Knowledge development and evidence-based practice: insights and opportunities from a postcolonial feminist perspective for transformative nursing practice

Colorectal cancer screening participation in First Nations populations worldwide: a systematic review and data synthesis

Background

First Nations populations have poorer colorectal cancer (CRC) survival compared to non-First Nations populations. Whilst First Nations populations across the world are distinct, shared experiences of discrimination and oppression contribute to persistent health inequities. CRC screening improves survival, however screening rates in First Nations populations are poorly described. This study seeks to define participation rates in CRC screening in First Nations populations worldwide.

Methods

A systematic literature search was conducted of PubMed, Embase, Cochrane Library, CINAHL, MEDLINE, grey literature, national registries and ClinicalTrials.gov. All sources were searched from their inception date to 18 February 2024. Studies were included if they reported CRC screening rates in adult (≥18 years) First Nations populations. We aimed to undertake a meta-analysis if there were sufficient data. Quality of papers were assessed using the Joanna Briggs Institute (JBI) appraisal tool. The study was registered with PROSPERO, CRD42020210181.

Findings

The literature search identified 1723 potentially eligible published studies. After review, 57 studies were included, 50 from the United States (US), with the remaining studies from Australia, Aotearoa New Zealand (NZ), Canada, Dominica and Guatemala. Additionally, eleven non-indexed reports from national programs in Australia and NZ were included. There were insufficient data to undertake meta-analysis, therefore a systematic review and narrative synthesis were conducted. CRC screening definitions varied, and included stool-based screening, sigmoidoscopy and colonoscopy. US First Nations screening rates ranged between 4.0 and 79.2%, Australia reported 10.6-35.2%, NZ 18.4-49%, Canada 22.4-53.4%, Guatemala 2.2% and Dominica 4.2%. Fifty-five studies were assessed as moderate or high quality and two as low quality.

Interpretation

Our findings suggested that there is wide variation in CRC screening participation rates across First Nations populations. Screening data are lacking in direct comparator groups and longitudinal outcomes. Disaggregation of screening data are required to better understand and address First Nations CRC outcome inequities.

Funding

None.

Grounding Wellness: Coloniality, Placeism, Land, and a Critique of "Social" Determinants of Indigenous Mental Health in the Canadian Context

Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.

The essential role of cultural safety in developing culturally-relevant prevention programming in First Nations communities: Lessons learned from a national evaluation of Mental Health First Aid First Nations

Mental Health First Aid is a population health approach that educates people to recognize and respond to mental health challenges. Since 2012, the Mental Health Commission of Canada has worked with six First Nations communities to develop a culturally-relevant version of the program called Mental Health First Aid First Nations (MHFAFN). This paper presents mixed methods, multi-informant data from a national evaluation to assess the extent to which the course was experienced as culturally safe by Indigenous participants, factors that contributed to these experiences, and ways in which cultural relevancy of MHFAFN can be improved. Our evaluation team conducted participant interviews and surveys, as well as facilitator interviews. Nearly all Indigenous participants (94.6%) experienced the course as safe. Participants and facilitators identified a range of factors that promoted cultural safety, including the knowledge and skills of the facilitators and the cultural components of the course. Participants that did not experience safety identified trauma-related factors and facilitation style. The findings suggest that MHFAFN may be situated in a way where shared cultural backgrounds are imperative to the success of the course. Further evaluation of the MHFAFN curriculum, with the goal of continual improvement, may help to further enhance participants' experiences in taking the course.

Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives

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.

Lesbian, gay, and bisexual (LGB) people's experiences of nursing health care: An emancipatory nursing practice integrative review

AIM

To review current research on lesbian, gay, and bisexual (LGB) individuals' experience of nursing services from an emancipatory nursing practice framework.

BACKGROUND

As LGB issues are marginalized in health care, it is important to understand LGB individuals' experiences of nursing.

DESIGN

An integrative literature review using critical analysis based on an emancipatory nursing practice framework was conducted.

DATA SOURCES

A search of all English nursing journals in the World of Science database was conducted.

