Lisa Goldberg

Discomfort, Judgment, and Health Care for Queers

This paper draws on findings from qualitative interviews with queer and trans patients and with physicians providing care to queer and trans patients in Halifax, Nova Scotia, Canada, to explore how routine practices of health care can perpetuate or challenge the marginalization of queers. One of the most common “measures” of improved cultural competence in health care practice is self-reported increases in confidence and comfort, though it seems unlikely that an increase in physician comfort levels with queer and trans patients will necessarily mean better health care for queers. More attention to current felt discomfort in patient–provider encounters is required. Policies and practices that avoid discomfort at all costs are not always helpful for care, and experiences of shared discomfort in queer health contexts are not always harmful.

Feminist and Queer Phenomenology: A Framework for Perinatal Nursing Practice, Research, and Education for Advancing Lesbian Health

A queer phenomenology would involve an orientation toward queer, a way to inhabit the world that gives “support” to those whose lives and loves make them appear oblique, strange, and out of place. (Ahmed, 2006) The climate of the health care system is a reflection of society, which often hesitates to support individuals who choose paths other than those, that are heteronormatively constructed. Consequences of such limited directedness include fear, misunderstanding, avoidance, and discrimination on the part of nurses toward individuals involved in same-sex partnerships (Goldberg, 2005/2006). A feminist and queer phenomenological framework offers an approach for perinatal nurses to advance lesbian health and, in particular, lesbian couples’ experiences of birthing, in the context of nursing practice, research, and education.

Queering the birthing space: Phenomenological interpretations of the relationships between lesbian couples and perinatal nurses in the context of birthing care

As health care institutions continue to promote diversity initiatives within the context of Family-Centered and Woman-Centered Care, the taken-for-grantedness of heteronormativity and homophobia remain pervasive in health care practices, including those of perinatal nurses, to the extent that nurses’ relationships with lesbian birthing couples are often thwarted. Attending to the complexities of queer (lesbian) orientations embedded in the philosophical tenets of feminist and queer phenomenology, this article draws upon experiential findings derived from interview data to understand lesbian couples’ relationships with perinatal nurses in the context of birthing care in eastern Canada.

In the Company of Women: enacting autonomy within the perinatal nursing relationship

An understanding of autonomy has important significance in North American health care. Although a respect for autonomy is necessary to protect the self-determination and agency of birthing women in hospital settings, I suggest that enactments of autonomy that are independent of relationships offer only an incomplete interpretation of such a vital concept. In this article I explore an understanding of autonomy situated within the context of a relational birthing narrative. In so doing, autonomy becomes conceptualized as contextual and concrete, giving rise to an embodied view of the birthing woman.

Queer Phenomenology, Sexual Orientation, and Health Care Spaces: Learning From the Narratives of Queer Women and Nurses in Primary Health Care

ABSTRACT Queer phenomenology as an interpretive framework can advance health research by illuminating why primary health care providers (HCPs) must move beyond definitions of sexuality as a set of reified identity formations indexed to normative gender, gender of partner, and sexual and reproductive practices. Our interviews with queer women participants and primary care nurses offer an implicit critique of heteronormative health care space, temporality, and power relations, as they form the lived experiences of our participants. We conclude by pointing to the limits of our methodology in exposing the larger relations of power that dictate experiences of heteronormative health care.

Accessing new understandings of trauma-informed care with queer birthing women in a rural context

AIMS AND OBJECTIVES Participant narratives from a feminist and queer phenomenological study aim to broaden current understandings of trauma. Examining structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. BACKGROUND Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. DESIGN Analysis of the qualitative data was guided by feminist and queer phenomenology. This was well suited to understanding queer womens storied narratives of trauma, including disempowering processes of structural marginalisation. METHODS Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. RESULTS Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that reconstructs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. CONCLUSIONS Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. RELEVANCE TO CLINICAL PRACTICE New trauma-informed assessment strategies reconstruct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re-experiencing the process of coming out as queer in opposition to the expectation of heterosexuality.

