Breast/chest feeding Support: Critically Analyzing a Canadian Policy Guiding Nursing Practice

The World Health Organization has identified the importance of improving the rates of breast/chest feeding for population health. Canadian health organizations have put public health resources toward breast/chest feeding support. Despite statements of purpose describing health promotional interventions to be focused on improving overall population health, many times these methods are based only upon biomedical knowledge and fail to adequately address the needs of diverse populations. Thus, in this paper we critique a Canadian policy providing clinical guidance to care providers through the application of a relational inquiry framework. We draw on the first author’s experience as a Public Health Nurse delivering breast/chest feeding support within the scope of these guidelines to further illustrate the point. The results from published evidence are integrated within this critique to provide an evidence base for policy improvement recommendations to improve the social, cultural, and political components of breast/chest feeding typically overlooked in current standards

Nurses - Workforce Commodity, or Autonomous Professionals: What Nurses Know about their Value, Working Conditions, Impacts on Patient Care, and Nursing Practice Concerns

The current focus on the critical shortage of nurses puts nurses at risk for representation as a health workforce commodity, rather than being recognized as an autonomous, knowledge-based profession without which the health of Canada’s population is in jeopardy. Nurses’ knowledge and professional role includes evaluation of their career, working conditions, and impact on patients and populations of care. The concern that nurses are leaving the profession can be analyzed within a feminist perspective related to autonomy and advocacy. The focus of this reflective commentary is to highlight, at a personal and collective level, that nurses are witnesses to the conditions fueling nursing shortages, the impact on the practice environment and the structural factors influencing these areas. We are therefore compelled to articulate the seriousness of our concerns and assert our knowledge and value as a profession

Policy-related Homelessness Discourses in Canada: Implications for Nursing Research, Practice, and Advocacy

Despite Canada’s commitment to several international human rights instruments recognizing the right to housing, homelessness remains widespread nationwide. Informed by critical political economy theory and critical discourse studies, we examined relevant literature focusing on homelessness policy-related documents in the Canadian context. The findings demonstrate interrelated homelessness policy discourses: 1) emergency shelters, 2) housing first, 3) social determinants of health, 4) human rights, and 5) political economy approach. We conclude that a critical political economy approach offers the most helpful way of understanding and responding to the homelessness crisis in Canada. Homelessness is a socioeconomic and political problem requiring nurses and health professionals to take sociopolitical actions. As nurses and health justice advocates, we stand in solidarity with labour movements to protect public health. This study can be adopted in local, national, and global settings

Where are they going, and what can we do to keep them? Intent to leave among nurses in British Columbia, Canada

Purpose. To identify: (1) alternate professions being considered by nurses, and (2) potential policy levers to retain them. Methods. This study describes responses to a subset of questions on a survey of nearly 15,000 nurses in British Columbia. Participants expressing intent to leave were asked what other professional options they were considering, and what changes they would need to keep them in nursing. We used thematic analysis to identify themes and sub-themes of participant responses. Results. Fewer than one in five nurses expressed intent to stay in the profession for more than two years. Participants cited a wide variety of other professional options available to them; the most commonly cited category was ‘anything but nursing’. When asked what they needed to stay in nursing, participants described improvements in compensation, safe staffing, work/life balance, workplace culture, physical and psychological safety, and opportunities for advancement

Nurses Supporting Harm Reduction: How Take-Home Naloxone is Conceived in the Context of Neoliberalism

Introduction – Individuals must be personally invested in their own recovery journey; however, the neoliberal perspective absolves the state of responsibility of this work and makes promotion of health merely an individual action. Naloxone distribution, as a harm reduction strategy, is presented herein as one practice engaged by nurses that demonstrates philosophical tension between neoliberalism and harm reduction. Background Literature – The research literature supporting the provision of take-home naloxone (THN), non-medically administered, is significant and broad. Discussion – The problem with neoliberal discourses of constrained healthcare resources in this case is that without broad availability of naloxone, drug poisonings will continue unchecked. There is an ethical call to nurses to support broad distribution of naloxone regardless of the costs involved. Conclusion – THN is not only a best practice to reduce the harms of substance use, but it is also a political and philosophical act to hand over the control of public health resources to the public

