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.

Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation

Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.

Social and Structural Determinants of Health: Exploring Occupational Therapy's Structural (In)competence

Background: In high-income countries, such as Canada, 50% of health outcomes are attributable to social determinants. Occupational opportunities are also structurally determined, yet these inequities are obscured by the White, Western assumptions and ableist neoliberal ideology in which the profession is deeply rooted. Purpose. To highlight the impact of structural injustices and other social determinants of health and occupation; explore the occupational therapy profession's structural competence; and build on existing knowledge to advance an agenda for action on injustice and inequity for the occupational therapy profession. Key issues. Occupational therapy's failure to prioritize education, research and action on systemic injustices and other social determinants of health and occupation reflects a lack of commitment to achieving the World Federation of Occupational Therapists' Minimal Standards. Implications. If occupational therapy is to advance knowledge and practices that address inequities in the social and structural determinants of health and occupation, we must strive towards structural competence.

Critiquing the Canadian Model of Client-Centered Enablement (CMCE) for Indigenous Contexts

Background. The Truth and Reconciliation Commission of Canada outlines the need for health care professionals to create more welcoming spaces for Indigenous Peoples. The scope of occupational therapy is continually expanding-yet the profession itself is grounded in and derived from a dominant Eurocentric worldview, and practice is designed to serve a homogenous Western populace. Purpose. To critically examine the Canadian Model of Client-Centered Enablement (CMCE) for its value within Indigenous contexts. Key Issues. The CMCE is positioned as a client-centered model, however there is a clear hierarchical client-professional relationship threaded throughout. Concepts such as enable, advocate, educate, coach, and coordinate demonstrate paternalistic authority, lacking reciprocity, knowledge-sharing, and power redistribution. Implications. Reimagining health care relationships as entrenched in social interconnectedness demands critical reflection and action. A model of practice that endorses social change and actively addresses colonial power inequities must root its paradigmatic foundations in postcolonial views of health care as a social relationship.

Occupational Therapy Roles in an Indigenous Context: An Integrative Review

BACKGROUND.

Indigenous peoples experience health inequities linked in part to lack of access to culturally-relevant health care. The Truth and Reconciliation Commission of Canada (TRC) calls on all health professionals, including occupational therapists, to reduce health inequities through improved work with Indigenous communities.

PURPOSE.

This integrative review of the literature explores how occupational therapists can improve their work with Indigenous peoples.

KEY ISSUES.

Communication and building relationships are central to effective work with Indigenous communities, along with reciprocity regarding knowledge exchange. Issues surrounding service provision are a significant concern, yet improvements are unlikely to be effective unless therapists can critically examine the (mainstream) Western cultural assumptions that infuse the profession and their own practices.

IMPLICATIONS.

Though nascent, there are identified directions for occupational therapists to meet the TRC's calls for more competent health care. Researchers should explore best ways for therapists to critically interrogate taken-for-granted professional assumptions mired in Western colonialism.

Incarcerated aboriginal women's experiences of accessing healthcare and the limitations of the 'equal treatment' principle

Background

Colonization continues in Australia, sustained through institutional and systemic racism. Targeted discrimination and intergenerational trauma have undermined the health and wellbeing of Australia’s Aboriginal and Torres Strait Islander population, leading to significantly poorer health status, social impoverishment and inequity resulting in the over-representation of Aboriginal people in Australian prisons. Despite adoption of the ‘equal treatment’ principle, on entering prison in Australia entitlements to the national universal healthcare system are revoked and Aboriginal people lose access to health services modelled on Aboriginal concepts of culturally safe healthcare available in the community. Incarcerated Aboriginal women experience poorer health outcomes than incarcerated non-Indigenous women and Aboriginal men, yet little is known about their experiences of accessing healthcare. We report the findings of the largest qualitative study with incarcerated Aboriginal women in New South Wales (NSW) Australia in over 15 years.

Methods

We employed a decolonizing research methodology, ‘community collaborative participatory action research’, involving consultation with Aboriginal communities prior to the study and establishment of a Project Advisory Group (PAG) of community expert Aboriginal women to guide the project. Forty-three semi-structured interviews were conducted in 2013 with Aboriginal women in urban and regional prisons in NSW. We applied a grounded theory approach for the data analysis with guidance from the PAG.

Results

Whilst Aboriginal women reported positive and negative experiences of prison healthcare, the custodial system created numerous barriers to accessing healthcare. Aboriginal women experienced institutional racism and discrimination in the form of not being listened to, stereotyping, and inequitable healthcare compared with non-Indigenous women in prison and the community.

Conclusions

‘Equal treatment’ is an inappropriate strategy for providing equitable healthcare, which is required because incarcerated Aboriginal women experience significantly poorer health. Taking a decolonizing approach, we unpack and demonstrate the systems level changes needed to make health and justice agencies culturally relevant and safe. This requires further acknowledgment of the oppressive transgenerational effects of ongoing colonial policy, a true embracing of diversity of worldviews, and critically the integration of Aboriginal concepts of health at all organizational levels to uphold Aboriginal women’s rights to culturally safe healthcare in prison and the community.

You just have to have other models, our DNA is different: the experiences of indigenous people who use illicit drugs and/or alcohol accessing substance use treatment

Objectives

In Canada, and elsewhere, indigenous peoples who use illicit drugs and/or alcohol (IPWUID/A) commonly experience vulnerability and a disproportionate burden of harm related to substance use. In Vancouver, Canada, there are concerns that inequitable access, retention, and post treatment care within substance use treatment programs may exacerbate these harms. This study sought to understand the policies and practices with the potential to produce inequities and vulnerabilities for IPWUID/A in substance use treatment, situate the vulnerabilities of IPWUID/A in substance use treatment within the context of wider structural vulnerability of IPWUID/A, and generate recommendations for culturally safe treatment options.

