Decolonizing nursing education: Reflecting on Paulo Freire's pedagogy of the oppressed.

Historically, nursing education's foundation has been framed by colonial practices of whiteness, which serves as a fulcrum for oppression, Western epistemic ideology, racial injustice, and health inequity. As a microcosm of the broader academy, nursing education must pivot to dismantle practices impeding the advancement of the profession and move to decolonize processes of professional edification. Decolonization is not a metaphor; it requires unlearning the deep socialization of Eurocentric perspectives embedded in nursing education and relearning in a new, inclusive manner that embraces historically marginalized knowledge systems and experiences. This paper aims to operationalize what this decolonization process would look like for nursing education while reflecting on Paula Freire's Pedagogy of the Oppressed. The authors will highlight the interrelationship of the main concepts of Paulo Freire's critical pedagogy, including liberation, critical consciousness, dialog, humanization, dehumanization, problem posing, and banking education.

Examining and mitigating racism in nursing using the socio-ecological model.

Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio-ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context-specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, multistakeholder approach, impacting nursing students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all-encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served.

No Health Equity Without Diversity: Strengthening Nursing Programs in Historically Black Colleges and Universities.

In April 2022, Adtalem Global Education sponsored a virtual summit entitled Advancing Equity in Healthcare, in which several of the authors of this article and other prominent health-care professionals examined the need to diversify the health-care profession. Topics included educational justice and its impact on health care, the business case for transforming and advancing health equity, and addressing systemic inequities and improving health outcomes for historically marginalized persons. The summit inspired the authors to write this paper to advocate for authentic, sustainable partnerships led by Historically Black Colleges and Universities, as a means to diversify nursing leadership and to stem systemic and structural inequities in health care.

A call for health justice: Striving toward health equity at a community health center.

Community health centers play a key role in promoting health justice and equity. Health justice, which is the attainment of health equity, or the fair, unambiguous, and non-arbitrary distribution of all health resources necessary for optimal health of the individual, family, and community, is necessary to optimize their wellbeing and to build healthy communities. Community-based health centers are well-positioned to lead in these efforts, as they connect with, seek to understand, and innovatively serve communities that experience complex health-related needs and are differentially impacted by structural vulnerabilities (i.e., racism). The purpose of this article is to present a nurse-led model of culturally responsive health care that is rooted in partnerships designed to address medical and health-related social needs. Current health inequities in the United States across constructs of race and socioeconomic status warrant comprehensive healthcare models that explicitly incorporate health justice, trauma-informed, and antiracist approaches into practice, especially when serving high/complex-need and under-resourced communities. Foundationally, it is imperative that these models of care strive toward equity regarding access to compassionate, affordable, culturally relevant health care; center community members' voices and guidance; promote growth and development of staff in understanding structural barriers and act to dismantle them; and create learning opportunities for students and staff to understand and address social determinants of health to provide high-quality care, with an ultimate goal to improve community health.

Promoting health equity with HBCUs: Breaking away from structural racism.

BACKGROUND: The United States continues to be plagued with pervasive health disparities. Leading health and professional organizations acknowledge structural racism as a contributing factor for the lack of a racially diverse nursing workforce particularly those serving in leadership roles which could help to mitigate health disparities among historically stigmatized populations. PURPOSE: Purpose Lack of funding for Historically Black Colleges and Universities (HBCUs) and lack of meaningful partnerships, stymie efforts that can be made by nursing programs at HBCUs. DISCUSSION: Discussion This position paper examines collaborative actions that can address upstream factors that perpetuate healthcare disparities through deep engagement between the policymakers, professional associations, industry, and educational institutions. METHODS: Faculty representing HBCU's and predominately White institutions, professional organizations, and staff met via videoconference to refine the focus of the paper, determine topic areas for writing teams, and refine details which occurred during weekly meetings. CONCLUSION: To disengage from structural racism, three critical recommendations are amplified with associated examples.

Educators Countering the Impact of Structural Racism on Health Equity.

Health equity endorses that all persons are respected equally, and society must exert intentional efforts to eradicate inequities. Race, frequently taught as an impartial risk factor for disease, is a facilitator of structural inequities stemming from racist policies. Nursing educators must help students understand the impact of structural racism on patient populations, communities, and society at large. This article illustrates the face of structural racism, highlights how structural racism impacts health care outcomes, and provides meaningful ways for educators to unmute racism and facilitate race-related discourse in the classroom to counter the impact of structural racism on health equity.

Race-induced trauma, antiracism, and radical self-care.

