THIRD EYE SEEING: EXAMINING DECOLONIAL, INTERSECTIONAL PEDAGOGIES IN
CANADIAN NURSING AND MEDICAL (NURSMED) EDUCATION
by
TAQDIR BHANDAL
B.Sc. Hon, Dalhousie University, 2012
M.A., York University, 2014
A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
in
THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES
(Gender, Race, Sexuality, and Social Justice)
THE UNIVERSITY OF BRITISH COLUMBIA
(Vancouver)
February 2022
© Taqdir Bhandal, 2022
The following individuals certify that they have read, and recommend to the Faculty of Graduate
and Postdoctoral Studies for acceptance, the dissertation entitled:
Third Eye Seeing: Examining Decolonial, Intersectional Pedagogies in Canadian Nursing
and Medical (NursMed) Education
submitted by
Taqdir Bhandal
in partial fulfillment of the requirements for
the degree of
Doctor of Philosophy
in
Gender, Race, Sexuality, and Social Justice
Examining Committee:
Dr. Annette J. Browne, Nursing, UBC
Supervisor
Dr. Cash Ahenakew, Educational Studies, UBC
Supervisory Committee Member
Dr. Sheryl Reimer-Kirkham, Nursing, TWU
Supervisory Committee Member
Dr. Minelle Mahtani, Gender, Race, Sexuality, and Social Justice, UBC
University Examiner
Dr. Patricia Spittal, Population and Public Health, UBC
University Examiner
ii
Abstract
The Third Eye Seeing project investigates how Decolonial, Intersectional Pedagogies can
inform Canadian Nursing and Medical (NursMed) Education. The intention of the project is to
contribute to the development of Canadian NursMed Education and efforts to redress deepening,
intersecting health and social inequities. Briefly, Decolonial, Intersectional Pedagogies are
philosophies of learning that encourage teachers and students to reflect on health through the
lenses of settler-colonialism, health equity, and social justice.
Drawing on Decolonial, Intersectional Pedagogies, Canadian NursMed Education could
ostensibly prepare learners to address the symptoms of modernity, especially settler-colonialism.
Diverse academic perspectives have led me to the following research questions: (A) What are the
ways in which Decolonial, Intersectional Pedagogies can inform Canadian NursMed Education?
(B) What are the potential struggles and adaptations required to integrate Decolonial,
Intersectional Pedagogies within Canadian NursMed Education?
Drawing on critical ethnographic research methods, I conducted in-depth interviews with
faculty members and engaged in participant observation of classrooms in university-based
Canadian NursMed Education. The dissertation as a whole, and the analysis was informed by
theoretical perspectives including decolonization, intersectionality, and critical theory.
Interpretive description guided the analysis of the themes reflected in the data.
The research findings are organized into three chapters, beginning with a presentation of
four common ‘institutional features’ influencing the uptake of pedagogical approaches: crowded
curriculum, academic freedom, the recent Truth and Reconciliation Commission Calls to Action,
and admissions processes. The next set of findings addresses the complex strategies participants
iii
applied to integrate Decolonial, Intersectional Pedagogies in their teaching approaches. Lastly,
the findings illustrate the emotional and spiritual toll some faculty members face when
attempting to deliver Decolonial, Intersectional Pedagogies.
Based on an analysis, I discuss the concept of Third Eye Seeing as a heuristic (in
solidarity with Two-Eyed Seeing) to apply in creating adaptive pedagogies for Canadian
NursMed Education. Through the application of multiple worldsenses teachers and students can
support movements towards health equity, social justice, and unlearning/undoing settlercolonialism. With this context in mind, this dissertation project intended to generate new
knowledge to stimulate dialogue and action regarding the role of Canadian NursMed Education
as an upstream determinant of health.
iv
Lay Summary
From 2015 – 2021, I led a research project to study social justice perspectives in
Canadian nursing and medical education (Canadian NursMed Education). Specifically, I
focused on two areas of theory and practice from social justice studies: decolonization and
intersectionality. Then I got curious about how current nursing and medical teachers (faculty
members) talk about and use these theories and practices in their classrooms. After reading
research studies and reports written prior to 2018, I interviewed and observed a total of 25
faculty members in nursing and medicine across the country in 2019. In 2020-2021 during the
surge of social justice movements, I put together a written report of the participants’ stories and
experiences. As Canadian NursMed Education continues to adapt in the COVID-19 pandemic, I
suggest it is an opportune time for teachers to evolve their teaching approaches using Decolonial,
Intersectional Pedagogies.
v
Preface
The research questions and purpose for the project are based on my previous research
programs, work experience, current interests, and suggestions from the supervisory committee.
Through the incredible mentorship and guidance of my supervisor, Dr. Annette Browne, the
scope of the study was clearly defined. I conducted all interviews and classroom observations.
Analysis of the stories and data took place in correspondence with Dr. Browne and committee
members Dr. Cash Ahenakew and Dr. Sheryl Reimer-Kirkham. The research writing and data
collection was done by me, the student, Taqdir Kaur Bhandal. The Behavioural Research Ethics
Board (BREB) at the University of British Columbia (UBC) approved the research design and
implementation reported in Chapter Four. The BREB certificate number was: H17-02627.
Publications from the project:
Bhandal, T. (2016). Possibilities for intersectional theorizing in Canadian historiography: The
subaltern narrative of Canadian medical schools. The Graduate History Review, 5(1), 46-82.
Bhandal, T. (2018). Ethical globalization? Decolonizing theoretical perspectives for
internationalization in Canadian medical education. Canadian Medical Education Journal, 9(2),
e33-e45.
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Table of Contents
Abstract......................................................................................................................................... iii
Lay Summary .................................................................................................................................v
Preface ........................................................................................................................................... vi
Table of Contents ........................................................................................................................ vii
List of Tables ............................................................................................................................... xii
Acknowledgements .................................................................................................................... xiii
Dedication .....................................................................................................................................xv
Chapter 1: Introduction ................................................................................................................1
1.1
The Central Problem ....................................................................................................... 4
1.2
Research Purpose and Questions .................................................................................... 5
1.2.1 Overarching Research Questions ................................................................................ 6
1.2.2 Sub-Research Questions ............................................................................................. 6
1.3
Organization of Thesis .................................................................................................... 7
Chapter 2: Synthesis of Literature ...............................................................................................8
2.1
Context: Deepening Health and Social Inequities in Canada ......................................... 8
2.1.1 Current Evidence on Health and Social Inequities ..................................................... 8
2.1.2 Health Equity and Settler-Colonialism in the Borders of Canada ............................ 11
2.1.3 Root Causes: Intersecting Modern Processes ........................................................... 11
2.1.4 Defining Settler-Colonialism .................................................................................... 14
2.1.5 Preparing the Next Generation of Nurses and Doctors to Heal Root Causes ........... 15
2.1.6 Pedagogies for New Paradigms of Canadian NursMed Education .......................... 18
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2.1.7 Social Determinants of Health: A Primary Pedagogical Lens .................................. 18
2.2
Culture, Culture Everywhere: The Gravitational Pull of Culturalism .......................... 20
2.2.1 Cultural Diversity...................................................................................................... 22
2.2.2 Cultural Competency & Sensitivity .......................................................................... 23
2.2.3 Cultural Safety .......................................................................................................... 24
2.3
Critical Pedagogies in Canadian Educational Studies .................................................. 27
2.4
Calls to Action Towards Decolonial, Intersectional Pedagogies .................................. 29
2.4.1 Equity, Diversity, and Inclusion and Anti-Racism ................................................... 30
2.4.2 Composition of Faculty in Canadian NursMed Education ....................................... 32
2.4.3 Truth and Reconciliation Commission ..................................................................... 36
2.5
Summary ....................................................................................................................... 38
Chapter 3: Theoretical Perspectives ..........................................................................................40
3.1
Positionality of the Researcher ..................................................................................... 40
3.2
Critical Theory .............................................................................................................. 44
3.3
Decolonization .............................................................................................................. 46
3.3.1 Decolonizing Education ............................................................................................ 46
3.3.2 Learning from Two-Eyed Seeing as Mi'kmaw Pedagogy ........................................ 48
3.3.3 Significance of the Third Eye in South Asian Epistemologies ................................. 49
3.3.4 Synergistic Pedagogies ............................................................................................. 50
3.3.5 Seeing through Multiple Perspectives (including Biomedicine) .............................. 50
3.4
Intersectionality............................................................................................................. 52
3.5
Summary ....................................................................................................................... 53
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Chapter 4: Methodology and Research Design .........................................................................55
4.1
Methodological Approaches ......................................................................................... 55
4.1.1 Critical Ethnographic Methods ................................................................................. 55
4.1.2 Studying Up .............................................................................................................. 60
4.2
Research Setting............................................................................................................ 61
4.3
Recruitment and Sampling ............................................................................................ 61
4.4
Ethical Considerations .................................................................................................. 62
4.5
Overview of Participants............................................................................................... 64
4.5.1 Number of Participants ............................................................................................. 67
4.5.2 Geography of Participants......................................................................................... 67
4.5.3 Ancestral Lineages and Religions of Participants .................................................... 67
4.5.4 Number of Years Teaching in Canadian NursMed Education ................................. 68
4.5.5 Genders of Participants ............................................................................................. 68
4.6
Data Collection ............................................................................................................. 69
4.6.1 Interview Process ...................................................................................................... 69
4.6.2 Observation Process .................................................................................................. 71
4.7
Data Analysis ................................................................................................................ 72
4.8
Rigour and Scientific Integrity...................................................................................... 75
4.8.1 Credibility of the Analysis ........................................................................................ 75
4.8.2 Limitations of the Research ...................................................................................... 78
4.9
Summary ....................................................................................................................... 79
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Chapter 5: "The Real Challenge is the System": Institutional Features ...............................80
5.1
Accreditation and Crowded Curriculum ....................................................................... 82
5.2
Academic Freedom in Canadian NursMed Education.................................................. 90
5.3
Having an Intervention: Responses to TRC Calls to Action ........................................ 96
5.4
Who Gets to Be a Nurse or Doctor? Admissions Processes ....................................... 103
5.5
Summary ..................................................................................................................... 113
Chapter 6: "We Need to Take Responsibility for Our Own Education": The Complexities
of Integrating Decolonial, Intersectional Pedagogies .............................................................115
6.1
Struggling with 'Culture': Circumventing Culturalism as a Pedagogy ....................... 115
6.2
EDI, Anti-Racism, and TRC Shape Teacher's Efforts ................................................ 126
6.2.1 Perspectives on Calls to Action: EDI and Anti-Racism ......................................... 127
6.2.2 Perspectives on Calls to Action: TRC .................................................................... 130
6.3
Attempts to Integrate Decolonial, Intersectional Pedagogies in Practice ................... 136
6.4
Summary ..................................................................................................................... 145
Chapter 7: "I Don't Feel Safe: The Emotional and Spiritual Costs of Implementing
Decolonial, Intersectional Pedagogies ......................................................................................146
7.1
The Limitations of Distracting Technologies ............................................................. 147
7.2
Resistance and Support from Colleagues ................................................................... 150
7.3
"It's a Difficult Place for Safe Conversations": Student Responses ........................... 161
7.4
Detecting, Interpreting, and Preparing for the Emotional and Spiritual Costs ........... 169
7.5
Summary ..................................................................................................................... 176
x
Chapter 8: Discussion & Implications: Opening up the Third Eye ......................................177
8.1
Third Eye Seeing as a heuristic in Canadian NursMed Education ............................. 180
8.2
Third Eye Seeing and the Institutional Features ......................................................... 182
8.2.1 Examining the Implications of Institutional Features ............................................. 182
8.2.2 Crowded Curriculum & Constant Consumption..................................................... 183
8.2.3 Academic Freedom and Admissions ...................................................................... 184
8.2.4 Punctuated Equilibrium and TRC Calls to Action.................................................. 186
8.2.5 Recommendations based on Chapter 5 Findings .................................................... 187
8.3
Third Eye Seeing and the Complexities of Evolving Pedagogies .............................. 189
8.3.1 Pathologization and Culturalism ............................................................................. 190
8.3.2 Pluralism and Collective Awareness ...................................................................... 191
8.3.3 Braiding Multiple Worldsenses .............................................................................. 192
8.3.4 Recommendations based on Chapter 6 Findings .................................................... 194
8.4
(Ad)dressing and Healing the Soul Wound in Canadian NursMed Education ........... 195
8.4.1 Examining Resistances and Supports ..................................................................... 196
8.4.2 Conscious Use of Digital Technologies .................................................................. 196
8.4.3 The Soul Pain of Settler-Colonialism and Student Reactions ................................ 198
8.4.4 Linking Roots with Colleagues............................................................................... 200
8.4.5 Recommendations based on Chapter 7 Findings .................................................... 201
8.5
Summary ..................................................................................................................... 203
Bibliography ...............................................................................................................................204
Appendix: Interview Guide.......................................................................................................251
xi
List of Tables
Table 1. Interview Participants ..................................................................................................... 80
Table 2. Observation Participants ................................................................................................. 81
xii
Acknowledgements
Land: Without the guidance and wisdom of the Land that I live with and on during the
course of this dissertation, the project would never have happened. I’m eternally thankful to the
planet and her medicines for carrying me through.
I am so grateful to have worked with Dr. Annette Browne as my supervisor throughout
the Third Eye Seeing project. Annette is an amazing role model for research done thoroughly,
with intention, grit, and perseverance. Every time a fellow student shared their struggles about
supervisors with me, I quietly thought– thank you Universe for sending me such an incredible
mentor. Annette is the main midwife of Third Eye Seeing and without her this manuscript could
not have been birthed. Annette – I’ll be dancing with you until the end!
I had the honour of having two incredible teachers and mentors as part of my supervisory
committee: Dr. Cash Ahenakew and Dr. Sheryl Reimer-Kirkham. Cash and Sheryl acted as
scholarly and spiritual guides during Third Eye Seeing and celebrated each milestone in the
journey. Sheryl and Cash – I’m in solidarity with you and your whole tribe as we continue to
cycle into this new paradigm of life!
Thank you to all of my ancestors, living and deceased who have gotten me to this place in
time.
xiii
The Third Eye Seeing project was financially and energetically supported by the
University of British Columbia Four Year Fellowship and The Canadian Institutes of Health
Research Doctoral Award.
The friendships and solidarities built during each phase of Third Eye Seeing were the
exact right connections to support me through. A huge thank you goes to the following
collectives and individuals: Thank you to all staff, faculty, and students at UBC’s Social Justice
Institute – unicorns unite! Thank you to all staff, faculty, and students in the nursing and
medical schools I visited and worked with – you all are so vital to the health of our communities
and the health of this project. So grateful for all of the speakers at the Next Level Summit 2021.
Thank you to my friends, Hilary, Rachael, Megan, Leanna, Hera, Guida, Alysha, Midori, and
Emily who have cheered me on, talked me out of quitting numerous times, and sat in ceremony
with me. Immense gratitude to Lisa Nichols for being a shining star to follow in the
collapse/composting of modernity. And finally, to the Thursday Morning Writing Group
(Shawna, Angela, Robin, Urooba, Roah and more!) who found me when I needed them most and
held me accountable to completing the manuscript and defense.
To my family members, Jeff, Noor, Bhera, Mom, Dad and all the Bethunes! WE DID
IT!!!!! Thank you all for the lessons you’ve taught me, all the laughs, all the cries, the marinated
chicken, Sunday dinners, and the paranthas that keep me nourished. Hopper, Berry, Lewis,
Moofli, Wallace, and Hank – you all keep us going day in and day out.
xiv
Dedication
I dedicate this project to the Earth.
xv
Chapter 1: Introduction
In Canada and across the globe, human health is being re-imagined, researched and
even declared as ‘in crisis’. Even prior to the COVID-19 pandemic, many scholars,
practitioners, and activists alike describe how the delivery of health care, modalities of
healing, and the practice of teaching in Canadian Nursing and Medicine (NursMed)
Education were reaching a critical juncture in the 21st century.
Notably, distinguished scholars, large-scale statistical censuses, and documentarians
have been reporting a widening gap in health and social equity across the globe and
nationally (Baru & Mohan, 2018; Hankivsky et al., 2017; Prasad & Sengupta, 2019; Ruckert
& Labonté, 2017; Walker et al., 2017). For instance, drug overdoses, especially of opioids,
have reached record highs in Canada (Fisher et al., 2019). Canadian income-related health
inequities are also a concern, especially in the context of the COVID-19 pandemic (Canadian
Institute for Health Information, 2016; Huffington Post Canada, 2021). There also continues
to be increases in the policing and imprisonment of communities racialized as Indigenous
Peoples and/or people of colour (Cole, 2020; Kaka, 2020; Maynard, 2017). Researchers in
the fields of critical educational studies, NursMed Education, and social justice suggest that
these statistics are symptoms of modern intersecting processes including settler-colonialism
(McGibbon et al., 2014; ScholarStrikeCanada, 2020; Terruhn, 2019).
The scholarly reporting of health and social inequities can serve to promote
wellbeing, compassion, and adaptations in these conditions, in service of a socially just and
sustainable humanity. As demonstrated during the spring, summer, and ongoing seasons of
1
the global pandemic, the health care labour force in Canada and beyond is critical to ensure
these adaptations.
The namesake of the project, ‘third eye’ is in strong solidarity with the lineage of
‘Two-Eyed Seeing’ conceptualized by Mi’kmaq Elders Murdena and Albert Marshall based
in what is also known as Halifax, Nova Scotia, Canada (Martin, 2012). Quoted in Martin
(2012), they share,
“Two-Eyed Seeing adamantly, respectfully, and passionately asks that we bring
together our different ways of knowing to motivate people, Aboriginal and nonAboriginal alike, to use all our understandings so that we can leave the world a better
place and not compromise the opportunities for our youth (in the sense of Seven
Generations) through our own inaction” (p. 21).
