Discussion: Nursing and Health Policy in Other Nations NURS 8100
Think for a moment about nurses who relocate because of professional opportunities. How could such a seemingly personal decision have a detrimental impact on global health care? As presented in this week’s Learning Resources, nurse migration is of global concern. In response to this issue, international health care organizations such
as the World Health Organization (WHO) and the International Council of Nurses (ICN) have positioned themselves to craft related policy as a solution. This is just one example of a global nursing policy effort.
There is no health care without mental health care and “access to mental health services is one of the most important and most neglected civil rights issues facing the Nation” (Haffajee et al., 2019). There are two policies addressing mental health in the United States (US), the Mental Health Parity Act (MHPA), enacted in 1996, to eliminate discriminatory insurance practices, and establish the no disparity principle, in health insurance between mental health and general medical benefits. The second was the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 to cover preventative services, mental health screenings and, eliminate the annual and lifetime benefit caps (Busch, 2012). The comparison policy is the Mental Health Act (1983) of the United Kingdom (UK), the main legislation that covers the mental health assessments, treatments, and the rights of these patients. This was amended to the Mental Health Act of 2007 mandating the health professionals, to detain, assess and treat these patients as needed, in the interests of their health, safety, or public safety (Keown et al., 2018).
The mental disorder still has associated stigma in both countries but has improved some. There are some notable differences in the policies: In the US a visit to a psychologist is perceived as routine, however, in Britain, the same visit is a major step, and an admission of an illness, which is still considered shameful, so these mental visits are publicized (Mills & Phull, 2017). This is mostly rooted in Britain’s reserved culture that, if a person is depressed, he should not make a fuss, but get on with it, or simply sort it out, so, these mental patients cannot share this information at work, fearing it would hamper their careers, and, if claiming that the job itself was contributing to that state, could be construed, as an admission that one is simply not up to the job (Mills & Phull, 2017). The U.S. has lesser mental health professionals, about 105 professionals per 100,000 people, while the UK has twice that number of mental health workers.
In the UK, mental health services are available, and free for everyone through the National Health Service (NHS), with both psychiatrists and psychologists being part of the system, however, the consultant-led medical services have an 18-week maximum wait that is mandated by law. To be able to obtain mental health care under the NHS system, patients must be referred to a psychiatric specialist by their General Practitioner (GP), because mental health care is regarded as part of a patient’s overall health care and is approached in the light of their full medical history, with no reported issues or any care denial (Mulvaney-Day et al., 20 19) This applies to all mental patients, except those experiencing mental issues related to drug and, or alcohol abuse, who do not require a referral from a GP to obtain treatment. There is flexibility in the choice of practitioner, and the patients have the right to choose their first mental health practitioner, and if unsatisfied, can opt for a second opinion.
There are still waiting lists for some treatments, like inpatient treatments, but most services are outpatient, similar to the US (Keown et al., 2018). The U.S mental health policies have been described as being in the dark ages because, they were not covered, and it was legal for the insurance companies to completely deny them, just because they could, and. It was only with the passage of the Affordable Care Act (ACA), in 2008, that the U.S system was slightly comparable to the U.K system. The UK system is considered very superior due to easy and free access through primary care, to the US system, because its care access depends on the sick person’s ability to pay, leaving the patients at the mercy of the expensive inaccessible insurance coverage plans.
US citizens in comparison to the UK citizens are among the most willing individuals, to seek mental health treatments, but they are the least likely to report access or affordability issues, which results in high unmet needs. This reflects a limited health system capacity, inability to meet the required needs, with data reporting that the US has some of the worst mental health-related outcomes, the highest suicide rates in the industrialized world, and the second-highest drug-related death rates in the world (Mulvaney-Day et al., 20 19).
