Nursing homework

Contents lists available at ScienceDirect

Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr

Determining if nurses are involved in political action or politics: A scoping literature review

Donna M. Wilson (Dr., RN, PhD) (Professor)a,⁎, Frederick Anafi (RN, PhD student)a, Elizabeth Kusi-Appiah (RN, MN) (Research Coordinator)a, Elizabeth Mirekuwaa Darko (RN, MN student)a, Kali Deck (RN, BN, MN student)a, Begoña Errasti-Ibarrondo (RN, PhD) (Senior Assistant Professor)b

a Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada T6G1C9 b Faculty of Nursing, University of Navarra, Spain

A R T I C L E I N F O

Keywords: Nurse Nursing Nursing association Political action Politics Public policy Literature review Global

A B S T R A C T

Background: There is much current as well as long-standing concern that nurses need to be more involved in and also more adept at politics and political action for the advancement of the profession, and for the health and wellbeing of the public. Objectives: An historical scoping literature review was carried out to identify if, as well as why, when, and how nurses become involved in government or meso-level political action or politics, and what is or has been gained through this involvement. Design: Scoping literature review. Settings (including geographical location): Worldwide published literature. Participant: Nil. Methods: Research and non-research articles on the topic were identified in a decade-by-decade search of the CINAHL database, all relevant ones were retained, and the per-decade findings in them were compared over time. Results: Only 25 research reports, published 1988–2019, were identified. These studies were conducted in a few, mostly developed, countries. They provide a varied picture of nurse or nursing association involvement in po- litical action and policy circles. In contrast, the opinion and theory articles demonstrate increased nurse and nursing association involvement in, as well as rising skill in political action and public policy engagement, although primarily in the United States and Canada. Conclusions: Research and case reports are needed now in all countries to correct the view that nurses and nursing associations are apolitical, and to gain information on how and why nurses and nursing associations become politically active and also determine what is gained through this activity.

For many years, nurses have been thought of, by themselves and others, as apolitical (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014; Benton, Al Maaitah, & Gharaibeh, 2017; Mason, 1990). Yet, some nurses now and in the past clearly have engaged in political action (Fyffe, 2009), with these activities broadly expected “to attain a pur- pose by the use of political power or by activity in political channels” (Merriam-Webster Dictionary, 2019, no page). Moreover, some nurses have been elected or appointed to office, and have therefore gained a direct role in government and thus public policy-making (Hall-Long, 2009). Regardless, there is much current and long-standing concern

that nurses need to be more involved in and also more adept at politics and political action for the advancement of the nursing profession (Schrock, 1977; Wilson, 2002). Moreover, increased political immer- sion and savvy are advised to help nurses meet their professional mandate of working “autonomously and in collaboration with others to enable individuals, families, groups, communities and populations to achieve their optimal levels of health” (Canadian Nurses Association, 2015, p. 5). This imperative is clearly reflected in a statement of con- cern by an American nurse educator:

https://doi.org/10.1016/j.apnr.2020.151279 Received 15 February 2020; Received in revised form 19 April 2020; Accepted 29 April 2020

⁎ Corresponding author. E-mail addresses: [email protected] (D.M. Wilson), [email protected] (F. Anafi), [email protected] (E. Kusi-Appiah),

[email protected] (E.M. Darko), [email protected] (K. Deck), [email protected] (B. Errasti-Ibarrondo).

Applied Nursing Research 54 (2020) 151279

0897-1897/ © 2020 Elsevier Inc. All rights reserved.

T

Table 1 Research Literature Review Findings – Chronological Order by Publication Date.

Author(s) (year published) Country of study

Research study purpose or aim. Findings on: - if and why nurses become involved in political action or politics, - when and how nurses were involved in political action or politics, and - what was gained through this nursing involvement in political action or politics.

Hardy (1988) United States

Historical study of one nursing association's political action to gain federal funding for nursing education, 1952–72.

The American Nurses Association realized in the 1950s that federal funding was needed for nursing education programs. They were consequently active in federal government circles 1952–72 through lobbying and other activities. As a result, support for education was gained over the years (although variable), as well as lessons gained on nursing leadership and political considerations (i.e. learning about the federal political climate).

Gesse (1991) United States

Randomized survey of 600 American nurse-midwives to determine their political participation behaviors. Participants were surveyed by mail; 59.7% response rate achieved.

Voting was their main political activity. They generally believed they could influence government activities, but largely through their professional association.

Hagerty, Bissonnette, Bostrom, Lovell, and Sieloff (1995) United States

Survey of 362 psychiatric nurses in Michigan to explore their political action and politics; 140 participants (38.7%) responded by mail.

These nurses were aware of the need for more nursing involvement in political and healthcare arenas.

Foreman and Monkman (1998) England

Using an evaluative research method, 24 new nurse graduates were surveyed to determine what they knew about politics, leadership development, and political action.

A gap existed between what they knew and what they should know about political/government influences on health.

Antrobus and Kitson (1999) England

Qualitative study using ethnography with a purposive sample of 24 nurse leaders who were interviewed about their views on politics and political successes.

The interviewed nurses knew the involvement of nurses in politics was necessary, but they widely viewed nursing as being impacted by politics instead of nurses impacting policy. Some “effective” nurse leaders were known by them to be actively or actually involved in macro-level political or government spheres.

Chan and Cheng (1999) Hong Kong

Quantitative description study using convenience sampling of 350 undergraduate nurses about their level of political participation and perception of political efficacy; 311 (89%) responded.

There were some positive signs of both political awareness and participation among the respondents; but they generally did not feel nurses had the power to influence government policy. Their personal political activities were mainly confined to voting in general elections. There were no evident attempts to influence politicians.

Williamson and Drummond (2000) Canada

A qualitative approach was used to examine a primary health care component added an existing children's program; a series of education sessions aimed at strengthening parent capacities to enhance their children's health; 10 focus groups were conducted with 65 parents.

This study found the low-income parent abilities to enhance their children's health and manage their children's illnesses were limited by low incomes, inadequate healthcare coverage, and lack of transportation; as well as a lack of knowledge. Nurses were identified as needing to advocate politically for health education and social action strategies that challenge the socioeconomic (i.e. lack of affordable and accessible transportation) and political conditions that negatively affect health equity.

Rains and Barton-Kriese (2001) United States

Qualitative, exploratory study comparing 9 undergraduate nursing and 8 political science students on their political competence.

The nursing students viewed politics as something other people do. However, the nursing students gave many examples of practical activities of nursing activism and involvement in the community, but public policy activism was not identified as a nursing activity.

Cramer (2002) United States

Quantitative study to determine why nurses are not more politically active and savvy; 121 (70%) out of 168 participants responded.

Having free time and personal efficacy were predictors of political activity.

Williams (2002) England

A qualitative study using phenomenology to examine the views of 28 operating room nurses on the quality of the care they deliver at a time when the government was making health system changes.

They generally felt the care quality they provided was at an appropriate level, and they supported the government's policy to ensure high quality care in the health system. Some identified a political need and the opportunity for care improvement, but many felt they lacked the political influence or support to do this.

Wilson (2002) Canada

A descriptive-comparative study to test the theory of Cohen et al. on the political participation of nurses and non-nurses; 9 of 14 interviewed.

The nurses who engaged in this political action did so because they were oriented to the public good while the others acted for personal or corporate gain; all had prepared for and spoke at a government forum. Nurses also collaborated with others. All were pleased that the bill they advocated against was not passed; a major victory.

