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Index de Enfermería

versión On-line ISSN 1699-5988versión impresa ISSN 1132-1296

Index Enferm vol.27 no.4 Granada oct./dic. 2018  Epub 20-Ene-2020



Society cares. Human security and risk management from the nurse perspective

Lucía Cilleros-Pino1  , Maximino Díaz-Hernández1  , José Enrique Hernández-Rodríguez1 

1Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria. Islas Canarias, España.


The challenges that the society has to tackle related to security and risk management are a dare for Nursery and a new field of study called Society Cares. In relation with the security, United Nations Program for Development develops a theoretical framework which urges the countries to create Human Security policies. Security must be taken into account not only as a lack of physical violence, but also as a guarantee of rights, opportunities and quality for people's lives. On the other hand, all societies have to tackle a lot of different and difficult risks and all of them may be prejudicial for people's health and they can also create threats on a large scale and are able to hurt society health and to change healthy systems. Nursery must deal with these determining concepts and cover knowledge which goes beyond people's clinical cares and it must also develop Society Cares.

Key words: Society cares; Risk; Risk management; Nursing management; Human security


The concept of security has evolved epistemologically from the sixties until the moment in which the United Nations Development Programme (UNDP) created the concept of Human Security in its Human Development Report published in 1994 where it was explained and disseminated. In that moment, the definition of security changed from the State's protection to the individual's. In this way, Human Security acquired a new human dimension instead of the state-centred approach which was established until that moment. "This conception developed a profound transition in people's minds as a consequence of going from nuclear to human security, what determines the change of the state-centred approach to the protection of the individual who this security is created for. Consequently, security starts to be taken into account not only as a lack of physical violence, but also as a way of guaranteeing individuals' rights, opportunities and life quality which are adjacent conditions to welfare and all-round development of each human being".1

Human Security instigators agree that individuals must be more important than the State when talking about security. In this way, policies must guarantee individuals' legal, health and social security by providing them with the necessary conditions and resources to guarantee their development and welfare.

The different international authorities have declared that it is necessary that the States protect individuals in all political designs. Furthermore, the 2030 Agenda for Sustainable Development of the World Health Organization (WHO) has suggested all-round and ambitious aims, emphasizing security and equity, to guarantee that the most vulnerable people can have the same resources, welfare and dignity than the rest of the population. In this way, the Japan Center for International Exchange and the Pan American Health Organization have declared: "the Human Security Approach addresses the linkages among different sources of health threats and ensures that interventions are integrated so as to build and sustain health resilience at the individual, community, and institutional levels as a path toward health for all through universal health coverage".2 Thereby, Human Security is established as the main point from which institutional policies must start and which also allows to distinguish between patients and population's oriented health care.

The WHO considers that nursing staff is a mainstay of healthcare services to guarantee the above mentioned aims. The WHA 138/34 of 2015 report describes the progress made in the application towards implementation of three resolutions on health workforce development. The WHA 66.23 resolution, called <Transforming health workforce education in support of universal health coverage> of 2013 explains specifically the significant role played by nurses and midwives in health systems.3 In particular, the report by the Secretariat of the 69th World Health Assembly held in 2016 explains that "analysis of data from the WHO's Global Health Observatory highlights the significant role played by midwives and nurses in the provision of health care globally. Data for 2004 and 2009 (which provide the widest possible range of records from all Member States) suggest that the two professions account for an average of 68% of the total number of dentists, laboratory workers, midwives, nurses, pharmacists and physicians worldwide".4

On the other hand, there a lot of different and complex risks which all societies must tackle, for example, technological, environmental, climatic, terrorist, health, economic or industrial risks, among others. And all these risks are not only liable to damage individuals' health, but also to cause threats on a large scale which may harm population health and shake health systems. For example, the Ebola epidemic which took place in West Africa in the years 2014-2016, "the largest, most severe and most complex Ebola epidemic in the nearly four-decade history of the disease".5 Furthermore, the actions which were taken affected health care providers' security. This situation caused riots, pillaging and violent attacks on health staff. Large scale threats affect not only individuals and population's security, but also the stability of territories.

