The Nursing Profession: Social Justice in Contemporary Nursing - Essay Example

SOCIAL JUSTICE IN CONTEMPORARY NURSING due: Table of Contents Table of Contents 2 Introduction 3 Social justice in practice 3 Social justice and ethical practice 6 Policy concerns versus social justice 9 Conclusion 12 Bibliography 13 Introduction Social justice can be defined as the act of fair distribution of resources and responsibilities among populations mainly focussing on social groups and their relationship with others in the society. Within the nursing profession, social justice is not a new concept. According to Pfitzinger (2013, p.1), national nursing organizations such as the Canadian Nurses Association (CNA), American Association of Colleges and Nursing (AACN) and International Council of Nurses (ICN) have been critical on the importance of their professional engagement in social justice within practice as a means in meeting the needs of their patients. In spite of this, relevant studies indicate that the nursing profession has inconsistently continued to define social justice (Browne 2008, p. 83-85; Judy et al. 2010, p. E3-4), a critical concept that has introduced discrepancies between professional expectations and competence within practice. This paper will critically analyze the concept of social justice within the nursing profession by analyzing related literature and debate on policy concerns and forces that affect social justice within the practice. Also, the paper will analyse the application of nursing professional values in relation to social justice. Social justice in practice As identified in the introductory section, the concept of social justice within the nursing practice is surrounded by inconsistencies that cut across nursing expectations and practice. A study conducted by Pfitzinger (2013, p.1) involving the review of literature published on PubMed and CINAHL databases revealed that a majority of currently published articles related to social justice within nursing lacked a defined action plan and had inconsistencies within the definition of the notion of ‘social justice’. Additionally, those that have action plans were unable to guide clearly nurses on how to engage in acts related to social justice. The education system is challenged with inadequate instructional methods that prepare the engagement and integration of concepts of social justice in nursing due to the uncertainty of the topic within practice (Browne & Tarlier 2008, p.85; Judy et al. 2010, p.E1-9). With the existence of such confusion, nurses are not expected to deal accurately with the vice of social injustice within the practice. Interestingly, pressure is mounting on instructors regarding the introduction of social justice concepts within the classroom setting with the looming confusion of defining the concept (Boutain 2005, p.405). Pfitzinger (2013, p.1) clearly explains the scenario within the nursing education sector by underlining the short period of one semester that instructors have to introduce and teach concepts surrounding the topic. Nurses have a significant influence on people’s health globally, an aspect that can be improved through re-investing in the concept of social justice. Social justice is a fundamental nursing value that demands fair and equitable distribution of nursing and health related resources to the society. Even though its value has highly been advocated by various nursing associations (CNA, AACN & ICN), it is clearly evident that there has been continuous toleration of disparities concerning health care among the minority and vulnerable populations of the society. An article published by Cohen (2010, par 2) reveals that nurses indeed witness outcomes of inequalities during their day to day activities within the practice. The same sentiments are echoed by Kleba et al. (2014, p.66 ) who stated that mistreatment of elders is a hidden, unrecognised, and underreported practice among nurses. Studies show that health professionals, including nurses, are still in the dark regarding the various forms of abuse of elders that take place. Also, a proper course of action that is to be taken when abuse occurs is not clearly stated. This concept is included in the broad concept of social justice and needs to be clearly understood to help improve the interaction of nurses and the elderly. Inequities in health outcomes are shaped by racism and oppression factors that affect access to health care, but can be addressed through the conceptualisation of social justice by addressing the factors that influence health inequities. These prompts for a quick development of structures to address the understanding of social justice and exercising socially-just actions, which aim at improving the health of the vulnerable populations that they serve on a day to day basis. The vice has attracted a number of advocacies that aim at conduction research, providing education and developing research, policy, and practice as means to deal with the vice for example, the presentation of the development of educational competencies and a social justice framework (Buettner and Lobo 2012, p.955-7). It is important to note that there is a looming demand for health reforms worldwide due to the significant increase in chronic diseases, aging population and rising costs of health care. As a result, the society’s expectations from the field of nursing have heightened. For that reason, nurses are expected to utilise their skills