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Posts tagged ‘social justice’

Theory of Social Justice in Nursing

Our current featued article is titled “Emancipatory Nursing Praxis: A Theory of Social Justice in Nursing” by Robin R. Walter, PhD, RN, CNE.  In the short video below, Dr. Walter shares what she sees as the important take-aways from her study.  I hope you will not only view the video, but also download this article from the ANS website, then return here to share your comments and ideas related to her work!

Historical Nursing Documents Archived by City of Toronto

This update has been provided by Adeline Falk-Rafael to follow-up on the ANS article titled “Towards Justice in Health.”An Exemplar of Speaking Truth to Power.

Our article “Towards Justice in Health: An exemplar of speaking truth to power” is an analysis of 6 issues of the magazine (TJH) produced by Nurses for Social Responsibility (NSR) in Toronto, Canada, between 1992 and 1995. The article reported that the request of the magazine’s editors for archival of the magazine in the Library and Archives Canada had been denied.

A few days ago, Cathy Crowe, one of the magazine’s editors, notified us that the City of Toronto Archives has accepted both the 6 issues of the magazine and the NSR’s newsletters which predated the magazine and were alluded to in the article but were not part of the analysis. As Cathy Crowe noted, they will now be available “to aid and inspire future nurse and academic researchers on nursing and social justice.”

The vision and courage of these remarkable nurses for social responsibility is evident in some of the topics they wrote about and in which they actively sought change between 1985 and 1995. Their newsletter s and, in the later years, their magazine, covered many contentious issues that impacted health, including the environment, the sale of arms and war itself, women’s reproductive rights, health care policy, trade agreements, lesbian nurses, and needle-exchange programs, as well as issues that affected nurses in the workplace, such as working conditions and staffing mix. As we said in the article, they were exemplars in speaking truth to power and it is fortunate that the newsletters and magazines will now be available for aspiring historians and activists.

The images below of the newsletter and the magazine provide examples of the amazing topics that were addressed in this publication! Their placement in the City of Toronto archives provides a valuable resource and inspiration for nursing’s continuing social justice commitment.  For more information about Dr. Falk-Rafael’s and Dr. Bradley’s analysis of these important historical publications, see their blog message published here in August 2014.



Moving beyond Rhetoric to Action: Understanding Inequalities to Health Care Services

Rhetoric admonishing nurses and other health care professionals to address inequalities in health care is a common message; it is less often that we learn about concrete action to do just that!  In our current featured article, titled “Understanding Inequalities in Access to Health Care Services for Aboriginal People: A Call for Nursing Action” the authors describe a research initiative they undertook in partnership with Aboriginal people to create meaningful action addressing barriers that result in inequalities.  The authors, Brenda L. Cameron, PhD, RN; Maria del Pilar Carmargo Plazas, PhD, RN; Anna Santos Salas, PhD, RN; R. Lisa Bourque Bearskin, MN, RN; Krista Hungler, MSc have shared this very interesting description of their work:

Hello to Everyone on behalf of the Access Research Team and many thanks to Dr. Peggy Chinn and the Advances in Nursing Science Journal for the opportunity to accompany the article with a blog. Attached is an  Overview of the access initiative diagram and below is a photo of the authors of this article.

To begin: It was quite startling to come to the end of a two day community consultation workshop (2002) where ten areas identified as urgently needing health research were set aside. Instead a community request was issued to study access to

Krista Hungler, Sandra Kwagbenu, Maria del Pilar Camargo, Brenda Cameron, Elder Rose Martial, Raymonde Lisa Bourque Bearskin, and Anna Santos Salas. The photo is by Veronica Guerra Guerro

L to R: Krista Hungler, Sandra Kwagbenu, Maria del Pilar Camargo, Brenda Cameron, Elder Rose Martial, Raymonde Lisa Bourque Bearskin, and Anna Santos Salas. The photo is by Veronica Guerra Guerro

health care services for Indigenous and marginalized populations. Researchers from several health professions, healthcare professionals, community members with province-wide representation, and students of every level sat back and listened. This access research was not to be the current approach to access with numbers and statistics, i.e., how often Indigenous people saw specialist physicians, how many emergency visits. It was to be in collaboration with the Indigenous people and not couched only in terms of western research philosophies and methodologies.

