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SocialJustice_AConceptAnalysis.pdf
CONCEPT ANALYSIS
Social justice: a concept analysis
Kelly Buettner-Schmidt & Marie L. Lobo
Accepted for publication 17 September 2011
Correspondence to K. Buettner-Schmidt:
e-mail: [email protected]
Kelly Buettner-Schmidt BSN MS RN
Assistant Professor
Department of Nursing
Minot State University, Minot, North
Dakota, USA
and PhD student
Robert Wood Johnson Foundation Nursing
and Health Policy Doctoral Study,
University of New Mexico, Albuquerque,
New Mexico, USA
Marie L. Lobo PhD RN FAAN
Professor
College of Nursing
University of New Mexico, Albuquerque,
New Mexico, USA
BUETTNER-SCHMIDT K. & LOBO M.L. (2012)BUETTNER-SCHMIDT K. & LOBO M.L. (2012) Social justice: a concept analysis.
Journal of Advanced Nursing 68(4), 948–958. doi: 10.1111/j.1365-2648.2011.05856.x
Abstract Aim. This article is a report of an analysis of the concept of social justice.
Background. Nursing’s involvement in social justice has waned in the recent past. A
resurgence of interest in nurses’ roles about social justice requires a clear under-
standing of the concept.
Data sources. Literature for this concept analysis included English language articles
from CINAHL, PubMed, and broad multidisciplinary literature databases, within
and outside of health-related literature, for the years 1968–2010. Two books and
appropriate websites were also reviewed. The reference lists of the identified sources
were reviewed for additional sources.
Review methods. The authors used Wilsonian methods of concept analysis as a
guide.
Results. An efficient, synthesized definition of social justice was developed, based
on the identification of its attributes, antecedents and consequences that provides
clarification of the concept. Social justice was defined as full participation in society
and the balancing of benefits and burdens by all citizens, resulting in equitable living
and a just ordering of society. Its attributes included: (1) fairness; (2) equity in the
distribution of power, resources, and processes that affect the sufficiency of the
social determinants of health; (3) just institutions, systems, structures, policies, and
processes; (4) equity in human development, rights, and sustainability; and (5)
sufficiency of well-being.
Conclusion. Nurses can have an important influence on the health of people
globally by reinvesting in social justice. Implications for research, education, prac-
tice and policy, such as development of a social justice framework and educational
competencies are presented.
Keywords: concept analysis, health promotion, nurse roles, politics, public health
nursing, public policy, social justice
� 2011 The Authors
948 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd
J A N JOURNAL OF ADVANCED NURSING
‘Social justice is a matter of life and death’.
Commission on Social Determinants of Health
(CSDH 2008, p. 3)
Introduction
Nursing has a long history of involvement in social justice,
although interest in it has waned in the recent past.
Nightingale (Watson 2008) and Lillian Wald (Sklar 2003,
Anderson 2007) were social justice advocates. Nightingale’s
political efforts in social and economic issues ‘kindled the
light of justice’ (Boykin & Dunphy 2002, p. 14). Fitzpatrick
(2003) questioned at what point nursing left the path of
having social justice principles and respect at its core.
Leuning (2001) stated, ‘‘The question of ‘Who suffers and
why?’ should always be in the foreground of our scholarly
discussions and in our practice’’ (p. 300). Appeals for nursing
to have a multidisciplinary social justice language (Boutain
2005) and to reinvest in social justice (Drevdahl et al. 2001)
have occurred. Social justice has been identified as the
broadest outcome in a conceptual model for nursing and
health policy (Fawcett & Russell 2001, Russell & Fawcett
2005).
The primary aim of this concept analysis is to identify
social justice’s attributes, antecedents and consequences and
to develop a synthesized definition though the use of
Wilsonian concept analysis methods based on a multidisci-
plinary literature review (Wilson 1963, Hupcey et al. 1996,
Rodgers & Knafl 2000). A secondary aim is to determine
whether or not involvement in social justice issues is
appropriate for the nursing profession and whether or not
nursing has reinvested in social justice, thereby reclaiming its
role in addressing global social injustices.
Background
Social justice took a back seat when the perspective of nurses
changed from viewing health as a social mandate to viewing
it as an individual responsibility (Boutain 2005); however,
there is a resurgence of interest in nursing’s role in social
justice issues. Watson (2008) questioned ‘a world that is
spending close to $600 billion for a war on terrorism and
little or nothing to combat poverty and provide basic child
health care for its citizens’ (p. 54). She identified poverty,
mortality rates, disease, and suffering as the ‘outer manifests
of social injustice’, stating that bioethics frames this ‘as issues
of race, ethnicity, and power’ (Watson 2008, p. 55).
The American Nurses Association (ANA) incorporated
social justice into its Code of Ethics (2001), Social Policy
Statement (2003), Nursing Scope and Standards of Practice
(2004) and Public Health Nursing: Scope and Standards of
Practice (2007). Social justice concepts are included in some
nursing undergraduate curricula (i.e. Boutain 2005, 2008,
Beaty 2008, Vickers 2008). Of the nursing specialties, public
health nursing is most attuned to social justice as a corner-
stone of public health [Minnesota Department of Health
(MDH) 2001].
However, do nurses currently embrace their history and
role in advocating for social justice? Do they understand
social justice, apply nursing knowledge to rectify injustices
and view advocacy beyond individual clients to include social
justice advocacy? Do the ANA and other organizations
provide a social justice framework empowering nurses to
apply social justice in practice? Does social justice need to be
explicitly addressed by the profession so that nurses can once
again be a force for addressing social injustices?
This article provides an analysis of the social justice
concept guided by Wilsonian methods of concept analysis
(Wilson 1963, Hupcey et al. 1996, Rodgers & Knafl 2000).
Using Wilsonian methods requires explicating the following
iterative steps: Step 1 – isolating the questions of the concept;
Step 2 – developing the right answers; Step 3 – identifying
uses of the concept; Step 4 – answering the questions of the
concepts; Step 5 – reanalysing the initial concept for current
relevance in nursing; and Step 6 – identifying potential uses of
social justice for nurses.
