Socio-Political Awareness is a key aspect of knowledge for nurses and other health care professionals.

Photo by swapnil-dwivedi-Bwbq9_AuZ7c-unsplash.jpg

For the remainder of this century, the most worthy goal that nurses can select is that of arousing their passion for a kind of political activism that will make a difference in their own lives and in the life of our society.” (Peggy Chinn, 1984)

Colm O’Gorman, Executive Director of Amnesty International Ireland, has helpfully outlined the ‘Right to Health’ and reminded us that Nurses are ‘State Agents’ – with responsibility and duties to help realise the right to health. 

How? By providing the highest standard of care, respecting dignity, in a non-discriminatory way. We should check our biases, our ideologies and our prejudices.   

To contextualise that, I suggest that the ideologically based views of very powerful political, corporate and social actors have been so influential in popular discourse that many people have accepted their stories about health care, without question. They have achieved this via the billionaire owned pressbillionaire ownership of broadcast media, the Public School-Oxbridge nexus and its stranglehold on powerful jobs in the civil service, politics and journalism, through the work of so called ‘think tanks’ and through dark money campaigns on social media.

This must be challenged. 

Although there is no limitless right of access to ‘rights to health’, because of the constraints of resources and of science, we must press for the highest attainable standard of physical and mental health. It is my assertion that governments have used ideological reasons, such as deficit and debt reduction and an aversion to State run health services, to avoid delivering the highest attainable standards of health. The argument of ‘lack of resources’ is largely bogus. 

Nursing Theory 

Various nursing theorists have suggested or implied that politics and political awareness and knowledge is, or ought to be, a component of nursing knowledge advocacy and leadership. Nancy Roper referred to the sociocultural, environmental and politico-economic factors influencing the Activities of Living, while also lamenting a lack of their application. Jill White developed Barbara Carper’s ‘patterns of knowing’ to include it. Jane Salvage argued that it needs to be understood and acted upon, and that nurses should ‘wake up and get out from under’. Other writers include White, Lewenson, and Falk Rafael. 

Kath Melia back in 1984 illustrated the pressures of the clinical working context on student nurses, while more recently in 2013 Alexandra Hillman and colleagues described how patient care can be compromised by the systems nurses work within. I have argued socio-political knowing should be explicitly part of the sustainability agenda for nursing, while the social determinants/political determinants of health approach are predicated upon it.

Other health concepts such as Barton and Grant’s (2006) health map, Lang and Rayner’s (2012) ecological public health model and Ottersen et al’s (2014) focus on global governance for health also brings political awareness into play. Finally, Political Awareness has been identified as one of the key dimensions for Nursing leadership by Cunningham and Kitson back in 2000.  

The Social Determinants of Health

The Social Determinants of Health are the conditions in which people are born, grow, live, work and age.  These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. 

The social determinants of health literature, for example the “Fair Society Healthy Lives” report of 2010, refers to health being a matter for social justice and fairness. Some authors have highlighted the health policy role for nurses which although advocating for nurse involvement in public policy making, does so probably withinaccepted frames of reference such as ‘neoliberalism’ , of ‘finacial/rentier capitalism’ and ‘individual responsibility for health’. They are devoid of critical concepts such as Foucault’s ‘governmentality’, or of ‘managerialism’ and what Graham Scambler calls the ‘capitalist class-command dynamic’ in his ‘Greedy Bastards Hypothesis’ of Health Inequalities.

Nurse Education

In the education and curriculum development literature writers such as that of Paulo Freire, Carl Rogers, Stephen Sterling and David Orr suggest that teaching and learning should go beyond skills teaching to address such issues as personal growth and social transformation. Romyn discusses the idea of ‘emancipatory pedagogy’ in nurse education which accords with aspects of what Peter Morrall calls ‘provocative pedagogy’

It is my contention that undergraduate nursing education is one in which politics is largely absent in nursing curricula and fails to equip student nurses with tools of analysis that renders them blind to social and political systems that are often unfair, unjust and oppressive. A tool of analysis for example is the concept of ‘the social gradient’ in health.

Nurse Education also fails to politically socialise students. It is a self marginalised education denuded of any critical importance and ignores or marginalises the vast epidemiologcal and sociological literature on inequalities in health and illness. Nurse educators themselves, beyond a few ‘individual enthusiasts’, lack the requisite skills or concepts to engage in this project, resulting in the lack of politics or health policy in nurse education. This is not to say nursing education, as it currently is, lacks importance. The requirement for clean, kind and compassionate care is emphasised daily in seminars, lectures and tutorials. 

