Accepted: 23 May 2017

DOI: 10.1111/nin.12211

F E AT U R E

Drawing on antiracist approaches toward a critical

antidiscriminatory pedagogy for nursing

Amélie Blanchet Garneau1  | Annette J. Browne2 | Colleen Varcoe2

1
Faculté des Sciences Infirmières, Université
de Montréal, Montréal, QC, Canada
2
School of Nursing, University of British
Columbia, Vancouver, BC, Canada
Correspondence
Amélie Blanchet Garneau, Faculté des
Sciences Infirmières, Université de Montréal,
Montréal, QC, Canada.
Email: amelie.blanchet.garneau@umontreal.ca
Although nursing has a unique contribution to advancing social justice in health care
practices and education, and although social justice has been claimed as a core value
of nursing, there is little guidance regarding how to enact social justice in nursing prac-
tice and education. In this paper, we propose a critical antidiscriminatory pedagogy
(CADP) for nursing as a promising path in this direction. We argue that because dis-
crimination is inherent to the production and maintenance of inequities and injustices,
adopting a CADP offers opportunities for students and practicing nurses to develop
their capacity to counteract racism and other forms of individual and systemic dis-
crimination in health care, and thus promote social justice. The CADP we propose has
the following features: it is grounded in a critical intersectional perspective of discrimi-
nation, it aims at fostering transformative learning, and it involves a praxis-­oriented
critical consciousness. A CADP challenges the liberal individualist paradigm that domi-
nates much of western-­based health care, and the culturalist and racializing processes
prevalent in nursing education. It also situates nursing practice as responsive to health
inequities. Thus, a CADP is a promising way to translate social justice into nursing
practice and education through transformative learning.

KEYWORDS
antidiscrimination, antiracism, critical pedagogies, critical theories, discrimination, nursing
curriculum, nursing education, racism

1 |  BACKGROUND Coakly, 1998; Mustillo et al., 2004; Oxman-­

A growing body of research continues to demonstrate the profound
effects of health and social inequities on peoples’ health, access to
care and overall well-­being. Krieger (2014), for example, has focused
on the health effects of racial discrimination by demonstrating a di-
rect causal relationship with hypertension, low birthweight, prema-
ture labor, and other significant health issues. Building on Krieger’s
landmark studies, others have contributed to the growing body of ev-
idence showing that racial discrimination both has direct physiological
effects on health and operates structurally to affect people’s access
to the social determinants of health such as education, employment,
income, housing, and health care (Borrell, Kiefe, Williams, Diez-­Roux,
& Gordon-­
Larsen, 2006; Bourassa, McKay-­
McNabb, & Hampton,
2004; Harris et al., 2006; Krieger, 2000, 2001; Krieger, Sidney, &
Martinez et al., 2012;
Penn & Wykes, 2003; Poudrier, 2003; Smedley, Rich, & Erb, 2005;
Veenstra, 2009; Williams, Neighbors, & Jackson, 2003; World Health
Organization, 2013). In 2010, the World Health Organization identi-
fied racism explicitly as a social determinant of health inequities (Solar
& Irwin, 2010) and Turner (2016) has built a ‘business case’ for redress-
ing persistent racially based inequities, showing how racial discrimina-
tion undermines the United States economy. Despite these compelling
trends and the long-­standing agreement that race is not a biological
category (UNESCO, 1952), nursing has not adequately integrated dis-
cussions of race and racism as historically and socially constituted and
situated, and discrimination more widely, into the nursing curriculum.
Because race and racism are key determinants of health inequi-
ties (Krieger, 2014; Solar & Irwin, 2010), racializing and discriminatory
processes are primary targets for social justice interventions, including

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in health care contexts and nursing education. However, racial dis-
crimination rarely operates in isolation from other social dynamics.