Wilson (1963) described the questions of concepts as
potentially questions of fact, value and concept. This analysis
isolated four questions of concept (Step 1): (1) a question of
fact: What is social justice and how is it defined; (2) a
question of value: Is social justice appropriate for the nursing
profession; and two questions of concept: (3) What are the
attributes, antecedents and consequences of social justice;
and (4) Has nursing reinvested in social justice?
Data sources
To develop the right answers (Wilsonian Step 2), the
boundaries of the analysis must first be determined (Hupcey
et al. 1996), which for this analysis are defined by data
sources, search terms and other limits. Second, all the uses of
social justice within the boundaries need to be identified.
Then, the right answers can be developed.
A CINAHL database search for articles published from
1994 to 2010 was conducted using the term ‘‘social justice’’
without selection of a specific field, resulting in 2245 articles;
this was refined by limiting the results to full-text articles,
leaving 830 articles. Further refinement with ‘social justice’ in
the Title field resulted in 80 articles; the term ‘nurs*’ reduced
the list to 29 articles, which were then reviewed.
JAN: CONCEPT ANALYSIS Social justice
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A PubMed database search for articles published from
1968 to 2010 was conducted for the term ‘social justice’,
resulting in 10,663 citations; limiting the results to humans,
English language and full-text availability left 1029 articles.
Further refinement of articles with ‘social justice’ in the Title
field resulted in 25 articles, 9 of which were included in the
public health related and 3 were in the nursing related and 2
were not pertinent, leaving 11 medical-related articles
reviewed. Additional sources were identified through broad
searches of the literature in numerous disciplines. Two social
justice books were reviewed, and relevant websites were
searched. The reference lists of identified sources were
appraised for additional sources. Only English language
sources were used.
Results
This section continues with Wilsonian Steps 3 and 4 and
includes the findings of the multidisciplinary literature
review, developing the right answers, provision of cases and
a discussion of uses and contexts. A synthesized definition is
provided along with attributes, antecedents and conse-
quences.
All uses of social justice within the identified boundaries
No social justice definitions were found in commonly used
dictionaries and thesauri; this was not surprising, as Hayek
(n.d., as cited in Novak 2000) stated that entire books and
treatises have been written on this topic without defining it. A
recent community health concept analysis discussed social
justice without providing a definition (Baisch 2009). Searches
of discipline-specific references and reviews of literature in
discipline-specific databases revealed lengthy explanations.
Health: nursing
Although social justice was previously considered a critical
value for all nurses (Fahrenwald et al. 2007), Liaschenko
(1999) found that justice as a central moral concept lacked
attention in the literature and argued for Young’s (1990)
view of justice inclusive of action and enabling full social
participation. Drevdahl et al. (2001) found that when nurses
did address social justice, a social justice framework was not
used. A specific social justice framework does not exist;
however, several nursing frameworks include social justice
(Fawcett & Russell 2001, MDH 2001, Boykin & Dunphy
2002, Boutain 2005, 2008, Russell & Fawcett 2005, Schim
et al. 2007, Pacquia 2008, Watson 2008). Boutain (2005,
2008) called for a more complex view to assist nurses to
participate in social justice, and Schim et al. (2007) placed
social justice at the centre of the nursing paradigm. Reimer
Kirkham and Anderson (2002) stated that ‘postcolonial
nursing scholarship will permit more thoughtful attention to
the issues of equity and social justice within health and health
care that fall within the mandate of nursing’ (p. 16).
Educating nurses on social justice has been discussed in recent
literature (e.g. Boutain 2008, Cohen & Gregory 2009). The
need to find and use nursing’s political will to address equity
issues globally was stressed (Drevdahl et al. 2001, Ervin &
Bell 2004) through organizational and individual action
(Liaschenko 1999).
Varying opinions exist as to the adequacy of ANA
guidance on social justice, with some authors expressing
support for ANA’s guidance (Fahrenwald et al. 2007, Bou-
tain 2008, Manthey 2008) and others finding it lacking
(Bekemeier & Butterfield 2005). Two of the five strategic
priorities of the Public Health Nursing Section of the
American Public Health Association (Anderson 2007) are
ensuring social justice and eliminating health disparities.
Ervin and Bell (2004) added concerns related to international
threats to the common good as further priorities.
The American Association of Colleges of Nursing’s (AACN
2008) Essentials of Baccalaureate Education for Professional
Nursing Practice identified social justice as a core nursing
value and defined it as ‘acting in accordance with fair
treatment regardless of economic status, race, ethnicity, age,
citizenship, disability, or sexual orientation’ (p. 28). Previ-
ously, in examining the 1998 Essentials, Fahrenwald et al.
(2007) found AACN’s focus narrow and not inclusive of the
broad issues of health and determinants of health. The 2008
Essentials does discuss determinants of health, vulnerable
populations and health disparities, although its primary focus
remains on individuals and healthcare systems.
The Canadian Nurses Association’s (CNA’s 2008) Code of
Ethics for Registered Nurses lists ‘Promoting Justice’ (p. 17)
as one of seven values and responsibilities and provides
explicit practice recommendations to address social justice.
The Code includes terminology such as rights, equity,
fairness, allocation of resources, system and structural
changes, social determinants of health and global health.
The Code’s focus is inclusive of individuals, groups, commu-
nities, programmes, policies, legislation, regulations, systems
and structures. Supporting information File S1 in the online
version of the article in Wiley Online Library includes
additional nursing articles defining and describing social
justice (Pangman & Seguire 2000, Drevdahl 2002, Redman
& Clark 2002, Fitzpatrick 2003, Jackson 2003, Reimer
Kirkham et al. 2005, Davison et al. 2006, McGee 2007,
Browne & Tarlier 2008, Foley 2009, Weisz 2009,
Dysart-Gale 2010).
K. Buettner-Schmidt and M.L. Lobo
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Health: public health
The foundation of public health is social justice (Powers &
Faden 2006, National Association of County and City Health
Officials 2010), with equity and social justice frequently
interchangeable (Levy & Sidel 2006, CSDH 2008).
