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Public Health Nursing Vol. 18 No. 4, pp. 219–224 0737-1209/01/$15.00 q Blackwell Science, Inc.

Developing Political Competence: A Comparative

Study Across Disciplines Joanne W. Rains, D.N.S., R.N., and Paul Barton-

Kriese, Ph.D.

Political activism deserves attention not as an end, but as a Abstract Political activism is one way that nurses care for means. Political activism provides a mechanism to promote individuals and communities, and intervene in the broad range health through the enactment of supportive public policy, of socioeconomic factors influencing health. Though policy advo-

to transform health systems, and to correct reimbursementcacy is a core public health function and a valuable nursing structures that discriminate among providers or recipients.activity, the process of acquiring requisite skills and attitudes Nurses can use political involvement to translate caringfor political involvement is not often explored. What crucial into meaningful actions at organizational, local, state, andexperiences enfranchise nursing students toward future policy federal levels and to intervene in areas where health chal-involvement? What is the student journey toward political compe-

tence? Do nursing students vary from students of other disciplines lenges intersect with the broad socioeconomic issues of the in this process? In-depth interviews were conducted with bacca- day. Political involvement represents a valid and valuable laureate nursing students and political science students who were nursing activity that promotes health and encourages posi- near graduation. Content analysis of interview transcripts re- tive change by modifying sociopolitical, economic, and vealed several themes. Despite rich examples of activism, nursing environmental factors that determine health (Reutter & students viewed public policy as a barrier, and did not see connec- Williamson, 2000). tions between the personal, professional, and political. Nursing

The process of becoming a competent care provider toseemed grounded in application and service, demonstrating by individuals and families, however, has received much moreinvolvement that they could ‘‘walk the walk.’’ Political science scholarly attention than the stages and processes involvedinvolvement originated in theory, and resulted in more articulate in developing political competence. Although Benner’sdiscourse on the subject: they could ‘‘talk the talk.’’ The data (1984) description of the novice, beginner, and expert maysuggest a need for interdisciplinary dialogue, faculty modelling

of political competence, opportunities for students to realize per- translate from practice into policy arenas, different compe- sonal, professional, and political connections, and a concern of tencies and attitudes are needed. Most often, a simple invi- socialization in the context of global citizenship. tation to ‘‘get involved’’ or ‘‘be political’’ comes from

nurse educators, and students are left to make the linkKey words: political competence, policy, activism. between their professional responsibilities and their per- sonal citizenship roles.

The nursing student’s journey toward professionalism, democratic citizenship, and competence in the core public health function of policy work involves many academic and personal experiences. What crucial experiences em- power and enfranchise students toward future public policy

Joanne W. Rains and Paul Barton-Kriese are with Indiana involvement and policy advocacy? Do nursing students University East, Richmond, Indiana. differ from students in other disciplines in this process?Address correspondence to Joanne Rains, Indiana University

This article describes an exploratory research study com-East, 2325 Chester Boulevard, Richmond, IN 47374. E-mail: [email protected] paring undergraduate nursing and political science students

219

Rains, J., & Barton-Kriese, P. (2001). Developing political competence: A comparative study across disciplines. Public Health Nursing, 18(4), 219-224.

220 Public Health Nursing Volume 18 Number 4 July/August 2001

on their political competence. Political competence in the The legacy, mandate, and most importantly, ongoing health-related needs within society, however, continue tocontext of nursing will be discussed, as well as citizenship

in the context of contemporary society. Research methodol- warrant an emphasis on political competence within nurs- ing. ‘‘The pathway to healthy functioning is not exclusivelyogy and findings will be presented, along with implications

for education and practice. or even mainly through the laboratory, but more and more through society and economy’’ (Miller, 1995, p. 346). AsPOLITICAL COMPETENCE IN THE CONTEXT health is increasingly understood as, to a large degree, aOF NURSING function of social, economic, and political factors, nursing can promote health by advocating for public policy thatFlorence Nightingale, Sojourner Truth, Lillian Wald, and

Margaret Sanger represent historical examples of effective takes health consequences into consideration. ‘‘Healthy public policy,’’ as this approach is named, assumes thatpolitical activism that showed the value of nursing’s direct

involvement in politics. They labored politically for healthy health is seen broadly, that socioenvironmental risk factors are addressed, and that the health consequences of publicenvironments, racial equity, better community conditions,

and reproductive health choices because each of these fac- policy on all topics are considered (Reutter & Williamson, 2000).tors significantly influenced health (Leavitt & Mason,

1998). As a profession, nurses have collectively used politi- Public health nursing has embraced these challenges and explicitly emphasizes citizen development and politicalcal expertise to ‘‘open nurse-training schools, organize pro-

fessional associations, and participate in social issues’’ activism. Public health nurse educators appreciate the im- portance of understanding how the political process works(Lewenson, 1998, p. 41).