REVIEW METHODS

Established methods were used to search, identify, and appraise articles meeting the criteria of examining LGB individuals' experiences of nursing services, published in the years 2009 to 2015. Sixteen articles that met the inclusion criteria were identified independently by the two authors. Data were analysed using descriptive and critical phases of enquiry.

RESULTS

Results show a nexus of experiences of exclusion and oppressive social norms. Our analytical framework highlighted absences in nursing practice. No research indicates that LGB people experience nurses as advocates or participatory health care processes.

CONCLUSION

Standards, training, and systems need to be devised that ensure inclusionary nursing practices, that encourage nurses to act as advocates for LGB health care justice, and that allow LGB individual to participate in the development of health care policies and procedures.

A Bicultural Researcher's Reflections on Ethical Research Practices With Muslim Immigrant Women: Merging Boundaries and Challenging Binaries

Bicultural researchers are well positioned to identify tensions, disrupt binaries of positions, and reconcile differences across cultural contexts to ensure ethical research practices. This article focuses on a bicultural researcher's experiences of ethically important moments in research activities with Muslim immigrant women. Three ethical principles of respect, justice, and concern for welfare are highlighted, revealing the implications of binary constructions of identity, the value of situated knowledge in creating ethical research practices, and the need to recognize agency as a counterforce to oppressive narratives about Muslim women.

Illustrating the Importance of Critical Epistemology to Realize the Promise of Occupational Justice

This article argues that it is vital to embrace critical reflexivity to interrogate the epistemological beliefs and principles guiding occupation-based scholarship to move away from frameworks that are incongruent with calls for occupational justice. For this purpose, we describe an epistemic tension between the stated intentions to demonstrate that occupation-based work can be a means to create a more just society and the epistemological beliefs that have historically dominated occupation-based scholarship. To exemplify the potential implications of this tension, a critical analysis of Creswell’s social justice/transformative design is presented, illustrating that work that expresses a commitment to social justice while relying on positivist/postpositivist assumptions often risks perpetuating injustices through neglecting their sociopolitical construction. Drawing upon critical social theory, we highlight how engagement with critical epistemological assumptions can facilitate addressing the sociopolitical “roots” of occupational injustices and highlight directions for social transformation

Structural impact on gendered expectations and exemptions for family caregivers in hospice palliative home care

Evidence of gender differences in the amount and type of care provided by family caregivers in hospice palliative home care suggests potential inequities in health and health care experiences. As part of a larger critical ethnographic study examining gender relations among clients with cancer, their family caregivers and primary nurses, this article describes gendered expectations and exemptions for family caregivers within the sociopolitical context of end-of-life at home. Data were collected from in-depth interviews (n = 25), observations of agency home care visits (n = 9) and analyses of policy and home care agency documents (n = 12). Employing a critical feminist lens, a gender-based analysis revealed that structural discourses emphasizing an artificial divide between public and private spheres constructed end-of-life at home as private and apolitical. Associated with care of home and family, women were most impacted by these public/private discourses underpinning neoliberal values of cost-efficiency. Findings suggest that a critical perspective is needed to assist policy makers and healthcare providers to view how caregiver experiences are shaped by structures that control the availability of resources. Thus, instead of focusing on caregivers' deficits, interventions should be directed at the social, political and economic conditions that shape gendered experiences.

Construct Validity of Almutairi's Critical Cultural Competence Scale

Cultural diversity in health care settings can threaten the well-being of patients, their families, and health care providers. This psychometric study evaluated the construct validity of the recently developed four-factor, 43-item Critical Cultural Competence Scale (CCCS) which was designed to overcome the conceptual limitations of previously developed scales. The study was conducted in Canada with a random sample of 170 registered nurses. Comparisons with the Cultural Competence Assessment instrument, Scale of Ethnocultural Empathy, and Cultural Intelligence Scale provided mixed evidence of convergent validity. Modest correlations were found between the total scale scores suggesting that the CCCS is measuring a more comprehensive and conceptually distinct construct. Stronger correlations were found between the more conceptually similar subscales. Evidence for discriminant validity was also mixed. Results support use of the CCCS to measure health care providers' perceptions of their critical cultural competence though ongoing evaluation is warranted.

