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NURS 8100 Discussion Selecting a Policy Analysis Framework

NURS 8100 Discussion Selecting a Policy Analysis Framework

NURS 8100 Discussion Selecting a Policy Analysis Framework

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Policies form a critical part of any professional body as they have a substantial influence on how the activities are run and the directions which the operations take. One such area is nursing. Policy making is an area of interest in nursing as it influences the nature of care offered to patients and how the nurse professionals operate within the care settings (Rasheed et al., 2020). The implication is that nurses should be up to date with current policies that directly impact or affect patient care, the nursing profession, and nursing activities. Nurses can ensure this by participating in various policy issues and advocacy processes. Therefore, the purpose of this assignment is to analyze a policy issue. Various aspects will be discussed, including the policy definition, application of a policy analysis framework in exploring the issue, policy options or solutions, and building a consensus.

I appreciate your post and thoughtful points. Nurses should have a voice in politics because we are in the trenches and since we are firsthand witnesses have the best voice to not only policies that will affect nursing and healthcare but also to patient care. Haidrani (2017) interviewed a nurse practitioner who has been involved in policy making changes and she reports that it not only has increased the vision of nurses but has expanded her view as well. True initially when entering into this foreign world of politics it may seem difficult but there is no better way to learn than to get into the thick of it. Nurses have a duty to advocate for patients and nurses (and healthcare) alike.

Part One: The Policy Issue

Currently, there are various policy issues in the area of nursing which directly impact patient outcomes and the nurses’ working environment. One of them is the nursing shortage. The issue of nursing shortage has existed for years and, surprisingly, is still a policy issue to date. A nursing shortage is a case where the available nursing professionals like registered nurses can not adequately fill the available professional slots implying that the demand has exceeded the supply (Haddad et al., 2022). The nursing shortage has been shown to lead to various undesirable impacts such as increased rates of mortality and morbidity as well as higher cases of medical errors.

This issue has affected the policy arena for decades, with legislators participating in the law-making processes geared toward reducing nursing shortages (Haddad et al., 2022). In addition, various lobby groups and nursing professional organizations have been advocating for an increased number of nursing staff for better nurse-to-patient ratios. Currently, there are politics surrounding the issue. For example, one of the major discussions has been expanding the expansion of nursing roles to reduce nursing shortage (Marć et al.,2019). While some argue that expansion of the nursing roles would be key to reducing nursing shortage, others argue that such expansion may put the patients at risk since nurses are not well equipped or trained to handle some patient care services.

As earlier discussed, the nursing shortage has been a policy issue for some time now and has attracted various stakeholders such as healthcare professionals and legislators. The latest attempt to solve the problem through policy-making and process came recently when the legislation titled the build back better act which was an initiative by President Biden. As part of this legislation, there was a provision for the nursing workforce (Peter, 2022). The proposal was to invest about $5 billion in nursing care and the nursing workforce in the next decade. Specifically, $500 was proposed to be used in the expansion of the nurse corps program, which offers scholarships and also helps in repaying student loads for APRNs and RNs to encourage more to go for the nursing course. Another $170 million would be used to grow and diversify the perinatal nursing workforce. Other funds would go to schools of nursing to help them in developing, disseminating, reviewing, and evaluating health professional training and increasing the staffing levels for the nursing homes (Peter, 2022). This policy proposal recently received a major obstacle when Senator Joe Manchin stopped supporting the bill alleging failure to match the preferred cost, hence retracting his support. Such opposition halted the bill, but President Biden indicated that the government would continue deliberating on how the bill could be brought back to ensure its implementation.