Olsan et al. (2003) United States

A pilot qualitative study using 5 nursing students to explore if service learning helps develop nursing student political identities.

The course was intended to raise student nurse awareness of the need for and value of nurse involvement in public policy-making. A practicum was set up, where the students worked with a community partner. The students all gained confidence and skills in political action.

Croghan, Johnson, and Aveyard (2004) England

A mixed-method study compared views of 38 school nurses with the expectations of their managers and policy-makers in government, to discover any potential, practical, or ideological conflict. Data included job descriptions, policy documents, interviews, and questionnaires.

Although work issues were present; when asked, these nurses supported the government's new child-centered public health public policy. They felt valued by their clients and by their local and national employers.

Schreiber and MacDonald (2010) United States

A qualitative inquiry using grounded theory done in the socio- political context of American nurse anaesthesia practice to determine how they protected and promoted their profession; 18 were interviewed.

These nurses kept constant vigil, with public credibility maintained through regulatory and educational standards. They also were active in political vigilance and taking action in governmental and policy arenas, and by having a continuous information loop about politics and their profession.

Burgess and Purkis (2010) Canada

A qualitative study using a sampling method to recruit 17 NPs to examine if and how collaboration advanced the NP role integration within primary healthcare services in British Columbia.

These nurses realized the political nature of the NP role and the extent to which NPs relied on collaborative relations at all levels of the health system to advance the NP role integration. To have the NP role initiated in the province, nurse activism was needed, and to ensure

(continued on next page)

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

2

the nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care… Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solu- tions that promote and increase the participation of nurses in the political process and health policy.

(Fyffe, 2009, p. 698)

Since this 2009 assessment of need, it is not evident if nurses in developed or developing countries have become more politically active and/or more adept at politics and political action. Moreover, it is im- portant to recognize, since no systematic literature reviews appear to have been conducted, that Fyffe's apolitical assessment of nurses as a whole may not have been accurate then or even now at this current time. To address this concern, an historical literature review was completed in early 2020 to identify if, as well as why, when, and how nurses become involved in government-level political action or politics,

Table 1 (continued)

Author(s) (year published) Country of study

Research study purpose or aim. Findings on: - if and why nurses become involved in political action or politics, - when and how nurses were involved in political action or politics, and - what was gained through this nursing involvement in political action or politics.

that the role was retained, nurse activism was needed. As a consequence, the NP role was successfully initiated in the province.

Burgess and Sawchenko (2011) Canada

A qualitative study using a participatory action research approach to examine the post-legislation role development of 11 NPs in British Columbia.

A community of practice partnership of NPs and community leaders had developed, with the NPs developing collaborative relationships with people who had power. After the NP role was introduced, a collaborative practice model was used to build collegial and collaborative relationships for power sharing and to shape policy. The model addressed the internal interests and needs of participating NP and other nurse members while attending to the external concerns of the organization, and it contributed to health system improvement.

Burgess, Martin, and Senner (2011) Canada

A qualitative study using participatory action to examine dimensions of NP role integration in the primary health care sector of British Columbia; 17 out of 24 NPs participated.

NPs were introduced in the province in 2005. This NP role integration was linked with the politics of primary healthcare reform and the promise of holistic health-promoting care for individual clients and broader communities.

Sidebotham and Ahern (2011) Australia

Phenomenological study with 18 British midwives and nurses recruited through snowball sampling and direct recruitment to explore reasons for moving to Australia.

The nurses moved to work in Australia mainly because of factors such as disillusionment with their working conditions at home, and unfavorable national politics impacting their nursing work or lives in Britain.

Zhou, Windsor, Theobald, and Coyer (2011) Australia

A qualitative study to examine 28 China-educated nurses and their work integration experiences in Australia.

This study identified a need for government action to prevent societal and workplace racism.

Hyshka, Bubela, and Wild (2013) Canada

A case study of media texts, jurisprudence, scientific evidence, and legislation to examine the role of evidence in political decision making on supervised injection sites.

Supervised injection sites were determined to be within the nursing scope of practice, but court action was thought to be required to establish a stable legal and policy basis for supervised injection facilities across Canada; places where nurses could provide needed care.

El-Jardali et al. (2014) Lebanon

Qualitative case study to explore the use of evidence in policymaking related to the development of a revised nursing practice law in Lebanon, through interviews and a panel discussion; 17 stakeholders involved.

Evidence was not found to be a major factor in supporting and passing a (delayed) new nursing act, the first since the 1960s, to modernize nursing education and nursing work in the country. Personal politician relationships with nurses and many other push/pull factors were responsible instead for the delay in passing this needed bill.

Dorin, Krupa, Metzing, and Büscher (2016) Germany

A quantitative study using insurance claim data to analyze gender- specific disparities in homecare services; data for 2524 persons were used in addition 1031 survey responses from insured participants.

This study revealed a need for more homecare support for older women to help them remain in their own homes, with this study thus revealing a need for political action by nurses to ensure their government addresses this need.

MacDonnell and Buck-McFadyen (2016) Canada

Life history study using a critical feminist lens of four generations of Canadian nurses was done to determine their political interests and abilities; focus groups and interviews were conducted with 40 registered and student nurses.

Each generation had political and other factors that necessitated and promoted nursing activism both inside and outside of the workplace. This historic activism in policy and political venues was thought to have helped shape the transformative potential then and now of nursing.

Waddell, Audette, DeLong, and Brostoff (2016) United States

A case study of an American hospital-based interdisciplinary legislative action interest group that was intended to increase nurse engagement in legislative advocacy.

This study revealed the effectiveness of this group, as members gained a working knowledge of health policy and gained the ability to advocate politically and testify at public hearings. This group's success was based in part on exploring the clinical implications of existing and pending health policies and regulations. Another factor for success was the creation of a feedback loop to inform policy makers about the realities of nursing practice and patient care.

Gunn et al. (2019) 22 OECD countries

A quantitative study of 22 high-income OECD countries, using time- series analysis of data to investigate relationships between gender regimes and gender equality policies.

Using gender as a macro-level determinant, and nursing professionalization indicators, this study found regulated nurse and nurse graduate ratios had averages that differed across the countries, but were highest in earner-carer regimes where gender-equity policies were present. Lowest ones were in traditional family countries where gender-equity was not prominent. Gender equality policies were also influential on education and labour market sectors.

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

3

and determine what is or has been gained through this involvement (if anything). This is a report of the findings reached through a systematic decade-by-decade search for and analysis of published research and other information using the scoping literature review method.

1. Overview of scoping literature reviews

Scoping reviews are typically done to determine the amount and type of research that has been completed on a defined topic or question (Levac, Colquhoun, & O'Brien, 2010). These reviews are also intended to assess the state of existing evidence and identify evidence gaps (Levac et al., 2010). In this way, scoping reviews are like other sys- tematic literature reviews (Arksey & O'Malley, 2005). However, in scoping reviews, research articles are not eliminated from review if research methodological or other quality concerns are identified (Armstrong, Hall, Doyle, & Waters, 2011). In scoping reviews, all types of research reports are retained, and not just randomized control trials or experimental studies as is done with Cochrane reviews (Levac et al., 2010). Instead, the entire body of published research literature is re- tained and assessed, since these reviews are typically focused on a new topic or question that is beginning to gain or needing attention (Whittemore & Knafl, 2005). Moreover, scoping reviews are unique as they can incorporate non-research literature, such as opinion and theory articles, if these will provide additional insights or relevant in- formation (Levac et al., 2010).