My assertion might be supported if it can be shown that student nurses lack a critical understanding of the socio-political context in which they work. This is not to say however that student nurses are not political or are not interested in politics. Rather that their interest and understanding especially in relation to health may be lacking and only slightly better than their peer groups. The need to understand health delivery systems, rights, funding, inequalities, access, outcomes and determinants are key components of the fully rounded professional nurse. 

Further, I suggest that that any student nurse who is active, interested and knowledgeable is so, despite not because of nursing education. I take it as self evident that this matters and not merely for the reason that it suits many in positions of wealth and power and influence to have a huge number of health workers (600,000 registrants in the UK alone) either ignorant, confused, uninterested and inactive in regards to the ecological, social and political determinants of health. 

We have nurses schooled in the biomedical aspects of health delivery, or rather disease treatment, but rather less in the socio-political approach to health. Student nurses are introduced to a BioPsychoSocial (BPS) model to health however, the curriculum process and learning experiences may often dilute this, emphasizing the bio at the expense of the Psycho-Social while ignoring the Ecological. 

“Dame Donna Kinnair, the Chief Executive and General Secretary of the Royal College of Nursing, claims she was told by the Government to “bring your membership under control” as they feared the nursing voice is getting “too loud”.

See https://nursingnotes.co.uk/rcn-chief-told-bring-membership-controlvoice-too-loud/

This is an example of nurses beginning to raise their voice

What is Politics?

Politics can be defined simply as ‘the process of influencing the scarce allocation of resources’ which can be clearly seen in recent Nuffield Trust and King’s Funds reports on staffing in the NHS. The RCN’s campaign ‘Frontline First’, while laudable, is also a very narrowly focused campaign which is about resource (staff) allocation. 

However, this does not go far enough as it fails to engage with more critical analyses of power and legitimacy of the exercise of power, concerning itself with more ‘mundane’ issues of resource allocation within laregly uncritically accepted frames of reference as suggested above. 

Politics is much more than knowing the manifestos of political parties or the internal machinations at Westminster. Political action is much more than the 5 year placing of crosses on ballot papers. Engaging in politics requires at least a critical understanding of power. For example, the ex Labour minister Tony Benn outlined questions to ask the powerful: 

  1. We should know who has power, 
  2. What power they have, 
  3. Where did they get it from, 
  4. In whose interest do they wield it, 
  5. To whom are they accountable and 
  6. How do we get rid of them? 

This does not apply only to Westminster, but in every organisation including an NHS Trust. 

Students’ Knowledge and Interest in Politics

To test the hypothesis that student nurses lack a critical understanding of a socio-political approach to health, a survey of student nurses in several universities in the UK could be undertaken. Siobhan McCullough in 2012 undertook just one such survey in Northern Ireland in which 81% of students claimed ‘not much knowledge’ of politics and 60% claimed either ‘never’ or ‘less than once week’ to follow politics in the media. A caveat to this must be that politics in this context may mean ‘Party, Westminster, Stormont politics rather than political issues. 

If Russell Brand’s Youtube site is any guide, many people are very interested in politics, just not the dominant media fed variety of political talking heads, the representatives of mainstream political parties. If we widen the definition of politics to include social movements around health, climate change and human rights then according to Paul Hawken (2007) there is a global ‘Blessed Unrest’ involving millions of people, a global ‘environmental and social justice movement’ that does not appear in the mainstream media. Extinction Rebellion is currently clearly demonstrating interests in political issues. 

Yet, nurses are not to be treated as an homogenous group for political purposes. For example, the free market nurse think tank Nurses for Reform (NFR):

 “….long argued that the NHS is an essentially Stalinist, nationalised abhorrence and that Britain can do much better without its so called ‘principles’

Whether this group actually has a huge number of nurses supporting it has been questioned. Nonetheless the point remains that nurses will probably vote for all parties, and none, at the next election. To what degree nurses are part of the ‘blessed unrest’ is unknown, McCulloghs small survey does not answer that question. Perhaps we should start asking?

How could nurses engage in politics?

  1. Choose your sphere of influence.
  2. Choose your issue.
  3. Engage in Civic Action and Public Advocacy
  4. Engage in Public Advocacy using all tools of public discourse.
  5. Read, Reflect. 
  6. Understand the social and political mechanisms at play such as the Violence of Austerity and concepts such as Structural and Institutional violence. 
  7. Join groups such as Medact.


For audio version and a complementary podcast on the Right to Health see http://www.wecommunities.org/blogs/3505

‘A Manifesto for Action Nursing’

see: https://socialtheoryhealth.wordpress.com/2016/07/07/a-manifesto-for-action-nursing/

This manifesto calls for a social movement for political activism by nurses and other health professionals, to address inequalities in health and the social inequalities that highly structure, but do not determine, health outcomes. This action can operate at individual, clinical, organisational, national and international level.

Our aim is to respond to threats to health and socialised health service delivery from corporate, financial and political interests. 