Methods

This research employed a qualitative indigenous-led community-based approach using the indigenous methodology of talking circles to explore experiences with substance use treatment. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited peers’ experiences of substance use treatment and were audio-recorded and transcribed.

Results

The talking circles identified three key themes that illustrated the experiences of IPWUID/A when accessing substance use treatment: (a) barriers to accessing detox and substance use treatment; (b) incompatible and culturally inappropriate structure, policies, and procedures within treatment programs, such as forced Christianity within treatment settings; and (c) the importance of culturally relevant, peer-led substance use treatment programming.

Discussion

Our work demonstrates that some IPWUID/A have limited access to or retention in mainstream treatment due to excessive waiting times, strict rules, and lack of cultural appropriate care while in treatment. However, IPWUID/A narratives revealed strategies that can improve IPWUID/A access and experiences, including those informed by the diverse perspectives of IPWUID/A and those that include trauma-informed and culturally safe practices.

Decolonizing and Indigenizing pharmacy education in Canada

BACKGROUND

An emphasis on equity, diversity, and inclusion is growing within the field of education, including health professions education. In particular, no published literature exists regarding decolonizing and Indigenizing pharmacy education. Post-secondary pharmacy programs in Canada have a unique opportunity to learn from the decolonizing and Indigenizing practices observed in the educational programs of other health professions and post-secondary institutions and become international leaders in this area.

METHODS

Literature searches on PubMed, MEDLINE, ERIC (Ovid), iPortal, and PsycINFO were performed, revealing zero articles on decolonizing and/or Indigenizing pharmacy education. Search terms were expanded to include all health professions education programs with published literature on decolonizing and Indigenizing practices. All publications that included either or both terms (decolonizing and/or Indigenizing) and within any realm of health professions education (e.g., curriculum, assessment, evaluation, instructional design) were reviewed.

RESULTS

Literature on decolonizing and Indigenizing health professions education in health disciplines, such as nursing and speech pathology, were reviewed. In conjunction with literature on decolonization and Indigenization of education, with a focus on post-secondary institutions, a number of strategies are proposed to decolonize and Indigenize pharmacy education.

IMPLICATIONS

Findings from this review will better inform post-secondary pharmacy education programs to engage in decolonization and Indigenization practices. Engaging in decolonization and Indigenization of pharmacy education is expected to not only improve the educational experience of Indigenous students in pharmacy programs, but also improve the care received by Indigenous patients from all graduates of pharmacy.

Decolonizing "Community" in Community Psychology

This article endeavors to craft pathways that disrupt dominant modes of knowledge production and imagine nonhierarchical epistemic possibilities in teaching community psychology. The first section of the article discusses how the decolonial turn inspires new ways of advancing the critical social justice agenda of community psychology. Drawing upon decolonial frameworks and allied critical theories, I outline how coloniality is entrenched in the ways we theorize, research, and teach about "communities"-and the importance of decolonizing the construct of community in community psychology. The second section presents three vignettes capturing student responses to endeavors in the classroom to dismantle notions of community-as-Other. I interpret these vignettes through a decolonial perspective in order to highlight how colonial discourses of community can be produced and potentially maintained in the classroom context. The third section outlines some pedagogical and curricular recommendations as a possible pathway toward decolonizing notions of community. I conclude with some questions/provocations geared toward advancing decolonial and liberatory praxis in community psychology.

Embodying Decoloniality: Indigenizing Curriculum and Pedagogy

Decolonizing may be conceptualized through the interconnected processes of deconstructing colonial ideologies and their manifestations, and reconstructing colonial discourse through Indigenous counter'narratives. Given that the field of psychology is firmly rooted in colonial systems of thought, it is integral that professionals in psychology and allied disciplines engage in meaningful, beneficial work with Indigenous communities through actively decolonizing and Indigenizing research, practice, and education. This paper illustrates an embodied approach to decoloniality through Indigenizing curriculum and pedagogy in community psychology and allied fields. Drawing on both Indigenous research and experience, the author presents a framework for decolonizing and Indigenizing curriculum through: (a) deconstructing what is not working in service provision with Indigenous communities; (b) restor(y)ing colonial narratives through community'based Indigenous perspectives that highlight the importance of love, good relationships, Indigenous knowledge, local approaches to wellness, responsibility, identity/belonging, and the land/earth in community wellness; and (c) how Indigenous best practices may be engaged through community'based processes and transformations. The author then discusses how Indigenous pedagogies may be enacted using Indigenous protocols and ethics, talking circles, storytelling, and land'based pedagogies. The paper concludes with the author's reflections on the challenges and rewards of decolonizing and Indigenizing in conventional postsecondary educational systems.

Decolonizing Community Psychology by Supporting Indigenous Knowledge, Projects, and Students: Lessons from Aotearoa New Zealand and Canada

Community psychology has long stood as a social justice agitator that encouraged reformation both within and outside of the academy, while keeping a firm goal of building greater well-being for people in communities. However, community psychology's historically Euro-centric orientation and applied, interventionist focus may inadvertently promote colonial agendas. In this paper, we focus on the example of Indigenous Pacific peoples, drawing upon experience working among Indigenous iTaukei Fijian communities and with Indigenous frameworks for promoting student success in Aotearoa New Zealand and Canada. We outline how community psychology curricula can strive toward decolonization by (a) teaching students to respectfully navigate complexities of Indigenous knowledge and traditions that contest colonial ways of being and doing, (b) act as facilitators who build toward collaborative community projects and model this research practice to students, and (c) boost Indigenous student success by fostering relationships with instructors and fellow students that are embedded within the relational model of self that is often absent in individualistic-oriented Western academic settings.