Decolonizing Nursing

Series: Notable Works
See Recording of March 9th Platica, hosted by Caroline Ortiz

As the year 2020 starts to unfold, along with escalating tensions world-wide related to power imbalances, inequities, and injustices, I am drawn to consider how our own endeavors related to the development of nursing knowledge intersect with these very large tensions that so directly shape the health of people worldwide.  I will not even attempt to present you with a “laundry list” of ways in which we could begin to tackle these issues as nursologists – the list alone would greatly exceed the boundaries of a reasonable blog post. Instead, I have decided to focus on one critical topic that repeatedly rises to the surface in many nursing discourses – the topic of racism.  Despite the fact that race and racism so repeatedly rise to the surface with a clear intent to address this issue, there is typically little or no substantive discussion that begins to reach deep down into explanations or understanding of what is really going on. Our efforts to  address the issues are sincere and well-intended but more often than not, end up being superficial “remedies” – often remedies that themselves have clear and undeniable racist dimensions. Seldom, if ever, is there a recognition or discussion of the ways in which nursing perspectives sustain the structures of racism. 

The nursing literature, over the past decade, has provided our discipline with a number of notable sources addressing race and racism, most prominently from an emancipatory, critical theory perspective (see Kagan et al., 2014).  But one notable work in particular is well worth our focus – titled “Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative” authored by Canadian and South African  authors Elizabeth McGibbon, Fhumulani M Mulaudzi, Paula Didham, Sylvia Bartond and Ann Sochane (McGibbon et al., 2014)

 The authors draw on Canadian experience, where culturally, there is very active, visible and dedicated progress toward truth and reconciliation addressing the injustices imposed by European settlers on native Indigenous peoples (see for example the excellent webinar on “Racism and Privilege in the Everyday”).  The United States in general is far behind Canada, South Africa and other colonized nations in openly and systematically embedding awareness of these injustices in public discourse. Unlike other colonized countries, the US has not yet established practices and programs that attempt to address the significant injustices that have seriously harmed those who have been historically disadvantaged, as well as the effects of these colonizing systems and practices on those who have inherited white settler privilege.  The truth is that each situation in which there is disadvantage for some and advantage for others has specific and unique characteristics, but the common threads that run through all such situations, particularly where race and skin color are concerned are significant. McGibbon and her colleagues have provided a cogent explanation that specifically addresses the realm of nursing theory, and ways in which colonization inhabits much of our nursing theorizing. This is not to say that certain nursing theories should be banned from our lexicon because of their colonized and colonizing characteristics.  Rather, examining nursing perspectives from this standpoint is a key that can begin to shift nursing into spaces, actions and ways of theorizing that hold potential to resist the harmful dynamics of colonization, specifically the dynamics of racism.

As Dr. McGibbon reiterated to me in a recent personal communication:

Colonization is a term that refers to the Eurocentric project of empire building that was motivated by the intent to “civilize” the rest of the world.

“Decolonization” is the process of exposing, resisting and transforming the continuing presence and influence of colonial practices and thought.

The project of colonization historically involved indiscriminate destruction of the ways of life, the cultural values, ways of being, spiritual traditions – the whole experience of people who were not European (read not white skinned) – in other words, people of dark skin.  In their article, McGibbon and colleagues provided a detailed and clear explanation of the nature of colonization, as well as the contributions of postcolonial scholars, particularly those of indigenous backgrounds, who have taken bold steps to reveal the devastation and painful struggle, as well as the courage and skills of survival for those who have been, and still are harmed by colonial practices and thought. 

Most significantly, McGibbon and colleagues provided several still-relevant clues where we can focus our attention in the quest to decolonize nursing.  The first challenge is raising awareness of ways in which colonization, and its racist underpinnings persist in nursing thought. They stated: 

Nursing has developed within all of the . . .  contexts of colonization, including the intersections of racism and sexism that inform the colonial project. Embedded beliefs and assumptions provide a foundation for the colonizing of intellectual development in nursing. Similarly, racism and white privilege play a central role in the continued colonization of the profession.” (p. 183)

First, they addressed the persistent belief that we have now moved beyond the “old” days when the white settlers arrived to inhabit, uninvited, the lands of indigenous people.  The same belief persists in the United States where we sustain the notion that we are beyond the slavery of African people that ended decades ago. Since those “days” are in the long-ago past, we tend to sustain the notion that we are now all equal – that we all inhabit the “same” world and that the cultural [read dominant white culture] norms are true for all.  We recognize that there are disparities, and acknowledge some of the disadvantages experienced by people of color, but fail to recognize, or acknowledge that white privilege remains as powerful a dynamic as it ever was. The languages of “diversity” and “multiculturalism” actually sustain this dynamic; when examined closely these perspectives in nursing treat cultures of color as “other” – as interesting curiosities.  Culture is seen as characteristics of any practices that are not white.  Notice that there are rare, if any discussions of white dietary practices, rituals, family relationships, religious practices. “White” experience is typically seen as diverse and individualized, as the “norm” against which other practices are judged or compared, whereas the experience of the “other,” of “people of color” are seen as essentialized markers of difference, with the “white” norms as the point of reference.

