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What is Social justice in a Nursing Context
1. What is Social
Justice?
“SOCIAL JUSTICE IS A MATTER OF LIFE AND DEATH. IT AFFECTS THE WAY
PEOPLE LIVE, THEIR CONSEQUENT CHANCE OF ILLNESS, AND THEIR RISK OF
PREMATURE DEATH”
“We watch in wonder as life expectancy and good health continue to
increase in parts of the world and in alarm as they fail to improve in
others”
4. Stories
I will use some of my experiences working in health,
in the north, and as a nurse, often an outsider,
working in different situations, as someone with a
lot of privilege.
You are a part of the story.
5. Social Justice Unit
Concepts:
Marginalization
Oppression
Health Disparities
Health Determinants
Advocacy
Political and Social Activism
Population Health
Social Justice
6. Canadian Nurses Association
Foundation of the Code
Nursing ethics is concerned with how broad
societal issues affect health and well-being. This
means that nurses endeavour to maintain an
awareness of aspects of social justice that affect the
social determinants of health and well-being and to
advocate for improvements.
7.
8.
9.
10. ᒥᐢᑕᑎᒼ mistatim [NA]
horse
a spotted horse, i.e.: a pinto, masinâsowatim (na); a
stud or male horse, nâpestim (na); a young horse, i.e.:
usually refers to a yearling, oskastim (na); a harness
horse or a work horse, otâpahâkan (na); s/he has
horses or dogs, otemiw (vai); an untamed horse,
pikwatastim (na) (Northern Cree); an untamed horse,
pakwatastim (na) (Plains Cree); it is a good or nice
horse or dog, takahkatim (na); a white horse or white
dog, wapâstim (na); a saddle horse, tehtapîwatim (na)
12. We Don’t See Things As They
Are, We See Them As We Are
“It has been well said that we do not see things as they are, but
as we are ourselves. Every man looks through the eyes of his
prejudices, of his preconceived notions. Hence, it is the most
difficult thing in the world to broaden a man so that he will
realize truth as other men see it.”
Anaïs Nin
13. Invisible Backpack
“All of us carry an invisible ‘backpack’ of our culture, experiences,
beliefs, values and morals. Whenever we encounter another
person, our backpack is present with us and influences how we
interact with our patients and their families”.
Scott Harrison
Invisible Knapsack Peggy McIntosh
14. What is Culture?
Behaviour is what you do…
Culture is how you do it…
15. Everything is about CULTURE!
Everybody knows about it
Everybody does it
Nobody talks about it
Kathleen Bartholomew, RN, MN
17. What are the most important
factors affecting the health of individuals?
Whether people are healthy or not, is determined by
their circumstances and environment.
Income and social status
Education
Physical environment
Social support networks
Genetics
Health services
Gender
18. Determinants of Disease? Or
health?
Both the etiologic agents directly responsible for disease
and other factors that facilitate exposure, multiplication,
and spread in the population
=agent, host, and environmental factors
https://quizlet.com/
19. 12 Determinants of Health
(Population Health Approach)
Income and Social
Status
Biological and genetic
endowment
Culture
Education and
Literacy
Employment and
working conditions
Gender
Healthy child development
Health services
Physical environments
Personal health practices
and coping skills
Social support networks
Social environments
19
(Public Health, 2016)
20. Determinants of Health
Determinants of health are those
factors considered to determine
health status of individuals, groups,
communities or populations.
They are the conditions for health.
20
21. Determinants of Health
# 1: Income and Social Status
“Social gradient” of health:
Higher income better housing, nutrition,
education, life choices, psychosocial well-being
Social status affects health by determining the
degree of control people have over life
circumstances, and therefore their capacity to
take action
21
(Public Health, 2016)
22. What does privilege have to
do with health?
PRIVILEGE
HTTPS://WWW.YOUTUBE.COM/WATCH?V=HD5F8GUNUGQ
23. Recognizing my Privilege.
Firstly, to be an effective ally I need to recognize the privileges I may
(unknowingly) be benefitting from.