For example, experiences of discrimination are amplified by issues
of poverty, substance use, or stigmatizing chronic conditions such as
HIV or mental health issues (Hancock, 2007; Varcoe, Browne, & Ponic,
2013). Varcoe et al. (2013) argue that while discrimination may man-
ifest as interpersonal and obvious (for example through derogatory
culturalist, race-­or ethnicity-­based comments), it is in fact systematic,
built into the structures of society, and often invisible. Discrimination
therefore can be understood as ‘all means of expressing and institu-
tionalizing social relationships of dominance and oppression’ (Krieger,
2014, p. 250).
Approaches to fostering social justice by countering discrimination
must be based on this broad understanding, taking the systemic and
structural nature of discrimination into account, and examining the
intersections among multiple forms of discrimination. In this paper,
we propose a critical antidiscriminatory pedagogy (CADP) to enhance
the capacity for nursing to address key social justice issues. We pay
particular attention to systemic discrimination as inherent to the pro-
duction and maintenance of health and social inequities and injustices
(Krieger, 2014; Marmot, Friel, Bell, Houweling, & Taylor, 2008). We
focus attention on the value-­added of focusing on multiple, inter-
secting forms of discrimination, including the stigma of poverty, the
harms of culturalist assumptions, and the impact of racialization, age-
ism, and gendered inequities, among others, and how these are often
co-­constituted determinants of health and well-­being for individuals,
communities, and populations. We discuss the theoretical roots and
key characteristics of a CADP grounded in critical theories and peda-
gogies, and identify implications for nursing education. We argue that
adopting a CADP offers opportunities for nurses and future nurses to
develop their capacity to counteract various forms of individual and
systemic discrimination in health care contexts and holds promise for
moving social justice as a professional value into transformative learn-
ing and action.
2 |  APPROACHES TO ADDRESSING
SOCIAL JUSTICE AND HEATH INEQUITIES
IN NURSING
To address health and health care inequities, nursing scholars and
educators have advocated for curricular changes based on the prin-
ciples of social justice (Chinn, 2014; Hardy, 2011). Thorne points out
that although many nursing scholars have operated from a stance of
liberal individualism, social justice ‘has been a dominant normative
position for nursing for as long as we have been professionalized’
(2014, p. 79). Social justice perspectives, however, have not been
taken up easily in nursing curricula and approaches to addressing
social injustices, and health inequities in nursing have varied in dif-
ferent contexts and across time. Canales and Drevdahl (2014) argue
further that even if social justice is at the core of the nursing disci-
pline, it is very often absent or may operate as mere rhetoric in the
nursing curriculum.
2.1 | Culturally congruent care and
multicultural approaches
Although distribution of inequities and their impacts are racialized,
a focus on the racialization of health and social inequities has not
been a driving force in nursing education and practice. Rather, the
primary means of teaching about health inequities in nursing has
been to frame health and social inequities as stemming from cultur-
ally or ethnically based issues. Hence, nursing practice and education
have been dominated by attention to cultural sensitivity and cultural
competence, drawing on a plethora of theories and models orient-
ing nursing practice and education toward culturally congruent care
(e.g., Andrews & Boyle, 2002; Campinha-­Bacote, 1998; Leininger,
1991; Papadopoulos, Tilki, & Taylor, 1998; Purnell & Paulanka, 2008).
These theories and models have been developed from cultural diver-
sity and multiculturalist perspectives, often founded in a culturalist
ideology, which is prominent in nursing and health care, and pro-
moted by a majority of schools, universities, and other public insti-
tutions (Vandenberg & Kalischuk, 2014; Varcoe & Browne, 2015). In
such approaches, health and health behaviors are seen as primarily
determined by an individual’s presumed ethnocultural, and often
racialized identity. For example, dietary practices and adherence to
dietary advice are often interpreted as ethnocultural, and factors
such as food availability and affordability tend to be overlooked. As a
consequence, and in concert with the long recognized dominance of
liberal individualism in nursing with its emphasis on individuals freely
making independent choices (Browne, 2001), culturalism and racialism
are frequently used as the primary analytical lenses through which to
explain health behaviors and health issues, including health inequities
(Browne & Reimer-­Kirkham, 2014; Vandenberg & Kalischuk, 2014;
Varcoe et al., 2013). For example, lower access to prenatal care is ex-
plained as the choices of individuals arising from their particular ethnic
values rather than as the consequence of racialized social and eco-
nomic disadvantage, including overt discrimination that deters access
to care. Such understandings ignore root causes of health inequities
by obscuring the contribution of structural inequities such as institu-
tional racism and discrimination.