Beauchamp’s (1976) ‘Public Health as Social Justice’ defined
justice as the fair and equitable distribution of society’s
benefits and burdens. Braveman and Gruskin (2003) clarified
that equities focused on distribution of resources and other
processes that drive health inequality, and Stanley (2002)
called for ‘rigorous science to improve public health and
social justice’ (p. 44).
Providing international leadership, the World Health
Organization developed the CSDH (2008), which determined
that health inequities were impacted by political, social and
economic forces and recommended influencing the social
determinants of health to improve health equity. Achieving
health equity to ensure social justice was described using the
terms rights; fairness; distribution of power, income, goods
and services; unequal distribution of health-damaging expe-
riences; economic arrangements; politics; distribution of
healthcare; society; social stratification; and living conditions.
Other public health social justice language included the terms
disadvantaged (van den Bergh et al. 2009); disenfranchised
and political rights (Peréz & Martinez 2008); financing of
healthcare, prestige, deprivation, marginalization, equal
opportunities, freedom to participate fully in one’s society
and social structures (Braveman & Gruskin 2003); and
caring, dignity and collective health (Krieger & Birn 1998).
A book by Powers and Faden (2006) focused on people in
social communities or groups, social institutions such as
governments and markets, inequalities, politics and the
means of allocation. They identified social justice concerns
as ‘worries about subordination and stigma, lack of respect,
lack of institutions, and social practices that adequately
support capacities for attachment and self-determination’
(p. 6). Powers and Faden stated that their primary concern
was the ends to be achieved through social justice, although
they also stated that public health should be concerned about
the distribution of resources and outcomes of social justice.
They identified six essential dimensions of well-being to be
achieved at a sufficient level for all: health, reasoning, self-
determination, attachment, personal security and respect.
These dimensions related to disadvantage and privilege.
Levy and Sidel’s (2006) book focused on social injustices,
defined as ‘the denial or violations of…rights of
specific…groups…based on the perception of their inferiority
by those with more power or influence’ and ‘policies or
actions that adversely affect the societal conditions in which
people can be healthy’ (p. 6); also that social justice is
grounded in distributive justice. Root causes were identified
as poverty, the income gap between people, unequal distri-
bution of resources, discrimination, the lack of human rights
protection and political disenfranchisement. Social injustice
was considered a principle cause and consequence of war and
terrorism (Levy & Sidel 2006).
As the leading cause of death worldwide, tobacco use has
been identified as a social justice issue, with calls to action for
healthcare providers and others to address the related
injustices (Healton & Nelson 2004, Buettner-Schmidt 2005,
2006). Associated terminology includes disparities, exploita-
tion, basic human rights of good health, education, fair and
equal treatment, disenfranchisement, well-being and health
promotion (Healton & Nelson 2004). A full listing of public
health references reviewed can be found in supporting
information File S2 in the online version of the article in
Wiley Online Library.
Health: medicine
The Online Medical Dictionary ‘Social justice’ (1998) defined
social justice as, ‘An interactive process whereby members of a
community are concerned for the equality and rights of all’ (–1).
Thirteen articles on social justice from medical journals were
reviewed, 11 from the initial search and 2 identified from the
readings. Nineteen social justice-related terms were identified
within the articles; see supporting information Tables S1 and
S2 in the online version of the article in Wiley Online Library
for matrices linking terms to articles. Lee and Cubbin (2009)
hypothesized that social injustices can lead to poor health
outcomes and called for equitable opportunities for all to be
healthy. Van Rosendaal (2006) described physicians’ ethical
conflicts as a struggle between the doctor–patient relationship
requirements and social justice responsibilities and recom-
mended that physicians have ‘a broader sense of community
responsibility in their practice of medicine’ (p. 1525). Azetsop
and Rennie (2010) argued that medical individualism has led to
‘[a] moral vacuum, exaggeration of human agency, and a
thin…conception of justice’ (p. 1).
Philosophy
Rawls (1971, 1999, 2001) stated, ‘Justice is the first virtue of
social institutions’ (Rawls 1999, p. 3). Rawls clarified that
justice and fairness are not the same concepts and that
equality is a hypothetical concept to begin the development of
the justice concept.
According to Wenar’s (2008) interpretation of Rawl’s
social justice philosophy, a just society has ‘free citizens
holding basic equal rights cooperating within an egalitarian
system’ (– 1) institutions included the political constitution,
legal system, economy and organizations that ‘distribute the
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Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 951
main benefits and burdens of social life’, including rights,
opportunities, work, recognition, distributions of income and
wealth and more (4Æ1 The Basic Structure section, – 1).
Wenar found that Rawls’ theory of justice related to citizens’
good, collective good, reciprocal advantage of all, fair equal
opportunity of all, economic equality, political equality,
equal basic rights, self-respect and affirmation of self.
Law
The American Bar Association (ABA) does not have a legal
definition for social justice, although representatives of the
organization have made statements about their duty to ‘bring
social justice to the world’ (Rand 2006, p. 461). The ABA
Center for Racial and Ethnic Diversity promotes social justice
in the justice system (ABA n.d. ). Current legal social justice
issues include racism, sexism, the environment and the ‘rela-
tions between rich nations and poor nations, to the first world
and the rest of the world’ (Kennedy 2005, p. 93). Rand pro-
vides descriptions of social justice: ‘empowerment of under-
represented minority groups’ (Solorzano & Yosso 2001, as
cited in Rand 2006, p. 460) and ‘the process of remedying
oppression’ (Edwards & Vance 2001, as cited in Rand 2006).
Psychology, sociology and social work
Psychological social justice definitions were influenced by
authority, power and peer pressure, which affect how others
are treated (Hatfield & Rapson 2005). Oppression was
recognized as the domination and control of others through
institutional systems and policies, with social justice
described as full and equal participation of all of society’s
groups, equal distribution of resources, physical and
psychological safety, security of all and included the pro-
cesses and institutional context (Morgan & Vera 2006).