Contemporary examples of involvement include three and what nurses can do to enhance and safeguard the nation’s health through health policy and healthy publicnurses reelected in 1998 to the U.S. House of Representa-

tives: Representatives Capps from California, McCarty policy. They believe that nursing’s voice is needed in the debate over shrinking resources and the discussion overfrom New York, and Johnson from Texas. The American

Nurses Association Political Action Committee (ANA- access to affordable health care for all. Though exposed to this concept in other clinical rotations, it is in publicPAC) works to help elect officials who support nursing’s

issues and values. Nurses contributed over $1 million in health that nursing students most directly encounter the relationships between multiple socioeconomic factors andelection years 1994, 1996, and 1998 to ANA-PAC, which

helped elect 88% of its endorsed candidates (ANA, 2000). health, as well as the strategies to confront these challenges through policy advocacy (Brydolf, 1996; Ferraro, 1998;ANA-PAC represents one part of an assertive political

voice for nursing, and the ANA also carries this voice into Reutter & Williamson, 2000). If nurse educators—specifically public health nursinglegislative debates and through the publication of docu-

ments such as Nursing’s Agenda for Health Care Reform educators—are to facilitate this developmental process, they must understand clearly the requisite skills and atti-(ANA, 1991) and the Social Policy Statement (ANA,

1995). tudes. Halstead, Rains, Boland, and May (1996) postulated six abilities that characterize a politically aware baccalaure-These examples, however, belie the current relative in-

visibility of the profession, including its contribution to ate nursing graduate. They include the ability to: (1) analyze the profession’s involvement in health care policy deci-health, political action, and political power. Lewenson

(1998) suggested that the invisibility could be explained sions, (2) incorporate global trends in local health issues, (3) understand how various political arenas and processesas a mistaken perception or as a real change. Nursing’s

activism may be undetectable because the public perceives shape health care delivery, (4) influence the various politi- cal arenas and processes, (5) advocate for health-promotingthe nursing profession as conservative, politically unin-

volved, and primarily women’s work; the public assumes policy changes, and (6) commit to work as political activists in the promotion of health. This composite may assist nursethe profession to be minimally involved. It is also possible,

however, that nurses really are less active than in the past. educators to understand and model political competence, and to prepare nursing students to continue the legacy andThe political expertise of early nurse leaders, including

such strategies as ‘‘persuasion, the cultivation of political mandate of policy activism. friendships, letter-writing campaigns, defiance of the law, and harnessing the collective voice of nurses’’ (p. 55), may CITIZENSHIP IN THE CONTEXT OF indeed have declined in the profession. Conger and Johnson CONTEMPORARY SOCIETY (2000) suggested that when nursing narrowed its focus from population care and prevention to individual curing Nursing’s pursuit of political influence is usually set in

the context of professional roles and responsibilities. That(parallel to medicine’s advances and abilities), the profes- sion withdrew socially and politically. framework grounds the action in health, caring, and client/

Rains and Barton-Kriese: Developing Political Competence 221

community advocacy. Though useful, this professional ori- (N 4 8). Eight of the nine nursing students were female; seven of the eight political science sample were female.entation isn’t all that is needed to help student nurses

or novice practitioners find links between the personal, The two faculty researchers conducted individual in- depth interviews, matching nursing students to nursingpolitical, and professional. Understanding political influ-

ence in the context of citizenship is also helpful. faculty and political science students to political science faculty. All interviews occurred when the students were be-The expression of citizenship is unique to each political

culture, but it involves the five following attributes: a sense tween 1 and 3 months from graduation. Interviews were not related to class or program requirements and were struc-of identity (national or multinational), an enjoyment of

rights and benefits, the fulfillment of obligations and duties, tured with the same open-ended questions (see Table 1). All interviews were completed before data analysisaccepting the responsibility to be interested and engaged

in public affairs, and an acceptance of basic values held began. The two investigators performed content analysis of the interview transcripts both individually and together.by most of society (Cogan, 1998). Citizenship involves

a reciprocal relationship between the individual and the The written transcripts of the interviews were read aloud multiple times, and the main ideas or topics were identified.collective that is neither passive nor pessimistic.

