The classification of interviews showed that three sub-themes of “insufficient educational content”, “limited competency of nursing educators”, and “inappropriate education approaches” led to the emergence of the main theme called “social justice; a neglected component of academic education” (Table 2).
Social Justice; a Neglected Component of Academic Education
Proper education plays a major role in training justice-seeking nurses. Social justice and its importance in healthcare are constituents of the nursing syllabus. More attention given to this issue in practical and objective areas of education by educators can influence students’ thoughts, attitudes, and behavior to pursue justice in health systems. However, Iran’s education system has unfortunately failed to promote justice because of insufficient educational content, limited competency of nursing educators, and inappropriate education approaches.
- Insufficient Educational Content
The development of a comprehensive nursing curriculum, especially on ethical issues such as social justice, contributes substantially to the preparation of socially and morally conscious nurses who are able to make significant changes in the public health at local, national, and international levels. In this study, the participants highlighted some weaknesses in the existing nursing curriculum content such as inattention to social justice, discontinuity in presenting courses on ethical values, and allocating most nursing courses to medical issues and clinical care.
1.1 Inattention to Social Justice in Nursing Curriculum
Social justice is a core nursing value which plays a significant role in promoting justice by nursing students and nurses; however, according to the participants, it has unfortunately been neglected in existing nursing curriculum. In this regard, one participant stated,
“In the fourth semester, we studied a course on nursing ethics. I think there was no discussion on social justice because I don’t remember anything about this topic” (Participant No. 7).
Regarding the importance of teaching social determinants of health, another participant stated,
“I was not aware of the importance of social issues in health until I participated in a workshop called ‘social justice in health’. It really changed my beliefs and broadened my perspective” (Participant No. 10).
1.2 Discontinuity in Presenting Courses on Ethical Values
Values are major components of the nursing profession. The institutionalization and development of professional values such as social justice contribute significantly to the future of this profession. The few number of courses presented on ethical values and discontinuity in presented courses (for instance, no course on ethical values is provided for postgraduate students) were major items mentioned by the participants. In this regard, one of the participants stated,
“When students are repeatedly reminded about the importance of a value, they will realize its importance, and the value will be institutionalized among them. We partially studied professional values and social justice issues in the fourth semester of our undergraduate courses; however, no similar course was provided for us afterwards during master programs” (Participant No. 5).
1.3 Allocating Most Nursing Courses to Medical Issues and Clinical Care
Diseases and clinical care are among the most fundamental parts of theoretical and practical training provided for nursing students; however, due to the multidimensional nature of the nursing profession, special attention should be given to other dimensions as well. According to the research results, the existing nursing curriculum focuses mainly on transferring knowledge and skills associated with physical and routine care. One participant stated,
“Most of our courses were related to various diseases and nursing care, and educators rarely talked about ethical and legal issues during their lectures” (Participant No.6).
- Limited Competency of Nursing Educators
Educators play an undeniable role in training competent nurses through institutionalizing beliefs and behaviors. Using proper teaching and behavioral approaches, educators can improve students’ critical thinking skills and prepare them to promote justice in health systems. According to the participants, insufficient capacities of nursing educators in teaching social justice issues and inappropriate value perspectives of educators in developing social justice were the main properties of this category.
2.1 Insufficient Capabilities of Educators in Teaching Social Justice issues
Educators must be equipped with sufficient scientific, practical, and ethical capacities in order to effectively institutionalize the concept of social justice in students. According to the participants, nursing educators’ insufficient knowledge and experience of social justice issues make it difficult for them to transfer such knowledge to their students. One participant said,
“When I was a student, I once informed my educator about unjust patient admission procedure in the surgical department, yet my educator recommended me to do what the head nurses would say. I did not see the necessary authority in my educator to establish justice” (Participant No. 11).
2.2 Inappropriate Value Perspectives of Educators in Developing Social Justice
The participants highlighted the important role of nursing educators ethical perspectives in promoting the quality of education and training qualified nurses who would provide services tailored to the needs of society. They also argued that ethical values could help educators establish and expand social justice in health systems. According to the results, most of the educators had undesirable value perspectives on establishing social justice in the area of health. In this respect, participant number 5 stated,
“When a nurse has no right to make any decisions in a healthcare system, what can I say to the student about social justice?” (Participant No. 5).
- Inappropriate Education Approaches
Education approaches are considered an essential part of the educational structure playing a key role in transferring ethical values such as social justice to students. Given the abstract nature of social justice, choosing the best education approach helps educators resolve complicated problems during teaching in order to institutionalize professional values and beliefs. According to the findings, educators adopt poor education approaches to transfer ethical values such as social justice and self-awareness to students. In this regard, focusing on traditional education approaches and using insufficient affective learning approaches were cited by the participants.
3.1 Focusing on Traditional Education Approaches
Undoubtedly, lecturing is one of the most widely used education approaches; however, this traditional method is very ineffective in teaching abstract concepts such as social justice. According to the participants, educators mostly use lecturing approach to teach social justice issues, and students are rarely involved in the teaching process. One participant argued that educators mainly used teacher-centered approaches in ethical discussions, stating,
“We (the students) had no active role in the professional ethics class. The educator spoke on relevant topics based on availed syllabus and gave some examples of clinical ethical issues. However, I think that educators must discuss social justice issues with students to help them visualize and understand cases of injustice and discuss appropriate reactions in such situations” (Participant No. 13).
3.2 Using Insufficient Affective Learning Approaches
The use of affective learning strategies such as reflective activities and simulations leading to emotional responses play an important role in creating self-reflection and transferring professional knowledge and skills to nursing students. However, based on the participants’ experiences, affective learning approaches are not used effectively and systematically in teaching ethical issues such as social justice. In this regard, one participants stated,
“Since there are too many topics on professional ethics, we (educators) can only convey basic issues to students, and it is difficult for us to adopt other learning strategies such as affective approach” (Participant No. 4).