to the full extent and take a substantial leadership role in planning, developing health policies, and provision. Despite such demands, Nurses form the largest part of the health professional workforce, but they are often limited in their scope of practice. Grace and Willis (2012, p.198-10) view social justice as an indispensable responsibility in the nursing profession that has provided a significant outcry for the understanding and implementation of the key concepts in social justice. However, there has not been any reliable conception of social justice that can undergird practical, educational, research, and policy endeavours. They acknowledge social justice as a problem in the nursing profession and suggest Power and Faden’s (2006) model of social justice as helpful to the practice. The focal point of the model is investigating and finding solutions to the primary causes of social injustices as they lie within the structure of society. Six fundamental aspects of well-being are emphasized as universal human needs. The six dimensions are not hierarchical and are interrelated. Any deficiency in one of the six affects others and makes it hard to live even a minimally decent life. The model is mostly used in the crisis of child abuse and its aftermath’s effects on well-being and is an example of its utility for structuring practice, knowledge development, and policy initiatives in nursing. Service to the underserved population should be given very critical consideration when the concept of social justice is assessed. The underserved section has proven to be the larger part of the population that seeks medical attention. The voice of these people is given less significance because they are represented as being less important than others. This calls for solemn action in order to curb social injustices in the nursing practice. Boutain (2005, p.407) states that the concept of social justice needs to be defined and conceptualised to enable the facilitation of care of the underserved in nursing practice. Social justice and ethical practice As with any other nursing concept, social justice is also subject to policies and regulations to ensure fair treatment is given to everyone. Policies on structural inequities are established to ensure uniform distribution of health resources among regions of different socioeconomic status. Such policies address disparities in resource allocation that leave some areas resource inadequate as others enjoy full benefits. Among the factors that influence resource distribution are politics, geographical location, and population distribution, factors that work to the disadvantage of the underprivileged. Thus, the nursing community must seek to understand such underlying factors and their impact on the people they serve, work with, and the overall organisation so that they can make informed choices. The World Health Organization (WHO) (2011, p.13-15) outlines actions on how countries can address health inequities and promote social development through implementing policies on social determinants to improve the health and well-being of their citizens. As the implementation of this course continues, a review of the programme shows that many countries that have adopted the recommendations of the WHO Commission on Social Determinants of Health have made tremendous achievements in reducing structural inequities. Among the recommendations include the New Public Health (NPH) policy that has used the approach of protecting and enhancing the well-being of both individuals and the society through studying underlying factors and recognizing their interrelationships with people. In addition, the WHO (2011, p.6) recognizes the growing prevalence of violence as a form of social injustice against nurses and nursing students within the health care system, and the negative impacts it has on quality of care. These incidences of violence are common in workplaces such as hospitals, primary care centres, outreach services, educational institutions, and long-term facilities. Gillespie et al., (2014, p.467-9) affirms these statements by noting that all health care professionals can be subject to some form of violence, a majority of the victims being nurses. Nurses and nursing students are exposed to workplace violence as most of them as exposed to horizontal violence during their placements (Çelebioğlu et al. 2010, p.690-1). When this happens, most feel abused, and their rights violated upon leading to stress, depression and even abandonment of careers. On the other end, abused people might simulate the same behaviour from practice and thus perpetuate it. As has been evidenced, structural violence determines the number of nurses going into the profession, remaining, or leaving. A policy of ‘zero tolerance’ to any form of violence towards nurses in their workplace is encouraged. Both Employers and the Government have the responsibility of funding and supporting initiatives that promote a healthy environment for nursing practice which include equity among works (RNAO 2OO8:par:1). To address health inequities among low-income workers, (Baron et al. 2014, p.3-5) suggested an integrated approach through a socio-ecological framework to improve access to quality health care for these individuals. It was purposely designed to eliminate discrimination in health care provision since the majority of US citizens are of low economic status (Baron et al. 2014, p.1-2). Due to this intervention, more