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Policy OptionsResearch Paper

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¶ … medical field have supported integrated substance abuse therapy and mental health as the 'best practices' with regards to treating co-occurring maladies, it is rare to find integrated therapy models. System-level factors often prove to be hindrances to providers and practitioners who may welcome change. Fundamental to integrated therapy is the modification, as well as fusion, of substance abuse and mental health interventions by the practitioner into a single consistent package (Drake, Mueser, Brunette, & McHugo, 2004, p. 367). However, even if the provider organization and practitioner deliver consolidated dual diagnosis and therapy, or agree to participate in reforms for facilitating such therapy, larger transformations at the system-level should supplement it. For provider organizations and practitioners to create cohesion in their treatment, integration of service provision throughout the system has to be ensured, or at least, services must be coordinated. Moreover, substance abuse and mental health initiatives should ensure availability of numerous related service links prepared to deal with client requirements. Significant gaps exist between the requirement and availability of such consolidated services; also, administrative elements frequently hinder rather than support change. These "hindrances" often take the form of policies (fundamental in financing), or politics might lead to creation of "turf battles" for that finance. Efficiency of nursing in the realm of policy-making often hinges on comprehension of the policy procedure itself. Resolving this apparently mysterious procedure with theory proves to be most valuable when it assists in bringing to light possibilities for use in specific situations (Blackman, 2005). This paper discusses policy alternatives and options pertaining to the issue of tobacco consumption.

Nurses have, in previous works, drawn on analytical social theoretic perspectives for analyzing nursing as a demoralized group, comprehending marginalization, considering different systems for scientific study and processes, and considering nursing education models. There has, however, been a comparatively small amount of discussion with regards to how these perspectives could fuel nursing research-related questions, elucidate nursing's policy and political progress, and promote participation of nurses in tobacco control politics (Malone, 2006). The foremost reason behind preventable deaths and disability in America is tobacco consumption. As per the World Health Organization, tobacco also ranks as the second biggest reason for deaths on a global scale, and may take the lives of around 10 million individuals around the globe every year by the year 2020 (WHO, 2005). Nearly everybody's system gets affected upon consumption of tobacco (United States Department of Health and Human Services [DHHS], 2004); it also impacts all demographic groups who nurses interact with, right from expectant mothers and their unborn children, to senior citizens. Tobacco consumption also excessively impacts marginalized communities, with whom nurses have customarily been engaged (Apollonio & Malone, 2005).

Policy options and alternatives

Policy process structures, like Kingdon's, provide a lens for understanding formulation of policies within the framework of contradictory ideals and the broader socioeconomic environment. Kingdon's exemplary policy process structure consists of three distinct streams: problems, politics, and policies. Policy alternatives or solutions are presumed to exist, on different policy communities' or policy actors' radars; these communities include administrators, bureaucrats, activists, congressional staff, researchers, and academics. These concepts crop up in numerous networks, by means of deliberations, meetings, reports, and other more formal processes. In the realm of policy, the issue isn't generating a recommendation; rather, the issue lies in whether or not the option is technically possible and consistent with policy actors' values. Another stream of Kingdon is politics, which comprises of three subdivisions: (a) national mood; (b) pressure group campaigns; and (c) policymaker's ideology. In the first case, the national mood is said to be positive if a critical mass of citizens has common notions. In the second case, pressure groups, when mobilized, can impact policy actors' actions. Policies which are formulated and perceived as beneficial to many groups of citizens, hence balancing interests, will more likely remain on policymakers' agenda. Finally, policymakers' ideology is also a crucial element. (Kubiak, Sobeck & Rose, n.d).