Building on the motivational vision of the quote above, Third Eye Seeing energetical
and empirically also aligns with the concept of “braiding” put forth by the Decolonial Futures
Collective which is,
“… a practice yet-to-come located in a space in-between and at the edges of
Indigenous and non-Indigenous ways of knowing and being, aiming to calibrate each
sensibility towards a generative orientation and inter-weave their strands to create
something new and contextually relevant, while not erasing differences, historical and
systemic violences, uncertainty, conflict, paradoxes and contradictions” (Elwood et
al., 2019. p. 21).
2
In South Asian philosophies, the third eye is considered one of seven energy centers
or chakras of the human body as passed down orally and in scriptures of South Asian
philosophies including Buddhism, Sikhism, Yoga, Ayurveda. I can note here that these
philosophies go beyond borders, and are influenced by thousands of years of migrations that
have taken place on the South Asian subcontinent. For instance, Ayurveda is a fusion of
Northern Indian modalities, with Indigenous Dravidian perspectives, which themselves are
connected to East African healing methodologies (LaFleur-Gangji, 2020).
The third eye is predictably located in between the two physical eyes at the top of the
nose bridge – creating three eyes through which one can see. Brahma Kumaris1 say this
about the third eye,
“The memorial of the soul is found in the…‘third eye', located in the centre of the
forehead. Although invisible to the eye, a moment's meditation can re-open an
awareness of this inner energy. This soul energy keeps us going - keeps us going for
centuries.” (2020)
This dissertation project is written during an important turning point of health,
humanity, and Canadian NursMed Education (2015 – 2021). The concept of the third eye
provides another necessary reminder we can continue to evolve pedagogies to heal and care
for colleagues, patients, clients, and our fellow humans and more-than-humans despite the
daily challenges of modernity2. Moreover, Third Eye Seeing builds solidarities with Two-
1
Brahma Kumaris is a feminist centered Vedas inspired educational organization.
Modernity is a large-scale human created process understood to have started in approximately 1492
according to the Gregorian calendar of linear time. It can be further broken down into its most well-known
2
3
Eyed Seeing, Decolonization, and Intersectionality in service of dismantling settlercolonialism through multiple ways.
1.1 The Central Problem
Through Third Eye Seeing I intend to create and share scholarly knowledge about
Canadian NursMed Education as an upstream determinant of human health. While the
intersections of income level, gender, sexuality, sex, ability and more have robust research
programs in the realm of interdisciplinary health professions (Brosnan et al., 2016; Nisker,
2019; Sheppard et al., 2017; Siller et al., 2018; Wilsey et al., 2020), racialized identity,
religion, spirituality, and ancestry in relation to health, health care, and pedagogy are reemerging as important areas of inquiry in 21st century Canadian NursMed Education.
Namely, in this dissertation I examine pedagogy, or philosophies of teaching, in the
research milieu which aim to redress the symptoms of modernity, especially settlercolonialism. The project unpacks the central problem of Canadian NursMed Education’s
implications in and response to the widening gap in health and social inequities. The
outcomes of the research include a timely report on the state of Decolonial, Intersectional
Pedagogies. Moreover, the dissertation builds on ongoing discussions about the process and
impact of engaging pedagogies that attend to calls for anti-racism, social justice,
decolonization, and intersectional diversity in Canadian NursMed Education.
components: colonialism, capitalism, heteropatriarchy, and environmental extraction from the Earth (Lugones,
2010; Mignolo, 2011; Chakravorty Spivak, 1999).
4
1.2 Research Purpose and Questions
The Third Eye Seeing dissertation project investigated how Decolonial, Intersectional
Pedagogies can inform Canadian Nursing and Medical (NursMed) Education. The purpose of
this study was to contribute to dialogue regarding the ongoing development of Canadian
NursMed Education. Briefly, Decolonial, Intersectional Pedagogies are philosophies of
learning that encourage teachers and students to reflect on health through the lenses of
settler-colonialism, health equity, and social justice. The goals of Decolonial, Intersectional
Pedagogies are to prepare teachers and students to understand and address the root causes of
health and social inequities. The intention is to influence Canadian NursMed Education as
an upstream determinant of health.
Implementing Decolonial, Intersectional Pedagogies can serve as a radical action step
towards addressing practice recommendations from recently published strategic frameworks
intended to institutions of higher education written by organizations such as the Truth and
Reconciliation Commission (2015), Canadian Association of Schools of Nursing (2015;
2020), the Association of Faculties of Medicine of Canada (2015; 2020), Canadian Institutes
of Health Research (2019), Public Health Agency of Canada (2018), and Universities Canada
(2017).
The published frameworks are largely influenced by social justice movements with
particular attention to colonialism, such as Black Lives Matter (Taylor, 2017; Potvin, 2020),
Idle No More (Kino-nda-niimi Collective, 2014), and No One is Illegal (Abji, 2013), that
have gained momentum over the last several years. The field work for Third Eye Seeing was
conducted prior to 2020, on the cusp of the COVID-19 pandemic and global paradigm shift.
5
Multiple academic perspectives from the social and health sciences, educational
studies, and critical theoretical perspectives have led me to focus on the following
overarching research questions:
1.2.1 Overarching Research Questions
Part A: What are the ways in which Decolonial, Intersectional Pedagogies can inform
Canadian NursMed Education with a focus on critically examining settler-colonialism, health
equity, and social justice?
Part B: What are the potential struggles and adaptations required to integrate Decolonial,
Intersectional Pedagogies within Canadian NursMed Education in service of redressing
intersecting health and social inequities?
1.2.2. Sub-Research questions
To frame Third Eye Seeing inquiry in service of receiving participants’ stories, the
project also includes 3 sub-research questions:
1. How do participants understand the potential significance of Decolonial, Intersectional
Pedagogies for informing and evolving Canadian NursMed Education?
6
2. How do participants describe the intended outcomes of current pedagogies for the practice
of teaching, for student learning, for shifting knowledges, and for opening space to critically
examine settler-colonialism, health equity, and social justice?
3. What is the feasibility of adapting Decolonial, Intersectional Pedagogies into the long-term
context of Canadian NursMed Education? What are some of the projected struggles?
1.3 Organization of Dissertation
Chapter 1 is an introduction to the project and the research questions. Chapter 2
synthesizes key scholarly literature framing the context of the research questions. Chapter 3
details the theoretical perspectives that inform the Third Eye Seeing project. Chapter 4
details the methodology, research design based on critical ethnographic methods, and the
analysis that took place during the study.
Moving into the findings and discussion, Chapter 5 is a synopsis of the modern
institutional features of Canadian NursMed Education as described by the research
participants, that frame the context in which teachers may implement Decolonial,
Intersectional Pedagogies. Chapter 6 outlines the complexities of applying Decolonial,
Intersectional Pedagogies in everyday classroom settings. Chapter 7 examines the emotional
and spiritual toll of making an effort to braid Decolonial, Intersectional Pedagogies into
Canadian NursMed Education. Chapter 8 is a discussion of the main findings, in the context
of the synthesis of literature and theoretical perspectives. The chapter also concludes the
main text of the dissertation and provides some suggested recommendations from Third Eye
Seeing project findings.
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Chapter 2: Synthesis of Literature
2.1 Context: Deepening Health and Social Inequities in Canada
In the first section of this chapter, I review the implications of deepening health and
social inequities for Canadian NursMed Education and the primary lens through which they
are examined: social determinants of health. In the second section, I describe several
lineages of pedagogies also typically employed to examine health equity: cultural diversity,
cultural competency, and cultural safety. Scholars in the fields of education have been
exploring the critical concepts informing the Third Eye Seeing research purpose and
questions such as settler-colonialism and social justice. In the third section, I examine
relevant themes from Canadian educational studies. In the fourth and final section, I briefly
explore two significant genres of national policies that impact Canadian NursMed Education:
Equity, Diversity, and Inclusion and the Truth and Reconciliation (TRC) Calls to Action.
2.1.1 Current Evidence on Health and Social Inequities
In Canada and elsewhere, many communities are experiencing increasing and
inequitable risks to their mental, physical, emotional, and spiritual health. The empirical
evidence for deepening health and social inequities range from population-based health
indicators to personal narratives. Health indicators intersect across income level, racialized
identity, ancestry, gender, sex, sexuality, religion, citizenship, ability, age, and more. Three
notable examples emerge from recent literature with a focus on Canada. First, on a relative
8
scale, income related inequities are increasing in Canada, which impacts people’s access to
health services, medicines, recovery programs, therapy, and health care in general (CIHI,
2016). Second, people who identify as women, girls, femmes, and non-binary continue to
inequitably experience gender-based violence, which has been exacerbated by the COVID-19
pandemic restrictions (Cotter & Savage, 2019). Third, in the present moment, the health
consequences of racialization are becoming more and more pronounced in the modern world
(Anderson, 2006; Garner & Selod; Henry et al., 2017; Hilario et al., 2017; Igenoza, 2017;
McGibbon & Etowa, 2009; Syed, 2020; Toronto Public Health, 2013).
In this dissertation, racialization3 is lens to be included into the dialogue regarding the
ongoing development of Canadian NursMed Education. Racialization refers to social
processes, institutional cultures, and experiences based on constructed divisions between
different groups of people according to skin colour, geography, language, religion, and/or
ancestral lineage (Das Gupta et al., 2007). It can be noted that racialization is similar to, but
not the same as the social construction of race and racism. In this dissertation, the concept of
race is understood as a largely social construct that governs and is governed by the
particularities of time, space, place, and historical context (Hankivsky, 2011, p. 13). In
3
Scholars like Anne Fausto-Sterling (2008) have debunked static links between cellular make-up and racebased patterns of health and disease. Using the case of two illnesses of the bones, osteoporosis and rickets,
Fausto-Sterling demonstrates that the use of race as a static category to measure bone health and
development “does scientific damage” (p. 683). Instead, she points to the need to study links between genetic
regulation across the human life-cycle and the social, economic, political, and cultural factors that shape
nature and our nurturing environments. Indeed, while in general people of different ancestral lineages vary
on the spectrum of physical characteristics including melanin levels in skin, below the surface, contemporary
advances in genomic science demonstrate that there are no significant biological differences between groups
of humans based on the modern ethnic categories under which we have organized. In this way, “human
biology has wrongfully been ‘racialized’” (Krieger, 2000, p. 212). As such, race and racialization are closely
linked, though different. Racialization is "the process by which societies construct races as real, different and
unequal in ways that matter to economic, political and social life" (Ontario Human Rights Commission, 2015).
9
Canada and beyond, 2020+ marked the daily use of race as an identity (e.g. Black, White,
Brown, Red, Yellow) and the politicized application of these terms by media, activists, and
researchers in Canada (e.g. Black Lives Matter, Whiteness, Brown Girl Magazine, Red
(Indigenous) Power and Idle No More, Yellow Peril for Black Lives). Building on these
social categorizations, racism is an interpersonal and institutionalized process in which
people and communities face discrimination, oppression and differences in power based on
their perceived race. From 2010-2021, there has been a resurgence of many social justice
movements that invoke and challenge race-based inequities and racism.
A review of literature on these movements reveals that communities racialized as
Black, Brown, and/or Indigenous Peoples experience inequitable experiences of policeinitiated violence, representation in prisons, and forced displacement from land in the borders
of Canada and beyond. These experiences impact their/our health and wellbeing, and
influence treatment in the health care system (Kino-nda-niimi Collective, 2014; Maynard,
2017; McGibbon et al., 2014; Potvin, 2020; Reynolds & Robson, 2016; Waldron, 2018;
Winnipeg Sun, 2013).
According to leading scientists, health and social inequities are products of unjust,
avoidable barriers to many necessities of life4. Deepening health and social inequities cut
across the ‘intersections’ of racialized identity, ancestry, socio-economic status, ability, sex,
gender, citizenship, religion, and sexuality (Ahenakew, 2011; Akbar & Panichelli, 2019;
Barker, 2017; Browne, 2017; Crenshaw, 2020; Hill Collins, 2019; Kellett & Fitton, 2017;
McGibbon, 2021; Muntinga et al., 2016; Reimer-Kirkham, 2019, Sen & Iyer, 2019). Recent
4
The necessities of life include access to health/healing care, clean water, nutritious source of food,
affordable housing, spiritual practices, and a strong sense of self-worth and community.
10
reports suggest there has been minimal progress made in the last decade towards reducing the
health and social equity gap in Canada (Block, Galabuzi, and Tranjan, 2019; Canadian
Institute of Health Information, 2016). Events of 2020 and the emerging paradigm of the 21st
century provide new hope for shifting narratives of health and social inequity in Canada
towards peace, prosperity, sustainability, and collective wellbeing.
2.1.2 Health Equity and Settler-Colonialism in the Borders of Canada
To move forward the health equity agenda in Canada, the Third Eye Seeing project
review of literature begins by acknowledging the 500 year-long history of settler-colonialism
on the land currently called Canada (Batacharya & Wong, 2018; Kino-nda-niimi Collective,
2014; Million, 2013; Reyonlds & Robson, 2016; Thobani, 2007). Until approximately 1492
ACE, what’s now hegemonically known as North America was habited en masse by diverse
groups of Indigenous Peoples. Indigenous Peoples continue to live and attempt to thrive in
the borders of Canada (Battiste, 2016; Martin, 2012; Sheridan & Longboat, 2006; Srikanth,
2010; Young Leon, 2017). My colleagues, mentors, and peers have taught me that many
Indigenous Peoples maintain a caretaking relationship with land (rather than through the lens
of property and ownership), paired with many specialized ways of surviving in and tending
to different environments (Ahenakew, 2019; Battiste, 2016; Dechinta, 2015). Commenting
on this relationship, Coulthard (2014) encourages a shift in focus, “from an emphasis on the
capital relation to the colonial relation” (p. 10, emphasis original).
An examination of colonial relations reveals the physical, mental, emotional, and
spiritual wounds of settler-colonialism in Canadian NursMed Education and beyond
11
(Ahenakew, 2019; Duran & Duran, 1995; Goodman & Kazimi, 2016; Mayuzumi, 2006;
Nielsen, 2016). According to my analysis, research and practice suggests settlers from
around the world have systematically marginalized and attempted to erase Indigenous
Peoples’ epistemologies and ways of living on the basis of ‘racism’. This colonial movement
has been recorded across ethnic and religious minorities around the world, and continues on
today. In present day, communities designated as Indigenous Peoples, settlers, and
arrivants5, are grappling with the symptoms and root causes of settler-colonialism in Canada
and beyond.
2.1.3 Root Causes: Intersecting Modern Processes
The literature reviewed for Third Eye Seeing suggests health and social inequities are
the outcome of macroscopic structures such as settler-colonialism described above. As stated
previously, at any given time in the modern period (~1492-2021+) a person’s and
community’s birth, health, and death are in large part determined by their ancestry, racialized
identity, income level, gender, sex, sexuality, citizenship, religion, spirituality, ability, age,
and more. These ‘intersecting’ relations commonly listed above allow for nuance in the
description of human experience. These intersecting relations are sometimes addressed in
Canadian NursMed Education under the framework of the ‘social determinants of health’,
5
The term arrivant has a distinct literary genealogy. Vimalassery et al. (2016) describe, “In Transit of Empire,
Jodi Byrd uses the term “arrivant” in order to “signify those people forced into the Americas through the
violence of … colonialism and imperialism around the globe…”41 Arrivant, which invokes the title of a collection
of poems by Kamau Brathwaite, provides another way to conceptualize the landscape of colonialism and
Indigenous presence, overlaid in complicated ways with the practice of diaspora” (p. 2).
12
which are further explored in the coming pages (Hunter & Thompson, 2019; Raphael, 2016).
The social determinants of health framework tends to use the language of income,
employment and working conditions, education, childhood experiences, physical
environment, social supports, healthy behaviours, access to health services, biology and
genetic endowment, gender, culture, and race/racism, to describe the factors that determine
individual and population health (Government of Canada, 2020).
From a critical perspective, scholars of social justice describe colonialism (Dhamoon,
2015), neoliberal capitalism (Baru & Mohan, 2018), heteropatriarchy (Arvin, Tuck, Morrill,
2013; Barker, 2017; Combahee River Collective, 1977), border-imperialism (Gahman &
Hjalmarson, 2019; Walia, 2013), and environmental extraction (Klein, 2015; McAdam
Saysewahum, 2016; Waldron, 2018) as interwoven modern, macroscopic structures of
humanity. Their writings suggest that these social structures manifest as everyday health and
social inequities across the diversity of intersecting relations. Moreover, research and
activism demonstrates how each one of the social structures inflect one another.
Yet, due to many factors, the review of literature shows that a critical examination of
settler-colonialism has been an understudied and under taught area in Canadian NursMed
Education, particularly in relation to root cause of health and social inequities. To give one
notable example, Jumah et al. (2013) conducted a survey of residents and program directors
on Canadian obstetrics and gynecology departments which, “clearly showed that residents
had a wealth of knowledge about disease-specific issues” (CIHR, 2021). When commenting
on the study findings, Jumah shares, “but they didn't know why Indigenous women had
worse health outcomes, and that's critical because that's where the social determinants of
health factor in” (CIHR, 2021). In the Third Eye Seeing project, I aim to highlight the
13
integration of Decolonial, Intersectional Pedagogies in Canadian NursMed Education as one
significant way to raise consciousness of settler-colonialism. This project is undertaken in
service of redressing the root causes of health and social inequities.
2.1.4 Defining Settler-Colonialism
According to a canonical text of decolonization theory, settler-colonialism is the
process by which a group of people settle in an area; create surface level treaties about
sharing space, boundaries, and the Earth’s bounty; and, then go on to do the opposite by
systematically attempting to erase Indigenous Peoples’ relationship with land and life (Tuck
& Yang, 2012). Settler-colonialism also views humans as the ego-center of terrestrial life,
and therefore perpetuates the notion that humans have the right to control and dominate over
land (Dei & Jaimungal, 2018, p. 20). This point is expanded upon in Chapter 3: Theoretical
Perspectives. According to my analysis of the literature reviewed for this dissertation, settlercolonialism is a form of social, economic, political, and earthly colonization built on the
principles of scarcity rather than abundance, which has implications for how health and
wellbeing are conceptualized in Canadian NursMed Education.
