By Joan Kub, PhD, MA, PHCNS, BC


I began my career in public health nursing working in a tuberculosis (TB) clinic in inner city Baltimore. This was at a time when the Baltimore TB rate was very high.  New strategies were needed to better address not only screening of those at risk of TB but to improve adherence to TB regimens. These needs existed at a time of dwindling resources in the TB program.  It was also a time when there were a few patients experiencing what we would now call treatment failure due to drug resistance. I will never forget one patient for whom we creatively advocated for treatment at National Jewish Hospital in Denver because he was going to die in Baltimore.  Access to appropriate care with few resources available was a challenge. This particular patient was lucky but others were not so lucky.  Patients within our clinic were often extremely poor and vulnerable with limited resources.


Professional codes of ethics in public health and in nursing include the foundation value of justice.  This is particularly true for public health nursing where nurses encounter justice issues from a population or community perspective evident by healthcare disparities and inequities.


In thinking about healthcare disparities, often related to access to care, what exactly does adhering to the principle of justice mean? How do inequalities and inequities relate to justice?  How do nurses address determinants of health within the context of the sociocultural and political environment?


In caring for patients with tuberculosis, for example, vulnerability may be related to access to care, poverty, or other social determinants of health.  Social determinants include poor housing conditions, low education, or even neighborhood conditions.


One other factor relevant to our discussion of justice is stigma. Stigma is an issue important to human dignity and has particular relevance to the value of justice. It raises issues of fairness and human rights.  When certain groups of patients are viewed skeptically and critically, they can experience discrimination. This is not unique to patients with infectious diseases such as TB but is also seen in the care and treatment of patients with mental health or substance use disorders.  It is seen in how certain groups because their cultures, races, or economic statuses are treated differently.


What are nurses called to do in these circumstances? The ANA Code of Ethics asserts in the first provision that nurses are called to care for every person regardless of their diagnosis. The American Association of College of Nursing has defined social justice as a core value in nursing education and defines it in accordance with fair treatment. These are stringent requirements and mandate nurses to be culturally humble, open minded, and non-judgmental in their attitudes and actions.


We are left with several important questions.  How do we contribute to an environment where justice is more than a slogan and is consistently practiced? Nursing has a long history of involvement in social justice beginning with Florence Nightingale and public health nurse leaders such as Lillian Wald and the Henry Street Settlement.  How do we as a profession reinvest in social justice?  How do we socialize new nurses to the role of advocacy in practice?



KUB profileJoan Kub, PhD, MA, PHCNS, BC is an Associate Professor in the Department of Community-Public Health in the Johns Hopkins University School of Nursing.”

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Joan Kub
Nursing Ethics

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