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Enhancing Curiosity and Critical Reflexivity for Nursing Leaders


Julianne Baarbé (BScN, PhD) is a PhD-trained research trainee at York University where she studies the efficacy of day programs for vulnerable individuals living with dementia and their family/friend caregivers to improve quality of life and delay long-term care placement. She recently completed her Bachelor in Science in Nursing at University of Toronto, where she consolidated in primary health care. Julianne’s interests lie in supporting vulnerable older adults across the continuum of care. She hopes that these supports will prevent cognitive decline by acting on modifiable dementia risk factors (diabetes, hypertension, stroke, depression, social isolation) and improve quality of life.

 

In a famous parable, six blind men confronted an elephant, and they began to describe what they had found to each other. One blind man felt the elephant’s tusk and exclaimed that he had found a spear. Another blind man felt the ear and shouted that he had found a fan. Another blind man felt the trunk and two other blind men felt the side and leg of the elephant. Each blind man correctly described their unique perspective, yet each blind man knew only part of the full picture (Figure 1).


Figure 1: The Parable of the Blind Men and the Elephant—Our Experience is Rarely the Whole Truth [1]. Image Modified from Sketchplanations, CC4.0 BY NC.



As the parable of the blind men and the elephant illustrates, a story is not always how it seems. We may perceive a story that to us is compelling, when our colleagues or patients perceive an alternate story that is also impactful. For instance, we may perceive vaccines as scientific and perfectly safe, whereas people who have histories of being harmed by the medical establishment may perceive vaccines as risky. As future nurse leaders, we must be alert to our feelings, perspectives, assumptions, and the resulting stories. Alone, like the blind men, we have a limited view of the full picture. We must be open-minded and reflect on the subjectivities and stories of our patients and colleagues who have been oppressed by longstanding discourses of structural violence, especially by anti-Black and anti-Indigenous racism. As future nurse leaders, we can create a future for nursing by constructing fulsome stories through curiosity, honesty, and an openness to learn, so that we may center the voices of those impacted by structural racism for whom we have been entrusted as nurses and hold responsibility.


My own motivation to write this blog for future nursing leaders comes from my observation of blind spots in the health care system, after my own older sister by two years went missing. She was subjected to violence, and I believe that her needs were undetected. I am heartbroken, but also, I enter nursing with a strong desire to aid those who hold untold stories and subjectivities like my sister. I hope that others do not fall through the cracks like she did. As a future nurse, I wish to expose blind spots in our health care system and contribute to leadership that will bring awareness and rally a response to unmet needs through curiosity, humility, and love.


One of the foremost challenges facing nursing today is structural racism that has oppressed and continues to oppress Black, Indigenous and Peoples of Colour (BIPOC). Structural racism refers to a system of racial bias that has permeated institutions and society with a discourse of white supremacy, leading to the revoking of privilege and opportunity from people of colour [2]. Due to the prevailing discourse of structural racism, BIPOC individuals continue to be marginalized and face ongoing cycles of exclusion and poor health outcomes.


BIPOC individuals are often excluded from treatment, education, research, policies, and leadership positions [2,3]. Social and health impacts include sustained levels of poverty, poor access to education, increased risk for chronic diseases, poor mental health, increased substance use, increased infant mortality, forced apprehension of children, incarceration, and premature death [2,3]. Importantly, these effects arise from structural racism, including redlining practices that revoke mortgages and other privileges from people of colour [4,5], instead of from an actual difference in biology. Despite prevailing violence that continues to impact the health of individuals in the BIPOC community, society remains structured on white supremacy, as seen by high paying jobs and leadership roles held mainly by white people across educational, hospital and judicial organizations.