health facilities have been built to increases accessibility to health services and meet the health demands of the low-income. The introduction of service-learning in nursing education has seen the practices of the profession improve as it has promoted the growth of practical leadership skills within the nursing community (Browne and Tarlier 2008, p.89). It prepares students for leadership and advocacy positions in nursing organizations, health care centers effectively. As primary care health providers, nurses, interact with patients more often and can make important decisions regarding the patient treatment process and the financial implications for both the patient and the hospital. Continuous professional development in the nursing practice through training and seminars is critical in addressing social injustices. It is through proper training on social issues that nursing practitioners and students understand social practices that improve their problem-solving skills when dealing with injustices and oppression. The introduction of social justice into the curriculum imparts the necessary knowledge to influence the level of practice and service delivery to patients. It also addresses the growing cases of ethnic and social discrimination in healthcare centres. Through scholarships, nurses get an opportunity in which they can champion for access to affordable healthcare. It is also the responsibility of nurses to provide education to co-workers, the media, professional organisations, and the general public. In doing so, they would raise the issues of health inequities by enlightening the public on the scope, cause, and impact health inequities have on people’s lives. Nurses can also empower individuals and communities to advocate social change themselves by transferring knowledge, skills, and control. The nursing profession also requires nurses to provide compassionate care, which involves physical, emotional, mental, and spiritual care (Curtis et al. 2012, p.792-3). This ensures that all patients receive adequate and appropriate care regardless of their background. In addition, nurses are obliged to provide safe, compassionate, competent, and ethical care to patients (Carnevale et al.2009, p.815-17). They also promote health and well-being by working with people to help them attain high levels of health. Nurses should also uphold dignity and respect for everyone. They should recognise and respect individual’s informed choices on social issues. Respect for an individual’s decision is an important determinant of patient outcomes, especially for the aged, where ethical concerns are also at play. A nurse should promote justice in all aspects of patient care by safeguarding human rights, equity, and fairness. Policy concerns versus social justice From our former discussion, it is clearly evident that issues related to health disparities are synonymously linked to social determinants of health and should be viewed as subjects of ethical and human rights concern. In the actual sense, these issues have political ties, which, when addressed could significantly improve the nursing practice. Actually the issue has been placed at the forefront in health care reforms by the USA government; communities and the legislature is putting more efforts in providing worthwhile health care without giving up the basic rights of anyone (Cleary 2007, p.23). According to Groh et al. (2011, p.401), poor implementation of the concept of social justice as a fundamental factor that limits the role of nurses as advocates of health reforms as the poor implementation of the concept of social justice. These sentiments introduce us to question the ethical obligation of nurses in addressing social determinants related to health as well as the ability of the contemporary nursing practice in permitting nurses towards taking action when dealing with social determinants of health. This section will seek to answer these questions through reviewing various policy concerns and forces that affect social justice. The nursing profession is mounted on distinct ethical practices that have been developed over a long period of time to form numerous associations depending on state and geographic location (for example ANA and ICN) that are based on justice, advocacy, confidentiality and responsibility (Potter 2013). Such associations form principles (such as Code of Ethics for Nurses (ICN)) that define ethical practice within the nursing professional, and act as instruments of consultancy. The ICN (2012 p.2) provides nurses with four fundamental principles namely: promotion, restoration, prevention of illness and alleviation of suffering. Within the document, nursing is identified as a universally accepted profession and thus must conform to elements that respect fundamental human rights. Therefore, respect is paramount in nursing care and should be equal across all persons despite their age, colour, location or even disability. Further, section two of the code identifies the importance of nurses in rendering health services to individuals, families as well as communities. Coordination of health activities should also be done within such groups As stipulated above, the code provides us a clear perspective of nursing in relation to social justice through the responsibility of alleviating suffering, an element that practitioners should endeavour to accomplish even beyond their arenas of practice. Along these lines, political