Health Inequity and Institutional Ethnography: Mapping the Problem of Policy Change

Health equity (HE) is a central concern across multiple disciplines and sectors, including nursing. However, the proliferation of the term has not resulted in corresponding policymaking that leads to a clear reduction of health inequities. The goal of this paper is to use institutional ethnographic methods to map the social organization of HE policy discourses in Canada, a process that serves to reproduce existing relations of power that stymie substantive change in policy aimed at reducing health inequity. In nursing, institutional ethnography (IE) is described as a method of inquiry for taking sides in order to expose socially organized practices of power. Starting from the standpoints of HE policy advocates we explain the methods of IE, focusing on a stepwise description of theoretical and practical applications in the area of policymaking. Results are discussed in the context of three thematic areas: 1) bounding HE talk within biomedical imperialism, 2) situating racialization and marginalization as a subaltern space in HE discourses, and 3) activating HE texts as ruling relations. We conclude with key points about our insights into the methodological and theoretical potential of critical policy research using IE to analyze the social organization of power in HE policy narratives. This paper contributes to critical nursing discourse in the area of HE, demonstrating how IE can be applied to disrupt socially organized neoliberal and colonialist narratives that recycle and redeploy oppressive policymaking practices within and beyond nursing.

Intersection of Climate Change and Health: An Explication of the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

The US National Academy of Medicine released its consensus study for the next decade entitled The Future of Nursing 2020-2030: Charting a Path To Achieve Health Equity (National Academies of Sciences, Engineering, and Medicine, 2021). This paper examines the report, its implications for nursing globally, its focus on systemic, structural, and institutional racism, and the intersection with climate change and deleterious health consequences. The National Academies of Science, Engineering, and Medicine (NASEM) has led in addressing the critical role of the nursing profession in achieving optimal population health outcomes in the US. Yet, relevance exists for nursing in other global areas. The most recent US report focuses on social determinants of health (SDoH) and explicitly addresses climate change as a looming public health threat. An analysis of the key foci of nursing’s role in climate change amidst the critical role of health equity globally is explicated.

Problematizing transitions in relation to correctional centres for people living with HIV: Unpacking the taken for granted.

Transitions into and out of correctional facilities for people living with HIV are a pivotal point in the HIV treatment cascade where adherence metrics are significantly affected. In this paper I use Alvesson and Sandberg’s problematization method of literature analysis to critique and understand the taken-for-granted assumptions underpinning how knowledge is generated within the intersecting fields of HIV, transitions, and corrections. Utilizing problematization, two assumptions underpinning knowledge generation are identified: the linearity of the HIV care continuum model and the tendency to create and perpetuate spatially segregating metaphors of transitions inside versus outside correctional facilities for people living with HIV. These assumptions are discussed in the context of how they shape dominant ways of thinking and practicing in the field. An alternative way to understand transitions for people living with HIV is proposed along with recommendations to guide the HIV care practices of nurses and other healthcare providers.

Nurses as Boundary Actors in Sustainable Health Care: A Discussion Paper

The devastating global health impacts of climate change are becoming more apparent and more frequent. Health care systems are increasingly burdened by the response to these impacts. Paradoxically, as they respond to the negative health effects of climate change, these same resource intense health care systems are contributing to further climate change. Organizations and academics have issued a call to action for health care workers to mitigate climate change and promote environmental sustainability. Nurses are an integral part of health care systems but have been delayed in answering this call. In this paper we argue that nurses are particularly well suited to mitigating climate change in health care systems because their existing role is central to patient care, and as a result they interface with other health care providers and have developed proficiency in articulation work.

