The correlation between the socio-political activity of nurse educators and their knowledge of health policy

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1 Academia Journal of Educational Research 1(4): , April 2013 DOI: ISSN: Academia Publishing Research Paper The correlation between the socio-political activity of nurse educators and their knowledge of health policy Accepted 19 th April, 2013 ABSTRACT *Salminen L 1, Stolt M 1, Nieminen H 1, Juutilainen P 1, Paltta H 2 and Leino-Kilpi H 1,3, 1Department of Nursing Science, University of Turku, Finland. 2Turku University of Applied Sciences, Health Care, Turku, Finland. 3Hospital District of South-West Finland, Turku, Finland. *Corresponding author. leesalmi@utu.fi; Tel: Nurse educators who are competent regarding socio-political issues and who have good societal networks are confident in engaging in the development of education and behave as agents of change. However, research in this field is scarce. This study aims to describe the socio-political activity of nurse educators and their knowledge regarding health policy and education policy from the point of view of the nurse educators themselves, as well as from the point of view of nursing education administrators. The data were collected by a structured Nursing Teachers Social Activity (NTSA) questionnaire via from nursing teachers (N=765) and the educational administrators of nursing education programmes (N=45). The questionnaire included five background factors and eight items regarding social activities of nursing teachers. The response rate was 46% (n=342) among nursing teachers and 38% (n=17) among education administrators. The data were analysed using descriptive statistics. The results showed that the nursing teachers are quite active in society activities even though almost half of them evaluated themselves as quite inactive. Nursing teachers often publish professional papers and reports but seldom articles in international peerreviewed scientific journals. Teachers participate mostly in local working groups. Nursing education administrators evaluated the social activity of nursing teachers as quite good. Although nursing teachers knowledge about health policy was quite good by their own opinion, they felt they must update and improve their knowledge. Key words: Socio-political activity, nurse educator, nursing, education, health policy, education policy, administration. INTRODUCTION The challenge of building strong, responsive, and sustainable healthcare systems is faced by most nations in the world. Globally, healthcare systems struggle against gaps and inequities in healthcare due to greater complexities of healthcare needs, rising costs, and a shortage of healthcare personnel (European Commission, 2009). Moreover, the ageing population, increasing healthcare needs and technological developments have changed both the objectives of health policy and the competence demanded of nursing staff and nursing education (WHO, 2009). Nurse educators should be visionaries, because they are in a central position to carry out nursing education in order to meet the future needs of society (Salminen et al., 2010). Nurse educators should also prepare future nurses to actively take part in socio-political discussions (Carnegie and Kiger, 2009). The socio-political activity of nurses and nurse educators impacts nursing practice on all levels, including research and education (Hall-Long, 2009). Research on nurse educators socio-political activity and their interaction, or engagement with society is scarce. These studies have focused on the characteristics of the

2 Academia Journal of Educational Research; Salminen et al. 058 nurse educator, the problems of clinical teaching, the changes in educators duties that have taken place as a result of education reform, and the clarification of the role of the nurse educator (Gillespie and McFetridge, 2006; Salminen et al., 2010). Socio-political activity is described, in this study, as activity that is undertaken by a member of political or other social organizations, being active in municipal positions of trust and expert tasks, or being the author of written publications (Falk-Rafael, 2005; Primomo, 2007). According to these rare earlier studies, nurse educators have been socio-politically active (Paltta, 1998; Holtrop et al., 2000; Caira et al., 2003) and they believe that their actions can improve the health of citizens (Holtrop et al., 2000), even if they feel they are not highly respected in society (Salminen et al., 2011). Nurse educators act in organizations and in positions of trust, but their publishing activity is minor (Paltta, 1998; Short, 2007). Those nurse educators who participate especially actively in politics have better knowledge regarding political challenges to and possibilities for education than those who do not (Holtrop et al., 2000). For both nurse educators and nurses, the most common reason for not participating in socio-political decision-making is lack of time (Holtrop et al., 2000) and lack of the knowledge or the skills needed to influence policy formulation (Taft and Nanna, 2008; Vandenhouten et al., 2011). Furthermore, participation is impeded by the lack of support and encouragement from