For this historical scoping review, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) library database was solely used to identify nursing research and other nursing articles on the topic of political action and public policy engagement. Since the 1940s, CINAHL has been the library database that was designed to meet the educational and information needs of practicing nurses, nurse educators and ad- ministrators, and nursing students. Over 5,300 nursing and nursing- relevant journals are currently indexed in CINAHL. This library data- base was expected to contain much of the research and other literature published to date on the topic of nurses or nursing groups and their political action or policy engagement.

As advised by a university librarian, potential articles to review were identified through an all-years, English-language search of titles and abstracts in the CINAHL database using the keywords/MeSH terms: “politics or political action or political activity” combined with “nurse or nurses or nursing.” This yielded 550 potential articles with abstracts, and when “research” was added as a search team, this narrowed the number to 163 possible research articles published in scholarly peer- review journals for review. After these 163 full articles were read, in a decade-by-decade process, 25 were found relevant for review and re- tained.

A second search and selection process was then conducted, invol- ving a reading of the titles and abstracts of the 387 remaining other potential articles, and then full papers of many, with this done to identify any missed research study reports (none were found), as well as all other papers on the topic of political action or public policy parti- cipation by nurses (46 in total). As the focus of this review was gov- ernment or macro-level political action and involvement of nurses, since public policy and government policy-making is critical to health systems and the health and wellbeing of the public, articles focused on organizational or meso-level and work or micro-level politics or poli- tical action were excluded from review.

As indicated, 25 research reports were identified as relevant for inclusion in this scoping review. Each of these research articles was assessed by one reviewer and then a second independently to identify research findings oriented to if, as well as why, when, and how nurses become or became involved in political action or politics, and what is or has been gained through this involvement. These findings were placed in Table 1 for information organization purposes. This Table facilitated an assessment of the research findings gained for each decade and then a comparison of findings across the decades. Following this, the other

(non-research) identified articles were read in order of publication date and relevant information from them was added to the following decade- by-decade description of research and other findings. This approach permitted a decade-based comparison of research and non-research findings.

2. Findings

The following is a narrative decade-by-decade overview of research findings, with corresponding non-research articles published in each decade included to augment or contrast this evidence.

2.1. Pre-1970

No pre-1970 research or other articles on the topic of nursing po- litical action or policy engagement were identified in the CINAHL da- tabase.

2.2. 1970–79 decade

In the 1970–79 decade, no research reports were identified, but two other articles were relevant for review. The first described the political lessons learned by nurses in Britain through labour unrest, including a strike in the early 1970s (Lewis, 1976). The second highlighted the need for political consciousness among nurses (Schrock, 1977).

2.3. 1980–89 decade

One 1980–89 research article was identified for review. It featured a historical study of the successful involvement of the American Nurses Association in 1952–72 policymaking to gain federal funding for nur- sing education (Hardy, 1988). Rising political aptitude and skills over that time period were reported, as such: “forces internal to the Asso- ciation, such as fiscal stability and membership; leadership, decisions, and actions of the organization and structural units; and (awareness of) political considerations (i.e. the political climate in Congress and the White House)” (Hardy, 1988, p. 205).

Seven other articles with relevant information were also identified in this decade. One focused on the political activity undertaken by the Canadian Nurses Association when they actively and successfully lob- bied the Federal Government in support of the 1984 Canada Health Act (Dick, Harris, Lefman, & Savage, 1986). The six remaining non-research articles focused on the need for nurses to get politically active and gain political acumen; including an article describing an elective course on politics that was designed for American nursing students to develop their political knowledge and skills (Schutzenhofer & Cannon, 1986). In 1986, a call went out for American neuroscience nurses to gain an understanding of policy, politics, and policymaking so they could enter the political area and meet their societal responsibilities as nurses (Hodges & Hardy, 1986). An education-oriented article highlighted how American healthcare policy is shaped to inform and encourage nurses to advocate for a “humane and equitable healthcare system” (MacPherson, 1987, p. 1). Similarly, a 1989 article by American nurses Hinkle and McQuide outlined legislative processes and strategies so neuroscience nurses would be better able to influence legislators (Hinkle & McQuide, 1989) . American nurses were also encouraged in two 1989 articles to develop and use political skills; to help advance practice nurses gain prescribing authority (Harkless, 1989) and for nursing image im- provement (Stanik, 1989).

2.4. 1990–99 decade

In the 1990s, five research reports were identified. These studies all revealed minimal political activity by individual nurses or nursing groups. For instance, Gesse's (1991) survey study focused on the poli- tical participation behaviors of American nurse-midwives revealed

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

4

voting was their main (if not sole) political activity, although they generally believed they could influence government activities but lar- gely through their professional association. Similarly, Chan and Cheng's (1999) survey of nurses in Hong Kong about their political participation and political efficacy found voting was their main political activity, and they did not believe nurses were able to impact government policy. Moreover, Hagerty et al.'s (1995) survey of psychiatric nurses in Mi- chigan revealed their wish for more nursing involvement in political and healthcare arenas. Foreman and Monkman's (1998) survey study of new nurse graduates in England revealed a gap between what they knew and what they should know about political and government in- fluences on health care. Antrobus and Kitson's (1999) qualitative in- terview study of 24 nurse leaders in England also raised questions about the political involvement and political successes of nurses there, since nurses and nursing leadership were widely viewed by them as being impacted by politics, although some “effective” nurse leaders were said to be actively involved in macro-level political or government spheres (Antrobus & Kitson, 1999).

The findings from those five studies contrast markedly with what six other (non-research) articles in this decade indicate. All six were written by American nurses. A 1990 article advised that nurses were openly embracing their political and political action roles, after having viewed these before as dirty and unprofessional (Mason, 1990). An- other early 1990s article reported that nurses and nursing groups were more politically active than ever before (Meyer, 1992). In 1994, Hay- lock advised that nursing's move into politics had been hampered by past traditional female socialization constrictions but recent action against sexism had helped women (and nursing groups) to become a political force (Haylock, 1994); with the American Nurses Association said to have taken a lead in health system reform efforts. Moreover, growing awareness of the importance of macro-level politics was evi- dent, with three papers advising nurse researchers to consider politics when forming research questions, and when collecting data and de- scribing the findings (Maurin, 1990; Miller, 1997; Winter & Lockhart, 1997).

2.5. 2000–09 decade

Seven 2000–09 research reports were identified for review. The findings within these seven studies were varied in relation to demon- strating if nurses in this decade were politically informed or politically active. Williamson and Drummond's (2000) Canadian study revealed nurses needed to become active politically to combat child poverty. A qualitative study found American nursing students viewed public policy as a barrier to their professional work, as compared to political science students who were more informed and articulate about public policy (Rains & Barton-Kriese, 2001). An American study of practicing nurses found free time and personal efficacy were needed for political activity by them to occur (Cramer, 2002). Williams's (2002) study of operating room nurses in England revealed they believed they were performing safe care at the time their government was seeking to simultaneously improve the quality of care and care efficiency within the healthcare system. Wilson's (2002) Canadian study tested a theory of political development by comparing the political action of nurses and non- nurses who collaborated to stop a private members' healthcare bill from receiving government assent; with this study showing nurses alone among the intervening groups and individuals acted for the public good, and not their own personal or corporate benefit. Olsan et al.'s (2003) study revealed service-learning partnerships were effective for raising political knowledge and skills among American student nurses. Croghan et al.'s (2004) study in the United Kingdom of school nurses showed they felt valued by their clients and by their local or national employers, felt positive about their role changes in recent years, and they supported a new child-centered public health role being advanced through public policy.