arenas are not exceptional to nurses when protecting and ensuring that all persons have access better health facilities. Again, the second sections of the elements entitle nurses to preserve and maintain social justice through the provision of services to all persons inclusive of their families and the community at large. Therefore, nurses are given a sole responsibility to go beyond their medical contexts of health care to social and political while striving to protect the people and the community they serve. Comparable, the American Nurses Association (ANA) (2010, p.28) refers to social justice and alleviation of suffering as a requirement to the entire nursing profession. The third section of the code cuts across the concern for the welfare of the injured, sick and vulnerable members of the society. In addition, the practice of nursing includes the protection, promotion, alleviation of suffering and restoration of healthcare of not only individuals but also families and communities. As clearly underlined by ANA, all nurses have the responsibility of promoting social justice by supporting universal access to health care, influencing policy, and delivering nursing care irrespective of social deterrents. In addition, they are obliged to remain politically active and lead in advocating patients’ rights. In the process of doing their duties, the professional values of the nursing practice recognise social reforms as part of the duty to improve the accessibility, quality, and reduced cost of treatment. Individuals or the nursing association can advocate social change if it is deemed beneficial to patients, the community, and the nursing profession as a whole. The ANA does refer to human rights directly, and thus creating a refutable room on the recognition of health and health-care as human rights. Nevertheless, the code clearly supports the existence of change linked to social structures that affect health within the nursing profession, a typical form of promotion of social justice within the practice. The link of the profession to existing social structures links the practice to social determinants of health and health disparities, which form topics of concern to social justice. When working to address social structures related to ill health and alleviating suffering, the code instils ethical permission over nurses. Therefore, nurses indeed have the obligation to address social determinants affecting health. The ANA Code (2010) further provides that nurses form a collaboration with other health professionals and the public to create a strong network while striving to promote community, national and international health needs. Clearly, the provision encourages the collaboration and collective responsibility of health systems across the globe and thus linking social justice within the nursing arena to political action. Changes can be made through the legislation of new health care policies or amendment of existing ones. Legislators rely upon the health experts in order to develop appropriate health care plans, and nurses are the best suited to influence these decisions, due to their significant number within the healthcare system. Nurses are always encouraged to communicate with their legislators on issues affecting nursing since it is the role of the legislator to further the interests of his constituents. Also, nurses can defeat poorly designed legislations through lobbying. When laws regarding health-care economics are made, it is nurses who can provide information, as they understand the cost of treatment most effectively. Therefore, nurses are required to have knowledge of current health care treatment, so as to assist in developing health policies. Conclusion The contemporary nursing environment has so far offered nursing practitioners with tremendous opportunities that will ideally position them to participate in reform processes. From documents such as ANA and ICN, it is clearly evident that such reforms are determined to improve healthcare globally as there exists refutable evidence of nursing practitioners moving beyond personalised and individualized care to care that touches the society at large. In spite of the tremendous effort made by nurses, their contributions will only remain relevant in the prevailing political and economic trends are influenced by daily realities. Thus, they must be able to remain adamant in their beliefs of promoting the welfare of the society regardless of any policy and political forces. This paper has so far expounded on social justice in contemporary nursing. From the literature review, we have clearly illustrated the need for the promotion of social justice within the nursing arena as few peer-reviewed documents exist. We have also established the link between social justice and the nursing practice by identifying its importance in practice. Lastly, we have critically analysed two policies, ANA and ICN in safeguarding social justice within the health and nursing practices. Bibliography AMERICAN ASSOCIATION OF COLLEGES OF NURSING, 2010. The essentials of baccalaureate education for professional nursing practice. 2008. Washington, DC: Author, . AMERICAN NURSES ASSOCIATION, 2010. Nursings social policy statement: The essence of the profession. Nursesbooks. org. BARON, S.L., BEARD, S., DAVIS, L.K., DELP, L., FORST, L., KIDD‐TAYLOR, A., LIEBMAN, A.K., LINNAN, L., PUNNETT, L. and WELCH, L.S., 2014. 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