employers and family members, as well as by nurses poor knowledge of health policy (Deschaine and Schaffer, 2003; Whitehead, 2003; Leavitt, 2009; Kunaviktikul et al., 2010). Those nurse educators who are competent regarding socio-political issues and who have good societal networks, are confident to engage in the development of education and behave as agents of change (Holtrop et al., 2000; Coburn and Russell, 2008). For this reason, it is important to describe nurse educators socio-political activity and their knowledge of health and education policies. In Finland, socio-political and regional activities have defined one of the duties of universities (Universities Act, 2009) and polytechnics (Polytechnics Act, 2003). This means that the results of education and research can be utilised both regionally and nationally. The activity of nurse educators in society covers a wide variety of functions and ways of thinking (Holtrop et al., 2000; Primomo, 2007; Coburn and Russell, 2008). In addition to teaching, the recognised forms of socio-political action are membership and activity in political or other organizations, activity in municipal positions of trust and expert tasks, voting, and writing for mass media, journals, and textbooks (Rains and Barton-Kriese, 2001; Falk-Rafael, 2005; Primomo, 2007; Koivula et al., 2011). The aim of this descriptive, cross-sectional survey design study was to describe nurse educators socio-political activity and their knowledge regarding health policy and educational policy from the point of view of the nurse educators, as well as from the point of view of nursing education administrators. The research questions were: 1. What is the socio-political activity of the nurse educators? 2. What is the nurse educators knowledge about health and education policy? In this study the term 'nurse educator' refers to an educator who teaches students of nursing who wish to attain the qualification of Registered Nurse in a degree programme (Bachelor) in nursing at the polytechnic level. In Finland, a nurse educator must have a Master s degree, three years of work experience in the health care system, and 60 ECTS of pedagogic studies (Polytechnics Act, 2003). An educational administrator is defined as a head of one or more nursing education programmes and a leader of nurse educators. MATERIALS AND METHODS Sample and data collection Data was collected via during 2007 from all nurse educators (N = 765) teaching in all degree programmes in nursing in all polytechnics in Finland which have nursing education programmes (N = 25) and from educational administrators during The pilot test involving nurse educators was conducted in one of these polytechnics and was therefore excluded from the primary study. The first e- mail survey and two reminders had a poor rate of response from educators. Therefore, data collection from educators was completed with a paper-and-pencil questionnaire leading to a response rate of 46% (n=342). The educational administrators were recruited from nursing education programmes from 14 polytechnics. Polytechnics were selected from across Finland, thereby covering polytechnics from all geographical areas. Before the data collection the questionnaire was pilot-tested on three (n=3) educational administrators. The number of polytechnics (n=14) represents half of the polytechnics in Finland and was considered to be sufficiently representative of educational administrators. The educational administrators responded to the survey and their response rate after two reminders was 38% (n=17). The data was collected with the structured Nursing Teachers Social Activity (NTSA) questionnaire. The NTSA included five background questions (age, gender, academic degree, official title and length of work experience in current position) and eight questions encompassing sociopolitical activity of nurse educators: levels and ways of socio-political activity (4 items), knowledge of health and education policies (2 items) and the effect of health and education policies contents on the actions of nurse educators (2 items). A five-point Likert scale was used (5=

3 Academia Journal of Educational Research; Salminen et al. 059 knowledge is very good, 1 = knowledge is very poor). In addition, nurse educators responded to four questions related to their participation in socio-political activities and in ways to update health and education policy knowledge. The NTSA developed earlier (Paltta, 1998) was modified for the purpose of the current study. An expert panel, consisting of five university educators with PhDs working in nurse educator education evaluated the questionnaire and the validity thereof. Pilot-test with 20 nurse educators and three administrators led to some revisions to increase the clarity of the items. Ethical considerations Good scientific practice was followed in this study (National Advisory Board on Research Ethics, 2002; Pauwels, 2007). Permission to conduct the study was obtained from all the polytechnics, according to their practices. In addition, permission to use and modify the questionnaire was obtained from the original author. All participants were informed via about the study, voluntary participation and data collection. Participants