A reflection on the decolonization discourse in nursing

Decolonizing HIV Nursing for Health Equity: Challenges, Strategies, and Paths Forward

ABSTRACT

This commentary explores the imperative of decolonizing HIV nursing within the global context of HIV care. Acknowledging historical colonial influences, it examines persistent disparities and challenges in current HIV nursing practice, emphasizing the need for transformative approaches that center marginalized voices and challenge hegemonic structures. Drawing on frameworks such as critical race theory and postcolonial perspectives, it advocates for culturally responsive care models and community-led initiatives to address health inequities. Case studies from diverse global settings illustrate successful decolonized approaches, highlighting the impact of inclusive policies and partnerships in improving health outcomes. Recommendations include reframing cultural competency training in nursing education, promoting diverse health care leadership, and prioritizing research on intersectional health disparities. By embracing decolonization, nurses can lead efforts toward a more equitable and effective global HIV response, ensuring dignity and empowerment for all affected communities.

Building a Pluriverse of Nursologies: A paradigm for decolonial theory and knowledge development in nursing

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.

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.

Decolonizing nursing for health equity: A scoping review

BACKGROUND

The recent push to "decolonize nursing" has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword.

PURPOSE

This article clarifies "decolonizing nursing" by addressing the following questions: (a) How has "decolonizing nursing" been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity?

METHODS

We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included.

DISCUSSION

"Decolonization" has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes.

CONCLUSION

Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism's historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

Decolonizing approaches for transforming academic culture through authentic expression, community, and belonging

The National Commission to Address Racism in Nursing (2022) cites structural and systemic racism in nursing education as significant factors contributing to retention disparities among minoritized students. Establishing a culture of belonging was outlined in the Commission's report as essential to addressing these disparities. At the University of California, Irvine, the Centering Youth & Families for Empowerment and Resilience (CYFER) Lab embraces belonging and collectivity as core principles. The CYFER Lab supports the well-being and professional development of minoritized and/or marginalized health sciences students through community-engaged research and self-care practices. Our commentary examines three core Lab practices-Buen Vivir, prioritizing well-being, and nonhierarchical structures-through the lens of decolonization, an approach we posit can enhance inclusivity and belonging in nursing education. The achievements and growth of our Lab members, along with our expanding body of community-based research, demonstrate that such practices provide an effective alternative model for success in research and education.

Do no harm: A call to action by nurses to dismantle structural violence against LGBTQ+ youth

This commentary addresses structural violence - an overlooked and unrecognized harm within nursing. Structural violence within nursing practice refers to the violent impacts of racism, classism, homophobia, and transphobia as well as other biases on vulnerable and underprivileged groups. As one of the largest and most trusted health professions, collectively nursing has the power to leverage their influence to mitigate the harmful effects of structural violence when caring for LGBTQ+ youth.

Decolonizing nursing education: Reflecting on Paulo Freire's pedagogy of the oppressed

Historically, nursing education's foundation has been framed by colonial practices of whiteness, which serves as a fulcrum for oppression, Western epistemic ideology, racial injustice, and health inequity. As a microcosm of the broader academy, nursing education must pivot to dismantle practices impeding the advancement of the profession and move to decolonize processes of professional edification. Decolonization is not a metaphor; it requires unlearning the deep socialization of Eurocentric perspectives embedded in nursing education and relearning in a new, inclusive manner that embraces historically marginalized knowledge systems and experiences. This paper aims to operationalize what this decolonization process would look like for nursing education while reflecting on Paula Freire's Pedagogy of the Oppressed. The authors will highlight the interrelationship of the main concepts of Paulo Freire's critical pedagogy, including liberation, critical consciousness, dialog, humanization, dehumanization, problem posing, and banking education.

Advancing health equity in prelicensure nursing curricula: Findings from a critical review

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.

From informed to empowered consent

Informed consent is ethically incomplete and should be redefined as empowered consent. This essay challenges theoretical assumptions of the value of informed consent in light of substantial evidence of its failure in clinical practice and questions the continued emphasis on autonomy as the primary ethical justification for the practice of consent in health care. Human dignity-rather than autonomy-is advanced from a nursing ethics perspective as a preferred justification for consent practices in health care. The adequacy of an ethic of obligation (namely, principlism) as the dominant theoretical lens for recognising and responding to persistent problems in consent practices is also reconsidered. A feminist empowerment framework is adopted as an alternative ethical theory to principlism and is advanced as a more practical and complete lens for examining the concept and context of consent in health care. To accomplish this, the three leading conceptions of informed consent are overviewed, followed by a feminist critique to reveal practical problems with each of them. The need for a language change from informed to empowered consent is strongly considered. Implications for consent activities in clinical practice are reviewed with focused discussion on the need for greater role clarity for all involved in consent-beyond and inclusive of the patient-physician dyad, as the practice and improvement of consent is necessarily a transdisciplinary endeavour. Specific concrete and practical recommendations for leveraging nursing expertise in this space are presented. Perhaps what is most needed in the discourse and practice of consent in health care is nursing.