 Planning should be documented because it serves as a blue-print for implementation.

Steps of planning process :

 Analysis of health situation
 Establishment of objectives and goals
 Assessment of resources
 Fixing priorities
 Write up the formulated plan
 Programming and implementation
 Evaluation

The Strategic Planning Process:

Mission

8
 Objectives

Situation analysis

Strategy formulation

Implementation

Control

This process is most applicable to strategic management at the business unit level of the organization.
For large corporations, strategy at the corporate level is more concerned with managing a portfolio of
business. For example, corporate level strategy involves decisions about which business units to
grow, resource allocation among the business units, taking advantages of synergies among the
business units and mergers and acquisitions. In the process outlined here, “company” or “firm” will
be used to denote a single-business firm or a single business unit of a diversified firm.

Mission:

A company mission its reason for being. The mission often is expressed in the form of a mission
statement, which convesys a sense of purpose to employees and projects a company image to customers.
In the strategy formulation process, the mission statement sets the mood of where the company
should go.

Objectives :

Objectives are concrete goals that the organization seeks to reach, for example, an earnings growth
target. The objectives should be challenging but achievable. They also should be measureable so that
the company can monitor its progress and make corrections as needed.

Situation analysis :

9
 Once the firm has specified its objectives, it begins with its current situation to devise a strategic pain
to reach those objectives. Changes in the external environment often present new opportunities and
new ways to reach the objectives. An environmental scan is performed to identify the available
opportunities. The firm also must know its own capabilities and limitations in order to select the
opportunities that it can pursue with a higher probability of success. The situation analysis therefore
involves an analysis of both the external and internal environment. The external environment has two
aspects : the macro-environmental analysis includes political, economic, social and technological
factors and sometimes is referred to as a PEST analysis.

An important aspect of the micro-environmental analysis is the industry in which the firm operates or
is considering operating. Michael Porter devised a five forces framework that is useful for industry
analysis. Porter’s 5 forces include barriers to entry, customers, suppliers, substitute products and
rivalry among competing firms.

The internal analysis considers the situation within the firm itself, such as:

 Company culture
 Company image
 Organizational structure
 Key staff
 Access to natural resources
 Position on the experience curve
 Operational efficiency
 Operational capacity
 Brand awareness
 Market share
 Financial resources
 Exclusive contracts
 Patents and trade secrets

A situation analysis can generate a large amount of information, much of which is not particularly
relevant to strategy formulation. To make the information more manageable, it sometimes is useful to
categorize the internal factors of the firm as strengths and weaknesses, and the external environment
factors as opportunities and threats. Such as analysis often is referred to as a SWOT analysis.

Strategy Formulation :

Once a clear picture of the firm and its environment is in hand, specific strategic alternatives can be
developed. While different firms have different alternatives depending on their situations, there Also
exist generic strategies that can be applied across a wide range of firms. Michael Porter identified
cost leadership, differentiation and focus as three generic strategies that may be considered when
defining strategic alternatives. Porter advised against implementing a combination of these strategies

10
 for a given product; rather, he argued that only one of the generic strategy alternatives should be
pursued.

Implementation :

The strategy likely will be expressed in high-level conceptual terms and priorities. For effective
implementation , it needs to be translated into more detailed policies that can be understood at the
functional level of the organization. The expression of the strategy in terms of functional policies also
serves to highest any practical issues that might not have been visible at a higher level.

The strategy should be translated into specific policies for functional areas such as:

 Marketing
 Research and development
 Procurement
 Production
 Human resources

Control :

Once implemented, the results of the strategy need to be measured and evaluated, with changes made
as required to keep the plan on track. Control systems should be developed and implemented to
facilitate this monitoring. Standards of performance are set, the actual performance measured and
appropriate action taken to ensure success.

Dynamic and continuous process :

The strategic management process is dynamic and continuous. A change in one component can
necessitate a change in the entire strategy. As such, the process must be repeated frequently in order
to adapt the strategy to environmental changes. Throughout the process the firm may need to cycle
back to a previous stage and make adjustments.

Drawbacks of this process:

The strategic planning process outlined above is only one approach to strategic management. It is
best suited for stable environment. A drawback of this top-down approach is that it may not be
responsive enough for rapidly changing competitive environments. In times of change, some of the
more successful strategies emerge informally from lower levels of the organization, where managers
are closer to customers on a day-to-day basis.

Another drawback is that this strategic planning model assumes fairly accurate forecasting and does
not take into account unexpected events. In an uncertain world, long-term forecast cannot be relied

11
upon with a high level of confidence. In this respect, many firms have turned to scenario planning as
a tool for dealing with multiple contingencies.