Understanding the invisibility of black nurse leaders using a black feminist poststructuralist framework

AIM This paper explores the invisibility and underrepresentation of Black nurses in formal and informal leadership roles using a Black feminist poststructuralist framework. The paper describes historical and contemporary challenges experienced by Black nurses throughout their nursing education and in practice. It also highlights how social and institutional discourses continue to marginalise and oppress Black nurses as leaders and render them invisible. BACKGROUND Diversity among nursing leaders is essential to inform health care delivery, develop inclusive practices and provide culturally sensitive care. Despite this glaring need for diversity within nursing in Canada, there remains a significant underrepresentation of Black nurses in the workforce and as leaders. DESIGN This is a discursive paper on Black nurses in nursing education and the workforce as well as their location as leaders in health care through a critical analysis using Black feminist poststructuralism. METHODS A review of the literature involved searching electronic databases CINAHL, NovaNet, PubMed and Google Scholar using keywords including: Black; African; Nurses; Leaders; Feminism; Poststructural. Articles were screened by titles and abstracts before accessing full-text for relevant articles. RESULTS Black feminist poststructuralism uncovers how power, language, subjectivity and agency are constructed by the historically ingrained social and institutional discourses of everyday life for Black nurses. Experiences of discrimination and oppression were common throughout nursing education and practice for Black nurses, resulting in feelings of marginalisation and isolation. CONCLUSION The invisibility of Black nurse leaders is the result of generational oppression and discrimination manifested through discourses. Systemic, institutional and historical discourses perpetuate barriers for Black nurse leaders, resulting in their invisibility or absence in practice. RELEVANCE TO CLINICAL PRACTICE This paper is designed to generate discussion related to the invisibility of Black nurse leaders by providing an understanding of the historical experiences of Black people, their entry into the nursing profession and the present day challenges they face. This discussion will inform health care practice, policy, and structuring by identifying the barriers to leadership for Black nurses.

Understanding Lesbian Experience

Understanding Lesbian Experience Lesbian couples feel marginalized in many aspects of perinatal care, and the attitudes of health care providers are directly responsible for this. Heterosexism is the institutional assumption that heterosexuality is the norm for relationships; any variation is considered deviant. Homophobia is a learned discriminatory practice and prejudice that represents a fear of lesbians and gay men.Lesbian couples feel marginalized in many aspects of perinatal care, and the attitudes of health care providers are directly responsible for this. Heterosexism is the institutional assumption that heterosexuality is the norm for relationships; any variation is considered deviant. Homophobia is a learned discriminatory practice and prejudice that represents a fear of lesbians and gay men.

A critical review of human milk sharing using an intersectional feminist framework: Implications for practice

OBJECTIVE Driven by a growing body of research demonstrating the health benefits of human milk over substitute feeding preparations, the demand for human milk donations in North America is rapidly increasing. In the context of an increasingly institutionalized and commercialized human milk market, informal peer-to-peer milk sharing networks are commonplace. Race, class, gender and sexual orientation are intersecting aspects of identity and power that influence participation in breastfeeding and the domain of milk exchange. Using an intersectional feminist framework, we critically review studies of participation in milk sharing to examine the identities and socio-political circumstances of milk sharing participants. DESIGN, SETTING AND PARTICIPANTS We use an intersectional feminist framework to conduct a critical review of the evidence pertaining to human milk sharing participants in North America. The search strategy included relevant databases (Pubmed, CINAHL) and hand-searches of key journals. We include research studies with participants in the United States and Canada and where participants milk shared as recipients or donors. FINDINGS Of those studies that examine socio-political identities such as race and class, participants are largely white and high-income. Many studies did not examine socio-political identities, and none examine sexual orientation. Themes we identify in this review include: (1) Socio-political identities; (2) Milk sharing supports parental health; (3) Socio-political influences; (4) Resistance against institutionalization. IMPLICATIONS FOR PRACTICE Maternity care providers can advocate for improved access to breastfeeding support and pasteurized human donor milk to address inequities. Maternity care providers can bring consciousness of intersecting socio-political identities to discussions with families about milk-sharing.

Rendering LGBTQ+ Visible in Nursing: Embodying the Philosophy of Caring Science:

Although health care institutions continue to address the importance of diversity initiatives, the standard(s) for treatment remain historically and institutionally grounded in a sociocultural privileging of heterosexuality. As a result, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities in health care remain largely invisible. This marked invisibility serves as a call to action, a renaissance of thinking within redefined boundaries and limitations. We must therefore refocus our habits of attention on the wholeness of persons and the diversity of their storied experiences as embodied through contemporary society. By rethinking current understandings of LGBTQ+ identities through innovative representation(s) of the media, music industry, and pop culture within a caring science philosophy, nurses have a transformative opportunity to render LGBTQ+ visible and in turn render a transformative opportunity for themselves.