Elizabeth McGibbon

Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter‐narrative

Although there are notable exceptions, examination of nursings participation in colonizing processes and practices has not taken hold in nursings consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward decolonizing the profession. The authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursings intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter-narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health.

A Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA).

The Canadian public health sector’s foundational values of social justice and equity, and its mandate to promote population health, make it ideally situated to take a strong lead in addressing persistent and unacceptable inequities in health between socially disadvantaged, marginalized or excluded groups and the general population. There is currently much attention paid to improving understanding of pathways to health equity and development of effective population health interventions to reduce health inequities. Strengthening the capacity of the public health sector to develop, implement and sustain equity-focused population health initiatives - including readiness to engage in a social justice-based equity framework for public health - is an equally essential area that has received less attention. Unfortunately, there is evidence that current capacity of the Canadian public health sector to address inequities is highly variable. The first step in developing a sustained approach to improving capacity for health equity action is the identification of what this type of capacity entails. This paper outlines a Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA), grounded in the experience of Canadian public health equity champions, that can guide research, dialogue, reflection and action on public health capacity development to achieve health equity goals.RésuméLe secteur canadien de la santé publique, avec ses valeurs fondamentales de justice sociale et d’équité et son mandat de promotion de la santé des populations, est idéalement situé pour jouer un rôle de premier plan face aux iniquités en santé persistantes et inacceptables entre les groupes socialement défavorisés, marginalisés ou exclus et la population générale. On essaie beaucoup, en ce moment, de mieux comprendre les voies de l’équité en santé et d’élaborer des interventions efficaces en santé des populations pour réduire les iniquités en santé. Une mesure tout aussi essentielle et pourtant moins reconnue est de renforcer les capacités du secteur de la santé publique à élaborer, à mettre en oeuvre et à soutenir des initiatives de santé des populations axées sur l’équité - y compris la volonté d’employer en santé publique une grille d’équité basée sur la justice sociale. Malheureusement, il semble que la capacité actuelle du secteur canadien de la santé publique d’aborder les iniquités varie considérablement. La première étape, si l’on veut mettre au point une approche soutenue en vue d’améliorer les capacités d’agir sur l’équité en santé, est de déterminer ce qu’une telle capacité implique. Notre article définit un « cadre conceptuel de la capacité organisationnelle pour une action de la santé publique en matière d’équité », ancré dans l’expérience des champions de la santé publique canadienne sur la question de l’équité, pour orienter la recherche, le dialogue, la réflexion et l’action sur le renforcement des capacités en santé publique et atteindre les objectifs d’équité en santé.

Rural interprofessional primary health care team development and sustainability: establishing a research agenda

Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.

Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients

Objectives To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada. Setting Population-based, secondary analysis of provincial administrative health data. Participants All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. Primary and secondary outcome measures (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of ‘urgent’ angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old). Results FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20–30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) Conclusions Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.