Social justice in pandemic immunization policy: We're all in this together.

Policy decisions regarding immunization during a pandemic are informed by the ethical understandings of policy makers. With the possibility that a vaccine might soon be available to mitigate the deadly COVID-19 pandemic, policy makers can consider learnings from past pandemic immunization campaigns. This critical analysis of three policy decisions made in Alberta, Canada, during the 2009 H1N1 influenza pandemic demonstrates the predominance of distributive justice principles and the problems that this created for vulnerable groups. Vulnerable groups identified in Alberta include rural and First Nations populations. We propose a social justice approach as a viable alternative to inform pandemic immunization policy and invite debate.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning.

AIMS AND OBJECTIVES: To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes. BACKGROUND: The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed. DESIGN: A scoping review was conducted using the Arksey and O'Malley framework. METHOD: CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used. RESULTS: Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation. CONCLUSION: The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes. RELEVANCE TO CLINICAL PRACTICE: Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.

Analysis of Undergraduate Nursing Students' Sensitivity to Microethical Dilemmas During Simulation.

BACKGROUND: Simulation can extend ethics education in undergraduate nursing programs beyond the cognitive domain. However, the degree to which nursing students recognize and respond to microethical dilemmas in simulation is unknown. METHOD: Using a mixed-methods convergent parallel design, 68 third- and fourth-year undergraduate nursing students completed a sensitivity questionnaire. Twelve students also participated in an interview. Data were compared to create meaning. RESULTS: Many students reported having a high level of ethical sensitivity toward microethical dilemmas during simulation. However, some students expressed uncertainty in their ability to identify microethical dilemmas during nurse-patient interactions. Students also reported limited confidence in being able to transfer their ethical knowledge to the practice setting. CONCLUSION: Nurse educators must be moral agents during simulated learning experiences by helping students learn what microethical dilemmas are and strategies to manage them. [J Nurs Educ. 2020;59(2):88-92.].

Social inclusion/exclusion as matters of social (in)justice: a call for nursing action.

Social inclusion/exclusion involves just/unjust social relations and social structures enabling or constraining opportunities for participation and health. In this paper, social inclusion/exclusion is explored as a dialectic. Three discourses--discourses on recognition, capabilities, and equality and citizenship--are identified within Canadian literature. Each discourse highlights a different view of the injustices leading to social exclusion and the conditions supporting inclusion and social justice. An Integrated Framework for Social Justice that incorporates the three discourses is developed and used to critique the dominant focus on distributive justice within foundational Canadian nursing documents. We propose a broader conceptualization of social (in)justice that includes both relational and structural dimensions. Opportunities for multilevel interventions to promote social justice are identified. This framework is congruent with nursing's moral imperative to promote health equity and with the multiple roles played by nurses to promote social justice in everyday practice.

Social support and family assets: the perceptions of low-income lone-mother families about support from home visitation.

BACKGROUND: Research on lone-mother families has commonly focussed on psychosocial risk factors and deficits rather than family assets (strengths and resiliency characteristics). The negative impacts of poverty and social isolation have been well documented. Home visitation programs provide formal support to overburdened families, yet little research has focussed on the meaning of support (e.g., formal and informal) from the perspective of families. METHODS: This qualitative exploratory descriptive study was completed in southwestern Alberta, with a purposeful sample of 13 families (mean annual income of dollar 15,423 and 2.1 children) using mixed measurement (clinical tools and 2 semi-structured interviews). RESULTS: Similarities and differences in support and three lone-mother family structures were identified. A few lone-mother families described transformative experiences related to affirmative support from the home visitor. Not all families reported having 'enough support' to meet their needs. Sources of change in family assets included: a) support from the home visitor, b) 'other supports', or c) personal growth. On balance, support from home visitation was most commonly described as supporting these changes. SUMMARY: Support and assets were explored from a broad family and environmental context. Practice implications for home visitation and areas for future research were identified.

The safety of Canadian early discharge guidelines. Effects of discharge timing on readmission in the first year post-discharge and exclusive breastfeeding to four months.

BACKGROUND: Few studies have examined earlier discharge in relation to Canadian guidelines for earlier discharge and infant feeding. We addressed differences in readmission (1 year post-discharge) and exclusive breastfeeding (4 months) for newborns and mothers discharged within 48 hours compared to those with a longer hospital stay. METHOD: A cohort of 1,357 vaginally delivered singleton normal newborns and their mothers (births between January 1, 1996 and March 31, 1997) were studied by linking five databases and a chart audit. RESULTS: Overall there were no differences in infant and maternal readmission or rates of exclusive breastfeeding. CONCLUSION: Canadian guidelines for earlier discharge appear appropriate for vaginally delivered singleton normal newborns and their mothers with timely home visitation.