Citizenship within the United States currently faces sev- In some sessions, all interviews from one discipline were read consecutively; in another session, the researchers al-eral severe threats. Braungart and Braungart (1998) cited

problems such as increasing pluralism and diversity, which ternated between a nursing and a political science tran- script. Researchers sought emerging themes within andthreaten our unified sense of identity. Low voter turn-out

and declining loyalty to political parties suggest a disaf- between each discipline, with a criterion for inclusion being that a theme was apparent to both researchers.fected citizenry. Lastly, a willingness to serve and sacrifice

for the whole contradicts the American culture of individu- The limitations of this study are those of a qualitative research approach. The nonrepresentative sample wasalism and materialism. Images of rugged individualism and

‘‘pulling yourself up by your own bootstraps’’ pervade the small, limiting generalization of findings. No attempt was made to control extraneous variables like age, family atti-culture. Skepticism toward government and any consolida-

tion of power can be seen as both an American strength tude regarding politics, or prior political involvement. Fi- nally, bias was possible, although the structured set ofand a flaw.

Nurses are called to the American political table in the interview questions was followed systematically to reduce interviewer bias, and, to increase reliability of the students’context of this political culture and these challenges to

citizenship. Certainly, nurses as citizens have, to some answers, the interview was unrelated to program require- ments or course grade.extent, shaped political attitudes and acquired knowledge

through primary and secondary school, family experiences, RESULTSmedia exposure, and community life. But how do under-

graduate nursing education and professional socialization Though the interview was based on the nine questions in contribute to the development of competencies to effec- Table 1, the findings best organized around four more tively influence policy and politics? What is the student journey toward political competence or active citizenship? TABLE 1. Structured Interview Questions On what sources do they base their opinions about public

1. How do you assess the needs and desires of the polity (or thepolicy? How do they live their beliefs as citizens and as community)?a professionals? Does the nursing student experience differ

2. What is public policy?from that of students in other disciplines? In an attempt 3. How does public policy fit into your role as a professional?to begin to address these questions, we conducted a small 4. Are there merits to interdisciplinary collaboration and

exploratory study comparing undergraduate nursing and conversation as it relates to meeting the needs and desires of political science students on their political beliefs and the polity (or the community)? behaviors. 5. Does democratic practice (i.e., citizen involvement, having a

voice/vote, freedom of speech and press) relate to you as a professional? Why or why not?METHODOLOGY

6. How does the academy (or university) foster your democratic citizenship as a nurse (as a political scientist)?This cross-sectional comparative study was conducted at

7. How do you see yourself as a community change agent?a small regional university campus in the Midwest. Clear- 8. What is the role of local government in your professionalance was obtained by the school’s Institutional Review

development?Board. A convenience sample was drawn from two popula- 9. What is the role of local government in the improvement oftions of college students: senior-level baccalaureate nursing

the human condition (i.e., poverty, hunger, safety)? students (N 4 9) and senior-level political science students

222 Public Health Nursing Volume 18 Number 4 July/August 2001

general questions summarized below in the following Their responses again suggest a disconnect, in this case between their personal or social self and their professionalsections. self.

The political science students reported more variety inWhat Are Your Views on Public Policy? the sources of their political opinions and perspectives.

Nursing students tended to view public policy as an inhibi- Unlike the nurses who focused on the expressed needs of

tor or barrier. For example, one described policies as clients, they sought information and knowledge that added

‘‘guidelines that tell me what I can and cannot do’’ (C.O., to who they were as a person and citizen. They listed

personal communication, March 28, 1998). There were media, community colleagues, and work-related exposures

negative comments about policy lagging behind societal to data, policies, or personalities. One student said ‘‘Knowl-

values and stifling public discourse and debate. The con- edge is the most important aspect of policy. When you

cept of policy conjured up images of rigid systems, with know, you have access, and when you have access, you

rules for all to obey. have power. When you have power, you can influence

The nursing students viewed politics as something other policy. When you have policy [that] has gone via this route,

people do. There was a ‘‘disconnect’’ among the personal, you have democracy’’ (B.B., personal communication,

political, and professional. The responses reflected prac- April 10, 1998). The political science students seemed

titioners trained in prescribed procedures, following guide- to maintain a compatibility between perceptions of their

lines, and disinclined to question authority. They displayed professional responsibilities and personal self-image.

