A critical review of social and health inequalities in the nursing curriculum

"They bring the topic [of social justice] but stop there": Nursing students' perceptions of teaching practices that develop awareness and engagement with social justice

BACKGROUND

Pedagogical frameworks grounded in social justice, such as decolonizing and anti-racist educational practices, are essential in nursing programs. While scholars have begun to examine nurse educators' conceptualizations of social justice, there remains a lack of knowledge about student perspectives regarding nurse educators' approaches to incorporating social justice in education.

OBJECTIVE

To understand nursing students' perceptions about educational strategies that develop critical awareness and engagement with social justice and positively influence professional practice.

DESIGN

A qualitative study informed by Critical Feminist Pedagogy and guided by Interpretive Description methodology.

SETTINGS

A school of nursing in Western Canada.

PARTICIPANTS

Ten undergraduate and graduate nursing students recruited through convenience sampling.

METHODS

Students participated in one-on-one semi-structured interviews. A set of questions developed to facilitate data analysis allowed the deconstruction of the data to identify broad-based inductive categories. Contrast and comparison methods were also used. Members of the research team provided analytic insights into the categories, and subsequently, all members discussed the findings and developed the interpretive frame.

RESULTS

Student participants reported that educational strategies promoting awareness and engagement with social justice need to go beyond superficial engagement and awareness of social justice. Researchers' analysis suggests that cohesiveness between awareness and action in social justice is urgently needed within academia to adopt a decolonizing and anti-racist pedagogy in nursing and better prepare students for professional practice. From the data analysis, teaching strategies that enhance cohesiveness include: embracing personal development, creating community spaces and disrupting knowledge and curriculum hierarchies.

CONCLUSIONS

Understanding students' perceptions and incorporating their suggestions is critical to integrating socially just teaching practices that embrace a learner-centred pedagogy. Our findings offer suggestions for teaching strategies that foster critical awareness and engagement with social justice. Combined, these contribute to our understanding of signature pedagogies in nursing with the intention of increasing the adoption of anti-racist and decolonizing approaches.

Challenging anti-racism in nursing education: A moral and professional call to action

The call to implement anti-racism pedagogy in nursing education and practice is reverberating globally. Racist ideologies are foundational to systems of health inequity. An antiracist approach is critical to dismantling systemic racism and promoting optimal health outcomes in the quest for health equity. Therefore, employing an anti-racist pedagogy within nursing education that allows students and teachers to reflect on their roles in dismantling racist structures and transforming equity outcomes in practice and society, is a moral undertaking. However, for nursing education to make significant inroads in health equity, it cannot be guided by the same Eurocentric motives and value systems that continue to shape health inequities. We must transcend the boundaries of Eurocentric knowledge construction to intentionally shift how nurses think and practice within systems of inequities. Alongside the pressing and growing call for radical transformation of students and teachers through anti-racist pedagogy, we also provide directions to teaching strategies that support the uptake of anti-racism in nursing curricula and classroom engagement.

The impact of socioeconomic inequality on access to health care for patients with advanced cancer: A qualitative study

Objective

In Canada, populations experiencing socioeconomic inequality have lower rates of access to screening and diagnosis and higher mortality rates than people from higher-income areas. Limited evidence exists concerning their experiences when living with advanced cancer. We explored how socioeconomic inequality shapes the experiences of patients with advanced cancer.

Methods

We utilized a qualitative study design that combined tenets of hermeneutic phenomenological inquiry and critical theory. Four individuals with advanced cancer from low-income neighborhoods, three family members, and six cancer care providers were accrued through a tertiary cancer center in a western Canadian city. One-on-one interviews and brief notes were used for data collection. Data were analyzed through thematic analysis.

Results

Three interrelated themes were identified: 'Lack of access to socioeconomic supports,' 'Gaps in access to health care resources and services,' and 'Limited access to symptom relief.' Patients experienced inadequate finances, housing, and transportation. Most patients lived alone and had limited family and social support. Patients reported lack of knowledge of available resources and health system navigation issues, including communication problems with providers and among levels of care. Cancer care providers and patients described issues achieving symptom relief as well as challenges associated with extensive disease.

