Policy Advocacy and Nursing Organizations: A Scoping Review

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sj-docx-1-ppn-10.1177_15271544211050611 - Supplemental material for Policy Advocacy and Nursing Organizations: A Scoping Review

Supplemental material, sj-docx-1-ppn-10.1177_15271544211050611 for Policy Advocacy and Nursing Organizations: A Scoping Review by Patrick Chiu, Greta G. Cummings, Sally Thorne and Kara Schick-Makaroff in Policy, Politics, & Nursing Practice

sj-docx-2-ppn-10.1177_15271544211050611 - Supplemental material for Policy Advocacy and Nursing Organizations: A Scoping Review

Supplemental material, sj-docx-2-ppn-10.1177_15271544211050611 for Policy Advocacy and Nursing Organizations: A Scoping Review by Patrick Chiu, Greta G. Cummings, Sally Thorne and Kara Schick-Makaroff in Policy, Politics, & Nursing Practice

Abstract

Policy advocacy is a fundamental component of nursing's social mandate. While it has become a core function of nursing organizations across the globe, the discourse around advocacy has focused largely on the responsibilities and accountabilities of individual nurses, with little attention to the policy advocacy work undertaken by nursing organizations. To strengthen this critical function, an understanding of the extant literature is needed to identify areas that require further research. We conducted a scoping review to examine the nature, extent, and range of scholarly work focused on nursing organizations and policy advocacy. A systematic search of six databases produced 4,731 papers and 68 were included for analysis and synthesis. Findings suggest that the literature has been increasing over the years, is largely non-empirical, and covers a broad range of topics ranging from the role and purpose of nursing organizations in policy advocacy, the identity of nursing organizations, the development and process of policy advocacy initiatives, the policy advocacy products of nursing organizations, and the impact and evaluation of organizations’ policy advocacy work. Based on the review, we identify several research gaps and propose areas for further research to strengthen the influence and impact of this critical function undertaken by nursing organizations.

Introduction

As a profession, nursing has a long history of engaging in advocacy to strengthen and advance the profession, patient care and outcomes, health systems, and public policy. Nursing organizations in particular, continue to serve as critical platforms for policy advocacy—the practice of engaging in political processes to initiate, enact, and enforce structural and policy changes to benefit populations (Canadian Nurses Association, 2020; MacDonald et al., 2012a; Matthews, 2012). While a plethora of extant literature focuses on advocacy within nursing, attention is largely placed on examining strategies to strengthen individual nurses’ advocacy skills at the patient level, with limited attention to advocacy at the policy level (Ellenbecker et al., 2017; Reutter & Duncan, 2002; Reutter & Kushner, 2010; Spenceley et al., 2006). Further, despite recognizing policy advocacy as a fundamental component in meeting the profession's social mandate (Bowman, 1973; Catallo et al., 2014; Duncan et al., 2015), policy advocacy enacted by nursing organizations has been subject to less critical examination. This is an important area of inquiry, as advocacy groups are considered one of the most powerful forces in shaping policy agendas, processes, and outcomes (Gardner & Brindis, 2017; Miljan, 2018).

To strengthen this function of nursing organizations, examining their policy spheres of influence and impact, decision-making processes, and advocacy approaches can be particularly meaningful. While much can be learned from the policy advocacy work of organizations in other disciplines, advocacy organizations are not equal in their ability to influence public policy; some have greater political clout than others (Bryant, 2009). The nursing profession's experience in policy advocacy is likely unique given various historical, social, and political factors (e.g., nursing as a gendered profession, the dominance of medicine, society's perceptions of nurses and nursing); and as a result, we chose to situate the review within the nursing context. Although some literature on this topic exists, no comprehensive review has been undertaken to examine the nature, extent, and range of scholarly work focused on nursing organizations and policy advocacy. To our knowledge, two synthesis papers related to this topic exist: MacDonald et al. (2012a) conducted a scoping review to examine the factors that influence nursing organizations’ priority setting when undertaking policy advocacy, and Benton et al. (2017) conducted an integrative review to examine the differences between regulatory bodies, professional associations, and trade unions. Although these reviews provide a useful overview of specific issues related to nursing organizations’ policy advocacy work, without a comprehensive understanding of the scope of literature that exists, identifying knowledge gaps and areas for further research remains difficult.

The purpose of this review was to fill this knowledge gap by assessing the nature, extent, and range of scholarly work focused on examining policy advocacy undertaken by nursing organizations. Specific objectives included mapping the available body of literature in relation to purpose, time, location, and source; identifying the volume of scholarly work; identifying the ways in which policy advocacy by nursing organizations has been studied; identifying gaps within the literature; and informing the development of additional research questions.

Methods

We conducted a scoping review based on Arksey and O’Malley’s (2005) framework with updated guidance by Levac et al. (2010) and Peters et al. (2020). Given the exploratory and descriptive nature of the research question, we identified that a scoping review would be the most appropriate knowledge synthesis method.

Research Question

The research question that guided the scoping review was: what is the nature, extent, and range of scholarly work focused on examining nursing organizations’ advocacy to influence change at the policy level? Levac et al. (2010) suggest that combining broad questions with a clearly articulated scope of inquiry and defining concepts within the question can be useful to establish an effective search strategy. As a result, we understood policy to be “a statement of direction resulting from a decision-making process that applies reason, evidence, and values in public or private settings” (Skelton-Green et al., 2014, p. 88). This included organizational, nursing, health, and public policy at the local (e.g., state or provincial), national, and global levels. Advocacy referred to “the act of supporting or recommending a cause or course of action, undertaken on behalf of persons or issues” (Canadian Nurses Association, 2017). Nursing organizations referred to regulatory bodies, professional associations, nursing labor unions, specialty nursing practice groups, and nursing student groups at the local, national, and international level.

Search Strategy

A search was conducted in July 2020 with the assistance of a professional librarian. We searched six databases, including CINAHL, Medline, Embase, Scopus, HealthSTAR, and ProQuest, given the broad range of literature focused on the review topic as indicated in an initial cursory search. The basic structure of the search was organized under three concepts derived from the research question including nursing organizations, advocacy, and policy. Based on these concepts, search terms and search strings were developed ( Table 1 ). Subject headings were used and “exploded” when possible to increase the number of relevant papers ( Table 2 ).

Table 1.