In nursing, we have a strong and steady commitment, in theory and in practice, to the idea of “the whole” This idea is expressed in the term that is sometimes spelled with the letter “w” (wholism), and sometimes starting with the letter “h” (holism). The difference between the spellings is subtle, but noticing this difference, and embracing both meanings, provides a bridge to also understand the concept of intersectionality. So first, the meanings of the two “whole” spellings (with acknowledgement of Helen Erickson’s explanation shared with me in a personal communication several years ago)!

Wholism, spelled with a “w”, focuses on the parts that make up the totality of a phenomenon, or an experience. For example a focus on how a person with diabetes is managing their diet, while recognizing and accounting for a host of other factors that make up the whole of the experience..

Holism, spelled with an “h”, focuses on the totality of the phenomenon, or experience. For a person with diabetes, starting with a focus on the whole experience by asking, for example: “How are you managing the challenges of daily living?”.

The concept of intersectionality touches on this subtle distinction, but brings to the fore the social and political forces that shape, and that are embedded in, human experience – forces that are typically overlooked and dismissed as “outside” the boundaries of “the whole.” The concept was first described by Kimberlé Crenshaw, African American legal scholar, in her quest to understand the power dynamics when people of color interact with the legal system. Her awareness emerged as she watched the Anita Hill hearings during the U.S Supreme Court confirmation of Clarence Thomas. Feminist activists were supporting Hill, and anti-racism activists were defending Thomas. Both groups were calling for justice and equality – one based on gender (believe women), and the other based on race (resist anti-black racism). But instead of joining together to support each other’s calls for justice and protesting the complex issues embedded in the situation, they were weakening each other’s movements, with no clear message calling for justice for Black women (Mohdin, 2020)

Intersectionality is defined as

the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, classism) combine, overlap or intersect, especially in the experiences of marginalized individuals or groups. (see https://www.merriam-webster.com/dictionary/intersectionality)

What this means is that the entirety of a person’s experience is shaped by various characteristics – the parts of the whole AND the whole of the parts. It is where a person’s complex characteristics come together, or intersect, that social significance comes to the fore. So for example, the experience of all women is influenced by the fact that they are women, placing them at disadvantage relative to people who are not women. But white women and women of color have vastly different experiences in their social, political, institutional and personal experience. Black men and Black women have common experiences shaped by being Black, but their gender identity plays a significant role in shaping their experience. Then add in many other identities, and the differences and complexities multiply.

In nursing and healthcare, these differences are recognized as health and healthcare disparities, or as social determinants of health (which are in fact often social determinants of death). We cannot pretend that we “treat everyone the same” when our actions serve to perpetrate and sustain injustices based on race, gender and class, particularly when these identities come together to amplify their disadvantage. If we are to address the tragic disparities suffered by childbrearing Black and Brown women for example, we must pay attention to difference, and respond to people differently based on their complex individuality, and their social situation of the moment. The immutable characteristics of the person (race, gender and other characteristics) are not “the problem.” Nor will a focus on these characteristics alleviate the health challenges that are part of their everyday experience. Rather, the social and interpersonal responses of others related to these differences are manifested as racism and sexism (prejudiced or discriminatory responses). They pile together as multiple discriminations that have a dynamic and lasting presence. When a number of intersecting identities come together that place a person at double, triple, quadruple disadvantage, their disadvantage, and their risk, multiplies out of proportion.

There are three nursing theories that directly address the concerns that the concept of intersectionality addresses, as well as defining nursing responses:

• The Emancipatory Theory of Compassion (authored by Jane Georges) addresses compassion as nursing’s response to human suffering. The theory addresses both the suffering of patients and nurses, and goes beyond the nurse-patient relationship to contextualize suffering and compassion of communities and populations. The theory asserts that it is axiomatic for nursing to find ways to decrease suffering, share power, increase compassion, speak the unspeakable, teach moral imagination, and enhance voice (description by Shannon Constantinides).
• Emancipatory Nursing Praxis (authored by Robin Walter) describes and explains the transformative learning process nurses experience as they come to know and engage in social justice as allies. This process involves intrapersonal characteristics and socio-environmental factors that work in concert to provide nurses with a basic awareness that ‘something is not right’ or ‘something needs to be done’. The process aims toward three goal-directed processes: human flourishing, achieving equity, and transforming social relationships.
• Critical Caring (authored by Adeline Falk-Rafael) focuses on a caring/social justice ethics and political activism that underpins practice, and the relevance to nursing practice of the carative health promoting process of contributing to the creation of supportive and sustainable physical, social, political, and economic environments. Critical caring is conceptualized as a way of being (ontology), knowing (epistemology), choosing (ethics), and doing (praxis) expressed through 7 carative health promoting processes derived from Watson’s 10 clinical caritas processes.

As nurses, we can no longer be despairing in the face of injustices. We can act in local, personal encounters, as well as in our communities and larger social contexts. We can recognize the ways in which intersectional identities influence the human health experience, and shape our practices to overcome injustices related to these identities. We can join with other nurses, healthcare providers and consumers to work toward specific change in the direction of justice.

Additional Resources

Kimberlé Crenshaw on Intersectionality, More than Two Decades Later. (n.d.). Retrieved July 12, 2024, from https://www.law.columbia.edu/news/archive/kimberle-crenshaw-intersectionality-more-two-decades-later

Mohdin, Aamna. (2020, November 12). Kimberlé Crenshaw: the woman who revolutionised feminism – and landed at the heart of the culture wars. The Guardian. https://www.theguardian.com/society/2020/nov/12/kimberle-crenshaw-the-woman-who-revolutionised-feminism-and-landed-at-the-heart-of-the-culture-wars