Recent empirical studies have highlighted that educational
approaches focusing on culture alone are not sufficient to ad-
dress discrimination and racism in health care (Allen, Brown,
Duff, Nesbitt, & Hepner, 2013; Hardy, 2011; McDermott, 2012;
McDermott et al., 2015). Thus, even with the best intention of pro-
viding culturally congruent care, multicultural approaches in nurs-
ing education have failed to challenge racism and discrimination
at the level of clinical practice, as well as at the organizational and
systemic levels.
2.2 | Racial discrimination and antiracist approaches
In concert with the critiques of individualistic and multicultural ap-
proaches in nursing education, some authors have argued for a critical
turn in cultural competence and the inclusion of concepts related to
racism and other individual and systemic forms of discrimination in its
BLANCHET GARNEAU et al.
conceptualization and in health professionals’ education (Almutairi &
Rodney, 2013; Blanchet Garneau & Pepin, 2015; Herring, Spangaro,
Lauw, & McNamara, 2013; Sakamoto, 2007). For example, strategies
involving critical reflection (Blanchet Garneau, 2016) and reflexive
antiracism training (Franklin, Paradies, & Kowal, 2014) have been pre-
sented as promising alternatives to multiculturalist education. These
strategies include reflection upon the root causes and impacts of dis-
crimination and racism in society while avoiding essentialist perspec-
tives of culture.
This attention to racism and antiracism is not new in nursing.
Historically, nursing leaders such as Ethel Johns, Lavinia Dock,
and Margaret Sangster worked to change gendered discriminatory
policies and practices affecting women and racialized minorities
(Thorne, 2014). More recently, nursing scholars have continued
to draw attention to the need for analyses in nursing focused on
issues of racism, and the impacts of racism on health and health
care (Anderson, 2006; Anderson et al., 2009; Barbee, 1993; Taylor,
Mackin, & Oldenburg, 2008). These scholars, reflecting a critical
theoretical orientation, emphasize the need to understand issues
of racism as extending well beyond individualistic explanations, as
imbricated with broader social trends such as global migration pat-
terns and the global neoliberal political-­economic context, which
sustains racialized and gendered inequities. However, prior to the
1990s, nursing scholarship tended to frame racism and other forms
of discrimination as individual-­level issues related to people’s par-
ticular attitudes, prejudice or biases, overlooking issues of systemic
or institutional racism (Drevdahl, Philips, & Taylor, 2006). Although
individualistic interpretations of racism predominate, Barbee (1993),
Drevdahl, Taylor & Phillips (2001; Drevdahl et al., 2006), and Taylor
(1999) were instrumental advancing compelling arguments about
the invisibility of attention to race or racism in nursing discourse as
stemming from the individualistic and often Euro-­centric focus of
the discipline.
Beyond these analyses, there are few documented expe-
riences, discussions, or research reports on the integration of
antiracist pedagogy in the curriculum in nursing (e.g., Alleyne,
Papadopoulos, & Tilki, 1994; Blakeney, 2005; Cortis & Law, 2005;
Hagey & MacKay, 2000; Hassouneh, 2006; Nairn, Hardy, Parumal,
& Williams, 2004). Antiracist pedagogy is theoretically grounded
in the critical pedagogy (Freire, 1970; Giroux, 1997; Kincheloe,
2008; McLaren, 2015) and orients learners through an analysis
of systems of oppression and domination to ‘explain and counter-
act the persistence and impact of racism using praxis as its focus
to promote social justice for the creation of a democratic soci-
ety in every respect’ (Blakeney, 2005, p. 119). Thus we propose
an explicit critical antidiscriminatory pedagogy for nursing. The
CADP we propose in this paper builds on ideas from antiracist
approaches, takes a broad contextual and structural approach to
understanding racism and discrimination, and extends beyond a
singular dimension to integrate an intersectional perspective. A
CADP pushes beyond culturally sensitive, tolerant, and respectful
attitudes promoted by multiculturalist approaches toward a criti-
cal cultural perspective.