The 23 other (non-research) articles identified in this decade

similarly demonstrated variable nursing involvement in political or public policy spheres. These articles were mostly written by American nurses. One inspirational article highlighted the experiences of an American nurse's public policy involvement through her having been an elected legislator (Hall-Long, 2009). However, 11 articles written by American, British, or Australian nurses noted the relevance of politics or political action for nurses, and urged nurses or nursing groups to become politically active (Borthwick & Galbally, 2001; Des Jardin, 2001; Wachs & Ennen, 2001; Hewlett, Bleich, Cox, & Hoover, 2009; Hodges, Williams, & Carman, 2002; Johnstone & Kanitsaki, 2009; Madsen, 2009; Maslin-Prothero, Masterson, & Jones, 2008; Milstead, 2003; Rubotzky, 2000; Stevens, 2000). Eleven American articles pro- vided guidance or advice to help nurses become more politically en- gaged and more successful in this action (Abood, 2007; Carnegie & Kiger, 2009; Garey, 2007; Hart & Jacobson, 2000; Kent & Liaschenko, 2004; Long, 2005; McCloskey, 2002; McInnis, 2008; Twedell & Webb, 2007; Whitehead, 2003; Yoho, Sridaromont, Ho, & Decker, 2004).

2.6. 2010–19 decade

Twelve 2010–19 research articles were found relevant for review. The first published was a paper arising from a Canadian participatory action research study that identified the political nature of nurse practitioner (NP) integration in the British Columbia province's healthcare system, including the large extent to which NPs relied on collaborative relations at macro and other levels to advance their role integration (Burgess & Purkis, 2010). Another report of that ongoing study featured a collaborative practice model that helped introduce the NP role in that province; it enabled NP macro and meso-level political involvement through an intention to improve the healthcare system (Burgess & Sawchenko, 2011). A third paper from that study revealed provincial legislation was necessary for NP title protection, provincial funding was needed for universities to initiate NP graduate education programs, and three-year start-up provincial funding was essential so regional health authorities would be able to hire NPs (Burgess et al., 2011). That third research report also highlighted that NPs needed to develop:

collaborative relations, at multiple levels, with managers, clients and community, colleagues, researchers, and policy leaders. Advancing role integration required NPs to cultivate partners at all levels of the health-care system and to be well grounded in the dynamics of change in order to navigate the power and politics of public health care reform… The NP role is decidedly political, be- cause it represents a new way of delivering care to clients and communities.

(Burgess et al., 2011, p. 32)

Two additional Canadian research reports were relevant for review. A case study of the introduction of supervised injection sites in Vancouver, British Columbia, involving an analysis of jurisprudence, legislation, scientific research, and media texts was done to describe the role of evidence in government decision-making (Hyshka et al., 2013). This study revealed supervised injections were within the nursing scope of practice, but court action would likely to be required to establish a stable legal and policy basis for nurse-supervised injection facilities to exist (Hyshka et al., 2013). An historical study that focused on four generations of Canadian nurses, using a critical feminist lens, revealed each generation had political and other factors that promoted nursing activism both within and outside of their workplaces, with this activism in policy and political venues having helped to shape the transformative potential of nursing then and now (MacDonnell & Buck-McFadyen, 2016).

Two American studies in this decade are also notable. One was a grounded theory study of the socio-political context of American nurse anaesthesia practice that focused on how these nurses had protected and promoted their profession (Schreiber & MacDonald, 2010). They

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

5

found the nurses had kept constant vigil, with public credibility main- tained through regulatory and educational standards; they used poli- tical vigilance to take action in governmental and policy arenas, and they initiated and maintained a continuous information loop about politics and their profession (Schreiber & MacDonald, 2010). A case study of an American hospital-based interdisciplinary legislative action interest group found it was effective for increased nurse engagement in legislative advocacy (Waddell et al., 2016). Moreover, effectiveness was revealed as being due to their members' gaining a working knowledge of health policy, and the abilities to advocate politically and testify at public hearings (Waddell et al., 2016). Their success was also said to be based in part on their exploring the “clinical implications of existing and pending health policies and regulations, while also creating a feedback loop to inform policy makers about the realities of nursing practice and patient care” (Waddell et al., 2016, p. 15).

Three reports of research studies in other developed countries were also reviewed. A phenomenological study found British midwives who moved to Australia to work did so because of disillusionment over their working conditions in Britain which arose from unfavorable national political policies that impacted their nursing work (Sidebotham & Ahern, 2011). A study in Australia about the work integration experi- ences of nurses from China revealed a need for government action to reduce or prevent societal and workplace racism (Zhou et al., 2011). A study in Germany, using insurance claim data to analyze gender-spe- cific home-care service accessibility differences, revealed a need for political action by nurses to advocate for more government-funded home-care so older women would be more likely to remain in their own homes (Dorin et al., 2016).

One relevant research report was of an investigation conducted in a developing country. El-Jardali et al. (2014) studied the use of evidence in policymaking related to the development of a nursing practice law in Lebanon, through a qualitative study that involved interviews and a panel discussion. This study found evidence was not used as much as unstructured decision making, with the political environment and power plays between stakeholders instead influential for policy-making (El-Jardali et al., 2014).

A more recent study report featured the impact of gender-equity public policies as a macro-level influence on the professionalization of nursing and the nursing workforce in 22 high-income developed OECD countries over the years 2000 through 2015 (Gunn et al., 2019). That study showed a positive effect of gender-equity policies, not only for nursing, but also for every country's educational system and labour market (Gunn et al., 2019).

Four other (non-research) articles published in this decade focused on nurses or nursing groups and their needed or evident political action. One article described how nursing associations in Canada had been active in communicating their policy platforms and strategies to enable nurses to actively influence the 2015 Canadian federal election out- come (Whyte & Duncan, 2016). American nurses were urged to be more politically active (Clabaugh & Neuberger, 2011), such as by using po- litical action to reduce the incidence of skin cancer (Maguire-Eisen, 2013). American nurses were also advised to use political framing for issue analysis, such as the nurse practitioner scope of practice through actions such as building a stakeholder coalition and having a united voice for legislative solutions (Smith, Buchanan, & Cloutier, 2019).

Another four other (non-research) articles focused on politics and nursing education or nursing research. Smith, Brown, and Crookes' (2015) article advised the need for historical studies to develop the professional identity of nursing, and thus improve an understanding of the social and political contexts that have impacted and could continue to impact nursing practice. Salmon, Browne, and Pederson (2010) discussed the value of using participatory action research as a tool for political activism in Canada. Cioffi (2013) advanced the view that un- dergraduate and graduate nurses in Australia need to be educated to be more political, so their healthcare system can better serve increasingly- diverse population needs. The most recent report featured the value of

the ICN policy leadership development education program for pre- paring “top” nurses to be able to drive policy for improved population health, enhanced health care, and nursing profession advancement (Salvage, Montayre, & Gunn, 2019).

3. Discussion of findings

This scoping review of research and other articles identified through the CINAHL library database was helpful for revealing some nurses and nursing associations in a number of countries have been interested about and also engaged in macro or government-level public policy and political action since the 1970s, if not before. Using only the CINAHL database as an information source may explain the small number of research articles for review, and thus the meager amount of evidence of nursing macro or government-level public policy-related political ac- tion and/or political involvement. Moreover, relatively few other (non- research) articles on that topic were identified in this database.