Cycles of colonialism have been going on for thousands of years and propagated by
various groups of humans across linear time. In general, for much of the last 300+ years,
Canadian NursMed Education has operated in parallel and in alignment with British and
French settler-colonialism (Million, 2013; Reynolds & Robson, 2016). According to some
educational scholars, standardizing curriculum historically allowed British and (less-so)
French settlers and Canadian NursMed Education leaders to maintain dominant norms to
14
acculturate students and teachers into: “desired ontological, epistemological, and axiological
frameworks” (Biermann, 2011, p. 391). The dominant norms can be summed up by the term
‘modernity’. As stated above, modernity encompasses the nexus of heteropatriarchy,
neoliberal capitalism, and colonialism, the same social structures described earlier in this
chapter (de Sousa Santos, 2019; Hill Collins, 2019; Mignolo, 2011). The structures of
modernity influence and can create health and social inequities.
In summary, settler-colonialism is an attitude, practice, and structure that aims to
limit the possibilities of human flourishing through one narrow perspective, which is often
enforced through violent means. Using critical pedagogies to unlearn settler-colonialism
then necessitates an acknowledgement that in some ways ‘we have no idea what we are
doing’ when it comes to imagining new pedagogical futures through Decolonial,
Intersectional Pedagogies. In this way, integrating Decolonial, Intersectional Pedagogies in
Canadian NursMed Education can support moves to “take the first step even when you don’t
see the whole staircase” (Luther King, Jr. in Chopra, 2014, p. 73).
2.1.5 Preparing the Next Generation of Nurses and Doctors to Heal Root Causes
The review of scholarship above demonstrates communities, health care systems,
educational institutions and more are called to adapt to new paradigms of anti-racism, gender
equality, redistribution of wealth, and living consciously of climate change. Research
suggests the coming decades of communication, relationship building, unlearning, learning,
and teaching in Canada can potentially support the evolution of our society and species
towards social justice and sustainable relationships with the Earth (Kluttz & Walter, 2020;
15
Stein et al, 2020). Canadian NursMed Education is one significant area of practice that has
the potential to evolve and adapt in service of redressing deepening health and social
inequities.
As an extension of the social welfare system and of settler-colonialism, Canadian
NursMed Education prepares the next generation of nurses and doctors to provide essential
health care to communities currently residing in the borders of Canada through particular
pedagogies (Bhandal, 2018; Chiu, Duncan, Whyte, 2020; Duan, 2020; Hayman et al., 2020).
As such, the pedagogies or philosophies of teaching informing Canadian NursMed Education
have the potential to shape how patients, health care providers, and all Canadians experience
health care. In this way, Canadian NursMed Education could serve as an upstream
determinant of health. For instance, across the border, Washington state has passed into law
a requirement for medical students to complete training in critical race theory prior to
graduation (State of Washington Senate, 2021). At the same time, the surge in social justice
movements is also facing opposition in educational policy. At least 20 US state Attorneys
General are pursuing legislation that would essentially ban teaching concepts such as “critical
race theory” in schools (Williams, 2021). The global events of 2020 provide additional
evidence for advancing pedagogy in Canadian NursMed Education with a focus on
decolonization and intersectionality (theories which are further explored in Chapter 3:
Theoretical Perspectives).
In this dissertation, I have chosen to examine Canadian Nursing and Medical Schools
together as two institutions that educate the next generation of nurses and doctors. It can be
noted that Nursing and Medicine differ in many ways. For instance, departments of
Medicine tend to hold more power, privilege, and prestige in the university and society more
16
broadly. This has meant that Medicine typically receives more funding and resources for
education, infrastructure, salaries and more. Also, Nursing and Medicine have almost binary
gendered legacies, whereby Nursing has historically (until quite recently) been led by and
occupied by women and Medicine has been dominated by men in settler-colonial Canada.
While these trends are changing, the differences between Nursing and Medicine cannot be
erased. Instead, the Third Eye Seeing project is meant to be an intersectional examination of
Canadian NursMed Education with the understanding that in clinical practice, nurses and
doctors tend to work closely together, especially in acute care and community settings.
Moreover, the education of nurses and doctors represents an upstream determinant of health,
whereby the examination and evolution of pedagogies in these two important fields of health
professions can trickle down and influence patient experiences, health system planning, and
policy. Finally, while Nursing and Medicine have distinct philosophical and practical
differences, they share colonial legacies, a dominance of biomedicine as pedagogy (explored
further in the coming pages), and histories of excluding Indigenous Peoples and/or people of
colour. Further research can be done on the two fields of health professions separately in
more detail, to parse out the nuances of the Third Eye Seeing findings and contribution.
2.1.6 Pedagogies for New Paradigms of Canadian NursMed Education
Extrapolating a definition of pedagogy from the historical and contemporary context
is difficult. Simply put, many authors define pedagogy not just about the teacher-student
interaction but rather a process of changing and facilitating learning during a world in crisis
(Grande, 2015; McLaren & Jaramillo, 2017; Stein et al., 2020). Indeed, pedagogy is
17
political. hooks describes, “our work [as teachers] is not merely to share information but to
share in the intellectual and spiritual growth of our students” (hooks, 2014, p. 114). In this
dissertation ‘pedagogy’ is used in its broadest form and encompasses: the governance of
Canadian NursMed Education; the buildings and land in which teaching occurs; the flow of
people in and out of Canadian NursMed Education; the methods used for teaching; the
emotional, mental, physical, and spiritual space created in Canadian NursMed Education;
and, the written and oral knowledges shared between administrators, teachers, and students
(Diffey & Mignone, 2017; Herzog, 2017; Oyewo, 2018; Adefarakan, 2018). In the third
section of this literature review, I expand on the field of ‘critical pedagogy’ and the specific
niche I am referring to as ‘Decolonial, Intersectional Pedagogies’.
2.1.7 Social Determinants of Health: A Primary Pedagogical Lens
Research and experience demonstrate that health and social impacts of settlercolonialism have been historically taught in a ‘light’ way in Canadian NursMed Education.
Most often settler-colonialism is coded into important pedagogies such as ‘social
determinants of health’ or related fields of inquiry such as ‘global health’ or ‘culture and
health’, which are discussed in subsequent sections and chapters (Bhandal, 2018; Clark et al.,
2016; Huish, 2012; Premkumar et al., 2016; Wass & Mole, 2017; White et al., 2017). The
social determinants of health (SDOH) are a framework influenced by critical social theory
that considers how different levels of social relations influence peoples’ health (McGibbon,
2021; Raphael, 2016). However, from my reading, in the classroom SDOH can easily get
taken up on a surface level, whereby health is seen as abstract and out of context from
18
modern processes (Baum et al., 2016; Baum, 2016; Goldblatt, 2016; Marmot & Allen, 2014).
At the same time, the surface symptoms of settler-colonialism are usually taught in one
course, scattered, or lost in an integrated and crowded curriculum whereby individual
teachers are tasked with approaching the topics on their own according to their current sets of
knowledges (Blackstock, 2018; Mills & Creedy, 2019; St. Denis, 2011).
Canadian NursMed Education also experiences its own specific challenges as an
institution. The majority of nursing and medicals schools in the country face the boundaries
of crowded curriculum (Finnell et al., 2018; Weston, 2018), meeting accreditation standards
(Association of Faculties of Medicine of Canada, 2019; Canadian Association of Schools of
Nursing, 2019), and ultimately fitting in all the skills required of the current Canadian health
care system. This tends to maintain a status quo in the pedagogies of Canadian NursMed
Education. Even when there is interest in Decolonial, Intersectional Pedagogies, students
and teachers often do not have enough time, money, and talent recruitment capacity to go
beyond surface-level understandings. In one literature review of health professions
education, researchers find that approximately 0.5% of a student’s time in the classroom is
spent on ‘cultural competency’ education in Canada, US, UK, Australia, and New Zealand
(Spencer, 2015). At the same time, the structures of universities and institutional features do
not tend to foster Decolonial, Intersectional Pedagogies in classrooms and beyond (Dei &
Jaimungal, 2018).
Moreover, the clause of Academic Freedom can prohibit Canadian universities from
being able to direct mandatory training for faculty or the mandatory inclusion of specific
content (Sultana, 2018). As such, the majority of teachers in Canadian NursMed Education
may not have the capacity to teach the complexity of settler-colonialism, modern processes,
19
and all root causes of health and social inequities. At the same time, the ancestral diversity
of teachers in Canadian NursMed Education is reflective of modern processes (Henry et al.,
2017). Due to the lack of training and/or lived experience there could be a major gap in
pedagogical pluralism. This gap itself may reproduce settler-colonialism. The Third Eye
Seeing project aims to explore this potential area of inquiry in scholarly knowledge.
2.2 Culture, Culture Everywhere: The Gravitational Pull of Culturalism
In the previous section, I described how the social determinants of health (SDOH) are
perhaps a primary pedagogy through which health equity is considered in Canadian NursMed
Education. Culturalism is another primary pedagogical lens through which health equity is
approached. In culturalism, culture is viewed as an unchanging characteristic inherent to a
person or community based on where they are roughly (and usually in a lump sum) “from” in
the world (Chircop et al., 2013; Hilario et al., 2017; Melamed, 2006). Research suggests the
gravitational pull towards explaining topics through cultural differences is influenced by
liberal multiculturalism, post-colonial migration, and settler-colonialism in the borders of
Canada (Anderson et al., 2003; Reimer-Kirkham et al., 2002, St. Denis, 2011). Scholars
suggest culturalism can work to divert attention away from the root causes of health and
social inequities, such as settler-colonialism, and shift instead to cultural differences. For
instance, writing in the Canadian high school curriculum context, St. Denis (2011) finds that
multiculturalism approaches can serve to,
20
“enable a refusal to address ongoing colonialism, and even to acknowledge
colonialism at all. This leads to the trivializing of issues, to attempts to collapse
[Indigenous] rights into ethnic and minority issues, and to forcing [Indigenous]
content into multicultural frameworks.” (p. 315)
In this dissertation, I am interested in pedagogies that focus on critically examining
how modern processes are implicated in health and social inequities. As such, I view
culturalism as a pedagogy that may present a challenge to the integration of Decolonial,
Intersectional Pedagogies.
The literature review I conducted shows that ‘culture’ continues to be deployed as a
proxy for assigning distinct biological and/or social attributes to people according to the
processes of racialization, migration, colonialism, and more (Anderson et al., 2003;
Carnevale et al., 2015; Dogra, 2010; Dogra, 2016; Etowa et al., 2011; Jefferies et al., 2019;
Young et al., 2012). Critical scholars of health delineate that this understanding narrows
culture to one point in time, and problematically perpetuates ‘culture’ as a catch all term to
explain away the root causes of health inequities (Anderson et al., 2003; Reimer-Kirkham et
al., 2002; Bannerji, 2000; Haque, 2010; Hilario et al., 2017). In the following section, I
detail two commonly circulating pedagogies that are influenced by culturalism: ‘cultural
diversity’ and ‘cultural competency/sensitivity’. I share brief insights from the literature on
these two teaching philosophies. I also discuss ‘cultural safety’ in the context of where
Decolonial, Intersectional Pedagogies may find allyship and space to be integrated in
Canadian NursMed Education.
21
2.2.1 Cultural Diversity
According to an expansive review of medical schools in Canada, cultural diversity
training tends to have two inter-related meanings in Canadian NursMed Education (Dogra,
2010). Firstly, it refers to the acquisition of quantifiable skills, attitudes, and knowledge that
facilitate positive interactions between ‘culturally’ diverse nurses, doctors, and patients
(Dogra, 2010). In this way, cultural diversity tends to re-create problematic cultural
inventories which present communities as static and unchanging. At the same time British
and French Canadian ‘culture’ is often centered as a static benchmark from which all
communities are distinguished (Thobani, 2007; Baldwin et al., 2011; Kluttz et al., 2020).
Cultural diversity training may promote some self-reflection on how a person’s self-defined
or researcher imposed ‘culture’ influences the patient’s context, life situation, health, and
relationship with the Canadian health care system (Bednarz et al., 2010; Brown, 2001;
Dogra, 2010; Nazar et al., 2015; Young et al., 2016). However, cultural diversity tends to
stay away from the historical context and root causes of health and social inequities such as
settler-colonialism. In this way, there is a gap in critical understandings of health and social
inequities.
2.2.2 Cultural Competency and Sensitivity
Cultural competency and cultural sensitivity are nebulous terms that are employed
ambiguously in Canadian NursMed Education (Grant et al., 2013; Kohlbry, 2016; Sharifi et
al., 2019). In general, cultural competency and sensitivity are considered a “set of academic
22
and interpersonal skills that allow individuals to increase their understanding and
appreciation of cultural differences and similarities within, among, and between groups”
(Spencer et al., 2015, p. 4). Here again, the notion of ‘cultural differences’ is used to explain
variations in health and health inequities across physical, mental, emotional, and spiritual
aspects. Leading scholars in the field have critiqued cultural competency literature and the
approach to teaching students to go into a health care setting with already fixed assumptions
about people who “look” like they ascribe to certain fixed cultural scripts (Anderson et al.,
2003).
I can share two empirical examples to illustrate this claim. In one case, Majumdar
(2007) surveyed literature on cultural competency and South Asian women’s experience of
marriage from the perspective of health in the United Kingdom. The author found the
majority of articles tended to reinforce perceptions of violence and abuse existing in every
South Asian marriage. Moreover, in the article Majumdar (2007) shows how much of the
literature on South Asian diasporic women’s health and wellbeing in the UK in marriage,
“served to support stereotypes of their passivity, and binary distinctions between supposedly
‘traditional’ and ‘modern’ women” (p. 316). In the review of Canadian literature, these
stereotypes persist in the cultural competency and sensitivity training students receive. In
another project, a research team in Canadian Nursing conducted a study on stereotyping in
health care, which found that dominant assumptions about Indigenous Peoples in media and
public discourse “negatively influence nurses’ interpretative framework” when caring for
patients racialized as Indigenous Peoples (Browne et al., 2009, p. 170).
In this way, cultural competency pedagogies can work to “pathologize” (Ahenakew,
2011, p. 14) communities based on biases such as racialized discrimination of what a person
23
is like based on their pre-conceived ‘culture’. In this dissertation, Decolonial, Intersectional
Pedagogies necessarily move away from ‘culturalism’ and the use of the term ‘culture’, and
towards nuanced and critical examinations of racialized identity, racialization, ancestral
lineage, religion, and spirituality.
2.2.3 Cultural Safety
Unsatisfied with the cultural competency model and the influence of culturalism,
Māori nurses in Aotearoa (New Zealand), Australia, and South Pacific Islands have moved
forward the practice and teachings of cultural safety6 (Ramsden, 1993). According to one
recent article generated in the Australian context, cultural safety as a framework consists of
“five concepts: reflexivity, dialogue, reducing power differences, decolonization and
regardful care” (Mackean et al., 2020, p. 340). Through the explicit mention of power and
decolonization, cultural safety acknowledges that any interaction in health care systems and
NursMed Education can invoke the trauma, pain, and violence of settler-colonialism
(Fernando & Bennett, 2019). In another article, the definition of cultural safety put forth
includes the following statement,
“cultural safety encompasses a critical consciousness where healthcare professionals
and healthcare organisations engage in ongoing self-reflection and self-awareness and
6
It should be noted that cultural safety is often used alongside the term ‘cultural humility’ as well. For
instance, one of the leading First Nations health care organization in the borders of Canada, First Nations
Health Authority, recently launched the Cultural Safety and Cultural Humility Webinar Action Series (FNHA,
2016).
24
hold themselves accountable for providing culturally safe care, as defined by the
patient and their communities, and as measured through progress towards achieving
health equity” (Curtis et al., 2019, p. 14).
As demonstrated by the use of the phrase ‘critical consciousness’ in the quote above, writing
and practice of cultural safety draws on critical theories and practices such as postcolonial
feminism, critical pedagogy, intersectionality, and decolonization, which are further explored
in Chapter 3: Theoretical Perspectives. In general, the cultural safety model is a continuation
of social justice projects led by feminist, anti-racism scholars from multiple positionalities,
including members of the Third Eye Seeing supervisory committee (Anderson et al., 2003;
Browne et al., 2009; Kurtz et al., 2018; Reimer-Kirkham et al., 2009, Yeung, 2016;).
Taken up in the borders of Canada, cultural safety teaches students to consider the
context of populations in relation to social, political, economic, and hxrstorical power
relations that influence health (Anderson et al., 2003; Bourque Bearskin, 2011; Browne,
Varcoe, Ward, in press; Kurtz et al., 2018). According to my reading the model has been
taken up by critical scholars in attempts to frame biomedicine co-constitutively with
Indigenous Peoples’ worldsenses7 on health (Curtis et al., 2019; Duthie, 2019, Milne et al.,
2016; Nelson & Wilson, 2018; Penn, 2014; Varcoe & Browne, 2014). Moreover, the model
has been applied in research and practice settings by leaders in the field such as Dion Stout
(2021) who describe how the Canadian health care system can be “alienating” to Indigenous
Peoples (quoted in Fitzhenry, 2021). The strengths of cultural safety in adapting and
7
The term “worldsense” and its significance for Canadian NursMed Education is explored in more depth in
Chapter 3 (Oyewumi in Adefarakan, 2018, p. 233).
25
evolving the health care system and Canadian NursMed Education are clear in the empirical
literature.