Our vision is for decreasing social and health inequalities in which the social gradient is greatly diminished 

Our goal is to create a networked social movement involving political and civic activism to bring critical understanding and action into the public sphere.

Qs for discussion:

  1. What are the most important issues affecting the health of populations at the local, national and international level?
  2. What practical action can student nurses take to ensure that minimum standards of health are attained?  
  3. What prevents student nurses from being interested or active in socio-political issues and how can they be overcome?
  4. What are the links between NMC Code and international laws on Right to Health?
  5. How do you think social media helps the nursing community to be more proactive in socio political issues?

Albarran J (1995)

Antrobus S (1998) Political Leadership in Nursing. Nursing Management  5(4): 26-28

Barton and Grant (2006) http://eprints.uwe.ac.uk/7863/2/The_health_map_2006_JRSH_article_-_post_print.pdf

Beall F (2010) The important role of nurses in political action  http://www.thefreelibrary.com/The+important+role+of+nurses+in+political+action.-a0234309354

Brown, S. G. (1996) Incorporating political socialization theory into baccalaureatenursing education. Nursing Outlook. 44, 120 – 123

Byrd, M.E., Costello, J., Gremel, K., Blanchette, M.S. and Malloy, T.E. (2012) Political Astuteness of Baccalaureate Nursing Students Following an Active Learning Experience in Health Policy. Public Health Nursing. 29 (5), pp433-443.

Cameron P, Willis K and Crack G (1995) Education for change in a postmodern world: redefining revolution. Nurse Education Today 15 (5):336-340

Carnegie, E. and Kiger, A. (2009) Being and doing politics: an outdated model or 21st century reality, Journal of Advanced Nursing, 65(9), pp1976-1984.

Carper B (1974) Fundamental Patterns of Knowing in Nursing Advances in Nursing Science

Cave T (2010) Nurses for Reform. BMJ ;340:c1371 doi: http://dx.doi.org/10.1136/bmj.c1371

Chaffee, M.W., Mason, D. J. and Leavitt, J.K. (2012) A Framework for Action in Policy and Politics. in Mason, D.J., Leavitt, J.K. and Chaffee, M.W. (eds) Policy and Politics in Nursing and Healthcare. (6th edn) St Louis: Elsevier Saunders.

Chinn P (2000) Looking into the crystal ball: positioning ourselves for the year 2000. Nursing Outlook. 39 (6): 251-256

Chopoorian T (1986) Reconceptualiszing the Environment, in Moccia P ed. New Approaches in theory development. New York National league for Nursing

Davies C (1995) Gender and the professional predicament of Nursing

Davies, C. (2004) Political leadership and the politics of nursing. Journal of Nursing Management. 12, pp253-241

Ennen K (2001) Shaping the future of practice through political activity: how nurses can influence health care policy. American Association of Occupational Health Nurses Journal  49(12): 557-569

Falk-Rafael A (2006) Globalization and global health: toward nursing praxis in the global community. Advances in Nursing Science. 29, 1, 2-14.

Fyffe T (2009) Nursing shaping and influencing health and social care policy. Journal of Nursing Management 17 (6):698-706

Hawken P  (2007) Blessed Unrest How the Largest Movement In the World Came Into Being 
and Why No One Saw it Coming. Viking Press New York

Lang and Rayner (2012) Ecological Public Health

Lewenson S (2000) Nurses in the political arena. The public face of nursing. Springer. New York.

Liberal conspiracy (2010) Where are all the ‘nurses’ for reform? available at http://liberalconspiracy.org/2010/01/25/where-are-all-the-nurses-for-reform/ accessed 1st May 2015.

Mccullough S  An exploration of political awareness among a cohort of all field students in one University in Northern Ireland

Ottersen et al (2014) Global Governance for Health https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62407-1/fulltext

Phillips C (2012) Nurses becoming political advocates Journal of Emergency Nursing 38 95) 470-471

Salvage J (1985) The Politics of Nursing. Heineman.

Scambler G (2015) Taking Social Class seriously. available at http://www.grahamscambler.com/taking-social-class-seriously/ accessed 1st May 2015.

Siviter B (2002) Personal interview of Nancy Roper at RCN Congress, Association of Nursing Students, reported in Fall 2002 edition “The ANSwer” (RCN)

Stevens P (1989) A critical reconstruction of environment in nursing: implications for methodology. Advances in Nursing Science. 11(4):56-68

White J (1995) Patterns of knowing: review, critique and update, Advances in Nursing Science 17(4):73-86

White R (1985) Political issues in Nursing Volume 1 Wiley Chichester

White R (1986) Political issues in Nursing Volume 2 Wiley Chichester

White R (1988) Political issues in Nursing Volume 3 Wiley Chichester