anonymity was secured and individual participants answers or polytechnics were not identifiable. Answering the questionnaire was considered informed consent to participate in the study. All the data were analysed and treated confidentially. Data analysis The data was analysed by SPSS for Windows (15.0). Descriptive statistics (frequencies, percentages, means, ranges and standard deviations) were used to describe participants background variables. Background variables such as age and nursing work experience were categorised. Significant associations between dependent variables and background variables of nurse educators were examined with the Pearson Chi-square -tests. The level of statistical significance was set at 0.05 (Burns and Grove, 2009). The amount of educational administrators was so small that significant associations between dependent variables and background variables were not reasonable to examine. The educational administrators were all female and most had a Master s degree in nursing science. Official titles varied, with degree programme manager and director being the most prevalent. Work experience in the current work ranged from 2 to 35 years (Table 1.) Socio-political activity of nurse educators A third of the nurse educators (38%) evaluated themselves as socio-politically active, while almost half (43%) evaluated themselves as passive (Table 2). Only a few nurse educators sat on the local council (5%), the municipal executive board (3%) or on municipal committees (10%). Statistically, socio-politically active nurse educators act significantly more on local councils (p<0.001), municipal executive boards (p<0.001), municipal committees (p<0.001) and other municipal confidential posts (p<0.001), than other educators. Similarly, nurse educators with more than fifteen years of work experience in nursing education act significantly more often in local councils, municipal executive boards, or municipal committees than do educators with less work experience (p<0.001). Nurse educators aged years act statistically more often statistically in municipal executive boards than do younger educators (p = 0.003). A majority (71%) of nurse educators had published some publication at least once during their career. Nurse educators mentioned that altogether 601 writings had been published; the average was 2.5 publications per educator. Nurse educators who evaluated themselves as sociopolitically active wrote more for the newspapers than those who evaluated themselves as being more passive (p<0.001). Furthermore, the principal lecturers had written statistically significantly more in professional papers, publications of educational institutions, and conference publications than senior lecturers and full-time educators (p<0.001). Nursing education administrators evaluated nurse educators as being active at the local institutional level, the national level and at the international level. Nursing education administrators evaluated the nurse educators socio-political activity as being largely rather passive (Table 2). RESULTS Participants Participants in the study consisted of nurse educators (n=342) and nursing education administrators (n=17, Table 1). The vast majority of the nurse educators were female (97%) and a mean age of 50 years, had taken a Master s degree of Nursing Science and had acted as lecturers. Their work experience in their current jobs varied from none to 35 years. Nurse educators knowledge of healthcare and educational policies Nurse educators evaluated their knowledge of the healthcare policy (mean 3.75; SD 0.99) and educational policy (mean 3.57; SD 1.04) as being favourable (Table 2). Most of the nurse educators reported that the content of the health policy directed their teaching to some extent (49%) or strongly (42%, Table 2) and the content of education policy 'to some extent' (56%) or 'strongly' (27%). Nurse educators with more than twenty years of work

4 Academia Journal of Educational Research; Salminen et al. 060 Table 1. Background of nurse educators and educational administrators. Nurse educator (n=342) Educational administrator (n=17) Background f % f % Age (years) Range Mean SD Gender* Women Men Academic degree* Master s of Nursing Science Licentiate of Nursing Science Doctor of Nursing Science Other Official title* Lecturer/Nurse educator Principal lecturer Full-time educator Dean, director of faculty 1 Degree programme manager 7 Director 2 Other Working experience in current work, years Range Mean SD * The amount of total responses varied due to missing information. experience evaluated their knowledge about education policy as being better than participants with less nurse educator work experience (p=0.011). Nurse educators maintained their knowledge of the health policy using different sources of information (Table 3). Nurse educators with a good level of knowledge regarding health policy used statistically significantly more official documents published by ministries (p = 0.012), attended more educational meetings (p = 0.001), had more discussions with experts (p<0.001) and with their colleagues (p = 0.004) than other participants. Principal lecturers (p = 0.001), nurse educators with more than fifteen years of working experience (p = 