The emancipatory potential of nursing practice in relation to sexuality: a systematic literature review of nursing research 2009-2014

Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health-care. Given the intersection of sexualities with a range of social injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty-eight articles met the inclusion criteria. Analysis consisted of a descriptive phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out.

Pragmatism and integrated knowledge translation: exploring the compatabilities and tensions

Aim

This paper presents a discussion of the role of the philosophy of pragmatism in the integrated knowledge translation approach to research.

Design

Critical inquiry is used to discuss bringing pragmatic philosophy and the integrated knowledge translation approach to research together to advance nursing knowledge.

Methods

This paper draws from the literature written on the philosophy of pragmatism and from the current literature on knowledge translation. The possibilities, tensions and limitations for underpinning an integrated knowledge translation research approach with pragmatic philosophy are discussed while highlighting the implications this has for creating knowledge aimed at advancing the practice of nursing.

Results

The implications for how nursing knowledge is created in using an integrated knowledge translation approach that is underpinned by pragmatic philosophy are important. Creating nursing knowledge that address the complex problems found in nursing practice is needed. In acknowledging the inseparability of knowledge and practice, researchers, practitioners, policy makers and the public can come together to co‐create knowledge that is useful for the practice of nursing. It is these implications of underpinning an integrated knowledge translation research approach with pragmatic philosophy that are significant in creating nursing knowledge that advances the practice of nursing.

Aboriginal women's experiences of accessing health care when state apprehension of children is being threatened

AIMS

To report findings from a study examining the impact of the threat of child removal on Aboriginal women's experiences accessing of healthcare services.

BACKGROUND

A wealth of data highlights the higher proportion of Aboriginal children in government care in Canada compared with non-Aboriginal children. Aboriginal women experience poorer health outcomes than non-Aboriginal women and face significant barriers to healthcare access. However, little is known about how these phenomena may intersect.

DESIGN

The study was conducted in two phases: (1) a secondary analysis of interviews with Aboriginal women and healthcare providers (n = 7) that were collected for a larger study; and (2) primary interviews with Aboriginal women (n = 9) and healthcare providers (n = 8), conducted between July-October 2011.

METHODS

Postcolonial feminist perspectives and the principles of exploratory, qualitative research guided this ethnographic study. Data were analysed using principles of thematic analysis and interpretive description.

FINDINGS

Aboriginal women whose children are involved with the child protection system often experience complex sociopolitical and economic challenges, which intersect with the threat of apprehension. Such threat did not impact women's decisions to seek healthcare services for their children, but experiences of racism, prejudice and discrimination in mainstream healthcare agencies and the fear of child apprehension influenced their decisions to access health care for themselves in ways that deterred access.

CONCLUSION

Racism, judgment and discrimination towards Aboriginal mothers in healthcare agencies must be addressed. Educating healthcare providers about culturally safe approaches to care is critical to mitigating the ongoing impact of colonialism and its effects on health of Aboriginal people.

Critical cultural competence for culturally diverse workforces: toward equitable and peaceful health care

In this article, we argue that attaining equity, and therefore peace in health care delivery, necessitates that nursing and other health care professions more carefully attend to the sociocultural context in which health care is delivered. That sociocultural context includes culturally diverse patients, families, and communities, as well as health care providers who are themselves culturally diverse. We draw on findings from Almutairi's doctoral research with health care providers in Saudi Arabia to argue for what he has identified as critical cultural competence for health care providers. In so doing, we explicate the complexity of cultural and linguistic issues and power relations induced by race, class, and gender that can contribute to vulnerabilities for health care providers and recipients alike.

