Letter to Friends: My Quest for Racial Healing.

This past year brought the deadliest pandemic of our time and a huge social awakening and movement for racial justice. It became clear to me in late spring that I needed to learn more about structural racism, White supremacy, racial healthcare disparities, unconscious bias, and my own prejudices that govern my attitudes, values, behaviors, and decisions as a nurse leader, faculty member, board member, and a human being. To that end, I began to read, watch, and listen to both scholarly and lay journals and media that provide historical and current empirical accounts and studies of how racism and White supremacy have dominated our society, organizations, and communities in the United States for hundreds of years.

Community nurses and chronic disease in Israel: Professional dominance as a social justice issue.

Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease-related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand how the roles and trends in community health nursing in Israel may differ from developments in other countries. In-depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care-givers were asked open-ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere.

Feasibility of Social Media-Based Recruitment and Perceived Acceptability of Digital Health Interventions for Caregivers of Justice-Involved Youth: Mixed Methods Study.

BACKGROUND: Caregiver involvement is critical for supporting positive behavioral health and legal outcomes for justice-involved youth; however, recruiting this population into clinical research studies and engaging them in treatment remain challenging. Technology-based approaches are a promising, yet understudied avenue for recruiting and intervening with caregivers of justice-involved youth. OBJECTIVE: This mixed methods study aimed to assess the feasibility of recruiting caregivers of justice-involved youth using social media into clinical research and to understand caregivers' perceptions of the acceptability of digital health interventions. METHODS: Caregivers of justice-involved youth were recruited through paid Facebook advertisements to participate in a Web-based survey. Advertisement design was determined using Facebook A/B split testing, and the advertisement with the lowest cost per link click was used for the primary advertisement campaign. Survey participants were offered the option to participate in a follow-up qualitative phone interview focused on the perceived feasibility and acceptability of digital health interventions. RESULTS: Facebook advertisements were successful in quickly recruiting a diverse set of caregivers (80/153, 52.3% female; mean age 43 years, SD 7; 76/168, 45.2% black, 34/168, 20.2% white, and 28/168, 16.7% Latinx; and 97/156, 62.2% biological parents); cost per click was US $0.53, and conversion rate was 11.5%. Survey participants used multiple social media platforms; 60.1% (101/168) of the participants indicated they would participate in a digital health intervention for caregivers of justice-involved youth. Survey respondents' most preferred intervention was supportive and motivational parenting messages via SMS text message. Of the survey respondents, 18 completed a phone interview (12/18, 67% female; mean age 45 years, SD 10; 10/18, 56% black, 7/18, 39% white, and 1/18, 6% Latinx; and 16/18, 89% biological parents). Interview participant responses suggested digital health interventions are acceptable, but they expressed both likes (eg, alleviates barriers to treatment access) and concerns (eg, privacy); their most preferred intervention was video-based family therapy. CONCLUSIONS: Recruiting and intervening with caregivers of justice-involved youth through social media and other digital health approaches may be a feasible and acceptable approach to overcoming barriers to accessing traditional in-person behavioral health care.

Co-Design to Support the Development of Inclusive eHealth Tools for Caregivers of Functionally Dependent Older Persons: Social Justice Design.

