Developing a Health Advocacy Campaign
Order Instructions:
Will attach specific instructions. Policy I want to focus on is reducing the nurse to student ratios for school nursing from 1:750 to a ratio based on acuity of the
students. NASN has some good resources on this subject. We are also to use the Health Policy and Politics: A nurse’s guide by Jeri A Milstead.
Answer;
Developing a Health Advocacy Campaign
Reducing the nurse to student ratios for school nursing from 1:750 to a ratio based on acuity of the students; this healthy advocacy campaign will be extremely
strategic in promoting policies that can better the target population’s health.
Section A
Population health issue and affected population
Insect sting and food allergies that lead to anaphylaxis are increasingly diagnosed with a higher frequency. Food allergies are presently very prevalent among
the school-age children. One in every twenty five students are affected. This represents a 25% increase from 19997 to 2012. Food allergies result to 30-50% of the
anaphylaxis cases (Cianferoni & Muraro, 2012). 90% of the food allergy reactions results from wheat, soy, shellfish, fish, tree nuts, peanuts, eggs, and milk.
Children suffering from food allergies have two to four times risk of suffering from asthma and other allergic reactions compared to the counterparts.
Advocacy programs and attributes for effectiveness
FARE (Food Allergy Research and Education) advocacy is acknowledged as a leading voice whose intention is improving the environment for persons suffering from
food allergies. This includes people who are vulnerable to life-threatening anaphylaxis. FARE is extremely active in activities connected to food labeling, school
policies, transportation, emergency services, and restaurant regulations. FARE collaborates with policymakers at all government levels on laws and initiatives aimed at
promoting a safer world for people with food allergies. The food allergic community is given a chance of contributing towards the intended changes. The advocacy
program is mainly kept live by advocates through delivering messages of safety, access, and awareness to government leaders (Cianferoni & Muraro, 2012).
FAACT (Food Allergy & Anaphylaxis Connection Team) is actively involved in maintaining food allergies. They have Food Allergy Conference that is held annually
with the intention of offering educational sessions that are led by leading food allergy advocates and medical professionals. Education and support are offered to
family members, caregivers, school personnel, teens, and healthcare professionals. The most recent food allergy research is presented and workshops are offered to
different target groups; registered dieticians, nurses, school personnel, parents and food service personnel. Teens and siblings share experiences, partake in team-
building activities, as well as learning.
Health advocacy campaign’s plan
Public health issue
The school nurse has many roles including offering case management services; intervening with potential and actual health problems; promoting safety and
health; facilitating positive student reactions to normal development; and collaborating with other professionals so as to build family and student capacity for self-
management, adaptation, learning, and self-advocacy. Presently, 98% of the children in US spend their day at school. Notably, sixteen percent of the 52 million
students suffer from chronic emotional, physical, and other health challenges. Today, students face escalated social issues in addition to the need for interventions
and preventive services for chronic and acute health issues. This highlights the vital role that school nurses are supposed to play.
In the US, 9% of the children aged less than 18 years suffer from hay fever annually, 12% are treated from respiratory allergies, and 13% from other forms of
allergies. During anaphylaxis, students experience difficulty swallowing and breathing, feeling an impending doom, systemic hives, low blood pressure, wheezing, and
unconsciousness. The prevalence of anaphylaxis has escalated rapidly. 16-18% of the students suffering from food allergies experience allergic reactions while at
school (Kim & Fischer, 2011). Around 25% of the students who are treated from anaphylaxis have never been previously diagnosed with life-threatening allergies. This
calls for the need of non-patient specific epinephrine that can be utilized in the school settings.
Accidental food allergens’ ingestion frequently occurs among students while within the school environment. Research reports that accidental milk protein
ingestion by students with acknowledged milk allergies lead to a forty percent reaction rate among which 15% of the reactions were severe. So that the school staff are
in a position to support students suffering from life-threatening emergencies, they should be aware of how to do it and prepared to respond and prevent anaphylactic
reactions. In this regard, training should be offered annually to the staff so that they are able to respond during extracurricular activities, school days, field
trips, and school programs.