Every U K resident has some form of health coverage, even before dissecting mental health services, which is distinctive, and their definition of health coverage includes mental health services. Nothing in the US mental system is free, and the patients solely depend on their insurance, and access to care depends on the affordability of the premiums, hindering much-needed care access. The NHS England expanded access to talk therapies in primary care settings more than a decade ago, through the Increasing Access to Psychological Therapies program. It now has more than 1.4 million patients in the program, served by specialized, nonclinical mental health practitioners, which has been described as the world’s most ambitious effort to treat depression, with reported favorable favorable outcomes (Keown et al., 2018). The US. leaders could learn from the UK, in terms of prioritizing mental health on the policy agenda, initiating interventions to reduce cost, and related access barriers, and overall improving and promoting the availability of community-based needed care.
The World Health Organization (WHO) is a global, technical, and normative agency that encourages research sets standards, and develops a wide range of advisory for governments and other stakeholders in its active Mental Health Division. The WHO through its division of the Plan of Action on Mental Health (PAHO), engages in the development and implementation of programs for the promotion and prevention of mental health systems and services. It then approves and adopts them through the World Health Assembly, an example is the adoption of the Comprehensive Mental Health Action Plan 2013–2020 by the 66th World Health Assembly, with a goal to promote further development of mental health policies across the world (Jenkins et al., 2011). These were broad strategies for mental health promotion, prevention of mental illness, promotion of rights, early childhood programs, life course skills, healthy working conditions, protection against child abuse, and domestic and community violence among others. In its 2001 Report, the WHO, functioned as a catalyst, setting out the rationale, with a broad framework for the development of mental health programmers (Jenkins et al., 2011).
References
Busch S. H. (2012). Implications of the Mental Health Parity and Addiction Equity Act. The American journal of psychiatry, 169(1), 1–3. https://doi.org/10.1176/appi.ajp.2011.11101543
Haffajee, R. L., Mello, M. M., Zhang, F., Busch, A. B., Zaslavsky, A. M., & Wharam, J. F. (2019). Association of Federal Mental Health Parity Legislation with Health Care Use and Spending Among High Utilizers of Services. Medical care, 57(4), 245–255. https://doi.org/10.1097/MLR.0000000000001076
Jenkins, R., Baingana, F., Ahmad, R., McDaid, D., & Atun, R. (2011). International and national policy challenges in mental health. Mental health in family medicine, 8(2), 101–114.
Keown, P., Murphy, H., McKenna, D., & McKinnon, I. (2018). Changes in the use of the Mental Health Act 1983 in England 1984/85 to 2015/16. The British Journal of Psychiatry, 213(4), 595-599. doi:10.1192/bjp.2018.123
Mills, J., & Phull, J. (2017). The Mental Health Act 1983. InnovAiT. 2017;10(11):638-643. doi:10.1177/1755738017727021
Mulvaney-Day, N., Gibbons, B. J., Alikhan, S., & Karakus, M. (2019). Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. American journal of public health, 109(S3), S190–S196. https://doi.org/10.2105/AJPH.2019.305023
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In this week’s learning resources we reviewed how healthcare is provided in various countries impacting the international continuum of care. This international continuum of care has been a topic of interest for centuries, but really pick up momentum as individuals gained access to convenient and fast international travel. Bodenheimer & Grumback (2020) shared that there is no universal design for healthcare delivery. This discrepancy can be a barrier and opportunity for each country to tailor the delivery system to what their population of citizens. For example, social determinants of health are addressed differently in each country. Additionally, various nursing organizations are also focused on the international continuum of care. The International Council of Nursing (n.d.) is focused on several international nursing policies like socio-economic welfare. This is a demonstration of the role of an international organization in developing policy.
I am currently working in collaboration with a university in Rwanda creating curriculum content for a Nursing Leadership and Midwifery graduate level program. I am also an international nursing mentor and am working with students in Rwanda and Kenya on implementing quality improvement projects. The country that I am comparing to the U.S. is Rwanda.
A policy that Rwanda’s Ministry of Health (n.d.) is working on is related to how social determinants of health are addressed. Rwanda is currently rebounding from civil war in the mid 1990’s. In the past several decades they have made significant improvements in address it’s citizens social determinants of health. However, the country has an opportunity to optimize this effort due to persistent extreme poverty, overexploited land, and effects of climate change on housing and healthcare (Government of the Republic of Rwanda Ministry of Health, n.d.). The country’s nursing population is also largely midwives due to lack of providers in the country. Bazirete et. al. (2020) shared how social determinants of health impact maternal mortality and morbidity in rural Rwanda.