Counselling, case management and health promotion for people living with HIV/AIDS: an overview of systematic reviews

Our objective was to identify all existing systematic reviews related to counselling, case management and health promotion for people living with HIV/AIDS. For the reviews identified, we assessed the quality and local applicability to support evidence-informed policy and practice. We searched 12 electronic databases and two reviewers independently assessed the 5,398 references retrieved from our searches and included 18 systematic reviews. Each review was categorized according to the topic(s) addressed, quality appraised and summarized by extracting key messages, the year searches were last completed and the countries in which included studies were conducted. Twelve reviews address topics related to counselling and case management (mean quality score of 6.5/11). Eight reviews (mean quality score of 6/11) address topics related to health promotion (two address both domains). The findings from this overview of systematic reviews provide a useful resource for supporting the development and delivery of evidence-informed support services in community settings.

Igniting an agenda for health promotion for women: critical perspectives, evidence-based practice, and innovative knowledge translation

Health promotion is a set of strategies for positively influencing health through a range of individual, community-based, and population interventions. Despite international recognition that gender is a primary determinant of health and that gender roles can negatively affect health, the health promotion field has not yet articulated how to integrate gender theoretically or practically into its vision. For example, interventions often fail to critically consider women's or men's diverse social locations, gender-based power relations, or sex-based differences in health status. Yet without such analyses, interventions can result in the accommodation or exploitation of gender relations that disadvantage women and compromise their health. In this paper, we seek to ignite an agenda for health promotion for women. We discuss the need for a conceptual framework that includes a sex-gender-diversity analysis and critically considers 'what counts' as health promotion to guide the development and implementation of evidence-based practice. We also consider how innovative knowledge translation practices, technology developments and action research can advance this agenda in ways that foster the participation of a wide range of stakeholders.

Current trends in feminist nursing research

Despite an increasing number of feminist studies in nursing, few reviews on current trends in feminist nursing research have been published. This article aims to explore the current trends in feminist nursing research and provide recommendations for future feminist studies in nursing. In multiple database searches, 207 articles were retrieved. These were reviewed based on 5 criteria: (1) epistemological background, (2) research questions, (3) research participants, (4) research methods, and (5) implications for changes. The review indicated that feminist nurse researchers with diverse epistemological backgrounds adopted new research methods to ask new questions; expanded their focus to include differences in ethnicity, class, sexual preference, and disability; and incorporated these diversities among women in a global context in their research. Based on these findings, recommendations for future feminist research in nursing are outlined.

Othering: difference understood??: a 10-year analysis and critique of the nursing literature

It has been 10 years since Advances in Nursing Science (ANS) published the first article that articulated othering within a nursing framework. This issue's topic, Critique and Replication, provided an opportunity for analysis of the influence of the original ANS article on the visibility and application of othering within nursing literature. Comprehensive searches of major health databases identified 32 publications citing the original ANS article. The analysis focused on exclusionary and inclusionary othering, role taking, and constructions of the other. Results indicate that although othering has become more visible within nursing literature, exclusionary othering dominates. The article concludes with thoughts for moving beyond othering and toward engagement.

Critical inquiry and knowledge translation: exploring compatibilities and tensions

Knowledge translation has been widely taken up as an innovative process to facilitate the uptake of research-derived knowledge into health care services. Drawing on a recent research project, we engage in a philosophic examination of how knowledge translation might serve as vehicle for the transfer of critically oriented knowledge regarding social justice, health inequities, and cultural safety into clinical practice. Through an explication of what might be considered disparate traditions (those of critical inquiry and knowledge translation), we identify compatibilities and discrepancies both within the critical tradition, and between critical inquiry and knowledge translation. The ontological and epistemological origins of the knowledge to be translated carry implications for the synthesis and translation phases of knowledge translation. In our case, the studies we synthesized were informed by various critical perspectives and hence we needed to reconcile differences that exist within the critical tradition. A review of the history of critical inquiry served to articulate the nature of these differences while identifying common purposes around which to strategically coalesce. Other challenges arise when knowledge translation and critical inquiry are brought together. Critique is one of the hallmark methods of critical inquiry and, yet, the engagement required for knowledge translation between researchers and health care administrators, practitioners, and other stakeholders makes an antagonistic stance of critique problematic. While knowledge translation offers expanded views of evidence and the complex processes of knowledge exchange, we have been alerted to the continual pull toward epistemologies and methods reminiscent of the positivist paradigm by their instrumental views of knowledge and assumptions of objectivity and political neutrality. These types of tensions have been productive for us as a research team in prompting a critical reconceptualization of knowledge translation.