Allergies have a huge impact on families’ lives. This is based on the fact that families with allergic members report higher stress levels for the child and
parents. Parents are usually very anxious about sending their allergic children to school. The school environment’s changes and entering school are stressful events. A
majority of the parents perceive these events as chances that escalate the child’s risk of being exposed to allergens. According to research, childcare and schools
settings that have school nurses have high chances of offering immediate treatment and having emergency care plans. Immediate treatment for allergies and prophylaxis
leads to increased positive outcomes. The school nurse has a great role in leading staff awareness, treating and preventing life-threatening reactions, and ensuring
that students have a safe school environment.
Proposed policy solution
According to NASN (National Association of School Nurses), the effective and safe management of anaphylaxis and allergies in schools needs a multidisciplinary,
collaborative team approach. The school nurse should be the leader in the comprehensive management approach. It is important for school districts to have concise,
clear, and all-inclusive policies aimed at addressing allergies management in school settings. These policies should be reviewed every year. There should be
development of developmentally proper Emergency Care Plan and Individualized Healthcare Plan (Kim & Fischer, 2011). Maintaining healthy environments is extremely
essential. There is a need for special attention so that students are protected by reducing allergens and providing allergen-safe areas. It is worth noting that
banning some foods may create a false security sense.
There is a great need for schools to employ the professionally RNs who can effectively supervise and conduct school health programs that address a number of
health problems, particularly allergies. For allergies the affected students are in the general population and, therefore, a formula-based approach with a nurse-to-
students ratio of 1:750 is appropriate based on the student populations’ needs (Carlisle et al., 2010).
Policy’s specific objectives
1. Educating the staff
2. Coordinating and planning of care
3. Promoting and ensuring a safe environment
4. Promoting prompt emergency responses in case of exposure to life-threatening allergens
5. Supporting student’s self-management and self-administration of allergies (National Institute of Allergy and Infectious Diseases, 2010).
Means of conveying information to different stakeholders
Depending on the stakeholder, the key messages meant for them should have all the components. The communication strategies should aim at meeting the stakeholders’
needs (National Institute of Allergy and Infectious Diseases, 2010). The most convenient communication methods include face-to-face meetings, public meetings, the
media (news releases, press conference, and TV advertisements), special events/ celebrations, on-scene activities, focus groups, social media, workshops, internet,
fact sheets, public notices, and presentations (Morris et al., 2011).
Establishing policy support and influencing policymakers
These two aspects can be effective is the school involves all the policymakers and stakeholders in the preparation and planning of the complex nursing and
medical needs of students. The school nurse should also be uniquely prepared with expertise, experience, and education so that the policymakers are confident with the
policies that are supporting (Branum &Lukacs, 2009). The school nurse should be keen on working in partnership with all the stakeholders.
Applying the effective advocacy programs’ attributes to the proposed advocacy campaign
For the proposed advocacy campaign to be effective, there is a great need for transparency so that the stakeholders and policymakers support it. The campaign
should have a keen interest in improving the environment so that the students are in a safe environment. These efforts should be all-round and include transportation,
school restaurant, and emergency services. Collaborating with policymakers is very vital. The suffering children should be involved in the campaign through learning
and team-building activities. Education and support should be offered to all the stakeholders regularly (Branum &Lukacs, 2009).
Section B
Enaction through modification, regulation, or creation of a new regulation or legislation
School districts’ policies on allergies management should be consistent with the state and federal laws, established safe practices, and nursing practice
standards. Moreover, the policies should promote evidence-based information. Therefore, the enaction will be through the regulation and support of the existing
legislation and regulation. This is based on the fact that there are numerous state laws that permit students to carry and self-administer emergency medication
including epinephrine as needed. On the same note, there are several state laws that support the use of and supply of stock epinephrine in school settings for both
diagnosed and non-patient specific patient use (Carlisle et al., 2010).