Part 2: Analysis Using a Policy Analysis Framework

Policy frameworks are key in analyzing policies in several contexts. One of the most common policies is the centers for disease control’s policy analytical framework. According to this theory, analysis of an issue can be done using four major steps. The steps include problem or issue identification, identification of a suitable policy solution, identification and description of policy options, and formulating a strategy that can be applied to fully adopt the policy solution (“CDC,” 2020). Therefore, this framework can be used in the analysis of the policy in various contexts such as social, ethical, legal, historical, and economic/or financial. The first and the second steps in the framework are key in analyzing the policy issue. The social context of the issue is that the nursing shortage is closely connected to various social issues. For example, an inadequate number of nurses potentially lead to poor rehabilitation of individuals such as those who have been impacted by drug and substance abuse, nursing services to individuals who have faced violence, and even survivors of natural calamities.

Nursing shortage as a policy issue also has an ethical context. For example, it is ethical that patients access equitable patient care and get appropriate nursing services. However, an inadequate number of nurses negatively impact access and the nursing services, an indication that appropriate strategies should be used towards solving the problem (Marć et al.,2019). One of the adverse impacts of nursing shortage is medical errors; the medical errors can be deadly to patients and also increase healthcare costs. When medical errors occur, a possibility is that patients may sue the healthcare institution hence damaging the institution’s image.

The historical context of the policy issue. As earlier indicated, the nursing shortage has been an issue for years and has been caused by factors such as perceived poor working conditions, the desire by nurses to move on and seek greener pastures, nurse burnout, and an increase in the number of the aging population which needs more care. Therefore, there have been attempts to formulate legislation with the major aim of fighting it. It is worth noting that, from a historical point of view, it is not possible to narrow down on a single causative factor since the problem of nursing shortage is complex.

The problem of nursing shortage also has a financial or economic context. As earlier discussed, nursing shortage results in various undesirable impacts (Marć et al.,2019). For instance, medical errors have been associated with a nursing shortage as nurses have to attend to more patients within a time schedule. Such a requirement leads to fatigue and burnout, which offers a ground for medical errors. These errors are costly. For instance, the errors cost up to $20 billion every year in the USA, showing how expensive it is. Correcting the problem attracts a lot of money, as revealed in the recent bill, the build back better bill. It is evident that more funds are needed for training nurses, offering nursing scholarships, and developing nursing programs that align with the current market demands to help ease the problem.

The policy also has theoretical underpinnings. While the policy had several aspects included, a huge part of it was focused on nursing care and the nursing workforce. This aspect majorly aimed to improve the patient-nurse ratio by using various initiatives and increasing funding that can then be used to implement these programs. One of the theoretical underpinnings of the policy is that an increase in the number of the nursing workforce would improve the nature of patient care services, especially after the Covid-19 pandemic, which saw the need for nursing services substantially rise. Another underpinning has been drawn from Jean Watson’s theory, especially offering patient care through a holistic approach (Watson & Woodward, 2020). It is important that nurse offer affection and cares to patients, and these are only possible if the management ensures that there is appropriate staffing. Adequate staffing ensures that the nurses are able to offer holistic care to patients without burnout, hence appropriate patient outcomes.

There are various stakeholders of interest in this policy. Among them are nurses who are directly affected as an increase in funding for scholarship and training would improve the nursing workforce hence better outcomes. The other stakeholders include patients who would have improved access to care (Jarrar et al., 2018). The next stakeholders include legislators, both democrats and republicans, nursing training institution leaders, and other healthcare professionals. The importance of the issue means that there are nursing position statements regarding the issue. For example, during the covid-19 pandemic, the American Nurses Association indicated that they are the severe nursing shortage is of deep concern and is likely to have considerable impacts on the nursing profession and the healthcare delivery system. These will eventually impact negatively on the nation’s health. They, therefore, called for it to be called a national crisis.

Part 3: Policy Options/Solutions

The issue of nursing shortage can be solved through various levels, including no change, partial change, and maximum change. It is evident that the first level is not a good option for this issue as adjustments are needed to ensure that the problem of nursing shortage is solved. As such, partial changes can be made to the existing strategies. One of the possible solutions is to establish more nurse training institutions to ensure that more individuals enroll in the course. This will go all the way toward reducing the shortage. Another solution is increasing funding and scholarship opportunities for nursing, which would encourage more to register for the course (Harris, 2019).