Conclusions

Study findings suggest that socioeconomic inequality interferes with the ability of persons with advanced cancer to access health care and contributes to less optimal cancer outcomes. Socioeconomic inequality may increase symptom severity. Findings call for the development of tailored interventions for populations with advanced cancer and socioeconomic inequality.

Advancing health equity in prelicensure nursing curricula: Findings from a critical review

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts are explicitly present in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well-integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula.

Navigating healthcare systems: A qualitative study on socially marginalised patients' experiences of hospital transition and support by social nurses

BACKGROUND

Socially marginalised patients face many challenges related to their health condition and often have several contacts with healthcare and social service workers. The Danish social nursing initiative, whose nurses have experience and knowledge about marginalisation, aims to support socially marginalised patients during hospital admission and through hospital transitions. However, there is limited knowledge about the hospital transitions of patients being supported by a social nurse.

OBJECTIVES

The objectives of this study were to explore (1) the perspectives of socially marginalised patients on the transition from hospital to home and (2) how these patients experience the importance of social nursing on patient trajectories after hospital discharge.

METHODS

A qualitative study with a phenomenological and hermeneutic approach was performed at a large hospital in southern Denmark. Adult patients who had contact with a social nurse during hospital admission were purposely sampled. Data were collected between January 2023 and March 2023. Initial patient interviews were conducted during hospital admission with a second interview 7-22 days after discharge. Systematic text condensation was used for the analysis, and Nvivo 12 supported data storage and coding.

ETHICAL APPROVAL

The study is registered with the Danish Data Protection Agency (22/47509). Informed consent was given by the participants.

RESULTS

Sixteen patients participated in the study. The participants experienced major challenges in their transitions from the hospital, which were generally related to their interactions with many different social and healthcare services. While the social nurses supported the patients and helped facilitate care during hospital admission and after discharge, the participants identified transitional care gaps related to multidisciplinary cooperation and standardised care options.

CONCLUSIONS

This study identifies challenges related to the hospital transition of socially marginalised patients, which indicates a gap in healthcare services. Future research should focus on improving interprofessional collaboration with socially marginalised patients across healthcare services.

Investigating the fundamental levels of a signature pedagogy in nursing education: A scoping review

BACKGROUND

A signature pedagogy is a unique approach that provides a blueprint for curricular decision-making, as it reflects how we teach (surface structures), why we teach (deep structures), and what we believe are vital concepts or values all learners should embody (implicit structures).

OBJECTIVE

To investigate what is known from the existing literature about a signature pedagogy to support undergraduate nursing education.

DESIGN

This scoping review adopted Arksey and O'Malley's framework to guide the analysis of data. Two electronic databases were used to explore studies on educational strategies, content, and values published in Arabic, English, Filipino, French, Portuguese, and Spanish between 1972 and 2022.

RESULTS

A total of 258 articles were included in this review. The analysis revealed that the majority of articles were at the surface (n = 189), followed by the deep (n = 123), with the least number examining the implicit level (n = 90) associated with signature pedagogy levels. Results reflect a limited focus on implicit level; the core concepts and values that all learners should understand and grasp for their future practice to construct their professional identity and engage in healthcare transformation.

CONCLUSIONS

The findings from this scoping review, should not be an isolated movement within nursing education. The first step is to engage in discourse amongst all stakeholders, educational and healthcare nurse leaders, regarding the state of the profession. As a profession we need to understand what is the preferred future of nursing and what are the necessary educational processes to ensure the profession is actualizing their mandate. A call to action to develop a unique signature pedagogy should provide synergy between education and practice to enhance learner's competencies as a future professional.

Receiving person-centred care in a hospital-A qualitative study of socially marginalised patients' experiences of social nursing

BACKGROUND

Socially marginalised people are at a substantially increased risk of diseases and typically have several contacts with the healthcare system. Health professionals at hospitals often lack the knowledge, skills, confidence, and time to provide relevant care for socially marginalised patients. Danish hospitals have implemented a social nursing initiative consisting of social nurses with specialised knowledge about marginalisation to support socially marginalised patients. Limited research into patients' perceptions of social nursing has been undertaken.

