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Participation of nurse leaders in health policy development: an action research approach.

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Introduction All aspects of nursing education, practice and research are influenced by health policy. Proactive participation in the policy arena is key to excellence in clinical practice and education for nursing. Nurses constitute the majority of healthcare personnel in most countries, playing a major role in providing quality care. South Africa has a nurse-based healthcare system with nurses comprising 80 per cent of health professionals. The nursing leadership is instrumental in influencing both policy and nursing practice. Therefore it is important that nurses understand and influence the public policy process. However, their participation in health policy development is limited, even though they play a critical role in providing care for individuals. This study contributes to the body of knowledge on the participation of nurse leaders in health policy development. It is hoped that the knowledge gained from this study may, at some point, be put into practice. Purpose To determine and analyse the extent of nurse leaders’ participation in the health policy development process in selected regional and tertiary hospitals in the province of KwaZulu-Natal in South Africa. Methodology This study adopted an action research design using convergent mixed methods. Statistical data was also required to measure the effectiveness of research interventions. Both qualitative and quantitative data sources were given equal emphasis and equal weight. Eight face-to-face in-depth interviews of a minimum length of 20 minutes were conducted. Quantitative data was collected through self-administered questionnaires to 81 participants to allow for generalisation. Data were collected during 2015 to inform the diagnostic phase of the action research process. The second phase of the study consisted of a knowledge translation policy workshop and the development of a policy brief document. Results Findings from all data sources in the current study showed that the participation of nurse leaders in health policy development was limited, especially at provincial and national levels. Those who had participated did so at an institutional level. Nurse leaders participated only at the implementation stage. Their level of knowledge and confidence in health policy development was low, which has implications for the interpretation and implementation of the policies. Conclusion The findings of the study suggest that there is an increasing disconnection between policy and delivery. This serves as a barrier to involving the people who are in the frontline and responsible for delivering results, in policy development. Since nurse leaders are implementers of policy, their involvement in policy development would encourage greater ownership and result in better assessment of policy feasibility. The findings and recommendations of this study have implications for practice, education and policy-making in South Africa.


Doctor of Philosophy in Nursing. University of KwaZulu-Natal, Durban, 2016.