Module Components

• Overview
• Learning Activities

Nurs 810 - Evidence-Based Policy Development

Module 7: Theories of Policy Development

Overview

There are a variety of different conceptual frameworks for understanding policy making. For example,

• The rational approach is similar to the nursing process in which the problem is defined, goals are identified, policy alternatives are examined, and a policy is selected that is most closely aligned with the goal. However, this approach is based on a more ideal world where rationality dominates without consideration of emotion, or the influence of special interests.
• Incrementalism is an approach in which policy makers limit themselves to small changes at the margins of existing policies rather than systematically tackling entire existing policies. Hence, it has limited usefulness as an approach likely to achieve desired health outcomes.
• The Stage-Sequential model of policy making is a process characterized by four stages: (1) policy agenda setting, (2) policy formulation, (3) program implementation, and (4) policy evaluation. Each stage is most useful in identifying times and places where different tactics for influencing policy come into play. However, this model has limitations in defining the policy problem and linking the problems to the solution.
• The advocacy coalition framework, originally developed by Sabatier and Jenkins-Smith and modified over time by them and others, focuses on the impact of coalition structure and behavior, shared beliefs and coordination patterns, and scientific evidence and technologic information on policy change.
• Kingdon’s model of health policy development is one of the most widely used frameworks for advancing a policy initiative. This model views the policy development process as occurring in three streams: the problem stream, the policy stream, and the political stream. Kingdon describes these streams as floating around waiting for a “window of opportunity” to open through the coupling together of any two streams. This window of opportunity offers an environment that is considered crucial for policy development.

In this online session, learners will explore Kingdon model-based strategies for policy development, and discuss the use of evidence as a mechanism to coalesce policy streams.

Objectives

After completing this module, the learner should be able to:

• Apply Kingdon’s health policy development model in designing strategies to advance a health policy initiative
• Synthesize bodies of evidence to influence the problem, solution, and political streams in accordance with Kingdon’s model.

The module objectives support the following course objectives:

Synthesize and apply health policy development theories to the design and implementation of strategies aimed at evidence-based policy formation.

Required Readings

• Dickson, G. & Flynn, L. (2008). Nursing policy research: Turning evidence-based research into health policy. Springer: New York.
• Chapter 17, Palumbo, M.V. State funding for nurse faculty loan repayment: The Vermont experience, pp. 329-342.
• Chapter 18, Flynn, L. Thomas-Hawkins, C., & Bodin, S.M., Using research to influence federal policy: The nephrology nurses’ experience, pp. 343-348.
• Mason, D.J., Dickson, E., McLemore, M.R., & Perez, G.A. .(Eds.). (2022). Policy & politics in nursing and health care. (7th Ed.). St. Louis, MO: Elsevier Saunders.
• Chapter 7, O’Grady, E.T., The policy process, pp. 52-64.
• Giese, K. (2020). Coronavirus Disease 2019’s Shake-Up of Telehealth Policy: Application of Kingdon’s Multiple Streams Framework.  The Journal for Nurse Practitioners, 16, 768-770. (available on course reserves)

Directions

Read the module and required readings within the module. Then complete the learning activities for the module.