In one example, researchers conducted a scoping review on the facilitators and
barriers of cultural safety in Canadian emergency departments (Berg et al., 2019). The
authors found that when perspectives of cultural safety were integrated into care patients of
all racialized identities and ancestral lineages felt “valued and respected” (Berg et al., 2019,
p. 4). In a second example, Guerra and Kurtz (2017) examine 26 articles that assess the
cultural safety curricula and training offered by health professions programs in the borders of
Canada. In general, they find that there is an increasing awareness of the importance of
cultural safety in health care provision, especially in relation to diverse Indigenous
communities. Although cultural safety is increasingly integrated in Canadian NursMed
Education, Guerra and Kurtz (2017) find that there is not enough practice, time, and
advocacy afforded to teaching about ancestral relations, learning and unlearning settlercolonialism, and other aspects of cultural safety. In this way, due to the constraints of a
crowded curriculum and the discomfort associated with unlearning settler-colonialism, the
criticality of cultural safety may be lost. In this way, cultural safety may provide one entry
point to open up conversations about health and social inequities, however there is still
significant need for philosophies of teaching such as decolonization and intersectionality to
be integrated into Canadian NursMed Education.
26
2.3 Critical Pedagogies in Canadian Educational Studies
In contrast to ‘culturalism’ as an entry point, the lineage of critical pedagogy offers
insights into how groups of people are marginalized and essentialized8 by modern social
structures such as settler-colonialism, heteropatriarchy, neoliberal capitalism, and
environmental extraction. The social structures listed above work in conjunction with each
other. As stated previously, in this dissertation, I focus primarily on the process of settlercolonialism in the geography of Canada, and the intersections of racialized identity, ancestral
lineage, and spirituality in relation to the advancement of pedagogies in Canadian NursMed
Education.
Critical pedagogies in education (such as the anti-racism, feminist, LGBTQ2S+, and
other intersectional education movements in Canada) attend to questions of who controls the
conditions of knowledge production, the value inscribed within certain knowledges, and the
ideological performances in classroom practices (Cavanagh et al., 2019; Cowden & Singh,
2013; Luke & Gore, 2014; Zebracki, 2020). Key scholars based in the US, Canada, and
Brazil assert the importance of pedagogies that enable students to question and shape the
meaning of what it means to exist as humans in a relational way (hooks, 2014, Giroux, 2011,
Freire, 2000). They provide tools for undoing, explaining, and naming ‘injustices’.
Criticality is premised on the epistemological knowledge that comes from understanding the
marginalized groups in society, and the importance of social context and personal experience
in the generation of knowledge. Falling into this broad category of pedagogies are authors
8
Essentialism is a framework that depict heterogenous groups as homogenous even though they are made up
of “people whose values, interests, ways of life, and moral and political commitments are internally plural and
diversity” (Narayan quotes in Matthes, 2016, p. 355).
27
who have written about the applicability of intersectionality to the theory and practice of
teaching including feminist, queer, and/or racialized as Indigenous Peoples and/or people of
colour scholars, many of whom are cited in the pages of this manuscript.
Through a review of literature, I also find that critical pedagogies been taken up by
some scholars and teachers in medical education (Cavanagh et al., 2019; Ross, 2015;
Sharma, 2019) and nursing education across the globe (Lynam, 2009; McGibbon et al., 2014;
Dyson, 2017; Blanchet Garneau et al., 2018). Critical pedagogies clearly articulate the ways
in which health is shaped, the social is constructed, and how power operates through the
relations of racialized identity, ancestry, gender, sex, sexuality, class, ability, religion,
spirituality, citizenship, etc. Critical pedagogies are an important vantage point from which
to challenge hegemonic, paternalistic, and scarcity-based perspectives that reproduce health
and social inequities across the globe.
Indigenous scholars expand critical pedagogies to critique dominant pedagogies
within Canadian educational institutions that have the potential of perpetuating harm, and
suggest models for braiding in multiple worldsenses and scarring the “soul wound”
(Ahenakew, 2019, p. 61). Building on the work of Alexander (2005), Ahenakew writes,
“Today’s [hxrstorical] trauma is added to [hxrstorical], intergenerationally
transmitted trauma, both reproducing dismemberment. This pain of dismemberment
manifests on the Indigenous side as embodied practices of self-hate, disconnection,
numbing, and checking out. On the settler side, it also manifests through different
forms of numbing, including overconsumption. Both sides, however, are trying to
respond in ineffective ways to the original pain of the soul wound” (2019, p. 61).
28
In Canadian NursMed Education, the soul wound manifests along the full spectrum of
positionality in many ways. A critical investigation of pedagogies in my own life as a
member of Canadian NursMed Education reveals disconnection by tuning out the root causes
of health and social inequities, numbing by keeping my mind occupied, and overconsumption
of knowledge to the point of exhaustion. The purpose of this dissertation is to turn and run
towards the soul wound in service of healing the health of the collective and the Earth. I
serve this purpose through a particular niche of critical pedagogy: Decolonial, Intersectional
Pedagogies.
2.4 Calls to Action Towards Decolonial, Intersectional Pedagogies
The composition of faculty in Canadian NursMed Education can influence the
approaches to pedagogy, and is representative of persisting health and social inequities
(Henry et al., 2017). The makeup of faculty, of pedagogy, and curriculum in Canadian
NursMed Education is being called to change with the rise of two notable movements across
Canada: Equity, Diversity, and Inclusion and The Truth and Reconciliation Commission
(TRC) (Henry et al., 2017; TRC, 2015). Equity, Diversity, and Inclusion is a commonly
circulating discourse and practice that aims to expand the current demographics of teachers,
students, and staff across racialized identity, gender, sex, class, ability, citizenship, age, and
more. Recent movements have led to adoption of anti-racism language in universities as
well. Yet, critiques of Equity, Diversity, and Inclusion (EDI)9 point to the watering down of
9
In the final stages of writing the Third Eye Seeing manuscript, I have noticed a trend towards the use of
Equity, Diversity, Inclusion and Anti-Racism (EDIA). I use Equity, Diverity, and Inclusion (EDI) and EDIA
interchangeably.
29
explicit decolonial, intersectional perspectives which serve to maintain the status quo, and
corporatized interpretations of critical perspectives (Dei, 2018).
The Truth and Reconciliation Commission is an intervention into Canadian settlercolonial consciousness, with the aim to disrupt the violent and traumatic ways that settlercolonial institutions relate to and with Indigenous Peoples (Ahenakew, 2019; Arvin et al.,
2013; Reading et al., 2016). All of the Calls to Action above demonstrate the need to
investigate if and how Decolonial, Intersectional Pedagogies can inform Canadian NursMed
Education. In the following sections, I provide more details and insights into Equity,
Diversity, and Inclusion and TRC Calls to Action and their implications for implementing
Decolonial, Intersectional Pedagogies in Canadian NursMed Education.
2.4.1 Equity, Diversity, and Inclusion and Anti-Racism (EDIA)
The emergence of the policy term Equity, Diversity, and Inclusion (EDI) (and now
with the addition of Anti-Racism – (EDIA)) in Canadian NursMed education is one area
where the practices of pluralism, multiple worldsenses, and social justice are being practiced
and also critiqued. Just in the past few seasons there has been increased attention on Equity,
Diversity, and Inclusion and Anti-Racism especially as it pertains to the process of
racialization, and the development of Canadian NursMed Education. A collective of nursing
schools in Canada recently released the following statement,
“Schools of nursing are uniquely positioned to play a leadership role in combating
racism in Canada. As professionals, we are charged with providing the best healthcare
30
to all; care that is highly responsive to people’s social, ethnocultural or gendered
locations. Nurse educators are called to create inclusive, non-racist environments for
students and create curricula that equips nurses to ensure the delivery of equitable
healthcare to all.” (CASN, 2020).
Similarly, the organizational body of Canadian medical schools also released a statement
along the same lines,
“As the voice of academic medicine in Canada, we, the Association of Faculties of
Medicine of Canada, stand against racial discrimination as well as all other forms of
discrimination. The AFMC is committed to working with health partners to ensure
that our environments are diverse, inclusive, culturally safe and foster equity.”
(AFMC, 2020).
Notably, both documents reference ‘racism’ and ‘racial discrimination’ as the current focus
of their attentions, specifically in relation to Equity, Diversity, and Inclusion. These
statements provide important context for the research questions and analysis in this
dissertation. Notably, the publication of Equity, Diversity, and Inclusion and anti-racism
statements from accrediting associations such as the Canadian Association for Schools of
Nursing and the Association of Faculties of Medicine of Canada offer institutional legitimacy
to the goals of Decolonial, Intersectional Pedagogies.
However, the very nature of institutional legitimacy must be examined and critiqued
as, “unexamined, seemingly benevolent practices tend to reproduce the same affective and
31
performative investment patterns that characterize colonial relations” (Stein et al., 2021, p.
20). In this way, the Equity, Diversity, and Inclusion can be applied in a conscious way by
continually unearthing, scarring, and healing the “circular colonial process” through which
Canadian NursMed Education and universities as institutions have been built (Stein et al.,
2021, p. 23). One step in the path towards integrating Decolonial, Intersectional Pedagogies
in conscious ways has been the diversification of Faculty members in Canadian NursMed
Education, explored in the next section.
2.4.2 Composition of Faculty in Canadian NursMed Education
One of the main Calls to Action among EDI literature and policy is to increase the
number of faculty members racialized as Indigenous Peoples and/or people of colour in
Canadian academia. This has been a central focus of the work for the last 5 years in Canada,
and especially in 2020+ (Gaudry & Lorenz, 2018; Henry et al., 2017). This particular avenue
of Equity, Diversity, and Inclusion work comes from a policy history of the Employment
32
Equity Act (Government of Canada, 1995), whereby some residents of Canada are legally
divided two racialized groups: ‘visible minorities10’ and ‘Indigenous Peoples11’.
A review of literature corroborates the claim that current Equity, Diversity, and
Inclusion policies and practices aim to increase proportional representation of ‘visible
minorities’ and ‘Indigenous Peoples’ in Canadian faculty, teaching approaches, senior
administration, and more. At present, approximately 19% of people living in Canada identify
as visible minorities, and 5% as Indigenous Peoples according to recent census data
(Statistics Canada, 2015; Statistics Canada, 2018). Drawing language from the United
States, the colloquialism of ‘people of colour’ is now often used in lieu of ‘visible minority’.
10
Visible minorities are defined by Statistics Canada as “persons, other than Aboriginal peoples, who are nonCaucasian in race or non-white in colour,” and as consisting “mainly of the following groups: Chinese, South
Asian, Black, Arab, West Asian, Filipino, Southeast Asian, Latin American, Japanese, and Korean” (Statistics
Canada, 2015). According to my analysis and experience, ‘visible minorities’ are residents of Canada who
deviate from the aesthetic normal of it meant to be a ‘Canadian’ in 1995 when the Employment Equity Act
underwent the last significant legislative change. Generally, these are members of the population whose
ancestors were born (or they themselves) in modern countries ranging from Pakistan to Bolivia to Yemen to
Zambia to Malaysia. Due to influence from across the USA-Canada national borders, more and more
individuals are using the colloquialism ‘person of colour’ rather than ‘visible minority’ to identify their
belonging to an “Othered” group (Said, 1985). Caucasian is the racialized legal term for people of European
ancestry ranging from modern day Denmark to Poland to Ukraine to Portugal who, in news media and
emerging research are all lumped into the racialized category of “white”. It should be noted that the term
‘visible minority’ does not include Indigenous Peoples.
11
On the term ‘Indigenous Peoples’: “Through the UN Declaration on the Rights of Indigenous Peoples, along
with the International Labour Organizations’ Indigenous Peoples and Tribal Peoples Convention
169, “Indigenous Peoples” has become the global standard in terminology. While “Indigenous Peoples” is still
an English phrase that attempts to encompass Indigenous Peoples across the globe, it succeeds in many ways
that “Aboriginal” does not. First, by including “Peoples” after “Indigenous Peoples” it recognizes that there is
more than just one group of Indigenous individuals. We’re not a monolith community, we’re a collective
made up of many separate, sovereign, unique, and wonderful Nations. Second, the etymological meaning of
this term is internally consistent. Indigenous Peoples comes from the Latin word indigena, which means
“sprung from the land; native.” Therefore, using “Indigenous Peoples” over “Aboriginal” reinforces land claims
and encourages territory acknowledgements, a practice which links Indigenous Peoples to their land and
respects their claims over it. However, we recognize that “Indigenous Peoples” is not a perfect term. It’s still
an umbrella term for a large group of people and it should only be used in situations where you are addressing
all Indigenous Peoples groups as a collective. If possible, you should always use Nation-specific terms,
particularly for territory acknowledgments.” (Animikii.com, 2020)
33
Established researchers who identify as Indigenous Peoples and/or people of colour in
Canada recently published the findings of a longitudinal, comprehensive study on the
application of equity in Canadian universities (Henry et al., 2017). Their extensive research
reveals that the numbers of faculty members racialized as people of colour are almost
representative of the demographics of Canada in some departments, and significantly lagging
in others. However, their findings also show that Indigenous Peoples are disproportionately
underrepresented in faculty, especially in senior administrative positions (Henry et al., 2017).
There are also significant employment inequities (especially in relation to financial income)
that members of groups racialized as Indigenous Peoples and/or people of colour experience
(Henry et al., 2017, p. 51).
The scholars quantify some of these inequities into a “race tax” whereby “faculty
members [who self-identity at Indigenous Peoples and/or people of colour] end up with extra
teaching, supervisory, mentorship, and service work…it is something that one cannot escape
as long as they are employed” (Henry et al., 2017. p. 165). In this way, the study shows that
teachers racialized as Indigenous Peoples and/or people of colour are expected to do the
lion’s share of work that the modern university refers to as Equity, Diversity, and Inclusion.
This is especially the case, after the release of the Truth and Reconciliation Commission
(TRC) Calls to Action, for Indigenous Peoples working in the institutions of Canadian
universities (Elwood, Andreotti, Stein, 2019; Henry et al., 2017).
At the same time that Canadian NursMed Education and all post-secondary programs
are ramping up their attention to these important issues, there are some critiques of Equity,
Diversity, and Inclusion policies. These critiques have implications for understanding how
Decolonial, Intersectional Pedagogies might be taken up in full or diluted in Canadian
34
NursMed Education. For instance, Ahmed (2012) who has been following the movement in
the United Kingdom finds that the use of Equity, Diversity, and Inclusion in universities “has
been treated as a symptom of what academics have called the corporatization of the
university” (p. 52). Here Ahmed is suggesting that these policies and practices do not
necessarily approach health and social inequities through critical perspectives. Instead, they
may reproduce some aspects of modernity (Ahmed, 2012; Ahmed, 2017). Leading scholars
in Canadian educational studies echo this claim that Equity, Diversity, and Inclusion,
“began as a reaction against affirmative action, and it was claimed that Equity,
Diversity, and Inclusion provided a less controversial alternative. The expected
benefits lie not necessarily in addressing system structures but rather in decreasing
conflict and stress, enhancing productivity of heterogeneous teams or work groups,
and improving morale, job satisfaction, and retention” (Henry et al., 2017, p. 179).
In this quote above the authors also point to the overlap between corporate language
and the intentions behind Equity, Diversity, and Inclusion. An excerpt from a research
publication in Canadian obstetrics and gynecology illustrates how a focus on productivity
and linear growth is presented, “Diversity and inclusion of people and ideas drive innovation
and excellence. These are needed to continue to advance our field and support our patients,
families, and reproductive community” (Maxwell & Lorello, 2020, p. 934). In this way, the
language of Equity, Diversity, and Inclusion may add to the complexity of integrating
Decolonial, Intersectional Pedagogies into Canadian NursMed Education. Cognizant of the
35
critiques, teachers in Canadian NursMed Education continue to explore dialogue and
pedagogy through Equity, Diversity, and Inclusion as a Call to Action.
2.4.3 Truth and Reconciliation Commission
In addition to the language, policy, and practice of Equity, Diversity, and Inclusion,
the Calls to Action from the Truth and Reconciliation Commission provide further evidence
for the need to integrate Decolonial, Intersectional Pedagogies in Canadian NursMed
Education. In the borders of Canada, the violent erasure of Indigenous Peoples worldsenses,
the trans-Atlantic slave trade, the indentured labour of families from the Global South, and
are just some of examples of the pain and scars inscribed on communities during the building
of the Canadian nation through settler-colonialism (Million, 2013; de Sousa Santos, 2019;
Reynolds & Robson, 2016). One significant instrument of settler-colonialism in Canada
is/are the Indian Residential Schools (TRC, 2015). In 2015, the Truth and Reconciliation
Commission on Indian12 Residential Schools report was released. The TRC committee
released the Calls to Action document which compiled knowledge from survivors, family
12
It should be noted that the term ‘Indian’, as in The Indian Act, or Indian Status Card, is still a legal category
in Canada that does not refer to people like myself who come from the South Asian countries ‘East’ India,
Pakistan, Bangladesh, or Sri Lanka that were formed after the fall of the British Raj in 1947 (Bhandal, 2014).
Nor does it refer to people classified as West Indian who share another complex network of colonial
relationships (Alpers, 1997; Donnell, 2018). Instead, the legal, racialized category of “Indian” refers to
Indigenous Peoples of Turtle Island (An English translation of the Cree word for the land referred to as North
America) who are governed separately according to the archaic, colonial law titled The Indian Act. As stated in
a previous footnote, in recent years, the language of Indigenous Peoples has been adopted in lieu of
Aboriginal. Surprisingly, my review of the literature shows that there is a major gap in Canadian scholarship
that adequately describes the interconnection of these Indian hxrstories and what they mean for Canadian
NursMed Education.
36
members, community leaders, researchers, and more who made public the long history of
violence and trauma inflicted on Indigenous Peoples (TRC, 2015).