During the pandemic, structural racism worsened as BIPOC individuals disproportionately became sick and died from the coronavirus [6]. Many of these individuals hesitated before receiving the coronavirus vaccine [7]. Vaccine hesitancy among BIPOC individuals makes sense, when we consider the historic practice of forced sterilization of Black and Indigenous peoples at the hands of health providers [3,8]. Doctors and nurses also participated in unethical medical experimentation of Black and Indigenous peoples, including the Tuskegee Syphilis Study which denied Black people known treatments for syphilis and the Havasupai Tribe Genetic Research Study where blood samples were unethically collected from Indigenous peoples [7]. During the pandemic, vaccine mandates further eroded trust of BIPOC individuals in government institutions, by exposing these people to stigma and fear [9].


Intersectionality theory is one way to help counter white privilege and correct these wrongs, as highlighted by Ruiz and colleagues [10]. Intersectionality refers to viewing the multiple layers of oppression that influence one’s social location and experience of health inequity [10]. As a white woman in my 30s training to be a nurse, I hold a position of privilege and power in society due to my social location. I hold the potential to wield this power in positive and negative ways, which will influence my patients who are often sick and very vulnerable. Out of respect and compassion, deeply aware of my white skin, I will look to the multiple layers of oppression that influence my patients and colleagues, and I will humbly hear the voices of the peoples who have been oppressed. With this lens, I will begin a path of reconciliation for those who experienced histories of violence.


We can expect to encounter a wide range of subjectivities and experiences that shape our BIPOC colleagues and patients. BIPOC individuals are often subject to multiple layers of oppression from racism, classism, sexism, heterosexism, agism and ableism that intersect together to create health disparities [2]. When there are conflicts in priorities, we can be open-minded and find common ground. As Alison Thompson [11] eloquently expressed in the context of vaccine compliance, people ultimately want to make good decisions that will support health of their loved ones. Thus, as health providers, we can hold strong trust that people want to make good decisions. This knowledge provides a common ground to engage in open dialogue, non-judgmentally to provide trustworthy sources of information that demonstrate positive regard, that will help our patients and colleagues in their decision-making.


White people ought to take active roles in challenging discourses of white supremacy [12]. By applying an intersectionality lens, we can view the unique social location, historical narratives and subjectivities of ourselves, our colleagues, and our patients, that cumulatively shape one’s privilege and oppression in society [10]. As a white woman in my 30s and as a future nurse, I have considered how people of my type have done the worse kind of damage possible to BIPOC individuals. It is high time that we now amplify the voices of BIPOC patients and colleagues and build strong relationships that will support their experiences accessing healthcare [7] and their growth and promotion in the workforce. As future nursing leaders, we must reckon with ourselves about legacies of structural violence and humbly correct for past wrongs.


In the future, we will continue to see health disparities in BIPOC individuals due to prevailing narratives of white supremacy. We will see ongoing conflicts between the priorities of white people and BIPOC individuals related to perceived health needs, funding allocation, research priorities, and vaccine compliance. To counteract these conflicts, as nurse leaders, we must become allies for BIPOC individuals. Allyship involves respectful, non-judgmental attitudes that centers the views of BIPOC individuals. As the nursing leaders of tomorrow, we must listen to the narratives and subjectivities of people who experienced oppression, and we must bring these perspectives to the forefront.


As a white nursing student in my community placement, I had an opportunity to practice allyship recently with my preceptor, a Black nurse. After assessing a patient, I felt concerned by their fluctuating oxygen saturation and considered notifying the Director of Care who happened also to be a white nurse. However, my preceptor, as a Black nurse, did not feel this action was warranted. I remembered my positionality as a white student and the positionality of my preceptor, a Black nurse. Through this lens, I felt respect towards my preceptor, even while I felt concern for the patient. I sought to understand my preceptor’s perspective and ask her questions. Soon, my preceptor notified the Director of Care of her own accord. She disclosed to me afterward that she often felt targeted by her colleagues with lighter skin and perceived microaggressions acutely. These microaggressions prevented her from speaking up. In particular, she felt targeted when people spoke to her boss about her behind her back. This was very eye-opening to me, and I was grateful that I could practice allyship by seeking her opinion with a curious, open mind.