BACKGROUND: eHealth can help reduce social health inequalities (SHIs) as much as it can exacerbate them. Taking a co-design approach to the development of eHealth tools has the potential to ensure that these tools are inclusive. Although the importance of involving future users in the development of eHealth tools to reduce SHIs is highlighted in the scientific literature, the challenges associated with their participation question the benefits of this involvement as co-designers in a real-world context. OBJECTIVE: On the basis of Amartya Sen's theoretical framework of social justice, the aim of this study is to explore how co-design can support the development of an inclusive eHealth tool for caregivers of functionally dependent older persons. METHODS: This study is based on a social justice design and participant observation as part of a large-scale research project funded by the Ministry of Families as part of the Age-Friendly Quebec Program (Québec Ami des Aînés). The analysis was based on the method developed by Miles and Huberman and on Paillé's analytical questioning method. RESULTS: A total of 78 people participated in 11 co-design sessions in 11 Quebec regions. A total of 24 preparatory meetings and 11 debriefing sessions were required to complete this process. Co-designers participated in the creation of a prototype to support the search for formal services for caregivers. The majority of participants (except for 2) significantly contributed to the tool's designing. They also incorporated conversion factors to ensure the inclusiveness of the eHealth tool, such as an adequate level of digital literacy and respect for the caregiver's help-seeking process. In the course of the experiment, the research team's position regarding its role in co-design evolved from a neutral posture and promoting co-designer participation to one that was more pragmatic. CONCLUSIONS: The use of co-design involving participants at risk of SHIs does not guarantee innovation, but it does guarantee that the tool developed will comply with their process of help-seeking and their literacy level. Time issues interfere with efforts to carry out a democratic process in its ideal form. It would be useful to single out some key issues to guide researchers on what should be addressed in co-design discussions and what can be left out to make optimal use of this approach in a real-world context.

'The Problem of the Color Line': Faculty approaches to teaching Social Justice in Baccalaureate Nursing Programs.

Social justice is put forth as a core professional nursing value, although conceptualizations within foundational documents and among nurse educators remain inconsistent and contradictory. The purpose of this study was to explore how faculty teach social justice in theory courses in Baccalaureate programs. This qualitative study utilized constructivist grounded theory methods to examine processes informing participants' teaching. Participants utilize four overarching approaches: fostering engaging classroom climates, utilizing various naming strategies, framing diversity and culture as social justice, and role modeling a critical stance. They deploy specific strategies, varying largely by race, educational background, and nursing specialty. A background in social sciences supports pedagogy that interrogates health inequities rather than merely raising awareness about disparities. Findings also reveal that faculty of color navigate institutional structures predicated upon colorblind racism and problematic views of culture, which many white faculty teaching non-Community Health Nursing courses described doing. To enact social justice and be answerable to our communities, concerted anti-oppression efforts are needed across education, research, practice, and policy. This includes sustained commitment to address colonialism and whiteness in every institution that defines, promotes, and claims to advance nursing so that we can fulfill our responsibility to address unjust systems and structures to serve our communities.

The relationship amongst nurses' perceived organizational justice, work consciousness, and responsibility.

BACKGROUND: Nurses' perceived organizational justice is one of the factors influencing their social responsibility and conscientiousness. Social responsibility and conscience are major requirements for providing high-quality and standardized care. OBJECTIVE: The aim of the present study is to investigate the relationship of perceived organizational justice with work consciousness and the social responsibility of the nurses. METHODS: The present cross-sectional study was performed on 380 nurses who had at least 1 year of job experience and willingness to participate in the study. The study was conducted in Zanjan province, Iran, in 2018. The study subjects were selected via stratified random sampling. The data were collected using an organizational justice scale, corporate social responsibility scale, and consciousness scale. Questionnaires were completed through self-reporting. The data were analyzed using partial correlation coefficient and linear regression analysis. ETHICAL CONSIDERATIONS: Research ethics approval (with the code of IR.ZUMS.REC.1397.47) was obtained from Zanjan University of Medical Sciences. RESULTS: The results indicated that nurses felt injustice in all dimensions of organizational justice (2.66 ± .753). They feel the most sense of injustice in distributive justice (2.19 ± .798). In three dimensions, except the ethic dimension, the social responsibility was in a desirable range (2.79 ± .703). In two dimensions, work consciousness was in a desirable range. The results showed a significant and positive relationship between all dimensions of social responsibility and all dimensions of organizational justice (r = .072). However, no statistically significant relationship was observed between the dimensions of organizational justice and conscience (r = -.002). CONCLUSION: Based on the obtained results, social responsibility and the work consciousness of the nurses are affected by organizational justice. Therefore, nursing managers are suggested to change their management styles to reduce the sense of organizational injustice in nurses and have long-term productivity.

Gross Negligence Manslaughter in Healthcare: Time for a Restorative Justice Approach?