Rhizomatic Assemblages: Connecting Climate Change to Nursing Action

Calls for nursing action to address climate change are resounding throughout the nursing community, yet many nurses feel ill-prepared to engage in climate action. As a collective practice discipline, we argue that nursings’ internalized a rigid view of what nursing is and, through self-disciplining practices, actively police our knowledge and practice to conform within a bounded domain that fails to view global issues, such as climate change, as being within the scope of nursing. To build nurses’ climate action capacity, we draw on Deleuze and Guarttari’s (1987) concept of rhizomatic assemblages to make an explicit connection between health and climate change, but also how climate action is a moral imperative in the scope of nursing education and practice. Using examples in the four domains of nursing - education, practice, research, and policy, we present how nurses can engage in coordinated and collaborative efforts both within and outside of ‘traditional’ nursing practice to address the connecting and complicated pathways of a changing climate.

Commitment to Positive Change: Structural Anti-racism Audit of Nursing Education Programs

Amidst many opportunities to create positive change and examine systemic anti-racist decolonial practices (Moorley et al., 2020), we are advocating for concrete action at the root of Nursing education programs by way of a structural anti-racism audit. Based on decolonial and antiracist theory (Garneau et al, 2018; Gaudry & Lorenz, 2018; Kendi, 2019; McGibbon & Etowa, 2009), we propose to engage in systems-level action (McGowan et al, 2020; Mulgan, 2006; van Wijk t al., 2018) and examine institutional structures through an anti-racist framework (Sutton, 2002) based on audit processes for equity, diversity, and inclusion (Chun & Evans, 2019; Olson, 2020; Skrla et al., 2004; Skrla et al., 2009; Zion, et al., 2020). Structures within and influencing curriculum, pedagogy, evaluation will be examined to advance systems-level anti-racist practices and policies (Moorley et al., 2020) with Nursing students, faculty, staff, leadership as a foundation for equitable Nursing education and care (National Collaborating Centre for the Determinants of Health, 2014). This anti-racist approach to Nursing education reform promises to address the pernicious harms of discrimination in the healthcare system, as noted in a recent report on Indigenous-specific racism (Turpel-Lafonde, 2020). We aim to conduct a strengths-based structural anti-racism audit that does not lose sight of disparities (Fogarty et al., 2018). We are currently conducting a literature review and audit framework development and will pilot the structural anti-racism audit in fall 2021. Rather than requesting endorsement of our project, and with respect for diverse approaches, we asked Nursing colleagues to sign this letter to demonstrate shared commitment to critically examine racist challenges and anti-racist opportunities in their Nursing program at a structural level (see this survey: https://forms.gle/tZPN2z1kUoARNPp1A

Moving beyond the rhetoric of social justice in nursing education

We argue that while the discipline of nursing aligns with the ideals of social justice and anti-racism, it has been challenging for nurse educators to translate these ideals into practice. In this discussion paper, we explore these challenges. Of note, there is little guidance for nurse educators to support student knowledge development in addressing the complex issues surrounding anti-racist and anti-discriminatory practice. Accordingly, we utilized Peggy Chinn’s Peace and Power framework as a guide to develop an anti-racist practice that is underpinned by critical pedagogy. Our aim is to provide teaching and learning strategies for nurse educators to address racism, discrimination, and oppression in undergraduate nursing learning environments. Implications of this article include guidance for nurse educators who are committed to anti-racist pedagogical practice.

Etuaptmumk (Two-Eyed Seeing) and Ethical Space: Ways to Disrupt Health Researchers’ Colonial Attraction to a Singular Biomedical Worldview

Indigenous research on Turtle Island has existed for millennia, where knowledge(s) to work with the land and its inhabitants are available for next generations. These knowledge systems exist today but are rarely viewed as valid biomedical ‘facts’ and so are silenced. When Indigenous knowledge is solicited within health research, the knowledge system is predominantly an ‘add-on’ or is assimilated into Western understandings. We discuss disrupting this colonial state for nurse researchers. Two concepts rooted in Indigenous teachings and knowledges, Etuaptmumk (Two-Eyed Seeing) and Ethical Space, shed light on ways to disrupt health researchers’ attraction to a singular worldview which continue to privilege Western perspectives. Knowledge rooted in diverse knowledge systems is required to challenge colonial relations in health research and practice. A synergy between Etuaptmumk and Ethical Space can support working with both Indigenous and biomedical knowledge systems in health research and enhance reconciliation.