PDF POLICY RESEARCH IN ADVOCACY SUMMARY: REVISION NOTES

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The think tank's practice of advocacy is a gentle art which is proactive, but not so much This overview is not meant to be all-inclusive; there are several other tools studies refer to a study that focuses on a clear policy change and tracks back to The case study above comes from: PLA Notes (), Issue 36, pp​
Table of contents

Isabel Hampton Robb, an early leader in the development of American nursing education, encouraged obedience as the primary activity of the nurse. In Robb stated:. Above all, let [the nurse] remember to do what she is told to do, and no more; the sooner she learns this lesson, the easier her work will be for her, and the less likely she will be to fall under severe criticism.

Implicit, unquestioning obedience is one of the first lessons a probationer must learn, for this is a quality that will be expected from her in her professional capacity for all future time Hamric, , p. While Nightingale expected obedience in following the rules and medical direction, her intent was to allow nurses the autonomy of purpose to advocate for patients and the profession Nightingale, Advocacy is now identified both as a component of ethical nursing practice and as a philosophical principle underpinning the nursing profession and helping to assure the rights and safety of the patient.

Nurses are seen as advocates both when working to achieve desired patient outcomes and when patients are unable or unwilling to advocate for themselves. Since advocacy has been considered a major component of nursing practice - politically, socially, professionally, and academically.


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Despite the seeming lack of a professional focus on advocacy before the early s, it is argued that Nightingale implicitly laid the foundation for nurse advocacy and established the expectation that nurses would advocate for their patients. Nursing is now recognizing how [Nightingale's] ideas and techniques can be useful in the 21 st century. Nightingale did not directly address the concept of advocacy.

She did, however, demonstrate advocacy in exceptional ways throughout her lifetime.

At least 13, letters remain in public archives and private collections. She was the shadow author for a number of official government documents relating to healthcare in the military and the subcontinent of India Bostridge, ; Mawbray, However, they are now publically available. Nightingale was a singular force in advocating for as opposed to with individuals, groups, and the nursing profession.

Her expressions of advocacy grew with age, experience, and public acceptance of her as both nurse and expert. Her significant contributions include her advocacy for egalitarian human rights and for advocacy in her leadership roles. Nursing is now recognizing how her ideas and techniques can be useful in the 21 st century. As a young woman, Nightingale became acutely aware of the unequal status and opportunity provided to men as compared to women in English society.

Stark described the social structure:. Victorian England was a country in the grip of an ideology that worshipped the woman in the home. Women were viewed as wives and mothers, as potential wives and mothers, or as failed wives and mothers. Now, why is it more ridiculous for a man than a woman to do worsted work and drive out everyday in a carriage?

On one hand, assuming the superintendency of this institution had to have been extremely daunting for a woman of 32 entering her first employment. The hospital was a newly acquired facility in poor condition with inadequate furnishings and a poorly trained staff. She reported that in the first month of occupancy she had experienced a gas leak with small explosions, a fight between workmen in the drawing room, a drunken foreman, and the death of 5 patients Verney, On the other hand, it was the opportunity to participate in a healthcare situation under her control that allowed her to create and utilize environmental and patient care standards that were to become foundational to the development of modern nursing Selanders, a.

Her first major concern, however, was a policy held by the Committee stating that only individuals who were members of the Church of England would be admitted to the institution. Nightingale could not accept this position, perhaps because of her liberal Unitarian upbringing and her deeply rooted beliefs in the value of individuals without respect to religious preference. In a private note to her close friend and ally, Mary Clarke Mohl, she airs her frustration, indicating she would leave the post if this disagreement could not be resolved:.

From committees, charities, and schism, from the Church of England, from philanthropy and all deceits of the devil, good Lord deliver us. My committee refused me to take in Catholic patients; whereupon I wished them good morning, unless I might take Jews and their Rabbis to attend to them. Verney, , p. Eventually, she won the battle with the Committee so that patients of all faiths — or no faith — were equally admitted to the hospital Verney, This allowed her to meet the committee members on equal social footing.

Use of personal position and social acquaintances, logic and debating skills, and the development of statistical evidence were tools she would refine and employ over the next fifty years. Nightingale next turned her attention to the development of care standards for patients, including the right to a peaceful death.

The chronically and the mentally ill were often ignored by staff. Nightingale, however, accepted these patients and allowed them to remain as long as she believed that they were benefiting from care despite staff objections. Nightingale never wavered from the idea that a basic human right was high-quality patient care provided by a dedicated nursing staff. Nightingale advocated for patients on a larger stage during her 20 months in Scutari and the Crimea.

These nurses were individually selected for their ability to nurse, the likelihood that they would accept authority, and the expectation that they would remain for the duration of the conflict. Ultimately, many of those selected did not fulfill these criteria. However, Nightingale never wavered from the idea that a basic human right was high-quality patient care provided by a dedicated nursing staff. Following her return to England she established similar operating principles at The Nightingale School at St.

