The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time

Science of Unitary Human Beings: Toward Anti-racist Actions for Human Environment Wellbecoming

Rogers' Science of Unitary Human Beings (SUHB) and several theories that emanate from Rogers' work contain foundational concepts that may lend themselves toward nursing actions to address important social justice mandates, to advocate and to act for equity, and to uproot systems of oppression and racism in nursing. However, at the same time, theoretical concepts such as power arising from ascendant theories of SUHB are often used with little to no critical reflection for past and present-day histories of racism and power inequities in nursing and in society writ large. Using concepts related to SUHB such as integrality, turbulence, power, and patterning, we critically explore the potential of developing anti-racism reflections and actions through 3 theories: Barrett's Knowing Participation in Change; Butcher's Kaleidoscoping in Life's Turbulence; and Smith's Turbulence-Ease in the Rhythmic Flow of Patterning. We acknowledge that SUHB was/is largely developed within a framework of whiteness by scholars who were/are working from academic positions and social identities of societal safety and privilege. This requires nurses to reflect on how that history shapes SUHB. We also acknowledge the urgent need for ongoing anti-racism and justice work by nurses. As a call to action, we suggest a start by critically building upon existing theoretical foundations in SUHB to develop a more explicit anti-racist theorizing-praxis in nursing for the wellbecoming of humans and nonhumans alike.

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand

AIM

To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.

DESIGN

An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens.

METHODS

Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles.

DATA SOURCES

Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023.

RESULTS

Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing.

CONCLUSION

Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism.

REPORTING METHOD

This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPLICATIONS FOR THE PROFESSION

Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care.

IMPACT

This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

Nursing students' reactions to a graphic novel: A multi-national descriptive qualitative study

BACKGROUND

Undergraduate nursing programme teaching and learning methods and content must evolve to meet the changing evidence base, healthcare context and needs of new generations of nurses. Art-based and narrative methods have been employed to help student nurses explore complex issues, including patient experiences of health and illness, person-centred care and social determinants of health. One creative visual teaching tool is the graphic novel. However, little is known about student perceptions of graphic novels and how they facilitate student nurses' reflection, engagement and learning. Gaining such an understanding may be of especial value for teaching Generation Z students who are used to interacting with complex visual imgery and prefer alternatives to text-heavy documents.

OBJECTIVE

The objective was to explore student nurses responses to Vivian, and graphic novels in general, as teaching resources in undergraduate nursing curricula in England, Sweden, and Aotearoa New Zealand.

DESIGN

A social constructionist critical framework informing a descriptive qualitative study.

SETTING AND PARTICIPANTS

Undergraduate nursing students in Sweden, England, and Aotearoa New Zealand.

METHODS

Data were collected using focus groups and semi-structured interviews. Braun & Clark's method for thematic analysis was used to analyse the data.

RESULTS

Three themes were developed: 1) reflections on clinical practice, including reflections on palliative care, holistic care for older people and communication between patients and staff; 2) graphic novels' usefulness as a teaching resource, in which students regarded them as an alternative way to learn; and 3) Vivian as a form of the graphic novel.

CONCLUSION

The graphic novel Vivian helped nursing students engage in critical reflection and with challenging theoretical concepts. It, and graphic novels in general offer an alternative to print-based texts, which may heighten their appeal to Generation Z learners.

Examining and mitigating racism in nursing using the socio-ecological model

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.

Trauma- and Violence-Informed Empowering Care for Sexual Assault Survivors

BACKGROUND

Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity.

AIM

To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens.

METHODS

We used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board.

RESULTS

In a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up).

CONCLUSIONS

These behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.

The concept of intersectionality in bioethics: a systematic review

BACKGROUND

Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a "traveling concept", which also made its way into bioethical research.

METHODS

We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included.

RESULTS

The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies.

CONCLUSIONS

This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions.

Nursing student perceptions of racism and health disparities in the United States: A critical race theory perspective

BACKGROUND

Limited research has been done on nursing students' awareness of racial disparities and their readiness to address bias and racism in clinical practice.

PURPOSE

This study investigated nursing students' perceptions of how racial disparities affect health outcomes, including maternal outcomes, in the United States.

METHODS

Interpretive description was used and supported by the critical race theory as a framework to guide the data collection, analysis, and interpretation to understand participants' perceptions surrounding racism and health disparities.

