Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Institutional Area, Gurgaon, 122002, India.
Independent Consultant, Geneva, Switzerland.
Int J Equity Health. 2018 Jul 9;17(1):98. doi: 10.1186/s12939-018-0814-0.
Current policy priorities to strengthen the nursing sector in India have focused on increasing the number of nurses in the health system. However, the nursing sector is afflicted by other, significant problems including the low status of nurses in the hierarchy of health care professionals, low salaries, and out-dated systems of professional governance, all affecting nurses' leadership potential and ability to perform. Stronger nurse leadership has the potential to support the achievement of health system goals, especially for strengthening of primary health care, which has been recognised and addressed in several other country contexts. This research study explores the process of policy agenda-setting for nurse leadership in India, and aims to identify the structural and systemic constraints in setting the agenda for policy reforms on the issue.
Our methods included policy document review and expert interviews. We identified policy reforms proposed by different government appointed committees on issues concerning nurses' leadership and its progress. Experts' accounts were used to understand lack of progress in several nursing reform proposals and analysed using deductive thematic analysis for 'legitimacy', 'feasibility' and 'support', in line with Hall's agenda setting model.
The absence of quantifiable evidence on the nurse leadership crisis and treatment of nursing reforms as a 'second class' issue were found to negatively influence perceptions of the legitimacy of nurse leadership reform. Feasibility is affected by the lack of representation of nurses in key positions and the absence of a nurse-specific institution, which is seen as essential for creating visibility of the issues facing the profession, their processing and planning for policy solutions. Finally, participants noted the lack of strong support from nurses themselves for these policy reforms, which they attributed to social disempowerment, and lack of professional autonomy.
The study emphasises that the nursing empowerment needs institutional reforms to facilitate nurse's distributed leadership across the health system and to enable their collective advocacy that questions the status quo and the structures that uphold it.
目前，印度加强护理行业的政策重点集中在增加卫生系统中的护士数量上。然而，护理行业还存在其他一些重大问题，包括护士在医疗保健专业人员层级中的地位低下、工资低以及过时的专业治理体系，所有这些问题都影响了护士的领导潜力和履职能力。加强护士的领导力有可能支持实现卫生系统目标，尤其是加强初级卫生保健，这在其他一些国家背景下已经得到承认和解决。本研究探讨了印度护士领导力的政策议程制定过程，旨在确定在该问题上制定政策改革议程的结构性和系统性障碍。
我们的方法包括政策文件审查和专家访谈。我们确定了不同政府任命的委员会就有关护士领导力的问题及其进展提出的政策改革。专家的意见用于了解若干护理改革提案缺乏进展的原因，并根据霍尔的议程设置模型，使用演绎主题分析对“合法性”、“可行性”和“支持”进行分析。
缺乏关于护士领导力危机的可量化证据，以及将护理改革视为“二等”问题，被认为对护士领导力改革的合法性产生了负面影响。可行性受到护士在关键职位上代表性不足以及缺乏专门的护士机构的影响，而后者被视为对面临的问题产生可见度、对其进行处理和规划政策解决方案至关重要。最后，参与者指出，护士自身对这些政策改革缺乏强有力的支持，他们将其归因于社会无权和缺乏专业自主权。
本研究强调，护理赋权需要体制改革，以促进护士在整个卫生系统中的分布式领导，并使他们能够进行集体倡导，质疑现状和维持现状的结构。
