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Posts tagged ‘Emancipatory Nursing’

Theory of Social Justice in Nursing


Our current featued article is titled “Emancipatory Nursing Praxis: A Theory of Social Justice in Nursing” by Robin R. Walter, PhD, RN, CNE.  In the short video below, Dr. Walter shares what she sees as the important take-aways from her study.  I hope you will not only view the video, but also download this article from the ANS website, then return here to share your comments and ideas related to her work!

Issue Topic Planned on Emancipatory Nursing


We are delighted to announce the addition of a new issue topic for ANS Volume 41 Number 4!  Manuscripts are due April 15, 2018, so there is ample time to wrap up your project and plan for this issue!  Here are the details:

Emancipatory approaches to nursing research and practice have escalated in the context of major political and cultural upheavals worldwide. For this issue we seek scholarship that informs emancipatory nursing practice and research. We welcome research reports that use emancipatory methodologies, emancipatory philosophic analyses, critical and feminist critiques of existing discourses and practices, description of and evidence supporting emancipatory nursing practices.  Date manuscripts are due: April 15, 2018.

Moving beyond Rhetoric to Action: Understanding Inequalities to Health Care Services


Rhetoric admonishing nurses and other health care professionals to address inequalities in health care is a common message; it is less often that we learn about concrete action to do just that!  In our current featured article, titled “Understanding Inequalities in Access to Health Care Services for Aboriginal People: A Call for Nursing Action” the authors describe a research initiative they undertook in partnership with Aboriginal people to create meaningful action addressing barriers that result in inequalities.  The authors, Brenda L. Cameron, PhD, RN; Maria del Pilar Carmargo Plazas, PhD, RN; Anna Santos Salas, PhD, RN; R. Lisa Bourque Bearskin, MN, RN; Krista Hungler, MSc have shared this very interesting description of their work:

Hello to Everyone on behalf of the Access Research Team and many thanks to Dr. Peggy Chinn and the Advances in Nursing Science Journal for the opportunity to accompany the article with a blog. Attached is an  Overview of the access initiative diagram and below is a photo of the authors of this article.

To begin: It was quite startling to come to the end of a two day community consultation workshop (2002) where ten areas identified as urgently needing health research were set aside. Instead a community request was issued to study access to

Krista Hungler, Sandra Kwagbenu, Maria del Pilar Camargo, Brenda Cameron, Elder Rose Martial, Raymonde Lisa Bourque Bearskin, and Anna Santos Salas. The photo is by Veronica Guerra Guerro

L to R: Krista Hungler, Sandra Kwagbenu, Maria del Pilar Camargo, Brenda Cameron, Elder Rose Martial, Raymonde Lisa Bourque Bearskin, and Anna Santos Salas. The photo is by Veronica Guerra Guerro

health care services for Indigenous and marginalized populations. Researchers from several health professions, healthcare professionals, community members with province-wide representation, and students of every level sat back and listened. This access research was not to be the current approach to access with numbers and statistics, i.e., how often Indigenous people saw specialist physicians, how many emergency visits. It was to be in collaboration with the Indigenous people and not couched only in terms of western research philosophies and methodologies.

From this request we sat down together and talked together for three years; at times coming to a consensus and moving forward, but other times, no movement at all. Sitting together at the table for this time was in a way, the research itself. It was an arduous, long process of building trust and relationships with each other with continuous clarifying of what was meant by each suggestion, what each step comprised that was decided upon, what possible fallout might occur. There were many issues on the table, some overt and some yet to appear but each one had to be thoroughly addressed before we could move on. Memoranda of Understandings had to be negotiated and signed, safety issues were addressed through the design of advisory groups and involvement of the people in each data gathering step was planned. We did not move forward without full agreement at the table. Others over this time period joined the table and again we renegotiated every step. During this time we agreed upon, designed and undertook three exploratory grants (Aboriginal populations in urban, inner city, and rural areas) in an open conversational manner with extensive advisory groups attached to each one as well as Elder scholars. The findings of these became the basis of our movement forward.