From this request we sat down together and talked together for three years; at times coming to a consensus and moving forward, but other times, no movement at all. Sitting together at the table for this time was in a way, the research itself. It was an arduous, long process of building trust and relationships with each other with continuous clarifying of what was meant by each suggestion, what each step comprised that was decided upon, what possible fallout might occur. There were many issues on the table, some overt and some yet to appear but each one had to be thoroughly addressed before we could move on. Memoranda of Understandings had to be negotiated and signed, safety issues were addressed through the design of advisory groups and involvement of the people in each data gathering step was planned. We did not move forward without full agreement at the table. Others over this time period joined the table and again we renegotiated every step. During this time we agreed upon, designed and undertook three exploratory grants (Aboriginal populations in urban, inner city, and rural areas) in an open conversational manner with extensive advisory groups attached to each one as well as Elder scholars. The findings of these became the basis of our movement forward.

A focus on developing sensitive and comprehensive indicators for access to health care services for Indigenous people came into view early in the discussions. But we were also told by people participating in the exploratory grants that they had had enough of evaluation projects and reports. In the inner city exploratory grant, inner city residents took us to the Director’s office in one of the inner city agencies and pointed out the numerous reports that existed on the need for healthcare access appropriate to inner city and downtown core residents. They asked us: how will this study be different, there has been no action attached to these reports stemming over the last ten years. When will studies lead to action on the issues identified? Was there nursing action that had occurred in response to these reports? Will this work just enhance researcher’s careers or just prove that the healthcare system is doing something instead of nothing? These questions were the standard, the bottom line, which we were given not only from inner city residents but from all participants and healthcare professionals in our projects. We have learned that we must declare how particular research studies will benefit researchers as well as the knowledge development the studies would produce. We also had to plan how to move the findings to actions.

Moving forward: We placed Indigenous Healthcare workers called, Community Health Representatives (CHRs) in Canada, in healthcare sites with a high percentage of utilization by Indigenous people. This intervention turned out to be one of the cornerstones of our research initiative. This manuscript portrays some of this work. Our findings opened the door to understanding how even the most simple institutional mandated protocol when accompanied by overt rudeness or a stigmatizing comment, caused fright. And often there were unseen consequences down the road, i.e., never seeking care again until the condition was far advanced. Even if the institution triggered horrific memories of government residential schools (in Canada), the presence and health knowledge of an Indigenous CHR mitigated that fear. As well the CHR assisted them to communicate safely their healthcare history with few repercussions, judgments and racist practices from the institutions’ healthcare staff. Outcomes were more positive when the CHR was there. For further information see our Access Community report (2014) link below.

The call for action: The people in our studies talked about respect, feeling safe, undoing decades of harm from government and healthcare agencies, rejecting positioning statements from some past research and institutional practices, fighting for rights to have sensitive cultural and healthcare and Indigenous understandings at all points of access. Indeed our work to date shows a pressing need for joint interdisciplinary and intercultural efforts to reduce current health disparities through collaborative participatory work with Indigenous peoples.

Our findings suggest that nurses in particular the need to engage with Indigenous people and their culture to create safe access for them as often nurses are their first point of contact. All nurses know about the need to be aware of the social determinants of health and the health disparities that exist for certain populations. Nurses also know about the importance of honouring cultural traditions of health. But our research team is also aware that activating this knowledge in day to day practice needs additional careful attention and thought. As well increasingly so, the actions of nurses are prescribed by healthcare protocols and policies to ensure a specific outcome that is tied to an economic parameter. Caring for someone who is very ill takes a toll on the prescribed and allowable economic outcome for certain. Based on our studies to date in our specific healthcare institutions, our practicing nurses need support to take action to mitigate the growing and alarming reports of disingenuous care documented in our findings.

Perhaps it is again, sitting around a table with a social justice framework and consciousness raising activities to work toward incorporating research findings into actions. As health disparities climb even as we write this blog, the time to start this is now. There is much work to do to support nurses and other healthcare professionals who work under institutional dictates to then plan their care with the understanding that individuals and families with low SDOH need our special attention. We would also like to draw attention to the Indigenous social determinants of health identified by Loppie-Reading and Wein (2009) as a way to increase further understanding of implementing the SDOH in actual practices of nurses and allied healthcare professionals.