Being racialized as Black in the United States has contributed to this population having to operate with a level of race-induced trauma, especially those who are darkly melanated. Historically, Black persons have been terrorized into colonization, and the cultural psychology of anti-Blackness has been entrenched in our society. Through the practice of racialization, the historical, social, and political processes of constructing racial identities and meanings have impacted the formation of understanding of the body and the rationalization of hierarchy. In addition, the internalization of these ideas of hierarchy and difference within power/knowledge relations that they (re)produce is pervasive among people in the United States. This article aims to explicitly highlight racism as trauma, address the relevance of radical self-care when disrupting anti-Black racism, and consider steps to promote trauma responsiveness when incorporating these practices.

Illuminating antiracist pedagogy in nursing education.

In the profession of nursing, whiteness continues to be deeply rooted because of the uncritical recognition of the white racial domination evident within the ranks of nursing leadership. White privilege is exerted in its ascendency and policy-making within the nursing discipline and in the Eurocentric agenda that commands nursing pedagogy. While attention to antiracism has recently increased, antiracism pedagogy in nursing education is nascent. Pedagogical approaches in the nursing profession are essential. Because it encompasses the strategies used to transmit the science in how nurses practice and teach, which has predominantly been informed using a Eurocentric lens. This paper presents a literature review on antiracist pedagogy in nursing education, discussing how nurse educators can integrate antiracism pedagogy in nursing education, highlighting examples presented by the authors. Key terms related to antiracism are reviewed. The resultant themes from the literature review include resistance to antiracist pedagogy, managing emotional responses, and supporting transformative learning using an antiracist approach. The primary implementation of Eurocentric pedagogical approaches whiteness pervasive in nursing education must be uprooted. Antiracist and other antioppressive learning approaches must be embraced to understand the insidiousness of racial inequities and its power in sustaining structural oppression in nursing academia.

Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing.

BACKGROUND: The 2019-2020 American Academy of Nursing (Academy, 2019) policy priorities document states that "they have a clear and distinct focus on social determinants of health and uses this lens to advance policies and solutions within each of the three overarching priorities" PURPOSE: This consensus paper seeks to establish conceptual clarity and consensus for what social determinants of health mean for nursing, with emphasis on examples of health policies that advance planetary health equity and improve planetary health-related quality of life. METHODS: Volunteers from five Expert Panels of the Academy met via videoconference to determine roles and refine the focus of the paper. After the initial discussion, the first draft of the conceptual framework was written by the first three authors of the paper and, after discussion via videoconference with all the co-authors, successive drafts were developed and circulated for feedback. Consensus was reached when all authors indicated acceptance of what became the final version of the conceptual framework. FINDINGS: A conceptual framework was developed that describes how the social determinants of health can be addressed through nursing roles and actions at the individual, family, and population levels with a particular focus on the role of health policy. The paper provides a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health. DISCUSSION: Nursing actions can support timely health policy changes that focus on upstream factors in the six key areas of the social determinants of health and thus improve population health. The urgent need to eliminate systematic and structural racism must be central to such policy change if equity in planetary health-related quality of life is to be attained.

Understanding Racism as a Historical Trauma That Remains Today: Implications for the Nursing Profession.

In order to promote health equity and support the human rights mandate contained in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements, the nursing profession must understand historically the creation of race, white supremacy in the United States, and entrenched racial terror and brutality toward black and brown racialized populations. Considering the limited racial diversity in the nursing profession despite its stated mission to increase diversity, the profession must build a path to understanding antiblack racism as a historical trauma that remains to this day, a path that encompasses antiracist ideology. Antiracism education is critically needed at the pre-professional and professional levels, for nursing students, providers, educators, administrators, and researchers to inform our own understanding of bias within the contexts of our educational and health-care systems. Dismantling racism requires an enduring commitment to the ultimate goal of social justice for ourselves, our patients, and our communities. This article presents antiracism actions that nurses should employ to dismantle racism, focusing primarily on personal-level initiatives, with self-work as the starting point.

Structural competency in mental health nursing: Understanding and applying key concepts.

Achieving mental health equity requires that nursing address structures that impede the ability of individuals and populations to achieve optimal mental health. Consistent with calls for structural change, this paper intends to promote structural competency in mental health nursing by applying this concept to the field. The first half of the paper discusses structural competency and key concepts vital for its development, namely, structure, social influencers of mental health, equity, structural justice, and historical understanding. In the second half we apply structural competency to mental health nursing at the educational, practice and system levels and conclude with recommendations for change.

Achieving Health Equity Through Eradicating Structural Racism in the United States: A Call to Action for Nursing Leadership.

