Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently (...) sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies. (shrink)

Nursing education holds a history framed in white supremacy and whiteness. Efforts to employ antiracist strategies have been hindered, largely due to an inability for faculty to acknowledge and hold accountability for racialized harms that occur within nursing educational structures. A nurse–midwifery program in the Pacific Northwest United States uncovered harm that impacted students and identified a need to respond and hold accountability. Guided by the framework of Transformative Justice, a truth and reconciliation process was implemented as a first step (...) to better address racism within nursing and nurse–midwifery education. This paper describes the process to support other institutions in their work to address harms within nursing education. (shrink)

Nursing education, as with professionalization projects, is fraught with epistemicide, false separations, and a focus on expertise over relations and accountability. This is a critical reflection of the first 5 years of a four‐semester prelicensure Community Engagement course series. As the course lead, I have consistently initiated adjustments, based on experiences teaching multiple sections and synthesizing comments and feedback from students and faculty, with an eye toward longstanding and pressing concerns in the world around us. Two broad epistemic arrangements emerge (...) from this critical excavation: (1) naturalized hierarchy, false separations, and appraisals of relevance and (2) relationality and reflection as unsettling. There is a need for sustained collective examination and shift in how the nursing education and healthcare industries curate the meanings and practice of “community,” “health,” and “nursing,” peering out from the regulatory oversight of neoliberal forces. How might we situate student progression, program implementation, institutional contracts, and curricular standards within the contexts of nursing programs' responsibilities to local communities in light of unfolding events locally and globally and their historical antecedents? How are we all, as faculty, disrupting siloes, false separations, and the contradictions of professionalism and the biomedical model to intentionally advance health equity? May we continue to illuminate the presence of community as being everywhere, not merely in juxtaposition to acute care. May we unsettle the prevailing theorization and practices of community throughout nursing education and commit to imagining and practicing relational praxis. (shrink)

Canadian Schools of Nursing rest upon white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. The diversity that exists in clinical nursing and is emerging within the graduate student population is not currently reflected within nursing faculty and academic leadership. Black, Indigenous, and People of Color (BIPOC) nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity persists across nursing knowledge generation, research, and (...) healthcare practices that ultimately aim to serve the increasingly diverse Canadian population. This narrative inquiry study examined the experiences of eight BIPOC graduate nursing students as they navigated white academic nursing spaces. The findings are presented to reflect their experiences of entrenched in whiteness, erasure of identity, and navigating belonging. These study findings highlight the importance of surfacing academic nursing history shaped by colonialism and racism, the need to diversify nursing faculty and the graduate nursing student population, and implementing nursing curricular and syllabi audits to ensure that they reflect the multitude of ways of knowing to expand dominant Eurocentric and Western knowledge in nursing education. (shrink)

Sharply in focus in the United States right now is the disproportionate COVID‐19 infection, hospitalization, and mortality rates of Black, Indigenous, Hispanic, and Pacific Islanders living in the United States in contrast to White people. These COVID‐19 disparities are but one example of how systemic racism filters into health outcomes for many Black, Indigenous, and other People of Color (BIPOC). With these issues front and center, more attention is being given to the ways that White medical professionals contribute to these (...) disparities, including their socialization to ignore or deny inequities. As such, the present study sought to understand how educating White health‐care pre‐professionals about systemic racism might influence their understanding of and responsibility for disrupting White supremacy. Data were drawn from 49 White‐identified nursing students who participated in a mapping project that uncovered instantiations of systemic racism in the United States. Participant written reflections were analyzed using thematic analysis. Findings revealed that mapping projects can develop White people's knowledge and understanding of systemic racism. We introduce the construct, transformative dissonant encounters, to describe how this project precipitated shifts in world view necessary for White people to confront systemic racism. Implications for nursing educators, psychological researchers, and antiracist activists are discussed. (shrink)

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus‐based clinical learning environment for nursing education. By analyzing (...) documents and interviews with the help of reflexive thematic analysis three themes were generated: “Intention to educate beyond nursing education,” “Educating in alliance with society,” and “The educative ambiguity of the Clinical Learning Centre.” The case study indicates that the incorporation of norm criticism into a campus‐based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus‐based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics. (shrink)

The Scandinavian welfare states are known for their universal access to healthcare; however, health inequalities affecting ethnic minority patients are prevalent. Ethnic minority patients' encounters with healthcare systems are often portrayed as part of a system that represents objectivity and neutrality. However, the Danish healthcare sector is a political apparatus that is affected by policies and conceptualisations. Health policies towards ethnic minorities are analysed using Bacchi's policy analysis, to show how implicit problem representations are translated from political and societal discourses (...) into the Danish healthcare system. Our analysis shows that health policies are based on different ideas of who ethnic minority patients are and what kinds of challenges they entail. Two main issues are raised: First, ethnic minorities are positioned as bearers of ‘culture’ and ‘ethnicity’. These concepts of ‘othering’ become both explanations for and the cause of inappropriate healthcare behaviour. Second, the Scandinavian welfare states are known for their solidarity, collectivism, equality and tolerance, also grounded in a postracial, colour‐blind and noncolonial past ideology that forms the societal self‐image. Combined with the ethical and legal responsibility of healthcare professionals to treat all patients equally, our findings indicate little leeway for addressing the discrimination experienced by ethnic minority patients. (shrink)

Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio‐ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context‐specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, multistakeholder approach, impacting nursing (...) students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all‐encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served. (shrink)

Healthcare environments continue to prove discriminatory and marginalizing towards patients and healthcare workers themselves, which contributes to inequitable health outcomes across lines of socially constructed difference. This content and discourse analysis of nursing identity scholarship asks whether there is a connection between nursing identity and oppressive behaviour by examining the construction of nursing identity and the foundational discourses, sometimes in absentia, that support such a construction. Bourdieu's concepts of social fields and Audre Lorde's concept of the master's house are applied (...) as a framework towards understanding the constructs of power and status in healthcare. The analysis identifies a gap in nursing identity literature where social constructs of difference are not considered. In the reviewed literature, nursing identity has been co‐opted by the professionalization project in effort to stabilize a conceptualization of nursing's contribution to healthcare towards gaining professional and societal status. This leads to a monolithic, apolitical representation of nursing identity that erases difference, denies historical influence, universalizes nursing work and further marginalizes marginalized identities. The oppressive and hegemonic nature of a universal nursing identity may contribute to a lack of disciplinary reflexivity about the ongoing influences of foundational discursive constructs of gender, epistemology, power and professional status. (shrink)

Ethnic minority patients face challenges concerning communication and are at higher risk of experiencing health problems and consuming fewer healthcare services. They are also exposed to disparaging societal discourses about migrants which might undermine healthcare institutions’ ambitions of equitable health care. Therefore, healthcare professionals need to critically reflect on their practices and processes related to ethnic minority patients. The aim of this article is to explore healthcare professionals’ experiences of working with ethnic minority patients by using the critical incident (CI) (...) technique. In two focus group sessions, participants discussed challenging events in their encounters with patients. The critical incidents show that healthcare professionals may experience unfamiliar situations related to their work performance, prejudice toward patients, and labeling by patients the professionals do not identify with. The professionals’ reflections are discussed in relation to social discourses on migration and their work conditions, and the possible influence on the professionals’ preconceptions and the patient–professional relationship in health care. Reflections about work experiences with ethnic minority patients and aligned societal discourses should be included in healthcare workers’ professional development. Critical incident reflections at work may contribute to better‐coping strategies for healthcare professionals and improved patient–professional relationships with ethnic minority patients. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be disenfranchised (...) from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

Racism in health and healthcare has long been recognised as a structural issue. While there has been growing research and a number of important initiatives that have come from approaching racism as a structural issue, there is a range of implications that yet have to be explored as they relate to health and healthcare. Conceptualising racism in this way provides a means to consider how it shapes and is shaped by a range of global injustices and serves as a foundation (...) for more egregious harms. It also suggests that if we are to dismantle racism, we need to look both within and beyond the traditional domains of health and healthcare and account for a range of broader forces that sustain and re‐enforce racism. We first discuss the issue of responsibility, drawing on Young's social connection model to argue that we all have a responsibility to take action in addressing structural racism. We will then deal with a question that naturally follows, namely how we discharge our responsibilities, with a focus on the role of disruptive action in challenging power and ignorance in dismantling racism in health and healthcare. (shrink)

Race and racism are matters of urgent concern for the international nursing community. Recent global events have presented the discipline with an opportunity to generate and sustain long overdue discussions. However, with this opportunity comes a need to consciously attend to what we mean by race and racism, especially in the context of the nursing literature. Indeed, the development of antiracism depends on how we conceptualise race and racism; it is these conceptualisations that actively shape the scope and priorities of (...) antiracist organising and action. The aim of this critical interpretative synthesis (CIS) is to examine conceptualisations of race and racism in the nursing literature by drawing on contemporary race scholarship. The synthesis of diverse literature is enabled through the explorative and expansive process of the CIS method. This review generates three synthesising arguments—a problem ‘of’ not ‘for’; conceptual inconsistencies and drift; and reliance on the lens of experience—that both critique and contribute to the nursing literature. In the pursuit of antiracism, this article urges us to pay close attention to our conceptualisations of race and racism by illuminating the pitfalls that occur when our conceptualisations are inconsistent, contradictory, or simply neglected. (shrink)