As a true ally I am aware of my privilege and I am willing to speak up
about it without taking attention away from those who are marginalized.
As a true ally this can only be decided by those who I am working with,
that is, it is not up to me at all.
Really, I am aligning myself with others, it is an action, and an act of
doing something, and not something to be turned on or off when it is
convenient.
25. Determinants of health
#2: Biology and Genetic Endowment
Physiological make-up is an important health
determinant
#3: Culture & ethnicity
Cultural norms shape health-promoting (or
damaging) behaviors
Biases create stereotypes influencing physical and
mental well-being
Discrimination prevents equitable access to other
health determinants
Ethnicity increases risk for certain illnesses
(Public Health, 2016)
25
26. Determinants of Health
#4: Education and Literacy
Knowledge and skills for problem solving,
employment, health care
Increases opportunities for income and
security
#5: Employment and Working
Conditions
Meaningful employment, economic stability,
and a healthy work environment >> good
health
(Public Health, 2016)
26
27.
28. Determinants of Health
#6: Gender – LGBT+
Risk for particular psychosocial and physical
conditions
#7: Healthy Child Development
Prenatal and early childhood experiences have a
major impact on health outcomes
#8: Health Services
Availability/accessibility of primary, secondary and
tertiary prevention services (interventions)
(Public Health, 2016)
28
29. Determinants of Health
#9: Physical Environment
Air, water quality, housing, community safety
#10: Personal Health Practices and
Coping Skills
Need environments that promote healthy
choices, teach healthy behaviors
Coping skills key to maintaining health
(Public Health, 2016)
29
30. Precautionary Drinking Water Advisories (PDWA)
and Emergency Boil Water Orders (EBWO)
Currently in Effect for Waterworks that are Regulated by the Water
Security Agency or Saskatchewan Ministry of Environment
NOTICE: While Water Security Agency and Saskatchewan Ministry
of Environment (Environment) make every effort to post and
remove listings of Precautionary Drinking Water Advisories (PDWA)
and Emergency Boil Water Orders (EBWO) in a timely manner, from
time to time circumstances may arise that prevent timely revisions
to this website. In the event consumers require additional
information regarding application of a PDWA or EBWO, they are
advised to contact their water supplier, the Water Security Agency,
or Environment as outlined on the site-specific PDWA or
EBWO(see: http://www.saskh2o.ca/pdwa_ebwo.asp ). If questions
arise after hours regarding a PDWA or EBWO, a Water Security
Agency or Environment Environmental Project Officer may be
reached by calling 1-844-536-9494.
Fri, 13 Oct 2017 17:36:07 CDT
http://www.saskh20.ca/reports/GOC/EnvActive.pdf
31. Determinants of Health
#11: Social Support Networks
Family, friends, and communities
important in dealing with stressful
situations
Psychosocial, economic, educational and
physical resources for health within social
support network
(Public Health, 2016)
31
32. Determinants of Health
# 12: Social Environments
Values and norms of society that affect
health of individuals and communities
Status of women & children
Equity & diversity versus discrimination and
inequity
Individual and community safety
(Public Health, 2016)
32
37. Imbalance Creates Illness
Holistic approach to address issues and
factors that impact illness targeting not just
the disease, but also the social determinants
of health and economic circumstances.
It is recognized that the whole family (broadly
defined) is as impacted by disease and needs
healing just as the individual who is ‘sick’
requires care, treatment and support.
38. Physical Mental Emotional
Spiritual Health
My perspective is that each of these four parts can be treated as
its own body.
Each requires its own form of sustenance and exercise to be
healthy
39. Individual Health
Unus pro omnibus, omnes pro uno
Un pour tous, tous pour un
"One for all, all for one“
Public Health vs Personal decisions
Vaccines
49. Advocacy
Advocacy refers to the act of supporting or
recommending a cause or course of action,
undertaken on behalf of persons or issues. It relates to
the need to improve systems and societal structures to
create greater equity and better health for all. Nurses
endeavour, individually and collectively, to advocate
for and work toward eliminating social inequities.
