What Got Us Here Won't Get Us There: Critical History in Radical Black Re-imaginations of Canadian Nursing Histories.

As a "foursome" of nursing history students and scholars, upcoming, junior, and seasoned, we presented a panel on new work and possibilities related to histories of Blackness and Black nurses in Canadian nursing history. Our presentation was the 2023 keynote Hannah Panel Presentation for the joint Canadian Society for the History of Medicine (CSHM-SCHM) and the Canadian Association for the History of Nursing (CAHN-ACHN) conference. Reflecting and expanding our perspectives, we share the relevance and significance of engaging with histories of Canadian Blackness and (in)visibility of Blackness in nursing history. This paper considers the overarching question of how does engaging with histories of Canadian Blackness serve as an anti-racist strategy when examining, analyzing and understanding the history of nursing and health care? A core tenant of this work aims at acknowledging how institutional relationships of power are reproduced within scholarship unless there is space for radical re-imaginations. The disruption to power is achieved by exploring the connections between nursing and history from the perspective of Black nurses' history or Black feminist thought. We also disrupt power by our form, in challenging expectations of scientific inquiry as the only format of valid knowledge production within the discipline. Possibilities of arts-based methodology as a site for democratization in nursing knowledge are evoked through the metaphoric language (water, fire, air and earth) interwoven within the text. We highlight how each of us engages with nursing history, further complicating previous narratives of our collective Canadian past. In publishing our thoughts on historical inquiry in a nursing journal, we hope to provoke more curiosity and interest in history within our discipline as a site for liberation!

"They bring the topic [of social justice] but stop there": Nursing students' perceptions of teaching practices that develop awareness and engagement with social justice.

BACKGROUND: Pedagogical frameworks grounded in social justice, such as decolonizing and anti-racist educational practices, are essential in nursing programs. While scholars have begun to examine nurse educators' conceptualizations of social justice, there remains a lack of knowledge about student perspectives regarding nurse educators' approaches to incorporating social justice in education. OBJECTIVE: To understand nursing students' perceptions about educational strategies that develop critical awareness and engagement with social justice and positively influence professional practice. DESIGN: A qualitative study informed by Critical Feminist Pedagogy and guided by Interpretive Description methodology. SETTINGS: A school of nursing in Western Canada. PARTICIPANTS: Ten undergraduate and graduate nursing students recruited through convenience sampling. METHODS: Students participated in one-on-one semi-structured interviews. A set of questions developed to facilitate data analysis allowed the deconstruction of the data to identify broad-based inductive categories. Contrast and comparison methods were also used. Members of the research team provided analytic insights into the categories, and subsequently, all members discussed the findings and developed the interpretive frame. RESULTS: Student participants reported that educational strategies promoting awareness and engagement with social justice need to go beyond superficial engagement and awareness of social justice. Researchers' analysis suggests that cohesiveness between awareness and action in social justice is urgently needed within academia to adopt a decolonizing and anti-racist pedagogy in nursing and better prepare students for professional practice. From the data analysis, teaching strategies that enhance cohesiveness include: embracing personal development, creating community spaces and disrupting knowledge and curriculum hierarchies. CONCLUSIONS: Understanding students' perceptions and incorporating their suggestions is critical to integrating socially just teaching practices that embrace a learner-centred pedagogy. Our findings offer suggestions for teaching strategies that foster critical awareness and engagement with social justice. Combined, these contribute to our understanding of signature pedagogies in nursing with the intention of increasing the adoption of anti-racist and decolonizing approaches.

"We have dealt with so much. There's more coming?": Improving Knowledge About Brain Health in Adults Living With Congenital Heart Disease.

