Description
Week 1 Response Paper Instructions
This reflection and analysis paper will be based on all the required readings from the first
week (you may also include optional readings if you wish to do so).
Response paper is no longer than three, double-spaced pages (excluding the title page
and reference list).
You will be evaluated on your analysis of the readings/topics assigned for that week.
Description
In a reaction or response paper, writers respond to the texts they have read. In responding to
multiple texts, you must also discover how the texts relate to one another. A reaction paper may
include a discussion of interesting questions that the readings raise for the student, but such a
discussion is not sufficient by itself.
Writing good response papers is more demanding than it might appear at first. It is not simply a
matter of reading the text, understanding it, and expressing an opinion about it. You must allow
yourself enough time to be clear about what each text says and how the texts all relate to one
another. In other words, response papers require you to synthesize the intellectual work of
others—that is, bring it together into an integrated whole. In preparing to write response papers,
therefore, it is crucial that you allow yourself not just enough time to do the readings but enough
to digest what you have read and to put the results together into a unified account.
Grading Rubric (total of 8 points):
• Section 1: 2 point
• Section 2: 3 points
• Section 3: 2 point
• Clarity of the writing; APA (including reference list and in-text citation): 1 point
Section 1. Summary of the work:
• Write an informative synthesized summary of all the required readings.
• Condense the content of the work by highlighting its main points and key supporting points.
• Use direct quotations from the work only to illustrate important ideas; otherwise, make sure
to rephrase ideas to avoid plagiarism.
• Summarize the material so that the reader gets a general sense of all key aspects of the
original work.
• Do not discuss in great detail any single aspect of the work, and do not neglect to mention
other equally important points.
• Do not include in the first part of the paper your personal reaction to the work; your
impression will form the basis of the second part of your paper.
Section 2. Your reaction to the work (these are simply examples of possible ways to
reflect on the readings):
• How is the assigned work related to ideas and concerns discussed in the course in relation
to the construction of knowledge, evidence, ethics, and how we know what we know?
• How is the work related to nursing education and practice in our present-day world?
• Did the work increase your understanding of a particular issue? Did it change your
perspective in any way?
• Evaluate the merit of the work: the importance of its points, its accuracy, completeness,
organization, and so on.
• Include your own voice by weighing arguments, evaluating evidence, and raising critical
questions. If there seems to be something important that none of the authors address, point
it out and state what you think its significance is. Try to be as specific as possible.
• Accord each text the weight it deserves. Don’t forget to synthesize your account by showing
how the texts relate to one another.
Section 3: Conclusion
• Provide overall thoughts on the readings.
• Provide any recommendations related to how the topic can improve people’s understanding
and implementation of nursing education and evidence-based practice.
Citations and reference list:
• Make sure to cite the articles as you discuss them in the paper.
• On a separate page, provide a reference list of all the readings you used for the assignment.
Unformatted Attachment Preview
Accepted: 23 May 2017
DOI: 10.1111/nin.12211
F E AT U R E
Drawing on antiracist approaches toward a critical
antidiscriminatory pedagogy for nursing
Amélie Blanchet Garneau1
| Annette J. Browne2 | Colleen Varcoe2
1
Faculté des Sciences Infirmières, Université
de Montréal, Montréal, QC, Canada
Although nursing has a unique contribution to advancing social justice in health care
2
School of Nursing, University of British
Columbia, Vancouver, BC, Canada
Correspondence
Amélie Blanchet Garneau, Faculté des
Sciences Infirmières, Université de Montréal,
Montréal, QC, Canada.
Email: [email protected]
practices and education, and although social justice has been claimed as a core value
of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy
(CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices,
adopting a CADP offers opportunities for students and practicing nurses to develop
their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has
the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis-oriented
critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western-based health care, and the culturalist and racializing processes
prevalent in nursing education. It also situates nursing practice as responsive to health
inequities. Thus, a CADP is a promising way to translate social justice into nursing
practice and education through transformative learning.