50. CNA CODE OF ETHICS -
Advocacy
ADVOCATE: actively supporting a right and good
cause; supporting others in speaking for themselves or
speaking on behalf of those who cannot speak for
themselves
Advocacy involves engaging others, exercising voice
and mobilizing evidence to influence policy and
practice. It means speaking out against inequity and
inequality. It involves participating directly and
indirectly in political processes and acknowledges the
important roles of evidence, power and politics in
advancing policy options.
51. CNA CODE OF ETHICS -
Advocacy
Nurses should endeavour as much as possible,
individually and collectively, to advocate for and work
toward eliminating social inequities by:
iii. In collaboration with other health-care team members
and professional organizations, advocating for changes
to unethical health and social policies, legislation and
regulations.
52. Restoring Balance through Harm
Reduction
North American culture looks at problems of
substance abuse as individual problems rather than
looking at the larger societal picture.
In individualistic societies we blame the individuals,
often missing the larger patterns and forces at work.
Most social ills are seen as the result of actions by
people who are “bad”.
The individualistic perspective frequently narrows
the ethical discussions to consideration of individual
rights rather that collective goals and
responsibilities.
We are far too focused on individual behaviour to
see the larger context that encourages people to act
ethically.
53. “Our preference would be that no one would engage in the risk and
harm that goes with drug use, but we know there has to be help and
support for those already addicted,” said Regina Police Service
spokesperson Elizabeth Popowich.
The province said in a written statement that it’s not currently
considering supervised consumption sites, but it is monitoring them in
other places and will review evidence and research as it becomes
available.
Harm Reduction & Substance Use
Harm-reduction advocates call for safe
injection sites in Regina
54. Harm Reduction Nurses Association
(HRNA)
Position Statement - Safer Injection
HRNA BELIEVE THAT SAFER INJECTION INCLUDES THREE
COMPONENTS:
1. How you inject
2. Where you inject
3. What you inject
Safer injection reduces the risk of complications (including soft
tissue infections, venous injury, endo-carditis, sepsis), prevents
blood-borne diseases and overdose-related death, and improves
health.
http://www.hrna-aiirm.ca/wp-content/uploads/2018/01/hrna-aiirm_infosheet_saferinjection_en_180116.pdf
55.
56. Speak with one voice vs
Many voices
Coordination is always the best.
Largest voice for the biggest ears
Divide and conquer? Divided we fall
Can’t we just all get along? If not, what can we agree
on?
57. Types of Advocacy
Self-advocacy, personal advocate
Group advocacy.
Peer advocacy.
Citizen advocacy.
Professional advocacy.
Non-instructed advocacy.
58. Advocacy
Not always about solving a problem
It is about change, or sparking the
conversation
“Make them smart before you make them mad”
59. Who should advocate for
whom/which group when?
And when do we stop…
What will stop you from being an advocate?
When is it time to let ‘the other’ advocate for themselves?
60. Let me tell you a story …
This is a story about a mom and a dad, and a child, and a the child’s
grandparents…
61. David Vs. Goliath - Was
David Really Such A Hero?
Risk – We often face
a risk in acting, and a
risk in not reacting!
62.
63.
64. What can be done to
improve the health of
individuals in our
community?
65.
66.
67.
68. “
”
& DonT be
arfaid to kame
mit sakes
Ask questions, listen, and then ask
more questions.
69. Lateral Kindness
Please be kind to each other
Respectful and responsible relationships, there are no apps
for that.
Be Grateful
Be Great!
70. Contact information
Greg Riehl RN BScN MA
Indigenous Nursing Student Advisor
Saskatchewan Polytechnic Indigenous Nursing
Saskatchewan Polytechnic
Regina Campus
Email: greg.riehl@saskpolytech.ca