The TRC names several explicit requirements related to Canadian NursMed
Education. In the space below, I share three of the Calls to Action that stand out as
particularly necessary for Canadian NursMed Education:
Call to Action 22: We call upon those who can affect change within the Canadian
health care system to recognize the value of Indigenous Peoples healing practices and
use them in the treatment of Indigenous patients in collaboration with Indigenous
healers and elders where requested by Indigenous patients.
Call to Action 23: We call upon all levels of government to: i) Increase the number of
Aboriginal professionals working in the health-care field. ii) Ensure the retention of
Aboriginal health-care providers in Aboriginal communities. ii) Provide cultural
competency training for all healthcare professionals.
Call to Action 24: We call upon medical and nursing schools in Canada to require all
students to take a course dealing with Indigenous Peoples health issues, including the
history and legacy of residential schools, the UN Declaration on the Rights of
Indigenous People, Treaties and Indigenous Peoples rights, and Indigenous Peoples
teachings and practices. This will require skills – based training in intercultural
competency, conflict resolution, human rights, and anti-racism.
37
This momentous call for interruption into settler-colonial ‘business-as-usual’ can be
attributed to Indigenous Peoples activists, scholars, and organizers alongside allies who
continue to name the ongoing violence inflicted upon, and resilience of Indigenous Peoples
communities across the globe (Chung, 2016; Million, 2013; Reading et al., 2016; Symenuk et
al., 2020).
Scholars suggest that the TRC stemming from the Indigenous Peoples vs. Canadian
Government Settlement Agreement is perhaps one of most significant interventions made
into Canadian consciousness in the last decade (Metallic et al., 2017; Reading et al., 2016).
The TRC Calls to Action are another key piece of the educational context in which
Decolonial, Intersectional Pedagogies can be implemented in Canadian NursMed Education.
The TRC process is one record of the “soul wound, a metaphor for historical trauma” that
continues to exist in the land, people, and water that support and surround the borders of
Canada that is a cause of health and social inequities (Ahenakew, 2019, p. 36). As I will
further detail in the findings, it often came up as a pivotal point in which Third Eye Seeing
project participants organized their teaching approaches, and understood the implications of
Decolonial, Intersectional Pedagogies.
2.5 Summary
In summary, Chapter 2: Literature Review detailed four central themes in emerging
research to provide context for the Third Eye Seeing questions, design, findings, and
discussion. These are: 1) Current data demonstrating deepening, intersecting health and
social inequities in Canada and globally and the implications for Canadian NursMed
38
Education; 2) The gravitational pull of SDOH and culturalism as de-politicized pedagogies
used to explain health and social inequities; 3) The relevance of critical pedagogies as a
lineage to address settler-colonialism, health equity, and social justice in education at all
levels, and 4) Current calls to action in Canada, namely Equity, Diversity, and Inclusion and
the Truth and Reconciliation Commission, which provide further evidence for the need to
integrate Decolonial, Intersectional Pedagogies in Canadian NursMed Education. In Chapter
3, I present the main theoretical perspectives from which the project explores pedagogies in
Canadian NursMed Education.
39
Chapter 3: Theoretical Perspectives
This chapter explores the main theoretical perspectives framing the Third Eye Seeing
research questions and design. Namely, I identify: (1) critical theory, (2) decolonization, and
(3) intersectionality as guides for research and pedagogy in the project. Drawing on the three
knowledge areas aligns an analysis of Canadian NursMed Education with social movements
aiming to evolve and adapt humanity in service of redressing health and social inequities.
The chapter begins with a discussion of my lived experience in the social world - or
positionality - as a health researcher. In the 21st century, scholars, policy makers, and youth
leaders alike are reaching a consensus for each person to locate their/our positionality in
relation to research, land, countries, and social identity in all settings. In Third Eye Seeing, I
share my positionality for the purpose of outlining the assumptions shaping my worldsense
as a researcher. Building on the literature review, Chapter 3 aims to provide the reader with
a theoretical and practical context for Third Eye Seeing methods, findings, and analysis.
3.1 Positionality of the Researcher
I have come to learn through the Third Eye Seeing literature review that every person
is living with the health impact of intergenerational trauma as a result of human evolution
over the last 150+ years. My health and perspective as a researcher is influenced by my
intersectional identity as a woman, female, Punjabi, Sikh, addict, Canadian settler, Canadian
citizen, millennial, and working-middle class member of capitalism. I was born and raised
on Coast Salish territory in what is now Burnaby, British Columbia, Canada. My maternal
40
lineage comes from generations of farmers living in small villages of modern day Pakistan.
My paternal lineage comes from rural teachers and farmers in small villages of modern day
India.
My homelands in South Asia were essentially under British control for over 200 years
during which my ancestors were subjected to unspeakable atrocities in the name of colonial
exploitation and oppression. In 1947, after the resurgence of the Indian Independence
Movement, the British Raj fell in South Asia leaving newly formed democratic states (Bose
& Jalal, 2017). Known as Partition, borders were drawn in 6 weeks by British officials who
had never visited the area, creating India (A Hindu Democracy), Pakistan (A Muslim
Democracy), Bangladesh, and Sri Lanka. My home state of Punjab, where the majority of
the population identifies as Sikh, was divided into India (about one third) and Pakistan (about
two thirds). Parts of it became modern-day Afghanistan as well. Millions of families were
displaced from their homes and/or killed during these years due to the traumatic colonial
process of dividing the region across religious lines. Political polarization fueled by
traumatized masculine leaders continued to breed in the area after Partition.
During the 1980s – 1990s+, Sikh religious minorities in Punjab began to immigrate to
Canada in larger numbers compared to earlier times. The 1990s marked the opening of the
Indian economy to ‘free’ trade across borders. In The Land of Five Rivers, Punjabi farming
families experienced a mass influx of financial capital from companies around the world
wanting mangos, rice, and wheat to be harvested from fertile regions of the Earth. After
some years of wealth and exposure to neoliberal capitalism (Bhandal, 2014), the reality of
land exploitation has set in. In 2020, accounts of village life passed down through my family
41
in Punjab are virtually synonymous with rates of intense addictions, cutting down trees, death
by depression, and ghostly beings.
In the 1990s, the meetings of Punjabi Indians and Indigenous Peoples of Turtle Island
also reached a critical mass. Though we share the English colonized name ‘Indian’, largescale immigration from Punjab solidifies my complicity in Canadian settler-colonialism as a
Punjabi-Canadian. Through the use of land ownership, voting in the democratic Canadian
political system, and participation in industrial work such as logging, my ancestors and
myself reproduce forms of settler-colonialism in Canada. Through Third Eye Seeing, I aim
to unravel the threads of my own complicity in settler-colonialism as a human, researcher,
and Canadian citizen. I do this work in the hopes of repairing human relationships, finding
moments of pleasure in the pain, and caring for the Earth.
One gendered implication of the British Raj and Partition is the increase in arranged
marriages between Punjabi women, men, and all genders for the purposes of survival. While
arranged marriages exist in many societies around the world, the process took on a particular
flavor after 1947. South Asia also experienced a bottleneck effect on diverse sexualities, and
a Victorian imposition of purity. After an arranged marriage my parents moved to Metro
Vancouver. They spent years in various forms of violence, disarray, and working low-income
jobs like rewinding tape cassettes by hand, canning asparagus, and delivering pizza. Holding
onto the intergenerational impact of Partition, I was able to survive childhood moving from
city to city in Metro Vancouver through the joy of reading. Libraries saved my life and the
lives of many diasporic children around the world. As a health researcher, I am acutely
aware of how intergenerational trauma has been passed down and amplified over the last 60
years in the South Asian diaspora in Canada and beyond.
42
Many years later, I left home in pursuit of a biology degree where I began a position
in a Faculty of Medicine in Canada, a settler-colonial institution located in Mi’kmaw
territories. It was in this role where the ongoing impact of colonialism in Canadian
NursMed Education became apparent to me. As part of my position, I worked with Canadian
NursMed Education students who were interested in completing electives in what were/are
referred to as the Global South (in contrast to the Global North), low-resource settings,
and/or low-income countries (Sen & Iyer, 2019). The narrative tended to follow the lines of,
‘Canadian NursMed Education students, mostly racialized as white, go to poor countries in
the Global South where they do not speak the local language to save sick and dying children
racialized as brown and black’. In two years of research and practice, I noticed that the
current format of education did not necessarily allow for teachers or students to question why
the children were sick and dying in the first place, nor our (as in every single person on the
Earth) own complicity in the colonial process of reproducing the image of a racialized Global
South as always poor, with few resources, and in need of aid.
A very similar narrative emerged after moving back to Metro Vancouver, Canada to
support a family member through hitting rock-bottom of an alcohol addiction. While
navigating the struggles of intervention, harm reduction, and recovery for family and my own
self, I volunteered for many years at a women’s health non-profit organization, which I also
identify as a settler-colonial institution. The organization is located in a village of
Musqueam, Squamish, and Tsleil-Waututh now called the Downtown Eastside. It is a village
43
home to many urban Coast Salish women-led actions, and opened up my worldsense13 to
ways that settler-colonialism operates in Canada.
From a university office to a community organization, I witnessed how biomedicine
was almost always unintentionally and intentionally privileged over Indigenous modalities of
healing when working with diasporic and Indigenous communities locally and globally.
While these attitudes and practices are changing, my experience in the field of health and the
experiences of my ancestors provide the foundation for asking questions about decolonial,
intersectional pedagogies in Canadian NursMed Education. Scholars in knowledge areas of
critical theory, decolonization, and intersectionality offer the theoretical tools required to
engage in research and practice that can be responsive to deepening health and social
inequities in the borders of Canada and beyond.
3.2 Critical Theory
A main tenet of ‘critical theory’ is the assertion that power, privilege, and oppression
are socially constructed processes experienced materially by our collective bodies, minds,
and spirits (Butler, 1999; Dhamoon, 2015; Collins, 2002; Fanon, 1952; Million, 2013). For
example, the passages on positionality above are critical readings of how the nations of
13
In this dissertation, worldsense is distinguished from worldview: “The term ‘worldview,’ which is used in the
West to sum up the cultural logic of a society, captures the West’s privileging of the visual. It is Eurocentric to
use it to describe cultures that may privilege other senses. The term “world-sense” is a more inclusive way of
describing the conception of the world by different [ancestral] groups.” (Oyewùmí in Adefarakan, 2018, p.
232)
44
Canada, India, and Pakistan, are built through colonial, patriarchal, and capitalist powers led
by particular groups of people in the last 150-500 years.
Much of critical theorizing comes from deconstructing these processes, understanding
marginalized (by ancestry, racialized identity, sex, gender, religion, sexuality, citizenship,
class, ability, age, etc.) groups in society, and centering social context and personal
experience in the generation of knowledge (Ahmad et al., 2013; Barker, 2017; Giroux, 2011;
Haritaworn, Kuntsman, Posocco, 2014; hooks, 2014). Moreover, critical theorizing indicates
institutions asserting power over individuals cannot be studied out of view of the modes of
thought and political rationality that underlie their governance (Bannerji, 2000; Chakravorty
Spivak, 1999; Foucault, 1980). Interestingly, I observe that in much critical theoretical
writing about social processes, the actual felt experience of being in a body, mind, mood, and
soul that absorbs, heals, and copes from trauma can be lost. This could be due to the
constraints of ‘objectivity’ that are often a necessary requirement of conducting health
research.
Nonetheless, critical theorizing can shed light on how power, privilege, and
oppression are expressed, signaled, reproduced or legitimized in the structures of health
education, health care, and health policy in the borders of Canada (Anderson, 2006;
Ahenakew, 2011; Browne et al., 2018; Etowa et al., 2017; Reimer-Kirkham, 2019). Feminist
researchers have provided clear evidence for the assertion that power is inextricably linked to
knowledge (Bunjun, 2011; Harding, 2016; Nader, 2014). Critical theorizing allows for
articulation of how power permeates through people and institutions, and how power
establishes hierarchies of knowledge (Andreotti et al., 2018; Ayeb-Karlsson, 2020; Jones et
al., 2012; Tuhiwai-Smith et al., 2016; Yeang, 2017). In Third Eye Seeing, power is
45
examined in relation to pedagogy. The research questions are informed by critical theory to
examine if Decolonial, Intersectional Pedagogies could gain more attention, impact, and
ultimately power to inform Canadian NursMed Education.
3.3. Decolonization
3.3.1 Decolonizing Education
In Third Eye Seeing, decolonization specifically refers to movements towards
repatriating land and life to Indigenous Peoples (Tuck & Yang, 2012). Decolonization
requires readers, students, teachers, and settlers, and more to “join us in these efforts, so that
settler-colonial structuring and Indigenous critiques of that structuring are no longer rendered
invisible. Yet, this joining cannot be too easy, too open, too settled. Solidarity is an uneasy,
reserved, and unsettled matter that neither reconciles present grievances nor forecloses future
conflict” (Tuck & Yang, 2012, p. 3). In this way, Third Eye Seeing aims to gather stories
and share research findings to unsettle Canadian NursMed Education in service of redressing
health and social inequities produced by settler-colonialism (Ahenakew, 2019; Elwood,
Andreotti, Stein, 2019).
According to key scholars, decolonization of Canadian NursMed Education
necessarily requires giving back land to Indigenous communities (including that which
universities are built on), pluralism in pedagogy, and a restructuring of social-politicaleconomic and education systems, to name a few of the actual practices to engage in.
Moreover, decolonization as a theoretical and practice perspective necessitates greater
emphasis on sustainability and braiding a regenerative, collective, healthy, relationship with
46
the Earth into Canadian NursMed Education. Especially in urban settings, current models of
nurse and doctor led health care in Canada rely on resource extraction of human labour, plant
medicines, fibers, and minerals essential to high-tech devices in the Global North from the
Global South (Lugones, 2014; Mignolo & Tlostanova, 2006; Tuck & Yang, 2012).
As a start, decolonization in research design can assume a futurist approach to
knowledge that does not reinforce a hierarchy of knowledge between Introduced
Northern/Western perspectives, Introduced14 Southern/Eastern perspectives, and Indigenous
perspectives. However, as a product of settler-colonialism in Canada, this hierarchy
currently exists in much of postsecondary education including Canadian NursMed Education.
In response to the hierarchy, ‘Two-eyed seeing’ is a teaching passed down by Indigenous
Elders and Knowledge Holders on Turtle Island. Quoting Mi’kmaw Elders Murdena and
Albert Marshall, Martin (2012) writes:
“Two-Eyed Seeing adamantly, respectfully, and passionately asks that we bring
together our different ways of knowing to motivate people, [Indigenous] and non[Indigenous] alike, to use all our understandings so that we can leave the world a
better place and not compromise the opportunities for our youth (in the sense of
Seven Generations) through our own inaction” (Bartlett, Marshall, Marshall, &
Iwama, in press, p. 11, quoted in Martin, 2012).
14
Herbalists Stephanie Morningstar and Shabina Lafleur-Gangji use the term ‘Introduced’ instead of ‘Invasive’
to describe species of plants that have travelled to a new geographic area to make homes in soil without being
invited by the current inhabitants. Introduced plants are described as being in dynamic equilibrium with
Native or Indigenous plants. I use the term Introduced here to suggest many of knowledge systems that
currently exist in North America and even South Asia have been Introduced to the region in (often violent and
colonial) ways.
47
In case of health knowledge, two-eyed seeing is often used to describe and
acknowledge two major worldsenses that are used in pedagogy, curriculum, and institutional
culture of Canadian NursMed Education: (1) Indigenous ways of knowing and (2)
biomedicine (Ahenakew, 2011; Martin, 2012). Two-eyed seeing is reminiscent of much
ancestral wisdom from around the planet that recognizes the need for humans to embrace
differences, express compassion, and care for the health of the Earth.
Researchers examining decolonization point to considerations of how to braid
Indigenous Peoples knowledge (thread) and biomedicine (brick) sensibilities into Canadian
NursMed Education (Elwood, Andreotti, Stein, 2019). This point builds on the concept of
‘two-eyed seeing’ (Martin, 2012). In other words, scholars, teachers, and activists ask: how
can we make space for multiple pedagogies and worldsenses of health care alongside
biomedicine?
3.3.2 Learning from Two-Eyed Seeing as Mi’kmaw Pedagogy
There are several epistemologies that are required to ground Decolonial,
Intersectional Pedagogies as they enter Canadian NursMed Education. Here, I foreground
Two-Eye Seeing, a very significant intervention into Canadian academia from Mi’kmaw
scholars Murdena and Albert Marshall (Marshall et al., 2015). I am currently living on
Mi’kmaw Territories and am governed by the Peace and Friendship Treaty, and I am
honoured to share the knowledges in service of upholding treaty relations and decolonizing
where I am (Battiste, 2016). Third Eye Seeing is in radical solidarity and alignment with the
48
revitalization of Indigenous Peoples knowledges, and the consciousness raising practice of
intersectionality stemming from African-American feminist movements. With this project, I
am interested in creating synergies between diverse pedagogies in service of undoing settlercolonialism, health inequities, and making moves towards social justice.
3.3.3 The Significance of the Third Eye in South Asian Epistemologies
The Third Eye, according to South Asian diasporic philosophies, is the imagination
energy center of each individual person and collective consciousness. In my view, the Third
Eye is a tool present in every being that catalyzes the generation of creative solutions to the
daily demands on life, including health and wellbeing. At the same time, the Third Eye
supports perceptions of potential futures to be created. Finally, the Third Eye can also open
up possibilities for integrating Decolonial, Intersectional Pedagogies in Canadian NursMed
Education that may not be obviously visible to the physical eyes. Indeed, scholars of
spiritual health write,
“to realize and understand this [we] need a Third Eye, namely, a power of perception
and insight that enables them to grasp the meaning under the surface of things and
phenomena” (Song, 2002, p. xi).
In this way, the activation of the Third Eye can also support teachers and students in
Canadian NursMed Education to go beyond surface level understandings of health and social
inequities. This can allow for the imagination of innovative ways to encourage teachers and
students to reflect on health through the lenses of settler-colonialism, health equity, and
49
social justice. In some respects, the current context in which the Third Eye Seeing project
was conducted represents a perfect storm of social conditions to untangle and understand
from critical perspectives in Canadian NursMed Education.