A focus on developing sensitive and comprehensive indicators for access to health care services for Indigenous people came into view early in the discussions. But we were also told by people participating in the exploratory grants that they had had enough of evaluation projects and reports. In the inner city exploratory grant, inner city residents took us to the Director’s office in one of the inner city agencies and pointed out the numerous reports that existed on the need for healthcare access appropriate to inner city and downtown core residents. They asked us: how will this study be different, there has been no action attached to these reports stemming over the last ten years. When will studies lead to action on the issues identified? Was there nursing action that had occurred in response to these reports? Will this work just enhance researcher’s careers or just prove that the healthcare system is doing something instead of nothing? These questions were the standard, the bottom line, which we were given not only from inner city residents but from all participants and healthcare professionals in our projects. We have learned that we must declare how particular research studies will benefit researchers as well as the knowledge development the studies would produce. We also had to plan how to move the findings to actions.

Moving forward: We placed Indigenous Healthcare workers called, Community Health Representatives (CHRs) in Canada, in healthcare sites with a high percentage of utilization by Indigenous people. This intervention turned out to be one of the cornerstones of our research initiative. This manuscript portrays some of this work. Our findings opened the door to understanding how even the most simple institutional mandated protocol when accompanied by overt rudeness or a stigmatizing comment, caused fright. And often there were unseen consequences down the road, i.e., never seeking care again until the condition was far advanced. Even if the institution triggered horrific memories of government residential schools (in Canada), the presence and health knowledge of an Indigenous CHR mitigated that fear. As well the CHR assisted them to communicate safely their healthcare history with few repercussions, judgments and racist practices from the institutions’ healthcare staff. Outcomes were more positive when the CHR was there. For further information see our Access Community report (2014) link below.

The call for action: The people in our studies talked about respect, feeling safe, undoing decades of harm from government and healthcare agencies, rejecting positioning statements from some past research and institutional practices, fighting for rights to have sensitive cultural and healthcare and Indigenous understandings at all points of access. Indeed our work to date shows a pressing need for joint interdisciplinary and intercultural efforts to reduce current health disparities through collaborative participatory work with Indigenous peoples.

Our findings suggest that nurses in particular the need to engage with Indigenous people and their culture to create safe access for them as often nurses are their first point of contact. All nurses know about the need to be aware of the social determinants of health and the health disparities that exist for certain populations. Nurses also know about the importance of honouring cultural traditions of health. But our research team is also aware that activating this knowledge in day to day practice needs additional careful attention and thought. As well increasingly so, the actions of nurses are prescribed by healthcare protocols and policies to ensure a specific outcome that is tied to an economic parameter. Caring for someone who is very ill takes a toll on the prescribed and allowable economic outcome for certain. Based on our studies to date in our specific healthcare institutions, our practicing nurses need support to take action to mitigate the growing and alarming reports of disingenuous care documented in our findings.

Perhaps it is again, sitting around a table with a social justice framework and consciousness raising activities to work toward incorporating research findings into actions. As health disparities climb even as we write this blog, the time to start this is now. There is much work to do to support nurses and other healthcare professionals who work under institutional dictates to then plan their care with the understanding that individuals and families with low SDOH need our special attention. We would also like to draw attention to the Indigenous social determinants of health identified by Loppie-Reading and Wein (2009) as a way to increase further understanding of implementing the SDOH in actual practices of nurses and allied healthcare professionals.

In undertaking specific action on identified issues, we honour the Indigenous peoples of Canada, our original inhabitants. In addition, we know that it will take a concentrated effort to achieve equity in access for Indigenous peoples and we challenge others to facilitate Indigenous communities to undertake their own studies.

We sincerely thank the Indigenous people and the communities that guided this investigation into access to healthcare services and know that this is just a very small step in addressing the health disparities of Indigenous peoples in these particular communities and wider systemic difficulties. We also learned that research on Indigenous topics must be led by Indigenous research scholars and the communities themselves. We very much look forward to your feedback and many thanks for the opportunity to do this blog.

References

Cameron, B. L., Martial, R., King, M., Santos Salas, A., Bourque Bearskin, R.L, Camargo Plazas, M.D.P., Hungler, K. (2014). Access Research Community Report: Reducing health disparities and promoting equitable access to health care services for Indigenous peoples: Community Report. Edmonton, AB: University of Alberta, Faculty of Nursing.

http://www.nursing.ualberta.ca/Staff/Emeritae/BCameron.aspx

Reading, CL, Wien, F. Health inequalities and social determinants of Aboriginal Peoples’ health. Prince George, BC: National Collaborating Centre for Aboriginal Health. 2009.