Our intention is to contribute to the development of Canadian Nursing and Medical Education (NursMed) and efforts to redress deepening, intersecting health and social inequities. This paper addresses the following two research questions: (1) What are the ways in which Decolonial, Intersectional Pedagogies can inform Canadian NursMed Education with a focus on critically examining settler‐colonialism, health equity, and social justice? (2) What are the potential struggles and adaptations required to integrate Decolonial, Intersectional Pedagogies within Canadian NursMed Education in service of (...) redressing intersecting health and social inequities? Briefly, Decolonial, Intersectional Pedagogies are philosophies of learning that encourage teachers and students to reflect on health through the lenses of settler‐colonialism, health equity, and social justice. Drawing on critical ethnographic research methods, we conducted in‐depth interviews with 25 faculty members and engaged in participant observation of classrooms in university‐based Canadian NursMed Education. The research findings are organized into three major themes, beginning with common institutional features influencing pedagogical approaches. The next set of findings addresses the complex strategies participants apply to integrate Decolonial, Intersectional Pedagogies. Lastly, the findings illustrate the emotional and spiritual toll some faculty members face when attempting to deliver Decolonial, Intersectional Pedagogies. We conclude that through the application of Decolonial, Intersectional Pedagogies teachers and students can support movements towards health equity, social justice, and unlearning/undoing settler‐colonialism. This study contributes new knowledge to stimulate dialog and action regarding the role of health professions education, specifically Nursing and Medicine as an upstream determinant of health in settler‐colonial nations such as Canada, United States, Australia, and New Zealand. (shrink)

Since the COVID‐19 pandemic, ongoing reports have highlighted the urgency of addressing anti‐Black racism within Canada's healthcare system. The paucity of research within a Canadian context has created growing concerns among Millennials and Generation Zs for healthcare to address growing health disparities and health inequities that are attributed to institutional and structural racism. Recognizing the paradigm shift that has occurred because of the pandemic and the sleuth of racial killings, the nursing classroom has witnessed a change and a need for (...) nursing education to be relevant for the cohort of nursing students who are seeking answers. The scarcity of nursing literature addressing diverse forms of learning demonstrates the need for nursing education to explore new ways of being diverse, inclusive and innovative when teaching intergenerationally. In this paper, the author challenges nurse educators to revisit the student–educator relationship by introducing critical digital pedagogy to dismantle anti‐Black racism and promote student–educator engagement for transformative learning to occur. As an educator, the author implements the use of digital illustration as a tool of resistance for students and educators to assess, engage, act and reflect on creating change within nursing education. Using Black feminist thought and culturally responsive learning, the author introduces an arts‐based approach through the innovative design of an illustration, titled, ‘Ain't I a Nurse. Combining historical stories with contemporary socio‐political experiences, the author demonstrates how students and educators can enter a cognitive learning experience where they can connect mentally and emotionally, and in so doing re‐envision and recreate a new world that centralizes equity, diversity and inclusivity through critical discourses. Through the illustration anti‐Black racism is challenged and anti‐Black racism resistance is discovered as an antidote in dismantling anti‐Black racism within nursing education. (shrink)

In the profession of nursing, whiteness continues to be deeply rooted because of the uncritical recognition of the white racial domination evident within the ranks of nursing leadership. White privilege is exerted in its ascendency and policy-making within the nursing discipline and in the Eurocentric agenda that commands nursing pedagogy. While attention to antiracism has recently increased, antiracism pedagogy in nursing education is nascent. Pedagogical approaches in the nursing profession are essential. Because it encompasses the strategies used to transmit the (...) science in how nurses practice and teach, which has predominantly been informed using a Eurocentric lens. This paper presents a literature review on antiracist pedagogy in nursing education, discussing how nurse educators can integrate antiracism pedagogy in nursing education, highlighting examples presented by the authors. Key terms related to antiracism are reviewed. The resultant themes from the literature review include resistance to antiracist pedagogy, managing emotional responses, and supporting transformative learning using an antiracist approach. The primary implementation of Eurocentric pedagogical approaches whiteness pervasive in nursing education must be uprooted. Antiracist and other antioppressive learning approaches must be embraced to understand the insidiousness of racial inequities and its power in sustaining structural oppression in nursing academia. (shrink)

On 4 February 2021 a group of nurse scholar‐educators, nurses and other interested folks came together for the second of two virtual events to think together about the role of philosophy in the nursing world. The live streamed open access event provided an opportunity in the COVID‐19 pandemic for over 400 people to listen to five nursing scholars' presentations and to interact virtually through comments in chat and on the @IPONSociety Twitter social media platform. By reading the comments and questions (...) that were generated, and by looking at the social media comments related to the event, it is apparent that philosophy is an important thinking practice for nurses but many audience members critically expressed they felt excluded. Critical issues were raised by participants in chat and on Twitter—pointedly around the need for more representative voices—including the imperative to open nursing philosophy to diverse and disparate worldviews. This dialogue provides a summary of critical points raised during the live question and answer session for the panel entitled Addressing Current Debates in Nursing Theory, Education, Practice as well as examing comments selected from the @IPONSociety Twitter space in response to the panel. One commenter said it was great to see the discussion being lifted up from the influential roots of white supremacy, while other nurses expressed that they wished the panellists themselves were more diverse. In discussion of key takeaway, links are made to historical and ongoing structural oppressions in nursing where thinking practices like nursing philosophy and theory are still dominated by world views emanating from positionalities of able‐bodied cis‐gendered heterosexual western eurocentric whiteness. (shrink)

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts are explicitly present (...) in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well‐integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula. (shrink)