3.3.4 Synergistic Pedagogies
Third Eye Seeing is in epistemological alignment and solidarity with Two-Eyed
Seeing as a heuristic to use for designing, analyzing, and creating adaptive pedagogies for
Canadian NursMed Education. At the present moment, there is a worldwide rise in
consciousness about the symptoms of settler-colonialism such as structural racism, the
extraction of Earth’s resources, and the divisions of value placed across borders of the Global
North to Global South. All of these factors and fluctuating conditions have implications for
Canadian NursMed Education. Notably, there are intersecting inequities to which teachers
are responding (and must respond) with various pedagogical approaches.
3.3.5 Seeing through Multiple Perspectives (including Biomedicine)
In general, the term ‘biomedicine’ has a long and contentious history around the
world (Bode & Shankar, 2018; Engel, 2012; Hollenburg & Muzzin, 2010; Lock & Nyugen,
2010). To be brief, biomedicine represents the standard suite of science textbooks,
examinations, tutorials, lab protocols, that each student entering and exiting Canadian
NursMed education is expected to ‘know’. These topics generally include anatomy,
biochemistry of the body, cell biology, organic chemistry, thermodynamics and physics of
the body, pathophysiology, pharmacology, and overall health assessments.
50
In one of the most thorough anthropological reviews of biomedicine, Lock and
Nyugen (2010), write, “the extent to which medical traditions other than those of
biomedicine continue to flourish…provide incontrovertible evidence that biomedicine alone
is not sufficient to meet the needs of the vast numbers of people'' (p. 62). Here Lock and
Nyugen are describing how the complexity of modern medical knowledge interfaces with
biodiversity, multiple perspectives and Indigenous Peoples medicines.
At the same time, biomedicine – as enacted, manifested, and reinforced by NursMed - has connections to reproducing colonial logics in the borders of Canada and beyond. The
roots of biomedicine can be traced to Enlightenment, Cartesian philosophy, which advanced
the notion of the mind-body dualism (Lock & Nyugen, p. 90). On this basis, disease is
defined as a biophysical malfunction and the goal of treatment is to correct the malfunction
to cure the disease. This model stresses on the pathophysiology and altered homeostasis
focusing solely on the treatment of the disease often with little or no scope for the role of
intersecting power relations, nor the influence of mental, emotional, or spiritual states on
bodies. At the same time, the tools of biomedicine have been used by colonizers to
perpetuate violence and pain onto colonized subjects (Million, 2013, p. 135).
The literature suggests that moves towards unlearning settler-colonialism,
decolonization, and braiding will likely require more space alongside biomedicine for
Indigenous Peoples’ and diasporic healing modalities. As such, the research questions focus
on asking Third Eye Seeing participants about the potential significance of Decolonial,
Intersectional Pedagogies for informing Canadian NursMed Education, while also ensuring
students have the practical and clinical skills to promote the physical, mental, emotional, and
spiritual health of communities.
51
3.4 Intersectionality
Writings from diasporic authors and activists such as Davis (2011), Thobani (2007),
Bannerji (2000), hooks (2014), and Hill Collins (2002) have been and continue to be
springing boards for the concept of intersectionality in the current borders of Canada, USA,
and beyond. Intersectionality was born as an English term in the 1990s out of the work of
critical ethnic studies scholars Kimberlé Crenshaw and Patricia Hill Collins who exposed the
hegemonic ‘objectivity’, colour-evasive, racist, and gendered perspectives of US law,
education, society and more (Crenshaw, 2020; Hill Collins, 2019; Hill Collins & Bilge,
2021). In recent writings, Hill Collins describes the following conditions for intersectionality
as, “a lens for examining how critical analysis and social action might inform one another”
(Hill Collins, 2019 p. 4).
Intersectionality captures the fluctuating dimensions of health and social life
experienced differentially by every person that are commonly understood to include ancestry,
racialized identity, sex, gender, sexuality, socio-economic status, class, ability, age,
citizenship/nationality, and religion. These correspond with modern human-made and
temporal (or linear, time-dependent) structural processes like colonialism, hetero-patriarchy,
neoliberal globalization, ableism, border imperialism, nationalism, and many more on
various macro and micro levels. In the last decade, intersectionality is increasingly
recognized as a framework that can be applied to every type of research method and field. In
broad area of ‘health’ research, there are several articles and book sections elaborating on the
ways intersectional theorizing, analysis, and practice can be taken up in the service of healing
and addressing health inequities in Canada and beyond (Dhamoon & Hankivsky, 2011; Sen
& Iyer, 2019).
52
In this dissertation, intersectionality creates space to go beyond a singular ideal or
ideology of a ‘healthy’ person, towards a critical analysis of pedagogies in Canadian
NursMed Education (Akbar & Panichelli, 2019; Hankivsky & Mussell, 2018; Sewpaul,
2013; Waldron, 2018; Williams, 2017). Moreover, intersectionality has implications for
understanding the diverse worldsenses of Third Eye Seeing participants. Finally,
intersectional relations inform the range of knowledges, pedagogies, and people who are
currently members of Canadian NursMed Education (Henry et al., 2017).
In essence, using their personal experiences and positionality, authors of
intersectionality theory opened possibilities of composing and communicating lived
experiences, especially for people gendered and racialized as ‘women of colour’ (Brah &
Phoenix, 2013; Raguparan, 2019; Sadika et al., 2020). Third Eye Seeing employs
intersectional perspectives in order to make visible how participants describe and critically
examine settler-colonialism, health equity, and social justice in their own teaching practice
and experiences. Moreover, the project aims to analyze which aspects of Decolonial,
Intersectional Pedagogies are foregrounded by participants as they describe the potential
opportunities and challenges.
3.5 Summary
This chapter examined key tenets of three theoretical perspectives that inform Third
Eye Seeing questions, methodology, and analysis. These are: (1) critical theory, (2)
decolonization, and (3) intersectionality, which interweave and co-exist in solidarity in the
realm of research and practice. Each of the theoretical perspectives contribute knowledge,
53
wisdom, and evidence for critically examining settler-colonialism, health equity, and social
justice through Decolonial, Intersectional Pedagogies. Beginning with my positionality as a
researcher, I shared a description of how my lived experience and practice in the field of
health led me to ask the Third Eye Seeing research questions. Then, I summarized aspects of
critical theory, decolonization, and intersectionality from a range of authors, many of whom
are racialized and gendered as Indigenous women and women of colour. Authors who
continue to pass down the three theoretical perspectives point to the power of storytelling and
observation of social relations. In the following chapter, I detail the methodology and
research design of Third Eye Seeing which builds on the analysis presented above.
54
Chapter 4: Methodology and Research Design
Chapter 4 outlines the overarching research methodology and research design of the
Third Eye Seeing project. The methodology and design are informed by the theoretical
perspectives and my positionality as a researcher detailed in Chapter 3. I start the chapter by
discussing the application of critical ethnographic methods in the research design. Then, I
present a summary of the project setting, recruitment strategy, and participants. This is
followed by a detailed description of the fieldwork. I aim to share a comprehensive account
of how stories from participants were received, how observations were carried out, how data
collection was managed, and how the analysis was conducted. After a description of the
research design, key ethical considerations are reviewed. I then share a discussion of
scientific rigor and credibility. The chapter concludes by examining some limitations of the
research. The Third Eye Seeing project was funded by a Canadian Institutes of Health
Research Doctoral Award.
4.1 Methodological Approaches
4.1.1 Critical Ethnographic Methods
In contemporary health sciences, ethnography is used by a diverse range of
researchers to study peoples’ daily health and wellbeing in local, provincial, national, and
global settings (Pink, 2016; Draper, 2015; Hamilton & Taylor, 2017; Hill et al., 2019; Miled,
2019 Reed & Ellis, 2019; Vannini & Vannini, 2020). From my reading, especially of
55
decolonization and intersectionality theories and practices, the epistemological underpinning
of ethnography assumes that: social life is meaningful; people are social agents who are on a
spectrum of self and collective awareness; structural social processes such as settlercolonialism, heteropatriarchy, capitalism, and environmental extraction can work to govern
social agents; and culture itself is a dynamic and changing process (Adjepong, 2019; Davids
et al., 2014; Kaur Takhi, 2018; Roman, 2017). Moreover, ethnography assumes that social
agents within a specific field are knowledgeable about the rules, conventions, and evidence
within their field (Atkinson & Pugsley, 2007; Ybema et al., 2010).
The Third Eye Seeing project does not claim to be a full-scale ethnography of
Canadian NursMed Education. As one of the geographical largest bordered nations by
geographical size, interviews and observations at all nursing and medical schools in Canada
were beyond the scope of this dissertation. As such, Third Eye Seeing represents one braid
in the woven tapestry of Canadian NursMed Education. By critically examining the research
setting, the project draws on ‘ethnographic methods’ at a smaller scale.
Expanding ethnography through a ‘critical’ approach allows the researcher to engage
in a process that “involves ideological critique and challenges the status quo of power”
(Roman, 2017, p. 1). In education, critical ethnography builds on the principle of “schools as
sites of social and cultural reproduction mediated through human agency by various forms of
resistance and accommodation” (Anderson, 1989, p. 7). The lineages of critical ethnography
aims to make visible and subvert power relations within the institution of research itself.
Many scholars discuss how ethnography emerged, in part, as a research methodology to
study “Other” cultures and nations considered outside of settler-colonial ideals of healthy
humans (Johnson et al., 2004; Said, 1985, Shange, 2019). Indeed, some lineages of
56
ethnography have long histories of contributing to the reproduction of the civilized/native
binary which influences deepening health and social inequities in Canada.
In recent years, as the diversity of worldsenses in health research grows, there has
been an emergence of critical ethnographic methods. Since the rise of postmodernist,
poststructuralist, and postcolonial epistemological shifts in social sciences and humanities,
critical ethnographic methods are used to “bolster growing cultural self-critique in the West”
(Ybema et al., 2010, p. 350) and to document subaltern narratives of communities by
scholars (Gunaratnam, 2003, p. 86). From decolonial, intersectional theoretical perspectives,
the politics of location shape knowledge production and therefore ethnographic
representations are situated locally, are partial to the writer, and are socially constructed
(Parameswaran, 2001, p. 69). In this way, I understand that almost all research that draws on
ethnographic methods has some qualities of ‘autoethnography’, which allows the researchers
to position the findings in relation to one’s own stories, complexities of analysis, power
dynamics, and uncertainties (Ashlee et al., 2017). In the case of Third Eye Seeing, I
remained acutely cognizant of my own memories and complicity in coloniality by the very
nature of conducting the study, writing up the results, and witnessing instances of settlercolonial reproduction.
While all approaches to ethnography (like all other methodologies) are fraught with
ethical and analytic dilemmas, contradictions, and tensions, critical ethnographic methods
require the researcher to apply the approach of reflexivity. Feminist ethnographers have
herstorically brought forth the concept of ‘reflexivity’ in which the researcher can “explicate
positionality, increase accountability in research, and honor the goals and ideals of research”
(Anthym, 2018, p. 183). Moreover, according to Davies, “reflexivity expresses researchers’
57
awareness of their necessary connection to the research situation and hence their effects upon
it.” (2008, p. 7). In essence, reflexivity puts forth the assumption that the identity, energy,
and self-awareness of the researcher has an impact on the design, process, and analysis.
My reflexivity as a researcher begins with “an understanding of the importance of
[my] own values and attitudes in relation to the research process” and how my own “social
background and assumptions can intervene'' (Hesse-Biber & Levy, 2007, p. 129). Moreover,
by remaining self-aware and self-reflexive as a novice researcher and my own positionality, I
can engage in a process of meta-cognitive thinking through which biases, contradictions, and
surprises in the research can emerge. I engaged in the practice of reflexivity through various
methods including journaling, peer debriefing (explored in Credibility of Analysis), holding
ceremonies alone in stillness, mindfulness, meditation, and taking extensive jottings, and
writing up field notes throughout the interviews and classroom observations.
Further, I have learnt that critical ethnographic methods require the researcher to
understand the everyday lives of the participants within the context of what feminist
sociologist Dorothy Smith calls their “ruling relations” (1990, p. 74). These relations of
ruling manifest as the doings of organizations, governmental processes, and bureaucracies
and “constitute objectified knowledges” (Smith, 1990, p. 4). Canadian NursMed Education
exists in the ruling relations of Canadian academia, settler-colonialism, and other processes
of modernity. In an increasingly globalized world, critical ethnographic methods also require
the understanding that the national and religious boundaries, racialized assumptions, and
embeddedness of social relations have been destabilized (Chilisa, 2012; Gille & Riain, 2002;
Maisuria & Beach, 2020; Miled, 2019). In this dissertation, critical ethnographic methods,
specifically interviewing and participant observation, are employed with the aim of critiquing
58
modern processes and braiding Indigenous and diverse diasporic perspectives into Canadian
NursMed Education.
Yasmin Gunaratnam (2003) discusses examples and common themes of how the
research setting is influenced by intersectional relations of the researcher and participants. A
critical approach to knowledge production requires acknowledging that the research setting is
a space in which social constructions of power play out (such as colonialism,
heteropatriarchy, capitalism, environmental extraction, etc.). At the same time, when it
comes to analysis of the research findings, the notion that a researcher’s identity and
positionality will allow them to only have a partial understanding of people ‘different’ from
them can be dangerous. This assumption reproduces epistemological belief about
intersecting relations as binary, essential, and absolute.
As such my intended use of critical ethnographic methods aims to work both through
and against categories of difference. This principle is in alignment with my social justice
goals of creating community across constructed lines of individuality. In my view, all
researchers must remain vigilant about recognizing the colonial institutions within which we
conduct research and teach, and work to unlearn the reproduction of settler-colonial relations.
As Chandra Mohanty et al. (1991) writes “the existence of subaltern narratives in itself is not
evidence of decentering hegemonic histories and subjectivities. It is the way in which they
are read, understood, and located institutionally which is of paramount importance” (p. 34).
Such a perspective seeks to methodologically and practically explore the historical, political,
interacting, and fluid realities of pedagogy in Canadian NursMed Education.
59
4.1.2 Studying Up
Another methodological departure point is the choice of research ‘subjects’ or
participants. In this dissertation, I engaged in the process of “studying up” (Nader, 1972), a
methodological tool from feminist research in the social sciences and humanities which
““take[s] into account participants’ position of power, professional status, and sphere of
influence” (Aydarova, 2019, p. 34). I have never been enrolled in a nursing or medical
school, and instead I am trained as a community care educator and herbalist. In this way, I
am ‘studying up’ the hierarchy of health care providers in Canada. In Third Eye Seeing, the
process of studying up allowed me to gain knowledge and insight into the education of
mainstream health care providers, nurses and doctors, who hold the power of diagnosis,
treatment, and the arrangement of biomedical health care for many communities in Canada.
Moreover, as a graduate student, I exist on a metaphorically lower rung in the
academic ladder. The project participants included administrators and teachers who are also
faculty members within the university. On the note of hierarchy, Aydarova states, “one of
the first challenges that a researcher has to consider is the problem of access, as those who
occupy positions of power and privilege may be hard to access.” (Aydarova, 2019, p. 34).
As stated previously, the pace of academia (and most work environments) has increased in
the last several decades. Additionally, class sizes continue to grow in Canadian NursMed
Education to meet the national and global demands for health care providers (Woloschuk et
al., 2004; Russell et al., 2007). As such, faculty members often have competing priorities
including research, teaching, and administrative work. In some cases, they may even
continue their clinical practices. All of these factors culminate to influence how I as a
60
graduate student access the time and energy of participants, and bear witness to their stories
and pedagogies as educators.
4.2 Research Setting
The overall research field for Third Eye Seeing is university-based Canadian
NursMed Education. The specific study sites included: 1) 1 Western Canadian University
Medical School; 2) 2 Western Canadian Nursing Schools; 3) Virtual Sites through phone
calls based out of Vancouver to interview participants at various Canadian Nursing and
Medical schools. Each province or territory of Canada has its own nuanced histories and
procedures for Canadian NursMed Education. In recent years, curriculum is becoming more
integrated on a national level through the advent of digital technologies and standardized
exams (Raman et al., 2019; Singh-Carlson & May, 2020).
4.3 Recruitment and Sampling
The recruitment strategy for Third Eye Seeing was based on an extensive review of
faculty member profiles on the websites of nursing and medicine programs in Canada based
in universities. Based on the requirements of public institutions, the email addresses of
faculty members were open-access. A detailed table was produced by province and territory,
which listed key faculty members with interests in decolonization, intersectionality, health
equity, settler-colonialism, social justice, and related fields of research and teaching. This
list was then reviewed and supplemented by existing relationships with potential participants
held by myself and the supervisory committee. The sampling strategy therefore included
61
‘purposive sampling’ and ‘convenience sampling’ (Etikan et al., 2016). Purposive sampling
was used to generate an extensive list of potential participants who were deemed
knowledgeable in the research topic, and represented a range of worldsenses. Convenience
sampling allowed for an accessible entry point into the field based on pre-existing
relationships with colleagues (Etikan et al., 2016; Furrugia, 2019; Omona, 2013).
Based on the research questions, I paid close attention to variations in ancestral
identities of participants to ensure pluralism in the findings and analysis. Through guidance
of the supervisory committee, I began to make contact with the identified list of potential
participants working across the country in Canadian NursMed Education. An initial outreach
email was sent to all potential participants, with a copy of the study summary attached. All
participants who received the email and expressed interest to participate were subsequently
provided with an informed consent document. We then scheduled a time to connect. As a
small token of appreciation for their time, energy, and wisdom, all participants received a
hand-drawn card, homemade herbal tea blend, and bar of soap from an Indigenous-owned
company called Mother Earth Essentials by mail.