Social determinants of health is also a policy that is address in the U.S. The American Academy of Nursing has a policy from 2019 which prioritizes a focus on social determinants of health for nursing (Kuehnert et. al., 2022). We’ve incorporated social determinants of health into screening tools and electronic health records to provide targeted population health to support our existing healthcare system and reduce the burden on resources. Bedside nursing is incorporating social determinants of health into clinical practice by allowing the information to impact clinical decision making for improved health outcomes (Phillips et. al., 2020).
From the comparison between how Rwanda and the U.S. are creating policy around social determinants of health I’ve gained an understanding of how different the social needs of each country can be. Additionally, I’ve gained an understanding that it’s challenging to compare a third world and first world healthcare system. Each country is working with vastly different healthcare resources, infrastructure, and population health needs.
References
Bazirete, O., Nzayirambaho, M., Umubyeyi, A., Uwimana, M. C., & Evans, M. (2020). Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives. BMC Pregnancy and Childbirth, 20(1), 678. https://doi.org/10.1186/s12884-020-03389-7
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.
Government of the Republic of Rwanda Ministry of Health. (n.d.). Policies. https://www.moh.gov.rw/publications/policies
International Council of Nurses. (n.d.). https://www.icn.ch/nursing-policy
Kuehnert, P., Fawcett, J., DePriest, K. N., Chinn, P., Cousin, L., Ervin, N., Flanagan, J., Fry- Bowers, E., Killion, C., Maliski, S., Manughan, E., Meade, C., Murray, T., Schenk, B., & Waite, R. (2022). Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing. Nursing Outlook, 70(1), 10-27. http://doi.org/10.1016/j.outlook.2021.08.003
Phillips, J., Richard, A., Mayer, K. M., Shilkaitis, M., Fogg, L. F., & Vondracek, H. (2020). Integrating the social determinants of health into nursing practice: Nurses’ perspectives. Journal of Nursing Scholarship, 52(5), 497–505. https://doi.org/10.1111/jnu.12584
To prepare:
With information from the Learning Resources in mind, select a U.S. nursing- or health-
related policy.
Search the web and locate a similar policy in another country.
Consider how the two policies are similar and dissimilar.
Was an international organization involved in promoting the policies? If not, should they
have been?
By Day 3
Post a cohesive response that addresses the following:
Post information on the nursing or health-related policies you located including a
reference to the source.
Indicate the country you are comparing to the U.S.
Compare and contrast the two policies. What insights did you gain as a result of this
comparison?
What is the role of international organizations in developing policy? Provide a specific
example.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence
or research.
Share an insight from having read your colleagues’ postings, synthesizing the
information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from
your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after
synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting
perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question
posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting.
Note what you learned and/or any insights you gained as a result of the comments
made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning
Resources and any additional sources.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 10 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 10 Discussion
ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Nursing and Health Policy in Other Nations NURS 8100
Learning Resources
Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical
approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 14, “Health Care in Four Nations”
This chapter compares the health care systems in Germany, Canada, United
Kingdom, and Japan. All these nations offer universal health care; however, they
organize and finance health care in varying ways.
Asadov, D.A., & Aripov, T. Y. (2009). The quality of care in post-soviet Uzbekistan: Are
health reforms and international efforts succeeding? Public Health, 123(11), 725–728.
Note: You will access this article from the Walden Library databases.
The authors discuss why health care initiatives in developing countries, such as
Uzbekistan, are not succeeding, even with international involvement. They suggest
involving regional input and consideration for better success.
Baillie, L., & Gallagher, A. (2009). Evaluation of the Royal College of Nursing’s ‘Dignity:
At the heart of everything we do’ campaign: Exploring challenges and enablers. Journal
of Research in Nursing, 15(1), 15–28.
Note: You will access this article from the Walden Library databases.
This article provides details from a study concerning the Royal College of Nursing’s
campaign to promote dignity in care. The authors focus on two aspects of the
study—“enablers” and “challenges” of providing dignity in care to patients.