KEYWORDS
antidiscrimination, antiracism, critical pedagogies, critical theories, discrimination, nursing
curriculum, nursing education, racism
1 | BACKGROUND
Coakly, 1998; Mustillo et al., 2004; Oxman-
Martinez et al., 2012;
Penn & Wykes, 2003; Poudrier, 2003; Smedley, Rich, & Erb, 2005;
A growing body of research continues to demonstrate the profound
Veenstra, 2009; Williams, Neighbors, & Jackson, 2003; World Health
effects of health and social inequities on peoples’ health, access to
Organization, 2013). In 2010, the World Health Organization identi-
care and overall well-being. Krieger (2014), for example, has focused
fied racism explicitly as a social determinant of health inequities (Solar
on the health effects of racial discrimination by demonstrating a di-
& Irwin, 2010) and Turner (2016) has built a ‘business case’ for redress-
rect causal relationship with hypertension, low birthweight, prema-
ing persistent racially based inequities, showing how racial discrimina-
ture labor, and other significant health issues. Building on Krieger’s
tion undermines the United States economy. Despite these compelling
landmark studies, others have contributed to the growing body of ev-
trends and the long-standing agreement that race is not a biological
idence showing that racial discrimination both has direct physiological
category (UNESCO, 1952), nursing has not adequately integrated dis-
effects on health and operates structurally to affect people’s access
cussions of race and racism as historically and socially constituted and
to the social determinants of health such as education, employment,
situated, and discrimination more widely, into the nursing curriculum.
income, housing, and health care (Borrell, Kiefe, Williams, Diez-Roux,
Because race and racism are key determinants of health inequi-
& Gordon-
Larsen, 2006; Bourassa, McKay-
McNabb, & Hampton,
ties (Krieger, 2014; Solar & Irwin, 2010), racializing and discriminatory
2004; Harris et al., 2006; Krieger, 2000, 2001; Krieger, Sidney, &
processes are primary targets for social justice interventions, including
Nursing Inquiry. 2018;25:e12211.
https://doi.org/10.1111/nin.12211
wileyonlinelibrary.com/journal/nin
© 2017 John Wiley & Sons Ltd
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in health care contexts and nursing education. However, racial discrimination rarely operates in isolation from other social dynamics.
For example, experiences of discrimination are amplified by issues
BLANCHET GARNEAU et al.
2.1 | Culturally congruent care and
multicultural approaches
of poverty, substance use, or stigmatizing chronic conditions such as
Although distribution of inequities and their impacts are racialized,
HIV or mental health issues (Hancock, 2007; Varcoe, Browne, & Ponic,
a focus on the racialization of health and social inequities has not
2013). Varcoe et al. (2013) argue that while discrimination may man-
been a driving force in nursing education and practice. Rather, the
ifest as interpersonal and obvious (for example through derogatory
primary means of teaching about health inequities in nursing has
culturalist, race-or ethnicity-based comments), it is in fact systematic,
been to frame health and social inequities as stemming from cultur-
built into the structures of society, and often invisible. Discrimination
ally or ethnically based issues. Hence, nursing practice and education
therefore can be understood as ‘all means of expressing and institu-
have been dominated by attention to cultural sensitivity and cultural
tionalizing social relationships of dominance and oppression’ (Krieger,
competence, drawing on a plethora of theories and models orient-
2014, p. 250).
ing nursing practice and education toward culturally congruent care
Approaches to fostering social justice by countering discrimination
(e.g., Andrews & Boyle, 2002; Campinha-Bacote, 1998; Leininger,
must be based on this broad understanding, taking the systemic and
1991; Papadopoulos, Tilki, & Taylor, 1998; Purnell & Paulanka, 2008).
