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 âa long history of social justice,â1 (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 Nursesâ Association (ANA) has included social justice in its key documents, including the Code of Ethics for Nurses with Interpretive Statements, Nursingâs 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 nursingâs 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 â 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 nursesâ 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 AACNâs website, it âis the national voice for Americaâs baccalaureateand higher-degree nursing education,â 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, masterâs, and Doctor of Nursing Practice (DNP) programs. âUsing these documents, schools of nursing are able to ensure they adhere to the highest standards for their educational programs and meet accreditation guidelines.â9 How do these documents incorporate social justice into âcompetency expectationsâ?
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.
Summary of Analysis Results
Similar to the ANAâs foundational documents,2 the AACNâs Essentials of Baccalaureate Education for Professional Nursing Practice14 identified social justice as a professional value and defined it as âacting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation.â14 (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 âaccepting responsibility toâ 14 (p13) âpromoting 14 (pp13,21) and âadvocating forâ 14 (p26) social justice. A discussion of how the nurse can accomplish these actions is not provided.
The Essentials of Masterâs15 and Doctoral Education16 both address social justice within the health policy and advocacy essential. In the Masterâs Essentials15 glossary, social justice is presented as a âconceptâ that ârelates to upholding moral, legal, and humanistic principles.â 15 (p39) Although the Masterâs 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 âissuesâ 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 nursingâs 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/CCNE14 â 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 âthe national standard for nurse practitioner educational programs.â17 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 ânursing,â âeducation,â and âsocial justice.â Based on Medical Subject Headings (MeSh), we also conducted searches using âacademicâ and âjusticeâ in an effort to broaden the search and locate additional articles. The time frame was limited to 2006â2012 to build upon previous searches of social justice and nursing education conducted by Boutain18 ,19 and to identify the most current pub...