Exploring Anti-colonial Struggles in Nursing: A Situational Analysis of Indigenous Homelessness and Community Health Nursing

Abstract

Research Problem: Indigenous homelessness is rooted in colonialism and has profound impacts on health and wellbeing. Nurses encounter Indigenous people experiencing homelessness in their community health and harm reduction work, and yet little is known about how nurses struggle against colonial oppressions. Study Aim: The aim of this study was to critically examine how settler colonialism is embedded in nursing and how this influenced community nursing practices in the area of urban Indigenous homelessness. My research focused on community health and harm reduction nurses (CHNs) that primarily work with urban homeless communities and provide direct client care. Theory and Methods: My chosen method was Situational Analysis (SA), which is firmly located in a critical paradigm. One of the strengths of SA and part of my rationale for using this method was to provide an in-depth relational ecological overview of systems, structures and circulating discourses impacting nurses’ actions. Therefore, this thesis tacks back and forth between the niche of CHNs working in a medium sized city in Ontario and the broader situation of Ontario and Canada. My theoretical framework was rooted in feminist and Indigenous strands of relational ethics. I also draw on intersectionality, critical race, and anti-colonial theories. I conducted interviews with CHNs and together we covered much ground in relation to Indigenous homelessness. I also analyzed extant discursive data including websites and news media articles. Key Findings: I began with an analysis of racist policies at the intersections of harm reduction and homelessness. I described circulating discourses and harm reduction backlash. I reviewed websites of nurse regulatory colleges and nursing associations to look for progress on the Truth and Reconciliation Commission (TRC) Calls to Action. Cultural competency/safety were key frameworks found during this review. However, these frameworks may have limited effect against racism and CHNs noted considerable confusion among these concepts. In the interviews, leadership and organizational support emerged as essential (dis)enablers of CHNs actions. CHNs also described some promising practices, and I situated these findings within the overall progress on the TRC Calls to Action, nursing ethics, and Indigenous rights. Internal struggles among CHNs included their abilities to see racism and overcome silence. Important relational practices included narrative elicitation, bearing witness, suspending judgment, assuming a learner stance, and shared decision making. CHNs also described how they engaged in systems navigation, care coordination and tremendous amounts of advocacy to ensure that clients had equitable access to care. However, CHNs struggled to engage in higher levels of advocacy and advocacy for people rather than with them was common practice. Sharing stories were essential to build trusting relationships and the concept of narrative care holds promise as an anti-oppressive framework for CHNs harm reduction practices. Healing centered engagement may also be an important framework to re-orient nursing practices towards community level healing and taking action with Indigenous people experiencing homelessness. Indigenous worldviews and relational ethics are essential frameworks for anti-oppressive nursing praxis and anti-colonialism.