American Indian/Alaska Native (AI/AN) populations in the United States continue to experience overall health inequity, despite significant improvement in health status for nearly all other racial‐ethnic groups over the past 30 years. Nurses comprise the bulk of healthcare providers in the U.S. and are in an optimal position to improve AI/AN health by transforming both nursing education and practice. This potential is dependent, however, on nurses’ ability to recognize the distinct historical and political conditions through which AI/AN health inequities have (...) been produced and sustained. Nurse providers, educators, and leaders must in turn recognize how the sustained conditions of marginalization and expropriation that underpin current AI/AN health inequities continue to shape contemporary AI/AN health outcomes. This manuscript builds upon the extant literature of AI/AN historical health policy and utilizes decolonial theorizations of nursing and a cultural safety framework to propose a series of immediately actionable steps for nursing intervention into AI/AN health inequity. Ultimately, we suggest that it is crucial for nurses to collaborate with AI/AN individuals and communities across educational and clinical settings to further refine these approaches in alignment with the disciplinary obligation of promoting social justice within healthcare. (shrink)

This paper offers a theoretical discussion on why the nursing profession has had a delayed response to the issue of climate change. We suggest this delay may have been influenced by the early days of nursing's professionalization. Specifically, we examine nursing's professional mandate, the generally accepted metaparadigm, and the grand theorists’ conceptualizations of both the environment and the nurse–environment relationship. We conclude that these works may have encouraged nurses to conceptualize the environment, as well as their relationship with it, mainly (...) in terms of the individual patient, and as such, nurses have not been encouraged to understand these concepts from a broader perspective. By not having the philosophical and theoretical foundations to understand the environment in relation to society, it is not surprising that nurses have had a delayed response to climate change and may not have viewed it as a professional concern. A planetary health perspective is suggested as a theoretical basis for nursing education, research and practice. Taking on a planetary health perspective could help nurses progress the profession and move healthcare systems towards supporting a climate‐resilient future. (shrink)

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, (...) and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer‐reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically. (shrink)

This study will be of interest to anyone concerned with a critical appraisal of mental health service users’ and carers’ participation in research collaboration and with the potential of the postcolonial paradigm of cultural safety to contribute to the service user research (SUR) movement. The history and nature of the mental health field and its relationship to colonial processes provokes a consideration of whether cultural safety could focus attention on diversity, power imbalance, cultural dominance and structural inequality, identified as barriers (...) and tensions in SUR. We consider these issues in the context of state‐driven approaches towards SUR in planning and evaluation and the concurrent rise of the SUR movement in the UK and Australia, societies with an intimate involvement in processes of colonisation. We consider the principles and motivations underlying cultural safety and SUR in the context of the policy agenda informing SUR. We conclude that while both cultural safety and SUR are underpinned by social constructionism constituting similarities in principles and intent, cultural safety has additional dimensions. Hence, we call on researchers to use the explicitly political and self‐reflective process of cultural safety to think about and address issues of diversity, power and social justice in research collaboration. (shrink)

In this paper, we bring together Foucault's biography and oeuvre to explore key concepts that support the analysis of nurses' acts of resistance. Foucault reflected on the power relations taking place in health services, making his contribution especially useful for the analysis of resistance in this context. Over three decades, he proposed a nonnormative philosophy while concomitantly engaging in transgressive practices guided by values such as human rights and social justice. Hence, Foucault's philosophy and public activism are an apparent contradiction, (...) but we argue that when analysed together they allow for a different understanding of his work. We describe the evolution of the concept of resistance in Foucault's work, supported by the approaches of Brent Picket (1996) and Miguel Morey (2013). Foucault started his work considering the idea of transgressiveness as it connects to being at the margins of society. He then spent considerable time elaborating the concept of power and identifying resistance strategies as forms of power exercise. In doing so, he considered that people engage with social change from multiple positions, including limited desire for change, fomenting reforms, or engaging in everyday revolutionary acts. As he further elaborated on power relations and defined resistance, Foucault asserted that resistance involves both repressive and productive dimensions of power, governance of biological life, state governance, and deliberate practices of illegalisms. Finally, Foucault shifted his attention to the freedom of ethical subjects, proposing the use of counter‐conduct and counter‐discourses to speak truth against oppression. Such framework offers a comprehensive lens for analysing nurses' acts of resistance within the complexities of the healthcare system and in society. In summary, Foucault's conceptual framework on resistance expands the role of nurses, to understand them not only as caregivers, but also as political agents capable of confronting and transforming oppressive institutional practices. (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)