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3 | KEY FEATURES OF A CADP
Antiracist pedagogy is a promising starting point from which to move
toward social justice in the curriculum and serves as a foundation upon
which to develop a CADP. Systematically and intentionally including
antidiscrimination content in initial and continuing nursing education
could motivate meaningful collective action and promote the devel-
opment of critical consciousness among future nurses (Hardy, 2011).
A CADP both acknowledges and challenges the long tradition of lib-
eral individualism in health care, as well as culturalist and racializing
processes prevalent in nursing. In this approach, education based on
developing humanistic care that is sensitive and respectful, without ad-
dressing structural conditions related to health and health care is seen
as insufficient (Dovidio, Gaertner, & Saguy, 2015). A CADP also offers
the opportunity to tackle discrimination within the profession itself.
Importantly, nursing scholars have drawn attention to the dynamics of
racism within nursing (Das Gupta, 1996), including the experiences of
racialized nurses in practice contexts dominated by whiteness (Hagey
et al., 2001; Nichols & Campbell, 2010), and the similar experiences of
nursing students (Koch, Everett, Phillips, & Davidson, 2014). Nursing
scholars also have paid increasing attention to the discrimination
experienced by internationally educated nurses, particularly those
who are racialized (Baptiste, 2015; Tuttas, 2015; Wheeler, Foster, &
Hepburn, 2014). A CADP takes into account not only experiences
of discrimination of patients, but also of nurses and nursing students
(Mapedzahama, Rudge, West, & Perron, 2012; Nielsen, Alice Stuart, &
Gorman, 2014). The CADP we propose has the following features: it
is grounded in a critical intersectional perspective of racism and other
forms of discrimination, it aims at fostering transformative learning,
and it involves a praxis-­oriented critical consciousness.
3.1 | Expanding beyond antiracist and
multiculturalist perspectives: a critical intersectional
perspective of discrimination
Building on antiracist pedagogy and developed from a critical per-
spective, the CADP we discuss in this paper extends beyond an indi-
vidualistic and essentialist perspective of discrimination. We advocate
for a critical intersectional perspective of discrimination because, as
much as the translation of multiculturalism and cultural competence
into nursing practice and education has brought criticism for focus-
ing on differences and obscuring broader institutional and societal
influences on health and health care, dominant conceptualizations of
discrimination have also been criticized for putting the blame on in-
dividual behaviors and attitudes (Krieger, 2014; Varcoe et al., 2013).
Often, discrimination as a concept is taken up from an individualistic
vantage point. According to Varcoe et al. (2013), discrimination is still
widely conceptualized and measured following a stress-­coping per-
spective (e.g., Sawyer, Major, Casad, Townsend, & Mendes, 2012).
Informed by theories from the discipline of psychology, discrimination
is then narrowly considered as a psychosocial stressor ‘that can lead
to adverse changes in health status and altered behavioural patterns
that increase health risks’ (Williams & Mohammed, 2013, p. 1152).
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Consequently, most studies do not consider the multiple causal path-
ways by which discrimination can affect health. The conceptualization
of discrimination in itself is then an important factor in reproducing
primarily individual-­level perspectives on discrimination.