DISCUSSION

Nurse educators should guide students to look beyond individual behavioral and risk factors and consider systemic issues as a leading contributors to health disparities.

CONCLUSION

The most critical finding was the lack of participants' understanding of systemic racism and its impact on health disparities. While they often attributed racial disparities to low socioeconomic status and lack of education, they did not understand the relationships between social determinants of health and systemic racism.

Intersectionality in nursing research: A systematic review

AIM

This systematic literature review aimed to identify, appraise and synthesize available research studies that apply intersectionality in nursing research.

DESIGN

Systematic review.

DATA SOURCES

Empirical and theoretical nursing studies published before February 2022 were identified from the PubMed and CINAHL databases. Studies were eligible for inclusion if they substantially covered the topics of intersectionality and nursing, had undergone peer-review, and were written in English.

REVIEW METHODS

The PRISMA 2020 statement for reporting systematic reviews was used to report findings. The Joanna Briggs Institute Critical Appraisal tools were used to assess the quality of the included research studies.

RESULTS

Out of 331 identified studies, 60 studies were substantially about nursing and intersectionality, and were included in the review. There are a myriad of ways that the concept of intersectionality has been adopted in nursing research. Furthermore, there was great heterogeneity in the definition and application of the concept of intersectionality, and only a few studies were empirical.

CONCLUSION

There is a need for robust and clear framing of how the concept of intersectionality is defined and understood in nursing research. There is also a need for more empirical research effectively adopting the concept of intersectionality to enhance our understanding of how health inequities operate within the field of nursing.

NO PATIENT OR PUBLIC CONTRIBUTION

No patients, service users, caregivers or members of the public were involved in this work.

Addressing systemic racism and intergenerational transmission of anxiety using Bowenian family therapy with African American populations: A Discursive paper

AIM

To examine the intergenerational impact of systemic racism on mental health, depicting the evolution and patterns of anxiety symptoms and the application of the Bowenian family therapy to understand the interrelatedness and long-standing impact of intergenerational trauma in African American families. This article highlights interventions that increase awareness of and promotes physical and mental health for African American populations.

DESIGN

Discursive Paper.

METHOD

Searching literature published between 2012 and 2022 in PubMed, SCOPUS, EBSCO Host and Google Scholar, we explored factors associated with systemic racism and generational anxiety.

DISCUSSION

Evidence-based literature supports the application of the Bowenian family therapy theoretical framework to understand the intergenerational impact of systemic racism and to address the transmission of anxiety symptoms in African American  populations.

CONCLUSION

Culturally appropriate interventions are needed to decrease anxiety symptoms in an attempt to heal intergenerational trauma and to improve family dynamics in African American populations.

IMPACT TO NURSING PRACTICE

Nurses play an integral role in providing holistic quality patient-centred care for African American populations who have experienced racial trauma. It is critical for nurses to implement culturally responsive and racially informed care with patients that focuses on self-awareness, health promotion, prevention and healing in efforts to address racial trauma. Application of Bowenian family therapy can aid in the reduction of both intergenerational transmission of racial trauma and generational anxiety.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or drafting of this discursive paper. The authors reviewed the literature to develop a discussion.

Building Solidarity with Black Nurses to Dismantle Systemic and Structural Racism in Nursing

Systemic and structural racism in nursing have profound impacts on Black People, Indigenous Peoples, and People of Color. They contributed to underrepresentation in faculty, senior nurse executives, and presidents' positions in academic and healthcare organizations, physical and mental health issues in racialized groups. This quality improvement study described ways in which the Black Nurses Task Force of the Registered Nurses Association of Ontario can build solidarity with nursing and government organizations to dismantle systemic and structural racism in nursing. This study used a structured online survey, comprised of quantitative and qualitative questions. The qualitative data were analyzed using interpretative thematic analysis and the quantitative data were analyzed with descriptive statistics. Findings showed that 88% of participants experienced racism and 63% said racism affected their mental health. Three themes emerged from the qualitative data: Social support for Black nurses, accountability of leaders and solidarity with Black nurses. These findings demonstrated the urgent need to dismantle systemic and structural racism in nursing.