0.001) and nurse educators who took part in development activities (p = 0.009) obtained statistically significantly more regular information about health policy by discussions with experts than those who did not take part in development activities. Nurse educators participated in different socio-political activities and updated their health and education policy knowledge via a diverse body of methods (Table 3). Nurse educators who evaluated themselves as being sociopolitically active (38%) were more active members of social organizations (p = 0.000) and reported that they had better knowledge about health policy than others (p<0.001). The educational administrators evaluated nurse educators knowledge of the health policy (mean 4.0; SD 1.0) and education policy (mean 3.0; SD 1.0) as positive. The majority of education administrators estimated that health policy impacts nurse educators actions powerfully (47%), as does education policy to some extent (53%) (Table 3). DISCUSSION This study described nurse educators socio-political

5 Academia Journal of Educational Research; Salminen et al. 061 Table 2. Socio-political activity of nurse educators and their knowledge and its impact to the health and education policies. Nurse educator (n=342) Educational administrator (n=17) Socio-political activity f % f % Degree of socio-political activity* Very passive Rather passive Cannot say Rather active Very active Participation to working groups# Local institutional level National level International level Being a team leader in own working place Yes Publications# No publications Professional paper Reports Conference abstract Text book Article in newspaper Article in national peer- reviewed scientific journal Article in international peer- reviewed scientific journal Nurse educator s knowledge about the health policy Very poor Poor Not poor but not good Rather good Very good Nurse educator s knowledge about the education policy Very poor Poor Not poor but not good Rather good Very good The impact of health policy to nurse educator s actions None Little Some extent Strongly The impact of educational policy to nurse educator s actions None Little Some extent Strongly *The number of total responses varied due to missing information. # the number of total responses is higher than the number o f participants due to the possibility to select more than one option.

6 Academia Journal of Educational Research; Salminen et al. 062 Table 3. Nurse educators participation in socio-political activities and ways to update knowledge of health and education policy. Nurse (n=342) f % Participation in socio-political activities# Active member of socio-political organisation Member of a socio-political organisation but not actively participating in its activities Not a member of a socio-political organisation but sometimes participates in its activities Not a member and does not participate in activities Positions in political organisation# Member of parliament 0 0 Member in a local/municipal council 18 5 Member in a municipal executive board 10 3 Member in a municipal committee Other municipal confidential post educator Sources of knowledge about health policies# Professional papers Newspapers Television, radio Internet Legislative documents, other official documents Discussions with colleagues Educational meetings Discussions with experts Others 25 7 Sources of knowledge about education policies# Trade papers Newspapers Television, radio Internet Legislative documents, other official documents Discussions with colleagues Educational meetings Discussions with experts Others 16 5 # The number of total responses is higher than the number of participants due to the possibility to select more than one option. activity and their knowledge of health policy and education policy evaluated from the perspective of nurse educators themselves and education administrators. The research in the field is scarce and the results of this study fill this gap by producing more information about educators sociopolitical activity. Based on the results, nurse educators are socio-politically rather active. The socio-politically active nurse educators were active in organizational activities, in positions of trust and in expert tasks and publications, whereas the socially passive nurse educators were passive in all of these fields. More than half of the nurse educators participated in development activities of public health services in the vicinity of their own polytechnics. This is one way of realising the socio-political and regional activity tasks of the educator (Polytechnics Act, 2003). Finnish nurse educators activity as political decision-