Clarke, S. P., & Aiken, L. H. (2008). An international hospital outcomes research
agenda focused on nursing: Lessons from a decade of collaboration. Journal of Clinical
Nursing, 17(24), 3317–3323.
Note: You will access this article from the Walden Library databases.
The authors depict findings from an international nursing survey, which concludes that
nurses work experiences (positive and negative) are remarkably consistent across
countries, regardless of cultural differences. The authors propose that a global effort to
improve the nurses work environments will lead to improved patient care.
Crigger, N. (2008). Towards a viable and just global nursing ethics. Nursing Ethics,
15 (1), 17–27.
Note: You will access this article from the Walden Library databases.
This article discusses global justice and the nursing profession, and proposes five
characteristics to guide global ethics. The author proposes that technology and
business can act as barriers to global justice.
Eckenwiler, L. A. (2009). The WHO code of practice on the international recruitment of
health personnel: We have only just begun. Developing World Bioethics, 9(1).
Note: You will access this article from the Walden Library databases.
The World Health Organization (WHO) has drafted a Code of Practice to encourage
global health care policies. The author focuses on the detrimental impact of health care
professionals migrating from source countries (usually the global South) to destination
countries. The author suggests that WHO could be more specific in the code relating to
stakeholders and shared responsibilities to promote collaboration by all parties involved
in global health care.
Koch, K., Schurmann, C., & Sawicki, P. (2010). The German health care system in
international comparison: A patient perspective. Deutsches Arzteblatt International
107(24), 427–434.
Note: You will access this article from the Walden Library databases.
This article provides information gleaned from a Commonwealth Fund survey on
international health care experiences. The authors report a variation in patient
experiences and satisfaction internationally but German respondents reported less
satisfaction than most countries. German patients tend to be seen by more than one
doctor, and perhaps the reported dissatisfaction can be traced to a lack of coordination
in care.
Lartey, S., Cummings, G., & Profetto-McGrath, J. (2014). Interventions that promote
retention of experienced registered nurses in health care settings: A systematic review.
Journal of Nursing Management, 22(8), 1027-1041. doi:10.1111/jonm.12105
Note: You will access this article from the Walden Library databases.
The authors of this study examine the effectiveness of strategies for retaining
experienced Registered Nurses. Noting the challenges of nursing shortages on a global
scale, the authors explore those factors that could promote the retention of experienced
nurses and suggest new opportunities for fulfilling a sustained nursing workforce.
Tyer-Viola, L., Nicholas, P., Corless, I., Barry, D., Hoyt, P., Fitzpatrick, J., & Davis, S.
(2009). Social responsibility of nursing: a global perspective. Policy, Politics & Nursing
Practice, 10(2), 110–118. doi: 10.1177/1527154409339528
Note: You will access this article from the Walden Library databases.
This article depicts a study that examines nursing, social responsibility, and global
health. The authors focus on concepts such as social justice, human rights, nurse
migration, and nurse education as well as strategies to address these issues.
World Health Organization (WHO). (2010). Managing health workforce migration—The
global Code of Practice. Retrieved from
http://www.who.int/hrh/migration/code/practice/en/index.html
In 2010, WHO created the “Code of Practice on the International Recruitment of Health
Personnel,” which urges a global policy on the recruitment of health care workers that
would result in better global health care outcomes.
International Council of Nurses. (2010). International Council of Nurses. Retrieved
from http://www.icn.ch/
This website provides information from the ICN, an international federation of nurses
associations. The ICN is a global organization, operated by nurses that advocates the
profession of nursing and promotes global health care policy.
Royal College of Nursing. (2011). The Royal College of Nursing. Retrieved
from http://www.rcn.org.uk/
The RCN represents the interests of nurses in the United Kingdom and promotes health
care policy.
Optional Resources
Evans, C., & Ndirangu, E. (2008). The nursing implications of routine provider-initiated
HIV testing and counseling in sub-Saharan Africa: A critical review of new policy
guidance from WHO/UNAIDS. International Journal of Nursing Studies, 46(5), 723–731.