However threat sources are valued in a different way by the different groups of population. Risks are also perceived differently because this concept has a dual nature. On the one hand, risks may be measured empirically and objectively. On the other hand, they have a socio-cultural dimension and which reflects the values of social organizations. That is, it may be known the empirical risk of a threat, but it also affects the perception of this risk caused by believes, given information, social ideologies, etc. It must be also taken into account that "in a globalized and disordered environment as the one we live in, it seems that the information we receive about possible risks causes the formation of fear spirals easily".6 It seems necessary that different important parties introduce the possibility of risk exploitation as a conscious way of controlling the society or as a way of being carried away by all the situations which derive from system corruptions. An example of risk transnational management was the health crisis of the Swine Flu (H1N1), the pandemic which was caused by a variation of the Influenzavirus A (subtype H1N1) which appeared in 2009 and which caused public alarm and controversy with regard to its management. Conclusions related to this fact are explained in the report created by the Social Affairs and Health Committee of the Parliamentary Assembly of the Council of Europe where the following conclusions, among others, are explained: "the way in which the H1N1 influenza pandemic has been handled, not only by the World Health Organization (WHO), but also by the competent health authorities at the level of the European Union and at national level is alarming. Some of the consequences of decisions taken and advice given are particularly troubled, because they led to distortion of priorities of public health services across Europe; they wasted large sums of public money and also caused unjustified scares and fears about health risks faced by the European public at large".7

The new challenges of nursing in the face of global threats

Nursery as a science represents a crucial part of health systems. Nurses' political involvement at national and international levels, as well as holding authority charges must be an objective for this group. In this way, WHO supports its Member States "to engage actively nurses and midwives in the planning, development, implementation and evaluation of health and health system policy and programming".8 Nursing must cover knowledge which goes beyond individuals' clinical care and it must develop Society cares. So, how can these objectives be achieved?

State-approved and Continuing Education are essential to reach necessary excellence levels and research abilities to tackle new challenges. Threats derived from globalization and from the creation of new geopolitical spaceswhich represent global risks are fields which need education and research encouragement. It seems necessary that nursery knows and deals with threats and risk management in order to guarantee individuals, health systems and societies' health, with the purpose of working to prevent, give attention in alarm situations and institutional and social resilience. It is completely necessary to plan, manage and social empower the new challenges which plan about different health systems and put forward human security development and risk management as part of Society Cares.

In relation with the proposals of attention, it is necessary to declare that it needs to be developed new nursing models which allow new fields of global action and requirements of current adaptations of health systems. It is also necessary to include in these proposals Human Security principles and risk attention which goes beyond patients' security and community nursing.

Another challenge for Nursery in a global scale is to promote collaborative networks with other sciences in order to control fear, to inform the population of threats and risks, to promote empowerment and resilience from a wide point of view, that is from a Society Care point of view. It is necessary to research, study and know global and national risks and threats in order to reach aims raised in the 2030 Agenda for Sustainable Development where the word security is continuously mentioned.9

The concern of the Professional Nursing for providing quality care has been present since it began as a discipline and profession.10Information and Communication Technologies (ICT) are a key tool to develop this profession because they are necessary to pass on knowledge globally. Nursery in developed societies must work to exchange, develop and transfer global knowledge in order to promote not only the way in which the profession is perceived, but also cultural diversity, different care approaches, etc. through adequate and enough funding for its development. It must be the main part of global actions. In this sense, a challenge which has not been reached yet is to make global platforms of nursing knowledge management work. It may be a meeting point for professionals to exchange experiences, challenges, information and opportunities.

The challenge of this profession is to consolidate itself in global management spaces with its own sense and to create a great mass which takes part in national and transnational decision-making. Nursery must go beyond clinical and operative management and involve passionately in national and international nursing management of risks and threats which affect different societies and work in the community prevention and resilience. And this is something which the profession must take part in and defend the participation in the decision-making and national actions about national and international emergencies and security management, because nurses and midwives represent 68% of worldwide health staff. For this reason it is necessary to promote research and education in these new challenges which are related to different health systems, as well as develops security and risk management as Population Care Elements.


Migrations, social conflicts, wars, biological, industrial, economic, food, political, health risk, etc. represent spaces of social care for nursery because societies claim global care for global risks and threats. Furthermore, it is known that risks may be exploited depending on some interests; this is why it is very important to value that 68% of health staff may be critical observers of governmental and corporate actions. They are a great group which are able to control actions of authorities, organizations, lobbies and different groups of interest. Past situations show that fear and uncertainty may be very useful for some social stakeholders.

Ultimately, Human Security empowers individual; it gives him tools and knowledge and it catalyzes social rights while policies centred in this philosophy create better quality of life and determine equality in people's opportunities. However, this empowerment needs knowledge about risks and uncertainty. It also needs management not only individually but collectively. Experiences have shown that global threats compromise health systems severally. For this reason, nursery as a global element of systems must cover these new challenges, Society Cares.


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Received: April 02, 2018; Accepted: June 14, 2018

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