OBJECTIVE

To explore patients' experiences with the in-hospital social nursing initiative.

DESIGN

A qualitative study was conducted using a phenomenological hermeneutical approach.

SETTING

Odense University Hospital, Denmark.

PARTICIPANTS

Patients aged 18 years and older who had been in contact with a social nurse during hospital admission were purposely sampled. Data saturation was reached when 15 participants were recruited.

METHODS

In-depth patient interviews were conducted from November 2021 to April 2022 using a semi-structured interview guide. The interviews were transcribed verbatim and analysed using systematic text condensation. NVivo 12 software was employed for the analysis. Patient representatives were involved to validate the analysis and interpretations.

RESULTS

Three themes were identified: (1) an equal and trusting relationship, (2) receiving person-centred care, and (3) coherence in the patient trajectory. The results show that when patients have established a relationship with a social nurse, they are willing to let her into their lives and share personal information. Patients also experience person-centred care and coherence in their trajectory when a social nurse participated in their treatment and care.

CONCLUSION

The findings indicate that the social nursing initiative bridges the gap between socially marginalised patients and healthcare services.

The contribution of the nursing profession to the establishment of social justice: A grounded theory study

BACKGROUND

Social inequities in the healthcare system threaten global health. Efforts to establish equity in healthcare is a key goal of healthcare systems worldwide. Social justice is a basic value of the nursing profession that always merits attention.

OBJECTIVE

This study aimed to identify and explain the processes of the nursing profession's participation in establishing social justice in healthcare system.

RESEARCH DESIGN AND METHODS

This qualitative study was conducted using the grounded theory method.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected through in-depth, semi-structured, individual interviews with 26 participants, 23 of whom were members of the nursing profession. Sampling started purposefully and, then, continued with theoretical sampling. Field notes were also taken for data collection. Data analysis was performed using Corbin and Strauss' 2015 method.

ETHICAL CONSIDERATIONS

The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran.

FINDINGS

The "Professional Dynamics in the Path of Justice" was the study's core category. This theory is the result of nine main categories: "inefficient professional authority," "social justice, a neglected component in education," "clinical concerns, barriers to nurses' presence in society," "individual input reserves to facilitate social justice," "inadequate maturity of the profession in the path of equity in health," "promoting justice in clinical practice," "a tendency to community-oriented profession," "use of personal approaches for justice promotion," and "emerging justice-expanding nursing." These categories cover the underlying factors, strategies, and outcomes of the nursing profession's participation in establishing social justice process in healthcare.

CONCLUSION

The theory of professional dynamics in the path of justice can be used as a practical guide to describe the role of nurses in establishing social justice. Further studies with a quantitative approach to applying this theory are recommended.

Expert patients leading activities on social justice: towards patient-centered education

BACKGROUND

Social justice is recognized by reputable international organizations as a professional nursing value. However, there are serious doubts as to whether it is embodied in Catalan nursing education.

OBJECTIVES

To explore what nursing students take away from two teaching activities led by expert patients (one presentation and three expert patient illness narratives) on the topics of social justice, patient rights, and person-centered care.

RESEARCH DESIGN

Qualitative study using a content analysis approach. The research plan included (1) think-pair-share activities (additional faculty-assisted presentation and three faculty-assisted, semi-structured scripted narratives); (2) paired reflections; (3) focus groups; and (4) content analysis of paired reflections and focus groups.

PARTICIPANTS AND RESEARCH CONTEXT

Fourth-year nursing degree students at the Autonomous University of Barcelona (UAB), Spain. Convenience sampling was used.

ETHICAL CONSIDERATIONS

The UAB Research Ethics Committee did not deem it necessary to apply any specific measures. We fully explained to patients that they could decide what medical information they would share with the students that was relevant to their learning, and we provided students with guidelines about patient confidentiality, dignity, and respect.