How existing regulations and laws can impact the advocacy efforts
In states where the existing regulations and laws permit, school nurses can administer epinephrine in case of life-threatening situations in school settings.
This is particularly for physician-standing orders and non-patient specific epinephrine. Federal laws such as the Individual with Disabilities Education Act, American
Disabilities Act, as well as the 1973 Rehabilitation Act’s section 50 guard the legal rights of all allergic students. This is in addition to the FSMA (Food Safety
Modernization Act) that was made a law in 2011 January. These laws can be extremely supportive of the advocacy efforts. They can be quoted when planning and
implementing the advocacy programs. This is based on the fact that the laws guard the individual rights of students and direct schools towards the development of
voluntary food allergy management guidelines. At the same time, they curb preempting state laws.
Methods for influencing policymakers and legislators/ ‘three legs’ of lobbying
Policymakers can be influenced successfully if they are involved in coordinating student health-care; and implementation and development of comprehensive ECP
and IHP with the guardians or parents, students, school staff, and healthcare provider. For the campaign to be effective, these three aspects have to be incorporated;
the capital leg incorporates everything about the laws that impact on the campaign such as the US Congress, state legislature, and county or city council. There will
be part-time lobbyists, lobby days, and meetings with Legislature Committees’ staff (Young, Munoz-Furlong & Sicherer, 2009). At the grass roots or community leg, the
community will be involved actively through education and awareness creation. In addition, there will be forums where all the community members’ concerns will be
addressed. The media leg will involve the use of media to reach all those concerned. There will be online forums, TV, social media, and blogs. This will be aimed at
reaching many people, targeting the elected officials, and counter all the negative information that is delivered through these channels.
Obstacles in the legislative process and overcoming them
A lot needs to be done when enacting legislations. While some legislators may be supporting the campaign, others are usually against it, which leads to delayed
implementation. To solve this, there is a great need to collaborate with the Senator so that the legislation is approved. The legislative policies may be too difficult
to go through. This is because there policy should be developed after consultations with the school nurses, healthcare providers, and pediatric physicians’
representatives, parents, school administrator, NGOs, and food service administrators. This really delays the process of enactment. While consultations are important,
the gravity of the issue should be highlighted so that it is passed without wasting time.
Section C
Ethical dilemmas and resolving them
When dealing with allergic children, they may refuse to be treated or the interventions associated with the campaign (Sicherer & Mahr, 2010). This is more so
if the child is aware that the intervention or therapy carries along severe side-effects or significant risks. If there is such a case, the doctor should adhere to
this decision. If the nurse and child advocates for the therapy or intervention but the parent denies, then it should be implemented.
There may be a more complicated situation if parents dent safe and beneficial interventions. The nurses should make efforts to convince the parents regarding
the benefits associated with the intervention.
The allergens advocacy campaign will incorporate immense lobbying. There are some lobbyists who attempt influencing policies in luxurious locations (Sicherer &
Mahr, 2010). Others make campaign contributions then ask the clients as well as friends to make their campaign contributions. The ethical challenge involved in this
is that a majority of the people regard money involvement in systems to be inherently corrupt. In addition, the links between elected officials and lobbyists is
normally clouded. There may be murky systems where exchange of money is necessary for decisions to be made. If there is no transparency, people believe that there is
corruption and the fail to act as advocates (Young, Munoz-Furlong & Sicherer, 2009).
Ethics laws and reporting requirements
The CRC’s (United Nations Convention on the Rights of the Child) Article 12 argues that children possess the right of expressing their views freely. These
views should be taken gravely in accordance to their maturity and age. This law emphasizes that children aged as less as 7 years should be involved in the medical
decision making.
South African Legislation; The Children’s Act (2005’s Act 38); a child is defined as person less than 18 years. According to the Children’s Act Section 10, if
a child has maturity, age, and development stage that permit him to participate in decision making, then he can participate in a proper way. The child’s views should
be given the due consideration (Boyano-Martinez et al., 2009). Based on Section 129, children from 12 years and over can consent to proper medical treatment so long as
they have adequate maturity of doing so, including surgery. If the child is less than 12 years, his guardian or parent should give the consent. The legislation clearly
emphasizes that children should be involved in making decisions about their health (Boyano-Martinez et al., 2009).
