African Nova Scotian nurses' perceptions and experiences of leadership: a qualitative study informed by Black feminist theory.

BACKGROUND: People of African Nova Scotian (ANS) ancestry are a culturally distinct group who experience numerous socioeconomic inequities and health disparities, secondary to structural and social determinants of health. Understanding the experiences of ANS health practitioners is important in addressing anti-Black racism in health care. We sought to critically examine the leadership experiences of ANS nurses in health care practice. METHODS: We used Black feminist theory to guide this qualitative study. We conducted 1-on-1 semistructured telephone interviews with ANS nurses and analyzed interview transcripts using Critical Discourse Analysis. RESULTS: We interviewed 18 nurses of ANS ancestry. We conceptualized study findings in 3 overarching areas: People of ANS ancestry as a distinct people, institution of care, and leadership philosophy and practice. Each area, and its corresponding themes and subthemes, illustrated an emergent understanding of factors that influence leadership among ANS nurses, such as socialization, early exposure to care and diversity in health care. Participants perceived and practised leadership in a manner that transcended formal titles or designations. INTERPRETATION: African Nova Scotian ancestry is implicated in the perception and practice of leadership among ANS nurses, who considered leadership to be a fundamental component of nursing practice that was grounded in community-oriented care. This study provides new insights that could inform recruitment, retention and representation of ANS people in nursing and other health professions.

Black nurses in the nursing profession in Canada: a scoping review.

BACKGROUND: With migration occurring over a series of centuries, dating back to the 1600's, the circumstance regarding Black people in Canada is a complex account. A plethora of social issues and the failure to adequately acknowledge and reconcile historical issues, has resulted in health inequity, disparities and knowledge gaps, related to the Black population in Canada. In nursing, historical records indicate a legacy of discrimination that continues to impact Black nurses. The profession has begun reckoning with anti-Black racism and the residual effects. This scoping review sought to chart the existing evidence on Black nurses in the nursing profession in Canada. METHODS: JBI methodology was used to search peer-reviewed evidence and unpublished gray literature. Sources were considered for inclusion based on criteria outlined in an a priori protocol focusing on: 1) Canada 2) Black nurses and 3) nursing practice. No restrictions were placed on date of publication and language was limited to English and French. All screening and extractions were completed by two independent reviewers. RESULTS: The database search yielded 688 records. After removing duplicates, 600 titles and abstracts were screened for eligibility and 127 advanced to full-text screening. Eighty-two full-text articles were excluded, for a total of 44 sources meeting the inclusion criteria. Seven sources were identified through gray literature search. Subsequently, 31 sources underwent data extraction. Of the 31 sources, 18 are research (n = 18), six are commentaries (n = 6); one report (n = 1) and six are classified as announcements, memoranda or policy statements (n = 6). The review findings are categorized into five conceptual categories: racism (n = 12); historical situatedness (n = 2); leadership and career progression (n = 7); immigration (n = 4); and diversity in the workforce (n = 4). CONCLUSIONS: This review reveals the interconnectedness of the five conceptual categories. Racism was a prominent issue woven throughout the majority of the sources. Additionally, this review captures how racism is exacerbated by intersectional factors such as gender, class and nationality. The findings herein offer insight regarding anti-Black racism and discrimination in nursing as well as suggestions for future research including the use of diverse methodologies in different jurisdictions across the country. Lastly, the implications extend to the nursing workforce in relation to enhancing diversity and addressing the ongoing nursing shortage.

African Canadian nurses in the nursing profession in Canada: a scoping review protocol.

OBJECTIVE: The objective of this review is to synthesize the evidence on African Canadian nurses in the nursing profession in Canada. INTRODUCTION: With approximately 1.2 million people of African descent, Canada has committed to addressing the United Nations' decade for people of African descent. Intergenerational racism continues to result in multisectoral discrimination against African Canadians. Studies suggest that African Canadians are under-represented in nursing, and encountering systemic barriers to entering and advancing in the profession. Additionally, African Canadian nurses experience racism from patients and colleagues, as well as systemic racism through hiring and promotion. INCLUSION CRITERIA: This review will consider sources that include African Canadian nurses who identify as Black or as of African descent. All levels of professional nursing practice will be included (practical nurses, registered nurses, and advanced practice nurses, including nurse practitioners and clinical nurse specialists). Qualitative, quantitative, and mixed methods studies and gray literature will be searched. METHODS: This review will be conducted in accordance with the JBI methodology. Databases to be searched from inception to the present include CINAHL, MEDLINE, Embase, Sociological Abstracts, Gender Studies Database, America: History and Life, PsycINFO, Academic Search Premier, and Scopus. Studies published in English and French will be included. A comprehensive search strategy developed with a librarian will be used to retrieve relevant sources. Two independent screeners will screen titles and abstracts as well as full texts of relevant sources. Data will be extracted by two independent extractors then presented narratively, using appropriate tables and figures. SYSTEMATIC REVIEW REGISTRATION NUMBER: Open Science Framework Preregistration October 3, 2019. Open Science Framework Link for Abstract https://osf.io/6a2fe/?view_only=57d86d5b7c1d464182692d0f4bb9b396.