Consequently, the information gained through this review was in- adequate for determining if, why, and how nurses or nursing groups become involved in macro-level political action or politics, and what is or has being gained through this involvement. A larger future multi- database and online search for published research and other literature is therefore recommended, particularly as many policy journals are not indexed in the CINAHL library database. It is possible though that po- litical action and public policy engagement are not common among nurses and nursing groups, and so have not been the focus of much nursing attention.

Regardless, this decade-by-decade review of CINAHL-indexed lit- erature did reveal an increase over time, since the first publication in 1976, in the number of published research and other reports. This in- crease suggests a rising aptitude among individual nurses and nursing organizations for macro-level political action and government-oriented public policy or political engagement. It cannot be said then that nurses or nursing groups are entirely or predominantly apolitical. Major dif- ferences across countries were apparent however, as American and Canadian nurses and nursing groups appeared to be more advanced in relation to political awareness and engagement. Two global “hot spots” for political action were thus revealed; with nurses in Canada and the United States urged to recognize this capacity and assist nurses and nursing groups within their own country and elsewhere to become more politically engaged and adept at political or public policy work. The leadership of Sigma Theta Tau (2019) in relation to nursing ad- vancement for global health is a current illustration of this advised work.

The timing for these initiatives is opportune, as this review suggests nurses globally are aware of the importance of public policy and also aware of the imperative that they be politically active. Efforts such as the Nursing Now Campaign launched by the World Health Organization and the International Council of Nurses (Nursing Now, 2019) and with 2020 being the International Year of the Nurse (World Health Organization, 2019) are thus highly welcome, as they are well designed and positive initiatives to help more nurses engage in political action. This engagement could mean more nurses and non-nurses will come to recognize that nurses are active politically and that their activism is important and beneficial for public health and wellbeing. To that end, it would be relevant now to recognize nurses who are current or past leaders in “public policy” or “political action.” One of the most obvious is Bethany Hall-Long, an American nurse, who wrote about her work as a legislator (Hall-Long, 2009). She served in the Delaware Senate from 2009 to 2017 and the Delaware House of Representatives from 2003 to 2009 (Wikipedia, 2019).

However, other nurses have been elected to government and so they too have likely been instrumental in actions to influence or initiate public policy. It would be helpful for research to determine how these nurses became interested in and involved in macro-level politics and political action. Another research need is to determine what was

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

6

accomplished by their direct involvement in political or policy circles. Research should also focus on the political involvement of nursing as- sociations and other nursing groups. These studies are needed to clearly and effectively counter the view that nurses are apolitical or politically inept.

One consideration for this future research is that some nurses should start programs of research that are focused on political action and participation. Another consideration is of the research methods that should be used. Some past studies involved a survey of nurses to gain information about their political involvement, thoughts, or knowledge; with these including surveys of student nurses and practicing nurses, as well as nursing managers or leaders. Many of the other reviewed studies were qualitative in design, with interviews and panel discussions or focus groups used to gain evidentiary insight or information from small numbers of people. Some case studies and historical studies were also noted, with these often oriented to determining why and how a public policy was crafted. Two studies used mixed-method approaches to gain both quantitative and qualitative evidence. In the future, all of these study types could gain needed evidence. Studies such as these may be crucial for enabling nursing political successes, particularly success stories that help nurses see political action gains as a possibility. It would also help to learn how common policy courses are now in graduate and undergraduate nursing programs, and what the im- mediate and future impact of these courses are on students.

Hopefully, the future focus of nursing research will be on govern- ment or public policy activism and action, as many of the “political” articles that were rejected from review focused on politics and power in the workplace. In the most recent 2010–19 decade, interprofessional power struggles between nurses and physicians were often featured (Alaçam & Altuntaş, 2017; Andersen, Østergaard, Bendix, & Lorentzen, 2019; Barlow, Hargreaves, & Gillibrand, 2018; Basar & Basim, 2016; Labrague et al., 2017; Lowe, Plummer, & Boyd, 2018; Ware, Bruckenthal, Davis, & O'Conner-Von, 2011). This focus of nursing concern suggests nurses are continuing to establish their autonomous professional responsibilities and roles in the workplace, and potentially also maintain or assert the legitimacy of registered nurses in healthcare systems (Cohen, 2007). This nursing preoccupation over being ac- knowledged and respected for their practice knowledge and skills is likely an outcome of the long-standing hierarchical power of physi- cians. As compared to medicine, a profession mainly comprised of males until recently, nursing has been and continues to be a pre- dominately female profession (Canadian Institute for Health Information, 2018). However, females are increasingly experiencing gender equity (United Nations, 2019). Politicians are increasingly fe- male now; with nurses thus having more opportunity to be elected to government to fulfil direct public policy roles.

Moreover, it is time for nursing to stop what may be a never-ending fight for professional legitimacy in the workplace and healthcare system, and instead focus on making and influencing public policy. It is in this “new” arena that nurses and nursing can be recognized and appreciated for having a unique body of knowledge and a distinct set of professional values that are highly relevant and important to the public. For this change to occur, centers of nursing policy research and political action are advisable. These centers could be situated in universities or nursing associations to help gather nurses with research expertise and with interest in public policy and political action. Centers such as these may be needed to lobby governments to initiate Chief Nursing Officer positions, so nurses are more visible and active in government. Another

focus could be to increase positions for nurses within health depart- ments, so more nurses are directly engaged in policy-relevant work and policy-making.

4. Conclusion

Scoping literature reviews are helpful for revealing what is known about a defined topic or question. This review revealed an increase in research and other articles over time on macro-level nursing policy and political action, but with little overall evidence identified that reveals a clear or sustained interest and commitment among nurses to act poli- tically in government spheres for the public good. Scant evidence was thus found on if, why, and how nurses become involved in macro-level political action or politics, and what is or has gained through this in- volvement. However, it is apparent that some nurses and nursing as- sociations, primarily in Canada and the United States, are politically active. This activity does not appear to be widely recognized, however. This situation may explain why Brokaw (2016) recently said limited nursing participation in public policy or politics is a result of nurses lacking an awareness of its importance. Moreover, Brokaw (2016) said nurses have inadequate skills, little time and resources for involvement, and limited formal policy education. This blanket statement cannot obscure the fact though that this review revealed some individual nurses and nursing groups are politically aware and at times deeply and effectively involved in politics and political action. Nurses have im- portant insights, values, and knowledge of great relevance to public policy. In the future, many more nurses with the aptitudes and skills should be politically active and effective at public policy agenda setting and policy-making. This change is not only important for public health and wellbeing, but also so students and other nurses can be mentored and encouraged to be politically active.

No external funding.

CRediT authorship contribution statement

Donna M. Wilson: Conceptualization, Data curation, Formal ana- lysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing. Frederick Anafi: Data curation, Formal analysis, Software, Validation, Visualization, Writing - original draft, Writing - review & editing. Elizabeth Kusi-Appiah: Conceptualization, Data curation, Validation, Visualization, Writing - original draft, Writing - review & editing. Elizabeth Mirekuwaa Darko: Conceptualization, Data curation, Validation, Visualization, Writing - original draft, Writing - review & editing. Kali Deck: Conceptualization, Data curation, Validation, Visualization, Writing - original draft, Writing - review & editing. Begoña Errasti-Ibarrondo: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing - original draft, Writing - review & editing.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influ- ence the work reported in this paper.

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

7

Appendix A. Prisma figure

References

Abood, S. (2007). Influencing health care in the legislative arena. Online Journal of Issues in Nursing, 12(1), 15. https://doi.org/10.3912/OJIN.Vol12No01Man02.

