Unit 3 - Emancipatory Knowing

What is emancipatory knowing?

Involves reflecting on social, cultural, and political injustices​

• Human ability to recognize issues of injustice or inequity​

• Recognize that things could be different​

• Work to change a situation that improves lives​

• Emphasizes ACTION that comes from awareness of social injustices

Ageism

Discrimination, prejudice, or stereotyping of people/patients based on their age

• can be overt or implicit and can manifest in many ways

Vulnerability

Gap between a patient's needs and the resources available to meet them.

• It can also be defined as the likelihood that a patient's interests will not be considered fairly

• Can be influenced by several factors, including:​

  • Inherent factors: Age, sex, race, and other intrinsic characteristics ​

  • Acquired factors: Health behaviors, environment, and sociocultural behaviors ​

  • Medical factors: State of health, comorbidities, and other medical conditions ​

  • Social factors: Socio-demographics, legal status, and insurance ​

Disparity​

A preventable difference in health outcomes between groups of people. ​

Equity​

Everyone has a fair and just opportunity to achieve their best health, regardless of any factors that might affect their access to care or health outcomes

• “unequal” care may be necessary to meet needs of certain populations

Equality​

Treating all patients the same way, regardless of their needs or circumstances​

• Equality doesn’t take into consideration individual needs​

Examples of Emancipatory Knowing in Nursing

• Advocating for policy changes​

• Challenging discriminatory practices​

• Community engagement​

• Research and advocacy​

• Promoting health equity​

• Raising awareness about health disparities​

• Engaging in activism​

• Collaborating with other professionals​

• Documenting and challenging unjust practices​

Why does the U.S have some of the poorest health outcomes?

• The U.S. is one of the few wealthy industrialized nations without a universal healthcare system where all citizens are covered. ​

• Healthcare costs are among the highest globally leading to financial hardship for many.​

• Although there is a mix of public and private insurance, a significant portion of the population remains uninsured or underinsured. ​

Private Insurance

There’s a fee for service

• deductible before insurance pays

Medicare

Universal healthcare for those over 65​

• Part A - for hospital / surgery

• Part B – going to doctors office​ / outpatient care

• Part C – Medicare Advantage Plan - for profit, basically take your national funds and dictate what you get, but give you "benefits"​

• Part D - insurance for meds​

Medicaid

Federally funded but state-operated medical assistance program

• For low income or disabled people who can’t work

• Helps with maternal and child care​

• In WI, its called badger care​

Demographics Affecting Health-Care Delivery

• Rapidly aging population​

  • “Silver tsunami”​

  • More hospitalizations and admissions to nursing homes​

  • Tend to have more chronic issues​

  • Older adults have more political power​

• More people in need​

  • Urban poor and rural underserved​

• Chronic disease and illnesses​

What is quality care?

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

6 aims to evaluate and improve healthcare services: ​

• Effectiveness: Providing evidence-based healthcare services to those who need them ​

• Efficiency: A domain of healthcare quality ​

• Equity: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status ​

• Patient-centeredness: Providing care that is respectful of, and responsive to, individual patient preferences, needs, and values ​

• Safety: Avoiding harm to people for whom the care is intended ​

• Timeliness: A domain of healthcare quality ​

Key factors in High Quality Care​

• Client centered care​

• Evidence based practice/research​

• Informatics​

• Teamwork and collaboration​

• Just Culture – environment of quality and safety​

• Lifelong learning​

Social Determinants of Health

The non-medical factors that influence health outcomes ​

• They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life

Health Disparities

A preventable difference in health outcomes between groups of people​

• Includes differences in access to medical care, rates of disease, and opportunities to achieve optimal health​

• Often linked to social, economic, and environmental disadvantages​

• Can be caused by many factors, including: ​

  • Poverty ​

  • Environmental threats ​

  • Inadequate access to health care ​

  • Individual and behavioral factors ​

  • Educational inequalities​

• Gaps in healthcare quality follow socioeconomic patterns such as race, gender, or

poverty - zipcode matters

​

Health Equity

Idea that everyone should have a fair and just opportunity to achieve their best health, regardless of any factors that might affect their access to care or health outcomes and includes factors like

• Aims to ensure that everyone has access to affordable, culturally competent health care.