An intersectional perspective investigates ‘the interaction of nu-
merous characteristics of vulnerable populations, not only at the indi-
vidual level but also at structural levels so as to capture the multiple
contexts that shape individual lives and health statuses’ (Dhamoon
& Hankivsky, 2011, p. 16). Intersectional perspectives are useful in
drawing attention to complex dynamics of racism, gendered inequi-
ties, economic disparities, stigma, and other social processes, and how
they interact and are often co-­constituted to influence health and
well-­being. In this paper, we focus primarily on racial discrimination,
keeping in mind these complex dynamics, and draw on intersectional
theory to illuminate them. An intersectional perspective also allows
health care professionals to understand that they may be positioned at
multiple places in power relations, encountering both privilege and op-
pression at the same time in varying social conditions. A CADP offers
a framework for health care professionals to analyze power relations
at multiple levels and in multiple intertwined contexts to look at and
disrupt structural and individual-­level dynamics producing and repro-
ducing systemic discrimination. It provides opportunities to develop
strategies to change conditions of social injustices.
3.2 | Fostering transformative learning to
counteract the effects of discrimination
A CADP is closely linked to its critical theoretical roots as it aims to
foster transformative learning oriented toward action to counteract
the effects of discrimination at both individual and systemic levels in
health care. Transformative learning is ‘the process of using a prior
interpretation to construe a new or revised interpretation of the
­
meaning of one’s experience in order to guide future action’ (Mezirow,
1996, p. 162). There is a transformation of the learners’ frame of ref-
erence, which means that learners experience a deep, structural shift
in the basic premises of their thought, feelings, and actions. This new
understanding of the world is then translated into consequent actions.
To achieve this transformative learning, a praxis-­oriented critical con-
sciousness is central to a CADP.
3.3 | A praxis-­oriented critical consciousness
Praxis is the dialectical relation between theory and practice, where
reflection facilitates ‘a dialogue between theory and practice to
­develop a new understanding of the world of practice, and a new
ability to change practice’ (Nairn, Chambers, Thompson, McGarry, &
Chambers, 2012, p. 190). In critical pedagogy, Freire (1970) concep-
tualizes praxis as simultaneous reflection and action to transform the
world. The processes of reflection and action both interact to develop
critical consciousness among learners and give them the power to act
and resolve or change situations (Freire, 1970).
The development of critical consciousness is inherent to a CADP
because it involves new forms of understanding that connect one
more directly to counteracting discrimination. A CADP considers that
structural and interpersonal discriminations are inseparable and posi-
tions the individual within the larger forces at play in discriminatory
processes. It supports learners in developing new understandings of
their social locations and focusing their attention on their responsi-
bility for action—even if they perceive themselves as separate from
or not implicated in the conditions that give rise to discrimination.
Learners are invited to critically think about their social location and
uncover structural and systemic taken-­for-­granted assumptions that
shape their practice. The exploration of personal experience as struc-
turally produced is then always linked to a contextualized perspective
of the world and with knowledge of how one can counteract the ef-
fects of discrimination in health care.
Building on Freire’s (1970) notions of praxis and critical conscious-
ness, and in response to the individualist and decontextualized ap-
proach to care that dominates in nursing, Doane and Varcoe (2015)
propose a relational inquiry approach to nursing practice. A relational
inquiry approach has two core components: a relational consciousness
and inquiry as a form of action. A relational consciousness focuses on
the ‘relational interplay occurring at and between the intrapersonal,
interpersonal, and contextual levels’ shaping each nursing situation
(Doane & Varcoe, 2015, p. 4). From this perspective, inquiry is viewed
as a form of action and a method to navigate through the relational
experiences of people and contexts in each nursing situation. Keeping
in mind Freire’s ideals, and Doane and Varcoe (2015) concepts, we
argue that a CADP entails two processes which are central to a praxis-­
oriented critical consciousness: an explicit examination of structural
conditions and power dynamics requiring relational consciousness,
and taking action grounded in contextual knowledge.
3.3.1 | An explicit examination of structural
conditions and power dynamics
A CADP shifts the focus from acts of discrimination between two
persons to an analysis of structural processes by looking at power
relations at play. A CADP is then explicitly concerned with power
relations, knowing that power operates at all levels, in all directions,
among all players, and not just in a hierarchical, top-­down manner. The
dynamics of oppression and privilege are not necessarily intentional,
nor is intent related to the impacts of systemic discrimination. Rather,
it is important to understand that everyone is implicated and ‘caught
up’ in these systems of power, wittingly or not.