Nightingale again insisted that probationer students be admitted without respect to religious preference Bostridge, The development of educational standards in a tightly controlled environment began to elevate nursing as a respectable profession that provided women with meaningful employment Adern, During her fifty productive years, she continually benefited from the cumulative experiences of Harley Street, Scutari, the Crimea, and her interactions with government officials in determining the potential of nursing.

Her education, social stature, extensive range of acquaintances, and international travel provided essential context, opportunity, and a public voice. Her major contributions to the profession had evolved from leadership of a few at Harley Street and in the Crimea to the professional collective. She was able to explore the potential of a refocused nursing, as opposed to remodeling the status quo. While this was an inaccurate theory, it did focus attention on the role of the environment in relation to illness.

The deplorable conditions at Scutari reinforced this viewpoint, and led to her advocating for the importance of an appropriate environment for the patient both internally and externally. All of these factors are viewed as being within the purview of nursing. Although there is dispute as to the degree that the death rate was reduced in the Crimea, it is undeniable that there was a specific link between the state of the environment and the death rate Small, Nightingale was also a supporter of the sanitation movement in London.

She joined forces with reformers, such as Farr and Chadwick, in advocating for permanent improvements in public health Selanders, c. This emphasis was later extended to her environmental work in India Mowbray, She advocated for educated nurses who had a knowledge base and a specific role in healthcare. Further, she envisioned the extension of nursing as the essential force which would meet the growing healthcare needs in sectors outside of the hospital. This resulted in the development of nursing in the military, midwifery, poor law nursing care of paupers , and nurse visiting public health nursing Baly, This role expansion created a full range of services in and out of the hospital and across the life span, thus further expanding the role and autonomy of the nurse.

Two factors contributed to the success of this change. This allowed families to agree to send their daughters to nursing school, as nursing education was deemed to be in safe surroundings. She wrote prolifically and demonstrated methods that were effective. Her lessons have become the roadmap for future generations. The Table summarizes the major referents defined by Nightingale as essential to nursing practice, education, and research.

Nightingale understood the value of and the methods for achieving visionary leadership. She repetitively utilized techniques which have been developed as the s tairstep leadership development model Figure. The goal of this stairstep leadership development model is to identify a progression of stages through which individuals achieve positive leadership behaviors over time.

This model does not assume that an individual holds a formal leadership position in order to demonstrate leadership; rather, it assumes that all nurses are leaders by virtue of assuming the role of nurse.

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The ultimate goal of this model is that leaders and followers achieve a mutually defined goal with collective purpose and long-term effectiveness Selanders, d. The first three steps of the model identify the progression from novice nurse to someone who is experienced in a specific realm of nursing. This progression may be repeated multiple times as the nurse moves from position to position.

Additionally, it supports the idea that leaders are developed rather than the belief that some have innate leadership capabilities while others do not Broome, Expected outcomes of the model are that an individual ultimately will assume the characteristics of either a transvisionary or transformational leader. Burns , has defined these levels. Transactional leaders tend to exchange valued commodities, such as exchanging work for pay. This is often coercive in nature, and while perhaps effective for the short term, does not achieve long-term results.

Conversely, transformational leaders seek to create long-term or permanent change through the mutual identification of goals between individuals and the organization. The SFM evaluation was primarily backward-looking. It considered the changes that had taken place and looked for evidence that the research had contributed to those changes. It explicitly considered causality, asking if the same outcomes would have been observed without the research activities and outputs, with a methodical assessment of the merits of alternative explanations. The conclusions are plausible and well documented, but they are not conclusive and will not be fully convincing to some.

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Less attention was paid to the inherent quality of the research and outputs; the focus was on whether and how it influenced the policy process. It helped identify reasonable targets within the time and resource scope of the project being evaluated, while still theorising subsequent outcomes and impacts. This provides a partial solution to the problem of time lags.

Theoretical causal links were tested at each stage, marshalling evidence from various sources and triangulating wherever possible. This was easier to do and more successful in the FVC case with its limited geographic and sectoral scope. In addition, it was straightforward to eliminate alternative explanations for the policy change that occurred in that case; the law copied a document produced by the project almost verbatim, so the causality between the research and the outcome was clear. The exercise was valuable as a thought experiment. However, the results were subjective and biased, with only researchers in the room.

Using narratives to impact health policy-making: a systematic review

A similar exercise with broader representation of stakeholders is recommended. In contrast to typical requirements that evaluations should be independent, in these cases involving the researchers in evaluation design and analysis was more conducive to learning. The researchers themselves developed a list of lessons learned and recommendations for future research.

It seems safe to assume that those lessons will be better internalised and applied than a set of recommendations produced by an external evaluator. The approach is still open to potential criticism of lack of independence and objectivity. This is answered, at least in part, by the careful and transparent documentation of methods, the ToC and the results chart. These evaluations had three main audiences: 1 researchers involved in the projects; 2 research managers CIFOR management ; 3 research funders and the broader scientific and development communities.

Each group has different interests and expectations.