The article is available while it is featured for free download on the ANS web site!  We – the authors and I – would be delighted to know your comments, and welcome your discussion related to these very important issues!  Please use the space below to let us hear from you!

When the Unimaginable is Real


Dilmi S. Aluwihare-Samaranayake, MSN, MBA, author of our current featured article titled “Representations, Forbidden Representations, and the Unrepresentable Creating Visibility for Mapping Emancipatory and Transformative Nursing Praxis,” brings to light the plight of people who suffer unimaginable suffering and harm.  She proposes that our inability, even unwillingness, to represent these horrific experiences in written and spoken language impedes both the science and the practice of emancipatory nursing – an approach to nursing that seeks justice and remedies for human pain and suffering.  She shared this reflection on her work for ANS readers:

I am honored that my paper has been featured in this current issue of ANS. Grappling with the concepts representation, forbidden representation and the un-representable, together with tragic, devastating and unthinkably horrific life experiences of people plus feeling a strong sense for the importance of finding ways to help people, led me to write this paper.

There are those who drive decisions intentionally or unintentionally and those who harm Dilmi300themselves without thinking of the short or long-term consequences they face or the consequences for those around them. There is also no easy or set prescription to fit the amalgam of human experiences because of the diversity of circumstances and histories that shape people’s lives.

These views lead me to reflect on the following questions:

“Is it within the realm of possibility for us to prevent or alleviate horrific life experience? Is it possible for us to avoid natural and human disasters? As humans do our actions demonstrate that we value and respect all human life? Or is it our lack of value, respect and our presumptions that lead us to contribute to harming others and ourselves explicitly or implicitly. Can we really help people?”

Not to belittle the questions or the potential answers, but I believe the answers to these questions begin with a yes, although at different levels with different margins. I also suggest, however, that some life experiences do not need to be so horrific, and there is enough intelligence in the world and lessons to be learned to prevent horrific experiences, or at the very least, help people who have lived through these experiences to move forward.

I realize that debates on the aforementioned questions may seem hugely philosophical for some readers with representation, forbidden representation and the un-representable being new concepts or concepts not taken up for discourse frequently because of its marshy nature. I also appreciate that many readers may prefer to avoid these topics and because of this, these topics have not received the attention they deserve. However, in the wake of continuous incomprehensible life experiences faced by many, I believe dialogue (through writing, voice, drama and/or poetry) needs to happen and our research agendas must bring attention to the mélange of issues to assist in providing emancipatory and transformative nursing praxis and social justice that is, empowering and reflective.

Your views are welcome. Thank you.

While this provocative article is featured on the ANS web site, you can download it at no cost!  I join Ms. Aluwihare-Samaranayake in welcoming your views and comments related to her work, so after you have an opportunity to consider her article, please return here and share your ideas!

Informed Advocacy: An Emancipatory Nursing Perspective


The current ANS featured article is titled “Informed Advocacy: Rural, Remote, and Northern Nursing Praxis.”  In this article, the authors, Karen MacKinnon, PhD, RN; Pertice Moffitt, PhD, RN present present a synthesis of their combined research about nursing practices in Western and Northern Canada. They compared the stories of rural Canadian public health nurses with feminist and critical theoreticalnurse-advocate3_300 perspectives in order to discern evidence of informed advocacy as emancipatory nursing practice. In their conclusion they describe the elements of informed advocacy:

 . . . we learned that the informed advocacy work of rural, remote, and northern nurses includes the following dimensions: (1) ensuring that people’s concerns are heard  (by listening with intention and responding with action), (2) contextualizing practices  (by making visible or using information about the contexts of people’s lives to inform health care decision making), (3) safeguarding  (by ensuring that people remained safe), and (4) addressing systematic health inequities  (by mobilizing local resources and by providing leadership at the health system or health policy level).

We welcome your ideas and responses!  While this article is featured, it is available for free download, so visit the ANS web site now, read the article, and come back here to share your comments!