FINDINGS/RESULTS

The students engaged in reflection about their education (recognizing that it had been centered on the professional and not the patient) and their relationship with the patient, in which they reproduced low-involvement patient care by modeling behaviors of their nurse educator. Moreover, they valued a person-centered care model with an emphasis on the emotional part but left out decision-making as an individual right of people.

CONCLUSIONS

The think-pair-share activities were useful to spark self-reflection among students, who identified aspects to change in their own practice, and reflected about their own education process, both of which promote change.

Teaching Strategies for Health Advocacy for Undergraduate Nursing Students: A Scoping Review

AIM

The goal of this study was to identify strategies for teaching health advocacy for undergraduate nursing students.

BACKGROUND

Although health advocacy is a core skill of professional nursing practice, there are challenges in the health advocacy approach in nursing education.

METHOD

The databases LILACS, IBECS, BDENF, Medline, Web of Science, CINAHL, and the Cochrane Library were searched, without limit of time and language, for this scoping review; 11 articles were included. Data were analyzed and synthesized in a narrative form.

RESULTS

The following teaching strategies emerged: theoretical exposition and supervised clinical internship, technology-enhanced simulation, clinical experience, experiential learning, simulated social experiences, digital story making, and narrative pedagogy. The topic was taught according to several themes: economic disparity, health legislation, LGBTQ+ population, elder health, mental health, health policies, concept of advocacy, and nontechnical skills.

CONCLUSION

Teaching strategies for health advocacy should be based on constructivist education linked to social reality.

Teaching strategies to develop skills to address social inequalities in nursing education: A scoping review

OBJECTIVES

to identify teaching strategies for developing skills to address social inequalities in nursing education.

DESIGN

Following the Joanna Briggs Institute and PRISMA-ScR guidelines, a scoping review was performed to answer the following research question: "What are the teaching strategies employed to develop nurses' skills to address social inequalities?"

DATA SOURCES

Bibliographical search was conducted seven electronic databases until December 29, 2020, and updated on March 25, 2022. Papers published in Portuguese, English, and Spanish on competence and professional practice, social inequality, education/training, and nursing were included.

REVIEW METHODS

Seven reviewers screened the articles by reading titles and abstracts. Studies on teaching strategies used to develop nurses' skills to address social inequalities were included. Of the 1137 articles found, 61 were selected by the first screening, and 23 were included in the final sample. Data were analyzed and summarized as a narrative.

RESULTS

The included papers were published between 2000 and 2020, predominantly in the United States. Curricular and learning strategies, including service, experience, and interactive, were the most common, followed by university programs and civil society initiatives. Courses, classes, debates, and practical activities predominated as teaching activities. Teaching techniques focus on resources such as posters, videos, workshops, and seminars.

CONCLUSIONS

This review identified teaching strategies used to develop nurses' skills to address social inequalities. Curricular initiatives, learning strategies, university programs and civil society initiatives can expand students' understanding of social inequalities and be used to develop skills.

Impact of a Social Justice Course in Graduate Nursing Education

BACKGROUND

Social justice and health equity are foundational concepts to the graduate-prepared nurse's role. However, the integration of these concepts into graduate nursing education has been unclear.

PURPOSE

This study examined the impact of a newly created social justice course in a graduate nursing program.

METHODS

The impact of the Health Equity and Social Justice course on students' values and attitudes toward social justice was investigated through analysis of quantitative and qualitative data generated in the course.

RESULTS

Data were collected from 41 graduate nursing students. Findings demonstrated that students who completed the course had an increased endorsement of social justice values, goals, and behaviors. Students universally found the course to be transformational.

CONCLUSIONS

A social justice course in graduate education can be transformational in shaping students' values and attitudes toward health equity and social justice.