This article explores the merits of employing a restorative justice approach in cases of gross negligence manslaughter involving healthcare professionals, in line with the recent policy turn towards developing a just culture in addressing episodes of healthcare malpractice within the National Health Service in England. It is argued that redress for victims and rehabilitation of offenders should operate as key values, underpinning the adoption of a restorative justice approach in such cases. It would also be vital that a structured pathway was designed that established suitable protocols and safeguards for both victims and offenders taking account of problematic issues such as the informality of the process, power asymmetries between parties, and the context in which the offence took place. Taking all such matters into account, we propose that consideration be given to establishing a pilot involving the use of restorative justice in cases of gross negligence manslaughter involving healthcare professionals, which would be subject to judicial and stakeholder oversight to ensure transparency and accountability, which in turn could inform future policy options.

The ethics of concurrent care for children: A social justice perspective.

Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life-including fatigue, pain, dyspnea, and anxiety-with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care that required a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States' Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children's Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden's theory of social justice "as the moral foundation of public health and health policy" to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care.

Relationship between perceived organizational justice and moral distress in intensive care unit nurses.

BACKGROUND:: The nature of the nursing profession pays more attention to ethics of healthcare than its therapeutic dimension. One of the prevalent moral issues in this profession is moral distress. Moral distress appears more in intensive care units due to the widespread need for moral decision-making regarding treatment and care in emergency situations. In this connection, organizational justice is of high importance and, as a significant motivational tool, leaves important impacts upon attitude and behavior of personnel. AIM/OBJECTIVE:: This study aimed at investigation of the relationship between perceived organizational justice and moral distress in intensive care unit nurses. RESEARCH DESIGN:: This is a descriptive-correlational research which examined the relationship between perceived organizational justice and moral distress in intensive care unit nurses. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 284 intensive care unit nurses were selected via census sampling. The data were collected through questionnaires and then were analyzed via SPSS-20 using Pearson and Spearman correlation tests. ETHICAL CONSIDERATIONS:: This study was approved by the Committee of Ethics in Medical Research. Completion of informed consent form, guarantee of the confidentiality of information, explanation on purposes of the research, and voluntary participation in the study were moral considerations observed in this study. FINDINGS:: There was a statistically significant negative correlation between the total perceived organizational justice and the total moral distress (p = 0.024, r = -0.137) and also between "procedural and interactional justice and errors" and "not respecting the ethics principles." Meanwhile, no relationship was found by the findings between distributive justice and dimensions of moral distress. CONCLUSION:: According to the results of the study, there was a reverse significant relationship between moral distress and perceived organizational justice; therefore, the head nurses are expected to contribute to reduce moral distress and to increase perceived organizational justice in nurses.

How do I stand compared to agency workers? Justice perceptions and employees' counterproductive work behaviours.

AIMS: To test the influence of comparative procedural justice on the counterproductive behaviours of permanent nurses and care attendants who work with agency workers, and explore whether the perceived climate of competition between permanent and agency workers alters this relationship. BACKGROUND: Despite steady reliance on agency workers in the health care sector, there is a dearth of research on the reactions of permanent employees who may respond negatively to the presence of this external workforce. METHODS: Questionnaires were distributed to employees of three long-term care facilities and their supervisors. Hypotheses were tested using moderated mediation analyses on a sample of 232 employee-supervisor dyads. RESULTS: Comparative procedural justice was indirectly related to counterproductive behaviours via employees' organization-based self-esteem. This relationship was weaker when perceived climate of competition was high. CONCLUSION: Promoting high levels of comparative procedural justice among permanent employees, rather than status differences with agency employees, should avert behaviours that could harm organizational functioning and therefore patient care. IMPLICATIONS FOR NURSING MANAGEMENT: We discuss the leadership challenges to support neutral treatment and avoid the development of a competitive climate between permanent and agency workers (e.g., politics based on respect and collaboration, positive leadership).

Expanding perspectives: A social inequities lens on intimate partner violence, reproductive justice, and infant mental health.