The sociological literature differentiated social justice from
legal, political and economic justice (Alwin 2001) and
discussed social and economic inequalities and the allocation
of goods (Marshall 1998). ‘Distributive justice’ was an
alternate term for social justice (Marshall 1998, Alwin
2001). Alwin (2001) defined social justice as ‘the realm of
status, respect and the sense of worth given and received in
social interaction or in relation to society’ (p. 2696).
The Code of Ethics of the National Association of Social
Workers (2008) deems social justice to be a value and an
ethical principle. ‘Social workers challenge social injustice’
and ‘pursue social change, particularly with and on behalf of
vulnerable and oppressed individuals and groups of peo-
ple….focused primarily on issues of poverty, unemployment,
discrimination….[They] strive to ensure access…equality of
opportunity; and meaningful participation in decision
making for all people’ (Ethical Principles section, – 3).
Geography
Geographical social justice definitions included, ‘The distri-
bution of society’s benefits and burdens, and how this comes
about’ (‘Social justice’ 2000, Social Justice section, – 1) and a
sharing of resources and power (Ross & Rosati 2006), with
questions related to spatial access to resources and exposure
to environmental hazards.
Economics
The World Bank (2005) focused on social justice as inequal-
ities in opportunity and stated that a reduction in inequities
was consistent with and may be necessary to obtain long-term
greater efficiency and prosperity. The ABA (n.d.) Center for
Economic and Social Justice (n.d.) included economic justice
in their social justice definition, stating that social justice is a
guiding virtue in the creation of institutions, just social insti-
tutions give access to what is good, and peace follows justice.
Brinkman and Brinkman’s (2005) social justice conception
focused on: equality of opportunity and fairness as it relates to
income distribution; the struggle for power; institutional,
social and political structures; distributive justice; disparities;
social, political, legal and economic institutions; social order;
liberty; and equality of economic opportunity.
Nitsch (2005), a self-identified Catholic social economist,
explained that social justice is ‘inextricably connected’
(p. 556) to the common good and that distributive justice
requires that ‘the allocation of income, wealth, and power in
society be evaluated in light of its effects on persons whose
basic material needs are unmet’ (p. 556). Contributive justice
means that ‘persons have an obligation to be active and
productive participants in the life of society and that society
has a duty to enable them to participate in this way’ (p. 557).
Nitsch concluded that social justice consists of ‘every one’s
rights to share/participate in the common good in accordance
with her/his needs, coupled with his/her obligations to
contribute thereto in accordance with his/her ability’ (p. 562).
Religion
The term ‘social justice’ was first used in Roman Catholic
writings in 1840 and was defined as ‘the virtue that ordains
all human acts toward the common good’ (Calvez & Mass-
aro 2003, p. 242). Pope Paul VI (1967) created the Justice
and Peace Commission to address international social justice
obligations, stating, ‘Extreme disparity between nations in
economic, social and educational levels provokes jealousy
and discord, often putting peace in jeopardy’ (p. 76) and
those wealthier nations have a duty to aid developing nations
and an obligation to social justice. Manship (2005) stated
that the secular and religious origins of social justice can
augment each other, and he identified shared concepts as
K. Buettner-Schmidt and M.L. Lobo
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952 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd
human equality, distributive justice, rights, the common good
and the ‘fair distribution of resources by social structures and
institutions’ (p. 42).
Developing the right answers (Step 2)
The exploration of literature revealed differences among and
within the various disciplines about the uses of social justice.
However, the goal of obtaining social justice, that is,
attaining fairness and equity, appeared to be similar in each
discipline. A pertinent question was whether social justice
should be viewed through a religious or secular viewpoint.
Manship (2005) found that the views had similar concepts.
For the remainder of this article, the focus of the concept will
be on social justice as it relates to health.
Uses, cases and contexts of the social justice concept (Steps 2
and 3)
Model case. A model case can be found in a recent tobacco
control advocacy in North Dakota. The 1998 U.S. Tobacco
Master Settlement will result in payment of more than $246
billion over 25 years to the majority of US states. Adding in
tobacco taxes, total state tobacco revenues will be $25Æ1
billion in 2010 alone; however, states spend only 2Æ3% of
this revenue on tobacco prevention, cessation and control.
The Centers for Disease Control and Prevention (CDC)
provides recommended funding levels for each state;
currently, nine states fund at 50% or more of the recom-
mended level, and 31 states fund at <25% (Campaign for
Tobacco Free Kids, 2009). After several years of unsuccessful
efforts by advocates requesting the North Dakota Legislature
to fund tobacco prevention, cessation and control efforts
according to recommended levels, a voter initiative was
placed on the November 2008 election ballot. The voters
supported the recommended level of funding, resulting in
North Dakota being the only state funded at the CDC-
recommended level. This is an example of social justice
because the tobacco companies, who profited from selling an
addictive product that causes statistically significant morbid-
ity and mortality, are now paying to prevent the initiation of
new smokers and to assist in the cessation efforts of current
smokers.
Contrary case. A hospital-based clinic in Seattle increased
access to physicians to 24 hours per day and provided same-
day service, lengthier appointments, advocacy with insurance
companies and increased privacy in client areas to clients who
paid $3000 to $6000 per year above the regular premium
(Drevdahl et al. 2001). The clients were given the physicians’
email addresses and cell phone numbers for immediate
access. This clinic demonstrates that justice can be bought
(Drevdahl et al. 2001).
Related case. A teenage shoplifter was sent to juvenile
court and sentenced to 30 hours of community service.
This was a related case in that legal justice was served;
however, it was not related to social justice in a healthcare
context.
Social context
Social contexts change concepts (Rodgers & Knafl 2000).
For example, in religion, social justice was described as a
virtue, a moral duty and an obligation. In philosophy, it
was also considered a virtue but related to equality and
fairness. The legal profession considered social justice as
empowerment, a just ordering of society and remedying of
oppression. Surprisingly, in the field of geography, social
justice is discussed in terms of power and the distribution of
society’s benefits and burdens and the processes of distri-
bution. Nursing, public health and medicine focused
primarily on equity, health outcomes, participation, well-
being and social determinants of health. The World Health
Organization (CSDH 2008) focused on daily living condi-
tions; the inequitable distribution of power, money and
resources; and the impact of action, including the role of
civil society.