4.4 Ethical Considerations
The field of academic research, especially ethnography, has been a contested site for
critical perspectives such as decolonization and intersectionality. As such, considerations of
ethical participant involvement and representation were at the fore in this research project.
This was done through the conscious use of the theoretical frameworks which align with the
goals and intentions of the project. Prior to beginning fieldwork, I also completed the
62
Canadian Tri-Council Ethics Tutorial and obtained ethics approval from the University of
British Columbia Behavioural Research Ethics Board.
The confidentiality of participants was held of utmost importance during the
fieldwork and writing process. To ensure confidentiality, all hardcopy evidence of
participation was kept in a locked filing cabinet that could not be found by the participants’
employers or colleagues. Additionally, individual interviews and observations ensured that
study participants’ also remained anonymous to each other. Moreover, only the research
committee and a hired transcriptionist had access to the de-identified transcripts and
fieldnotes.
A master list of participant names was kept and coded using numbers. All interview
and observation data was coded using this master list. This master list will be destroyed
upon completion of the research project. In the manuscript writing, gender neutral SikhPunjabi pseudonyms are used and identifying information about participants is limited so
individuals cannot be identified in any written work that becomes public (including the
thesis, conference presentations, and publications). This decision is certainly fraught with
the challenges of representation and the politics of naming participants. Moreover, there is
the potential for a flattening of the analysis based on the current reality of racialized
polarization in the borders of Canada and globally. Ultimately, the pseudonyms are chosen
to protect the identity of participants during a time when tensions and experiences of trauma
are high, especially for teachers racialized as Indigenous Peoples’ and/or people of colour.
Finally, clinical classrooms and practice sites were not included in the study. To truly
receive informed consent from patients, family members, staff, and clinical instructors would
63
require significantly more time, energy, and meaningful relationship building than available
during this doctoral dissertation.
4.5 Overview of Participants
Here I describe the participants in the ‘sample’, their geographical location, and some
components of their intersectional identities. I am purposefully vague in sharing
demographic data about the sample of participants as the possible risk for participant
identification is very high. This is due to the small pool of faculty members in Canadian
NursMed Education who are not only interested but were actively practicing their
educational skills in Decolonial, Intersectional Pedagogies. Overall, participants in the Third
Eye Seeing project included faculty at various university-based programs in Canadian
NursMed Education. They were employees Canadian post-secondary institutions and were
selected based on their knowledge on the subject of curriculum development, course
structures, teaching experience, and ideas on teaching philosophies or pedagogies. Tables 1
and 2 below describe some demographic information about Third Eye Seeing participants.
64
Table 1. Interview Participants (P = Participant, Uni = University).
P
#
Pseudonym
Location in
borders of
Canada
Central
Program
Years Teaching
in NursMed
Harpreet
Faculty position in
Uni (teacher or
administrator)
Both
1
Nursing
32
2
Manjit
Teacher
Western
Nursing
1
3
Kulwant
Both
Central
Medicine
23
4
Jagdeep
Teacher
Eastern
Nursing
14
5
Manmeet
Teacher
Western
Nursing
40
6
Jasleen
Teacher
Western
Medicine
11
7
Prabjot
Teacher
Western
Nursing
27
8
Kirpal
Teacher
Central
Nursing
12
9
Akashpreet
Teacher
Eastern
Nursing
14
10
Gianleen
Both
Central
Both
9
11
Lavindeep
Administrator
Eastern
Both
8
12
Simranpal
Administrator
Eastern
Nursing
30
13
Tejbir
Teacher
Eastern
Medicine
17
14
Kaladhar
Teacher
Northern
Medicine
2
15
Gurneet
Teacher
Eastern
Nursing
20
16
Arneet
Teacher
Central
Medicine
10
65
Table 2. Observation Participants (P = Participant, Uni = University).
Classroom &
Topic
P#
Pseudonyms
Position in Uni
(teacher or
administrator)
Location in
borders of
Canada
Program
1
17
18
Sukhi &
Anandkaur
Teachers
Western
Nursing
2
19
Manjit &
Karmveer
Both
Western
Nursing
20+
combined
5
20
Manmeet &
Jassi
Both
Western
Nursing
50+
combined
6
Jasleen
Teacher
Western
Medicine 11
2125
Gidda Team
(Online
class)
Teachers
Western
Medicine 50+
combined
Indigenous
Peoples’
Health
2
Indigenous
Peoples’
Health
3
Building
Relationships
& Rapport
with Patients
4
SelfAwareness and
Reflexivity
5
Global Health
Years
Teaching
in
NursMed
30+
combined
66
4.5.1 Number of Participants
A total of twenty-five (n=25) Canadian NursMed Education faculty members
participated in interviews and observations (Tables 1 and 2). Faculty members that were
interviewed spoke with me by phone to talk about Decolonial, Intersectional Pedagogies in
Canadian NursMed Education (Table 1). Some faculty members allowed observation of
their physical or online classroom (Table 2). A few participants engaged in an interview and
opened up their classrooms for study (Table 2).
4.5.2 Geography of Participants
The project participants lived and worked across the borders of Canada (Table 1).
The majority were employed at a university close to the 49th parallel (further broken down
into Western, Eastern, and Central). Only one faculty member taught in a university
considered part of the Northern region of Canada. All of the interviews and observations
were conducted in English. Due to the cost of translation services, French-only programs
were excluded. With the limited funding for the project, all observations took place in the
borders of Western Canada.
4.5.3 Ancestral Lineages and Religions of Participants
At various points in the interview and observational process, each participant was
asked to share their ancestry in some capacity. To role model how this is defined, I phrased
my own ancestry as Sikh and Punjabi from modern-day India and Pakistan. In response to
this question, I received generous descriptions of where and how participants grew up, where
67
they did their own PhD, and how their ancestry influenced their approach to teaching. In the
process, some participants also disclosed their religious beliefs, spiritual practices, and
spiritual paths. This knowledge informed the analysis, however to maintain the deidentification of participants their ancestry or religion is not included in Table 1 or 2.
Overall, it can be stated that participants represented Indigenous Peoples of Turtle Island and
diaspora from all regions of the globe (Global North/West, Middle World (Ansary, 2009),
Global South/East, and Pacific Islands).
4.5.4 Number of Years Teaching in Canadian NursMed Education
I also inquired about the number of years participants had been teaching in Canadian
NursMed Education, which yielded rich feedback on the process of academic hiring, as well
as stories of participants' movements across the borders of Canada and beyond. Participants
ranged in the years that they had been teaching in Canadian NursMed Education, with a
mean of 16.8 years. The newest faculty member was in Year 1 of their position when we met
for the interview (Table 1). The most senior faculty member had been teaching for 40 years
as a clinical and theory instructor (Table 1).
4.5.5 Genders of Participants
Pivoting to gender, given the changing divisions of labour in nursing and medicine,
the majority of participants were women (22) and only three (3) were men. With the
emergence of multiple descriptions of gender in English, future studies could extend the
68
analysis to include non-binary, trans, and two-spirit perspectives in research on Decolonial,
Intersectional Pedagogies in Canadian NursMed Education.
4.6 Data Collection
Based on a proposal written with oversight of my supervisory committee, the research
design was constructed to capture first-hand accounts of implementing and engaging with
Decolonial, Intersectional Pedagogies in Canadian NursMed Education. Moreover, the
choice of methods allowed for triangulation of participants’ stories with the researcher’s
observations of pedagogy inside physical and online classrooms. The interviews and
observations took place between January 2019 and October 2019.
4.6.1 Interview process
In-depth interviews proceeded by phone using a call recording application paired with
an additional Olympus digital voice recorder as a backup file. Most interviews were
conducted for 60 minutes, though some variations in length were required based on faculty
members’ schedules and capacities. The shortest interview was 20 minutes and the longest
90 minutes. Each of the faculty members shared their preferred phone number which was
recorded into a password-protected, encrypted file. A few minutes before the phone
interview, I found a comfortable place to sit, set up my notebook and interview guide,
completed a 2-3 minute mindfulness meditation, and wrote down my reflections prior to the
interview, to engage in a process of ‘reflexivity’ (further explored at the end of this chapter).
69
A meditation was done in order to center myself and ensure that I was open as a listener to
receive the faculty member’s stories, then the interviews began.
The interview guide (Appendix A) and questions were designed based on common
pedagogies and contexts uncovered during the literature review process. Some examples of
the interview questions include
-
If you were in charge of [NursMed school] curriculum how would you go about
approaching the following topics: Ancestral diversity? Learning words or phrases in
multiple languages? Immigration & Citizenship? Racism? Colonialism?
-
Can you tell me a little about how you see [NursMed school] as being part of ongoing
settler-colonialism in Canada?
-
Health inequities experienced by Indigenous people and people of colour are
growing. Given how “crowded” the curriculum is, how do you make space to talk
about this in your classes? Prompts: How is it being done in [NursMed school]? What
improvements can be made? What are the current gaps?
-
As you know, everyday there are more and more people immigrating to Canada from
across the world. As globalization continues to happen, people tend to migrate along
religious lines. This religious diversity is reflected in students, teachers, families, and
more. In the interviews I’ve done so far, I notice that people are unsure or don’t have
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space to talk about the connection between spirituality and teaching [Nursing or
Medicine]. In your experience, how do you talk about spirituality in the classroom?
The framing of the questions above is in line with in-depth interviewing techniques that
“seek to understand the lived experiences of the individual” and that involve working with
small samples of participants (Hesse-Biber, 2014, p. 189). The interview guide prompted the
interview participants to reflect on critical pedagogies, their everyday approach to teaching,
as well as pedagogies on an institutional level. I recognized that in-depth interviews tend to
reflect the researcher’s assumptions about a research problem (which is informed by their
positionality) (Deterding & Waters, 2018). As such, the interview guide and questions
reflected the notion that settler-colonialism is an ongoing process in Canada, which has
implications for approaches to examining social justice and health equity in Canadian
NursMed Education.
4.6.2 Observation Process
In the following section, I describe the process through which I engaged in participant
observation. After initial contact, participants engaged in an informed consent procedure
similar to the interview process. The educator was also asked to brief the researcher on the
aims and objectives of the teaching in the class that was observed. For physical classroom
visits, teachers were asked to provide a brief announcement at the beginning and identify the
presence of the researcher.
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Three of the in-person classes were held in typical university lecture halls: theatre
style seating, students sitting in rows facing the teacher, and no art or windows on the walls.
One in-person class was held in an Indigenous learning center with one wall of floor to
ceiling windows, carved wooden posts and art work, and students sitting in pods around
common tables. For all of the observations, I sat at the back of the classroom in order to
observe the faculty members from the perspective of a student. I positioned myself to
experience the classroom as “situated knowledge” that reflects the social, political, and
economic contexts of Canadian NursMed Education (Simandan, 2019, p. 129). During the
process of observation, I carefully documented the participants’ choice of words, activities,
links to resources, and notes on their presentation slides. I also jotted down links to the
literature as they emerged during the course of the observation.
As per the intentions of Third Eye Seeing and the ethics application, I did not record
any of the student’s comments, names, or assignments. However, I did take note on whether
students seemed to be actively engaged in the pedagogies presented by the teacher. Notably,
I witnessed laptop screens and whether they mirrored the teacher’s presentation or whether
they were occupied with other course work or distractions like social media. The online
course was delivered in an asynchronous capacity, meaning that I examined the course
modules at my own pace in my own office.
4.7 Data Analysis
The process of data collection and analysis was informed by a range of literature on
critical qualitative methodologies, and guided by the supervisory committee who have
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extensive experience with qualitative analyses (Anderson, 1989; Atkinson & Hammersley,
2007; Chilisa, 2012; Hamilton, 2017; Hesse-Biber & Levy, 2007; Kaur Takhi, 2018;
Madison, 2011; Maisura & Beach, 2020; Parameswaran, 2001; Wilson, 2008; Ybema et al.,
2010). More specifically, I conducted a thematic analysis informed by the concepts of
‘interpretive description’ (Thorne, 2016) and ‘colonial power relations’ (Gunaratnam, 2003).
Both Thorne and Gunaratnam engage in research through critical realist epistemologies
which, “reject positivist notions of causality…and argue that both natural and social sciences
try to uncover the underlying structures of powers that affect the observable level.” (Turner,
2006, p. 440)
According to Thorne (2016), interpretive description necessitates an analysis that is
informed by “an actual practice goal” (in this case implementing Decolonial, Intersectional
Pedagogies in Canadian NursMed Education), and “an understanding of what we do and do
not know on the basis of the available empirical evidence” (p. 35). Moreover, the author
suggests that thematic analysis aims to “extend the interpretive mind beyond the selfevident” (p. 35). At the same time, Gunaratnam (2003) describes the process of thematic
analysis as an opportunity to “disrupt and reveal the limitations and the binarism of our use
of conceptual categories [such a racialized identity, ancestry, and religion] in analysis” (p.
134). Both of these perspectives on interpretation of data were considered while engaging in
the process of analysis.
To begin, I read the interview transcripts and observational field notes line by line
repeatedly and iteratively. This was done to identify recurring, surprising, and paradoxical
patterns in the data. In this process of thematic analysis, key points and linkages to the
theoretical perspectives were documented. Based on the initial comprehension of key
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themes, a code book of topic-based codes was developed drawing on words and phrases used
by Third Eye Seeing participants (Thorne, 2016, p. 144).
A computer software, NVivo, commonly used to store qualitative data sets, was
employed to code and manage the interview data. All observational field notes were
recorded, read, and coded by hand. As the field work process continued, excerpts from the
data were shared with my supervisor to discuss emerging insights on Decolonial,
Intersectional Pedagogies in Canadian NursMed Education. Printouts of code reports and the
draft code book were also read by the supervisor to “continually find ways to confirm or
challenge the basis upon which [my] mind [made] linkages between the pieces and parts
within the data” (Thorne, 2016, p. 158). As the analysis process continued, the research team
remained mindful of how the participants accounts of pedagogies were “both socially located
and in a constant process of individual production and negotiation” (Gunaratnam, 2003, p.
136)
To refine the thematic analysis, summaries of interviews and observations were also
shared with the committee members, who provided additional input on commonly circulating
themes informed by the Third Eye Seeing research questions and purpose. As field work
concluded and full-time data analysis began, the code book was further clarified and refined.
In the final stages, the thematic analysis moved towards a more conceptual representation of
the themes present in the data in relation to Decolonial, Intersectional Pedagogies.
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4.8 Rigour and Scientific Integrity
4.8.1 Credibility of the Analysis
Scholars identify several key techniques that are employed to ensure that the
reporting of findings and implications for the field are supported by a strong research
design (Amankwaa, 2016; Fusch et al., 2018; Liao & Hitchcock, 2018). In this dissertation, I
applied the concepts of audit trail, thick description, triangulation, reflexivity, and peer
debriefing to bolster rigour and credibility.
To begin, following ethics protocol, I kept detailed recordings, jotting, and field notes
during the entire research process. Amankwaa states, “an audit trail is a transparent
description of the research steps taken from the start of a research project to the development
and reporting of findings” (2016, p. 122). This included the raw stories and data, which
consists of recorded interview audio files, transcripts of interviews, handwritten field notes
pre and post interviews, and handwritten field notes of classroom observations. The audit
trail also included preliminary memos, including potential common themes that began to
emerge through the data collection process.
Second, I intentionally included long excerpts from interview transcripts and
observational field notes during the data analysis process with the committee and in the
dissertation manuscript to establish a pattern of ‘thick description’ (Ponterotto, 2006;
Williams, 2017). Thick description is often used to provide extensive accounts of the
findings. In this project, thick description is employed to build and share a rich set of data
that can be used to inform future research, especially as interest in Decolonial, Intersectional
Pedagogies grows in Canadian NursMed Education.
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Third, I went through the process of ‘triangulation’ (Fusch et al., 2018) to examine
the field from multiple angles. I employed “methodological triangulation” to examine the
same events (pedagogy in classrooms) through multiple forms of data collection such as
interviews and classroom observations (Fusch et al., 2018, p. 22). Moreover, I chose to
interview and observe participants who existed on a spectrum of knowledge, positionality,
and engagement with Decolonial, Intersectional Pedagogies. This was done to ensure
representation of participants with differing worldsenses.
I also triangulated the stories and data by cross-referencing the changes in curriculum,
the timeline for national Calls to Action, and accrediting organizations mentioned by
participants in the field. Many of the events and changes described by participants such as
the Truth and Reconciliation Commission and Equity, Diversity, and Inclusion movements
are well-documented through research and journalistic evidence online. Finally, I also read
the emerging findings in relation to multiple expert discussions including existing
scholarship and the perspectives of the supervisor and committee members.
Fourth, reflexivity played a significant role in the credibility of analysis, especially
given recent calls to raise collective consciousness and self-awareness during the COVID-19
pandemic. Notably, “researchers' insights into their social location and participation in the
research process have been used to examine the relationships between social contexts,
research methods and intersubjective relations in research” (Gunaratnam, 2003, p. 87). To
bring reflexivity into the dissertation manuscript, I approached the process iteratively by
continually refining the questions, and revising the manuscript in multiple stages. During all
stages of the design and analysis, I also remained mindful of how my own positionality
influenced the research.
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Finally, I also applied the practice of peer debriefing through the research study. Peer
debriefing can be defined as, “engaging professional colleagues in analytic discussions and
data interpretations” (Liao & Hitchcock , 2018, p. 159). In the proposal development stage, I
formally consulted with two faculty members at the Social Justice Institute who are not part
of my committee. I also regularly met with fellow graduate students, my peers, across
interdisciplinary fields to discuss our hunches, research flows, and questions for further
reflection.