France, C. (2008). The form and context of federalism: Meaning for health care
financing. Journal of Health Politics, Policy & Law, 33(4), 649–705. doi:
10.1215/03616878-2008-012
International Nursing Review. (2009). ICN initiative to fortify health workforce will open
new Centre in Uganda. International Nursing Review, 56(2), 151–152.
Pulcini, J., Jelic, M., Gul, R., & Loke, A. Y. (2010). An international survey on advanced
practice nursing education, practice, and regulation. Journal of Nursing Scholarship,
42(1), 31–39.
Also Read: NURS 8002 Assignment Locating And Critically Analyzing Primary Research Articles
In this week’s learning resources we reviewed how healthcare is provided in various countries impacting the international continuum of care. This international continuum of care has been a topic of interest for centuries, but really pick up momentum as individuals gained access to convenient and fast international travel. Bodenheimer & Grumback (2020) shared that there is no universal design for healthcare delivery. This discrepancy can be a barrier and opportunity for each country to tailor the delivery system to what their population of citizens. For example, social determinants of health are addressed differently in each country. Additionally, various nursing organizations are also focused on the international continuum of care. The International Council of Nursing (n.d.) is focused on several international nursing policies like socio-economic welfare. This is a demonstration of the role of an international organization in developing policy.
I am currently working in collaboration with a university in Rwanda creating curriculum content for a Nursing Leadership and Midwifery graduate level program. I am also an international nursing mentor and am working with students in Rwanda and Kenya on implementing quality improvement projects. The country that I am comparing to the U.S. is Rwanda.
A policy that Rwanda’s Ministry of Health (n.d.) is working on is related to how social determinants of health are addressed. Rwanda is currently rebounding from civil war in the mid 1990’s. In the past several decades they have made significant improvements in address it’s citizens social determinants of health. However, the country has an opportunity to optimize this effort due to persistent extreme poverty, overexploited land, and effects of climate change on housing and healthcare (Government of the Republic of Rwanda Ministry of Health, n.d.). The country’s nursing population is also largely midwives due to lack of providers in the country. Bazirete et. al. (2020) shared how social determinants of health impact maternal mortality and morbidity in rural Rwanda.
Social determinants of health is also a policy that is address in the U.S. The American Academy of Nursing has a policy from 2019 which prioritizes a focus on social determinants of health for nursing (Kuehnert et. al., 2022). We’ve incorporated social determinants of health into screening tools and electronic health records to provide targeted population health to support our existing healthcare system and reduce the burden on resources. Bedside nursing is incorporating social determinants of health into clinical practice by allowing the information to impact clinical decision making for improved health outcomes (Phillips et. al., 2020).
From the comparison between how Rwanda and the U.S. are creating policy around social determinants of health I’ve gained an understanding of how different the social needs of each country can be. Additionally, I’ve gained an understanding that it’s challenging to compare a third world and first world healthcare system. Each country is working with vastly different healthcare resources, infrastructure, and population health needs.
References
Bazirete, O., Nzayirambaho, M., Umubyeyi, A., Uwimana, M. C., & Evans, M. (2020). Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives. BMC Pregnancy and Childbirth, 20(1), 678. https://doi.org/10.1186/s12884-020-03389-7
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.
Government of the Republic of Rwanda Ministry of Health. (n.d.). Policies. https://www.moh.gov.rw/publications/policies
International Council of Nurses. (n.d.). https://www.icn.ch/nursing-policy
Kuehnert, P., Fawcett, J., DePriest, K. N., Chinn, P., Cousin, L., Ervin, N., Flanagan, J., Fry- Bowers, E., Killion, C., Maliski, S., Manughan, E., Meade, C., Murray, T., Schenk, B., & Waite, R. (2022). Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing. Nursing Outlook, 70(1), 10-27. http://doi.org/10.1016/j.outlook.2021.08.003
Phillips, J., Richard, A., Mayer, K. M., Shilkaitis, M., Fogg, L. F., & Vondracek, H. (2020). Integrating the social determinants of health into nursing practice: Nurses’ perspectives. Journal of Nursing Scholarship, 52(5), 497–505. https://doi.org/10.1111/jnu.12584