Judith A. MacDonnell

Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities

BackgroundThis article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada.MethodsA critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives.ResultsA continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse.ConclusionsThe analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions about, and ideological commitments to, sexual and gender diversity and health services access and equity. Thus, the continuum of discourses may serve as an important element of a health care organizations access and equity framework for the evaluation of access to good quality care for diverse LGBT populations. More specfically, the analysis offers four important points of consideration in relation to the development of a health services access and equity framework.

Arts-Based Critical Inquiry in Nursing and Interdisciplinary Professional Education: Guided Imagery, Images, Narratives, and Poetry

In this article, transformative educators are encouraged to use an arts-based critical inquiry approach within their diversity-sensitive teaching practice. Using a Socratic dialogue, the authors describe how guided imagery, images, narratives, and poetry have been useful in developing transformative insights in relation to spiritual/ecological values, sexual orientation, and culture in the context of nursing and interdisciplinary professional education. Arts-based approaches that incorporate constructivist dimensions can potentially stimulate critical inquiry in educational settings that can spark the thoughtful dialogue and passion needed for practitioners to engage in emancipatory practices for social change. The underlying adult learning theoretical frameworks for this teaching and learning dialogue are transformative learning and unlearning. Innovative arts-based and experiential approaches to diversity-sensitive teaching nurture the dynamic engagement and individual and collective reflection that fosters interpersonal understanding and hope for meaningful community connections and social change.

‘That would have been beneficial’: LGBTQ education for home‐care service providers

This paper reports qualitative findings from a pilot study that explored the lesbian, gay, bisexual, transgender and queer (LGBTQ) education needs of home-care service providers working in one large, urban Canadian city. The pilot study builds upon research that has documented barriers to health services for diversely situated LGBTQ people, which function to limit access to goodquality healthcare. LGBTQ activists, organisations and allies have underscored the need for health provider education related to the unique health and service experiences of sexual and gender minority communities. However, the home-care sector is generally overlooked in this important body of research literature. We used purposeful convenience sampling to conduct four focus groups and two individual interviews with a total of 15 professionally diverse homecare service providers. Data collection was carried out from January 2011 to July 2012 and data were analysed using grounded theory methods towards the identification of the overarching theme, ‘provider education’ and it had two sub-themes: (i) experiences of LGBTQ education; and (ii) recommendations for LGBTQ education. The study findings raise important questions about limited and uneven access to adequate LGBTQ education for home-care service providers, suggest important policy implications for the education and health sectors, and point to the need for anti-oppression principles in the development of education initiatives.

Becoming Resilient: Promoting the Mental Health and Well-Being of Immigrant Women in a Canadian Context

This paper reports on grounded theory findings that are relevant to promoting the mental health and well-being of immigrant women in Canada. The findings illustrate how relationships among settlement factors and dynamics of empowerment had implications for “becoming resilient” as immigrant women and how various health promotion approaches enhanced their well-being. Dimensions of empowerment were embedded in the content and process of the feminist health promotion approach used in this study. Four focus groups were completed in Toronto, Ontario, Canada with 35 racialized immigrant women who represented diverse countries of origin: 25 were from Africa; others were equally represented from South Asia (5), Asia (5), and Central or South America and the Caribbean (5). Participants represented diverse languages, family dynamics, and educational backgrounds. One focus group was conducted in Somali; three were conducted in English. Constructivist grounded theory, theoretical sampling, and a critical feminist approach were chosen to be congruent with health promotion research that fostered womens empowerment. Findings foreground womens agency in the study process, the ways that immigrant women name and frame issues relevant to their lives, and the interplay among individual, family, community, and structural dynamics shaping their well-being. Implications for mental health promotion are discussed.

Conceptualizing structural violence in the context of mental health nursing.