Alaçam, B., & Altuntaş, S. (2017). Career obstacles faced by female nurse academicians in Turkey. Journal of Nursing Research, 25(5), 353–360. https://doi.org/10.1097/jnr. 0000000000000176.

Andersen, A. B., Østergaard, T., Bendix, H., & Lorentzen, V. (2019). Co-creation of a model for Intersectoral Health Care delivery on type II diabetes - a collaboration between patients, healthcare professionals, and researchers. International Journal of Integrated Care, 2019 Annual Conference Supplement, 19(S1), 1–2. https://doi.org/10. 5334/ijic.s3571.

Antrobus, S., & Kitson, A. (1999). Nursing leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing, 29(3), 746–753. https:// doi/10.1046/j.1365-2648.1999.00945.x.

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3), 315–322. https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=96640888& site=eds-live&scope=site.

Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10. 1080/1364557032000119616.

Armstrong, R., Hall, B. J., Doyle, J., & Waters, E. (2011). “Scoping the scope” of a Cochrane review. Journal of Public Health, 33, 147–150 (doi:pubmed/fdr015).

Barlow, N. A., Hargreaves, J., & Gillibrand, W. P. (2018). Nurses’ contributions to the resolution of ethical dilemmas in practice. Nursing Ethics, 25(2), 230–242. https:// doi.org/10.1177/0969733017703700.

Basar, U., & Basim, N. (2016). A cross-sectional survey on consequences of nurses' burnout: Moderating role of organizational politics. Journal of Advanced Nursing, 72(8), 1838–1850. https://doi.org/10.1111/jan.12958.

Benton, D. C., Al Maaitah, R., & Gharaibeh, M. (2017). An integrative review of pursing policy and political competence. International Nursing Review, 64(1), 135–145. https://doi.org/10.1111/inr.12275.

Borthwick, C., & Galbally, R. (2001). Nursing leadership and health sector reform. Nursing Inquiry, 8(2), 75–81. https://search.ebscohost.com/login.aspx?direct=true&db=rzh &AN=107058447&site=eds-live&scope=site.

Brokaw, J. J. (2016, September 22). The nursing profession’s potential impact on policy and politics. American Nurse Today. https://www.americannursetoday.com/blog/ nursing-professions-potential-impact-policy-politics/.

Burgess, J., Martin, A., & Senner, W. (2011). A framework to assess nurse practitioner role integration in primary health care. Canadian Journal of Nursing Research, 43(1), 22–40. https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN= 104877601&site=eds-live&scope=site.

Burgess, J., & Purkis, M. E. (2010). The power and politics of collaboration in nurse practitioner role development. Nursing Inquiry, 17(4), 297–308. https://doi.org/10. 1111/j.1440-1800.2010.00505.x.

Burgess, J., & Sawchenko, L. (2011). Community of practice: A nurse practitioner

collaborative model. Nursing Leadership, 24(2), 99–112. https://doi.org/10.12927/ cjnl.2011.22468.

Canadian Institute for Health Information (2018). Registered nurses/nurse practitioners. Regulated nurses, 2017. Retrieved from https://www.cihi.ca/en/registered- nursesnurse-practitioners. and report: https://www.cihi.ca/sites/default/files/ document/regulated-nurses-2017-pt-highlights-en-web.pdf.

Canadian Nurses Association (2015). Framework for the practice of registered nurses in Canada 2015. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/ pdf-en/framework-for-the-pracice-of-registered-nurses-in-canada.pdf.

Carnegie, E., & Kiger, A. (2009). Being and doing politics: An outdated model or 21st century reality? Journal of Advanced Nursing, 65(9), 1976–1984. https://doi.org/10. 1111/j.1365-2648.2009.05084.x.

Chan, S. W., & Cheng, B. (1999). Political participation in Hong Kong: A study. Journal of Nursing Management, 7(3), 167–175. https://doi.org/10.1046/j.1365-2834.1999. 00124.x.

Cioffi, J. (2013). Being inclusive of diversity in nursing care: A discussion paper. Collegian, 20(4), 249–254. https://doi.org/10.1016/j.colegn.2012.11.004.

Clabaugh, K., & Neuberger, G. B. (2011). Research evidence for reducing sugar sweetened beverages in children. Issues in Comprehensive Pediatric Nursing, 34(3), 119–130. https://doi.org/10.3109/01460862.2011.593369.

Cohen, S. (2007). The image of nursing. How do others see us? How do we see ourselves? American Nurse Today, 2(5), 24–26. https://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=106152193&site=eds-live&scope=site.

Cramer, M. E. (2002). Factors influencing organized political participation in nursing. Policy, Politics & Nursing Practice, 3(2), 97–107. https://doi.org/10.1177/ 152715440200300203.

Croghan, E., Johnson, C., & Aveyard, P. (2004). School nurses: Policies, working prac- tices, roles and value perceptions. Journal of Advanced Nursing, 47(4), 377–385. https://search.ebscohost.com/login.aspx?direct=true&db=edswsc&AN= 000223349000006&site=eds-live&scope=site.

Des Jardin, K. E. (2001). Political involvement in nursing — politics, ethics, and strategic action…second article in a two-part series. AORN Journal, 74(5), 613–626. https:// doi.org/10.1016/S0001-2092(06)61760-2.

Dick, D., Harris, B., Lefman, A., & Savage, R. (1986). Getting into the act: A Canadian nurse's experience. CNA involvement in the Canada Health Act. International Nursing Review, 33(6), 165–170. https://search.ebscohost.com/login.aspx?direct=true&db= rzh&AN=107556139&site=eds-live&scope=site.

Dorin, L., Krupa, E., Metzing, S., & Büscher, A. (2016). Gender disparities in German home-care arrangements. Scandinavian Journal of Caring Sciences, 30(1), 164–174. https://doi.org/10.1111/scs.12236.

El-Jardali, F., Hammoud, R., Younan, L., Nuwayhid, H. S., Abdallah, N., Alameddine, M., ... Salman, L. (2014). The making of nursing practice law in Lebanon: A policy analysis case study. Health Research Policy & Systems, 12(1), 52. https://doi.org/10. 1186/1478-4505-12-52.

Foreman, K. E., & Monkman, J. (1998). Views of newly qualified nurses on politics, health care and leadership. British Journal of Therapy & Rehabilitation, 5(10), 525–529. https://doi.org/10.12968/bjtr.1998.5.10.14168.

Fyffe, T. (2009). Nursing shaping and influencing health and social care policy. Journal of

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

8

Nursing Management, 17(6), 698–706. https://doi.org/10.1111/j.1365-2834.2008. 00946.x.

Garey, T. D. (2007). Student leadership tracks: A model for nurse anesthesia faculty re- cruitment and retention. AANA Journal, 75(6), 406–408. https://search.ebscohost. com/login.aspx?direct=true&db=rzh&AN=105971180&site=eds-live&scope= site.

Gesse, T. (1991). Political participation behaviors of nurse-midwives. Journal of Nurse- Midwifery, 36(3), 184–191. https://doi.org/10.1016/0091-2182(91)90006-b.

Gunn, V., Muntaner, C., Ng, E., Villeneauve, M., Gea-Sanchez, M., & Choo, H. (2019). Gender equity policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000–2015. International Journal of Nursing Studies, 99(2019), 103388. https://doi.org/10.1016/j.ijnurstu.2019. 103388.

Hagerty, B. M., Bissonnette, T., Bostrom, A., Lovell, B., & Sieloff, C. (1995). The status of psychiatric nursing: Characteristics and perceptions of nurses in the state of Michigan. Issues in Mental Health Nursing, 16(5), 419–432. https://doi.org/10.3109/ 01612849509006943.