Evaluation tool for clinical nursing textbooks: bridging content analysis with evidence

One of the challenges nurse educators face is choosing a textbook that ensures congruency within the discipline of nursing, national and global health priorities, and the mission of the university. This article discusses the development of a tool that evaluates course content concurrently with evidence. The need to critically link content analysis and evidence within clinical nursing textbooks is deemed important given the discipline's imperative to prepare nurses to use the best evidence available for practice. The history and concept of evidence-based nursing practice is explored to develop an operational definition for the tool, which was designed to guide a realistic and expeditious process for this important faculty responsibility.

Integrating intersectionality and biomedicine in health disparities research

Persisting health disparities have lead to calls for an increase in health research to address them. Biomedical scientists call for research that stratifies individual indicators associated with health disparities, for example, ethnicity. Feminist social scientists recommend feminist intersectionality research. Intersectionality is the multiplicative effect of inequalities experienced by nondominant marginalized groups, for example, ethnic minorities, women, and the poor. The elimination of health disparities necessitates integration of both paradigms in health research. This study provides a practical application of the integration of biomedical and feminist intersectionality paradigms in nursing research, using a psychiatric intervention study with battered Latino women as an example.

Historical voices of resistance: crossing boundaries to praxis through documentary filmmaking for the public

This article contextualizes my forthcoming study of a particular instance of resistance in nursing history, the Cassandra Radical Feminist Nurses Network, and examines how nursing history can be produced as public media to advance progressive ideas about nurses and transformative and emancipatory nursing and healthcare. It argues that nurse-generated documentary filmmaking is a natural extension of theory and practice, linking several disciplinary and conceptual fields to support a praxis that is situated at the intersection of nursing, critical theory, and the humanities.

The link between nursing discourses and nurses' silence: implications for a knowledge-based discourse for nursing practice

Much emphasis has been placed on the importance of nurses' articulating what they do to counteract the invisibility of nursing practice. Yet there has been minimal focus on why nurses are silent. This article explores the link between technical and caring discourses and nurses' silence and suggests an alternative discourse that conceptualizes nursing as a knowledge-driven enterprise that shifts the focus from what nurses do to what nurses know by promoting nurses' practice knowledge as a language for articulating their practice.

Knowledge translation in everyday nursing: from evidence-based to inquiry-based practice

The interconnection of theory, evidence, and practice is most often conceptualized as an epistemological enterprise. In this article, we shift the discussion from one that is solely concerned with epistemology to one that considers the significance of ontology and the way in which epistemology and ontology are intricately intertwined in every nursing action. Drawing on deconstructive hermeneutics, we contend that to understand and affect the interconnection of theory, evidence, and practice, an ontological inquiry at the action level is required. Using a nursing practice example, we illustrate the complexities of knowledge translation and how effective integration of knowledge into practice involves an embodied process of ontological inquiry and action. This inquiry process draws on theory and evidence to enlarge and imagine possibilities for action in particular moments, situations, and contexts and rests in a way-of-being in which the interconnection of theory, evidence, and practice is embodied.

Culture, health, and inequalities: new paradigms, new practice imperatives

Abstract

This paper builds upon insights from a programme of research on culture and health that is informed by critical theoretical perspectives. The evidence generated through this research programme is drawn upon to critically examine the assumptions about the prevailing understandings of the links between culture, health, and health inequalities and to illustrate the need for new paradigms of practice. Using the case of children at risk because of their social, cultural, and material circumstances, the tenets of an alternative model of health care practice, the RICH-ER (Responsive, Intersectoral-Interdisciplinary, Child Health – Education and Research) model was introduced and studied.