structural nature of discrimination into account, and examining the
These theories and models have been developed from cultural diver-
intersections among multiple forms of discrimination. In this paper,
sity and multiculturalist perspectives, often founded in a culturalist
we propose a critical antidiscriminatory pedagogy (CADP) to enhance
ideology, which is prominent in nursing and health care, and pro-
the capacity for nursing to address key social justice issues. We pay
moted by a majority of schools, universities, and other public insti-
particular attention to systemic discrimination as inherent to the pro-
tutions (Vandenberg & Kalischuk, 2014; Varcoe & Browne, 2015). In
duction and maintenance of health and social inequities and injustices
such approaches, health and health behaviors are seen as primarily
(Krieger, 2014; Marmot, Friel, Bell, Houweling, & Taylor, 2008). We
determined by an individual’s presumed ethnocultural, and often
focus attention on the value-added of focusing on multiple, inter-
racialized identity. For example, dietary practices and adherence to
secting forms of discrimination, including the stigma of poverty, the
dietary advice are often interpreted as ethnocultural, and factors
harms of culturalist assumptions, and the impact of racialization, age-
such as food availability and affordability tend to be overlooked. As a
ism, and gendered inequities, among others, and how these are often
consequence, and in concert with the long recognized dominance of
co-constituted determinants of health and well-being for individuals,
liberal individualism in nursing with its emphasis on individuals freely
communities, and populations. We discuss the theoretical roots and
making independent choices (Browne, 2001), culturalism and racialism
key characteristics of a CADP grounded in critical theories and peda-
are frequently used as the primary analytical lenses through which to
gogies, and identify implications for nursing education. We argue that
explain health behaviors and health issues, including health inequities
adopting a CADP offers opportunities for nurses and future nurses to
(Browne & Reimer-Kirkham, 2014; Vandenberg & Kalischuk, 2014;
develop their capacity to counteract various forms of individual and
Varcoe et al., 2013). For example, lower access to prenatal care is ex-
systemic discrimination in health care contexts and holds promise for
plained as the choices of individuals arising from their particular ethnic
moving social justice as a professional value into transformative learn-
values rather than as the consequence of racialized social and eco-
ing and action.
nomic disadvantage, including overt discrimination that deters access
to care. Such understandings ignore root causes of health inequities
2 | APPROACHES TO ADDRESSING
SOCIAL JUSTICE AND HEATH INEQUITIES
IN NURSING
by obscuring the contribution of structural inequities such as institutional racism and discrimination.
Recent empirical studies have highlighted that educational
approaches focusing on culture alone are not sufficient to address discrimination and racism in health care (Allen, Brown,
To address health and health care inequities, nursing scholars and
Duff, Nesbitt, & Hepner, 2013; Hardy, 2011; McDermott, 2012;
educators have advocated for curricular changes based on the prin-
McDermott et al., 2015). Thus, even with the best intention of pro-
ciples of social justice (Chinn, 2014; Hardy, 2011). Thorne points out
viding culturally congruent care, multicultural approaches in nurs-
that although many nursing scholars have operated from a stance of
ing education have failed to challenge racism and discrimination
liberal individualism, social justice ‘has been a dominant normative
at the level of clinical practice, as well as at the organizational and
position for nursing for as long as we have been professionalized’
systemic levels.
(2014, p. 79). Social justice perspectives, however, have not been
taken up easily in nursing curricula and approaches to addressing
social injustices, and health inequities in nursing have varied in dif-
2.2 | Racial discrimination and antiracist approaches
ferent contexts and across time. Canales and Drevdahl (2014) argue
In concert with the critiques of individualistic and multicultural ap-
further that even if social justice is at the core of the nursing disci-
proaches in nursing education, some authors have argued for a critical
pline, it is very often absent or may operate as mere rhetoric in the
turn in cultural competence and the inclusion of concepts related to
nursing curriculum.
racism and other individual and systemic forms of discrimination in its
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BLANCHET GARNEAU et al.
conceptualization and in health professionals’ education (Almutairi &
Rodney, 2013; Blanchet Garneau & Pepin, 2015; Herring, Spangaro,
3 | KEY FEATURES OF A CADP
Lauw, & McNamara, 2013; Sakamoto, 2007). For example, strategies
Antiracist pedagogy is a promising starting point from which to move
involving critical reflection (Blanchet Garneau, 2016) and reflexive
toward social justice in the curriculum and serves as a foundation upon
antiracism training (Franklin, Paradies, & Kowal, 2014) have been pre-
which to develop a CADP. Systematically and intentionally including
sented as promising alternatives to multiculturalist education. These
antidiscrimination content in initial and continuing nursing education
strategies include reflection upon the root causes and impacts of dis-
could motivate meaningful collective action and promote the devel-
crimination and racism in society while avoiding essentialist perspec-
opment of critical consciousness among future nurses (Hardy, 2011).
tives of culture.
