Conectar
To identify structural barriers to the uptake and practice of anti-racism in nursing education, specifically in the Canadian context.
A deconstructive, critical, qualitative inquiry informed by critical race theory, critical whiteness, feminism and post-colonialism.
This study employed an anonymous online open-ended questionnaire and online focus groups with Canadian nurse educators from April to June 2021. The data were analysed through a contextualist thematic analysis that accounts for data as essential experience and also a product of discourse.
Structural barriers identified are organized into themes of: the academic environment; position and power; racism; program delivery; and Whiteness. Pervasive silence, especially white silence, can be interpreted in related contexts of precarity, self-interest and institutional violence. Overarching processes of precarity and resistance exert power over the environment of nursing education which act to destabilize, disrupt and discourage anti-racist efforts and education.
The sustainability of anti-racism should be a primary focus. This entails attending to structures in nursing and higher education that make nursing education precarious work, especially for educators racialized as Other in the white supremacist racial binary of White: non-White. Explicit and ongoing attention to conditions that silence is necessary for any progress to be made. Strategies of applying anti-racism need to be as complex as the barriers.
Many schools of nursing are engaged in attempts to include anti-racism as learning and environment. The structural barriers that interfere with effective integration of anti-racism as a lens for nursing education must be named and addressed so educators and schools can be successful. The implication of trying to incorporate anti-racism without addressing the barriers is a very superficial or pocketed application of anti-racism, and a continuation of the status quo that reproduces Whiteness and excludes and harms people racialized otherwise.
The study addressed both strategies and barriers to anti-racism in nursing education. This article addressed structural barriers in anti-racism in Canadian nursing education. The main findings are that processes of precarity specific to nursing education in institutions of higher learning, and resistance through Whiteness, decision-making hierarchy and regulatory structures interfere with the application of anti-racism. This research impacts nurse educators in all nursing schools and leaders in higher education. It also impacts all current and future nursing students as the recipients of the education we provide.
The paper adheres to COREQ checklist.
No patient or public contribution.
Low back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help them implement the guidelines. This trial will evaluate a multifaceted intervention to support general practitioners (GPs) and their patients with LBP implement the recommendations in the latest opioid prescribing guidelines.
This is a cluster randomised controlled trial that will evaluate the effect of educational outreach visits to GPs promoting opioid stewardship alongside non-pharmacological interventions including heat wrap and patient education about the possible harms and benefits of opioids, on GP prescribing of opioids medicines dispensed. At least 40 general practices will be randomised in a 1:1 ratio to either the intervention or control (no outreach visits; GP provides usual care). A total of 410 patient–participants (205 in each arm) who have been prescribed an opioid for LBP will be enrolled via participating general practices. Follow-up of patient–participants will occur over a 1-year period. The primary outcome will be the cumulative dose of opioid dispensed that was prescribed by study GPs over 1 year from the enrolment visit (in morphine milligram equivalent dose). Secondary outcomes include prescription of opioid medicines, benzodiazepines, gabapentinoids, non-steroidal anti-inflammatory drugs by study GPs or any GP, health services utilisation and patient-reported outcomes such as pain, quality of life and adverse events. Analysis will be by intention to treat, with a health economics analysis also planned.
The trial received ethics approval from The University of Sydney Human Research Ethics Committee (2022/511). The results will be disseminated via publications in journals, media and conference presentations.
ACTRN12622001505796.
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