This article explores how the intersections of gendered, racialized and neoliberal dynamics reproduce social inequality and shape the violence that nurses face. Grounded in the interviews and focus groups conducted with a purposeful sample of 17 registered nurses (RNs) and registered practical nurses (RPNs) currently working in Ontarios mental health sector, our analysis underscores the need to move beyond reductionist notions of violence as simply individual physical or psychological events. While acknowledging that violence is a very real and disturbing experience for individual nurses, our article casts light on the importance of a broader, power structure analysis of violence experienced by nurses in this sector, arguing that effective redress lies beyond blame shifting between clients/patients and nurses. Our analysis illustrates how assumptions about gender, race and care operate in the context of global, neoliberal forces to reinforce, intensify and create, as well as obscure, structural violence through mechanisms of individualization and normalization.

Enhancing our understanding of emancipatory nursing: a reflection on the use of critical feminist methodologies.

The aim of this analysis is to contribute to an understanding of emancipatory nursing in the context of higher education. Engagement with formative studies that used critical feminist methodologies led to my research focus on lesbian, gay, bisexual, and transgender (LGBT) health in my academic research program. Dimensions of emancipatory nursing include reflexivity, transformative learning, interdisciplinarity, praxis, and situated privilege. Several critical feminist methodologies are addressed: feminist ethnography, community-based participatory action research (CBPAR), and comparative life history. Commonalities across methodologies illustrate the potential for emancipatory outcomes/goals.

Walking the talk: insights into dynamics of race and gender for nurses.

This article explores how the dynamics of violence and support for nurses are influenced by the intersections of race, gender, and other social relations in various practice settings. Utilizing a qualitative study design, situated in the naturalistic and critical paradigms, this article is grounded in the experiences of key informants (KIs), each possessing significant expertise on issues of equity and violence, as well as insight into the current practice settings in Ontario, Canada. The individual KI interviews were analyzed using conventional qualitative content analysis, with its focus on capturing emerging insights. The findings reflect the everyday nature of gendered and racialized violence, the influence of setting and the effectiveness of existing resources. Professional, organizational, and broader policy implications are discussed to support diversely situated nurses within their various practice environments.

Examining the Development of Positive Space in Health and Social Service Organizations: A Canadian Exploratory Study

All health care sectors are currently examining factors that influence delivery of high-quality services for diverse groups with an understanding that minority populations experience barriers to service access that contribute to well-documented ill health and health inequities. With a goal of understanding dynamics that can improve access to care in the home care sector, this qualitative exploratory study examined processes to create inclusive, positive space for diverse lesbians, gay men, bisexuals, transgender, and queer (LGBTQ) people in community-based health and social service agencies. A purposeful sample of eight key informants from agencies in Toronto, Ontario, Canada, which offer programs and services to LGBTQ communities, completed in-depth interviews. Conventional content analysis and a critical lens were used. Themes offered insight into the histories, challenges, and turning points which shaped the development of LGBTQ-positive spaces in these organizations. Community engagement and leadership emerged as relevant, as did strategies to embed LGBTQ voices and visibility within everyday organizational functioning. Given the gap in literature addressing LGBTQ access to home care and the unique dynamics that shape care in the home, implications address the application of these study findings for creating positive space in the home care sector.

Activism as a feature of mental health and wellbeing for racialized immigrant women in a Canadian context

ABSTRACT Although immigrant women bear a disproportionate burden of chronic disease and mental health issues, limited research addresses how to promote their mental wellbeing. The authors first describe grounded theory findings from community-based focus group research with 57 racialized immigrant women in Toronto, Canada that used a critical gender and intersectional lens to explore the links among settlement, wellbeing, and activism. Secondly, a community mobilization strategy is described whereby racialized immigrant women discuss activism as a feature of wellbeing in various language communities while creating meaningful health promotion resources. Implications for creating activism-based initiatives to promote womens wellbeing are discussed.

Providing Health and Social Services to Older LGBT Adults

Little is known about the home care context for lesbian, gay, bisexual, and transgender (LGBT) older adults, most of whom, like the general older adult population, prefer to stay in their home and community for as long as possible. The very limited LGBT-focused home care literature available suggests that there are unique concerns about providing care in the home. In this chapter, access to affi rmative home care services for LGBT older adults is located within the context of the LGBT health services access research literature. A program of research focused on identifying key access and equity indicators and associated prompts to assist organizations to provide high-quality, affi rmative home care for these populations is described.