"You feel you have to be made of steel": The strong Black woman, health, and well-being in Nova Scotia.

The "strong Black woman" construct has been well-documented in the United States as both an aspirational icon and a constricting burden for African-heritage women. It has not been examined among African-Canadians. Drawing on qualitative interviews and standardized measures with 50 African-heritage women in Eastern Canada, our analysis reveals their perceptions of the construct as both strongly endorsed as a source of cultural pride, yet also acknowledged to take a terrible toll on health and well-being. The construct arises from and directly benefits racism. It is imperative that health professionals understand the ways it shapes health and help-seeking behaviors.

Awareness of palliative care and end-of-life options among African Canadians in Nova Scotia.

PURPOSE: To assess, using qualitative methods, the knowledge African Canadians living in Nova Scotia have regarding their options for palliative and end-of-life (EOL) care. DESIGN: This project engaged caregivers in a Black community in Nova Scotia, Canada, in an exploration of palliative and EOL care. A group of six caregivers who cared for someone who had died were recruited through purposive sampling. The caregivers met three times to (1) discuss their experiences, (2) receive a presentation from the palliative care service, and (3) discuss whether those services would be beneficial. This was followed by a community meeting to discuss the findings. FINDINGS: Knowledge of options for palliative care services is limited. Family centered care may be a reason why "system" is generally not aware of the EOL experiences of African Nova Scotians. DISCUSSION: Information about palliative care services is not filtering down to the community in a way that is meaningful to families. Families tend to self-select services that assist them in providing care in the home setting. There is a need to engage Black communities and palliative care services in developing culturally appropriate services.

Cancer care experiences and the use of complementary and alternative medicine at end of life in Nova Scotia's Black Communities.

PURPOSE: This qualitative study examines the meanings that African Canadians living in Nova Scotia, Canada, ascribe to their experiences with cancer, family caregiving, and their use of complementary and alternative medicine (CAM) at end of life. DESIGN: Case study methodology using in-depth interviews were used to examine the experiences of caregivers of decedents who died from cancer in three families. FINDINGS: For many African Canadians end of life is characterized by care provided by family and friends in the home setting, community involvement, a focus on spirituality, and an avoidance of institutionalized health services. Caregivers and their families experience multiple challenges (and multiple demands). There is evidence to suggest that the use of CAM and home remedies at end of life are common. DISCUSSION: The delivery of palliative care to African Canadian families should consider and support their preference to provide end-of-life care in the home setting.

Determinants of Black women's health in rural and remote communities.

The On the Margins project investigated health status, health-care delivery, and use of health services among African-Canadian women residing in rural and remote regions of the province of Nova Scotia. A participatory action research approach provided a framework for the study. Triangulation of data-collection methods--interviews, focus groups, and questionnaires--formed the basis of data generation. A total of 237 in-depth one-on-one interviews were conducted and coded verbatim. Atlas-ti data-management software was used to facilitate coding and analysis. Six themes emerged from the data: Black women's multiple roles, perceptions of health, experiences with the health-care system, factors affecting health, strategies for managing health, and envisioning solutions. The authors focus on 1 of these themes, factors affecting Black women's health, and discuss 3 subthemes: race and racism, poverty and unemployment, and access to health care.

Participatory action research (PAR): an approach for improving black women's health in rural and remote communities.

Women are among the most disadvantaged members of any community, and they tend to be at greatest risk of illness. Black women are particularly vulnerable and more prone than White women to illnesses associated with social and economic deprivation, including heart disease and diabetes. They utilize preventive health services less often, and when they fall ill, the health of their families and communities typically suffers as well. This article discusses the process of doing innovative participatory action research (PAR) in southwest Nova Scotia Black communities. The effort resulted in the generation of a database, community action, and interdisciplinary analysis of the intersecting inequities that compromise the health and health care of African Canadian women, their families, and their communities. This particular research effort serves as a case study for explicating the key tenets of PAR and the barriers to and contradictions in implementing PAR in a community-academic collaborative research project.