• It also acknowledges that different people may need different supports to achieve similar results.

• Health equity is different from health equality, which assumes that everyone will benefit from the same supports.

Policy vs. Politics vs. Political Action​

Policy​

• Actions taken by a government or organization to achieve a specific goal​

Politics​

• A process and reflects an attitude​

• Activities of individuals in groups or organizations working together to achieve agreed-upon goals​

Political action​

• Activities, methods, tactics, and behaviors that affect or potentially affect legislative and/or governmental processes and outcomes​

• Grassroots efforts – start at local level by volunteers in community​

• Lobbyists – change elected officials’ opinions or votes and support the give and take of political compromise within legislative bodies​

Drivers of Legislation​

• Funding​

• Public demand​

• Program issues​

• Constituent-specific issues​​

• Executive orders​

Aristocracy​

Power is held by a small, privileged ruling class, typically defined by hereditary titles, land ownership, and wealth

Authoritarian​

A system that concentrates power in a leader or small elite, suppressing political pluralism, civil liberties, and independent checks on authority

• It differs from democracy by lacking free elections and from totalitarianism by lacking a rigid ideology, focusing instead on control, stability, and obedience

Communism​

A single-party system based on Marxist-Leninist ideology, where the state controls the economy and means of production to create a classless society

Democracy ​

Political power is vested in the people, exercised either directly or through freely elected representatives.

• It emphasizes equality, civil liberties, and the rule of law, ensuring government accountability and protecting fundamental human rights

• Threats to democracy include apathy, factionalism, restrictions on the right to vote, cult of personality​

Dictatorship​

Power is concentrated in the hands of a single leader or a small elite group, characterized by authoritarianism, lack of democratic processes, and suppression of dissent.

• These regimes often maintain control through fear, military force, censorship, and manipulation of state structures

Monarchy​

Supreme authority is vested in a single individual—a monarch (king, queen, emperor)—who acts as head of state, often for life and hereditary

Oligarchy​

Power rests with a small, elite group of people, often defined by wealth, family, military strength, or corporate control.

• Unlike democracy, it serves the interests of the few, frequently operating behind the scenes to influence policy

Totalitarian​

An extreme, centralized form of authoritarianism where a single party or leader exerts absolute control over all public and private aspects of life, eliminating opposition and, in many cases, suppressing personal freedoms

• It uses technology, propaganda, and terror to ensure complete societal conformity

U.S Democracy

• Executive Branch​

  • President, VP, Cabinet​

  • Governor, Lieutenant Gov.​

  • Mayor​

  • Boards, commissions​

• Judicial Branch​

  • Federal, state, local court system​

  • Supreme, district/circuit & appeals, local​

• Legislative Branch​

  • Senate ​

  • House of Representatives

​

Lobbyist

Anyone who expresses opinion about an issue to a legislator​

• ANA is a lobbyist

3 concepts that constitute politics​

• Self-interest – kinds of issues they become involved in​

• Partisanship – membership in a political party​

• Ideology – beliefs and principles of an individual or group​

What provisions and standards from the Code of Ethics and Standards of Practice intersect with politics?

Code of Ethics ​

• Provision 9 – calls for nurses and professional organizations to promote social justice and eliminate health inequities​

• Provision 10 – calls for nursing to participate in global nursing to promote human and environmental health​

Scope and Standards of Practice ​

• Standard 8 – advocates for policies that increases access and improves care delivery​

• Standard 12 – the RN leads within the professional practice setting and the profession.​

Why should nurses be politically active?​

• Advocate for client or community needs ​

• Better patient care​

• Advocate for nursing needs​

• Better work conditions​

• Trusted voice​

• Critical thinking allows us to identify improvements or solutions​

• Need nurses in office​