Emotive context
The underlying emotive context of social justice was char-
acterized by intensity and deep emotions related to the social
injustices and whether or how to resolve the injustices.
Neutrality on the concept was not perceived by the authors.
The terms rights, duty, values and justice are in themselves
associated with emotion. Although the popular literature was
not included in this analysis, the current debate on health
system reform in the United States can be informative with
regard to the range and depth of emotions related to social
justice.
Practical results
Practical results should arise from the analysis of a concept
(Wilson 1963). The results of this social justice concept
analysis include informing the nursing profession about the
definition of social justice; identifying its antecedents,
consequences and attributes; determining the appropriateness
and role of nursing in social justice issues.
Results in language
Although a concept could have several meanings, it is
important to choose one that ‘works most efficiently’ without
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Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 953
being too restrictive (Wilson 1963, p. 63). The synthesized
definition of social justice developed by the authors is: full
participation in society and the balancing of benefits and
burdens by all citizens, resulting in equitable living and a just
ordering of society.
Attributes
Attribute development is challenging because organizations
and entities view social justice differently. Also, social justice,
being both a process and a product (discussed later),
contributes to difficulty in separating the attributes, anteced-
ents and outcomes. The attributes are: (1) fairness; (2) equity
in the distribution of power, resources and processes that
affect the sufficiency of the social determinants of health; (3)
just institutions, systems, structures, policies and processes;
(4) equity in human development, rights and sustainability;
and (5) sufficiency of well-being.
Antecedents
The antecedents of social justice are society, respect, political
will and popular support, justness and equity. Society is
inclusive of people and groups of people; legal, social,
economic, political institutions and systems; and govern-
ments and markets. Respect includes respect for others, for
members of groups and for self. Political will and popular
support are necessary to assure equitable processes. Justness
is inclusive of procedures, contributions, distributions, just
institutions and just social and political structures. Equity
from the start (CSDH 2008), that is, from prenatal develop-
ment, is essential in all dimensions of life, for example,
opportunities and access, full participation in decision-mak-
ing, social determinants of health, representation, rights and
justness.
Consequences
The consequences of social just are peace, liberty, equity, the
just ordering of society, sufficiency of social determinants of
health and health, safety and security for all of society’s
members.
Discussion
Study limitations
This study was limited to only English language articles and
by the availability of full text articles, which may have
resulted in the omission of some relevant articles.
Answering the questions of concepts (Step 4)
Four conceptual questions were posed. The first – What is
social justice? – was answered by the development of a
synthesized definition and was expanded on in the attributes
section.
The answer to the second question – Is social justice
appropriate for the nursing profession as a whole? – is an
emphatic yes; it is appropriate, and it is nursing’s duty and
obligation to address social justice.
Social justice has been central to the nursing profession
since Florence Nightingale (Boykin & Dunphy 2002,
Watson 2008). Lillian Wald demonstrated social justice
numerous times throughout her life (Sklar 2003, Anderson
2007). A review of the US guiding documents for the
nursing profession included language about social justice
(ANA 2001, 2003, 2004, 2007). Furthermore, several
nursing articles have been published on how the nursing
profession has addressed social justice (e.g. Reimer Kirkham
& Anderson 2002, Boutain 2008, Cohen & Gregory
2009).
The third question – What are the defining attributes,
antecedents and consequences of social justice? – was
addressed previously. The answer to the fourth question –
Has nursing reinvested in social justice? – is nebulous.
Concern exists that although language regarding social
justice is incorporated into ANA’s publications, it was
primarily a historical context, focused on individual
client care and not populations, and was without recom-
mendations for currently addressing social justice (Fahren-
wald et al. 2007). An in-depth review of the ANA’s
documents showed a lack of clarity and lack of a guiding
social justice framework (Bekemeier & Butterfield 2005).
The CNA’s Code of Ethics was found to more appropri-
ately include social justice (‘Social Justice: A Means to an
End’ 2006).
A review of the nursing literature revealed social justice
applications among numerous issues and populations, for
example, among people with dementia (Barnes & Brannelly
2008); people experiencing violence in the workplace
(McMurray 2006); workers’ rights (Harré 2005); the
homeless population (Ervin & Bell 2004); and tobacco
use (Buettner-Schmidt 2005, 2006). Although public
health nurses are expected to be involved in social justice
issues, several authors call for all nurses to be responsible
for social justice (e.g. Boutain 2005, Anderson 2007,
Manthey 2008, Watson 2008). Therefore, the answer to
whether or not there is a reinvestment in social justice by
nursing may be yes formally; however, more needs to be
accomplished.
K. Buettner-Schmidt and M.L. Lobo
� 2011 The Authors
954 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd
Conclusions
Reanalyzing social justice for current relevance in nursing
(Step 5)
Nursing and other disciplines lack a common definition of
social justice; this concept analysis resulted in the develop-
ment of a synthesized definition for the discipline of
nursing. The reanalysis of social justice illuminates the need
to study social justice as having two dimensions: a process
and a product. A CNA article (‘Social Justice: A Means to
an End’ 2006) discussed social justice as both the means to
an end and the end in itself. Both dimensions are often used
without clarifying whether or not the discussion involves
social justices’ processes or products. One research impli-
cation is to analyse each dimension as two parts of the
whole with separate, yet related, attributes, antecedents and
consequences. This would give clarity of understanding to
increase the effectiveness of social justice actions and
advocates.
Potential usages of social justice in nursing (Step 6)
The final concept analysis step is to identify potential uses
(implications) of the concept in nursing. Of the nursing
profession’s guiding documents analysed, there was inade-
quate conceptualization of and an inadequate framework for
the application of social justice in nursing (Bekemeier &
Butterfield 2005, Fahrenwald et al. 2007). A recommenda-
tion for further work is to analyse the recently released 2010
ANA guiding documents. Because nurses can have an
important influence on the determinants of health for all
people, the development of a social justice framework by
which all nurses can affect social justice is essential. Thus, a
second research implication is to develop and test frame-
works specific to social justice in nursing. Ethical frame-
works provide a start; however, specifically elucidating a
social justice framework could further guide the reinvest-
ment in social justice by nursing. Schim et al. (2007)
placement of social justice within nursing’s metaparadigm
presents an interesting framework worthy of further explo-
ration.