Another characteristic that reflects the effects of Euro-centric thought, and that persists as a pervasive characteristic in nursing thought, is the emphasis on empirics, and the presumption of “objectivity” in part because it is removed from the vicissitudes, the contamination, of everyday experience.  The gold standard of “evidence” presumes a certain “objectivity” that is apolitical and assumed to be universal to all human experience. The result is discourse that is largely grounded in white privilege, and its concurrent erasure of the experience of those with dark skin. When “race” is taken as a demographic variable, it tends to be treated, as in real life, as “different” and something other than what is presumed to be the “norm.” As McGibbon and colleagues pointed out, even when race and racism are brought into a conversation, the dominant impulse in relation to the nursing theoretical frameworks is to hide such dynamics in the larger metaparadigm concept of “environment.” 

Nursing’s search to become a credible science reflects this same dynamic of white privilege and unquestioned valuing of positivist values.  The focus of much of nursing’s theorizing is on the individual as a person with uninhibited free will, one who can care for oneself (with ample resources assumed to be available), with only a passing nod in the direction of the family and community (critical and central concerns for those who are not privileged).  The positivist assumption of the whole as the sum of the parts is reflected in just about all undergraduate nursing curricula, in the focus of our textbooks, and organization of hospitals, medical (and nursing) specialties – divided into children (under the medicalized label of pediatrics), various adult conditions (many of which have been transposed into major profit centers), mental health (again medicalized as “psychiatric”) etc.  To the extent that “family and community” is addressed, these vital, central dimensions of human experience are treated as separate and different from the individualized organizing concepts.

These dimensions of awareness are critical, but importantly, McGibbon and her colleagues devoted a significant focus on what this means for our current situation, and the future development of nursing knowledge.  They outline examples of everyday racism and the ways in which nurses of white privilege sustain racist practices, even when we wish not to do so and believe we do not. But as they correctly noted:

These experiences of ongoing racism form the fabric of everyday life for racialized nurses and are largely invisible for the perpetrators, be they in the individual, face-to-face realm, or at the level of governance and policy-making. (page 185)

They pointed to three significant steps that all nurses, and particularly white nurses and white nurse scholars, can take to begin to participate in the effort to decolonize nursing. These are  

  • Understanding racism and white privilege, and creating counternarratives that dismantle colonized thinking, in particular biomedical hegemony and other colonizing ideologies;
  • Committing to action based on social justice and human rights; and 
  • Sustaining attention to the structural determinants of health.

I would add one additional “goal” that deserves our particular attention as nursologist – the potential to completely re-vamp the organizing concepts and constructs of our discipline based on the insights from the three decolonizing projects that McGibbon and her colleagues outline.

The persistent question that always surfaces in these kinds of discussions (particularly among white people) is “What can I, as only one individual, do?”* In my view, the most important and fundamental step is to learn about and take to heart the ways in which our own actions and perspectives sustain racism in our everyday practices. For those of us who inherited white privilege, we have a particular responsibility to dedicate ourselves to our own self-awareness and commitment to change.  I have provided below a list of various resources that I have found invaluable in my own journey. Once we begin to explore our own experience, and understand the dynamics of colonization, we will begin to see a huge shift that will have great power in the direction of decolonizing nursing. 

Sources cited:

Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). (2014). Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge.

McGibbon, E., Mulaudzi, F. M., Didham, P., Barton, S., & Sochan, A. (2014). Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative. Nursing Inquiry, 21(3), 179–191. https://doi.org/10.1111/nin.12042

Resources for self-awareness

Recommended reading, especially for white people, but also for people of color to gain understanding of the ways in which white privilege is sustained.

DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Beacon Press.

Two part blog posted on The Scholarly Kitchen relating the everyday experiences of people of color in the white-dominated publishing industry, 

On Being Excluded: Testimonies by People of Color in Scholarly Publishing (Part 1).

On Being Excluded: Testimonies by People of Color in Scholarly Publishing, Part II

 “Everyday Feminism” webinars (available for a modest fee)

Beyond Diversity: How to Build a Truly Anti-Racist Organization

So… You Have White Guilt. What Now?

