What is Social justice in a Nursing Context

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”

2. Let’s start with an Icebreaker

3. What kind of learner are you?

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. 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 )

8. “What we see, we do not see.” Archie Weenie

9. 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

10. 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

11. What is Culture? Behaviour is what you do… Culture is how you do it…

12. Everything is about CULTURE! Everybody knows about it Everybody does it Nobody talks about it Kathleen Bartholomew, RN, MN

13. Why are some people healthy and others not?

14. 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

15. 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 /

16. 12 Determinants of Health (Population Health Approach) I ncome 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 ( P ublic H ealth, 2016)

17. 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

18. 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)

19. What does privilege have to do with health? Privilege https://www.youtube.com/watch?v=hD5f8GuNuGQ

20. 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.

21. To For With How do we build Trust?

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Equality Equity Reality

30. Equality Equity Reality

31. 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.

32. 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

33. 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

34. Rules that Guide

35. Bronze rule Do unto others as they have done unto you

36. Silver What you do not want done to yourself, do not do to others

37. Gold Do unto others as you would have them do unto you.

38. Platinum Do unto others as they want done unto them

39. THE PLATINUM RULE. TREAT OTHERS HOW THEY WANT TO BE TREATED

40. The word LISTEN has the same letters as the word SILENT

41. 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.

42. 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.

43. 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.

44. 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.

45. “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

46. Harm Reduction Nurses Association (HRNA) Position Statement - Safer Injection HRNA BELIEVE THAT SAFER INJECTION INCLUDES THREE COMPONENTS: How you inject Where you inject 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

47. 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?

48. T ypes of Advocacy S elf-advocacy, personal advocate G roup advocacy. P eer advocacy. C itizen advocacy. P rofessional advocacy. N on-instructed advocacy.

49. Advocacy Not always about solving a problem It is about change, or sparking the conversation “Make them smart before you make them mad”

50. 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?

51. 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…

52. David Vs. Goliath - Was David Really Such A Hero? Risk – We often face a risk in acting, and a risk in not reacting!

53. What can be done to improve the health of individuals in our community ?

54. & DonT be arfaid to kame mit sakes Ask questions, listen, and then ask more questions.

55. Lateral Kindness Please be kind to each other Respectful and responsible relationships, there are no apps for that. Be Grateful Be Great!

56. Contact information Greg Riehl RN BScN MA Indigenous Nursing Student Advisor Saskatchewan Polytechnic Indigenous Nursing Saskatchewan Polytechnic Regina Campus Email: [email protected]