A CADP both acknowledges and challenges the long tradition of lib-
This attention to racism and antiracism is not new in nursing.
eral individualism in health care, as well as culturalist and racializing
Historically, nursing leaders such as Ethel Johns, Lavinia Dock,
processes prevalent in nursing. In this approach, education based on
and Margaret Sangster worked to change gendered discriminatory
developing humanistic care that is sensitive and respectful, without ad-
policies and practices affecting women and racialized minorities
dressing structural conditions related to health and health care is seen
(Thorne, 2014). More recently, nursing scholars have continued
as insufficient (Dovidio, Gaertner, & Saguy, 2015). A CADP also offers
to draw attention to the need for analyses in nursing focused on
the opportunity to tackle discrimination within the profession itself.
issues of racism, and the impacts of racism on health and health
Importantly, nursing scholars have drawn attention to the dynamics of
care (Anderson, 2006; Anderson et al., 2009; Barbee, 1993; Taylor,
racism within nursing (Das Gupta, 1996), including the experiences of
Mackin, & Oldenburg, 2008). These scholars, reflecting a critical
racialized nurses in practice contexts dominated by whiteness (Hagey
theoretical orientation, emphasize the need to understand issues
et al., 2001; Nichols & Campbell, 2010), and the similar experiences of
of racism as extending well beyond individualistic explanations, as
nursing students (Koch, Everett, Phillips, & Davidson, 2014). Nursing
imbricated with broader social trends such as global migration pat-
scholars also have paid increasing attention to the discrimination
terns and the global neoliberal political-economic context, which
experienced by internationally educated nurses, particularly those
sustains racialized and gendered inequities. However, prior to the
who are racialized (Baptiste, 2015; Tuttas, 2015; Wheeler, Foster, &
1990s, nursing scholarship tended to frame racism and other forms
Hepburn, 2014). A CADP takes into account not only experiences
of discrimination as individual-level issues related to people’s par-
of discrimination of patients, but also of nurses and nursing students
ticular attitudes, prejudice or biases, overlooking issues of systemic
(Mapedzahama, Rudge, West, & Perron, 2012; Nielsen, Alice Stuart, &
or institutional racism (Drevdahl, Philips, & Taylor, 2006). Although
Gorman, 2014). The CADP we propose has the following features: it
individualistic interpretations of racism predominate, Barbee (1993),
is grounded in a critical intersectional perspective of racism and other
Drevdahl, Taylor & Phillips (2001; Drevdahl et al., 2006), and Taylor
forms of discrimination, it aims at fostering transformative learning,
(1999) were instrumental advancing compelling arguments about
and it involves a praxis-oriented critical consciousness.
the invisibility of attention to race or racism in nursing discourse as
stemming from the individualistic and often Euro-centric focus of
the discipline.
Beyond these analyses, there are few documented experiences, discussions, or research reports on the integration of
3.1 | Expanding beyond antiracist and
multiculturalist perspectives: a critical intersectional
perspective of discrimination
antiracist pedagogy in the curriculum in nursing (e.g., Alleyne,
Building on antiracist pedagogy and developed from a critical per-
Papadopoulos, & Tilki, 1994; Blakeney, 2005; Cortis & Law, 2005;
spective, the CADP we discuss in this paper extends beyond an indi-
Hagey & MacKay, 2000; Hassouneh, 2006; Nairn, Hardy, Parumal,
vidualistic and essentialist perspective of discrimination. We advocate
& Williams, 2004). Antiracist pedagogy is theoretically grounded
for a critical intersectional perspective of discrimination because, as
in the critical pedagogy (Freire, 1970; Giroux, 1997; Kincheloe,
much as the translation of multiculturalism and cultural competence
2008; McLaren, 2015) and orients learners through an analysis
into nursing practice and education has brought criticism for focus-
of systems of oppression and domination to ‘explain and counter-
ing on differences and obscuring broader institutional and societal
act the persistence and impact of racism using praxis as its focus
influences on health and health care, dominant conceptualizations of
to promote social justice for the creation of a democratic soci-
discrimination have also been criticized for putting the blame on in-
ety in every respect’ (Blakeney, 2005, p. 119). Thus we propose
dividual behaviors and attitudes (Krieger, 2014; Varcoe et al., 2013).
an explicit critical antidiscriminatory pedagogy for nursing. The
Often, discrimination as a concept is taken up from an individualistic
CADP we propose in this paper builds on ideas from antiracist
vantage point. According to Varcoe et al. (2013), discrimination is still
approaches, takes a broad contextual and structural approach to
widely conceptualized and measured following a stress-coping per-
understanding racism and discrimination, and extends beyond a
spective (e.g., Sawyer, Major, Casad, Townsend, & Mendes, 2012).
singular dimension to integrate an intersectional perspective. A
Informed by theories from the discipline of psychology, discrimination
CADP pushes beyond culturally sensitive, tolerant, and respectful
is then narrowly considered as a psychosocial stressor ‘that can lead
attitudes promoted by multiculturalist approaches toward a criti-
to adverse changes in health status and altered behavioural patterns
cal cultural perspective.
that increase health risks’ (Williams & Mohammed, 2013, p. 1152).