In case the caregiver, guardian, or parent is against the legislation, he has an obligation of obtaining a court order aimed at preventing the treatment. This
is mostly in cases where the medical team holds the belief that the treatment is in the best interests of the child. Parents and guardians cannot deny a child’s
treatment or withhold consent based on religious or cultural beliefs, unless they present an alternative choice that is medically accepted to the concerned treatment.
Specific population’s ethical challenges
Specifically, the targeted allergy advocacy campaign is meant for school children. There are many ethical challenges involved when dealing with children.
Children are never autonomous. This means that their parents are supposed to make the healthcare decisions. The beneficence ethical principle is invoked when making
decisions. The ‘best interests’ of the child is used to inform the decisions. Other factors that should be considered include the impacts of withholding or
administering the treatment, parents’ views, impacts of treatment, and risks of non or delayed treatment. When disclosing the information about allergies to children,
this should be done truthfully and all the relevant information should be discussed. Confidentiality should be promoted since this indicates respect for patients.
Infants as well as young children do not have the ability of making decisions, older children have their decisional capacity developing, while teenagers
possess developed decisional capacity. Judging a child’s capacity of making decisions is usually very difficult. In addition, there exist no clear guidelines regarding
judging their competency (American Academy of Pediatrics, 2008). To solve this, a number of factors should be considered when assessing children’s capacity to consent
to the campaign’s therapy and medications; reasoning, understanding, voluntariness, and the decisions’ nature. However, before children are permitted to make any
decisions, they should be provided with sufficient information regarding the issue.
References
American Academy of Pediatrics. (2008). The role of the school nurse in providing health services. Pediatrics, 21(5), 1052-1056. doi: 10.1542/peds.2008-0382
Boyano-Martinez, T., Garcia-Ara, C., Diaz-Perez, J., & Quince, S. (2009). Accidental allergic reactions in children allergic to cow’s milk proteins. Journal of Allergy
and Clinical Immunology, 123, 883-888.
Branum, A.M., &Lukacs, S.L. (2009). Food allergy among children in the United States. Pediatrics, 124, 1549-1555. doi: 10.1542/peds.2009-1210
Carlisle, S.K., Vargas, P.A., Noone, S. Steele, P., Sicherer, S.H., Burks, W., & Jones, S.M. (2010). Food allergy education for school nurses: A needs assessment
survey by the consortium of food allergy research. Journal of School Nursing, 26(5), 360-67. doi: 10.1177/1059840510369482
Cianferoni, A., & Muraro, A. (2012). Food induced anaphylaxis. Immunology and Allergy Clinic of North America, 32(1), 165-95.
Kim, H., & Fischer, D. (2011). Anaphylaxis. Allergy, Asthma and Clinical Immunology, 7 (Suppl 1): 56. Retrieved from http://www.aacijournal.com/content/pdf/1710-1492-
7-S1-S6.pdf
Morris, P., Baker, D., Belot, C., & Edwards, A. (2011). Preparedness for students and staff with anaphylaxis. Journal of School Health, 81(8), 471-76.
doi:10.1111/j.1746-1561.2011.00616.x
National Institute of Allergy and Infectious Diseases. (2010). Guidelines for diagnosis and management of food allergies in the united states: report of the NIAID
expert panel. Journal of Allergy and Clinical Immunology, 126(6), S1-S58.
Sicherer, S.H., & Mahr, T. (2010). Management of food allergy in the school setting. Pediatrics, 126, 1232-1239. doi: 10.1542/peds.2010-2575
Young, M.C., Munoz-Furlong, A., & Sicherer, S.H. (2009). Management of food allergies in school: A perspective for allergists. Journal of Allergy Clinical Immunology,
124(2), 175-183.
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