Intimate partner violence (IPV) poses a threat to the attainment of reproductive justice. Women who experience IPV are limited in their ability to parent their children in a secure and nurturing environment, which can have negative effects on the mother and child immediately and long-term, potentially distressing reproductive well-being across generations. Societal inequities faced by women, particularly women of color, within education, economic, and legal systems are associated with risk factors for IPV. This article will use national- and state-level data with case examples and the lens of reproductive justice to consider the impact of and potential solutions to historical and institutional inequities related to IPV.

La violencia por parte de la pareja íntima (IPV) representa una amenaza para el logro de la justicia reproductiva. Las mujeres que experimentan la IPV se encuentran limitadas en cuanto a su habilidad para criar a sus niños dentro de un ambiente seguro y propicio, todo lo cual puede tener efectos negativos en la madre y el niño inmediatamente y a largo plazo, y potencialmente resultar en un angustioso bienestar reproductivo a través de generaciones. Las desigualdades sociales que enfrentan las mujeres, y en particular las mujeres de raza negra, dentro de los sistemas educativos, económicos y legales se asocian con factores de riesgo para la IPV. Este ensayo usará información tanto al nivel nacional como estatal con ejemplos de casos y el enfoque de la justicia reproductiva para considerar el impacto de las desigualdades históricas e institucionales relacionadas con la IPV y las posibles soluciones a las mismas.

La violence entre partenaires intimes (VIP pour Intimate Partner Violence en anglais) constitue une menace pour la défense et l'atteinte de la justive reproductive. Les femmes qui font l'expérience de VIP sont limitées dans leur capacité à parenter leurs enfants dans un milieu sûr et chaleureux, ce qui peut avoir des effets négatifs sur la mère et l'enfant immédiatement ainsi qu'à long terme, ce qui a aussi le potentiel d'afliger de détresse le bien-être reproductif au travers des générations. Les inégalités sociales auxquelles font face les femmes, et particulièrement les femmes de couleur, au sein des systèmes éducatirs, économiques et légaux sont liés aux facteurs de risque pour le VIP. Cet article utilise des données nationales et au niveau des états américains avec des exemples de cas, ainsi que le prisme de la justice reproductive afin de considérrer l'imace des inégalités historiques et institutionnelles liées à la VIP ainsi que leurs solutions potentielles.

The importance of including aliases in data linkage with vulnerable populations.

BACKGROUND: Records pertaining to individuals whose identity cannot be verified with legal documentation may contain errors, or be incorrect by intention of the individual. Probabilistic data linkage, especially in vulnerable populations where the incidence of such records may be higher, must be considerate of the usage of these records. METHODS: A data linkage was conducted between Queensland Youth Justice records and the Australian National Death Index. Links were assessed to determine how often they were made using the unverified (alias) records that would not have been made in their absence (i.e. links that were not also made using solely verified records). Anomalies in the linked records were investigated in order to make evaluations of the sensitivity and specificity of the linkage, compared to the links made using only verified records. RESULTS: From links made using verified records only, 1309 deaths were identified (2.6% of individuals). Using alias records in addition, the number of links increased by 16%. Links made using alias records only were more common in females, and those born after 1985. Different records belonging to the same individual in the justice dataset did not link to different death records, however there were instances of the same death record linking to multiple cohort individuals. CONCLUSIONS: The inclusion of aliases in data linkage in youths involved in the justice system increased mortality ascertainment without any discernible increase in false positive matches. We therefore conclude that alias records should be included in data linkage procedures in order to avoid biased attenuation of ascertainment in vulnerable populations, leading to the concealment of health inequality.

The Curitiba Statement on Health Promotion and Equity: Italian version and analysis of criticalities.