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BLANCHET GARNEAU et al.
Consequently, most studies do not consider the multiple causal path-
more directly to counteracting discrimination. A CADP considers that
ways by which discrimination can affect health. The conceptualization
structural and interpersonal discriminations are inseparable and posi-
of discrimination in itself is then an important factor in reproducing
tions the individual within the larger forces at play in discriminatory
primarily individual-level perspectives on discrimination.
processes. It supports learners in developing new understandings of
An intersectional perspective investigates ‘the interaction of nu-
their social locations and focusing their attention on their responsi-
merous characteristics of vulnerable populations, not only at the indi-
bility for action—even if they perceive themselves as separate from
vidual level but also at structural levels so as to capture the multiple
or not implicated in the conditions that give rise to discrimination.
contexts that shape individual lives and health statuses’ (Dhamoon
Learners are invited to critically think about their social location and
& Hankivsky, 2011, p. 16). Intersectional perspectives are useful in
uncover structural and systemic taken-for-granted assumptions that
drawing attention to complex dynamics of racism, gendered inequi-
shape their practice. The exploration of personal experience as struc-
ties, economic disparities, stigma, and other social processes, and how
turally produced is then always linked to a contextualized perspective
they interact and are often co-constituted to influence health and
of the world and with knowledge of how one can counteract the ef-
well-being. In this paper, we focus primarily on racial discrimination,
fects of discrimination in health care.
keeping in mind these complex dynamics, and draw on intersectional
Building on Freire’s (1970) notions of praxis and critical conscious-
theory to illuminate them. An intersectional perspective also allows
ness, and in response to the individualist and decontextualized ap-
health care professionals to understand that they may be positioned at
proach to care that dominates in nursing, Doane and Varcoe (2015)
multiple places in power relations, encountering both privilege and op-
propose a relational inquiry approach to nursing practice. A relational
pression at the same time in varying social conditions. A CADP offers
inquiry approach has two core components: a relational consciousness
a framework for health care professionals to analyze power relations
and inquiry as a form of action. A relational consciousness focuses on
at multiple levels and in multiple intertwined contexts to look at and
the ‘relational interplay occurring at and between the intrapersonal,
disrupt structural and individual-level dynamics producing and repro-
interpersonal, and contextual levels’ shaping each nursing situation
ducing systemic discrimination. It provides opportunities to develop
(Doane & Varcoe, 2015, p. 4). From this perspective, inquiry is viewed
strategies to change conditions of social injustices.
as a form of action and a method to navigate through the relational
experiences of people and contexts in each nursing situation. Keeping
3.2 | Fostering transformative learning to
counteract the effects of discrimination
in mind Freire’s ideals, and Doane and Varcoe (2015) concepts, we
argue that a CADP entails two processes which are central to a praxis-
oriented critical consciousness: an explicit examination of structural
A CADP is closely linked to its critical theoretical roots as it aims to
conditions and power dynamics requiring relational consciousness,
foster transformative learning oriented toward action to counteract
and taking action grounded in contextual knowledge.
the effects of discrimination at both individual and systemic levels in
health care. Transformative learning is ‘the process of using a prior
interpretation to construe a new or revised interpretation of the
meaning of one’s experience in order to guide future action’ (Mezirow,
3.3.1 | An explicit examination of structural
conditions and power dynamics
1996, p. 162). There is a transformation of the learners’ frame of ref-
A CADP shifts the focus from acts of discrimination between two
erence, which means that learners experience a deep, structural shift
persons to an analysis of structural processes by looking at power
in the basic premises of their thought, feelings, and actions. This new
relations at play. A CADP is then explicitly concerned with power
understanding of the world is then translated into consequent actions.
relations, knowing that power operates at all levels, in all directions,
To achieve this transformative learning, a praxis-oriented critical con-
among all players, and not just in a hierarchical, top-down manner. The
sciousness is central to a CADP.
dynamics of oppression and privilege are not necessarily intentional,
nor is intent related to the impacts of systemic discrimination. Rather,
3.3 | A praxis-oriented critical consciousness
it is important to understand that everyone is implicated and ‘caught
up’ in these systems of power, wittingly or not.