Planning Cycle:

Assessing planning environment

Data collection and data analysis

Strategy formulation and target setting

Participatory plan formulation

Plan authentication
12
 Task adoptive and plan implementation

Mid term appraisal and correction

Evaluation and replanning

POLICIES
Definition :Policy is defined as a principles that govern actions directed towards given ends; policy
statement 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 government or institutional services.

Health policy :
It refers to the public or private rules, regulations, laws or guidelines that relate to the pursuit to
health and delivery of health services.

Implied and Expressed Policies

1.Implied Policies :Implied policies are neither written not 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 organization.

13
 2.Expressed policies:Expressed policies are donated verbally or in writing. Most organization have
may 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.

Policy decision

According to Mason, Leavitt,chaffee,2002

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

Types of policies :
1. Distributive policies :It extends goods and services to members of an organization, as well as
distributing the costs of goods or services amongst the members of organization. Example include
government policies that impact sending for welfare, public education, highways and public safety or
a professional organization’s policy on membership training.
2. 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 and bad
behavior can be easily regulated and punished through fines.
3. Constituent polices :These create executive power entities or deal wit laws.
4. Miscellaneous policies :Policies are dynamic, they are not just static list of goals or laws. Policy
blue-prints 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.

Impact of policy on nursing :The nurse has an opportunity to make an impact on policies in four
aspects of influence as identified by Talbot and Mason (1988). These are:-

1. Government :Laws, with their accompanying rules and regulations, control nursing practice and
health care.
 Nurses have been more involved in federal and state government, although local governments
provide many health care services.
 Local government control school health programs, local public hospital’s 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 candidate who support nursing and health care issues.
2. Workplace :Over 66% of nurse 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 the nurses.
Through collective action, nurse serving on committees in the institution can help eliminate these

14
 tasks. Nurses successfully practice the policies of change in their place of employment can influence
the type and quality of patient care.
3. Organizations : Important influences include professional organizations such as ANA and many
specialty organizations. The organizations work in a 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.
4. Community :political involvement with community often arises out of one’s own interest in living
and working in community that is supportive of the health and well being of its citizens.

Political vis-à-visnursing profession

Politics :The art or science of winning and holding control over a government. Policies are decisions,
politics is the influence of those decision.

Levels of politics in nursing :

1. Nurse citizen: A nurse citizen brings the perspective 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 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 part. Once nurses make a decision to become involved politically, they need to learn
how to get started. One of the best way is to form a relationship with one or more policy makers.
2. Nurse activists :The nurse activist takes a more role than the nurse citizen. Nurse activities 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 politician :Once the nurse realizes and experiences the empowerment that can come from
political activism, 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 organized skills in
running for office. The nurse politician can:
 Run for an elected office.

15
 Seek appointment to a regulatory agency.
 Be appointed to a governing board in the public or private sector.
 Use nurse expertise as a front line policymaker who can enhance health care and the profession.

Political issues affecting the practice of professional nursing and health care :
1. The patient safety act 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.
 The mean number of patients per RN who is providing direct patient care.
 Patient’s 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 :The 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 illness, especially cancer.

3. The HIV prevention act 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
high risk for domestic violence. As client advocates, nurse must support any legislation that prohibits
access to , or increases the cost of health care for any specific population.

5. The tele health bill of 1997 :Tele health 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 tele health networks in rural areas snd renames the Joint Working Group on Tele health.

6. Working families and flexibility act :It has been traduced to assist parents meet family and work
obligations. This bill proposes that employers compensate hourly rate 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.

16
 Causes of political apathy in nursing :Political apathy in nursing can be attributed to various
factors like:

 Lack of political knowledge :Nurses focus on clinical care and mostly ignore larger issues, partially
due to heavy work and also due to lack of understanding to influence public policies.
 Powerlessness in nursing : Another factors to considered when examining the inactivity of nurses,
in the policy process is gender issue, women who comprise a large percentage of nursing profession
have been suppressed.
 Perceived ethical conflict between professional values and political involvement : Many nurses
consider political activity as a negative behavior.

BIBLIOGRAPHY
 Basher P. sheebeer, khan S. Yaseen,’A concise text book of Advanced Nursing Practice’ Edition first
(2012), EMMESS Medical Publishers. Pp-72-81.

 Gulani k.k, Community Health Nursing (Principles& Practices), Edition Fisst (2005) kumar
publishers, Pp-226, 232-235

 www.uvm.edu.com

17
18