Impact of Education on Student Nurses' Advocacy and Ethical Sensitivity

The nursing literature emphasizes that there are still inadequacies, differences, and inconsistencies in the definition of nurses' advocacy role, and that nursing education plays an important role in educating nurses for patient advocacy. The aim of the present study is to determine the effects of advocacy education onsocial justice advocacy and ethical sensitivity. Pre-test, post-test, parallel group, randomized controlled study. The study was carried out on 80 undergraduate nursing students in Turkey. Students was divided into experimental (40) and control (40) groups. Experimental group received advocacy education cirruculum. Both groups were applied as Socio-Demographic Characteristics, as pre- test and post-tests Social Justice Advocacy Scale, and Moral Sensitivity Questionnaire. The data were statistically evaluated with, the chi-square test, Two-Way Anova. The study was approved by Selcuk University Faculty of Health Sciences Non-Interventional Clinical Research Ethics Committee (09.25.2019/1218). Written informed consent was obtained from all participants. The pre-test score of the intervention group and that of the control group were similar(p > 0.05). The study group's post-test score was significantly higher than its pre-test score and the post-test score of the control group "social justice advocacy skills" and "moral sensitivity Questionnaire." In two-way analysis of variance in repeated measures, there was a significant main effect of the type of groups. The two-way ANOVA results in repeated measures showed that group-time interaction was significant. The advocacy education cirruculum the experimental group increased in the social justice advocacy knowledge, attitude and skills and moral sensitivity. The advocacy education cirruculum the experimental group increased the social justice advocacy skills and moral sensitivity. The Advocacy education cirruculum can be suggested to be integrated into the undergraduate nursing curriculum.

Social inequalities for student leaders and professional organizations: Florence Nightingale's political legacy

OBJECTIVES

to analyze the nursing systems of understanding and social inequalities from the perspective of student leaders and representatives of nursing professional organizations.

METHODS

qualitative research supported by the theoretical framework of Marxist dialectics. Threerepresentatives of professional organizations and five student leaders participated in the study. Datawere obtained from individual interviews and submitted to Critical Discourse Analysis.

RESULTS

thediscourses are marked by commitment, relational identification and characterize the position of obligation and necessity of nursing in acting with the individuals in situations of inequality, indicating accountability as a social practice. Among the competencies necessary for nursing in confronting social inequalities, political competence is central and is associated with health advocacy.

FINAL CONSIDERATIONS

we conclude that acting on social inequalities is part of the historical construction of nursing. Here, we emphasized the historical importance of Florence Nightingale and her legacy for political action and leadership in nursing.

Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.

OBJECTIVE

To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.

DESIGN

The Campinha-Bacote model of cultural competence was used as the primary reference.

METHOD

A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.

RESULTS

Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.

CONCLUSIONS

Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

Global Health in Swedish Nursing Curricula: Navigating the Desirable and the Necessary

Global health challenges are likely to be aggravated in the coming years by rapid climate change and environmental degradation. To address the resulting health inequities, nurses need an integrated understanding of environmental and social determinants of health. This study adopts an explorative inductive approach to examine how global health and sustainability are expressed the course syllabi of undergraduate nursing programmes (n = 24) in Sweden. After excluding biomedical and other unrelated content, 67 syllabi were selected for a thematic analysis. Results indicate that global health, the social determinants of health and sustainability tend to appear in a fragmented manner in the syllabi. Global health content is often limited, relegated to elective courses, or altogether missing. A theoretical framework is lacking, and focus lies on an individual rather than structural perspective. Based on international policy, earlier studies on undergraduate nursing education and theoretical work, suggestions are made for how global health and sustainability content could be integrated into nursing education, notably by using a structural competency approach.

Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature

Understanding how to create structural change by actively counteracting racialized ways of interacting with Indigenous peoples at an individual and organizational level within health care systems and health professions education is essential for creating a more inclusive, equitable, and healthier society. In health professions education, the primary means of teaching about health inequities has been to frame them as stemming from culturally or ethnically based issues. While attention to culturally specific practices can be valuable to health and healing in some contexts, education that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. We present an organizational transformation framework grounded in equitable partnerships from a comprehensive critical review of the literature on the integration of equity and social justice in undergraduate health professions education with a focus on Indigenous health. We did a thematic analysis of the results and discussions presented in the 26 selected articles to identify promising practices and challenges associated with the integration of equity and social justice in undergraduate health professions education. The framework resulting from this analysis is composed of three interrelated components: 1) adopt critical pedagogical approaches that promote Indigenous epistemologies; 2) partner with Indigenous students, educators and communities; 3) engage educators in critical pedagogical approaches and health equity issues. This framework could guide the development of contextually tailored interventions that contribute to decolonizing health professions education.