This problem can also be solved using radical change. This radical change may come in the form of developing a new curriculum for the nursing course (Chan et al.,2019). This may involve integrating course content that focuses on offering care to a particular group of patients, such as the older population and the children. This will call for specialization when the nurses train. Specialization can be a major step to ensuring that nurse training registration goes up. Specializing from the first year of training can be key in encouraging more nurses to register for training hence helping to solve the problem of nursing shortage. The theoretical underpinnings of the policy options or solutions are those of the system theory. Open systems theory suggests that organizations are ordered in nature, and every part of the system is correlated to the other, and they work to achieve common goals. Therefore, the suggested solutions mean that nurses, as part of the healthcare organizations, are a critical part, and so increasing their number will help improve patient outcomes by improving patient to nurse ratio.

The proposed solutions have leadership and health advocacy requirements. Establishing more nurse training institutions means that more nurse leaders have to be trained to take leadership at the new training institutions. Again more nurse educators have to be trained to ensure there is enough personnel to train the nurses. Health advocacy for this solution would involve influencing nurse legislators to formulate and support legislation that would support the establishment of new institutions to improve the nurse staff numbers (Turale & Kunaviktikul, 2019). Increasing funding and scholarship opportunities also require advocacy in terms of suggesting policies that would help ensure that every state has a structure that offers more funding and scholarship for nurses.

Formulating and establishing a new curriculum for nurse training is a radical change that requires more leadership requirements. For example, leaders have to put in place a framework for identifying individuals that can lead in the curriculum change; such individuals need to have appropriate leadership qualities, nursing knowledge, and knowledge regarding current trends in nursing. In terms of health advocacy, nurse organizations will have to take an active part in ensuring that the new curriculum has appropriate content (Chan et al.,2019). Therefore, they will have to propose the content they feel should be part of the new curriculum and forward that to the new committee. They can then try to present their case in a bid to influence the outcomes and implementation process.

The options also offer opportunities for patient inter-professional collaboration. For example, establishing new nursing institutions would call for collaboration between the nursing profession and educators who would help in offering educational leadership. Again, financial experts will be brought on board to help advise on the financial viability of establishing each institution. Offering more funding and scholarship to nurses would mean more would be registered for nurse training. Therefore, other healthcare professionals can be brought in to help train the nurses in specific areas. Establishing a new curriculum will also offer an opportunity for inter-professional collaboration with curriculum development experts (Chan et al.,2019). Doctors may also be brought along to suggest possible courses which can help improve the nursing profession in a bid to reduce the nursing shortage.

Each of the suggested options has pros and cons. Establishing new nursing institutions can have the advantage of improving nurse trainees’ registration. However, the cost could be high due to the need to build new structures and acquire new equipment. However, it will be effective and efficient in increasing the number of nurses hence lowering the shortage. The option is feasible since the funding can be sourced. Increasing funding and scholarship for nurses may also be costly, but it will be effective and efficient in improving nurse enrolment hence lowering nurse shortage (Marć et al., 2019). This option is less feasible due to the fact that the healthcare system cost is already high, and it would only stretch it more. Curriculum change may have the advantage of aligning the nurse skills with the current and emerging patient requirements. It may be less costly. However, it will take a long time to implement. This option will also be effective and efficient. In addition, it will be feasible through a curriculum development committee.

Part 4: Building Consensus

Consensus building is key in reaching an agreement on a particular issue as appropriate. Therefore, in implementing the solutions, various steps will be taken to build consensus. The stages will entail problem definition, which in this case, in nursing shortage in the context of patient care, participant identification, and recruitment then follow (Ball, & Griffiths, 2021). This will involve bringing in interest groups, nurse organizations, and other professional bodies. The convening will then follow, which involves securing funds as the main aspect. Process design will then follow, which involves consideration of the proposed three solutions and evaluating them. Agreement approval and implementation eventually follow.

Conclusion

Policy issues exist in every society and may involve several steps that need to be considered for better solutions. This write-up has considered nursing shortage as a policy issue, and various considerations have been studied. Establishing more nurse training institutions and securing more funding for nurse scholarships and new curricula can be key to solving this problem.