Praxis is the dialectical relation between theory and practice, where
Critical thinking is essential to analyze structural conditions and
reflection facilitates ‘a dialogue between theory and practice to
power dynamics involved in the interlocking systems of oppression
develop a new understanding of the world of practice, and a new
embedded in society and affecting health and health care. Developing
ability to change practice’ (Nairn, Chambers, Thompson, McGarry, &
critical thinking among learners is central to a CADP. However, critical
Chambers, 2012, p. 190). In critical pedagogy, Freire (1970) concep-
thinking as part of a CADP departs from an analytic philosophy per-
tualizes praxis as simultaneous reflection and action to transform the
spective, which frames how critical thinking is currently conceived and
world. The processes of reflection and action both interact to develop
taught in nursing. Following an analytic philosophy perspective, think-
critical consciousness among learners and give them the power to act
ing critically focuses on cognitive processes, such as recognizing false
and resolve or change situations (Freire, 1970).
inferences and logical fallacies, and being able to distinguish opinion
The development of critical consciousness is inherent to a CADP
from evidence (Brookfield, 2007). Although these are essential intel-
because it involves new forms of understanding that connect one
lectual functions for nursing practice, this focus on cognitive processes
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BLANCHET GARNEAU et al.
tends to neglect social and political critique (Kincheloe, 2000). From a
and shame regarding privileged social locations, and orients learners
critical theoretical perspective, educators acknowledge the multiple
toward responsibility for action grounded in contextualized knowl-
methods of producing knowledge and challenge binary and true-or-
edge. For example, from a CADP perspective, Euro-Canadian middle-
false epistemologies in the service of challenging normative ideas and
class learners are not implicated as being personally responsible for
approaches, and to shift the status quo. They advocate for diverse
what they might construct as their white privilege, but are encouraged
perspectives on similar events and the importance of contextuality.
to take responsibility for their action or inaction about addressing in-
Critical pedagogy leads learners to engage in a reflexive dialogue to
tersecting forms of discrimination in health care. For example, in rela-
analyze the ways power operates and its effects on social structures. A
tion to the issues of diabetes noted above, nurses would be prompted
reflexive dialogue involves questioning the legitimacy of power struc-
to look beyond the commonly cited individual-level factors that are
tures that maintain the status quo, and leads learners to be able to
assumed to be risk factors for diabetes. Instead, they would draw on
challenge the way they think and act in their relationship to social, cul-
a wider field of vision to consider the socioeconomic forces impact-
tural, political, economical, and historical contexts (Kincheloe, 2008).
ing the etiology of diabetes, and plan programs, policies, and actions
For example, educators teaching about diabetes from a CADP would
to mitigate those impacts. This stance would push nurses to consider
integrate attention to power dynamics at the outset by underlining
how issues of poverty, stigma, and lack of access to affordable foods
the role of poverty and racial discrimination in the etiology of diabe-
must be in relation to nursing care for people living with diabetes.
tes, and the intersecting factors such as low income, racism, and gen-
Being aware without invoking guilt or attributing responsibility for this
dered inequities that can limit food security and access to health care
context is one way to foster agency, and is more constructive than
(Raphael, 2011). Such education would draw attention to the evidence
blaming individuals for issues that may arise because of one’s social
base regarding the global epidemic of diabetes among Indigenous peo-
positioning (Young, 2011).
ple and the colonial epigenetic factors underlying that epidemic.
3.3.2 | Taking action grounded in
contextualized knowledge
A CADP brings a contextualized perspective to understanding culture
4 | ‘WE MUST LIFT AS WE CLIMB’:
EDUCATING TO UNCOVER, CHALLENGE
AND DISRUPT DISCRIMINATORY
PROCESSES
and health, which helps to analyze the power relations, and dynamics
of oppression and privilege in health care and to act upon structural
Teaching from a critical antidiscriminatory perspective implies the
inequities such as discrimination and structural racism. Doane and
need to teach with a specific social and political intent, a transforma-
Varcoe (2015) argue that health professionals need to intervene to
tive impetus, which is to act upon individual and systemic discrimina-
address structural conditions at the contextual level while simultane-
tion. ‘Lift as we climb’ was the motto of the National Association of
ously focusing on individuals. Hence, nurses ought to develop skills to
Colored Women’s Clubs founded in 1896. The idea behind this phrase
infuse their caring practices with a contextualized view to counteract
is that transformative processes are collective and people need each
racism and discrimination in health care and address health inequities
other to make significant changes in the world. Transformative pro-
(Thompson, 2014).