Caring as Emancipatory Nursing Praxis


The new featured article in the current ANS issue challenges readers to examine values and believes that form a foundation for nursing as caring within complex technical and economically driven systems. The article, titled “Caring as Emancipatory Nursing Praxis: The Theory of Relational Caring Complexity,” is authored by Marilyn A. Ray, PhD, RN, CTN-A, FAAN and Marian C. Turkel, PhD, RN, NEA-BC, FAAN.  They have each provided interesting background about their work, and insight in to how their ideas have emerged:

From Dr. Ray:

My journey focusing on the study of human caring in complex hospital cultures began in 1969 as an MSN student in nursing and anthropology where I conducted an ethnography of a hospital. My interest in the study of nursing as a “small” culture and health care/hospital organizations as “small” cultures led to seeking a Master of Arts in Cultural Anthropology, and a PhD in

Dr. Marilyn Ray

Dr. Marilyn Ray

Transcultural Nursing where, within my dissertation, grounded theories of nursing as transcultural caring were discovered. The substantive theory of Differential Caring unfolded showing how the dominant environmental context of different hospital units influenced the meaning of caring, such as, the interrelationship between technology and caring in an Intensive Care Unit, economics and caring in Administration, and spiritual-ethical caring in the Oncology Unit. Analysis and insight led to the discovery of the formal theory of Bureaucratic Caring (rendering the paradox of human caring in complex organizations which continues today). Subsequent research on the technology and economics of caring, exposure to Rogerian unitary science and the emerging field of complexity science/s through teaching philosophical inquiry, caring science, qualitative research methods, and conducting research with the late Dr. Alice Davidson continued to open my mind to the significance of human-environment integrality. Over the past 20 years accomplishing funded research with Dr. Marian Turkel on economic caring within many public, military, and private complex healthcare systems exposed more of how the contextual dimensions of economics, political, legal and technological phenomena enlightened our understanding of contemporary practice, and how the research illuminated the discovery of the Theory of Relational Caring Complexity. This theory deepened our commitment to seeking understanding of human rights, social justice and social caring ethics as emancipatory praxis in complex systems and prompted us to share this content.

As a doctoral student of Dr. Madeleine Leininger, my classmates and I received the gift of exploring “caring as the essence of nursing.” As a former faculty member of the University of Colorado College of Nursing (and now as a Professor Emeritus at Florida Atlantic University), I have had the opportunity of sharing ideas of and learning about, and researching caring science, ethics, unitary science, complexity sciences, and the feminist ideal of peace power with Drs. Jean Watson, Sally Gadow, Marlaine Smith, Peggy Chinn, the late Alice Davidson, and many other professionals. This knowledge has directed and continues to direct the discipline of nursing. At the same time, as an officer in the United States Air Force Reserve, Nurse Corps, I was aware of how these ideals needed to be embedded in local and global cultures, including not only the military, but also, the Transcultural Nursing Society, World Health Organization and United Nations. I am a charter member of the International Association for Human Caring and have been committed to co-creating awareness of caring science and art, respect for human dignity, cooperation, and reasoned dialogue to lay the foundation for a sustained commitment to human rights and social justice. These actions hopefully will lead to peaceful coexistence among all people and a world without war. Nurses have the obligation to be examples of human caring–to seek ethical caring knowledge, promote moral mindfulness, give voice to the voiceless, cultivate humanity, understand transcultural nursing and social/cultural contexts, and exercise ethical judgment and evaluation to facilitate the creation of peaceful communities of caring worldwide.

From Dr. Turkel:

Like my co-author and colleague, I am committed to the advancement of the scholarship of caring science and complexity science. My professional career trajectory is grounded in the philosophical tenets of caring being essential to the disciplinary foundation of nursing and the theoretical concepts of caring and complexity serving as a framework for professional nursing