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)

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)

In recent years there have been several calls in professional and academic journals for healthcare personnel in Canada to raise the profile of postcolonial theory as a theoretical and explanatory framework for their practice with Indigenous people. In this paper I explore some of the challenges that are likely to confront those healthcare personnel in engaging with postcolonial theory in a training context. I consider these challenges in relation to three areas of conflict. First I consider conflicts around paradigms of (...) knowledge, wherein postcolonial theory operates from a different base from most professional knowledge in health care. Second I consider conflicts of ideology, wherein postcolonial theory is largely at odds with Canada’s political and popular cultures. And finally I consider issues around the question of Canada’s legitimacy, which postcolonial theory puts in doubt. I suggest ways in which these conflicts might be addressed and managed in the training context, and also identify potential positive outcomes that would be enabling for healthcare personnel, and might also contribute to an improvement in Canada’s relationship with its indigenous peoples. (shrink)

The profession of nursing has recognized the need for contextual and relational frameworks to inform knowledge development. Two‐Eyed Seeing is a framework developed by Mi'kmaw Elders to respectfully engage with Indigenous and non‐Indigenous knowledges. Some scholars and practitioners, however, are concerned that Two‐Eyed Seeing re‐instantiates dichotomized notions regarding Western and Indigenous knowledges. As dichotomies and binaries are often viewed as polarizing devices for nursing knowledge development, this paper explores the local worldviews in which Two‐Eyed Seeing emerged, proposing that the onto‐epistemological (...) and axiological ‘roots’ of the framework are antithetical to divisiveness, paradoxically asserting space for the dichotomy to stand. Two‐Eyed Seeing, if understood as a relational, decolonial praxis, could fundamentally change the way nursing scholarship and practice operate by facilitating space for diverse knowledges, ways of being, doing and relating. In this paper, considerations for nursing scholarship and practice, as well as recommendations to support the uptake of Two‐Eyed Seeing are explored. The authors assert that conceptual divisiveness, dichotomization and exclusion can be mitigated if nursing is informed by contextual knowledge, seeks to enact accountable partnerships with Indigenous knowledge holders, and holds the Mi'kmaq worldview upon which the concept developed in positive regard. (shrink)

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design (...) and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives. (shrink)

In this study, we discuss the colonial project as an eliminatory structure of indigenous ways of knowing and doing that is built into Canadian social and health institutions. We elaborate on the role nursing plays in maintaining systemic racism, marginalization and discrimination of Indigenous Peoples. Based on historical practices and present‐day circumstances, we argue that changing language in research and school curriculums turns decolonization into what Tuck and Yang call a ‘metaphor’. Rather, we propose decolonization as a political project where (...) nurses acknowledge their involvement in colonial harms and disrupt the assumptions that continue to shape how nurses interact with Indigenous people, including knowledge systems that perpetuate colonial interests and privilege. Decolonization requires nurses to understand the colonial practices that led to dispossession of land, erasure of knowledge, culture and identity, while upholding indigenous ways of knowing and doing in health, healing and living. As a political manifesto that liberates indigenous life from oppressive structures of colonialism and capitalism, The Red Deal is presented as a visionary platform for decolonization. The aim of this study is to articulate three dimensions of caretaking within The Red Deal as a framework to decolonize nursing knowledge development and practice. Based on the philosophical dimension embedded in The Red Deal that revoke norms and knowledge assumptions of capitalism that destroy indigenous ways of knowing and doing, we underscore an approach toward decolonizing nursing. Our approach rejects the apolitical nature of nursing as well as the unilateral western scientific knowledge approach to knowledge development and recognition. A critical emancipatory approach that addresses the socio‐political and historical context of health care, recognizes dispossession of land and adopts a ‘multilogical’ vision of knowledge that gives space for representation and voice is needed for true decolonization of nursing. (shrink)

There is an urgent call for nurses to address climate change, especially in advocating for those most under threat to the impacts. Social justice is important to nurses in their relations with individuals and populations, including actions to address climate justice. The purpose of this article is to present a Global Nurse Agenda for Climate Justice to spark dialog, provide direction, and to promote nursing action for just‐relations and responsibility for planetary health. Grounding ourselves within the Mi'kmaw concept of Etuaptmumk (...) (two‐eyed seeing), we suggest that climate justice is both call and response, moving nurses from silence to Ksaltultinej (love as action). We review the movement for climate justice in nursing, weaving between our own stories, our relations with Mi'kmaw ways of knowing, and the stories of the movement, with considerations for the (w)holistic perspectives foundational to nursing's metaparadigm of person, environment, and health. We provide a background to the work of the Global Nurse Agenda for Climate Justice steering committee including their role at the 26th United Nations Climate Change Conference in Glasgow, 2021, and share our own stories of action to frame this agenda. We accept our Responsibility for the challenges of climate justice with humility and invite others to join us. (shrink)