Background: Significant advances in managing congenital heart disease (CHD) have occurred over the past few decades, resulting in a fast-growing adult patient population with distinct needs requiring urgent attention. Research has recently highlighted the prevalence of neurocognitive differences among adults living with CHD. Yet, there is a lack of knowledge about the perspectives of people living with CHD and family members/caregivers on brain health. We sought to explore their perspectives to guide future research and clinical endeavours. Methods: Using the principles of integrated knowledge translation and qualitative interpretive description, we conducted 2 focus groups with 7 individuals with CHD and their family members as part of a virtual forum on brain health in CHD. Data analysis followed the principles of interpretive description. Results: A lack of understanding about overall brain health and neurocognitive differences in adult CHD was identified. To increase overall knowledge about brain health, initiatives should (1) focus on the individual living with CHD, involving family members and peers; (2) use social media and health care encounters for knowledge exchange; and (3) ensure a "balancing act" in the information provided to avoid feelings of worry and uncertainty about the future while simultaneously empowering people living with CHD. Conclusions: There is a pressing need for better education about brain health among individuals living with CHD. Our findings can guide clinicians in developing programmes of care and (re)design health services that address the brain-heart axis and neurocognitive differences in CHD.

Contexte: Des progrès significatifs ont été réalisés au cours des dernières décennies dans la prise en charge des cardiopathies congénitales, et il en résulte une croissance rapide de la population des patients adultes dont les besoins distincts requièrent une attention urgente. Des études récentes ont mis en évidence la prévalence des différences neurocognitives chez les adultes atteints de cardiopathies congénitales (CC). À ce jour, les connaissances sur les points de vue des personnes qui vivent avec la CC, des membres de leurs familles et de leurs aidants au sujet de la santé du cerveau sont insuffisantes. Notre objectif était d'explorer ces points de vue afin d'orienter les recherches à venir et les initiatives cliniques. Méthodologie: En nous basant sur les approches d'application des connaissances intégrées et de description interprétative (DI) qualitative, nous avons organisé deux groupes de discussion avec 7 personnes atteintes de CC et les membres de leur famille, dans le cadre d'un forum virtuel sur la santé du cerveau dans les CC. L'analyse des données a été réalisée selon les principes de la DI. Résultats: Un manque de connaissances au sujet de la santé du cerveau en général et des différences neurocognitives chez les personnes atteintes de CC a été observé. Afin d'améliorer le niveau des connaissances générales sur la santé du cerveau, les initiatives doivent : (1) être centrées sur les personnes qui vivent avec la CC, avec la participation des membres de leur famille et d'autres patients; (2) tirer profit des médias sociaux et des rencontres en contexte de soins de santé pour le partage de connaissances; et (3) veiller à maintenir un équilibre, puisqu'il convient d'outiller les personnes atteintes de CC sans toutefois causer de sentiment d'inquiétude ou d'incertitude quant à l'avenir. Conclusions: Nous avons constaté le besoin urgent d'améliorer les connaissances des personnes qui vivent avec une CC au sujet de la santé du cerveau. Les résultats obtenus pourront guider les cliniciens dans l'élaboration de programmes de soins et la conception (ou la refonte) de services de soins de santé qui intègrent l'axe cerveau-cœur et les différences neurocognitives associées aux CC.

Reflections on Black Nurses' Invisibility: Exploring the Contribution of Black Nurses to British Columbia (Canada), 1845-1910.

Black nurses are at the margins of the annals of history and there is a dearth of historical accounts of their work. Drawing on our historical research about Black nurses in British Columbia (Canada) between 1845 and 1910, we point to the complexity of Black women's lives and argue that Black nurses disrupted the conceptualization of Blackness and Black womanhood of the time. We demonstrate the vital contributions of Black nurses to the health of communities and add to existing scholarship that redefines the nursing narrative: one in which white nurses are not the start and end point of history.

Accelerating knowledge translation to improve cardiovascular outcomes and health services: opportunities for bridging science and clinical practice.

Knowledge translation (KT) is the exchange between knowledge producers and users to understand, synthesize, share, and apply evidence to accelerate the benefits of research to improve health and health systems. Knowledge translation practice (activities/strategies to move evidence into practice) and KT science (study of the methodology and approaches to promote the uptake of research) benefit from the use of conceptual thinking, the meaningful inclusion of patients, and the application of intersectionality. In spite of multiple barriers, there are opportunities to develop strong partnerships and evidence to drive an impactful research agenda and increase the uptake of cardiovascular research.

What nursing chooses not to know: Practices of epistemic silence/silencing.