Hall-Long, B. (2009). Nursing and public policy: A tool for excellence in education, practice, and research. Nursing Outlook, 57(2), 78–83. https://doi.org/10.1016/j. outlook.2009.01.002.

Hardy, M. A. (1988). Political savvy or lost opportunity? Evolution of the American Nurses’ Association policy for nursing education funding, 1952 to 1972. Journal of Professional Nursing, 4(3), 205–217. https://doi.org/10.1016/S8755-7223(88) 80138-8.

Harkless, G. E. (1989). Prescriptive authority: Debunking common assumptions. Nurse Practitioner, 14(8), 57–61. https://search.ebscohost.com/login.aspx?direct=true& db=rzh&AN=107521120&site=eds-live&scope=site.

Hart, S., & Jacobson, N. (2000). Primer on policy. The legislative process at the federal level. Policy, Politics & Nursing Practice, 1(1), 31–33. https://doi.org/10.1177/ 152715440000100106.

Haylock, P. J. (1994). Commentary on nursing’s new political era. ONS Nursing Scan in Oncology, 3(2), 3. https://search.ebscohost.com/login.aspx?direct=true&db=rzh& AN=107446705&site=eds-live&scope=site.

Hewlett, P. O., Bleich, M., Cox, M. F., & Hoover, K. W. (2009). Changing times: The role of academe in health reform. Journal of Professional Nursing, 25(6), 322–328. https:// doi.org/10.1016/j.profnurs.2009.10.008.

Hinkle, J., & McQuide, P. (1989). Political power for neuroscience nurses. Journal of Neuroscience Nursing, 21(1), 9–13. https://search.ebscohost.com/login.aspx?direct= true&db=edselc&AN=edselc.2-52.0-0024616759&site=eds-live&scope=site.

Hodges, L. C., & Hardy, G. R. (1986). Policymaking, politics, and the neuroscience nurse. Journal of Neuroscience Nursing, 18(6), 338–343. https://doi.org/10.1097/01376517- 198612000-00005.

Hodges, L. C., Williams, B. G., & Carman, D. D. (2002). Taking political responsibility for nursing’s future. Medsurg Nursing, 11(1), 15–24. https://search.ebscohost.com/login. aspx?direct=true&db=a9h&AN=6195021&site=eds-live&scope=site.

Hyshka, E., Bubela, T., & Wild, T. C. (2013). Prospects for scaling-up supervised injection facilities in Canada: The role of evidence in legal and political decision-making. Addiction, 108(3), 468–476. https://doi.org/10.1111/add.12064.

Johnstone, M., & Kanitsaki, O. (2009). Population ageing and the politics of demographic alarmism: Implications for the nursing profession. Australian Journal of Advanced Nursing, 26(3), 86–92. https://search.ebscohost.com/login.aspx?direct=true&db= rzh&AN=105359851&site=eds-live&scope=site.

Kent, R. L., & Liaschenko, J. (2004). Operationalizing professional values through PAC donations…political action committee. Policy, Politics & Nursing Practice, 5(4), 243–249. https://doi.org/10.1177/1527154404269100.

Labrague, L. J., McEnroe, P. D. M., Gloe, D., Tsaras, K., Arteche, D. L., & Maldia, F. (2017). Organizational politics, nurses’ stress, burnout levels, turnover intention and job satisfaction. International Nursing Review, 64(1), 109–116. https://doi.org/10. 1111/inr.12347.

Levac, D., Colquhoun, H., & O'Brien, K. (2010). Scoping studies: Advancing the metho- dology. Implementation Science, 5(69), 1–9. https://doi.org/10.1186/1748-5908- 5-69.

Lewis, S. S. (1976). Nurses and trade unions in Britain. International Journal of Health Services, 6(4), 641–647. https://search.ebscohost.com/login.aspx?direct=true&db= rzh&AN=107757011&site=eds-live&scope=site.

Long, R. E. (2005). From Revelation to Revolution: Critical Care Nurses' Emerging Roles in Public Policy. Critical Care Nursing Clinics of North America, 17(2), 191–199. https://doi.org/10.1016/j.ccell.2005.03.002.

Lowe, G., Plummer, V., & Boyd, L. (2018). Nurse practitioner integration: Qualitative experiences of the change management process. Journal of Nursing Management, 26(8), 992–1001. https://doi.org/10.1111/jonm.12624.

MacDonnell, J. A., & Buck-McFadyen, E. (2016). How activism features in the career lives of four generations of Canadian nurses. Policy, Politics & Nursing Practice, 17(4), 218–230. https://doi.org/10.1177/1527154416688669.

MacPherson, K. I. (1987). Health care policy, values, and nursing. Advances in Nursing Science, 9(3), 1–11. https://doi.org/10.1097/00012272-198704000-00008.

Madsen, W. (2009). Bottom lines: The influence of government funding on 20th century district nursing practice in Australia. Journal of Clinical Nursing, 18(19), 2710–2716. https://doi.org/10.1111/j.1365-2702.2009.02903.x.

Maguire-Eisen, M. (2013). Skin cancer: A growing health problem for children. Seminars in Oncology Nursing, 29(3), 206–213. https://doi.org/10.1016/j.soncn.2013.06.006.

Maslin-Prothero, S. E., Masterson, A., & Jones, K. (2008). Four parts or one whole: The National Health Service (NHS) post-devolution. Journal of Nursing Management, 16(6), 662–672. https://doi.org/10.1111/j.1365-2834.2008.00909.x.

Mason, D. J. (1990). Nursing and politics: A profession comes of age. Orthopaedic Nursing, 9(5), 11–17. https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=

107497297&site=eds-live&scope=site. Maurin, J. T. (1990). Research utilization in the social-political arena. Applied Nursing

Research, 3(2), 48–51. https://search.ebscohost.com/login.aspx?direct=true&db= rzh&AN=107520537&site=eds-live&scope=site.

McCloskey, B. A. (2002). The Controversy Surrounding Stem Cell Research. Policy, Politics, & Nursing Practice, 3(1), 4–13. https://doi.org/10.1177/ 152715440200300102.

McInnis, K. M. (2008). Using the nursing process to determine your candidate in the 2008 elections. Journal of Legal Nurse Consulting, 19(3), 13–16. https://search.ebscohost. com/login.aspx?direct=true&db=rzh&AN=105805756&site=eds-live&scope= site.

Merriam-Webster Dictionary (2019). Dictionary. Retrieved from https://www.merriam- webster.com/dictionary/political%20actiononline.

Meyer, C. (1992). Nursing on the political front. The American Journal of Nursing, 92(10), 56–64. https://doi.org/10.2307/3427030https://www.jstor.org/stable/3427030.

Miller, J. (1997). Politics and care: A study of Czech Americans within Leininger's Theory of Culture Care Diversity and Universality. Journal of Transcultural Nursing, 9(1), 3–13. https://doi.org/10.1177/104365969700900102. Retrieved from https:// search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107244470&site= eds-live&scope=site.

Milstead, J. A. (2003). Interweaving policy and diversity. Online Journal of Issues in Nursing, 8(1), 18. https://search.ebscohost.com/login.aspx?direct=true&db=a9h& AN=16508312&site=eds-live&scope=site.

Nursing Now (2019). Who we are. Retrieved from https://www.nursingnow.org/who- we-are/.

