Policy, Politics, and Nursing Practice最新文献

Nurses' political participation plays a crucial role in shaping how health-disease processes are understood and addressed, as well as in developing both our discipline and the profession. Yet, despite its importance, this area requires further advancement. This article explores key factors that influence nurses' involvement in political life, paying particular attention to the historical barriers that have limited our progress. Also, it examines the political process itself, and the different roles nurses can take on it. It also delves into the available evidence regarding the components of nurses' political competence. Finally, a series of recommendations is proposed to advance nurses' political competence across clinical, educational, and research fields.

BackgroundNurses have professional responsibilities to advocate for environmentally healthy practices and have rights to work in healthy environments. Many medical supplies are made with polyvinyl chloride, which is softened and made more flexible by adding phthalates, such as di(2-ethylhexyl) phthalate (DEHP). Patients, nurses, and other health workers are exposed to these toxins through dermal, inhalation, ingestion, and/or parenteral administration. Phthalates are classified as carcinogenic, mutagenic, reprotoxic, and endocrine-disruptors.PurposeThe purpose of our project is to develop a nurse-led advocacy plan focused on drafting, introducing, and passing a bill banning use of medical supplies made with DEHP and related plasticizers in North Carolina (NC) health systems and engaging nurses and other stakeholders in advocating for this policy change to protect the health of patients, employees, and the planet.Advocacy PlanWe developed a health policy advocacy plan describing the issue; goal; interest groups; partners; scientific evidence; advocacy strategies; and expected outcomes. We engaged our project partners in implementing successful advocacy efforts. On March 31, 2025, NC House Bill 592, Toxic-Free Medical Devices Act of 2025, was introduced in the NC General Assembly. The Senate version was signed into law on July 3, 2025.DiscussionNurses are well-positioned to advocate for policies that protect health by addressing primary drivers of health, including environmental risk factors. Our nurse-led health policy advocacy plan and actions supported the development and passing of a bill that protects patients and health services workers from DEHP and other toxic plasticizers linked to numerous health problems.

This study aimed to examine the normative and policy frameworks influencing midwifery care delivery in Italy, generating insights to inform strategies for strengthening the recognition, role, and capacity of midwifery within the Italian health system. An interpretative approach, guided by Walt and Gilson's Policy Analysis Triangle, including actors, context, process, and content, was used to analyse 141 European, national, and regional documents related to Italian midwifery.The analysis shows that despite formal recognition as a profession, Italian midwives operate in a context that remains only partially professionalized, shaped by historical, social, and institutional influences. Three interrelated characteristics of the Italian maternity care landscape were identified: a persistent biomedical and risk-oriented paradigm, a technocratic approach to childbirth, and a hierarchical professional structure prioritizing obstetric-led models of care. These factors collectively constrain the recognition of diverse care models, limit midwives' autonomy and professional visibility, and shape the choices available to childbearing individuals.The study concludes that comprehensive, multilevel strategic interventions are essential to advance midwifery in Italy and ensure care provision aligns with international standards. By situating midwifery within the broader sociopolitical and regulatory ecosystem, the study offers insights into cultural and institutional determinants of care delivery and highlights areas for future research, advocacy, and professional development aimed at promoting high-quality, accessible, and person-centered midwifery services.

BackgroundIn many Organization for Economic Cooperation and Development (OECD) countries, hospital nursing care is comprehensively provided by professional nurses and multidisciplinary teams, with no reliance on family companions. By contrast, China has historically depended on family caregivers at the bedside, a practice shaped both by deep-rooted cultural traditions of filial piety and by persistent nursing workforce shortages. With the introduction of the Hospital No-Companion Care Service Pilot Work Plan (2025-2027), China is entering a critical reform phase aimed at transitioning from informal family-dependent caregiving toward a more institutionalized, standardized, and professionalized hospital nursing model.MethodsThis study employed a comparative policy analysis combined with a narrative literature review. The review followed PRISMA guidelines for transparent literature selection and applied Walt & Gilson's Policy Triangle Framework to examine policy context, content, processes, and actors. Sources included PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Organization for Economic Cooperation and Development (OECD), World Health Organization (WHO), and Chinese government policy documents, ensuring both international and domestic perspectives were incorporated.ResultsFindings indicate that China's model addresses demographic aging and nursing shortages through hybrid approaches combining nurses with supervised assistants. Compared with OECD systems, China faces lower nurse density (2.9 vs. 9.2 per 1,000) and lower nurse-to-bed ratios (0.6:1 vs. 1.4:1). Preliminary pilot outcomes suggest notable improvements in patient safety, fall prevention, and satisfaction levels. However, they also reveal ongoing financing challenges, regulatory gaps, and varying degrees of cultural acceptance among patients and families, reflecting the tension between traditional caregiving norms and new institutional practices.ConclusionChina's no-companion model is both an innovative reform and a transitional stage in health system transformation. Long-term sustainability requires systematic investment in expanding nurse education, gradual integration of no-companion services into medical insurance coverage, and deliberate efforts to foster cultural adaptation through patient and family engagement strategies. China's experience offers lessons for low- and middle-income countries seeking professionalized care models under resource constraints, highlighting how institutional restructuring can respond to workforce shortages while respecting cultural contexts. This study provides policy insights into how professional nursing reform can balance workforce capacity, cultural expectations, and institutional accountability in the context of China's hospital no-companion care initiative.

