STRENGTHENING ADVOCACY & SOCIAL JUSTICE IN COMMUNITY HEALTH CARE : THE ROLE OF THE COMMUNITY HEALTH NURSE Benita Cohen, RN, PhD Faculty of Nursing, University of Manitoba Presented at 4 th Annual CHN Conference, Toronto, June 16, 2010

DEFINING ‘SOCIAL JUSTICE’ “Social justice means the fair distribution of society’s benefits, responsibilities and their consequences. It focuses on the relative position of one social group in relation to others in society as well as on the root causes of disparities and what can be done to eliminate them” [CNA, 2006]

DEFINING “ADVOCACY” “Advocacy: Interventions such as speaking, writing or acting in favour of a particular cause, policy or group of people….Advocacy often aims to enhance the health of disadvantaged groups…” [PHAC, 2007, Core Competencies, p.9] * Advocacy may involve lobbying, but it is much broader than that

DEFINING ‘ADVOCACY’ (cont’d) “Advocacy is promoting, fighting for and defending the welfare of others and it is based on caring and on the values of social justice and human rights” [Cathy Crowe, Street Nurse - Keynote Address, Anglican Outreach Networking Conference, October 2, 2004]

SUPPORT FOR CHN ROLE IN ADVOCACY FOR SOCIAL JUSTICE Strong theoretical support for expanding CHN role to social change agent Commitment to ‘emancipatory ethic’ (Falk- Rafael, 2005a; VanderPlaat, 2002) ‘Critical caring’ (Falk-Rafael, 2005b) Policy advocacy re: social equity (Daiski, 2005) ‘Bringing about social change’ to address child & family poverty (Cohen & Reutter, 2007)

SUPPORT FOR CHN ADVOCACY ROLE (cont’d) ‘Bringing about social change’ to promote social justice involves working for changes to team, organizational, and government policies with the goal of reducing or eliminating poverty, social exclusion, or other social inequities (Cohen & Reutter, 2007)

EXAMPLE: ADVOCACY TO ADDRESS CHILD/FAMILY POVERTY CHNs’ advocacy activities could include: Getting family poverty on agendas of health organization/employer and professional nursing organizations Initiating public discussion of health effects of poverty; how public policies can lock families into poverty Using the media to increase awareness (Cohen & Reutter, 2007)

SUPPORT FOR CHN ADVOCACY ROLE (cont’d) Strong professional/regulatory support Advocacy for anti-poverty measures (ICN, 2004) Advocacy for public policies that address SDOH, and for ‘social justice’; ethical responsibility (CNA, 2005; 2006; 2008) Advocacy a ‘standard of practice’ for CHNs (CHNC, 2008) Advocacy for SJ a discipline-specific ‘core’ Public Health competency (CHNC, 2009)

THEORY→ PRACTICE GAP Excellent examples of policy advocacy by nursing organizations (e.g., CNA, RNAO) However, empirical evidence suggests that most CHNs only minimally involved in advocacy for SC/SJ in their day-to-day practice (Ballou, 2000; Cohen, 2006; Cohen & Reutter, 2007; Meagher- Stewart, 2001; Williamson & Drummond, 2000)

BARRIERS TO CHN ROLE IN ADVOCACY FOR SJ CHNs’ actual/perceived lack of skills CHNs’ hesitance about engaging in an activity that they view as ‘political’ Lack of time due to mandatory programs Lack of support/encouragement and/or role modeling from managers Organizational philosophy does not promote this type of activity

BARRIERS (cont’d) Narrow job description Workload measures don’t capture advocacy activities Limited understanding/recognition (from other health professionals/public) about potential role of CHNs in advocacy for SC [Cohen, 2006; Cohen & Reutter, 2007; Falk-Rafael 2005a; MacDonald & Schoenfeld, 2003; Meagher- Stewart; 2001; Williamson & Drummond, 2001]

STRENGTHENING CHN ADVOCACY ROLE [‘Network Café, CHNAC conference, May 2008]  Better preparation of new nursing grads in advocacy skills; theory not enough  Utilizing professional organizations as an avenue for advocacy  Building community capacity  Coordinating discussion groups with key stakeholders to identify social issues  Providing information to help direct community development initiatives

REFERENCES Ballou, K. (2000) A historical-philosophical analysis of the professional nurse obligation to participate in sociopolitical activities. Policy, Politics, & Nursing Practice, 1(3), Canadian Nurses Association (2005) Social determinants of health and nursing: A summary of the Issues. Available at nurses.ca/cna/documents/ pdf/publications /BG8_Social_Determinants_e.pdf. Canadian Nurses Association (2006). Social justice : A means to an end, an end in itself. Ottawa: CNA. Available at cna-iic.ca/CNA/documents/pdf/publication/ Social_Justice _e.pdf. cna-iic.ca/CNA/documents/pdf/publication/ Social_Justice Canadian Nurses Association (2008) Code of ethics for registered nurses. Available at cna/documents/ pdf/publications/ CodeofEthics2008_e.pdf.

REFERENCES (cont’d) Community Health Nurses of Canada (2008) Canadian Community Health Nursing Standards of Practice. Toronto: CHNC. Community Health Nurses of Canada (2009). Public Health Nursing Discipline Specific Competencies Version 1.0. Available at Daiski, I. (2005) The Health Bus. Policy, Politics, & Nursing Practice, 6(1), Falk-Rafael, A. (2005a) Speaking truth to power: nursing’s legacy and moral imperative. Advances in Nursing Science, 8(3), Falk-Rafael, A. (2005b) Advancing nursing theory through theory- guided practice: the emergence of a critical caring perspective. Advances in Nursing Science, 28(1), International Council of Nurses (2004) ICN on poverty and health: breaking the link. Nursing Matters. Retrieved 22 July, 2004, from

REFERENCES (cont’d) MacDonald, M.B., & Schoenfeld, B. (2003) Expanding roles for public health nursing. Canadian Nurse, 99(7), 18. Meagher-Stewart, D. (2001) Public health nurses’ community development practice with women in high-risk environments. Unpublished doctoral dissertation, University of Toronto, Ontario. VanderPlaat, M. (2002) Emancipatory politics and health promotion practice: the health professional as social activist. In L. Young & V. Hayes (Eds.),Transforming health promotion practice: Concepts, issues, and applications (pp.87-98). Philadelphia: F.A. Davis Company. Williamson, D.L., & Drummond, J. (2000) Enhancing low- income parents’ capacities to promote their children’s health: education is not enough. Public Health Nursing, 17(2),

RECOMMENDED RESOURCE ‘Public Health Advocacy Toolkit’ (Public Health Alliance for the Island of Ireland)

CONTACT INFO Benita Cohen, RN, PhD, Associate Professor, Faculty of Nursing, University of Manitoba 377 Helen Glass Centre for Nursing 89 Curry Place Winnipeg, MB R3T 2N2 Ph: (204) Fax: (204)