Advocacy in nursing is the tendency by an individual nurse or a group of nurses to influence decisions within economic, political or social systems as well as institutions (Paquin, 2011). The core objective of advocacy is to initiate changes in the nursing world to make their day to day operations fluid and effective. Policy refers to the basic principles and guidelines that are set and enforced by relevant governing bodies within the field of nursing. They guide how operations are run on a day to day basis to achieve a particular goal (Mahlin, 2010).

The principles are meant to guide nursing decisions so as to obtain logical outcomes. Social Justice refers to equality in the distribution and access of social, economic, political and environmental factors which affect the health of individuals in society. It can further be described as the just relationship between people and society regarding social, political and economic factors (Paquin, 2011). It applies to people sharing similar problems such as financial stability.

Upstream advocacy in nursing refers to the approach in which nurses focus on the root cause of a particular nursing problem. It is unlike the common approach in which the nurses pay attention to the patients. In upstream advocacy approach, the nurses and other healthcare providers aim at identifying how individuals are exposed to diseases-inducing conditions, lifestyle as well as the environment (Paquin, 2011). Taking the example of a 56year old male migrant farm worker whose TB skin test came back positive, upstream advocacy will seek to establish the societal factors which have made the TB test in the patient to come back positive instead of subsiding.

The normal way would be, the nurses and caregivers treat the patient, and he goes home again. The nurses will assume that the patient will effectively take his medication and take all the necessary precautions advised to him. When he comes back again, they will treat the patient as being ignorant. However, in upstream advocacy, the respective nurse or nurses will seek to establish the kind of society and surrounding the patient is living in (Magnussen, Itano & McGuckin, 2005). For instance, it can be possible that the patient is willing to take his medication and follow all the necessary precautions such as living in a well-aerated environment but the economic, social and environmental factors are against his will. The patient might be having a low income, forcing him to live in congested places where he can afford the houses.

The example above can be used to illustrate the benefits of upstream advocacy in nursing practice. Unlike the normal tendency on nurse-patient interaction which seeks to deal with the patient, this system deals with the societal factors such as economic, social, environmental as well as political factors which make the patients suffer from a particular condition. When the conditions are identified and necessary measures were taken, it helps in improving the health condition not only of the patient but also the entire society. This is unlike the downstream focus in which nurses only improve the health of only a few who they come into direct contact.

Nursing is described as a provision which at providing holistic healthcare services to each and every individual in the society. When relating nursing to social justice, its socially be understood that, social justice applies to a population of people with the same or similar problems (Hanks, 2010). Thus, it should follow that, nursing assessment, as well as nursing intervention, should consider all the people in a society who are subjected to the same problems rather than only considering individual patients and their respective immediate needs. Relating to upstream advocacy mentioned above, social justice in nursing has largely transformed the traditional notion in which nursing care was only based on the individual nurse-patient relationship by ensuring that nurses extend their services to care for the entire community in a given society (Paquin, 2011). The goal of social justice in nursing is to ensure health improvement of individuals by generally improving the health of the society.

Taking the example of a 56-year old male migrant farm worker whose TB skin test came back positive, social justice seeks to address the problem to all individuals in the society who are at the risk of suffering from the same problem (Mahlin, 2010). When the nurses identify and address the social, economic and environmental factors in the society that caused the TB skin test to come back positive, they are practicing nursing social justice to the individuals in that society. Generally, social justice advocacy model encourages all the nurses to assume the role of activists and work towards bringing into line “what should be” and “what is” by actively participating in political as well as social issues that impact the health of the community and society.