As social justice is beginning to be integrated into under-
graduate nursing curricula, implications for practice and
research include development of social justice educational
competencies, incorporation of social justice into clinical
application and curricular analysis of social justice at the
programme level. Nurses’ strong history as social justice
advocates was diminished with the rise of the medical model
and with the majority of nurses providing inpatient care. By
developing a framework and educational competencies to
reinvest in social justice for nursing, along with the expand-
ing knowledge and acceptance of the social and behavioural
determinants of health, nursing may once again become a
strong influential force for social justice globally, thereby,
advocating for just and fair societies, reflected as peace,
health and well-being for all.
What is already known about this topic
• Florence Nightingale and Lillian Wald actively
addressed social injustices.
• The term social justice is used in documents guiding
practice for nurses.
• Some nurses, specifically public health nurses, recognize
their role in working towards social justice; however,
there is no clear understanding of what social justice is.
What this paper adds
• Social justice is defined as full participation in society
and the balancing of benefits and burdens by all citizens,
resulting in equitable living and a just ordering of
society.
• Attributes of social justice include: (1) fairness; (2)
equity in the distribution of power, resources, and
processes that affect the sufficiency of the social
determinants of health; (3) just institutions, systems,
structures, policies, and processes; (4) equity in human
development, rights, and sustainability; and (5)
sufficiency of well-being.
• Consequences of social justice are peace, liberty, equity,
the just ordering of society, sufficiency of social
determinants of health, and health, safety and security
for all of society’s members.
Implications for practice and/or policy
• This concept analysis provides a synthesized definition
of social justice for nursing assisting nursing to
proactively use social justice throughout nursing
research, education, practice and policy.
• Future development of a social justice framework and
educational competencies by which all nurses can
influence social justice globally is essential.
• Nurses need to gain a clearer understanding of social
justice, thereby allowing nursing to begin to reclaim its
role in addressing global social injustices, with the
ultimate goal of a just and fair society, reflected as
peace, health and well-being for all.
JAN: CONCEPT ANALYSIS Social justice
� 2011 The Authors
Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 955
Funding
Kelly Buettner-Schmidt received support for this research by
a grant from the Robert Wood Johnson Foundation Nursing
and Health Policy Collaborative at the University of New
Mexico (grant 60128).
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
KBS and MLL were responsible for the study conception and
design, performed the data analysis and made critical
revisions to the article for important intellectual content.
KBS performed the data collection and was responsible for
the drafting of the manuscript. MLL obtained funding.
Supporting Information Online
Additional Supporting Information may be found in the
online version of this article:
File S1. Annotated bibliography of a review of literature
identifying nursing’s definitions and descriptions of social
justice.
File S2. A listing of public health references reviewed for
the article.
Table S1. A matrix of social-justice-related terms cited six
or more times within the medical articles reviewed.
Table S2. A matrix of social-justice-related terms cited five
or fewer times within the medical articles reviewed.
Please note: Wiley-Blackwell are not responsible for the
content or functionality of any supporting materials
supported by the authors. Any queries (other than missing
material) should be directed to the corresponding author for
the article.
References
Alwin D.F. (2001) Social Justice. Encyclopedia of Sociology. Retrieved
from http://libros.unm.edu/search/tencyclopedia+of+sociology/ten
cyclopedia+of+sociology/1,1,5,E/l856&FF=tencyclopedia+of+soci
ology&5,,5,1,0 on 1 October 2010.
American Association of Colleges of Nursing (AACN) (2008) The
Essentials of Baccalaureate Education for Professional Nursing
Practice. Author, Washington, DC.
American Bar Association (ABA) (n.d.) About Us. Retrieved from
http://new.abanet.org/centers/diversity/Pages/Information.aspx on
1 October 2010.
American Nurses Association (ANA) (2001) Code of Ethics for
Nurses with Interpretive Statements. Author, Washington, DC.
American Nurses Association (ANA) (2003) Social Policy Statement,
2nd edn. Author, Washington, DC.
American Nurses Association (ANA) (2004) Nursing Scope &
Standards of Practice. Author, Washington, DC.
American Nurses Association (ANA) (2007) Public Health Nursing:
Scope and Standards of Practice. Silver Spring, MD.
Anderson D.G. (2007, Winter) Chair’s Message. Public Health
Nursing Section Newsletter. Retrieved from http://www.apha.org/
membergroups/newsletters/sectionnewsletters/public_nur/winter07/
default.htm#{B0C71FD6-72E3-46A2-AD9C-C46F66481C52} on
1 October 2010.
Azetsop J. & Rennie S. (2010) Principlism, medical individualism,
and health promotion in resource-poor countries: can autonomy-
based bioethics promote social justice and population health?
Philosophy, Ethics, and Humanities in Medicine: PEHM 5, 1.
Baisch M.J. (2009) Community health: an evolutionary concept
analysis. Journal of Advanced Nursing 65(11), 2464–2476.
Barnes M. & Brannelly T. (2008) Achieving care and social justice
for people with dementia. Nursing Ethics 15(3), 384–395.
Beaty B. (2008) A summit of sages exploring social justice and
nursing: an interview with Marie Manthey and Joanne Disch.
Creative Nursing 14(2), 82–89.
Beauchamp D.E. (1976) Public health as social justice. Inquiry XIII,
3–13.
Bekemeier B. & Butterfield P. (2005) Unreconciled inconsistencies: a
critical review of the concept of social justice in 3 national nursing
documents. Advances in Nursing Science 28(2), 152–162.
van den Bergh B.J., Gatherer A. & Møller L.F. (2009) Women’s health
in prison: urgent need for improvement in gender equity and social
justice. Bulletin of the World Health Organization 87(6), 406.
Boutain D.M. (2005) Social justice as a framework for professional
nursing. Journal of Nursing Education 44(9), 404–408.
Boutain D.M. (2008) Social justice as a framework for undergraduate
community health clinical experiences in the United States. Inter-
national Journal of Nursing Education Scholarship 5(1), 1–12.
