Philosophies and Practices of Emancipatory Nursing

Social Justice as Praxis

Paula N. Kagan, Marlaine C. Smith, Peggy L. Chinn, Paula N. Kagan, Marlaine C. Smith, Peggy L. Chinn

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135085346
• Edition: 1
• Topic: Medicina
• Subtopic: Infermieristica

*** Awarded First Place in the 2015 AJN Book of the Year Award in two categories - "History and Public Policy" and "Professional Issues" ***

This anthology presents the philosophical and practice perspectives of nurse scholars whose works center on promoting nursing research, practice, and education within frameworks of social justice and critical theories. Social justice nursing is defined by the editors as nursing practice that is emancipatory and rests on the principle of praxis which is practice aimed at attaining social justice goals and outcomes that improve health experiences and conditions of individuals, their communities, and society. There is a lack in the nursing discipline of resources that contain praxis approaches and there is a need for new concepts, models, and theories that could encompass scholarship and practice aimed at purposive reformation of nursing, other health professions, and health care systems. Chapters bridge critical theoretical frameworks and nursing science in ways that are understandable and useful for practicing nurses and other health professionals in clinical settings, in academia, and in research.

In this book, nurses' ideas and knowledge development efforts are not limited to problems and solutions emerging from the dominant discourse or traditions. The authors offer innovative ways to work towards establishing alternative forms of knowledge, capable of capturing both the roots and complexity of contemporary problems as distributed across a diversity of people and communities. It fills a significant gap in the literature and makes an exceptional contribution as a collection of new writings from some of the foremost nursing scholars whose works are informed by critical frameworks.

Section III Pedagogy of Praxis

Teaching for Social Justice

DOI: 10.4324/9780203069097-14

11 Social Justice

From Educational Mandate to Transformative Core Value

Mary K. Canales and Denise J. Drevdahl

DOI: 10.4324/9780203069097-15

Introduction

This volume is committed to explicating social justice within nursing and examining the many ways social justice influences practice, research, and education. As a recent concept analysis of social justice indicates¹ such an explication is a challenge for the nursing profession because social justice is defined in myriad ways, or not at all, within the nursing literature. These variations and omissions in themselves suggest that although the profession claims “a long history of social justice,”^{1 (p949)} it continues to struggle with what social justice means for practicing nurses, educators, and students.

Despite these struggles, the nursing profession in the United States has reinforced the importance of social justice through its continued reaffirmation of it as a core value. Beginning in 2000, the United States (U.S.) American Nurses’ Association (ANA) has included social justice in its key documents, including the Code of Ethics for Nurses with Interpretive Statements, Nursing’s Social Policy Statement, and Nursing: Scope and Standards of Practice.² Yet, as analyses by Bekemeier and Butterfield,² and Fry,³ White,⁴ and Allen⁵ before them demonstrate, these documents focus primarily on individual rights and the centrality of the nurse-patient relationship, and minimally address broader social determinants of health such as poverty, affordable housing, or access to health insurance, to name a few.

Because the ANA social policy documents often provide the framework for nursing’s link to social justice, these critiques from the literature raised questions for us regarding other influential nursing documents. Within nursing education in general, and undergraduate education in the United States in particular, increased emphasis has been placed on accrediting documents with some concerns raised regarding their expanding and influential role in determining the direction of nursing education.^{6 – 8} Although social justice is an element of these documents, to what degree is the concept integral to them?

We attempt to answer this question by examining how social justice is incorporated into nursing education in the United States. We recognize that although an international perspective is very valuable, it is beyond the scope and purpose of this chapter, which is a critique of U.S. documents and literature. We do however, in the concluding sections, return to the importance of learning from global nurse scholars who are engaged in social justice efforts.

Although practice is not easily separated from education, how students are socialized into the profession has a major impact on how they practice once they graduate and enter the workforce. The development of critical thinking skills essential for viewing the world and the values that guide nurses’ professional practice often are established in their early nursing education. We therefore believe an examination of social justice within nursing education is warranted. We begin this chapter with the results of a review of U.S. nursing accrediting documents. Following this review, results of a critical analysis of the nursing literature, examining the intersection of social justice and nursing education, are presented. We conclude with our interpretation of the results of these examinations and what they may mean for nurse educators and accreditation organizations.

Analysis of Nursing Education Documents

During the past 20 years, the American Association of Colleges of Nursing (AACN) and its accrediting agency, the Commission on Collegiate Nursing Education (CCNE), have emerged as the primary external organizations influencing U.S. nursing programs at all levels within the university. According to AACN’s website, it “is the national voice for America’s baccalaureateand higher-degree nursing education,” with membership expanding from 121 schools of nursing in 1969 to more than 690 today.⁹ AACN has developed a series of Essentials documents that outline competency expectations for graduates of baccalaureate, master’s, and Doctor of Nursing Practice (DNP) programs. “Using these documents, schools of nursing are able to ensure they adhere to the highest standards for their educational programs and meet accreditation guidelines.”⁹ How do these documents incorporate social justice into “competency expectations”?

We begin with an analysis of the primary documents that currently guide nursing education in the United States. Although one may argue that university-based nursing programs are guided by their respective missions and visions, in reality, external nursing organizations, in particular those directly involved in accreditation processes, have assumed a powerful and influential role in curricular decisions, especially at the graduate level.⁶ Despite this increasingly visible role in nursing curricular matters, we were unable to locate published reports or analyses examining these relationships.