a hesitancy in talking about themselves as political beings affecting the community. Even one student whose view of What Ways Do You Exhibit Democratic Actions? public policy was broader than most noted that ‘‘public policy relieves me from the physical burden of such tasks Nursing students provided many examples of practical ac-

tivities of activism and involvement. In many ways they(protecting general public) and places the duty on my spe- cies as a whole’’ (M.E., personal communication, March had been change agents in people’s lives and at collective

levels. Examples included advocacy for families with disa-29, 1998). Even as these students described rich examples of their bled children through testimony at school board hearings,

coordinating a nonfood pantry for HIV-affected families,social action in the community, they didn’t term it political. They ‘‘walked the walk,’’ but didn’t ‘‘talk the talk.’’ and advocating for prevention/screening activities during

committee work that resulted in a change in institutionPolitical science students, in contrast, could ‘‘talk the talk,’’ but were less active in practice and application. They policy. They didn’t take these activities lightly; ‘‘The advo-

cate has to have the passion . . . . Without the passionused rhetoric describing public policy as the workings of democracy in action. They were quite insightful as to the you aren’t convincing anyone. Power comes from that

passion’’ (D.D., personal communication, April 17, 1998).theory of majority and common good, but somewhat cyni- cal about the reality of powerful political influences such In terms of action, they described their goals as improve-

ment of the human condition, promotion of health andas money and self-interest. Though their words were de- scriptive, their community involvement was not as exten- prevention of disease; however, they did not describe these

activities as political.sive as the nursing students. They had not integrated political science theory with an understanding of how to Although the political science students could more

clearly articulate their knowledge and understanding of theapply it. culture of democratic action, they were less likely to have practiced such action. For example, one student describedWhat Are the Sources Upon Which You Base

Your Opinions? the activity of working in the mayor’s office as political activism and involvement; another linked theory to her

The nursing students emphatically credited the people they connection with the local Chamber of Commerce.

served (the clients) as the basis of their public policy prefer- ences. They valued the perspectives and needs of their What Is the Role of the University in Transference of clients, and showed evidence of having listened carefully Citizenship and Political Competence? to the desires, wishes, and concerns of those they were charged to help. One noted that ‘‘the bottom line is having Do educational programs play any role in the socialization

process of professional students and transference of theto have the population’s input’’ (J.D., personal communica- tion, April 18, 1998). Their answers emphasized the per- skills and values associated with citizenship and political

competence? How do students perceive the influence ofspective of the clients, but said little about their personal perspectives. They voiced a desire to empower others to their education?

Three themes emerged in the nursing student responsesspeak and act, or to advocate for those unable to do so.

Rains and Barton-Kriese: Developing Political Competence 223

that credit the university with a positive role in political exploratory study suggest areas for improvement in the transmission of civilization and citizenship. The educa-socialization. The participants clearly understood the uni-

versity’s function in the acquisition of knowledge and tional program for these students had not sufficiently helped them see connections, for example, to see that integrationskills, especially critical thinking skills. Secondly, the expe-

riences afforded in college were seen as providing opportu- of the personal, professional, and political would strengthen their voice and effectiveness. The need for such connec-nities for development. For example, one noted that the

‘‘system’’ fostered citizenship; by learning to navigate the tions has curricular, faculty development, and practice im- plications. Curriculum should provide opportunities tosystem and to use ‘‘all my wits’’ to open doors, she has

learned she ‘‘can do anything’’ (A.R., personal communica- explore the professional, personal, and political continuity or overlap. Faculty need to model personal behaviors thattion, April 2, 1998). Other examples were opportunities in

student government. Thirdly, college, for many, was an allow students to see an example but do not dictate specific political opinions or preferences. Those in the practiceexposure to the ‘‘other.’’ It provided exposure to different

views and perspectives and enlarged their sense of citizen- arena can strengthen nursing’s political voice by linking personal citizenship responsibilities to professional roles.ship beyond their family’s understanding or local traditions.

‘‘The more I’ve studied, the more I see gray areas, not just Students could observe these role models in the practice arena, and societal perceptions of invisibility or uninvolve-people in molds. I look with a more holistic approach and

don’t make moral judgments’’ (J.D., personal communica- ment could be altered. For nursing students to report that they view policy astion, April 18, 1998). Another said her learning included

‘‘a glimpse into alternative thinking’’ (M.E., personal com- a rule and inhibitor, rather than as a liberating mechanism for change and empowerment suggests at least some failuremunication, March 29, 1998).