References

Ball, J. E., & Griffiths, P. (2022). Consensus Development Project (CDP): An overview of staffing for safe and effective nursing care. Nursing Open9(2), 872-879. https://doi.org/10.1002/nop2.989

CDC (2020).policy analytical framework. https://www.cdc.gov/policy/analysis/process/analysis.html#:~:text=The%20policy%20analytical%20framework%20(Figure,policies%20that%20can%20improve%20health

Chan, Z. C., Cheng, W. Y., Fong, M. K., Fung, Y. S., Ki, Y. M., Li, Y. L., … & Tsoi, W. F. (2019). Curriculum design and attrition among undergraduate nursing students: A systematic review. Nurse education today74, 41-53. https://doi.org/10.1016/j.nedt.2018.11.024

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Harris, J. (2019). Challenges of nursing faculty retention. The Midwest Quarterly60(3), 251-270. http://www.pittstate.edu/engl/midwest.html

Jarrar, M. T., Rahman, H. A., Minai, M. S., AbuMadini, M. S., & Larbi, M. (2018). The function of patient‐centered care in mitigating the effect of nursing shortage on the outcomes of care. The International journal of health planning and management33(2), e464-e473. https://doi.org/10.1002/hpm.2491

The goal of policy analysis is to provide in-depth, relevant, and evaluative information about a policy. Using a framework as a guideline for the analysis provides scaffolding for logically and carefully considering the policy issue. To select a framework, one should consider the focus of the policy being analyzed and whether the policy is intended to be predictive or prescriptive. For this Discussion, you will choose a policy issue that is important to you and after evaluating the frameworks described in the Learning Resources, select the framework most appropriate for analyzing the issue.

Also Read:

NURS 8100 Discussion Agenda Setting

NURS 8100 Discussion Unintended Consequences of Health Care Reform

NURS 8100 Staying Current Online Resources

NURS 8100 Describe One or More Conditions or Challenges Specifically Related to the Passing of the PPACA

NURS 8100 With Posting Instructions in Mind, Select Either the Individual Mandate or Accountable Care Organizations as the Focus of your Discussion This Week

NURS 8100 Identify a State or National Politician (State Representative or Legislator, Senator, Congressman, Governor, etc.), or Aide, Whom You would Like to Interview

To prepare:

Reflect on your understanding of the policy process: how policy is formulated, adopted, implemented, and evaluated.
Review the various frameworks presented in this week’s Learning Resources and consider how they are applied to nursing and health policies. How do they assist you in understanding and shaping policy?
Brainstorm a list of the issues that are most important to your practice (these can be issues at the institutional, local, state, national, or international level). Then identify a specific nursing or health care policy related to one key issue, and consider which of the frameworks you would use to examine the issue.

Note: You may not select the Patient Protection and Affordable Care Act for this analysis.

By Day 3

Post a cohesive response that addresses the following:

Identify the policy you have selected.
Describe the framework that you would use for this particular issue, and provide your rationale.
At what other stages in the policy process might an analysis framework provide guidance?

Read a selection of your colleagues’ postings.

By Day 6

Respond to at least two of your colleagues selecting postings for which you have an alternative framework suggestion and explain how that framework might affect the analysis.

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.

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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 4 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 4 Discussion

Name: NURS_8100_Week4_Discussion_Rubric
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List View

Excellent Good Fair Poor

RESPONSIVENESS TO DISCUSSION QUESTION

Discussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

CONTENT KNOWLEDGE

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.

