Social inclusion/exclusion involves just/unjust social relations and social structures enabling or constraining opportunities for participation and health. In this paper, social inclusion/exclusion is explored as a dialectic. Three discourses – discourses on recognition, capabilities, and equality and citizenship – are identified within Canadian literature. Each discourse highlights a different view of the injustices leading to social exclusion and the conditions supporting inclusion and social justice. An Integrated Framework for Social Justice that incorporates the three discourses is developed and used to (...) critique the dominant focus on distributive justice within foundational Canadian nursing documents. We propose a broader conceptualization of social (in)justice that includes both relational and structural dimensions. Opportunities for multilevel interventions to promote social justice are identified. This framework is congruent with nursing's moral imperative to promote health equity and with the multiple roles played by nurses to promote social justice in everyday practice. (shrink)

Knowledge translation has been widely taken up as an innovative process to facilitate the uptake of research-derived knowledge into health care services. Drawing on a recent research project, we engage in a philosophic examination of how knowledge translation might serve as vehicle for the transfer of critically oriented knowledge regarding social justice, health inequities, and cultural safety into clinical practice. Through an explication of what might be considered disparate traditions, we identify compatibilities and discrepancies both within the critical tradition, and (...) between critical inquiry and knowledge translation. The ontological and epistemological origins of the knowledge to be translated carry implications for the synthesis and translation phases of knowledge translation. In our case, the studies we synthesized were informed by various critical perspectives and hence we needed to reconcile differences that exist within the critical tradition. A review of the history of critical inquiry served to articulate the nature of these differences while identifying common purposes around which to strategically coalesce. Other challenges arise when knowledge translation and critical inquiry are brought together. Critique is one of the hallmark methods of critical inquiry and, yet, the engagement required for knowledge translation between researchers and health care administrators, practitioners, and other stakeholders makes an antagonistic stance of critique problematic. While knowledge translation offers expanded views of evidence and the complex processes of knowledge exchange, we have been alerted to the continual pull toward epistemologies and methods reminiscent of the positivist paradigm by their instrumental views of knowledge and assumptions of objectivity and political neutrality. These types of tensions have been productive for us as a research team in prompting a critical reconceptualization of knowledge translation. (shrink)

Paradigm debates have been featured in the nursing literature for over four decades. There are at least two opposing paradigms specific to nursing that have remained central in these debates. Advocates of the unitary perspective (or simultaneity paradigm) consider their theories to be more philosophically advanced and contemporary alternatives when compared to the older more traditional ideas characteristic of models they describe as originating from the totality paradigm. In the context of these debates, I focus on some theoretical positions embedded (...) in the unitary perspective, noting their limitations with respect to integrating the individual and social mandates of nursing; nurses are responsible not only for individual health‐related needs, but also for the health of the collective. I explore two hypotheses that may explain the powers of endurance of the unitary perspective. Paley, who outlines the origins of nurses' ‘slave morality’, inspires the first hypothesis. The second hypothesis speaks to the location of nursing knowledge development in the context of liberal ideology. In this work, I outline key conceptualizations of the unitary perspective in order to clearly illustrate the limitations of the unitary perspective for nurses' social mandate. Then, I explore how slave morality and liberal ideological assumptions might both work to sustain the unitary perspective. A paradigm for nursing must have utility in addressing both the health‐related needs of individuals, and for addressing the health of the collective. To this end, I advance suggestions in three areas: first, to transform nurses' slave morality to more honest and noble aspirations; second, to examine liberal ideological premises; and third, to end paradigm debate by resituating elements of the unitary perspective to the level of mid‐range theory, where it could be most effective for research and practice with specific populations. (shrink)