In undertaking specific action on identified issues, we honour the Indigenous peoples of Canada, our original inhabitants. In addition, we know that it will take a concentrated effort to achieve equity in access for Indigenous peoples and we challenge others to facilitate Indigenous communities to undertake their own studies.

We sincerely thank the Indigenous people and the communities that guided this investigation into access to healthcare services and know that this is just a very small step in addressing the health disparities of Indigenous peoples in these particular communities and wider systemic difficulties. We also learned that research on Indigenous topics must be led by Indigenous research scholars and the communities themselves. We very much look forward to your feedback and many thanks for the opportunity to do this blog.


Cameron, B. L., Martial, R., King, M., Santos Salas, A., Bourque Bearskin, R.L, Camargo Plazas, M.D.P., Hungler, K. (2014). Access Research Community Report: Reducing health disparities and promoting equitable access to health care services for Indigenous peoples: Community Report. Edmonton, AB: University of Alberta, Faculty of Nursing.

Reading, CL, Wien, F. Health inequalities and social determinants of Aboriginal Peoples’ health. Prince George, BC: National Collaborating Centre for Aboriginal Health. 2009.

The article is available while it is featured for free download on the ANS web site!  We – the authors and I – would be delighted to know your comments, and welcome your discussion related to these very important issues!  Please use the space below to let us hear from you!

When the Unimaginable is Real

Dilmi S. Aluwihare-Samaranayake, MSN, MBA, author of our current featured article titled “Representations, Forbidden Representations, and the Unrepresentable Creating Visibility for Mapping Emancipatory and Transformative Nursing Praxis,” brings to light the plight of people who suffer unimaginable suffering and harm.  She proposes that our inability, even unwillingness, to represent these horrific experiences in written and spoken language impedes both the science and the practice of emancipatory nursing – an approach to nursing that seeks justice and remedies for human pain and suffering.  She shared this reflection on her work for ANS readers:

I am honored that my paper has been featured in this current issue of ANS. Grappling with the concepts representation, forbidden representation and the un-representable, together with tragic, devastating and unthinkably horrific life experiences of people plus feeling a strong sense for the importance of finding ways to help people, led me to write this paper.

There are those who drive decisions intentionally or unintentionally and those who harm Dilmi300themselves without thinking of the short or long-term consequences they face or the consequences for those around them. There is also no easy or set prescription to fit the amalgam of human experiences because of the diversity of circumstances and histories that shape people’s lives.

These views lead me to reflect on the following questions:

“Is it within the realm of possibility for us to prevent or alleviate horrific life experience? Is it possible for us to avoid natural and human disasters? As humans do our actions demonstrate that we value and respect all human life? Or is it our lack of value, respect and our presumptions that lead us to contribute to harming others and ourselves explicitly or implicitly. Can we really help people?”

Not to belittle the questions or the potential answers, but I believe the answers to these questions begin with a yes, although at different levels with different margins. I also suggest, however, that some life experiences do not need to be so horrific, and there is enough intelligence in the world and lessons to be learned to prevent horrific experiences, or at the very least, help people who have lived through these experiences to move forward.

I realize that debates on the aforementioned questions may seem hugely philosophical for some readers with representation, forbidden representation and the un-representable being new concepts or concepts not taken up for discourse frequently because of its marshy nature. I also appreciate that many readers may prefer to avoid these topics and because of this, these topics have not received the attention they deserve. However, in the wake of continuous incomprehensible life experiences faced by many, I believe dialogue (through writing, voice, drama and/or poetry) needs to happen and our research agendas must bring attention to the mélange of issues to assist in providing emancipatory and transformative nursing praxis and social justice that is, empowering and reflective.

Your views are welcome. Thank you.

While this provocative article is featured on the ANS web site, you can download it at no cost!  I join Ms. Aluwihare-Samaranayake in welcoming your views and comments related to her work, so after you have an opportunity to consider her article, please return here and share your ideas!

