The future of childhood maltreatment research: Diversity and equity-informed perspectives for inclusive methodology and social justice.

A long-standing practice in clinical and developmental psychology research on childhood maltreatment has been to consider prospective, official court records to be the gold standard measure of childhood maltreatment and to give less weight to adults' retrospective self-reports of childhood maltreatment, sometimes even treating this data source as invalid. We argue that both formats of assessment - prospective and retrospective - provide important information on childhood maltreatment. Prospective data drawn from court records should not necessarily be considered the superior format, especially considering evidence of structural racism in child welfare. Part I overviews current maltreatment definitions in the context of the developmental psychopathology (DP) framework that has guided maltreatment research for over 40 years. Part II describes the ongoing debate about the disproportionalities of minoritized children at multiple decision-making stages of the child welfare system and the role that racism plays in many minoritized families' experience of this system. Part III offers alternative interpretations for the lack of concordance between prospective, official records of childhood maltreatment and retrospective self-reports, and for the differential associations between each format of data with health outcomes. Moving forward, we recommend that future DP research on childhood maltreatment apply more inclusive, diversity and equity-informed approaches when assessing and interpreting the effects of childhood maltreatment on lifespan and intergenerational outcomes. We encourage future generations of DP scholars to use assessment methods that affirm the lived experiences of individuals and families who have directly experienced maltreatment and the child welfare system.

Centering diversity, equity, and inclusion in a regional professional nursing organization.

BACKGROUND: Professional nursing organizations can respond to threats to social justice by strengthening structures to support diversity, equity, and inclusion (DEI). PURPOSE: Describe implementation strategies and outcomes to advance DEI from the Western Institute of Nursing (WIN). METHODS: In 2019, WIN committed to prioritizing DEI by updating its vision and mission. A taskforce was assembled to conduct member surveys, focus groups, and open forums to generate recommendations on developing and implementing organizational change. DISCUSSION: These initiatives culminated in centralized efforts that include the formation of a standing committee, ongoing member surveys, selection of diverse conference topics and speakers, adoption of inclusive practices, and ongoing assessments to make recommendations to the Board to advance DEI. CONCLUSION: The work of the Committee ensures the organization remains committed to DEI. These strategies inform other nursing organizations as they advance DEI to impact research, education, policy, and practice.

Through the Looking Glass: Diversity, Equity, Inclusion, and Belonging: A Call for Action from the National Association of Pediatric Nurse Practitioners.

In response to growing health disparities, social inequities, structural racism, and discrimination, the National Association of Pediatric Nurse Practitioners established a Diversity, Equity, and Inclusion Taskforce. In 2020, this group transitioned into a national committee to infuse equity across the organization and empower pediatric-focused advanced practice registered nurses as agents of change to address health disparities. Emphasizing the critical need for understanding health disparities in the context of racism and discrimination, this committee champions a paradigm shift, transcending educational initiatives, advisory roles, advocacy efforts, leadership strategies, and community services to illuminate an equitable future for all children and families.

Operationalizing Equity, Inclusion, and Access in Research Practice at a Large Academic Institution.

INTRODUCTION: Healthcare advances are hindered by underrepresentation in prospective research; sociodemographic, data, and measurement infidelity in retrospective research; and a paucity of guidelines surrounding equitable research practices. OBJECTIVE: The Joint Research Practices Working Group was created in 2021 to develop and disseminate guidelines for the conduct of inclusive and equitable research. METHODS: Volunteer faculty and staff from two research centers at the University of Pennsylvania initiated a multi-pronged approach to guideline development, including literature searches, center-level feedback, and mutual learning with local experts. RESULTS: We developed guidelines for (1) participant payment and incentives; (2) language interpretation and translation; (3) plain language in research communications; (4) readability of study materials; and (5) inclusive language for scientific communications. Key recommendations include (1) offer cash payments and multiple payment options to participants when required actions are completed; (2) identify top languages of your target population, map points of contact, and determine available interpretation and translation resources; (3) assess reading levels of materials and simplify language, targeting 6th- to 8th-grade reading levels; (4) improve readability through text formatting and style, symbols, and visuals; and (5) use specific, humanizing terms as adjectives rather than nouns. CONCLUSIONS: Diversity, inclusion, and access are critical values for research conduct that promotes justice and equity. These values can be operationalized through organizational commitment that combines bottom-up and top-down approaches and through partnerships across organizations that promote mutual learning and synergy. While our guidelines represent best practices at one time, we recognize that practices evolve and need to be evaluated continuously for accuracy and relevance. Our intention is to bring awareness to these critical topics and form a foundation for important conversations surrounding equitable and inclusive research practices.

Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: An integrative review.

AIM: To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity. DESIGN: Integrative review. METHODS: The integrative review was informed by the Whittemore and Knafl's framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases. DATA SOURCES: Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022. RESULTS: Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity. CONCLUSION: Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration. IMPACT STATEMENT: Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy. SUMMARY STATEMENT: What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research. REPORTING METHOD: This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Exploring the complex cognitive, affective and behavioural processes of individuals with intellectual disabilities in financially abusive situations.

BACKGROUND: Understanding the cognitive processes of individuals with intellectual disabilities in financially abusive situations is critical to develop effective prevention strategies. AIMS: This study investigated how persons with intellectual disabilities define and analyse financially abusive situations, and how they would feel and act in situations that they consider abusive. MATERIALS AND METHODS: Twelve participants with intellectual disabilities participated in a semi-structured interview where they were asked to reflect on three vignettes illustrating financial abuse. We analysed the interviews using thematic analysis. FINDINGS: The findings revealed that individuals with intellectual disabilities considered the type of relationship between the victims and the perpetrators, the behavioural patterns of the perpetrators, and their own experiences when interpreting the situation. Furthermore, they discussed their emotional and behavioural reactions to the vignettes. CONCLUSION: This study has important implications in supporting the autonomy and decision-making rights of persons with intellectual disabilities regarding their finances and developing effective preventions against financial abuse among this population.

Cardiorespiratory fitness and physical activity in the lens of social justice - Reporting on the disparities that exist.

Cardiorespiratory fitness (CRF), heavily influenced by physical activity (PA), represents a strong and independent risk factor for a wide range of health conditions, most notably, cardiovascular disease. Substantial disparities in CRF have been identified between white and non-white populations. These disparities may partly account for group differences in susceptibility to poor health outcomes, including non-communicable disease. Race and ethnic differences in CRF may partly be explained by social injustices rooted in persistent structural and systemic racism. These forces contribute to environments that are unsupportive for opportunities to achieve optimal CRF levels. This review aims to examine, through the lens of social justice, the inequities in key social ecological factors, including socioeconomic status, the built environment, and structural racism, that underly the systemic differences in CRF and PA in vulnerable communities. Further, this review highlights current public health initiatives, as well as opportunities in future research, to address inequities and enhance CRF through the promotion of regular PA.

Scoping review on the link between economic growth, decent work, and early childhood caries.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic non-communicable disease that affects millions of young children globally, with profound implications for their well-being and oral health. This paper explores the associations between ECC and the targets of the Sustainable Development Goal 8 (SDG 8). METHODS: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to economic growth, decent work sustained economic growth, higher levels of productivity and technological innovation, entrepreneurship, job creation, and efforts to eradicate forced labor, slavery, and human trafficking and ECC all of which are the targets of the SDG8. Only English language publications, and publications that were analytical in design were included. Studies that solely examined ECC prevalence without reference to SDG8 goals were excluded. RESULTS: The initial search yielded 761 articles. After removing duplicates and ineligible manuscripts, 84 were screened. However, none of the identified studies provided data on the association between decent work, economic growth-related factors, and ECC. CONCLUSIONS: This scoping review found no English publication on the associations between SDG8 and ECC despite the plausibility for this link. This data gap can hinder policymaking and resource allocation for oral health programs. Further research should explore the complex relationship between economic growth, decent work and ECC to provide additional evidence for better policy formulation and ECC control globally.

Community health nurses leadership in advancing health equity.

OBJECTIVE: To describe the solutions community health nurses (CHNs) identify to address health inequities during the COVID-19 pandemic and to explore what leadership competencies enable CHNs to enact these solutions. DESIGN: Online survey, distributed to all members of the Community Health Nurses of Canada and associated provincial and territorial networks. PARTICIPANTS: Inclusion criteria included all nurses who were working during the COVID-19 pandemic in Canada. A total of 245 responses were included in the analysis. MEASUREMENT: The survey included 25 open ended and fixed response questions. Descriptive statistics were used to describe the quantitative data. Framework Analysis was used to analyze the qualitative data. RESULTS: Solutions focused on advancing health equity and expanding community relationships and partnerships were identified as priorities. To enact these solutions system transformation, engaging others, and developing coalitions were identified as the main leadership competencies required by CHNs. CONCLUSION: Participants in this study clearly articulated structural and process solutions to address health inequities among priority populations during the pandemic. CHNs described with practice knowledge and confidence that solutions enacted in system transformation with community partners are necessary to advance health equity.

