Decolonizing Nursing Knowledge – Q&A

Note from the team:
This is the last of the Q&A posts from the 
September 23rd Panel presentation.
But we encourage everyone
to continue to send us ideas and comments on this topic-
by responding to any of our blog posts, or using our Contact Form!

Comment: McGibbon (a Canadian nurse) has written extensively about colonialism in nursing.* She notes that periods of colonial history are not thought to be influential or relevant in modern nursing and hence are largely absent in nursing discourse and the nursing profession evolved within and alongside colonialist domination. These same beliefs and assumptions are embedded in nursing history and in present-day nursing knowledge and practices, professional codes of ethics, policy and position papers, and institutional nursing policies and procedures

She also discusses how the nursing metaparadigm is an inadequate mode of thinking about health and illness that fails to deal with the context of colonialism, globalization, pan-capitalism, and environmental degradation. “Broader systemic forces such as capitalism, globalization, imperialism, neocolonialism and neoliberalism must be integrated into our analysis if we are to continue to change oppressive practices that cause ill health”.

*See blog post describing McGibbon’s work

Daniel Suarez

Daniel Suárez-Baquero

I totally agree with your comment, we need to acknowledge our history, we need to recognize the past to build the future. However, colonization hides the history and only tells a biased and convenient truth that benefits the white elite that has dominated the discipline for years. This is the moment for us to have the courage that our antecessors didn’t, and change our curriculums, by telling the truth, applying critical race theory in our classrooms, and by developing a critical thinking in our peers and the future scholars of the discipline.

This is an invitation to all the nurses around the world to share their vision of the central structure of the discipline (the metaparadigm) and other Nursing conceptions. If a discipline wants to project itself in the future, it is necessary to evolve, adapt, and grow. Nevertheless, the dominant groups in Nursing have been promoting the oppression inside of the discipline and the reduction of nursing research, turning into a health research focus for the Schools of Nursing. Nowadays, universities have been graduating trained researchers with Ph.D. who serve other disciplines; instead of Nursing scholars who go to the core of the discipline to discuss, rethink, criticize, and expand it. That is one of the reasons why we are facing a state of disciplinary stagnation, leading us to overlook all the colonial control forces you point out, thus not producing a real change in the discipline.

For example, one first step that I made in this endeavor was with the publication of the article Critical Analysis of the Nursing Metaparadigm in Spanish-Speaking Countries: Is the Nursing Metaparadigm UniversalIn this paper, I discuss the differences in the core structure of Nursing knowledge grounded in the linguistic nuances between Spanish and English. Also, this paper shows the use of a concept that has been literally mistranslated in English, Cuidado; and the development in Spanish of other concepts like Environment. However, this is a small part of the vast nursing knowledge generated, reproduced, and explored in Spanish that has been excluded by the English-speaking academy.

Marlaine Smith, co-host of the panel presentation

Marlaine Smith

I’m enjoying this discussion. The metaparadigm is an early way that the focus of the discipline of nursing was articulated.  There are others to consider.  I looked across definitions citing four themes from this body of literature. (Regenerating Nursing’s Disciplinary Perspective, Advances in Nursing Science January/March 2019 – Volume 42 – Issue 1 – p 3-16 doi: 10.1097/ANS.0000000000000241).  The chapter by Sally Thorne in the Kagan, Smith and Chinn book (Nursing as Social Justice: a Case for Emancipatory Disciplinary Theorizing) addresses the issue of nursing’s disciplinary focus on social justice. (Thorne, S. (2014). Nursing as Social Justice: A Case for Emancipatory Disciplinary Theorizing. In P. Kagan, M. Smith, & P. L. Chinn (Eds.), Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis (pp. 79–90). Routledge Taylor & Francis Group.)

I do think that the discipline of nursing’s focus on how the environmental context, (including social, cultural, political, economic, physical dimensions) impacts health and well-being subsumes nursing’s necessary consideration of how racism, colonialism, globalization, pan-capitalism, and environmental degradation…impacts health and wellbeing. Also, I believe that caring is a defining focus of the discipline and social justice is caring at a community/global level. Perhaps this hasn’t been clearly articulated and needs to be made explicit.  

Bukola Salami

Bukola Salami

I agree that nursing has a colonial past in many ways.  Largely, all the history of nursing has been concentrated in North America and Europe and the focus has been on people of one particular race, White people.  There has been little attention paid to the history of nursing in Africa, the Middle East and Asia.  This lack of attention has to some extent also contributed to unparallel grounds in the advancement of nursing knowledge.  Our colonial tendencies extend to Standards of Practice and Entry to Practice frameworks.  Many of the nursing Standards of Practice, Entry to Practice Frameworks and Code of Ethics do not have the word “race” or “racism” in it.  Often when a related word is included, it is often about culture with a general statement on cultural sensitivity or if in more advanced ways cultural safety.  The framing, moreover, tends to blame the culture of the patient rather than the embedded racial inequalities in healthcare and in the broader society.  Also, many of the nursing standards of practice only discusses issues related to culture and race from the perspective of patient-nurse relationship but not how racial inequities exist in our profession.  It is my strong belief that if nursing is to advance and be anti-racist, that anti-racism has to be embedded as a Standard of Practice and as a mandatory Professional Competence. 

McGibbons explains that the metaparadigm is an inadequate mode of thinking about health and illness as it fails to deal with the context of colonialism, globalization, pan-capitalism and environmental degregation. Dr. Marlaine Smith argues that the metaparadigm is an early way that the focus of the discipline of nursing was articulated and that the discipline of nursing’s focus on how the environmental context, (including social, cultural, political, economic, physical dimensions) impacts health and well-being subsumes nursing’s necessary consideration of how racism, colonialism, globalization, pan-capitalism, and environmental degradation…impacts health and wellbeing.

I agree with both Smith and McGibbons point and do not think these points are contradictory.  Often when nurse educators teach the meta-paradigm the focus is on the concrete aspect and there is no broader focus on the global forces that shape health.  This is what we grapple with in nursing; in what ways do we move seamlessly from theory to practice in a way that our broader theoretical lens influence clinical practice in meaningful ways. This has been one of the debates in nursing.  Many of the nursing theories have focused largely from a positivist lens in an attempt to make nursing easily digestible to those working at the bedside, i.e. in clinical practice.  However, many nurses, such as myself have embraced broader theoretical approaches outside of nursing that challenges colonial and neocolonial influences on healthcare. It is a ripe time to think more about “environmental” context in nursing in a way that we can move seamlessly from theorizing the global forces that shape healthcare, the intersectional issues contributing to health, our the role of power inequities in health to also thinking about an individual patient (i.e with diagnosis of diabetes) within this broader global forces.  This broader theorizing and seamless shift can help us illuminate more into a sustainable future that may prevent readmission and promote health. It may also help in thinking more about healthcare administration, resource allocation and quality of care provided. 

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