Joan M. Anderson

Rewriting Cultural Safety Within the Postcolonial and Postnational Feminist Project Toward New Epistemologies of Healing

The concept of cultural safety, developed by indigenous nurses in the postcolonial climate of New Zealand, has not been widely examined in North America. In this article we explicate the theoretical and methodological issues that came to the forefront in our attempts to use this concept in our research with different populations in Canada. We argue that this concept prompts us to “think critically” about ourselves and our patients, and to be mindful of our own sociocultural, economic, and historical location. This critical reflection has implications for how we live, relate to one another, and practice in our various professional disciplines. On the basis of our findings, we discuss how the concept might be rewritten within a critical postcolonial and postnational feminist discourse.

Postcolonial nursing scholarship: from epistemology to method.

Postcolonial theory, with its interpretations of race, racialization, and culture, offers nursing scholarship a set of powerful analytic tools unlike those offered by other nursing and social theories. Building on the foundation established by those who first pointed to the importance of incorporating cultural aspects into nursing care, nursing scholarship is in a position to move forward. Critical perspectives such as postcolonialism equip us to meet the epistemological imperative of giving voice to subjugated knowledges and the social mandates of uncovering existing inequities and addressing the social aspects of health and illness. This article makes a case for the integration of postcolonial perspectives into theorizing and sketches out a research methodology based on the postcolonial tradition.

Pursuing common agendas: A collaborative model for knowledge translation between research and practice in clinical settings

There is an emerging discourse of knowledge translation that advocates a shift away from unidirectional research utilization and evidence-based practice models toward more interactive models of knowledge transfer. In this paper, we describe how our participatory approach to knowledge translation developed during an ongoing program of research concerning equitable care for diverse populations. At the core of our approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis. We discuss lessons learned including: the complexities of translating knowledge within the political landscape of healthcare delivery, the need to negotiate the agendas of researchers and practitioners in a collaborative approach, and the kinds of resources needed to support this process.

Women's perspectives on chronic illness: Ethnicity, ideology and restructuring of life

This inquiry into the lives of women living with a chronic illness brings to attention the complex processes that frame the existential meanings of illness. Data from immigrant Chinese and Anglo-Canadian women with diabetes are used to show that illness is constructed in a complex social, political and economic nexus. When the circumstances of womens lives are examined, styles of managing illness that could be attributed to ethnicity, become recognizable as pragmatic ways of dealing with the harsh realities of material existence. It is argued that the trends toward individualizing social problems, and shifting the responsibility for caretaking from the state to the individual, obfuscate the social context of illness, and exclude the socially disadvantaged from adequate health care.

Home care management in chronic illness and the self-care movement: An analysis of ideologies and economic processes influencing policy decisions

Over the past few decades there has been an increasing trend toward self-care and home health care, and one would suspect that these trends will continue into the next century. This article addresses the policy issues that have arisen from a program of research with families caring for a child with a chronic illness in the home and with women who have diabetes mellitus. The argument is developed that, although the home care and self-care movements can be seen as directed toward providing more humanistic care and promoting the independence of the client, the economic and sociopolitical factors that influence their development should not be overlooked. Furthermore, the “cost of caring” must be reckoned with in both human and economic terms. Cost-effective care, in the long run, will mean care that takes into account the social context of health and illness.

Ethnicity and illness experience: Ideological structures and the health care delivery system

This paper analyses the experiences of Anglo-Canadian and immigrant Chinese families with a chronically ill child by using the idea that the social organization and ideology of health care services generate particular illness experiences. Immigrant families find the ideology dissonant with their customs for managing illness. The disjuncture between practices often leads to non-compliance and ineffective treatment. Health professionals explain non-compliance by the obvious facts of cultural differences, but I argue that it should be understood by institutional practices that exclude families from participating in caretaking. I maintain that patients and families should be included in decisions that affect their lives. Pressures from government to economize by increasing home care services, and the increasing number of immigrants may force practitioners to negotiate culturally acceptable care with them.

Inequities in health and healthcare viewed through the ethical lens of critical social justice: contextual knowledge for the global priorities ahead.

The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels.

Living with a chronic illness: Chinese-Canadian and Euro-Canadian women with diabetes--Exploring factors that influence management

The study reported on here was designed to address how Euro-Canadian and Chinese-Canadian women living with diabetes experience and manage their illness in their day to day lives, and the factors that influence daily management (diet, exercise, medication and blood testing). It was hypothesized that womens patterns of diabetes management would be associated with (a) ethnicity and/or (b) fluency in English. It was also hypothesized that the extent to which women with diabetes (whether Chinese- or Euro-Canadian, fluent or not fluent in English) would carry out daily management in accordance with western health care practices would be associated with: (i) the extent to which desired professional care is experienced; (ii) the womens awareness of facts as endorsed by health professionals (biomedical knowledge); and (iii) her satisfaction with the support received from family and friends. A total of 196 women were interviewed to explore these hypotheses. While we do not yet know the magnitude or relative importance of each of the independent variables, the findings from this study suggest that the management of diabetes is a complex construct, comprised of several components, each being influenced by a number of factors. How a woman managed her illness was not reducible to her ethnicity. Instead, the contextual features of her life, coupled with her ability to access resources seemed to organize the ways in which she managed her illness. Diabetes management therefore becomes a multifaceted phenomenon, which has to be understood within the mediating circumstances of a womans life.

Knowledge development and evidence-based practice: insights and opportunities from a postcolonial feminist perspective for transformative nursing practice.

Although not without its critics, evidence-based practice is widely espoused as supporting professional nursing practice. Engaging with the evidence-based practice discourse from a vantage point offered by the critical perspectives of postcolonial feminism, the incomplete epistemologies and limitations of the standardization characteristic of the evidences-based movement are analyzed. Critical analysis of evidence is suggested, such that it recognizes the evidence generated from multiple paradigms of inquiry, along with contextual interpretation and application of this evidence. We examine how broader interpretations of evidence might contribute to nursing knowledge development and translation for transformative professional nursing practice, and ultimately to address persistent health disparities within the complex context of healthcare delivery.

Perspectives on the health of immigrant women: a feminist analysis.

This article focuses on the health status of two groups of immigrant women and their experiences surrounding help-seeking. It is argued that social, economic, and political forces play a crucial role in determining the subjective experiences of immigrant women in their contacts with the health care system. Case studies of Indo-Canadian and Greek women are used to illustrate this perspective.