Olsan, T. H., Forbes, R. A., MacWilliams, G., Norwood, W. S., Reifsteck, M. A., Trosin, B., & Weber, M. M. (2003). Strengthening nurses’ political identity through service- learning partnerships in education. Journal of the New York State Nurses Association, 34(2), 16–21. https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN= 106732759&site=eds-live&scope=site.

Rains, J. W., & Barton-Kriese, P. (2001). Developing political competence: A comparative study across disciplines. Public Health Nursing, 18(4), 219–224. https://doi.org/10. 1046/j.1525-1446.2001.00219.x.

Rubotzky, A. M. (2000). Nursing participation in health care reform efforts of 1993 to 1994: Advocating for the national community. Advanced in Nursing Science, 23(2), 12–33. https://doi.org/10.1097/00012272-200012000-00004. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=106993221& site=eds-live&scope=site.

Salmon, A., Browne, A. J., & Pederson, A. (2010). “Now we call it research”: Participatory health research involving marginalized women who use drugs. Nursing Inquiry, 17(4), 336–345. https://doi.org/10.1111/j.1440-1800.2010.00507.x.

Salvage, J., Montayre, J., & Gunn, M. (2019). Being effective at the top table: Developing nurses' policy leadership competencies. International Nursing Review, 66(4), 449–452. https://doi-org.login.ezproxy.library.ualberta.ca/10.1111/inr.12567.

Schreiber, R. S., & MacDonald, M. A. (2010). Keeping vigil over the profession: A grounded theory of the context of nurse anaesthesia practice. BMC Nursing, 9, 9. https://doi.org/10.1186/1472-6955-9-13.

Schrock, R. A. (1977). On political consciousness in nurses. Journal of Advanced Nursing, 2(1), 41–49. https://doi.org/10.1111/j.1365-2648.1977.tb03311.x.

Schutzenhofer, K. K., & Cannon, S. B. (1986). Moving nurses into the political process. Nurse Educator, 11(2), 26–28. https://doi.org/10.1097/00006223-198603000- 00012.

Sidebotham, M., & Ahern, K. (2011). Factors influencing midwifery migration from the United Kingdom to Australia. International Nursing Review, 58(4), 498–504. https:// doi.org/10.1111/j.1466-7657.2011.00916.x.

Sigma Theta Tau (2019). Sigma’s global initiatives. Retrieved from https://www. sigmanursing.org/connect-engage/our-global-impact/sigma's-global-initiatives.

Smith, K. M., Brown, A., & Crookes, P. A. (2015). History as reflective practice: A model for integrating historical studies into nurse education. Collegian, 22(3), 341–347. https://doi.org/10.1016/j.colegn.2014.04.005.

Smith, S., Buchanan, H., & Cloutier, M. S. (2019). Policy framing: A strategy for issue analysis. The Journal for Nurse Practitioners, 15(10), 760–763. https://doi.org/10. 1016/j.nurpra.2019.10.001.

Stanik, J. A. (1989). Individual actions to improve nursing’s image: A step toward sur- passing tomorrow’s expectations. Focus on Critical Care, 16(4), 261–265. https:// search.ebscohost.com/login.aspx?direct=true&db=edselc&AN=edselc.2-52.0- 0024711227&site=eds-live&scope=site.

Stevens, P. E. (2000). A nursing critique of US welfare system reform. Advances in Nursing Science, 23(2), 1–11. https://doi.org/10.1097/00012272-200012000-00003. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh& AN=106993220&site=eds-live&scope=site.

Twedell, D. M., & Webb, J. A. (2007). The value of the political action committee: Dollars and influence for nurse leaders. Nursing Administration Quarterly, 31(4), 279–283. https://doi.org/10.1097/01.NAQ.0000290425.03572.58.

United Nations (2019). Sustainable development goals. Goal 5: Achiever gender equality and empower all women and girls. Retrieved from https://www.un.org/ sustainabledevelopment/gender-equality/.

Wachs, J. E., & Ennen, K. A. (2001). Shaping the Future of Practice through Political Activity: How Nurses Can Influence Health Care Policy. AAOHN Journal, 49(12), 557–571. https://doi.org/10.1177/216507990104901207.

Waddell, A., Audette, K., DeLong, A., & Brostoff, M. (2016). A hospital-based inter- disciplinary model for increasing nurses’ engagement in legislative advocacy. Policy, Politics & Nursing Practice, 17(1), 15–23. https://doi.org/10.1177/ 1527154416630638.

Ware, L. J., Bruckenthal, P., Davis, G. C., & O’Conner-Von, S. K. (2011). Factors that influence patient advocacy by pain management nurses: Results of the American

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

9

Society for Pain Management Nursing Survey. Pain Management Nursing, 12(1), 25–32. https://doi.org/10.1016/j.pmn.2009.12.001.

Whitehead, D. (2003). The health-promoting nurse as a health policy career expert and entrepreneur. Nurse Education Today, 23(8), 585–592. https://doi.org/10.1016/ S0260-6917(03)00097-2.

Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648. 2005.03621.x. Retrieved from https://search.ebscohost.com/login.aspx?direct=true &db=edswsc&AN=000233018700010&site=eds-live&scope=site.

Whyte, N. B., & Duncan, S. M. (2016). Engaging nursing voice and presence during the Federal Election Campaign 2015. Nursing Leadership, 29((4), 19–34. https://doi.org/ 10.12927/cjnl.2016.24986. Retrieved from https://search.ebscohost.com/login. aspx?direct=true&db=edselc&AN=edselc.2-52.0-85032167564&site=eds-live& scope=site.

Wikipedia (2019). Bethany Hall-Long. Retrieved from https://en.wikipedia.org/wiki/ Bethany_Hall-Long.

Williams, M. (2002). Quality in operating theatre nursing: A phenomenological research study. Journal of Advanced Perioperative Care, 1(2), 47–55. https://search.ebscohost. com/login.aspx?direct=true&db=rzh&AN=106848109&site=eds-live&scope= site.

Williamson, D. L., & Drummond, J. (2000). Enhancing low-income parents’ capacities to

promote their children’s health: Education is not enough. Public Health Nursing, 17(2), 121–131. https://doi.org/10.1046/j.1525-1446.2000.00121.x.

Wilson, D. (2002). Testing a theory of political development by comparing the political action of nurses and nonnurses. Nursing Outlook, 50(1), 30–34. https://doi.org/10. 1067/mno.2002.121611. Retrieved from https://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=106956704&site=eds-live&scope=site.

Winter, M. K., & Lockhart, J. S. (1997). From motivation to action: Understanding nurses’ political involvement. Nursing and Health Care Perspectives, 18(5), 244–250. https:// search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107233213&site= eds-live&scope=site.

World Health Organization (2019). Health Workforce. Executive Board designates 2020 as the “Year of the Nurse and Midwife.”. Retrieved from https://www.who.int/hrh/ news/2019/2020year-of-nurses/en/.

Yoho, M. J., Sridaromont, K., Ho, T., & Decker, S. (2004). Student perspectives on the George Mason University 12th Annual Washington Health Policy Summer Institute. Policy, Politics & Nursing Practice, 5(4), 267–271. https://doi.org/10.1177/ 1527154404269101.

Zhou, Y., Windsor, C., Theobald, K., & Coyer, F. (2011). The concept of difference and the experience of China-educated nurses working in Australia: A symbolic interactionist exploration. International Journal of Nursing Studies, 48(11), 1420–1428. https://doi. org/10.1016/j.ijnurstu.2011.05.003.

D.M. Wilson, et al. Applied Nursing Research 54 (2020) 151279

10