C159-POLICY, POLITICS, AND GLOBAL HEALTH
PERFORMANCE ASSESSMENT
THE OBJECTIVE OF THE PERFORMANCE ASSESSMENT
For this assessment, you will develop a specific plan to advocate for policies that improve the health
of the public and/or the nursing profession.
•You will develop a plan for both a top-down and a bottom-up approach, bringing the nursing
perspective to policy makers and stakeholders.
•You will identify the values and ethical perspectives that underpin your position and develop criteria
to evaluate the success of your work.
•By the conclusion of the assessment, you will have a plan for a policy change that can be sent to
decision makers and a plan to work with an organization/community to promote policy change at the
local level.
•The purpose of this task is to ensure that nurse leaders can use policy as tool to advocate for
change.DEMONSTRATING COMPETENCIES
• In the first section of your paper (Part A), you’ll write about how this issue impacts nursing
and/or on patient outcomes. You’ll analyze the issue and provide rationale for why this is an
important issue.
• Part B asks you to develop a policy brief for the top-down approach (a formal policy set by
an authority that can require compliance). Generally, this would be through a rule-making
board, regulatory organization, or legal (legislative) process at the local, state, or national
level.
• Part C of the paper asks you to consider a community-based participatory (or bottom-up)
approach. You’ll select a group to collaborate with to positively impact the issue from the
ground-level. The group might be through a coalition within your healthcare system, a group
of nurses from your state nurses’ association, or another professional or community group,
who come together to collaborate on an approach to address the selected health issue.
• In the final part of your paper (Part D) you’ll discuss strengths and challenges of both the
top-down and bottom-up approach. You’ll make a recommendation for which approach you
believe would be the most effective to implement a positive change on this issue.HOW DO I SELECT A TOPIC?
• As defined in the task directions, the topic for your paper should be a policy “that improves
the health of the public and/or the nursing profession” (from the task instructions). You can
select any topic that impacts health or nursing as long as you can address all of the elements
of the rubric. The topic you select should be something that you’re interested in, because
you’ll spend quite a bit of time researching the issue from different perspectives.
• Topics might include a focus on policy to impact public health issues such as childhood
obesity, school health, communicable diseases, unintentional injuries, reproductive health,
or any health issue you think could be positively affected by a change in policy. Nursing
profession issues might include staffing ratios, minimum education levels, required
continued education, mandated overtime, etc.
• Your formal policy proposal could be at the local level (such as a city-county ordinance), the
state or federal legislative level (a law), or at the level of a regulatory organization such as a
School Board, Department of Health, OSHA, CMS, etc. .THE FINANCIAL IMPACT
• In this section, you will discuss what financial impact this policy will have on healthcare
organizations or community. What is the financial impact on this policy issue specifically?
• Will the financial impact affect the health care system positively or negatively? Will it be
worth pursuing? Does the long term impact of the policy change compensate for the up-front
costs, including personnel time, data tracking systems, and/or actual dollars?
• How will funding effect the policy? Is the funding available? If not, where will the money
come from?TOP DOWN APPROACH (PART B)
• The top-down approach is one in which a person, governmental entity, or
regulatory agency (an authority) sets a policy and expects compliance. It is
an authoritarian approach.
• You should understand the steps necessary to formalize policy from the top-
down approach. This depends on the level of your policy, i.e. What are the
steps to get a bill into law?
• If you are proposing a regulatory change, what steps are needed to have a
policy approved? Does the agency require public hearings? Or board
approval?DECISION MAKER
• The decision maker should be a specific person. This is someone who can endorse the policy and
move the policy forward through the formal approval process.
• To identify a decision maker, analyze the proposed policy. Why would this person receive the
policy brief and why does it require their attention?
• What challenges might the decision maker face in gaining formal approval? (i.e. are there groups
that might oppose the policy? Are there budget challenges? )
• What are the options and alternatives for the decision maker? What alternative policies should
be considered to address the issue? Why are you recommending your proposed policy as the
best option? What steps should the decision maker take from here?
• Propose a persuasive course of action for the decision maker- How can the Decision Meker be
prepared to address Challenges during the policy making process?BOTTOM UP APPROACH
• The “bottom-up” approach, or the Community Based Participatory approach, is
an approach where those who are impacted by the issue, usually the
stakeholders, collaborate to develop and support a policy (rather than being
told what to do by formal policy). The community-based approach generally
uses strategies such as outreach, education, and advocacy with stakeholders to
gain support for a policy change.
• Both approaches can be effective to implement change. In the Policy paper,
you’re asked to discuss both types of approaches. The ultimate desired
outcomes for each approach are the same – to positively impact the health
issue.BOTTOM UP APPROACH
• Identify an organization or community- this can be a professional association, community
group, a local organization committed to the issue, etc.
• Identify why this organization or community is interested in your topic. This needs to be
supported with evidence, such as media-newspapers, magazines ,discussions, policy briefs.,
etc.
• Does the group’s goal align with your goal? How do you know? Be sure to cite your
evidence.
• Discuss how three CBPR (Community-Based Participatory Research) principles could be
used in your collaborative work with the group.
• What is your plan to approach and collaborate with the organization/community group?
Specifically HOW will you contact them to invite members to collaborate with you?
• Discuss the key elements of how your collaborative group will incorporate the CBPR
principles that you’ll use to achieve your goals.EVALUATION OF WORK
• Evaluation of the process for each approach is a bit different. In the Top-down
approach you discuss in Part B, focus should be on the steps that need to be
achieved for the proposal to become a formal policy. For example, did the
decision maker agree to move the policy forward? What was the next step –
was it successful?
• When you evaluate the Bottom-up approach (in Part C), you might evaluate
the number of people who attend meetings, the number who actively
participate, how many groups or individuals agreed to support the policy
change?ANALYSIS OF BOTH APPROACHES (PART D)
• What are the strengths of the Top down and Bottom up
approaches?
• What are the weaknesses of the Top down and Bottom up
approaches?
• Which one approach would be more effective for your policy
issue? Why?OTHER TIPS
• Create a heading in your paper for each section of the rubric
• Be sure to read the rubric carefully and address the criteria specifically and concisely.
Use the C159 resource document (Rubric Tips) to understand each section of the
rubric!
• Analyze how your values and goals apply to your topic
• When choosing a topic, consider a topic you are passionate about
• Think in terms of advocacy. As a nursing leader, how will you convince others that
your issue is important and deserves attention? How can you use evidence to
support the need for this policy change?

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