One possible policy solution to the issue of high healthcare expenses for tobacco-related illnesses is imposing surcharges on tobacco-smokers who partake in state- financed insurance schemes such as: (a) Healthy Families (HF); (b) Major Risk Medical Insurance Program (MRMIP); and (c) Aid to Infants and Mothers (AIM). All the above schemes are created for individuals whose incomes lie between 100% and 250% of federal poverty line, which is too high a level to be entitled for a full Medicaid subsidy (known as Medi-Cal, in California). However, this income group doesn't have sufficient funds to acquire private health insurances. This proposal has dual advantages. The HF, as well as AIM, initiatives were formulated to ensure that every child can access basic healthcare, right from prenatal age up to 18 years. In view of increasing evidence that tobacco smoking negatively affects the environment, which in turn negatively affects the health of children, a smoking surcharge may motivate parents to quit smoking, thereby leaving healthier surroundings for their kids. Similarly, public health activists can aim at preventing future addictions to tobacco, as well as treating existing nicotine-dependent persons. Through introduction of extra charges for tobacco-dependent-individuals in community insurance schemes, the state can inspire private insurers towards adopting similar policies, with no new industry bylaw. Implementation of such systems by private employers has shown successful results (Blackman, 2005).

The second policy alternative to decrease healthcare costs linked to tobacco-related disorders doesn't necessitate any rise in governmental investment, nor does it require increased user fees. Rather, this alternative tackles the issue through regulations, by demanding that all organizations issuing health insurance wholly cover tobacco-quitting protocols sanctioned in the tobacco cessation guidelines of the Agency for Healthcare Research and Quality. Execution of this policy will not increase government costs to taxpayers. Furthermore, this proposal ascertains that everybody has uniform access to helpful interventions for quitting tobacco, thus preventing condemnations that only individuals with public-financed health insurance obtain fully-covered tobacco quitting benefits, which is the case at present (Blackman, 2005).

The final and chosen alternative policy is involvement of nurses in controlling tobacco use. In light of the alarming facts linked to tobacco usage, one may believe that nursing groups would be community leaders in the prevention and cessation of tobacco use, as well as in policy-related investigations, education, practice, and action. However, though professional institutions have released policy statements, in addition to occasional calls for paying more attention to this social problem, and though some nurses have raised their voices against tobacco for many years (almost heroically), little evidence exists that the profession of nursing has seriously attempted to tackle tobacco usage in an organized and persistent manner until the emergence of the Tobacco Free Nurses program, which revolves around cessation of tobacco use (Tobacco Free Nurses, 2005). Advocating a nursing plan on tobacco cessation study and practice will require nurses', as well as clients', education and motivation; nurses and patients need to be aware of tobacco's effects on one's body, in addition to tobacco industry's environmental impacts. Owing to nurses' numbers, moral authority, political capital, and class status in society, they are possibly the health professionals who most especially need to play a crucial role in this historic moment, for challenging the 'socially-responsible' claim made by the tobacco industry, and exploring alternatives to put a stop to the rising tobacco-related diseases and disorders (Malone, 2006). Education must play an instrumental role in liberating, problematizing, and questioning the use of tobacco. Collaboration of nurses, and involving the public and other nurses in discussions on why the tobacco industry is still allowed to continue making profits out of products that plainly harm all users, is a galvanizing experience (Kubiak, Sobeck & Rose, n.d).

One can draw on earlier nursing traditions for development of a more powerful public voice with regards to tobacco (Lewenson, 2002). The Settlement House campaign of the early 1900s, which called attention to prevailing social issues and a need for combined action, was led by nurses. The current historic moment that aims at ending the worldwide tobacco epidemic requires urgent involvement by nurses. The biggest professional group in the health sector is that of nurses; nearly every individual is acquainted with at least one nurse, and the masses can relate to nurses as ordinary working individuals. A common image of nurses is that of ethical, honest caregivers, thus according nurses a moral and political capital may prove effective to this cause (Malone, 2006). However, the profession of nursing, despite making advances, is still an essentially classed and gendered profession. The tobacco sector heavily marketed its products to all women, including nurses, in the past century; smoking was infamously portrayed as symbolic of women's empowerment. The work environments of nurses also influence what they consider as practice, in turn, influencing what particular activities they feel fall acceptably within the nursing realm. Obviously, these environments were also shaped by gendered societal relationships, by which women were relegated to stations of lesser status and authority within organizations; this contributes, in many ways, to ambivalence regarding tobacco usage. Awakening the passion of… [END OF PREVIEW]

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