PURPOSE: To advocate for strategic actions by U.S. nursing leadership that denote the presence, customs, and implications of racism that has been institutionalized within the structures of U.S. nursing leadership and the profession. ORGANIZING CONSTRUCTS: A racial equity framework is used to examine the barriers to quality health care and equitable health outcomes and to present evidence-based actions to dismantle structural inequities embedded in the nursing profession. METHODS: This article was developed through a comprehensive literature review and synthesis of relevant research, data, peer-reviewed literature, government reports, and organizational guidelines. FINDINGS: A commitment by U.S. nursing leadership to eradicate structural racism in nursing must be made in order to effect sustainable transformative change toward more equitable systems of health care. CONCLUSIONS: This article presents recommendations for nursing leadership in the United States to renew its commitment to quality health care through dismantling structural racism at all levels of direct and systems nursing practice and education, at the bedside, and in the boardrooms. CLINICAL RELEVANCE: Structural racism in nursing and health care also persists globally as a key social determinant of health. Its elimination aligns with international health care and nursing's policy priorities, yet change can only occur when senior leaders clearly understand it as a key barrier to health, and commit to transformative change in how their "systems" work. These recommendations can also be culturally adapted by global nursing for use in antiracism work.

Nursing colonialism in America: Implications for nursing leadership.

The purpose of this paper is to explore the nurse leader's role in understanding the impact of American colonialism - specifically racism, a product of colonialism - as a key determinant in shaping the education of nursing students and its influence on practicing nurses. American values have been grounded in its colonialism and continue to be influential in shaping beliefs, attitudes, behaviors, and policies within the United States. Like racism, American colonialism depends on its perceived death for its survival - this is its paradox. Historic roots of the nursing profession evolved within this context of American colonialism which has shaped the lens of individuals who are the leaders and practitioners in our profession. Therefore, it is important to examine strategies that challenge and decolonize the nursing profession and to become an accomplice, clarifying and addressing inclusion/exclusion in our profession's leadership machine including: hiring/promotion practices, confrontation of White silence, critiquing design and dissemination of knowledge development, and fostering widespread change in nursing education/curriculum. Understanding the invisible internalization and manifestation of racism within our profession must be addressed if we are to advance the integrity and quality of education and practice in the nursing profession and to promote equity of healthcare among all individuals in the United States.

Capital We Must Develop: Emotional Competence Educating Pre-Licensure Nursing Students.

Emotional competency is a skill commonly overlooked within the nursing curriculum. However, with the complexity of the health care environment and increased emphasis on team collaboration, nurse educators who focus on health promotion and technical, medical, and organizational competencies need to consider adding a focus on soft skills, such as emotional competency. This pilot study engaged 14 pre-licensure nursing students who were involved in an 18-month leadership program. Pre-post scores of the Emotional and Social Competency Inventory are described. Statistical significance was found with three core areas: emotional self-awareness, emotional self-control, and inspirational leadership.

Knowing Your Preference: The Nexus of Personality and Leadership.

Prelicensure nursing students must be prepared to address the new challenges that will confront them in the modern health care environment. Leadership development, the gaining of tools and education about the process of influencing and persuading others, is important when working with groups and teams in the work place. Recognition of one's personality preferences using self-assessment is a critical dimension of leadership development. This study examined the personality preferences of a cohort of prelicensure nursing students (N = 14) enrolled in an 18-month leadership program. Students completed the Myers-Briggs assessment before starting and at the completion of the program. Through active student-centered learning and experiential exercises, students became more aware of how they preferred to relate to others and how this might affect their work in groups and leading interprofessional teams. The most prominent personality type for both pre- and postassessment was extroversion, sensing, thinking, and judging.

Findings from a study of aspiring nursing student leaders.

BACKGROUND: Transformational leadership skills are critical to operate effectively in today's healthcare environment. Prelicensure nurses do not often practice these skills in a meaningful way during their undergraduate educational experience. OBJECTIVES: This paper describes quantitative pre-post findings from the Kouzes and Posner Student Leadership Practices Inventory to examine students' leadership attributes pre-post engagement in an 18 month undergraduate leadership program. DESIGN: This is a non-experimental convenience study that used a quantitative pre-post survey design collecting data from participants and observers using the 360 Kouzes and Posner Student Leadership Practices Inventory. SETTINGS: A private university in the northeastern region of the United States. PARTICIPANTS: Fourteen junior level nursing students who concurrently participated in a leadership program while concurrently completing their required academic courses for their bachelor's degree in nursing. METHODS: Paired sample t-tests were used to determine if there was statistical significance among student participants' and observers' perceptions of specific leadership behaviors and skills of students at the onset (pretest) and at the conclusion (posttest) of the leadership program. RESULTS: Participant and observer scores were positively correlated and statistical significance was identified in several practice areas. CONCLUSIONS: It is important to integrate transformation leadership skills into undergraduate curriculum since it supports students' engagement in their own learning and instills foundational knowledge critical to their leadership trajectory.

Culturally competent strategies for assessing and treating ADHD in African American adults.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with symptoms of inattention, hyperactivity, and impulsivity. When ADHD persists into adulthood, patients often experience occupational and social impairments and may present with mood, anxiety, or substance use disorders. Despite the deleterious effects of ADHD, many adults, especially minority patients, remain undiagnosed and untreated.