From the September 23rd Panel Q&A
There were several questions in the chat for me.
Q. As part of my master’s degree (UVIC) I am currently going through a practicum at a Nursing School in BC, Canada. This course is a 12-week course that focuses on care of acutely ill clients experiencing surgical interventions. As such, it’s very med/surg/anatomy heavy. How can we implement anti-racist and indigenous content into such a course?
While it is extremely important to learn pathophysiology and to become a skilled and competent nurse, it is even more important to understand how the lived experiences of each person you touch is impacted by disease and disability. How do they see their circumstances, how will they adapt to any changes in health status? The five Cs I discussed related to vaccine hesitancy can also apply to other situations. The five Cs can be applied e to your nursing history to help you humanize and better understand each person as a unique being. In so doing, I believe you become pro-person and of course anti-racist as well. For example:
Confidence- Is the patient confident that medical care will safely address their condition? Are they confident about the skill and abilities of the hospital staff?
Complacency- Does the patient believe the treatments are necessary
Convenience- Does the person understand what is going on as it relates to language and health literacy. Are they accessible to follow-up care? Can they afford follow-up care? Can they afford the hospitalization?
Communication- Are patients informed about their disease or disability?
Context – How does race/ethnicity, occupation, socioeconomic and other structural factors impact the person.
Q. While teaching student nurses about structural inequities, how can faculty members create safe spaces where BIPOC students are not retraumatized by the content presented?
Those of us who are BIPOC have an inner strength others do not recognize. We have had to deal with “twoness” all our lives. We have had to create an authentic self we can live with. As I briefly shared in the chat, it is the concept of ” twoness.” So, we often live within and without the white vs BIPOC world. The twoness phenomenon is discussed in W.E.B. DuBois’s book the “Soul of Black Folk.” He states the following:
. . a black man “ever feels his two-ness– an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder”(1705).
You as a teacher can accept that twoness is necessary. You can make clear to students that they need not be ashamed of being in the space they are in, and they have the right to develop their authentic self and to honor their lived experience. It is not about the trauma, it is about projecting the changed mission and values of a of decolonized nursing community.
Finally, nursing education needs to expose students to broader sociological concepts and adopt or design more macro level theories. Many of our nursing theories deal with the individual and not the interplay of health to economics, governance and human rights or as we discuss now, the social determinants of health. During my ten-year career as a nursing educator, I most often used Bronfenbrenner’s Ecological Systems Theory because it broadened student’s perspectives.
Q: Another I remember was about the new Commissioner of Public Health in Florida. This is my response:
Unfortunately, I have taught graduate students whose beliefs did not represent any degree of cultural humility and whose politics were toxic. These students justified their stance through their belief that the US did so much for the world’s people; they did not need to tolerate charity at home.
As a global health expert, I met with physicians who looked at me in blank disdain as I discussed a public health approach versus a medical approach and talked about what we now in terms of the social determinants of health. It was hogwash to them, the medical approach was the only approach that made sense and public health, nursing, or another theoretical approach was just a “garbage pan” approach to health care. We now have physicians who want to discuss and take credit for public health being medicine.
I say all this to say the following: I disagree with the policies that the new Surgeon General of Florida has issued. I believe they are irresponsible and unscientific. However, I have learned that some people just do not embrace the notion that “ to whom much is given, much is required.” In respect to my African -American and American Indian ancestors and to the ancestral lands we all live on, I believe more is required of all in the healing professions.
The new Surgeon General does not exhibit the cultural humility required of such a position. in my estimation. Impeccable credentials and a Harvard School graduation does not make one prepared to run a public health department. What is more distressing to me are Black folk willing to go against the grain to support policies that seem to only advance them personally. To paraphrase other comments about the new Florida State Surgeon General , he is more with #DeSantis than with public health and health care aimed at building trust, equity, and decolonization.. Finally, it is a key example of what happens when our educational programs have not seemingly changed mission and values to advance the interplay of health and human rights.