BACKGROUND: The Curitiba Statement of health promotion and equity is the main result of the World Conference on International Union for Health Promotion and Education (IUHPE - UIPES), held in May 2016 in Curitiba. The Curitiba Statement is the outcome of a participatory process, result of collaboration of all conference participants. The Curitiba Statement represents the continuity from Ottawa Charter for Health Promotion. This document remembers and asks to International Organizations, Governments, at all levels of the Institutions, the Health Sector, Citizens and Health Professionals and Researchers to change and eliminate all forms of discrimination and exclusion. STUDY DESIGN: Description of the translation and validation process. METHODS: The translation process from Spanish and English is based on the translation techniques enumerated by Fawcett in 1997: borrowing, calque, literal translation, transposition, modulation, reformulation, adaptation. RESULTS: The translation process produced some critical issues shifting from English to Italian: the most critical words and expressions correspond to the more significant ones of the Curitiba Statement, and these issues are reflected in research, politics and practice. In particular, we analyzed the translation of Inequity, Advocate, and Players, and then discussed their use in different expressions in the original text. CONCLUSION: Considering the Curitiba Statement's message has to be transversal, and it is addressed not only to Professionals but to all Citizens, researchers have made the choice of a clear translation for the Italian readers, not always similar to English form, but consistent and faithful in its content. To spread the culture and practice of Health Promotion, a deep attention in the translation of international documents could allow the propagation of ideas and strategies, from global to local.

Tunisian documentation of «Public Health¼ in post revolution, with a taste of freedom. For a fair, participatory and efficient National Health System.

CONTEXT: Following the Tunisian revolution of 2010/2011, a new Public Health literature emerged, by the ministerial departments as well as the civil society, which was marked by the transparency and the comprehensiveness of the approach. OBJECTIVE: To identify the key ideas of the new Tunisian Public Health discourse, reconciling the principles of a globalizing paradigm with the health problems of a country in transition. METHODS: During this qualitative research, a selected series of three Tunisian reports of Public Health, published in the first quinquennium of the revolution, was read by an independent team of experts in Public Health, not having contributed to their elaboration, to identify the consensual foundations of the new Public Health discourse. These documents were: the "2011 Health Map" of the Department of Studies and Planning of the Ministry of Health, the "Societal Dialogue Report on Health Policies, Strategies and Plans" (2014), and the "Report on the right to health in Tunisia" (2016). RESULTS: The reading of this sample of the Tunisian Public Health literature of the post-revolution brought out three consensual ideas: 1. The constitutional principle of the "right to health" (article 38 of the constitution) with its corollary the State's obligation to ensure access to comprehensive, quality and secure care; 2. The challenge of social "inequalities" of access to care, reinforced by a regional disparity in the distribution of resources, particularly high-tech (specialist doctors, university structures); 3. Advocacy for a National Health System, based on a universal health coverage for its funding and citizen participation in its governance. CONCLUSION: The new Tunisian Public Health literature, in post-revolution, calls on all stakeholders in Preventive and Community Medicine to replace their segmental, technical and hospital practices with a new approach, centered on the implementation of a National Health System that is based on a socialized financing of care and citizen participation in its management.

The Just War Tradition: A Model for Healthcare Ethics.

Healthcare ethics committees, physicians, surgeons, nurses, families, and patients themselves are constantly under pressure to make appropriate medically ethical decisions concerning patient care. Various models for healthcare ethics decisions have been proposed throughout the years, but by and large they are focused on making the initial ethical decision. What follows is a proposed model for healthcare ethics that considers the most appropriate decisions before, during, and after any intervention. The Just War Tradition is a model that is thorough in its exploration of the ethics guiding a nation to either engage in or refuse to engage in combatant actions. In recent years, the Just War Tradition has expanded beyond the simple consideration of going to war or not to include how the war is conducted and what the post-war phase would look like ethically. This paper is an exploration of a healthcare ethics decision making model using the tenets of the Just War Tradition as a framework. It discusses the initial consult level of decision making prior to any medical intervention, then goes further in considering the ongoing ethical paradigm during medical intervention and post intervention. Thus, this proposal is a more holistic approach to healthcare ethics decision making that encourages healthcare ethics committees to consider alternate models and ways of processing so that ultimately what is best for patient, family, staff, and the environment is all taken into consideration.