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 paper uses a semiotic, performative theory of language and post-colonial theory to argue that nursing's representations of ‘multiculturalism’ need to be grounded in a theory of whiteness, an historicized understanding of how ethnic/cultural differences come to be represented in the ways they are and informed by Foucault's notions of power/knowledge. Using nursing education and ‘cultural compentency’ as examples, the paper draws on a range of literatures to suggest more critical and politically productive ways of approaching difference from within nursing's (...) largely white interpretive framework. (shrink)

Neoliberal ideology and exclusionary policies based on racialized identities characterize the current contexts in North America and Western Europe. Nursing knowledge cannot be abstracted from social, political and historical contexts; the task of examining the influence of race and racial ideologies on disciplinary knowledge and inquiry therefore remains an important task. Contemporary analyses of the role and responsibility of the discipline in addressing race‐based health and social inequities as a focus of nursing inquiry remain underdeveloped. In this article, we examine (...) nursing's engagement with ideas about race and racism and explore the ways in which nursing knowledge and inquiry have been influenced by race‐based ideological discourses. Drawing on Henry and Tator's framework ofdemocratic racism, we consider how strategic discursive responses—the discourses of individualism, multiculturalism, colour‐blindness, political correctness and denial—have been deployed within nursing knowledge and inquiry to reinforce the belief in an essentially fair and just society while avoiding the need to acknowledge the persistence of racist discourses and ideologies. Greater theoretical, conceptual and methodological clarity regarding race, racialization and related concepts in nursing inquiry is needed to address health and social inequities. (shrink)

The influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (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)

Although there are notable exceptions, examination of nursing's participation in colonizing processes and practices has not taken hold in nursing's consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward decolonizing the profession. The (...) authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursing's intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter‐narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health. (shrink)