As soon-to-be nurse graduates and as nursing leaders of tomorrow, we will confront discourses of structural racism and violence that impact health equity of our patients and colleagues. Through humility and love, we must look within ourselves at our assumptions and motivations and actively dismantle narratives of white supremacy. As future nurse leaders, we can be sensitive to the subjectivities of those who have been marginalized by structural racism and center their voices. This may look like job promotion and leadership roles for members of the BIPOC community. The perspective of a BIPOC nurse leader is indeed valuable because they represent the voices of communities who have been oppressed and marginalized in society. Indeed, the elephant is in the room. The giant beast looms invisible without our BIPOC allies. Through relationships that increased trust, connection and representation for these communities, the blind will enlighten each other, collaboratively.


 

References

  1. Sketchplanations. The blind and the elephant. Johnson GD. Reality conundrum no background. OpenClipArt, 2016[cited 2023 September 8]. Available from https://sketchplanations.com/the-blind-and-the-elephant https://openclipart.org/detail/254260/reality-conundrum-no-background.

  2. National Museum of African American History & Culture (NMAAHC). Being antiracist. Smithsonian. [cited 2023 September 7]. Available from https://nmaahc.si.edu/learn/talking-about-race/topics/being-antiracist.

  3. Allan B, Smylie J. First peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. 2015 [cited 2023 September 7]. Available from https://www.wellesleyinstitute.com/publications/first-peoples-second-class-treatment/.

  4. Lynch EE, Halinka Malcoe L, Laurent SE, Richardson J, Mitchell BC, Meier HCS. The legacy of structural racism: Associations between historic redlining, current mortgage lending and health. SSM - Popul Heal 2021; 14: 100793. doi: 10.1016/j.ssmph.2021.100793.

  5. Mujahid MS, Gao X, Tabb LP, Lewis TT. Historical redlining and cardiovascular health: The multi-ethnic study of atherosclerosis. Proc Natl Acad Sci U S A 2021; 118: e2110986118. doi: 10.1073/pnas.2110986118.

  6. Gupta S, Aitken N. COVID-19 mortality among racialized populations in Canada and its association with income. Stat. Canada. 2022 [cited Setpember 7]. .Available from https://www150.statcan.gc.ca/n1/pub/45-28-0001/2022001/article/00010-eng.htm.

  7. Quinn SC, Andrasik MP. Addressing vaccine hesitancy in BIPOC communities - Towards trustworthiness, partnership, and reciprocity. N Engl J Med 2021; 385: 97–100. doi: 10.1056/NEJMp2103104.

  8. Taylor JK. Structural Racism racism and Maternal maternal Health health Among among Black black Womenwomen. J Law, Med Ethics 2020; 48: 506–517. doi: 10.1177/1073110520958875.

  9. Bardosh K, De Figueiredo A, Gur-Arie R, Jamrozik E, Doidge J, Lemmens T et al. The unintended consequences of COVID-19 vaccine policy: Why mandates, passports and restrictions may cause more harm than good. BMJ Glob Heal 2022; 7: 1–14. doi: 10.1136/bmjgh-2022-008684.

  10. Ruiz AM, Luebke J, Klein K, Moore K, Gonzalez M, Dressel A et al. An integrative literature review and critical reflection of intersectionality theory. Nurs Inq 2021; 28: e12414. doi: 10.1111/nin.12414.

  11. Thompson A. The paradox of vaccine hesitancy and refusal: Public health and the moral work of motherhood. In: Ballantyne P, Ryan K (eds). Living Pharmaceutical Lives. Routledge: London, 2021, pp 88–102.

  12. Van Herk KA, Smith D, Andrew C. Examining our privileges and oppressions: Incorporating an intersectionality paradigm into nursing. Nurs Inq 2011; 18: 29–39. doi: 10.1111/j.1440-1800.2011.00539.x.

The nursing blog series aims to promote critical reflection on various topics related to nursing practice, education, and professional development. The views expressed in the nursing blog posts are those of the respective author and do not necessarily reflect the official policy or position of UTIHI or affiliated organizations.

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