Social consciousness is being aware of self and the environment and responding to social injustices in the lives of self and the others. Issues such as sexism, racism, heterosexism, inequalities, and discrimination are factors of social injustice that affect nurses in today’s world. Nurses are meant to be agents of social change, and those who can contribute meaningfully to social injustices within the healthcare area are subjected to internal discrimination. Nurses in society are meant to challenge the social injustices institutionalized that challenges the health sector. A study conducted by Giddings (2015) collected different data from twenty-six women from different races, cultures, and experiences across the United States and New Zealand. The study evaluated the involvement of fairness and difference in the lives of the nurses.
Findings revealed that nurses felt marginalized, felt unfairness, and experience discrimination. But they had strong intentions to work for social justice (Giddings, 2015). For nurses to be a vital tool in changing the structures and systems that keep the health sector in disparity, the social injustices systems must be challenged. There is a need for nurses to have skills that would fix organizational processes that would sustain social equalities within the healthcare system. Relationships are primary in the nursing profession. The need to build the capacity for care and social practice requires that nursing education is focused on the mutuality principle. Nursing must focus on promoting. Nursing is the profession for which relationships are primary. Nursing can rebuild the capacity for caring and social and relational practice through the transformation of nursing education and the principle of mutuality. Nursing can be involved in the promotion of primary care and involvement in policies to ensure increased access and equality in healthcare.
In the health sector over time, there is a widened gap in the status of health among those who enjoy certain privileges and the ones who feel marginalized because of social identities. Health was described to be a significant right that humans must have access to In the WHO (World Health Organization) Constitution in 1978 (Peled, 2018). In the health industry, marginalizing and discriminatory practices are on the rise. This primarily affects nursing personnel, although they are well-positioned to confront the socially institutionalized injustices Perceived in the health sector. With this bothersome situation, little has been done to tackle the increasing disparities affecting the health system and investigating the nursing culture by collecting the stories of fairness and difference of nursing personnel which aims at the historical study of cross-cultural life.
Cultural safety which has its origin in New Zealand specifically Aotearoa and United States Of America where trans-cultural nursing originates from (Sangiovanni, 2018), are the two essential movements with the most influence on nursing practices, policies and education concerning worldwide cultural care of clients. Promoting awareness about cross-cultural issues has been made possible because of nursing practices (Sangiovanni, 2018).
The principal aim of the transcultural nursing movement is to utilize research-based knowledge to aid nursing personnel discharge effective, responsible, and safe care to individuals from separate cultural backgrounds (Villamin, 2014). The works of Madeleine Leininger and social anthropology is where transcultural nursing derived its theoretical positions.
The client's population of nurses constitute individuals with diverse backgrounds; hence, their needs are culturally specific. This is why the Nursing profession is perceived to be a homogeneous and politically neutral one.
The cultural safety movement started as a political movement in the late 1980s. There was a call to check the impact of discriminatory racial acts causing several health inequities and social disparities between two cultural groups: the dominant Pakeha (White) culture and Nurses who were Maori (indigenous people) (Villamin, 2014). The nurses who are Maori felt that their self-awareness culturally helps in the aiding the safety of culture and fixes at the center of its processes racism instead of having the assumption that nurses are a neural and homogenous group (Galambos, 2015).
The experience of nursing personnel who reported that their acts were as a result of social injustice awareness is the focus of this participatory, cross-cultural life history research. Social injustice self-awareness was what forced the nurses to act. This research was carried out based on three assumptions (a) nurses' experience is a microcosm of the society's larger structures and systems. (b) All persons experience a complex interweaving of privilege and oppression, and (c) There are differences in many social groups that exist, some groups are oppressed, and others are more privileged. Social consciousness development and institutionalized structures are the basis of social injustice, and this allows the social and political disparities continuity as opined by the final assumption.
The act of storytelling in life story forms was implored by an adaptation of oral history, life history methodology. Social theory and feminism informed this decision. By influencing usage of the participatory approach, the notion of the formation of critical consciousness (conscientization) by the process of questioning the nature of historical and social conditions was mainly the core purpose of Paulo Freire's (1972) pedagogy of empowerment, individuals and groups social transformation are as a result of these processes. Therefore, the nurses' reflection on their ways of living in relation to issues of power, social action, and oppression that could have resulted in changes in them socially and personally were the aims of structuring the interview (Giddings, 2015).
To capture the voices of the women and push the essence of their nursing profession, a feminist life story approach was implored and the narrative's constructing and analyses were made possible by this. Giddings (2015) conducted a research by studying a group of women nurses. In the stories of the women, they were described to be active subjects in the narratives account. The work the women handled socially to position themselves higher in the world, the judgmental values that helped shape their vision and the social nature of their life experiences the work were given close insights (Giddings, 2015).
Based on how the social and cultural representations of the women identities intersected, there were differences in their narratives and the meaning the women gave them. Methodologically, This analysis not only showed how the women differed in their narratives and meaning, but it was also useful in exploring the differences in the women's life experiences respectively in the Aotearoa New Zealand (n equals 13) and United States (n equals 13) respectively, twenty-six women in the nursing profession who are highly placed and hail from various cultural, racial, specialty backgrounds and sexual identity had 45 to 90 minutes of Participant Profiles and Life History Interviews (two to three each) conducted on them.