The Unique Lived Experiences of LGBQ Athletes: A Collegiate Women's Rugby Club Team as an Inclusive & Empowering Community.

There is ongoing debate regarding the culture of competitive women's sports. On one hand, women who participate in sports are viewed as adhering to and reinforcing heteronormative stereotypes and hegemonic masculinity. Conversely, women's sports are viewed as an inherently supportive environment for those involved. The current study explored the latter phenomena, specifically related to factors that promote an inclusive and empowering community for LGBTQ+ women. Eleven individual semi-structured interviews and one follow-up focus group with six participants were conducted with women from a collegiate women's rugby club team. All participants described their sexual identities as Lesbian, Gay, Bisexual, and/or Queer (LGBQ). A reflexive thematic analysis was used to analyze the data collectively. Participants described their collegiate rugby team as being one of their first encounters with a safe and inclusive LGBTQ+ environment. Membership on the team also was viewed as an important experience that helped participants come to terms with their sexual identity. Specifically, findings indicate the supportive actions of teammates, an inclusive team culture, and unique factors related to the sport of rugby helped promote an inclusive and empowering community for LGBTQ+ women. Indeed, from a critical positive youth development perspective, social justice life skills (e.g., allyship) provided actionable behaviors that promote an inclusive and empowering community for LGBTQ+ women. However, future research must seek to understand the lived experiences of all women's rugby participants, particularly transgender and athletes of color.

Theory analysis and evaluation of emancipatory nursing praxis: A theory of social justice in nursing.

PURPOSE: The aim of this paper was to analyze and evaluate the middle-range theory, emancipatory nursing praxis (ENP): a theory of social justice in nursing. METHODS: Peterson and Bredow's method was utilized to complete the theory evaluation. The theory was evaluated systematically to ensure the appropriateness of application for research in nursing education and transforming nursing students into social justice allies. FINDINGS: The ENP theory has not been widely used since its introduction in 2017, although it is even more relevant today after the revelation of profound societal inequities during the pandemic. The theory lacks testing and empirical indicators for utilization in nursing practice. CONCLUSION: ENP addresses the mandate from the American Association of Colleges of Nursing for nurse educators to foster the development of students as social justice leaders and competent caregivers across the life span. This theory provides a framework to apply in nursing education to improve the professional competency in social justice and disparities. However, further research is needed to develop tools to measure outcomes and generalizability. IMPLICATIONS FOR NURSING PRACTICE: ENP middle-range theory could support nursing educators and nursing programs to develop learning strategies and curricula to facilitate nursing students' knowledge and application in social justice advocates, allies, and leaders, thus improving individual, community, and global health outcomes.

When nursing education becomes political: Norm-critical perspectives in a campus-based clinical learning environment.

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus-based clinical learning environment for nursing education. By analyzing documents and interviews with the help of reflexive thematic analysis three themes were generated: "Intention to educate beyond nursing education," "Educating in alliance with society," and "The educative ambiguity of the Clinical Learning Centre." The case study indicates that the incorporation of norm criticism into a campus-based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus-based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics.

Tackling disrespect in health care: The relevance of socio-relational equality.

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a focus on respecting people's autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition.

Disparities in resource utilisation by families of children with cardiac conditions.

OBJECTIVES: There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds. METHODS: A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children's Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers' levels of education (fewer than 16 years vs. 16 years or more) and patients' medical insurance types (public vs. private) were compared with regard to the utilisation of resources. RESULTS: Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively). CONCLUSION: Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.

Believing That We Can Change Our World for the Better: A Triple-A (Agent-Action-Aim) Framework of Self-Efficacy Beliefs in the Context of Collective Social and Ecological Aims.

PUBLIC ABSTRACT: Many people do not act together against climate change or social inequalities because they feel they or their group cannot make a difference. Understanding how people come to feel that they can achieve something (a perception of self-efficacy) is therefore crucial for motivating people to act together for a better world. However, it is difficult to summarize already existing self-efficacy research because previous studies have used many different ways of naming and measuring it. In this article, we uncover the problems that this raises and propose the triple-A framework as a solution. This new framework shows which agents, actions, and aims are important for understanding self-efficacy. By offering specific recommendations for measuring self-efficacy, the triple-A framework creates a basis for mobilizing human agency in the context of climate change and social injustice.

Disrupting Racism in Ontario Midwifery.

