Social justice or market justice? The paradoxes of public health partnerships with managed care

Nurses’ Ethical Conflicts in Performance of Utilization Reviews

This article describes the ethical conflicts that a sample of US nurse utilization reviewers faced in their work, and also each nurse’s self-reported ethical orientation that was used to resolve the dilemmas. Data were collected from a sample of 97 registered nurses who were working at least 20 hours per week as utilization reviewers. Respondents were recruited from three managed care organizations that conduct utilization reviews in a large midwestern city. A cross-sectional survey design was used to collect demographic data and to ask closed-response, short-answer and open-ended questions. Ethical conflicts reported by nurses were similar across utilization review settings and many were justice orientated. Self-reported ethical orientations were similar across organizations, with beneficence dominating. Implications of these findings are discussed.

Discourses of social justice: examining the ethics of democratic professionalism in nursing

This essay provides a critical exploration of discourses of social justice in nursing. It examines commitments to social justice in the work of international nursing scholars and in professional codes of ethics in international nursing organizations. The analysis touches on salient conversations in philosophy, relating these ways of knowing to social justice as an ethical pattern in nursing practice. On the basis of this analysis, the discussion explores questions of professional formation in nursing, noticing when commitments to social justice are taken up or evaded in different models of professionalism. In concluding comments, implications of democratic professionalism are explored for professional formation in nursing, arguing for teaching, learning, and knowledge projects that contribute to social justice in our democracy.

Contractual design and PPPs for hospitals: lessons for the Portuguese model

Recently the Portuguese Government announced the launching of public-private partnerships (PPPs) to build hospitals with the distinctive feature that infrastructure construction and clinical activities management will be awarded to separate private parties. Also, one of the parties will be in charge of providing soft facilities. We explore alternative configurations of contracts and assess whether the equilibrium allocations attain the first-best solution.

Privatization of public services: organizational reform efforts in public education and public health

The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health.

Toward a critical theoretical interpretation of social justice discourses in nursing

Despite widespread appeals to social justice, nursing conceptions of this ideal have been critiqued as incomplete and inconsistent. With the aim of contributing to a critical dialogue on discourses of social justice in nursing, we explore contemporary theories of social justice and their move beyond a distributive paradigm, employing techniques of replication and critique of social justice discourses in nursing. We consider how postcolonial feminist theory can help us understand the relevance of more recent critical interpretations of social justice, particularly in reinterpreting and broadening nursing's individualistic focus on social justice so that due consideration and actions are directed toward the intersecting impact of historically and socially mediated conditions on health and human suffering.

Social Justice as a Framework for Professional Nursing

A persistent connection exists between health disparity and societal inequality. Since more research is designed to document, rather than alter, those trends, nurses are called on to reinvest in a social justice agenda. An educational focus on social justice is necessary to prepare future nurses to address health concerns related to how societies are structured. This article reports on how social justice was used as a framework to teach concepts related to professional nursing. The course structure is described, a focus on how the course content was taught is outlined, and conclusions are drawn. Linking content on social justice to professional nursing is important because research indicates that, if societal relationships are more equal, population health indicators between diverse groups become more stable nationally and globally.

Unreconciled inconsistencies: a critical review of the concept of social justice in 3 national nursing documents

A critical review of the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, Nursing's Social Policy Statement, and Nursing: Scope and Standards of Practice provides evidence that these documents present an inconsistent, ambiguous, and superficial conceptualization of social justice, and do not offer an adequate framework for nurses to address underlying issues that affect health outcomes. Despite expansive references to the historic role of nursing in social reform, the documents implicitly reinforce nursing practice directed toward the individual nurse-patient relationship and give short shrift to nursing models that endorse broad systems change intended to improve health.

Keys to the puzzle: recognizing strengths in a rural community

The elderly population in rural communities is growing. Rural populations generally experience excessive deficiencies in health care access, social services, and other goods and services needed for healthy living. An ethnographic study of multicultural elderly participants from a rural county in New Mexico was completed to explore the participants' definitions of health, health care perceptions, and health care needs. Several key issues regarding health care were identified, including the escalating cost of prescriptions, limited access to primary health care and specialty care, and social isolation and loneliness. However, despite these limitations, existing strengths and assets were also identified: elders' knowledge about sustaining health in austere conditions and caring for the sick using simple measures; an existing group of dedicated professional nurses applying their own and others' knowledge to the challenge of health care; and a preexisting community-based action group working to decrease fragmentation of services, streamline delivery of services, and work with legislators on funding priorities. Building on these strengths can provide the keys to the puzzle of transforming the current health care environment and improving inadequate health care for these elderly rural community members.

Teaching Social Justice

Social justice is a core nursing value and the foundation of public health nursing. Social justice ideology requires nursing students to uphold moral, legal, and humanistic principles related to health. As such, teaching social justice requires a basis in moral developmental theory. In addition, teaching social justice demands action beyond classroom pedagogy. The author describes how social justice is taught within a baccalaureate program. A social justice project is described and examples are provided.