Spirituality and Social Justice

In the current ANS featured article, author Sheryl Reimer-Kirkham, PhD, RN explores an area of scholarship that is rare in nursing literature – the interplay between social justice, religion, spirituality, health, and nursing. The article is titled “Nursing Research on Religion and Spirituality Through a Social Justice Lens.” Dr. Reimer-Kirkham uses the critical perspectives of postcolonial feminism and intersectionality to inform nursing’s perspectives on spirituality and social justice. She has shared this background about her work in this area:

Bringing together critical perspectives (such as postcolonial feminism and intersectionality) and research on religion and spirituality in nursing has opened up new and productive terrain.  And yet, conversations on religion/spirituality and social justice can be contentious:  for some religion is dismissed as too irrational, too political or violent, or too bound up in structures of power; for others religious/spiritual beliefs are held as too “sacred” for objective, scholarly analysis.  Such contentions leave many to appeal to secularism as the way to manage religion and spirituality in the public sphere.

Dr. Reimer-Kirkham

Dr. Reimer-Kirkham

However, attempting neat separations between religion and the secular can, according to philosopher Charles Taylor, do more to obscure what is going on in our world than clarify the moral issues we face.  Shying away from critical analyses of the intersections of faith with nursing, religion/spirituality with social justice and equity, leaves us open to incomplete analyses, and fails to account for influences on the values, beliefs and practices of many of our patients.  Several recently published books by nurse scholars move beyond generic approaches to spirituality to engage more specifically with the influence of various religious traditions.  See for example Stajduhar and Coward’s (2012) Religious understandings of a good death in hospice palliative care, SUNY Press; Taylor’s (2012) Religion: A clinical guide for nurses, Springer; and Fowler et al.’s (2011) Religion, Religious Ethics and Nursing,Springer.

My entrée into the integration of religion/spirituality with critical research came about during my doctoral research that examined intergroup relations in hospital settings.  As I conducted this ethnographic research, I realized that many of the hardspots described by nurses and patients in intergroup interactions were directly shaped by religious perspectives and often involved accommodating religious values and rituals, and yet these situations were nearly always conveyed to me as cultural matters.  While there is significant overlap between culture and religion/spirituality, there are also important distinctions. So I have worked toward more intentional analyses of religion and spirituality in the context of health and healthcare, and am convinced of the importance of intersectional approaches in such scholarship. Intersectional analyses inevitably require that we take seriously social relations of power mobilized through religion as it intersects with gender, race, class, ability, and other social categories; particularly as these social relations contribute to equity and inequity.  The relationship between social justice and religion is critical, but not always straight forward.  Human rights and religious accommodation can, in fact, represent competing interests (e.g., religious freedom vis-à-vis heteronormativity or patriarchy).

In this manuscript, I propose critical nursing scholarship on how religion and spirituality relate to social justice and social transformation in the context of health and healthcare. I look forward to your views on the matter!

I too hope you will read Dr. Reimer-Kirkham’s article and return here to join in a discussion of her ideas!  You can download the article at no cost while it is featured on the ANS web site!  

Health & Human Rights: A Vital Connection

As is the tradition of ANS, this current issue of the journal contains articles that will quite likely prompt many interesting

April -June 2012

April-June 2012

discussions! The issue of human rights might seem to be primarily one that belongs in the realm of politics and policy, but as the authors of the articles in this issue of ANS  so aptly demonstrate, human rights are invariably linked to health and well-being.  Falk-Rafael and Betker cite a report that says it best: “Social justice is a matter of life and death.”

The connection goes even further to encompass the matter of health and illness.  The article by Lee titled “Family Homelessness Viewed through the Lens of Health and Human Rights” makes this point very clear – their findings support the conclusion that being treated with dignity and respect is vital to health and well-being.

As nurses we face a fundamental challenge that requires honest reflection on what interests we serve not only in health care, but in the larger society.  Florence Nightingale laid a foundation for western nursing as fundamentally serving the best interests of society. By tending to the needs of those who are ill, at risk for illness, vulnerable, or whose well-being is challenged, we also tend to the needs of society.  But as nurses worldwide recognize, our social obligation goes beyond tending to individuals, to also taking bold steps to improve the social conditions under which people live and work and to shape public policy that creates those conditions.

In many countries around the world, the basic human needs and rights of the most vulnerable individuals have been undermined by the greed and desires of the few.  This is an issue that as nurses we cannot ignore if we take our social duty seriously.  It is time to step up to the challenge that faces our communities and nations, and to use our knowledge and our insights to advocate for social justice for all.  Take a look at the complete Table of Contents of this current issue of ANS.  This is the kind of evidence that nurses provide as a framework from which to build strong arguments that shape strong policies in favor of social justice.  Indeed, it is a matter of life and death, of health and illness.

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