Embedding LGBTQI+ competency into nursing education: Formative evaluation of an interdisciplinary project

BACKGROUND

In order to avoid perpetuating inequities faced by lesbian, gay, bisexual, transgender, queer, intersex, and other minority (LGBTQI+) communities, future nurses need to recognize and resist discriminatory, oppressive, heteronormative and cisnormative health and social systems.

OBJECTIVES

To share the development, embedding, and formative evaluation of an interdisciplinary project to improve LGBTQI+ health content across an undergraduate nursing curriculum.

METHODS

This paper describes a collaborative interdisciplinary project to embed LGBTQI+ health content across a 3-year undergraduate nursing degree. An anonymous cross-sectional online survey was sent to 87 student nurses enrolled in the final semester of their undergraduate degree. The survey included six Likert scale-type questions and five open-ended questions. Qualitative data were analyzed by inductive, reflexive thematic analysis.

RESULTS

Most students rated the topic relevant 'extremely' relevant (77 %) to nursing. Students' self-reported comfort discussing LGBTQI+ health in class varied from 'extremely' (42 %) through to 'not at all' (6 %). Thematic analysis of student responses to open-ended questions identified five themes: (1) Becoming aware of LGBTQI+ diversity; (2) Personal values and beliefs; (3) Learning in order to improve clinical encounters; (4) Inconsistency and a lack of incorporation across the curriculum; and (5) (Dis)comfort in the learning environment.

CONCLUSIONS

Opportunities to better embed LGBTQI+ competency included clear acknowledgement of wider systems of power and oppression, integration and consistent modeling by nursing faculty, and linkage of content to other equity issues to address the intersectional nature of inequities.

Time for different stories: Reflections on IPONS panel addressing current debates in nursing theory, education and practice

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.

Defusing Land Mines: Keywords About Race in Nursing Education

BACKGROUND

The call for nurse educators to facilitate conversations about racism with learners has become inescapable. Yet, nurse educators in the United States indicate they feel unprepared or uncomfortable leading classroom conversations about race.

METHOD

Keyword analysis maps the multiple meanings of vocabulary, creating a common foundation for productive dialogue. Selection of keywords is subjective, but each keyword must meet three criteria: a term that is in common use, definitions that change according to time and perspective, and use that illuminates larger phenomena.

RESULTS

Five keywords when teaching about racism are Caucasian, colorblind, diversity, reverse racism, and underrepresented minority. Each keyword carries connotations that may be perceived as upholding egalitarian ideals without acknowledging the pernicious mechanisms of racism itself.

CONCLUSION

Familiarity with keywords provides educators with solid ground for engaging in often ambiguous and troubling dialogues about racism. [J Nurs Educ. 2022;61(7):408-412.].

Structural Racism in America: A Summative Content Analysis of National Nursing Organization Statements

The public and brutal death of Black American George Floyd was a tragedy that had the potential to push the profession of nursing toward a perspective transformation. A summative content analysis of 49 professional nursing organization statements served as a pilot to explore the research question: Did the nursing profession experience a perspective transformation relating to racial justice and health equity following the death of George Floyd? Texts from the statements were analyzed for the presence of an equity lens, which is necessary for a perspective transformation. Each statement was assigned a rating score to determine the organization's readiness for a perspective transformation based on equity competencies adapted from CommonHealth Action. Findings demonstrated that the nursing profession is beginning to articulate the issue of racism in health care and is committed to advocating for patients of color; however, further understanding of the historical context of structural racism and the development of meaningful policy remains necessary for the profession to experience a perspective transformation.

Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review

AIM

This review aimed to identify the nature of racism in the nurse-patient relationship and summarize international research findings about it.

DESIGN

A scoping review of the international literature.

DATA SOURCES

The search process encompassed three main online databases of PubMed (including MEDLINE), Scopus and Embase, from 2009 until 2021.

REVIEW METHODS

The scoping review was informed by the Levac et al.'s framework to map the research phenomenon and summarize current empirical research findings. Also, the review findings were reflected in the three-dimensional puzzle model of culturally congruent care in the discussion section.

RESULTS

The search process led to retrieving 149 articles, of which 10 studies were entered into data analysis and reporting results. They had variations in the research methodology and the context of the nurse-patient relationship. The thematical analysis of the studies' findings led to the development of three categories as follows: bilateral ignition of racism, hidden and manifest consequences of racism and encountering strategies.