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma‐ and violence‐informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity‐oriented care for (...) primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma‐ and violence‐informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice. (shrink)

ResumoNeste artigo discuto o conceito de “A descolonização da enfermagem”, respondendo que é este processo, como e quando deve ser levado a cabo. Introduzo a ideia de domínio epistemológico e os conceitos de colonização e descolonização do conhecimentos na enfermagem. Descrevo as minhas experiências desde minha origem na América Latina e me confrontar com a academia anglo‐saxónica para discutir conhecimentos disciplinares de enfermagem e forneço reflexões sobre a descolonização da língua de enfermagem.

Colonialism, in its many forms and stages is often imposed as being central to the narratives of colonizedpeople and their cultures, as well as the genesis of their knowledge. In colonial discourse, lands and the occupants of these lands were ‘discovered’, further implying that colonized people did not have their own ways of knowing (nor even existence) before colonization. This narrative has been embedded within Euro‐American fields of study, including nursing, in which caring and healing practices that exist outside of (...) a colonial lens are dismissed and complicity with colonialism is downplayed or sanitized. This paper is a reflection on the current discourse on decolonizing nursing shaped by postcolonial, critical and Black feminist philosophies. After examining the decolonization discourse in nursing, I argue that current calls to decolonize nursing lack a clear description of the goals and process of doing so, making it unfeasible to hold those in the process of decolonizing accountable. In addition, the lack of intentionality in reckoning with past and current forms of colonialism embedded in nursing hinders the ability to engage with lessons that could shape the future. I conclude this discourse by discussing practical steps toward centrering diverse ways of knowing, and ensuring this process prioritizes communities and nurse scholars who have historically been silenced. (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)

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)

In this paper, we argue that nurses need to be aware of how the production of space in specific contexts – including health care systems and research institutions – perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two‐spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter‐spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us (...) the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter‐spaces, thereby instigating counter‐institutional practices, for those who experience otherness. (shrink)

Social justice is put forth as a core professional nursing value, although conceptualizations within foundational documents and among nurse educators remain inconsistent and contradictory. The purpose of this study was to explore how faculty teach social justice in theory courses in Baccalaureate programs. This qualitative study utilized constructivist grounded theory methods to examine processes informing participants' teaching. Participants utilize four overarching approaches: fostering engaging classroom climates, utilizing various naming strategies, framing diversity and culture as social justice, and role modeling a (...) critical stance. They deploy specific strategies, varying largely by race, educational background, and nursing specialty. A background in social sciences supports pedagogy that interrogates health inequities rather than merely raising awareness about disparities. Findings also reveal that faculty of color navigate institutional structures predicated upon colorblind racism and problematic views of culture, which many white faculty teaching non‐Community Health Nursing courses described doing. To enact social justice and be answerable to our communities, concerted anti‐oppression efforts are needed across education, research, practice, and policy. This includes sustained commitment to address colonialism and whiteness in every institution that defines, promotes, and claims to advance nursing so that we can fulfill our responsibility to address unjust systems and structures to serve our communities. (shrink)

The imperative to decolonise health disciplines underscores the need for a critical examination of the coloniality of nursing knowledge development. Decolonising nursing requires epistemic resistance aimed at exposing and dismantling epistemological hierarchies that marginalise indigenous knowledges. This paper introduces the ‘Pluriverse of Nursologies’ as paradigm to guide decolonial theorising in nursing. Through a four‐part exploration, I first elucidate the coloniality embedded in mainstream nursing knowledge. Next, I offer a decolonial critique of Fawcett's nursing metaparadigm as an exemplar of pyramidal epistemology. (...) I then discuss pluriversality as an approach to decolonising nursing knowledge. Finally, I introduce the Pluriverse of Nursologies (PoN) as a meta‐theoretical paradigm for theory and knowledge development that decentres and dismantles the pyramidal epistemology of colonial/modern nursing, and relinks diverse nursologies from marginalised communities to the centre of intellectual nursing discourse, thereby revitalising the theoretical landscape of the discipline. (shrink)