Please also see the webinar series recommended to me by Dr. McGibbon – produced by the Indigenous Cultural Safety Collaborative Learning Series (ICS)

* Addendum 2020-02-01: I have been asked to also address ways nurses of color can address issues of racism.  First, I fundamentally believe that it is unacceptable to expect that our colleagues of color have any responsibility here.  Addressing this issue from the standpoint of someone who is racialized is exhausting, frustrating and disheartening – the effort and energy required to deal with the effects of everyday racism is more than many can bear.  And, as a white person, it is presumptuous of me to assume that my suggestions will have merit.  Understanding this, here are a few ideas that I have picked up from listening to women of color who are engaged in this work:

  • When you see an opportunity to speak your truth, find allies who will hear your words and feel your experience.
  • Develop spaces where you are nurtured, where you are truly “at home” – where you can relax, be yourself, and speak your truth.  This is likely to be a context in which there are no white people (yet) – but having this space will nurture your confidence to search for other allies.
  • Find others who are actively involved in anti-racism work in your community. These colleagues will help you develop a clear and unwavering dedication, and the strength, to face the challenges of everyday experience.

31 thoughts on “Decolonizing Nursing

  1. Peggy, a passionate informed message for nursing and white nursing scholars…would love to heart-storm/ and hear ideas about what revamping core disciplinary concepts would look like. what would emerge… wonderful topic for Nursing Now and 2020 Year of Nurse and Midwife (have you noticed too, that often Midwife is left off in posts highlighting Nursing 2020…?

    Liked by 2 people

  2. Peggy, Thank you SO much for this magnificent blog!!!! Lots and lots to think about and do. Best regards, Jacqui

    Jacqueline Fawcett, RN; PhD; ScD (hon); FAAN, ANEF

    Professor, Department of Nursing

    College of Nursing and Health Sciences

    University of Massachusetts Boston

    100 Morrissey Boulevard

    Boston, MA 02125-3393

    (617) 287-7539 (Office)

    (617) 287-7527 (Fax)

    jacqueline.fawcett@umb.edu

    This message originates from the College of Nursing and Health Sciences at UMass Boston. It contains information that may be confidential or privileged and is intended only for the individual(s) or entity named above. It is prohibited for anyone else to disclose, copy, distribute, or use the contents of this message. If you received this message in error, please notify me immediately at jacqueline.fawcett@umb.edu. ________________________________

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  3. Thank you Peggy for this thoughtful and inspiring blog. It calls us to cultivate deep awareness of how we live our white privilege in everyday lives and our work in the discipline. How do the focus of the discipline and our theoretical concepts sustain racism? I’d love to have more dialogue about this. I agree that our focus on “lifestyle change” and “self care” are obvious examples of concepts grounded in a colonized view. One message that came to me out of the Anne Boykin Institute Summer Academy last year focused on “social justice as an expression of caring” is that Social Justice IS Caring at the community/global level. Most of our theorizing is focused on the individual when human-environment repatterning focused on the political, social, and economic structures is necessary to support health/healing, well-being/becoming, quality of life and human flourishing.

    Liked by 2 people

    • There is a well know line think globally, act locally or fix your own house first before fixing the world. Quite often people use the excuse that they are fixing the world and never deal with their own deficiencies and needs. They never fixed their own relationships with others. Self care is not just a theory. It’s well known that you can’t heal others without first healing oneself. In an airplane , who do you place the mask on first, yourself or others? Should we change that because it seems too “colonialistic.” Please don’t include self-care in the colonialism, anti-white narrative. I know you mean well but denigrating self care actually might cause more harm then good.

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  4. Thank you, Peggy, I appreciate the elegant way that you discuss such a sensitive topic. As an African American Ph.D. student and nurse-midwife, racism has always been a significant part of my professional life. Throughout my nursing education, racism was something rarely discussed, leaving me to feel invisible in spaces I wanted to be acknowledged and provided with ways to address issues that affected me as a Black woman. Thank you for bringing awareness to this topic and I am looking forward to more discussions.

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  5. Sensitivity to racial disparities is polarized by a white privileged bias, as so well stated in this blog by Chin. I found Chin’s blog insightful in the untangling of these ideas. Doing so is important to me because I do not want to perpetuate the injustice that continues to transfuse a steady stream of unconscious righteousness into practice as a white woman, nurse, etc.
    I found the resources helpful next steps and will engage with the mentioned blogs because on my own in the everyday soup of injustice, I cannot easily find the differentiations I need to change my behavior. This discourse is much needed in nurse discourse. Thank you for the translation.

    Liked by 2 people

    • Thank you so much for this – for sharing your commitment to take a new path for the future! We can do this, and will get better at it the more we practice new skills and build new understandings!