Social justice in health system; a neglected component of academic nursing education: a qualitative study

Background

In recent decades, increasing social and health inequalities all over the world has highlighted the importance of social justice as a core nursing value. Therefore, proper education of nursing students is necessary for preparing them to comply with social justice in health systems. This study is aimed to identify the main factors for teaching the concept of social justice in the nursing curriculum.

Method

This is a qualitative study, in which the conventional content analysis approach was employed to analyze a sample of 13 participants selected using purposive sampling method. Semi-structured interviews were conducted to collect and analyze the data.

Results

Analysis of the interviews indicated that insufficient education content, incompetency of educators, and inappropriate education approaches made social justice a neglected component in the academic nursing education. These factors were the main sub-categories of the study and showed the negligence of social justice in academic nursing education.

Conclusion

Research findings revealed the weaknesses in teaching the concept of social justice in the nursing education. Accordingly, it is necessary to modify the content of nursing curriculum and education approaches in order to convey this core value. Since nursing educators act as role models for students, especially in practical and ethical areas, more attention should be paid to competency of nursing educators, specially training in the area of ethical ideology and social justice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00534-1.

A Review of Tools to Screen for Social Determinants of Health in the United States: A Practice Brief

Increasingly, health care institutions are called on to address social determinants of health (SDH) given the connection to morbidity and mortality across populations. However, widespread implementation of screening for health-related social conditions (HRSC) is lagging. It is estimated that half of patients who have such needs may be missed by failure to screen routinely. Health care institutions face gaps in information related to screening tools. A review of tools that screen for HRSC at the individual level is needed to share readily available and applicable tools for integration in various settings, to communicate how tools are typically administered, and to assess whether tools capture domains corresponding with Institute of Medicine (IOM) core measures. To address these gaps, an unsystematic rapid review of the literature was conducted. In addition to peer-reviewed literature, Google, PubMed, and CINAHL databases and grey literature were searched with a focus on lead agencies or scholars in the field. English language publications from 2008-2018 with content related to SDH or health-related social condition screening tools were included. Nine commonly applied tools were selected and reviewed for content, setting, and method of administration. Fifteen common domains were identified and assessed for alignment with IOM recommendations and correspondence with the construct of social stability. This review consolidates essential information about HRSC screening tools in 1 place and provides practice, policy, and research recommendations to improve HRSC screening. This review is a practice brief that can help health care institutions and clinicians implement screening and interventions related to HRSC.

Cancer-related fatigue in head and neck cancer survivors: Energy and functional impacts

BACKGROUND

Survivors with head and neck cancer (HNC) report cancer-related fatigue (CRF) as a devastating, prevalent health issue that limits activity engagement and adversely influences quality of life.

OBJECTIVE

To explore HNC survivors' written responses and descriptors regarding CRF, and offer potential healthcare strategies based on findings.

METHODOLOGY

In written format, similar to responses on intake forms in outpatient-clinics, 25 HNC survivors provided descriptions of their CRF experiences and their perspectives on its impact. An exploratory descriptive research design was utilized, drawing on social theory for content analysis and thematic development.

RESULTS

Two main themes regarding CRF arose from the data: (1) CRF as a barrier to daily function; and (2) uncontrollable and unpredictable energy fluctuations.

CONCLUSIONS

To enhance outcomes of CRF symptom management in HNC survivors, a healthcare approach that targets the functional implications of CRF, and utilizes energy cultivation strategies when communicating about the negative impacts of CRF (including limited function and fluctuating energy levels) may be beneficial for HNC survivors. Further research into the effects of CRF on function for HNC survivors is warranted.

Factors Affecting Nurses' Impact on Social Justice in the Health System

BACKGROUND

Social inequities in health systems are threats to global health. Considering the important role of nurses in establishing social justice, identification of factors affecting nurses' participation in this area can contribute to the development of social justice.

OBJECTIVE

This study aimed to identify factors affecting nurses' participation in establishing social justice in the health system.