Critical thinking is essential to analyze structural conditions and
power dynamics involved in the interlocking systems of oppression
embedded in society and affecting health and health care. Developing
critical thinking among learners is central to a CADP. However, critical
thinking as part of a CADP departs from an analytic philosophy per-
spective, which frames how critical thinking is currently conceived and
taught in nursing. Following an analytic philosophy perspective, think-
ing critically focuses on cognitive processes, such as recognizing false
inferences and logical fallacies, and being able to distinguish opinion
from evidence (Brookfield, 2007). Although these are essential intel-
lectual functions for nursing practice, this focus on cognitive processes
BLANCHET GARNEAU et al.
tends to neglect social and political critique (Kincheloe, 2000). From a
critical theoretical perspective, educators acknowledge the multiple
methods of producing knowledge and challenge binary and true-­or-­
false epistemologies in the service of challenging normative ideas and
approaches, and to shift the status quo. They advocate for diverse
perspectives on similar events and the importance of contextuality.
Critical pedagogy leads learners to engage in a reflexive dialogue to
analyze the ways power operates and its effects on social structures. A
reflexive dialogue involves questioning the legitimacy of power struc-
tures that maintain the status quo, and leads learners to be able to
challenge the way they think and act in their relationship to social, cul-
tural, political, economical, and historical contexts (Kincheloe, 2008).
For example, educators teaching about diabetes from a CADP would
integrate attention to power dynamics at the outset by underlining
the role of poverty and racial discrimination in the etiology of diabe-
tes, and the intersecting factors such as low income, racism, and gen-
dered inequities that can limit food security and access to health care
(Raphael, 2011). Such education would draw attention to the evidence
base regarding the global epidemic of diabetes among Indigenous peo-
ple and the colonial epigenetic factors underlying that epidemic.
3.3.2 | Taking action grounded in
contextualized knowledge
A CADP brings a contextualized perspective to understanding culture
and health, which helps to analyze the power relations, and dynamics
of oppression and privilege in health care and to act upon structural
inequities such as discrimination and structural racism. Doane and
Varcoe (2015) argue that health professionals need to intervene to
address structural conditions at the contextual level while simultane-
ously focusing on individuals. Hence, nurses ought to develop skills to
infuse their caring practices with a contextualized view to counteract
racism and discrimination in health care and address health inequities
(Thompson, 2014).
Critical consciousness, then, is different from consciousness-­
raising. Being aware of racism and discrimination in not enough, and
a CADP helps learners to articulate this critical consciousness with
action. This self-­reflective and action-­oriented stance introduces a
problem identified by Lather, who developed a critical approach to
education informed by a feminist poststructuralist perspective: ‘How
can… self-­reflexivity both render our basic assumptions problematic
and provisional and yet still propel us to take a stand?’ (1991, p. 44).
Lather questions the possibility of becoming empowered by such self-­
reflexivity. If only consciousness is raised without articulating it with
action, there is a risk that this awareness causes feelings of helpless-
ness and powerlessness among learners, and paralyzes their action
(Mooney & Nolan, 2006; Wear, Zarconi, Aultman, Chyatte, & Kumagai,
2017). In line with a critical theoretical stance, one alternative is to re-­
orient reflection toward social, political, economic, and cultural con-
texts within which a person lives and to reflect on how this context is
shaping this person’s everyday life and actions. Learners are invited to
analyze the social context of themselves and each patient. Examining
the self from a critical perspective thus tends to limit feelings of guilt
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and shame regarding privileged social locations, and orients learners
toward responsibility for action grounded in contextualized knowl-
edge. For example, from a CADP perspective, Euro-­Canadian middle-­
class learners are not implicated as being personally responsible for
what they might construct as their white privilege, but are encouraged
to take responsibility for their action or inaction about addressing in-
tersecting forms of discrimination in health care. For example, in rela-
tion to the issues of diabetes noted above, nurses would be prompted
to look beyond the commonly cited individual-­level factors that are
assumed to be risk factors for diabetes. Instead, they would draw on
a wider field of vision to consider the socioeconomic forces impact-
ing the etiology of diabetes, and plan programs, policies, and actions
to mitigate those impacts. This stance would push nurses to consider
how issues of poverty, stigma, and lack of access to affordable foods
must be in relation to nursing care for people living with diabetes.