The political science students were more critical of the in the educational process. Did we fail to communicate these ideas because of a message-error (the intended mes-university, noting that some professors resided in ‘‘the

ivory tower,’’ removed from reality. The list of factors sage didn’t get through) or a sender-error (the faculty have not made the connections or do not model policy advocacy,influencing their political and professional opinions was

more diverse and lengthy than that of nursing students and citizenship, and political competence)? The remedy must correspond to the type of ‘‘error.’’therefore their assessment of the academy’s influence was

more limited. Hahn (1998) defined political participation, political in- terest, and political trust, and, very significantly, differenti- ates between political efficacy and political confidence.DISCUSSION Political efficacy involves a belief in the ability of the system to respond to the needs and will of the citizens,All of the interviewed students appeared to have beginning

perspectives and skills for political involvement. The expe- and political confidence entails a belief in one’s own ability to influence decisions made in groups. Although each ofriential path to that similar reality was different for the

students in nursing than for those in political science. Nurs- these concepts or orientations toward political participation is important, an educational effort to instill political confi-ing seemed grounded in application and service; political

science involvement began as theory. The nursing students dence in each nursing student would strengthen the profes- sion’s collective power and influence.reported greater influence by the university than did their

political science counterparts, who listed a broader range Placing the socialization of nursing students in the broader context of citizenship helps educators understandof contributing factors. Both sets of students would have

benefited by dialogue with colleagues from the other disci- broader challenges. When a cynical citizenry questions involvement, the invitation for professional activism andpline, who were undergoing similar processes, albeit de-

scribed with different terminology. For example, the term responsibility represents a difficult message. If faculty ex- hibit minimal political efficacy, as defined above as belief‘‘polity’’ resonated for the political scientists, although

nursing students used the term ‘‘community.’’ Our findings in the system, the challenge increases. Faculty are called to examine what they believe and model to effectivelysuggest that students and faculty across disciplines would

benefit from dialogue that brings together diverse perspec- assist nursing students to develop political competence. Other changing patterns of citizenship can inform thetives in the political activism context to answer relevant

questions or understand processes. For example, perhaps process of becoming politically competent. Ichilov (1998) noted a trend toward less nationalism and more globaliza-in this situation and through such dialogue, both nursing

and political science could learn to better ‘‘talk the talk tion and toward the use of technological advances to invigo- rate alienated citizens. Both trends complement the needsand walk the walk.’’

The remainder of this article will elaborate on issues of nursing as the profession increasingly emphasizes global health issues and increased use of technology. As citizen-from a specifically nursing perspective. Our data from this

224 Public Health Nursing Volume 18 Number 4 July/August 2001

O. Ichilov (Ed.), Citizenship and citizenship education in aship is understood from a global perspective, faculty can changing world (pp. 98–129). Portland, OR: Woburn.emphasize issues like emerging microbes, transcontinental

Brydolf, C. (1996). Nurses can make a difference by becomingspread of disease, world population issues, nuclear war politically active. Nurseweek (California Statewide Edition),threats, and world ecology and environmental issues. All 9(1), 1, 7, 26.of these issues relate to health and can more easily be

Cogan, J. J. (1998). Citizenship education for the 21st century:emphasized when students perceive themselves as global Setting the context. In J. J. Cogan & R. Derricott (Eds.),

citizens. Additionally, because technology affects every Citizenship for the 21st century: An international perspective aspect of life, learning, and nursing practice, it is natural on education (pp. 1–20). London: Kogen Page. to envision ways it can support political engagement and Conger, C., & Johnson, P. (2000). Integrating political involve- confidence. E-mail communication to lobby officials and ment and nursing education. Nurse Educator, 25(2), 99–103. accessing web-based sources of legislative or governmental Ferraro, G. A. (1998). Forward. In D. J. Mason & J. K. Leavitt information are two examples of the policy-technology (Eds.), Policy and politics in nursing and health care (3rd interface. ed., p. xix). Philadelphia: W.B. Saunders.

Hahn, C. L. (1998). Becoming political: Comparative perspec-Whether nursing educators understand their role as the tives on citizenship education. Albany, NY: State Universityencouragement of good citizenship or the development of New York Press.of political competence, it is an important aspect of the

Halstead, J. S., Rains, J. W., Boland, D. L., & May, F. E. (1996).professional preparation of nurses. The more committed Reconceptualizing baccalaureate nursing education: Out-faculty are as role models and the more deliberate faculty comes and competencies for practice in the 21st century.are themselves in the pursuit of political competence and Journal of Nursing Education, 35(9), 413–416.efficacy, the closer the profession comes to realizing nurs-

Ichilov, O. (1998). Patterns of citizenship in a changing world. ing’s historical mandate and meeting contemporary needs In O. Ichilov (Ed.), Citizenship and citizenship education in through activism and political involvement. a changing world (pp. 11–27). Portland, OR: Woburn.

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