Dr. Marian Turkel

Dr. Marian Turkel

practice. My journey into caring as a substantive area of study within the discipline unfolded when I entered graduate school at Florida Atlantic University (FAU) in 1989. It was a wonderful time to be at the university as our Dean, Dr. Anne Boykin was integrating caring into the curriculum and Dr. Leininger and Dr. Watson came to university sponsored conferences. I became very involved with the International Association for Human Caring (IAHC) and met Dr. Ray who was our eminent scholar. My favorite story is that I knew she was important, not sure what an eminent scholar was, and did not know if I was allowed to talk with her. She taught nursing leadership and we formed an instant personal and professional relationship as we had shared values related to caring in complex systems. As a nurse leader, I was always challenged by the paradox between caring and economics within complex systems and the social injustice that registered nurses often face in the real world of hospital nursing practice. My master’s thesis was A Journey into Caring as Experienced by Nurse Managers. Managers shared their frustration of trying to care when economics ruled decision making. My doctoral dissertation, Struggling to Find a Balance examined the paradox between caring and economics from the perspective of patients, nurses, and administrators.I was on faculty at Florida Atlantic University and the sentinel qualitative and quantitative research that Dr. Ray and I completed validated that caring was explicitly linked to improved patient and nurse outcomes and hospital system economic outcomes.

My life journey took a turn and my husband and I relocated to Chicago and then Philadelphia. I made an intentional decision to return to practice and began my journey into “praxis” (informed practice). I went back into the hospital setting but with a new lens, using research, evidence-based practice and caring theory to inform and transform practice. I continued my involvement with the IAHC, re-connected with Dr. Watson and became involved with the Watson Caring Science Institute (WCSI). As faculty within WCSI, I work with hospitals to create caring healing environments for employees, patients, and families by integrating caring theory into the practice setting. My scholarship is now focusing on leadership framed in caring science where intention setting, caring , love, peace, and values ground the practice of leadership. I just ended my IAHC Presidency May 2014 with a conference in Kyoto, Japan sponsored by IAHC and Kobe University. The conference theme was the Universality of Caring with over 781 Registered nurses from 20 countries and regions in attendance. On a personal note, I am moving back to Florida in July and returning to Holy Cross Hospital where I used to work and met my husband. My vision is to co- create a very innovative Service-Academic Partnership with Florida Atlantic University College of Nursing. In caring and peace, Marian

Visit the ANS web site to see this wonderful article – you can download it at no cost while it is featured!  Then return here to share your comments and ideas!

Overcoming “status quo bias” – a call for innovative action


The first featured article from the latest ANS issue focusing on “Innovations in Health Care Delivery” is the guest Editorial by Paula N. Kagan, PhD, RN.  Dr. Kagan’s scholarship is grounded in critical/emancipatory feminist perspectives, and she is the primary Editor of the forthcoming (2014) text  Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge Publishers. Dr. Kagan shared this message about her work, concluding with a call for action:

I have been interested in the idea of innovation for many years. I am attracted to radical change in areas such as the arts as well as nursing practice, in pedagogy, in ethics and policy approaches, and at various other points of social thought and practices. However, there is a horizon of embracing radicalism, a threshold at which there can be comfort in ambiguity and in difference and in creating drastic change. Think resistance. We do not have to stay attracted and attached to the status quo to the exclusion of real change. But how often that occurs.

Paula N Kagan, PhD,RN

Paula N Kagan, PhD,RN

During this election week, the astute Chris Hayes on MSNBC spoke about status quo bias, the human behavior characteristic that moves people to, at times irrationally, chose the status quo over options of change, some of which may be better choices than what constitutes the present circumstance. He was referring to status quo bias in decision-making, an effect demonstrated by Samuelson and Zeckhauser (1988) and applied to many fields of study.

I am perplexed at organizations that chronically spend time on improvement measures but in the end stay within the boundaries of tradition. I am perplexed at our unrelenting focus on acute care and hospital nursing. And, I am perplexed at nurse educators who prepare students to uncritically meet the status quo. We are not serving our students or the public.

Perhaps nurses can begin meetings, at any level of organization, with a consideration of the phenomena of status quo bias, resistance, and the practice of radicalism and make sure these concepts are included as ‘essential’ in the content of study for students (as well as in the practice of faculty and professional leaders) in nursing. Would that make a difference in our criticality, in our ideas of what constitutes innovation and progression?

You can read the full text of Dr. Kagan’s Editorial and download your copy on the ANS web site.  We would be delighted to engage with you here on this blog!  Leave your comments, ideas and questions here, and we will respond.

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