CONCLUSION

Racism threatens patients' and nurses' dignity in the healthcare system. There is a need to develop a framework of action based on the principles of culturally congruent care to eradicate racism from the nurse-patient relationship in the globalized context of healthcare.

IMPACT

Racism in the nurse-patient relationship has remained a relatively unexplored area of the nursing literature. It hinders efforts to meet patients' and families' needs and increases their dissatisfaction with nursing care. Also, racism from patients towards nurses causes emotional trauma and enhances job-related stress among nurses. Further research should be conducted on this culturally variant phenomenon. Also, the participation of patients and nurses should be sought to prohibit racism in healthcare settings.

An Overdue Reckoning on Racism in Nursing

ABSTRACT

In response to the killing of George Floyd on May 25, 2020, and with a sense of urgency, the authors created and conducted a unique approach-a reckoning-to confronting racism in nursing. The project began with a series of five online discussions centering on the voices of nurses of color, followed by further ongoing discussions aimed at building antiracist capabilities for all participating nurses. This article describes the implementation and early outcomes of the project and provides its underlying principles, which are based on insights from activists and scholars whose work has focused on antiracist guidelines.

Application of Postcolonial Feminist Theory, Chicana Feminist Thought, and Black Feminist Thought in Analyzing the Mental Health Needs of Latina Migrant Farmworkers: A Shared Legacy

The purpose of this theoretical article is to analyze the utility of postcolonial, Black, and Chicana feminist frameworks to inform nursing research and practice specific to mental health needs of Latina women migrant farmworkers. Twentieth-century Western feminist narratives overlooked the intersecting systems of oppression experienced by women of color, including Latina women. Feminist epistemologies are useful in understanding the complex sociopolitical contexts that have impacted women's health outcomes and well-being. This analysis is critical to shaping nursing care that meets the unique health needs of migrant farmworker women while considering their sociopolitical realities.

Undoing Racism and Mitigating Bias Among Healthcare Professionals: Lessons Learned During a Systematic Review

BACKGROUND

Research indicates that the implicit biases and racist attitudes of healthcare workers are fundamental contributing factors to race-based health inequities. However, few studies and reviews appear to have examined the provision and effects of anti-racist education and training on post-licensure healthcare workers. The purpose of this systematic literature review was to explore what research methods are being used to ascertain the training healthcare workers are receiving post-licensure and to identify the goals and outcomes of this training.

METHODS

Using PubMed, CINAHL, and Google Scholar databases, peer-reviewed articles meeting inclusion criteria were identified and reviewed by the authors from March through October of 2020 in alignment with the renewed national focus on anti-racism and racial justice. Studies or initiatives involving students were excluded as were commentaries on studies and studies not specific to racism or anti-racism.

RESULTS

Eleven articles were identified as meeting stipulated inclusion criteria. Few were outcome studies (n = 3), and many articles did not clearly delineate training methods, content, or outcomes assessed. Identified methods included group discussion, case studies, and online modules. Reported outcomes included increased self-awareness of implicit biases and racism. Only two studies focused specifically on nurses, with the majority of studies centering on physicians (n = 5).

CONCLUSIONS

A considerable knowledge gap exists regarding effective methods, tools, and outcomes to use for undoing racism and mitigating bias in healthcare professionals. Nothing less than a seismic paradigm shift is called for, one in which an anti-racist perspective informs all healthcare education, research, and practice.

An integrative literature review and critical reflection of intersectionality theory

Intersectionality theory has been used by nursing scholars to offer insight into how multiple systems of oppression mutually interact to impact health and to examine how multiple social modes of existence shape individual and group experiences of health inequality. The application of intersectionality theory, however, requires a reflexive critical lens to more effectively inform nursing science and practice. We draw on a comprehensive integrative literature review to offer a critical reflection by considering the semantic and structural consistency, generalizability, simplicity and complexity, and the utility and value of intersectionality theory to nursing science and practice. If nurses are to effectively utilize intersectionality theory, it is essential that we are able to analyze and speak to the multiple modes of existence based on historical, social, economic, and political processes that impact the health of those we serve. Critical examination of intersectionality enables nurses to further consider its value and usefulness when applied to nursing science and practice, particularly when addressing health and social inequalities.

Nurses as agents of disruption: Operationalizing a framework to redress inequities in healthcare access among Indigenous Peoples

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.