RESEARCH DESIGN AND METHODS

The study was conducted using conventional qualitative content analysis approach. Purposive sampling was used to select 14 participants in 2019. The data were collected through semi-structured interviews and analyzed concurrently with data gathering.

PARTICIPANTS AND RESEARCH CONTEXT

In total, six faculty members, five nursing managers, and three clinical nurses from three different universities were interviewed.

ETHICAL CONSIDERATIONS

The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran.

FINDINGS

Four main themes were found, including inadequate professional authority, insufficient attention to social justice in the area of education, clinical concerns as barriers to professional presence in society, and reflection of personality traits in the profession. These are the main factors affecting nurses' participation in establishing social justice in the health system.

DISCUSSION

Authorities need to take effective steps to establish social justice through reforming the health system's policy-making and power-acquisition domains, promoting nurses' involvement in social factors in health issues, and adding professional values as a part of nursing curriculum. The clinical practice environment can also be helpful through providing quality, safe, and cost-effective services. In addition, fair and efficient recruitment process for new nurses can contribute to the establishment of social justice in the health system.

CONCLUSION

Macro-level managerial factors such as policy, education, and clinical environment, along with personal factors, play a significant role in the participation of nursing profession in establishing social justice.

Are Nursing Students Learning About Social Determinants of Health?

Nurses must be knowledgeable about social determinants of health (SDH) to provide holistic care with improved patient outcomes. When evaluating the Baccalaureate of Science in Nursing curriculum, it is unclear if SDH are adequately identified, assessed, and discussed, or if students grasp their importance. To move to a population health approach, faculty need to be more inclusive of community and public health. For purposes of this study, the factors comprising SDH were identified as childhood experiences, housing, education, social support, family income, employment, communities, and access to health services. These eight factors were used to categorize participants' qualitative responses to baseline and completion surveys.

Learning outcomes of nursing curriculum in Turkey: a cross-sectional study

Objective

To assess the nursing curriculum and point out learning outcomes in Turkey.

Methods

A cross-sectional design was used in this study. This study was conducted between May and June 2017 from 23 undergraduate nursing schools’ education programs for one education and academic year's curriculum. The public information of the universities collected from their web sites and learning outcomes of the schools were classified as cognitive, psychomotor, and affective domains.

Results

It appears that half of the basic nursing courses are in the psychomotor domain, and the majority of basic medical sciences courses are in the cognitive domain. Learning outcomes about the affective domain mostly take place in basic nursing courses.

Conclusions

The findings of the results of this study can provide insight into current nursing education and guide new curricula to be developed.

The needs of LGBTI+ people within student nurse education programmes: A new conceptualisation

There is a growing body of international research evidence highlighting concerns around social exclusion and discrimination, significant health inequalities and health needs, and barriers to accessing effective healthcare for LGBTI + people. However, ways in which the healthcare needs of LGBTI + people can be addressed in student nurse education programmes have yet to be fully explored. The aim of this discussion paper is to present the evidence to support the inclusion of LGBTI + health throughout the nursing curriculum. A new conceptualisation of the full and effective integration of LGBTI + health content across and within the nursing curriculum is proposed. This can be achieved by further developing theory, skills simulation and practice learning opportunities. There is a need to ensure that nursing students are positioned and adequately prepared to effectively address concerns of social justice, reducing health inequalities, and providing responsive person-centred care for LGBTI + health service users.

Norm-Critical Potential in Undergraduate Nursing Education Curricula: A Document Analysis

The documents and literature that regulate nursing education are based on certain values and knowledge, and the underlying power in the curriculum raises the question of how health care professionals are molded during the course of their education. Norm criticism is a concept with its roots in critical pedagogy and gender and queer studies, emphasizing the origins as well as the consequences of marginalization, power, and knowledge of what is generally accepted as "normal" and "true." Norm criticism is used in this article to analyze the documents and literature underlying a nursing program in Sweden, which are shown to include a sometimes politically correct rhetoric, but one lacking a firm basis in social justice values.