Being aware without invoking guilt or attributing responsibility for this
context is one way to foster agency, and is more constructive than
blaming individuals for issues that may arise because of one’s social
positioning (Young, 2011).
4 | ‘WE MUST LIFT AS WE CLIMB’:
EDUCATING TO UNCOVER, CHALLENGE
AND DISRUPT DISCRIMINATORY
PROCESSES
Teaching from a critical antidiscriminatory perspective implies the
need to teach with a specific social and political intent, a transforma-
tive impetus, which is to act upon individual and systemic discrimina-
tion. ‘Lift as we climb’ was the motto of the National Association of
Colored Women’s Clubs founded in 1896. The idea behind this phrase
is that transformative processes are collective and people need each
other to make significant changes in the world. Transformative pro-
cesses require social movements across lines of race, gender, and
class, and at multiple levels of organization of the society in which we
live. The implementation of a CADP at the curriculum level will then
involve changes in institutional policies and procedures, and in teach-
ing approaches (Rowan et al., 2013; Thackrah & Thompson, 2013).
Considering that curriculum represents the total learning experi-
ences of the individual (Dewey, 1938), we thus advocate for an ex-
plicit commitment of initial and continuing nursing education to the
ethics of social justice as an organizing precept in the preparation and
support of professional nurses. This explicit commitment should go
beyond words and good intentions to become central to strategic
planning and translate into tangible actions to support social justice.
This would mean, for example, setting more explicit attention to anti-
racist, anticolonial, and antidiscriminatory approaches as part of social
justice expectations in curriculum and in professional guidance docu-
ments such as Codes of Ethics. For example, while attention to social
justice is noted in the Canadian Nurses Association Code of Ethics,
the emphasis tends to be on fairness, access and awareness of so-
cial justice issues (Bekemeier & Butterfield, 2005; Reimer Kirkham &
Browne, 2006), versus an explicit naming of the root causes of health
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and social inequities stemming from intersecting issues such as pov-
erty, racism, stigma, and discrimination. We also believe that health
care and education institutions should discourage and report actions
that run counter to, or that marginalize, strategies aimed at mitigating
the impacts of racism and other forms of discrimination as part of their
broader social justice mandates.
4.1 | Critically conscious educators for collective and
safe learning
We suggest that collective learning might be well suited to develop a
praxis-­oriented critical consciousness and foster transformative learn-
ing among learners. Indeed, adult educators have consistently advo-
cated for collaborative group learning (Brookfield, 1995; Freire, 1994;
Mezirow, 2000). However, group learning also brings challenges
related to power dynamics among team members. Authors such as
Ellsworth (1989), Gore (1992), and Lather (1992) have highlighted
the division in critical pedagogy between critically aware teachers and
ideologically duped students (Brookfield, 2007). Gore (1992) and Lather
(1992) have both argued that when the focus is only on developing
critical consciousness of the learners, educators tend to assume the
correctness of their ideological reading of the world. Ellsworth (1989)
raised the concern that educators ought to take into account their
own positionalities and learned racism, classism, or sexism. The adop-
tion of an intersectionality lens in a CADP allows considering the posi-
tionality of the educators and their self-­criticality as equally important
as those of the learners. Thus, educators, as well as learners, can learn
from becoming critically conscious. Educators must engage in self-­
criticism about the ideologies that underlie teaching methods because
teaching can also lend itself to the reproduction of social inequities.
Educators must therefore avoid indoctrinating learners but stimulate
them to examine the way power and knowledge work together and
reinforce one another.