Drawing from a keynote panel held at the hybrid 25th International Philosophy of Nursing Conference, this discussion paper examines the question of epistemic silence in nursing from five different perspectives. Contributors include US-based scholar Claire Valderama-Wallace, who meditated on ecosystems of settler colonial logics of nursing; American scholar Lucinda Canty discussed the epistemic silencing of nurses of colour; Canadian scholar Amelie Perron interrogated the use of disobedience and parrhesia in and for nursing; Canada-based scholar Ismalia De Sousa considered what nursing protects in its silences; and Australian scholar Janice Gullick spoke to trans invisibility in nursing.

Centering Black feminist thought in nursing praxis.

Femininity and whiteness dominate Western nursing, silencing ontologies and epistemologies that do not align with these dominant norms while perpetuating systemic racism and discrimination in nursing practice, education, research, nursing activism, and sociopolitical structures. We propose Black feminist thought as a praxis to decenter, deconstruct, and unseat these ideologies and systems of power. Drawing from the work of past and present Black feminist scholars, we examine the ontological and epistemological perspectives of Black feminist thought. These include (i) the uniqueness and particular experiences of people, (ii) the acceptance of ontological and epistemological pluralism of truths and ways of knowing, and (iii) the mandate for equity in the health, social, political, and environmental structures of society. By focusing our attention on lived experiences and voices of those systematically excluded in nursing practice, education, research, and society, Black feminist thought offers an anticolonial, antiracist, and antidiscriminatory foundation for more effectively upholding nursing's disciplinary mandate for social justice and equity.

Where is critical analysis of power and positionality in knowledge translation?

In Canada, the Eurocentric epistemological foundations of knowledge translation (KT) approaches and practices have been significantly influenced by the Canadian Institutes of Health Research (CIHR) KT definition. More recently, integrated knowledge translation (IKT) has emerged in part as epistemic resistance to Eurocentric discourse to critically analyse power relations between researcher and participants. Yet, despite the proliferation of IKT literature, issues of power in research relationships and strategies to equalize relationships remain largely unaddressed. In this paper, we analyse the gaps in current IKT theorizing against the backdrop of the CIHR KT definition by drawing on critical scholars, specifically those writing about standpoint theory and critical reflexivity, to advance IKT practice that worked to surface and change research-based power dynamics within the context of health research systems and policy.

"What Is the Right Decision for Me?" Integrating Patient Perspectives Through Shared Decision-Making for Valvular Heart Disease Therapy.

Innovations in the treatment of valvular heart disease have transformed treatment options for people with valvular heart disease. In this rapidly evolving environment, the integration of patients' perspectives is essential to close the potential gap between what can be done and what patients want. Shared decision-making (SDM) and the measurement of patient-reported outcomes (PROs) are two strategies that are in keeping with this aim and gaining significant momentum in clinical practice, research, and health policy. SDM is a process that involves an individualised, intentional, and bidirectional exchange among patients, family, and health care providers that integrates patients' preferences, values, and priorities to reach a high-quality consensus treatment decision. SDM is widely endorsed by international valvular heart disease guidelines and increasingly integrated in health policy. Patient decision aids are evidence-based tools that facilitate SDM. The measurement of PROs-an umbrella term that refers to the standardised reporting of symptoms, health status, and other domains of health-related quality of life-provides unique data that come directly from patients to inform clinical practice and augment the reporting of quality of care. Sensitive and validated instruments are available to capture generic, dimensional, and disease-specific PROs in patients with valvular heart disease. The integration of PROs in clinical care presents significant opportunities to help guide treatment decision and monitor health status. The integration of patients' perspectives promotes the shift to patient-centred care and optimal outcomes, and contributes to transforming the way we care for patients with valvular heart disease.

The Glasgow Coma Scale in adults: doing it right.

After 40 years, the Glasgow Coma Scale (GCS) is the resource of choice for assessing the level of consciousness in patients with neurological conditions. Clinicians' ability to monitor patients' conditions, identify deterioration and make clinical decisions depends on their ability to carry out GCS assessments, so it is vital that they understand it. This article explores how best to use the GCS in clinical practice and examines some of the factors that can affect the accuracy of assessments. The article also explains the difference between peripheral and central stimuli.