INTRODUCTION: There are a limited number of Canadian studies that explore the experiences of racism among health care providers who are Black, Indigenous, or people of color (BIPOC), and specifically within the context of midwifery in Ontario. More information is needed to better understand how to achieve racial equity and justice at all levels of the midwifery profession. METHODS: Semistructured key informant interviews were conducted with racialized midwives in Ontario to understand how racism manifests in the midwifery profession and to conduct a needs assessment of interventions required. The researchers used thematic analysis to identify patterns and themes within the data and to develop a better understanding of participants' experiences and perspectives. RESULTS: Ten racialized midwives participated in key informant interviews. The vast majority of participants reported experiences of racism in their work as a midwife, including being subject to or witnessing racism from clients and colleagues, tokenism, and exclusionary hiring practices. More than half of participants also emphasized their commitment to providing culturally concordant care for BIPOC clients. Participants relayed that access to BIPOC-centered gatherings, workshops, peer reviews, conferences, support groups, and mentorship opportunities constitute important supports for improving diversity and equity in midwifery. They also expressed a need for midwives and midwifery organizations to actively work to disrupt racism and the power structures in midwifery that enable racial inequity to proliferate. DISCUSSION: The manifestations of racism in midwifery have negative impacts on the career trajectory, career satisfaction, interpersonal relationships, and well-being of BIPOC midwives. It is crucial to understand the role of racism in midwifery and make meaningful changes toward dismantling interpersonal and systemic racism in the profession. These progressive changes will serve to create a more diverse and equitable profession, where all midwives can belong and thrive.

Racing the Machine: Data Analytic Technologies and Institutional Inscription of Racialized Health Injustice.

Recent scientific and policy initiatives frame clinical settings as sites for intervening upon inequality. Electronic health records and data analytic technologies offer opportunity to record standard data on education, employment, social support, and race-ethnicity, and numerous audiences expect biomedicine to redress social determinants based on newly available data. However, little is known on how health practitioners and institutional actors view data standardization in relation to inequity. This article examines a public safety-net health system's expansion of race, ethnicity, and language data collection, drawing on 10 months of ethnographic fieldwork and 32 qualitative interviews with providers, clinic staff, data scientists, and administrators. Findings suggest that electronic data capture institutes a decontextualized racialization within biomedicine as health practitioners and data workers rely on biological, cultural, and social justifications for collecting racial data. This demonstrates a critical paradox of stratified biomedicalization: The same data-centered interventions expected to redress injustice may ultimately reinscribe it.

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia.

OBJECTIVES: Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. METHODS: Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. RESULTS: Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. CONCLUSIONS: Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.

TERFs aren't feminists: lesbians stand against trans exclusion.

In this article, I examine lesbians' solidarity with trans people in the United States. Trans exclusionary radical feminists (TERFs) are feminists who believe that there is a stark difference between the biological reality of sex and the socially constructed nature of gender. They argue that sex is essential and innate. This leads some feminists to the argument that trans people are trying to infiltrate sex exclusive spaces. While TERFs are not always lesbians, lesbians are assumed to make up a large proportion of TERFs. As Thomsen and Essig argue that current ideologies within the media are allowing for the slippage between the terms "lesbian," "feminist," and "TERFs." Some scholars are suggesting that equating lesbian identities with transphobia and trans exclusion is but a new form of lesbian marginalization. I utilize 49 in-depth, qualitative interviews with lesbians across the United States to interrogate the stereotype that lesbians are largely TERFs. Through the voices of lesbians across the United States, I illustrate how many lesbians despise TERF ideology and argue that lesbians must stand in solidarity with trans people in the fight for social justice.

Closing the equity deficit: Sustainability justice in municipal climate action planning in Waterloo region.

There is growing recognition that often well-intended climate action solutions perpetuate and exacerbate manifestations of colonialism and racism due to the lack of equity and justice considerations in designing and implementing these solutions. There is limited research exploring why the integration of these considerations are lacking in municipal climate action planning. This exploratory descriptive qualitative study explored how municipal actors perceive and understand equity and justice in municipal climate action planning as a step toward addressing this issue. Semistructured interviews were conducted with seven members of the core management group from ClimateAction Waterloo region, and a template analysis of the interview data resulted in six themes. Findings suggested that those involved in municipal climate action planning understand and perceive justice and equity considerations as important to their work, however, translating this understanding to practice is a challenge due to structural (governmental and societal) and capacity (limited time, funding, resources, and knowledge) barriers. By better understanding how key actors consider justice and equity, we identify shifting colonial mental models as a potential pathway for transformative change given the central role of these actors.