Transcendent pluralism and the influence of nursing testimony on environmental justice legislation

Policy education in a research-focused doctoral nursing program: Power as knowing participation in change

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of Elizabeth Barrett's "Power as Knowing Participation in Change" theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes "power as freedom" instead of "power as control." This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings.

Transcendent pluralism: A middle-range theory of nonviolent social transformation through human and ecological dignity: Analysis and evaluation

BACKGROUND

Issues such as group bias, poverty, disempowerment, and violence contribute to poor health outcomes among at-risk populations. In all countries, there exist disparities among health status with worse health outcomes in individuals categorized as having less access to resources. Systemic forces perpetuate health inequities among at-risk populations furthering the divide between those in resource-rich environments and those afflicted by a lack of resources. The social devaluing of individuals and their environment contributes to this ongoing global suffering.

METHOD

In this article, I critically appraised the theory of transcendent pluralism: a middle-range theory of nonviolent social transformation through human and ecological dignity based on the criteria outlined by Fawcett.

CONCLUSION

The concepts identified in this theory offer nursing the tools to facilitate social change. Despite the theory lacking significant real-world nursing practice application, it has the potential to bridge nursing's ability to influence social change through research and practice.

Nursing strategies for environmental justice: A scoping review

OBJECTIVE

To describe types of strategic actions nurses take to promote environmental justice (EJ) through research, education, advocacy, and practice (REAP) reported in peer-reviewed literature.

DESIGN AND SAMPLE

A scoping review of literature was conducted that described EJ nursing strategies and included nurses listed as authors, subjects, partners, or organizational members. The sample consisted of 35 articles, representing 24 primary research studies and 11 nonresearch articles. Data were separately analyzed by research and nonresearch articles for a clearer understanding of evidence-based strategies within domains of REAP.

RESULTS

Articles in the sample highlighted the importance of authentic community partnership and represented diversity of nursing strategies that addressed a range of environmental exposures and subsequent health and racial inequities. Climate justice, a concept that emerged from the EJ movement and intersects with planetary health, is a recent focus in professional nursing.

CONCLUSIONS

This scoping review establishes an understanding of the extent of nursing knowledge and research in EJ and lays the groundwork for further research on effective EJ nursing strategies. Community-Based Participatory Research/Participatory Action Research methods are fundamental for EJ research, and further theoretical development is needed to guide evaluation of EJ nursing strategies for education, advocacy, and practice.

Exercising Nursing Essential and Effective Freedom in Behalf of Social Justice: A Humanizing Model

This article expands upon previous work by the authors to develop a model of nursing essential and effective freedom to facilitate nursing action in behalf of social justice. The article proposes that while social justice is rooted in nursing's ontological, epistemological, and moral foundations, the discipline's social justice mandate is constrained by its historical and contemporary location within an institutionalized medical paradigm. We present a model of nursing "essential" and "effective" freedom based on the philosophy of Bernard Lonergan to illustrate how nursing can transcend these barriers. This humanizing model is illustrated through personal narratives of the authors.

Transcendent Pluralism: A Middle-Range Theory of Nonviolent Social Transformation Through Human and Ecological Dignity

Transcendent pluralism is a middle-range theory that focuses on the emergence of human dignity within relationships among diverse peoples through nonviolent social transformation. The theory proposes that contemporary social problems that negatively influence health are rooted in human and ecological devaluation and that healing is needed through the advance of dignity. The theory has been developed through both deductive and inductive processes including 4 research studies. The theory of transcendent pluralism provides a framework for nurses seeking to advance dignity. This article provides an overview of the theory's development and components.

Modifiable Factors that Support Political Participation by Nurses

Political participation is an opportunity for individuals to give their time and energy in such a way that it benefits others and advances relevant agendas. Political participation is a key issue for nurses because they are familiar with clinical issues that directly impact health care policies instituted at the local, state, and federal levels. Collectively, nurses also represent the largest number of health care providers in the United States and are among the most trusted health professionals. However, there are many obstacles that prevent nurses from taking a more active role in politics, creating a gap in how nurses pursue and respond to political participation, or civic engagement. The purpose of this exploratory review is to identify modifiable factors that support political participation among nurses. A review of the extant literature revealed three primary factors that promote civic engagement among nurses: (a) integration of political education in the nursing curriculum; (b) value of active psychological engagement, including a personal interest in political knowledge and information; and (c) value of collective influence such as membership in professional organizations.

Priority setting and policy advocacy by nursing associations: a scoping review and implications using a socio-ecological whole systems lens

OBJECTIVE

We undertook an interpretative scoping review to examine organizational priority setting and policy advocacy and the factors that influence nursing associations' cross-sector public policy choices and actions.

METHOD

Evidence was drawn from research, narrative, and theoretical sources that described priority setting and policy advocacy undertaken by non-governmental, non-profit, and nursing associations. Text was extracted from selected papers, imported into NVivo 8, coded, and analyzed using a descriptive-analytical narrative method.

RESULTS

Many internal and external factors are shown to shape organizations' policy choices and actions including governance and governance structures, membership arrangements, legislative, professional, and jurisdictional mandates, perceived credibility, and external system disruptions.

CONCLUSIONS

Internal and external factors are identified in the literature as critical to how organizations succeed or fail to set achievable priorities and advance their advocacy goals. Case comparisons and longitudinal research are needed to understand nursing associations' policy choices and actions for cross-sector public policy given their complex organizational structures and dynamic professional-legal-social-economic-political-ecological environments. A socio-ecological systems perspective can inform the development of theoretical frameworks and research to understand leverage points and blockages to guide nursing associations' public policy choices and actions at varying points in time.

Using a site visit to a contaminated location as a focus for environmental health education for academic and public health nurses

We describe a conference initiative that is distinguished by the use of a "community case study" to increase the knowledge and skills of nursing faculty and public health nurses in environmental health and to provide networking support to facilitate infusion of environmental health into nursing curricula and public health nursing practice. The Institute of Medicine's (1995) general environmental health competencies for nurses provided the conference framework. Woburn, Massachusetts, a Superfund site, served as the community case study to illustrate a complex environmental health problem. Over an extended period of time, Woburn was contaminated with multiple chemicals that eventually contaminated the drinking water supply; a cluster of childhood leukemia cases was linked subsequently to the Superfund site contaminants. A 6-hr interpreted walking and bus tour of the Superfund site enabled us to visit the premises of responsible parties, the vapor extraction fields, the capped Well H in the wooded wetlands, and to tour the affected neighborhood. This intensive, hands-on approach to learning environmental health content and skills that incorporated multiple learning strategies serves as a model for developing future conferences for public health nurses and nursing faculty.