cesses require social movements across lines of race, gender, and
Critical consciousness, then, is different from consciousness-
class, and at multiple levels of organization of the society in which we
raising. Being aware of racism and discrimination in not enough, and
live. The implementation of a CADP at the curriculum level will then
a CADP helps learners to articulate this critical consciousness with
involve changes in institutional policies and procedures, and in teach-
action. This self-reflective and action-oriented stance introduces a
ing approaches (Rowan et al., 2013; Thackrah & Thompson, 2013).
problem identified by Lather, who developed a critical approach to
Considering that curriculum represents the total learning experi-
education informed by a feminist poststructuralist perspective: ‘How
ences of the individual (Dewey, 1938), we thus advocate for an ex-
can… self-reflexivity both render our basic assumptions problematic
plicit commitment of initial and continuing nursing education to the
and provisional and yet still propel us to take a stand?’ (1991, p. 44).
ethics of social justice as an organizing precept in the preparation and
Lather questions the possibility of becoming empowered by such self-
support of professional nurses. This explicit commitment should go
reflexivity. If only consciousness is raised without articulating it with
beyond words and good intentions to become central to strategic
action, there is a risk that this awareness causes feelings of helpless-
planning and translate into tangible actions to support social justice.
ness and powerlessness among learners, and paralyzes their action
This would mean, for example, setting more explicit attention to anti-
(Mooney & Nolan, 2006; Wear, Zarconi, Aultman, Chyatte, & Kumagai,
racist, anticolonial, and antidiscriminatory approaches as part of social
2017). In line with a critical theoretical stance, one alternative is to re-
justice expectations in curriculum and in professional guidance docu-
orient reflection toward social, political, economic, and cultural con-
ments such as Codes of Ethics. For example, while attention to social
texts within which a person lives and to reflect on how this context is
justice is noted in the Canadian Nurses Association Code of Ethics,
shaping this person’s everyday life and actions. Learners are invited to
the emphasis tends to be on fairness, access and awareness of so-
analyze the social context of themselves and each patient. Examining
cial justice issues (Bekemeier & Butterfield, 2005; Reimer Kirkham &
the self from a critical perspective thus tends to limit feelings of guilt
Browne, 2006), versus an explicit naming of the root causes of health
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and social inequities stemming from intersecting issues such as pov-
behaviors and toward actions that are often aimed at enforcing com-
erty, racism, stigma, and discrimination. We also believe that health
pliance with biomedical imperatives. Learners are encouraged to con-
care and education institutions should discourage and report actions
sider how their daily exposure to racializing and other discriminatory
that run counter to, or that marginalize, strategies aimed at mitigating
discourses requires conscious resistance. Although it is beyond the
the impacts of racism and other forms of discrimination as part of their
scope of this paper to provide specific strategies for implement-
broader social justice mandates.
ing CADP in curriculum, there is a burgeoning literature on which
to develop such strategies. Varcoe and McCormick (2007), Varcoe,
4.1 | Critically conscious educators for collective and
safe learning
Browne, and Cender (2014), and Browne et al. (2016) suggest ways
to tackle racial discrimination and health inequities in nursing practice
and education from a critical perspective. For example, from a CADP
We suggest that collective learning might be well suited to develop a
perspective, institutions should show an explicit commitment to fos-
praxis-oriented critical consciousness and foster transformative learn-
tering health equity by clearly stating in their mission and policies
ing among learners. Indeed, adult educators have consistently advo-
the importance of equitable access to health and health care access.
cated for collaborative group learning (Brookfield, 1995; Freire, 1994;
This statement could serve as a basis of discussion with students and
Mezirow, 2000). However, group learning also brings challenges
practicing nurses about how to disrupt pervasive discourses of egali-
related to power dynamics among team members. Authors such as
tarianism, and individualistic notions of choices and lifestyles, to draw