Social Nurses’ Descriptions of Nursing: A Qualitative Study of What Social Nursing is and Does?

Background:

In the meeting between socially marginalised patients and somatic hospitals, healthcare systems often encounter complex challenges related to health inequalities that are difficult to resolve. To help reduce these challenges, a nursing approach employing a nurse (RN) with in-depth knowledge of socially marginalised patients and competences in rehabilitation (“social nurse”) has contributed to diminish health inequalities. However, further insight into the potential benefits of social nursing is required.

Aim:

To examine how social nurses describe and experience the social nursing approach situated at somatic hospitals.

Methods:

A qualitative study of social nurses’ descriptions and experiences with a social nurse approach included eight Danish hospitals. One male and 12 female nurses (n=13) employed as social nurses at somatic hospitals participated. Thirteen semi structured interviews were conducted using the methodological frameworks of phenomenology and hermeneutics. The interviews were analysed employing a method inspired by the French philosopher Paul Ricoeur’s theory of interpretation.

Results:

Four themes emerged from the analysis: 1) A unique expertise encompassing experience and evidence-based knowledge 2) coordination towards a common goal to reduce patients’ vulnerability, 3) to see and understand patients as whole persons, thereby assuring successful treatment and 4) working with the system to avoid losing the patients.

The themes describe a unique expertise emerging from focusing healthcare efforts on the socially marginalised patients and the system in charge.

Conclusion:

The study indicated that the social nurse approach is a holistic nursing approach. Applying this approach allows for optimised treatment that fosters a more equal outcome across the spectrum of socially marginalised patients. The social nurse approach may contribute to diminishing health inequalities.

An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis

BACKGROUND

In this paper we discuss the emergence of many different methods for doing a literature review. Referring back to the early days, when there were essentially two types of review; a Cochrane systematic review and a narrative review, we identify how the term systematic review is now widely used to describe a variety of review types and how the number of available methods for doing a literature review has increased dramatically. This led us to undertake a review of current practice of those doing a literature review and the terms used to describe them.

METHOD

We undertook a focused mapping review and synthesis. Literature reviews; defined as papers with the terms review or synthesis in the title, published in five nursing journals between January 2017-June 2018 were identified. We recorded the type of review and how these were undertaken.

RESULTS

We identified more than 35 terms used to describe a literature review. Some terms reflected established methods for doing a review whilst others could not be traced to established methods and/or the description of method in the paper was limited. We also found inconsistency in how the terms were used.

CONCLUSION

We have identified a proliferation of terms used to describe doing a literature review; although it is not clear how many distinct methods are being used. Our review indicates a move from an era when the term narrative review was used to describe all 'non Cochrane' reviews; to a time of expansion when alternative systematic approaches were developed to enhance rigour of such narrative reviews; to the current situation in which these approaches have proliferated to the extent so that the academic discipline of doing a literature review has become muddled and confusing. We argue that an 'era of consolidation' is needed in which those undertaking reviews are explicit about the method used and ensure that their processes can be traced back to a well described, original primary source.

Bearing witness in nursing practice: More than a moral obligation?

In this paper, we explore the concept of bearing witness in nursing practice. We examine the description of bearing witness in the nursing literature, particularly that offered by William Cody who suggests that bearing witness results in the limited moral obligation of "true presence." We then turn to Lorraine Code's work on testimony, drawing parallels between the concepts of testimony and bearing witness. Code suggests that receiving testimony results in a responsibility to respond, and that this is an ethico-political obligation. We discuss these ideas in relation to a Canadian exemplar of witnessing the Truth and Reconciliation Commission of Canada's work to understand and address the historical injustices done to Indigenous peoples in Canada. Here, we focus on the Commission's definition of witnessing and highlight the experience of Shelagh Rogers who served as an honorary witness. As an outcome of our analysis, we suggest that bearing witness in nursing practice is most usefully conceptualized as both a moral and a political obligation. Implications for nursing practice are suggested, including first, the need to critically examine our own understandings of power and privilege in order to authentically bear witness and avoid being complicit in injustice, and second, the concomitant responsibility to take action to challenge injustice once we have borne witness to it.