Ages ranged 25 to 58 years, and years as a registered nurse ranged 1 to 39 years. Obtaining written consent from each participant was ensured.in the United States and New Zealand, research processes were approved by the ethical review committees.
As described in the research design credibility, complexity, specifically dependability, flexibility, and consensus are the standards of rigor for qualitative research that was applied. (Murray, 2013). In other to give facts about the women's experience of difference and fairness in their lives, The interviews were semistructured and duplicated in recorded tapes. To spur the nurses to tell the stories that mattered to them and follow their notions, broad, open-ended questions were initially asked (e.g., 'What has it been like for you being a nurse?'). Conversations developed and became more focused as ideas evolved, reflecting the narrative process of making joint meaning (Odom-Forren, 2019).
Solving healthcare disparities requires creating a resolute at the nursing leadership level. Some key factors to be used are role scope, access to data, use of values, creativity/innovation, relationships/partnerships, and types of support.
Use of Values
A PHN (Public Health Nurses) effective leadership is influenced by the value placed on health equity and social justice. The ability of a PHN to address child and poverty efficiently requires that value should be placed on equity and social justice; structural explanations of poverty should be supported. Consider political/social action as a genuine part of their role, and individuals living in poverty should be approached with a positive attitude (Griffin, 2013). To improve health equity, there is a need for structure-based initiative, distal and structural systems to develop long term social change and health ('Social injustice and public health', 2014). Structural tailored Public Health work needs to focus on individual behaviors that would help cater to the middle class and the mass (Griffin, 2013)
The Role Scope
The Role scope and clarity at the level of practice, impact effective leadership, i.e., clinical care and health education should be a focus of practice; their roles must be understandable, and the power to promote change must be valued by the PHNs (Giddings, 2014). Service delivery should be focused on, and it should foster the growth of partnerships with communities (Griffin, 2013). Standards and discipline must be structured to correspond with job descriptions and scope of practice.
Relationship and partnerships excite efficient leadership at all levels: the measure of performance needs to address the steps required to influence health inequity while understanding that trust-building in relationships and intersectoral partners require time to form. The importance of relations must be understood by Nursing leadership. Obtaining valuable information and enacting influence on clients requires a good relationship developed through practice (Giddings, 2014). There must make conscious effort to advocate for community work, develop relationships, balance priorities, and build trust. PHN roles and contributions require good understanding and definition for effective collaboration. For effective leadership development, there must be an organization to organization partnership and proper use of resources to develop best practices at all leadership levels. Guaranteeing adequate public health, social justice, and health promotion; community agency and academic relationships are important in the nursing curriculum.
There is a need to foster effective leadership at all levels, and this requires access to and collection of data. Health indicators need population base data. Health disparities are the metric by which one measure progress towards health equity (Rhodes, 2015). Community-wide databases of health information, including social determinant, can be assembled through data within primary care practices. Physicians use this data to comprehend the needs in their practice and what intercessions are required. Equity assessments can be conducted with these data as well. Data collected on health outcome from various groups are used for innovative programs and to ensure equity for all patients (Giddings, 2014)
Health determinants and pathways to health outcomes need to be widely understood (Griffin, 2013) Developing effective strategies towards health equity needs to be understood on how health disparities are produced or mitigated (Pralle, 2017). Understanding how health disparities are produced is essential with the use of the life course perspective.
Effective leadership is influenced by innovation and creativity at all levels: PHN needs adequate support and strengthened innovations (Discussion summary, 2009). An excellent way to stay ahead is by learning from others creativity and sharing knowledge (Griffin, 2013). The importance of professional autonomy is to help nurses find solutions inside their organizations to defeat some of the obstacles they face in approaching health and social inequities (Pralle, 2017)
Effective leadership is impacted by organizational culture. Leadership and culture shape each other; it is both performance-driven. An organization's culture is influenced by a leader for long term effectiveness. Leaders are seen as role models and in turn, set the agenda, their actions are checked consistently to know if it is in line with organizational values.
The biomedical model relies on public health agencies; for public health nursing practice, it should be moved to critical care and advocacy model. Also, to prioritize health equity, a shift in organizational culture is needed to put the PHN to work with initiatives that are structure-based while reaching many populations in different settings (Pralle, 2017). More significant socio-environmental aspects must be attended to by Public Health intervention that creates inequities to address social justice (Pralle, 2017)
Providing clear or explicit expectations of public health accountability is vital. All bureaucratic elements acting within the front-line staff, senior management, and middle management should be dismissed (Pralle, 2017).
Social consciousness is a level of consciousness shared by people and groups within a society. It involves understanding and becoming aware of the problems the community presents. Such problems include social injustice, which is mostly experienced by nurses and affects the performances in the public health domain, which escalates to healthcare disparities affecting patients. In the United States, there are disparities in health and health care, which cause made some certain groups be at high risk of being uninsured. This group of individuals is subjected to limited access to care, inadequate health care, and experiencing worse health results. Health and health care disparities are not only based on ethnicity and race but extend across a wide range of dimensions; It reflects a complex group of people, environmental and social factors. Disparities, apart from its impact on specific groups of individuals, it also affects continuous improvement in overall quality of care and health condition of the general population leading to unnecessary costs. Disparities must be addressed continually because the population is becoming more diverse.
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