Boykin A. & Dunphy L. (2002) Justice-making: nursing’s call. Policy,
Politics, & Nursing Practice 3(1), 14–19. doi: 10.1177/
152715440200300103
Braveman P. & Gruskin S. (2003) Defining equity in health. Journal
of Epidemiology and Community Health 57(4), 254–258.
Brinkman R.L. & Brinkman J.E. (2005) Cultural lag: a relevant
framework for social justice. International Journal of Social
Economics 32(3), 228–248.
Browne A.J. & Tarlier D.S. (2008) Examining the potential of nurse
practitioners from a critical social justice perspective. Nursing
Inquiry 15(2), 83–93.
Buettner-Schmidt K. (2005) Legislation and health policy. Youth and
tobacco use: nurses take a stand. Journal of Pediatric Healthcare
19(6), 396–399.
Buettner-Schmidt K. (2006) Social justice and secondhand smoke.
The Prairie Rose 75(4), 6.
Calvez J.Y. & Massaro T. (2003) Social Justice. New Catholic
Encyclopedia, 2nd edn. Gale, Detroit, MI.
Campaign for Tobacco Free Kids (2009) A Broken Promise to Our
Children: The 1998 State Tobacco Settlement 11 Years Later.
Retrieved from http://www.tobaccofreekids.org/reports/settlements/
FY2010/State%20Settlement%20Full%20Report%20FY%202010.pdf
on 1 October 2010.
K. Buettner-Schmidt and M.L. Lobo
� 2011 The Authors
956 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd
Canadian Nurses Association (CNA) (2008) Code of Ethics for
Registered Nurses. Author, Ottawa, ON.
Center for Economic and Social Justice (n.d.) Defining Economic
Justice and Social Justice. Retrieved from http://www.cesj.org/
thirdway/economicjustice-defined.htm on 1 October 2010.
Cohen B.E. & Gregory D. (2009) Community health clinical edu-
cation in Canada: part 2 – developing competencies to address
social justice, equity, and the social determinants of health. Inter-
national Journal of Nursing Education Scholarship 6(1), 1–15.
Commission on Social Determinants of Health (CSDH) (2008)
Closing the Gap in a Generation: Health Equity Through Action
on the Social Determinants of Health. Final report of the
Commission on Social Determinants of Health. World Health
Organization, Geneva, Switzerland.
Davison C.M., Edwards N., Webber J. & Robinson S. (2006)
Development of a social justice gauge and its use to review the
Canadian Nurses Association’s Code of Ethics for registered
nurses. Advances in Nursing Science 29(4), E13–E26.
Drevdahl D. (2002) Social justice or market justice? The paradoxes
of public health partnerships with managed care. Public Health
Nursing 19(3), 161–169.
Drevdahl D., Kneipp S.M., Canales M.K. & Dorcy K.S. (2001)
Reinvesting in social justice: a capital idea for public health nurs-
ing? Advances in Nursing Science 24(2), 19–31.
Dysart-Gale D. (2010) Social justice and social determinants of
health: lesbian, gay, bisexual, transgendered, intersexed, and queer
youth in Canada. Journal of Child and Adolescent Psychiatric
Nursing 23(1), 23–28.
Ervin N.E. & Bell S.E. (2004) Social justice issues related to uneven
distribution of resources. Journal of the New York State Nurses
Association 35(1), 8–13.
Fahrenwald N.L., Taylor J.Y., Kneipp S.M. & Canales M.K. (2007)
Academic freedom and academic duty to teach social justice: a
perspective and pedagogy for public health nursing faculty. Public
Health Nursing 24(2), 190–197.
Fawcett J. & Russell G. (2001) A conceptual model of nursing and
health policy. Policy, Politics, & Nursing Practice 2(2), 108–116.
Fitzpatrick J.J. (2003) Social justice, human rights, and nursing
education. Nursing Education Perspectives 24(2), 65.
Foley E. (2009) Advocating for social justice. Australian Nursing
Journal 17(3), 21.
Harré L. (2005) Campaigning for workers’ rights and social justice.
Kai Tiaki Nursing New Zealand 11(9), 2.
Hatfield E. & Rapson R.L. (2005) Social justice and the clash of
cultures. Psychological Inquiry 16(4), 172–175.
Healton C. & Nelson K. (2004) Reversal of misfortune: viewing
tobacco as a social justice issue. American Journal of Public Health
94(2), 186–191.
Hupcey J.E., Morse J.M., Lenz E.R. & Tason M.C. (1996) Wilsonian
methods of concept analysis: a critique. Scholarly Inquiry for
Nursing Practice: An International Journal 10(3), 185–210.
Jackson D. (2003) Culture, health and social justice. Contemporary
Nurse 15, 347–348.
Kennedy D. (2005) The social justice element in legal education in the
United States. Harvard Unbound 1(1), 93–104.
KriegerN.&BirnA.(1998)Avisionofsocial justiceasthefoundationof
public health: commemorating 150 years of the Spirit of 1848.
American Journal of Public Health 88(11), 1603–1606.
Lee R.E. & Cubbin C. (2009) Striding toward social justice: the
ecologic milieu of physical activity. Exercise & Sport Sciences
Reviews 37(1), 10–17.
Leuning C.J. (2001) Advancing a global perspective: the world as
classroom. Nursing Science Quarterly 14(4), 298–303.
Levy B.S. & Sidel V.W. (2006) Social Injustices and Public Health.
Oxford Press, New York, NY.
Liaschenko J. (1999) Can justice coexist with the supremacy of
personal values in nursing practice? Western Journal of Nursing
Research 21(1), 35–50. doi: 10.1177/01939459922043695.
Manship G.E. (2005) Irreconcilable differences? Bringing together
secular and reformed Christian social justice discourse in an
argument for universal access in health care. Christian Scholar’s
Review 35(1), 29–47.
Manthey M. (2008) Social justice and nursing: the key is respect.
Creative Nursing 14(2), 62–65.
Marshall G. (1998) A Dictionary of Sociology. Oxford Press, New
York, NY.