White privilege and professionalization: a decolonial and critical feminist perspective on professional nursing

This article offers a critical perspective linking invisibility with the political foundations of the dominant, Eurocentric model of modern nursing. Using critical feminist and decolonial feminist frameworks, this paper begins by analyzing gendered, reproductive labor in the centuries leading up to the industrial revolution in Britain and Europe and how the current dominant model of nursing was developed. The second part of the paper suggests a critical link between white supremacy, colonial violence and the professionalization of nursing work. Finally this paper calls on nursing scholarship to move beyond the narrow definition of nursing within the professional framework to include people who have done and continue to do the work of nursing despite being denied the title because of segregation and colonial violence.     

Vers des stratégies de plaidoyer structurel : une étude sur le processus de plaidoyer chez les infirmières en santé communautaire

In order to reduce social inequities in health, nurses need to move from patient advocacy to policy advocacy. Literature reports many barriers when nurses try to address the structural level of policy advocacy. Very little empirical research exists to show how nurses respond to these barriers and the resulting impact on the effectiveness of policy advocacy. This study characterized the types and the process of advocacy practiced by community health nurses. A collaborative ethnography with 21 nurses showed that their policy advocacy was often dismissed, leading to negative consequences such as less policy advocacy attempts, changes in their clinical evaluation with patients and personal experiences of moral distress. We argue that structural change will only occur when collective advocacy will be supported by organizations, therefore reducing inequities that affect both community health and working conditions of nurses. Afin de réduire les iniquités sociales de santé, les infirmières doivent dépasser le plaidoyer axé sur les individus en investissant des stratégies de plaidoyer ciblant les structures et les politiques. Dans cet article, nous soutenons que de ne pas exercer de plaidoyer structurel peut amener des conséquences néfastes pour les infirmières elles-mêmes et les communautés qu’elles desservent. Cette étude caractérise les types et le processus de plaidoyer exercés par les infirmières en santé communautaire. Une ethnographie collaborative avec 21 infirmières montre que leurs tentatives de plaidoyer structurel étaient ignorées, décourageant les tentatives futures, entraînant des changements dans leur évaluation clinique et des expériences de détresse morale. Nous argumentons que le changement structurel surviendra seulement lorsque les stratégies de plaidoyer seront collectivisées et soutenues par les organisations de santé, réduisant ainsi les iniquités affectant à la fois la santé communautaire et les conditions de travail des infirmières

Leadership and System Transformation: Advancing the Role of Community Health Nursing

It is widely recognized that structural and social determinants of health (SDoH) account for a large proportion of health inequities in Canada. According to the Public Health Agency of Canada (PHAC), many health actors are required to provide leadership and direction in tackling health inequities. In this paper we argue that community health nurses (CHNs) are well situated to play a critical role in health system transformation in Canada. CHNs are known for having a holistic and collaborative approach with competencies beneficial for the reduction of health inequities. However, to become more consistently effective advocates of health equity, CHNs require competencies in the principles of equity and social justice, community engagement, communication, coalition building, and system transformation. Having a critical mass of CHNs with appropriate leadership skills in knowledge generation and mobilization, advocacy, and collaboration is fundamental to effectively addressing health inequities in Canada

Developing Nursing Geography with an Ecological Lens

In this paper, we propose that community health nursing is a promising context for ecologically inclusive and “place-sensitive” (Andrews, 2002) nursing practice. With a strong grounding in social justice, we believe that Canadian community health nurses have the power to create a differential space of research and practice for environmental justice and planetary health thereby challenging harmful anthropocentric and biomedical models of health and health care. To do this, we theorize an ‘environmental nursing geography’ including Henri Lefebvre’s idea of the production of space. Lefebvre’s dialectics give us tools to ecologize space and place and further the efforts of CHNs to support the health of all people and the planet through justice and equity