Following the same logic, we must not assume that classrooms are
safe heavens (Varcoe & McCormick, 2007). As Brookfield states, ‘Neither
learners nor teachers leave their racial, class, or gender identities at the
classroom door, nor do they forget their previous participation in discus-
sions with all the humiliations and manipulations these often entailed’
(2007, p. 359). There are many times in a group where expressing one’s
voice may not feel safe. Educators can most certainly suggest ways to
foster a safe learning environment, but we cannot assume that they
have the power to create spaces that are free of prejudice. In addition,
silence should not be automatically associated with voicelessness but
could also be considered a deliberate political choice (Ellsworth, 1989).
We believe that creating a safe environment to question what is taken
for granted and to imagine ways to do and think things differently is a
collective responsibility that is shared by educators and learners.
4.2 | Developing strategies to implement a CADP
in the nursing curriculum
A CADP has the potential to lead learners to consider how their so-
cial and practice contexts direct them to focus on individual-­level
behaviors and toward actions that are often aimed at enforcing com-
pliance with biomedical imperatives. Learners are encouraged to con-
sider how their daily exposure to racializing and other discriminatory
discourses requires conscious resistance. Although it is beyond the
scope of this paper to provide specific strategies for implement-
ing CADP in curriculum, there is a burgeoning literature on which
to develop such strategies. Varcoe and McCormick (2007), Varcoe,
Browne, and Cender (2014), and Browne et al. (2016) suggest ways
to tackle racial discrimination and health inequities in nursing practice
and education from a critical perspective. For example, from a CADP
perspective, institutions should show an explicit commitment to fos-
tering health equity by clearly stating in their mission and policies
the importance of equitable access to health and health care access.
This statement could serve as a basis of discussion with students and
practicing nurses about how to disrupt pervasive discourses of egali-
tarianism, and individualistic notions of choices and lifestyles, to draw
attention to the root causes of health and social inequities and their
differential impacts on patients and populations, and to take action ac-
cordingly (Varcoe et al., 2014). Learners could also be invited to take
into account population statistics while attending to specific individu-
als, families, and communities. For example, while Aboriginal women
experience high levels of violence, providers should not assume any
individual woman will be experiencing violence. Similarly, stereotypes
and assumptions about substance use in some groups should not ob-
scure the fact that a percentage of any group of people will experi-
ence substance use issues. Moving thoughtfully between the general
and the particular can help to deepen understandings of marginaliza-
tion, vulnerability, risk, and precarity intrapersonally, interpersonally,
and contextually, and understandings of the dynamics of vulnerability
instead of locating vulnerability within individuals and individual-­level
behaviors (Varcoe et al., 2014). Finally, strategies could be developed
to find ways of situating nursing practice within the context of health
equity and inequities (Browne et al., 2016), including the role and re-
sponsibility of nurses in counteracting discriminatory, stigmatizing or
racist discourses that often operate in covert ways in practice settings.
This could help students and nurses to identify the forms of inequity
that pervade in their practice context and attend to the conditions
that shape health, inequities, and distribution of power through their
interactions with patients and colleagues, and in developing organiza-
tional policies and practices.
5 | CONCLUSION
The nursing discipline has a unique contribution to advancing social
justice in health care practices and education. Our commitment to
social justice must be visible in our actions. As Drevdahl et al. stated
15 years ago ‘although we speak the words of social justice, it is how
we act that demonstrates our philosophy’ (2001, p. 26). A CADP rep-
resents one of multiple ways to translate social justice into nursing
education and reclaim nursing’s mission of social justice. However, we
do not presume that a CADP is the only way to translate social jus-
tice in nursing education. As classrooms and workplaces are subject to
BLANCHET GARNEAU et al.
infinite possibilities and combinations of learning preferences and in-
tersecting social positions, a variety of approaches and methodologies
will be necessary to develop the field of CADP. Consequently, more
attention is needed in the nursing curriculum to teaching social justice
from various viewpoints. Efforts to integrate social justice into nursing
education from multiple perspectives are encouraged in this direction.
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