This analysis is intended to address this gap, beginning with an examination of social justice and its presence in these documents. Although we recognize that the technical college system educates 60% of U.S. educated registered nurses,¹⁰ social justice is not a component of associate degree accrediting documents.¹¹ We therefore limited the analysis to nursing programs at the university level, as it has been repeatedly reported that social justice is included in these documents.^{12 , 13} Table 11.1 provides a summary of this analysis in terms of the presence or absence of social justice concepts.

Table 11.1 Review of Accreditation Documents

Nursing Organization	Accrediting Agency	Programs Evaluated	Documents Reviewed	Presence of Social Justice in Documents
American Association of Colleges of Nursing (AACN)	Commission on Collegiate Nursing Education (CCNE)	Undergraduate: BSNGraduate Masters Doctor of Nursing Practice (DNP)	Essentials of Baccalaureate Education for Professional Nursing Practice (2008)^14Essentials of Master's Education in Nursing (2011)^15Essentials of Doctoral Education for Advanced Nursing Practice (2006)^16	Essential I-Liberal education for baccalaureate generalist nursing practiceEssential V-Health care policy, finance & regulatory environmentsEssential VUI-Professionalism & professional valuesEssential VI-Health policy & advocacyEssential V: Health care policy for advocacy in health care
National League for Nursing (NLN)	National League for Nursing Accrediting Commission, Inc. (NLNAC)	Undergraduate: BSN Graduate: Masters Education Clinical Doctorate	Standards and Criteria: Baccalaureate (2008)^11Standards and Criteria: Master's & Post-Master's Certificate (2008)^11Standards and Criteria: Doctorate (2008)^11	No referenceNo referenceNo reference
National Organization of Nurse Practitioner Faculty (NONPF)	National Task Force on Quality Nurse Practitioner Education (Accepted by AACN & NLN)	Graduate: Nurse Practitioner	Criteria for Evaluation of Nurse Practitioner Programs (2008)^18	No reference

Summary of Analysis Results

Similar to the ANA’s foundational documents,² the AACN’s Essentials of Baccalaureate Education for Professional Nursing Practice¹⁴ identified social justice as a professional value and defined it as “acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation.”^{14 (p29)} The primary discussion of social justice occurs within Essential I, ensuring a liberal education. Although included within three essentials of the baccalaureate document, the role of the generalist nurse is limited to “accepting responsibility to” ^{14 (p13)} “promoting ^{14 (pp13,21)} and “advocating for” ^{14 (p26)} social justice. A discussion of how the nurse can accomplish these actions is not provided.

The Essentials of Master’s¹⁵ and Doctoral Education¹⁶ both address social justice within the health policy and advocacy essential. In the Master’s Essentials¹⁵ glossary, social justice is presented as a “concept” that “relates to upholding moral, legal, and humanistic principles.” ^{15 (p39)} Although the Master’s definition is exactly the same as the AACN Baccalaureate Essentials (see above),¹⁴ it is interesting to note that the only references provided for the definition are previous AACN documents.¹⁵ The AACN Essentials for Doctoral Education¹⁶ does not include a definition of social justice. Neither document provides specific examples for enacting social justice or strategies for advocating for it. Although the documents recognize that social justice is influenced by health policy, as is equity, both are presented as health care delivery “issues” rather than desired outcomes or goals for populations.^{15 , 16}

The National League for Nursing (NLN), along with its accrediting agency the National League for Nursing Accrediting Agency, Inc. (NLNAC), is considered the oldest U.S. organization focused on maintaining standards for nursing education, with its Standards for Curriculum for Schools of Nursing first published in 1917.¹¹ Unfortunately, this long history does not correspond to nursing’s long history of valuing social justice because we were unable to locate any reference to social justice in our review of the 2008 edition of the NLNAC manual, which includes standards and criteria for nursing accreditation at all levels within the university.¹¹

Considering the limited attention to social justice in the AACN/CCNE^{14 – 16} documents and the omission of social justice in the NLN/NLNAC ¹¹ document, we were not surprised when our review of the graduate education criteria of the National Organization of Nurse Practitioner Faculty (NONPF), which were developed by its subsidiary, the National Task Force on Quality Nurse Practitioner Education, also omitted any reference to social justice.¹⁷ According to NONPF, CCNE has adopted the NONPF evaluation criteria into their accreditation standards whereas NLN has endorsed the evaluation criteria, recognizing the document as “the national standard for nurse practitioner educational programs.”¹⁷ Consequently, the only nursing organizations responsible for ensuring the educational standards for advanced practice nursing have adopted a document that disregards social justice.

Analysis of Published Literature

Considering the lack of attention to social justice in nursing accrediting documents, we then analyzed publications addressing social justice and nursing education. We reasoned that the published literature may more accurately reflect the efforts of nurses, particularly nurse educators, to integrate social justice into curricular and academic programming.

Each author conducted an independent literature search using the terms “nursing,” “education,” and “social justice.” Based on Medical Subject Headings (MeSh), we also conducted searches using “academic” and “justice” in an effort to broaden the search and locate additional articles. The time frame was limited to 2006–2012 to build upon previous searches of social justice and nursing education conducted by Boutain^{18 ,19} and to identify the most current pub...