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  6. A group of scholars/practitioners whose work is framed from the perspecti of the theory of Nursing As Caring are working on further development of the theory. In this ongoing commitment, this blog inspires important questions for us: What characteristics of the theory of Nursing As Caring reflect colonization? And what characteristics reflect decolonization? Thanks, Peggy, for the challenge!

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  7. Pingback: Decolonizing Nursing | NurseManifest

  8. Thank you Peggy! I embrace this dialog and personally want to hear/read your “laundry list”.. so important.
    This is such a critical topic in nursing and one that I am attempting to tackle in my dissertation work vis a vis the colonialism past and present in relation to immigrant crisis, and our US complicity in the wicked problems that drive the immigtation crisis. I am writing about the US and Global North ongoing involvement in Central America’s violation of Ingigenous land rights for extractie industries like oil, hydropower, sugar cane, mining and lumber, and climate injustice that is unequally consequential for people living in the Global South. As nurses we need to understand past and present history of extractive industrie that we as colonizers benefit from structurally, historically,economically. Yusoff (2018) –A Billiion Black Anthropocnes is highly recommended place to start to understand colonialism and how past and current practices privilege white poeple over BIPOC. Colonialism is not in the past. Also recommend listen to Crooked Media’s Podcast “This Land” to hear about 2018-19 Indigenous land rights battle here our own backyard.
    Hope to see and hear more about these important topics in 2020.
    Follow #decolonizethisplace on Instagram- a good place for beginning to educate ourselves, and #menadwhitesupremacy– also on Instagram.

    Liked by 1 person

  9. Thank you for addressing this ‘touchy’ subject with your usual clarity and relevant resources. Although our textbooks for nursing students give the necessary cultural notes, there is very little acknowledgement of the inherent racism in descriptions of how manifestations of different disorders affect non-pigmented skin. Pink and shiny, pallor, flushed all need to be broadened to account for manifestations all their varieties.
    So many thoughts on this subject! The Windrush generation (Commonwealth citizens sailing home to mother England only to be subjected to prolonged ignorance and sustained racism) affected many who entered the Nursing profession there. I will look for a significant research article that I have read on that topic.
    Thanks again!!

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  10. I would like to share this mimeo on my facebook page…is that permissible? Thanks,

    Savina Schoenhofer

    PS: I’m intrigued (and a little distracted) by the design of Peggy’s slides – the use of duct tape – and wondering where I can access that design.

    Liked by 1 person

    • Please do feel free to share the link to the video. The best way to do this is to share the link to this post – and let people know that from the post they will see a link to the video of the platica. this way folks will have access to the post that inspired the platica! the link to post is https://nursology.net/2020/01/14/decolonizing-nursing/.

      The theme for the slides is one that is available on google slides – the duct tape is definitely a fun feature!

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  11. Dear Dr. Chinn,
    I never imagined that what seemed a direction forward when Dr. Smith gave her presentation on regenerating nursing- a 50 year perspective in 2018, now has been taking back hundreds of years as you propose to totally revamp nursing to include the inheritance of the injustices of previous generations. Is that regenerative nursing? Is that truly healing the world, what we need so much of now. You bring up a study from a country, South Africa, a country you claim made more progress with race relations then the U.S., which simply isn’t true. They never instituted civil rights bills and affirmative action like the United States. To link South Africa to the United States in order to promote your narrative of the continuing colonization by “white” skin people is deceptive. Might I remind you that colonialists have been all skin colors including the Ottoman Empire, who were not white, the Persian Empire, not white. Colonialism is not just a white thing. But of course that doesn’t fit your goal which seems to promote division, guilt from the past, victimhood, all just the opposite of what our founding nurse theorists strived to erase. We should regenerate nursing by bringing togetherness and unity. Revamping nursing completely to include the guilt and inheritance of previous generations is opposed to the heart of holistic nursing which says, yes, there always will be evil and bad people but it’s the unity and the looking to the future by doing what is needed today, not with all the weight and baggage of the past, that will bring humanity closer together and after all the essence of nursing theory is so much deeper then skin color. As you well know, it’s the fluctuating rhythms of energy, the unity that we are all connected, this is what brings healing. What saddens me the most, besides the fact that your blog brings nursing backwards 100 years by excavating the past and putting the weight of evil and injustice on the shoulders of anyone who is “white” today, even those “white” nurses saving the lives of people of color every day without even thinking of color or that they inherit their own ancestor’s heinous crimes. The fact that you choose Martin Luther King’s birthday to write this divisive blog, separating people by their color of their skin, when Dr. King himself said,” Don’t judge a person by the color of their skin, but by their character.”

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  12. Pingback: Coronavirus in “Black & White” – Nanette D. Massey

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