McGee P. (2007) Sustained by a commitment to social justice. Nurse
Researcher 15(1), 84–87.
McMurray A. (2006) Peace, love and equality: nurses, interpersonal
violence and social justice. In Advances in Contemporary Nursing
& Interpersonal Violence (McMurray A. & Jackson D., eds),
eContent Management Pty Ltd., Sydney, Australia, pp. vii–x.
Minnesota Department of Health (2001) Public Health Interven-
tions: Applications for Public Health Nursing Practice. Author, St.
Paul, MN.
Morgan M. & Vera E. (2006) Encyclopedia of Multicultural
Psychology. Sage Reference, Thousand Oaks, CA.
National Association of County and City Health Officials (2010)
Health Equity and Social Justice Strategic Direction Team.
Retrieved from http://www.naccho.org/topics/justice/mission.cfm
on 1 October 2010.
National Association of Social Workers (2008) Code of Ethics of
the National Association of Social Workers. Retrieved from http://
www.socialworkers.org/pubs/Code/code.asp on 1 October 2010.
Nitsch T.O. (2005) Economics, social justice and the common good:
Roman-Catholic perspectives. International Journal of Social
Economics 32(6), 554–569.
Novak M. (2000, December) Defining social justice. First Things: A
Monthly Journal of Religion & Public Life 108, 11–13. Retrieved
from http:www.firstthings.com/issue/2000/12/december on 3
October 2011.
Pacquia D.F. (2008) Nursing care of vulnerable populations using a
framework of cultural competence, social justice and human rights.
Contemporary Nurse 28(1–2), 189–197.
Pangman V.C. & Seguire M. (2000) Sexuality and the chronically ill
older adult: a social justice issue. Sexuality and Disability 18(1),
49–59.
Peréz L.M. & Martinez J. (2008) Community health workers: social
justice and policy advocates for community health and well-being.
American Journal of Public Health 98(1), 11–14.
Pope Paul VI (1967) Populorum Progressio: Encyclical of Pope Paul VI
on the Development of Peoples. Retrieved from http://www.
vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_
26031967_populorum_en.html on 1 October 2010.
Powers M. & Faden R. (2006) Social Justice: The Moral Foundation
of Public Health and Health Policy. Oxford Press, New York, NY.
JAN: CONCEPT ANALYSIS Social justice
� 2011 The Authors
Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 957
Rand S. (2006) Teaching law students to practice social justice: an
interdisciplinary search for help though social work’s empower-
ment approach. Clinical Law Review 13(1), 459–504.
Rawls J. (1971) A Theory of Justice. Harvard University Press,
Cambridge, MA.
Rawls J. (1999) A Theory of Justice, rev. edn. Harvard University
Press, Cambridge, MA.
Rawls J. (2001) Justice as Fairness: A Restatement. Harvard
University Press, Cambridge, MA.
Redman R.W. & Clark L. (2002) Service-learning as a model for
integrating social justice in the nursing curriculum. Journal of
Nursing Education 41(10), 446–449.
Reimer Kirkham S.R. & Anderson J.M. (2002) Postcolonial nursing
scholarship: from epistemology to method. Advances in Nursing
Science 25(1), 1–17.
Reimer Kirkham S., Van Hofwegan L. & Hoe Harwood C. (2005)
Narratives of social justice: learning in innovative clinical settings.
International Journal of Nursing Education Scholarship 2(1), 1–14.
Rodgers B.L. & Knafl K.A. (2000) Concept Development in Nursing,
2nd edn. Saunders, Philadelphia, PA.
Ross R. & Rosati C. (2006) Social Justice. The Encyclopedia of
Human Geography. Sage Reference, Thousand Oaks, CA.
Russell J. & Fawcett G.E. (2005) The conceptual model for nursing
and health policy revisited. Policy, Politics, & Nursing Practice
6(4), 319–326.
Schim S.M., Benkert R., Bell S.E., Walker D.S. & Danford C.A.
(2007) Social justice: added metaparadigm concept for urban
health nursing. Public Health Nursing 24(1), 73–80.
Sklar K.K. (2003) Some of us who deal with the social fabric: Jane
Addams blends peace and justice, 1907-1919. Journal of the
Gilded Age and Progressive Era 2, 80–96. Retrieved from http://
www.jstor.org/stable/25144318 on 24 September 2010.
Social Justice (1998) In Online Medical Dictionary. Retrieved from
http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=social+justice on 10
November 2008.
Social Justice (2000) The Dictionary of Human Geography. Black-
well Publishers, Oxford, UK.
Social Justice (2006) Social justice: A means to an end, an end in itself
Canadian Nurse 102(6), 18–20.
Stanley F. (2002) From Susser’s causal paradigms to social justice in
Australia? International Journal of Epidemiology 31(1), 40–45.
Van Rosendaal G.M.A. (2006) Queue jumping: social justice and the
doctor-patient relationship. Canadian Family Physician 52(12),
1525–1526.
Vickers D.A. (2008) Social justice: a concept for undergraduate
nursing curricula? Southern Online Journal of Nursing Research
8(1), Article 6. Retrieved from http://snrs.org/publications/
SOJNR_articles2/Vol08Num01Art06.pdf on 1 October 2010.
Watson J. (2008) Social justice and human caring: a model of caring
science as a hopeful paradigm for moral justice for humanity.
Creative Nursing 14(2), 54–61.
Weisz V.K. (2009) Social justice considerations for lesbian and
bisexual women’s health care. Journal of Obstetric, Gynecological
& Neonatal Nursing 38(1), 81–87.
Wenar L. (2008) John Rawls. Stanford Encyclopedia of Philosophy.
Retrieved from http://plato.stanford.edu/entries/rawls/ on 1 Octo-
ber 2010.
Wilson J. (1963) Thinking with Concepts. Cambridge University
Press, Cambridge, UK.
World Bank (2005) World Development Report 2006: Equity and
Development. World Bank and Oxford University Press, Wash-
ington, DC.
Young I.M. (1990) Justice and the Politics of Difference. Princeton
University Press, Princeton, NJ.
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