In 2025, the International Council of Nurses (ICN) issued renewed definitions of "nursing" and "a nurse," marking the first comprehensive revision of its core terminology in more than two decades. The updated definition separates the discipline of nursing from the professional role of the nurse and adopts a rights-based, science-anchored, and climate-responsive framing. While early commentary from high-income countries has been largely positive, the implications for low- and middle-income countries (LMICs)-which carry the greatest share of the global nursing shortfall and depend heavily on community-based cadres-are more complex. This commentary critically examines the implications of ICN's updated definitions for LMIC settings. Drawing on a targeted review of MEDLINE, CINAHL, Scopus, and key ICN and World Health Organization documents, and guided by Walt and Gilson's policy analysis triangle, the paper analyzes how the definitions interact with context, actors, and processes in resource-constrained health systems. Three inter-related domains are explored: knowledge pluralism, financing, and workforce mobility. The analysis highlights how the definitions can elevate nursing's professional status, legitimize nurse leadership, and clarify regulatory expectations, while also risking the marginalization of unlicensed cadres and accelerating outward migration if adopted without safeguards. To translate global standards into equitable local practice, the paper outlines practical pathways for country-level integration: (1) establishing reciprocal evidence panels that combine culturally grounded and scientific knowledge in national guidelines; (2) study serve financing compacts that tie tuition relief to service in underserved regions, thereby converting the "triple dividend" of nursing investment into measurable returns; and (3) circular skills agreements that link international recruitment to reinvestment in domestic training capacity. Ultimately, the renewed definitions are a catalytic scaffold, not a panacea; their transformative potential will be realized only through deliberate, context-sensitive governance that aligns global standards with local realities.

Competence-based education is an emerging trend in nursing education. Finland has initiated a pilot program for a national exam designed to evaluate the knowledge of graduating nursing students. However, research concerning students' perspectives on exam quality and implementation remains scarce. The aim of this study was to explore graduating nursing students' experiences and identify key areas for improvement in the organizational implementation of competence-based national nursing examination in Finland. This study employed Elo and Kyngäs' qualitative content analysis, which examined a set of 109 mentions to open-ended questions from 106 graduating nursing students. The results revealed that students wanted better content validation, exam clarity, preparation resources, and flexibility in exams. The students also required explicit instructions and a structured framework for drug calculations. A competence-based national examination ensures compliance with standards, and it is essential to validate test questions and equip educators. Students need early preparation, and practice tests and materials should be improved for readiness.

Human papillomavirus (HPV) vaccination remains significantly underutilized despite its proven efficacy in preventing cancer. As of 2022, only 38.6% of children ages 9 to 17 years have received one or more HPV vaccine doses, with particularly low coverage among younger children (7.3% for ages 9-10 years) who would benefit most from early vaccination. This results in approximately 36,000 preventable HPV-related cancer cases annually, with an economic burden exceeding $1.7 billion. Significant disparities exist between metropolitan (39.4%-41.1%) and nonmetropolitan areas (30.0%). This brief presents evidence-based policy recommendations for state legislators to increase HPV vaccination rates through school-entry requirements, enhanced funding for equitable access, and provider education targeting children and adolescents aged 9 to 17 years. Implementation of these measures could prevent 90% of cervical cancers and substantially reduce five other HPV-related cancers, saving thousands of lives annually while lowering healthcare costs by an estimated $3.5 billion over a decade. Immediate action is essential to protect the current generation from future cancer risk.

The Well-Being Insurance for Seniors to be at Home (WISH) Act proposes universal social insurance for long-term care through activities of daily living (ADL) assistance. While this legislation addresses basic personal care needs, it overlooks the clinical complexity of aging adults who require both ADL support and ongoing health monitoring. This policy analysis examines how strategic nursing integration can enhance WISH Act effectiveness by addressing the gap between ADL-focused services and the complex care needs of beneficiaries with multiple chronic conditions. Using Russell and Fawcett's Conceptual Model for Nursing and Health Policy, this qualitative analysis evaluated policy sources, components, and four outcome levels. The study analyzed legislative text, congressional reports, and peer-reviewed literature on long-term care policy, nursing coordination, and international social insurance models. Analysis reveals that 85% of WISH-eligible beneficiaries will have multiple chronic conditions requiring clinical oversight beyond basic ADL assistance. Personal care workers encounter medication management challenges in 78% of cases, while falls, declining functional abilities, pressure ulcers, and adverse medication events frequently result in unplanned hospitalizations when clinical changes go unrecognized during routine personal care. Strategic nursing integration targeting the 35% highest complexity cases could reduce emergency department visits by 32% and hospital readmissions by 25% while achieving cost neutrality through prevention-focused interventions. Strategic nursing involvement in complex case identification, care transitions, chronic disease monitoring, and family caregiver support could bridge the clinical complexity gap while complementing existing Medicare services. This targeted approach maintains the WISH Act's core ADL focus while ensuring comprehensive community-based care for aging populations with complex health needs.