7 Academia Journal of Educational Research; Salminen et al. 063 makers has remained the same compared to an earlier Finnish study (Paltta, 1998). This may be because nurse educators do not feel that they are highly respected in society (Salminen et al., 2011). Nurse educators still hold the traditional idea of teaching, and they do not experience their work as influencing society. Evidently, health policy should direct teaching more strongly, so as to have an impact on nursing students and nurses socio-political activity (Caira et al., 2003; Vandenhouten et al., 2011). Nurse educators influence on society, for example, through different publications (Primomo, 2007) is meaningful, because of the idea of evidence-based nursing. The number of scientific publications has especially increased as a result of the increase in PhD degrees (Koivula et al., 2011). On the other hand, more and more scientific publications are needed for use in decisionmaking connected to matters of healthcare. In Finland, the new action plan for nursing care, Increasing the effectiveness and attraction of nursing care by means of management (Ministry of Social Affairs and Health, 2009) emphasises evidence-based nursing. The socio-political active nurse educators' knowledge of health policy was very good. Educators participating in municipal positions of trust have probably created networks in which they gain healthcare-policy-related information easily and reliably. Through these networks, they are also able to influence political decisions related to healthcare (Petit ditdariel, 2009). The views of the educational administrators in relation to the socio-political activity of nurse educators were mainly similar to those of nurse educators. Educational administrators evaluated that nurse educators actively participate at the institutional, national, and international levels of co-operation. At the international level, nurse educators reported their collaboration as being less active. The main reason for active participation in international collaboration is the demand of international co-operation as set by the Ministry of Education (Ministry of Education, 2009) in Finland. In the future, knowledge of health and educational policies needs to be maintained and improved, as these policies serve as the basis for evidence-based nursing education (Hall-Long, 2009). Without a broad knowledge of education-related policies, it is difficult to achieve the goals of national or international strategies guiding the implementation of nursing education. Nurse educators who are familiar with the contents of health and educational policies can adjust their actions to respond to changes in the health needs of both society and the population. Educational administrators are in a key position to encourage the educators to participate more actively in decision-making in society. They should arrange resources for educators to take part of the current socio-political debate, for example by writing to newspapers or other publications. This is important in every field of education. Education is highly valued and people believe educators opinions and visions. Educators should take their role as developer of society more actively. Reliability and limitations of the study The study was a national survey of all Finnish nurse educators working in polytechnics and a discretionary sample of nursing education administrators at Finnish polytechnics. The response rate of educators was 46%, which indicates that results can be reasonably applied to Finnish nurse educators. However, the data was sufficiently abundant to conduct statistical analyses related to associations between social activity and background variables. On the other hand, among educational administrators, the response rate was fair (38%), which limits apt generalization of the results. The comparison of the evaluations between nurse educators and educational administrators was done only at the descriptive level. The data for this study was part of a large survey, so the low response rate may relate to the length of the questionnaire. Also, collecting data using a web-based survey can decrease the response rate (Duffy, 2002). However, an inquiry made it possible to answer within the most suitable time frame. This measurement tool had been used before and was well-tested in describing nurse educators sociopolitical action. Conclusions The results of this study can be used to develop nurse educator education and training so that nurse educator candidates learn about healthcare policymaking and about taking part in societal discussions. Nurse educators who are familiar with the contents of health and educational policies can adjust their actions to respond to changes in the health needs of both society and the population. These worthwhile acts must be proliferated in the future. Recommendations for educational administrators can be set. First, they should give more time for educators to take part of the tasks of society. Secondly, more continuing education should be arranged for educators how to influence society, and third, international cooperation should see as an opportunity to develop the education. REFERENCES Burns N, Grove SK (2009). The Practice of Nursing Research.Appraisal, Synthesis, and Generation of Evidence.6 th Edition. Saunders Elsevier, St. Louis. Caira NM, Lachenmayr S, Sheinfeld J, Goodhart FW, Cancialosi L, Lewis C (2003). The health educator s role in advocacy and policy: principles, processes, programs and partnerships. Health Promot. Pract. 4(3): Carnegie E, Kiger A (2009). Being and doing politics: an outdated model or 21 st century reality? J. Adv. Nurs. 65(9): Deschaine JE, Schaffer MA (2003). Strengthening the role of public health nurse leaders in policy development. 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