CONTRIBUTION TO THE DISCUSSION

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

Points Range: 0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
Total Points: 30

The selected policy is the implementation of state agency worksite wellness programs, as directed by Texas Government Code, Section 664.053. The health of state employees affects the state’s healthcare expenditures and the productivity of state agencies. For example, obese individuals cost employers an average of $5,555 per year in covered medical, sick days, short-term disability, and workers’ compensation claims combined, whereas the average cost for an employee of recommended weight is $3,839 per year (Texas Department of State Health Services, 2020). Texas Government Code, Section 664.053 requires the Texas Department of State Health Services (DSHS) to designate a statewide wellness coordinator to create and promote a model wellness program for state agencies. The statute also directs DSHS to study the implementation and participation rates of state agency worksite wellness programs and report the findings to the Legislature biennially. In 2020, DSHS conducted two surveys, one asking agency wellness liaisons from across Texas state agencies about wellness programs at their respective worksites, and a second asking state employees about their use of wellness-related resources. Of the wellness liaisons surveyed, 65 out of 188 responded to the survey (a 35 percent response rate). Of the responding wellness liaisons, 99 percent reported that their agency has a wellness policy and 55 percent reported a wellness plan that involved implementing activities. However, 46 percent of liaisons reported their agency did not have a wellness budget. Most wellness activities implemented among state agencies required minimal resources so as to work within limited funds, time, agency size, and space. A total of 5,840 state employees out of 145,645 responded to the survey (a 4 percent response rate). A majority of respondents found wellness services and benefits useful but are not aware of the breadth of opportunities available. This indicates more work is needed to raise awareness of these benefits. DSHS leadership and the Statewide Wellness Coordinator will continue to provide technical assistance to wellness liaisons as they implement wellness programs at their agencies. They will also carry out statewide initiatives that align with the objectives of the model wellness program, Work Well Texas (Texas Department of State Health Services, 2020).

The framework is John Kingdon’s multiple streams theory. John Kingdon’s Agendas, Alternatives, and Public Policies advance theoretically by proposing a differentiation between the concepts of governmental agendas and decision agendas. The agenda is the list of subjects or problems to which governmental officials, and people outside of government closely associated with those officials, are paying some serious attention at any given time. For the author, an issue is placed on the governmental agenda when it catches the attention and the interest of policymakers. Kingdon expands the set of actors related to agenda-setting, considering not only decision-makers within the state but also individuals and groups related to them. In addition, given the complexity and the volume of questions facing policymakers, Kingdon reminds us that only a few issues are seriously considered within the governmental agenda at any given time. These issues correspond to the decision agenda: a subset of the governmental agenda where issues are ready for an active decision (Capella, 2020). In the highly competitive agenda-setting process, few issues move from the government agenda to the decision agenda. In his words, we should also distinguish the governmental agenda, the list of subjects that are getting attention, and the decision agenda, or the list of subjects within the governmental agenda that are up for an active decision. Kingdon explains how agendas change from time to time, proposing an explanatory model organized around three streams, the problems stream, the policy stream, and the political stream. The multiple streams model proposed by the author seeks to analyze the pre-decisional stages of the policy process by explaining policy formulation through three streams connected by a public policy entrepreneur who plays an important role when windows of opportunity make changes possible (Capella, 2020).

The policy is in the implementation stage. DSHS will focus on implementing statewide initiatives that align with the objectives of the model wellness program and will continue to support wellness liaisons as they implement related activities in their agencies. Additionally, DSHS plans to initiate demonstration projects at state agencies that currently do not participate in wellness programming. Such projects may include promoting lactation support policies, partnering with cafeteria/vending operators to increase healthy food options in state buildings, and maintaining annual initiatives such as the fitness challenge and wellness conference. Evidence-based, ready-to-implement activities will decrease the time and effort other agencies need to spend developing their own activities. State agencies would only need to make minor logistical changes to integrate activities into their system. Finally, through ongoing collaboration with the Employees Retirement System of Texas (ERS), DSHS will continue to address state-level issues related to improving employee health, raising awareness of available benefits, building wellness infrastructure across all agencies, and providing resources and technical assistance.

References

Capella, A. C. N. (2020). Policy agenda-setting studies: an overview of Brazilian research. Revista de Administração Pública54, 1498-1512.

Texas Department of State Health Services (2020). Implementation and Participation in State Agency Worksite Wellness