MACDONALD SE, NEWBURN‐COOK CV, ALLEN M and REUTTER L.Nursing Inquiry2013;20: 30–41 Embracing the population health framework in nursing researchIndividuals’ health outcomes are influenced not only by their knowledge and behavior, but also by complex social, political and economic forces. Attention to these multi‐level factors is necessary to accurately and comprehensively understand and intervene to improve human health. The population health framework is a valuable conceptual framework to guide nurse researchers in identifying and targeting the broad range of determinants of health. (...) However, attention to the intermediate processes linking multi‐level factors and use of appropriate multi‐level theory and research methodology is critical to utilizing the framework effectively. Nurse researchers are well equipped to undertake such investigations but need to consider a number of political, societal, professional and organizational barriers to do so. By fully embracing the population health framework, nurse researchers have the opportunity to explore the multi‐level influences on health and to develop, implement and evaluate interventions that target immediate needs, more distal factors and the intermediate processes that connect them. (shrink)

BURGESS J and PURKIS ME. Nursing Inquiry 2010; 17: 297–308 The power and politics of collaboration in nurse practitioner role developmentThis health services study employed participatory action research to engage nurse practitioners (NPs) from two health authorities in British Columbia, Canada, to examine the research question: How does collaboration advance NP role integration within primary health‐care? The inquiry was significant and timely because the NP role was recently introduced into the province, supported by passage of legislation and regulation and introduction (...) of graduate education programs. In separate and concurrent inquiry groups, the NPs discussed their practice patterns, role development progress and understanding of collaboration and role integration. The inquiry revealed the political nature of the NP role and the extent to which NPs relied on collaborative relations at all levels of the health system to advance role integration. Given that NP role development is still at an early stage in this province, as well as other provinces in Canada, this study provides important insights into the power and politics of role development, and offers direction for future role advancement. (shrink)

Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health‐care. Given the intersection of sexualities with a range of social injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty‐eight articles met the inclusion criteria. Analysis consisted of a descriptive (...) phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out. (shrink)

Normative and prescriptive claims regarding social justice are often inadequately developed in the nursing literature and, in consequence, they must be rejected in their current form. Thus, claims regarding social justice are frequently presented as mere assertion or, alternatively, when assertions are supported that support may be weak . This paper challenges the coherence of social justice as a shared nursing value and it is suggested that claims regarding the concept should be tempered.

While nurses can and do behave as intentional political agents, claims that nurses collectively do , should or must act to advance political objectives lack credibility. This paper challenges the coherence and legitimacy of political demands placed upon nurses. It is not suggested that nurses ought not to contribute to political discourse and activity. That would be foolish. However, the idea that nursing can own or exhibit a general political will is discarded. It is suggested that to protect and advance (...) political discussion, to aid explanatory adequacy and clarity, the form in which nursing associates itself with political claims merits critical appraisal. Thus significant numbers of nurses probably reject or disagree with many of the political claims that attach to them – claims often made on their behalf. More specifically, the individual beliefs and goals of nurses can be in conflict with the political pronouncements of nursing scholars and organizations . It is proposed that nurses need not share substantive normative beliefs/goals and, if this proposal holds, group descriptors such as ‘nurses’ and ‘nursing’ cannot meaningfully or easily attach to political claims. Shared value theory is linked to the fallacy of composition and the concept of collective ascription error is introduced to explore the implausibility of using group descriptors such as ‘nurses’ and ‘nursing’ to refer to the beliefs/goals of all nurses. (shrink)

This paper considers the social justice initiative of the Canadian Nurses Association (CNA). It focuses mainly on the two editions of the CNA's discussion document on social justice, and particularly on its emphasis on the principle of equity. The paper considers whether a coherent justification can be made for the CNA's espousal of equity, and the discussion focuses in turn on the principle of equity itself and on the CNA's position in relation to equity. A body of arguments supporting an (...) active moral role for professions, generally known as civic professionalism, provides a framework for exploring the CNA's role in this respect. Justifications for equity are explored in relation to the liberal‐contextualist spectrum, and civic professional arguments are subjected to the same structure of analysis. This is in turn related to evidence from the literature concerning nursing perceptions of equity. The paper concludes that contextualist justifications of equity and civic professionalism support one another more robustly than liberal justifications in relation to the CNA's initiative; and that they also sit more comfortably with the realities of the CNA's role in relation to nursing, and to the Canadian health care system. (shrink)