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Covering the Context: Health Care Doesn’t Occur in a Vacuum

August 10, 2009

LagerweyThirdReichArticleIn deciding what editorial content we should cover at AJN, we try to identify “cutting-edge” clinical topics and issues that are pertinent for most nurses and will inform their practice. But in recent years, AJN has taken a broader view of nursing’s role in promoting health. It’s not just about what we do with our patients when we interact with them—it’s about the context of the other parts of their lives and how that context affects health. How does a patient with heart disease or diabetes follow a proper diet if neighborhood grocery stores don’t even carry fresh vegetables? Can one stay healthy when continually under duress from an oppressive spouse or family member? Lillian Wald, whose work in the early 1900s provided a model for later public and community health efforts, understood that social context matters to health and that advocating for social justice is part of a nurse’s role.

One of the features in the August issue of AJN is an article by Mary Deane Lagerwey. She maintains that during the holocaust and World War II, AJN was silent on the issues and didn’t address German nurses’ complicity:

“Possible motivations for downplaying or suppressing certain information include nascent Cold War fear of communism and the perceived need for political unity, as well as U.S. and Western European anti-Semitism. In AJN‘s case, the motivation may well have been a desire to promote unity among nurses, but the end result was a lack of accountability. I contend that AJN chose not to speak up for human rights and turned an uncritical eye toward German nurses’ contributions to suffering and to the fates of Jews, including Jewish nurses.”

Clearly, AJN was among those who fell short in addressing the atrocities that occurred. As suggested by a post here last week, AJN has carried editorials, opinion pieces, and news reports about the Gulf War, Desert Storm, and the Iraq War, and about nurses and torture. We’ve also documented issues around women’s rights, AIDS in Africa, hunger, and poverty. (In November 2007, as part of a group of 200 journals organized by the Council of Science Editors, we focused an entire issue on poverty.)

But we get pushback, in the form of letters—some readers feel that we should focus on nursing in the United States only. When we’ve covered health issues in other countries, some readers react negatively, reminding us that we’re the AMERICAN Journal of Nursing. (The fact is, nurses throughout the U.S. are already caring for immigrants, many of whom are from countries involved in wars. These new immigrants may have TB, malaria, obstetric fistulas—or PTSD from subjection to torture or war.)

Hasn’t nursing always been about treating the whole person? Shouldn’t we be concerned about the context in which our patients live their lives from day to day? It’s my feeling that these nurses who write such letters are in the minority—am I wrong?

Shawn Kennedy, AJN editorial director

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