During the final stages of data collection and analysis, I began presenting stories and
the preliminary findings at conferences including the UBC Celebration of Health Education
Scholarship, the International Conference on Qualitative Health Research, and a workshop
on Anti-racism Praxis in Health Professions Education. Questions and comments by fellow
presenters and attendees helped to shape the final analysis and write-up. In the final stages of
writing, I also contacted several participants to invite them to discuss an overview of my
analysis, and the ways in which I was representing the findings through my framing of the
overarching themes.
The intent in inviting further dialogue with these participants was to establish further
credibility of the analysis, and to explore whether some of the participants found resonance
in how their stories are shared (Lather, 2007). In critical qualitative research, one intention
can be to, “encourage the learning of both researcher and researched, sharing knowledge
democratically, and fostering social action” (Lather, 2007, p. 3). At the same time, the
feedback process allowed me to, “get the story right as well as tell the story well” in service
of moving further towards decolonization and intersectionality in research (Tuhiwai-Smith,
2021, p. 357). The participants shared their positive feedback in relation to the overall
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framing of the findings, and suggestions for analytical insights in the manuscript. In
summary, drawing on documented methods of establishing credibility, I used the practices of
audit trail, thick description, triangulation, reflexivity, and peer debriefing to establish
rigorous and trustworthy research evidence on Decolonial, Intersectional Pedagogies in
Canadian NursMed Education.
4.8.2 Limitations of the Research
As with any research, a number of limitations emerged. Firstly, due to the constraints
of participants’ busy schedules, the seasons of academia, funding, and the limited scope of
graduate thesis work only 25 faculty members were able to participate in the study. In
relation to the scope and notion of ‘saturation’, Thorne (2020) writes,
“We often point our qualitative inquiry lenses toward expanding on existing
understandings of clinical phenomena that matter, adding new richness, texture, and
dimension to what is already known and understood about aspects that intrigue us.
But rarely, I would argue, are we intending to claim a finding that deserves to be
attached to the idea of saturation” (2019, p. 3).
In this way, the limits of the quantity of interviews and observations were mitigated
by probing the participants for in-depth, thick descriptions of their approaches to Decolonial,
Intersectional Pedagogies. Moreover, this dissertation is positioned as an exploratory project
that can create opportunities for a longer and larger research program. A second limitation
was geographical, where observations of classrooms were conducted in just two large
Canadian universities. This was primarily due to the added difficulty of access to
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professionalized programs such as Nursing and Medicine, and the funding constraints of
travel within the borders of Canada.
A final limitation is the project time frame. Perhaps fortunately, the fieldwork for
Third Eye Seeing was completed prior to 2020. As such, the data collection did not
necessarily capture faculty member responses to Decolonial, Intersectional Pedagogies in the
wake of the COVID-19 pandemic, surge in social justice movements such as Black Lives
Matter, Farmers’ Protest, and Indigenous Peoples’ advocacy for land rematriation, and the
rapid evolution towards online teaching in most universities. Continued research on this
topic can shed light on how teachers and administrators in Canadian NursMed Education
adapt their pedagogy in response to global paradigm shifts.
4.9 Summary
In this chapter, I began by presenting some key methodological approaches that
defined the progression of this dissertation, including the lineage of critical ethnographic
methods and the assumptions of studying up. I then detailed aspects of the research design,
ranging from the research setting itself to the process of data analysis and storytelling.
Finally, I shared the approach to establishing credibility, and some limitations that can be
addressed in future research. It is with great excitement that I present the voices and
observations of Third Eye Seeing participants, beginning with Chapter 5: Institutional
Features of Canadian NursMed Education.
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Chapter 5: “The Real Challenge is the System”: Institutional Features of
Canadian NursMed Education
The purpose of this dissertation is to investigate if and how Decolonial, Intersectional
Pedagogies can inform Canadian NursMed Education. Pedagogies are philosophies of
teaching that inform how participants approached learning in the classroom. Decolonial,
Intersectional Pedagogies stem from a lineage of critical pedagogy, which as stated in
Chapter 2, are premised on the epistemological knowledge that comes from understanding
the marginalized groups in society, and the importance of social context and personal
experience in the generation of knowledge. To examine some interwoven braids in the
current tapestry of Decolonial, Intersectional Pedagogies in Canadian NursMed Education, I
had the honour of interviewing and observing faculty members across the country. In the
following pages, I describe some common themes Third Eye Seeing participants identified as
‘institutional features’ that can act as barriers and facilitators to applying Decolonial,
Intersectional Pedagogies in their teaching practice.
Canadian Nursing and Medical schools were largely set up as private-turned-public
institutions starting approximately in the 1700s and grew in size, status, and biomedical
rigour into the 2000s (Bhandal, 2017). According to literature reviewed for this dissertation,
which reflected the perspectives of some Third Eye Seeing participants, Canadian NursMed
Education hxrstories15 differ greatly across intersectional relations and geographies. When
15
Drawing in intersectionality theory, I insert a recent feminist contribution to academic writing. Instead of
the commonly used English word ‘history’ which begins with the pronoun ‘his’, I invoke the term ‘hxrstory’ to
suggest a gendered perspective on the establishment of Canadian Nursing (herstorically women-led) and
Medical (historically men-led) Education.
80
asked how settler-colonialism is institutionalized, participants identified specific relational
cultures and policies that govern how their schools are run.
Participants pinpointed four ‘institutional features’ of Canadian NursMed Education
that influence their capacities to implement Decolonial, Intersectional Pedagogies: 1) the
organization of curriculum based on national regulatory association requirements 2) the
ambivalence of colleagues to Decolonial, Intersectional Pedagogies through the clause of
Academic Freedom 3) the influence of Truth and Reconciliation Commission Calls to Action
and 4) hxrstorical and contemporary patterns of student admissions. In this chapter, I explore
excerpts from interviews and observational field notes that focus on these four institutional
features of Canadian NursMed Education.
A few notes on pronouncing Sikh-Punjabi names in English.
-
Basically all “a” sounds in Gurmukhi (the language on the modern India side of the
border) are pronounced like the English “u” in pup and cup.
-
Almost all “o” sounds in Gurmukhi are pronounced like the English “oe” in Joe.
-
E.g. Arneet = Ur-neet, Prabjot = Prub-joe-t;
-
E.g. Kaladhar = Ku-lu-dhur; Jagdeep = Jug-deep
5.1 Accreditation and Crowded Curriculum
There are organizations corresponding with each health professions program in
Canada who are responsible for maintaining national curricular requirements, such as the
Canadian Association for Schools of Nursing (CASN, 2015; CASN, 2020) and the
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Association of Faculties of Medicine of Canada (AFMC 2015; AFMC, 2020). In the
interviews, participants16 used language such as “accreditation” and “strategic planning” to
symbolize processes that schools undertake in order to achieve the expectations of their
respective governing associations. Several of the participants reflected on the influence of
accrediting associations on pedagogies in Canadian NursMed Education. While conducting
participant observations in classrooms, I did not observe direct references to associations but
rather viewed snapshots of how the recommendations are implemented at the everyday level.
My analysis of the findings suggest that in the past few years, accreditation standards
have become more specific, thereby potentially reducing the curricular flexibility of
Canadian NursMed Education. As Kirpal, a teacher in Nursing put it, “there's going to be
even less and less room as we march towards the tightening of the professional discourse
called nursing.” For instance, Kirpal went on to describe the recently introduced US-based
NCLEX exam, which undergraduate nursing graduates are required to pass in order to work
as a Registered Nurse (NCSBN, 2014). According to several participants, the NCLEX
focuses primarily on technical and physiological elements of nursing, with fewer questions
concerning important considerations for providing care such as the positionality of patients
and the social, political, and economic context of their lives. Kirpal further elaborated,
“There's very little room in Canada. [There are] emerging perspectives that have a
huge impact on nursing right now, and will for the third millennium, and nurses need
to know this. And they have no idea. They're lagging two movements behind, always,
16
I interchangeably use the term teacher and educator, and specify when someone is an administrator. This
is in part due to literary diversity, and the participant’s role and title in the university as detailed in Tables 1
and 2.
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and that's because they're stuck having to get licenses and having to get
professionalized and having to ascribe to a set of principles and procedures...
So, I'm sad to report that it's really, really -- there is no room for these perspectives,
these critical perspectives, and very important and necessarily ones, and it's always a
reactive thing… There's no room for even linguistic decolonial thinking.”
Kirpal’s discussion provides an example of how a top-down structuring of Canadian
NursMed Education can dictate the direction of pedagogies. Students who graduate from a
Bachelor of Nursing need to pass the NCLEX exam in order to receive the designation of
Registered Nurse. Health authorities, who run hospitals and community health clinics are the
primary employer of nurses, and base their wages and positions for nurses on the RN license.
According to the discussion above, the ongoing professionalization of nursing may work to
contract the amount of time and energy teachers can spend on working with students to
understand and unpack Decolonial, Intersectional Pedagogies or what Kirpal refers to as
‘critical perspectives’. Instead, Kirpal suggested that in their school, Canadian Nursing
faculty are being pulled in the direction of teaching to a US-based test. In some ways, the
tightening of curriculum can be linked to the concept of “coloniality of
being/power/truth/freedom”, whereby the very ontology of universities is premised on
particular understandings of knowledge, power, health, and human progress (Wynter, 2003,
p. 269). Based on Kirpal’s interview excerpt above, it could be suggested that diminishing
space for critical perspectives in Canadian NursMed Education furthers institutional
complicity in ongoing settler-colonialism.
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Participants working in Medicine describe similar conditions for training new
doctors. The interviews and observations reveal that in addition to the MD licensing process,
Canadian medical students complete a 4-year degree and are then placed in clinical
residencies, which are often specific to different components of the body as defined by
biomedicine: eyes, throat, heart, skin, etc. In the efforts to instill scientific rigour, Kaladhar,
a teacher in Medicine, recounted how the standardization process can sometimes work to in
opposition to geographical and epistemological complexities in providing health care:
“There’s this tension between context specific and the standardization of medical
education. How do we walk with that so that we can create space for context and for
different worldviews? Yet, at the same time the standardization is all about quality
care and patient-centredness because that’s how it’s framed…
We need to really continue to push the system to also make sure that it’s context
specific as well… The accreditation in and of itself is very much kind of within the
biomedical worldview. Trying to push accreditation at the same time as being open to
[…] create opportunities for other worldviews and other ways of thinking [that] still
foster, you know, very, very competent physicians is challenging.”
In this excerpt, Kaladhar found that the process of accreditation is in ‘tension’ with
engaging with pedagogies that may suit their local social and physical geographies. They
referred to context specific care, for which one definition is “tailoring practices and/or
organizational policies and clinical guidelines to address the needs of local population
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demographics, and social and community realities that often shift depending on local politics,
epidemiological trends, and economic conditions” (Browne et al., 2015, p. 5). In their
response, Kaladhar offered their experience of negotiating context specific care in their
school’s curriculum compared to more general requirements prescribed by accreditors at the
national level.
Participants also recounted that crowded curriculum is a significant barrier for
constructing Decolonial, Intersectional Pedagogies within Canadian NursMed Education. For
example, as witnessed in the participant observations, students and teachers spend a
significant portion of their day in the classroom and/or on campus (8 – 9 hours days +
additional hours for class prep, study, and reflection). In the following excerpt of my field
notes, I describe the process of observing one teacher who was generous enough with their
time to meeting me at the beginning and end of their workday to brief and debrief,
“Manjit and I met quite early in the morning before the 9 am class time. By the time
we met for a chai and stroll to the classroom, they had already been to their office to
drop off materials, do some photocopying and review their lecture notes. The class
itself was three hours: a guest speaker first, a short break, and then a workshop style
class until closing. After the observation, I went to get lunch and write up my
fieldnotes and expand on my jottings.
At the end of the workday, around 5 pm, Manjit and I met at their office just to say
bye, as I had been working in the same building. We chatted a little, and they
mentioned they still had some work to do in prep for tomorrow.
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On my way out, I noticed students set up in various lounges and study areas with
laptops and snacks in tow.” (Participant observation, June 4th, 2019)
In the narrative above, I document one participant’s present in their office as a faculty
member from 8 am to about 5 pm (9 hours) with still more work ahead of them. In an
observation of Medicine, I also witnessed a common dedication and expectancy in the pace
of work. In the field notes excerpt below I documented my experience attending a first year
medical school classroom that took place in the first few days of the term,
“I am so grateful Jasleen was kind enough to allow me access to their classroom. As
someone who has worked in Medicine, I know how many hoops and barriers there
are to be in this position. So here I am!
As I have never been to the building the class is held in, I arrived on campus early in
the day to go find the room around 9 am. I noticed there were already teachers and
students in the public spaces.
The class itself started at 2 pm and afterwards I stuck around to finish field notes in
the same building. Watching some of the students study until 5 or 6 pm (including
myself), I recalled talking to Jasleen before the observation took place, and their
comment to the effect of ‘my calendar is out of control these days, I’m happy if I can
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cram in a granola bar between meetings and teaching’” (Participant observation,
September 9, 2019).
In my recounting of field notes above, the reader can see a similarity and invocation of
‘crowded curriculum’ in both experiences. Many participants had schedules similar to
Manjit and Jasleen, and shared that they often still do not have enough space to address
complex topics linked to Decolonial, Intersectional Pedagogies in nuanced ways. In
reference to a new course on diverse worldsenses of health, Akashpreet a teacher in Nursing
shares, “you can tell, you can sort of tell the students in your class who have somehow
managed to get that course in.” The participant’s response implies the challenges of access
to courses, and space for students to take courses addressing settler-colonialism, health
equity, and/or social justice.
To further illustrate the reality of a crowded curriculum, I share excerpts from
participants about language diversity. A major component of Decolonial, Intersectional
Pedagogies is a critique and witnessing of how one thinks. The language in which we are
taught, think, and communicate is directly linked to how one relates to patients and
communities (Martin, 2013; Mayuzumi, 2006; Lopez, 2019). Kulwant, an educator and
administrator in Medicine shared,
“As you know, there’s a great tradition of medical knowledge in Indigenous
communities to the point that for example in some of the languages there is a specific
tense for healing where healing, you know, individuals that are medicine woman,
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medicine man or elders will use this specific tense when they’re trying to heal a
person.”
In Canada, people speak over 200 Indigenous and/or diasporic languages as their first
language making it one of the most linguistically diverse countries in the modern world
(Statistics Canada, 2017). However, 80-90% of language diversity on the earth is expected
to be lost in one generation (Brown, Brown, Mascarenhas-Swan, 2019). When I asked Third
Eye Seeing participants who taught in linguistically diverse cities if students were
encouraged to learn care work phrases in multiple languages (e.g. “does this hurt?”), the
answer was a resounding “no”. The participant observations also revealed that all teachers
taught and communicated in English, and very few aspects of the course (e.g. land
acknowledgements, introductions, etc.) were communicated in another language.
In many of the interviews I asked participants if they brought up the topic of spiritual
plurality in relation to health, which scholars define as a key component of human life and
healing for thousands of years (Ahenakew, 2011; Nahardani et al., 2019; Reimer-Kirkham,
2019). I felt that a discussion about spirituality, or even the concept of religion, could reveal
how multiple worldsenses are discussed and imagined in Canadian NursMed Education. In
response to a question about considering spirituality in the classrooms, Prabjot, a participant
in Nursing answered:
“No unfortunately no. Our textbooks do, I know in the assessment form in practice
they do ask about ... they used to ask about religion but now they ask about ‘what
spiritual beliefs do you hold’ or something to that effect but we don’t talk about it in
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class. We do – let me correct this, we talk about it in Term 1 in the context of
understanding the patient. So when you’re working with a patient, besides doing your
physical assessments, what other aspects of a patient do we have to take into
consideration? the cultural component, the language component, spirituality
component and anything else.
And then I think after that it’s a hit and miss, we really don’t unless it’s in the context
of specific care for example maternity maybe, you know, spiritual beliefs around care
of the baby or care of the mom perhaps. Death and dying is the other place where you
may have spiritual beliefs around care of the body and the processes of dying, so that
is brought to bear but to say specifically is there a course on it, no. Is the concept
introduced and then it’s threaded through the curriculum depending on the context of
care.”
Over the course of the interviews, I noticed participants continually raised the issue of
balancing the amount of teaching time available to encourage teachers and students to reflect
on the context of health through the lenses of settler-colonialism, health equity, and social
justice. Rarely did participants’ relationship to cosmic consciousness, prayer and rituals, and
other elements of spiritual health come up in conversations despite some significant probing.
The Third Eye Seeing participants described trends towards large-scale, biomedically
oriented standardization of Canadian NursMed Education nationally. Some participants
suggest that making curriculum standard across the country can potentially work in
opposition to pedagogical explorations of Decolonial, Intersectional Pedagogies. As the
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findings above demonstrate, a significant determining factor for implementing Decolonial,
Intersectional Pedagogies is the correlation between accrediting associations, crowded
curriculum, and the growing call to redress health and social inequities.
Additional findings show that some teachers continued to bring their perspectives and
practices of Decolonial, Intersectional Pedagogies to Canadian NursMed Education whether
accrediting associations mandate them or not. I will further elaborate on how participants
engage in Decolonial, Intersectional Pedagogies in Chapter 6. In the next section, I examine
how they used their agency as members of public universities to integrate their political,
philosophies, and pedagogical values with the rights granted to them by another institutional
feature, Academic Freedom.
5.2 Academic Freedom in Canadian NursMed Education
The principle of Academic Freedom is central to the ability of teachers to bring
Decolonial, Intersectional Pedagogies and all forms of critical pedagogies into the classroom.
As described in Chapter 2, Academic Freedom has a long legacy in the founding of
universities and colleges as settler-colonial institutions of education in Canada. In theory,
teachers have Academic Freedom which means they/we have the right to pursue learning,
intellectual debate, research topics, and teaching philosophies without the fear of being
censored (Sultana, 2018; Williams, 2016). As with any policy, the practical implications of
Academic Freedom are subject to execution by senior leadership in relation to additional
members of the university or college. Manmeet, a teacher in Nursing, described the doubleedged sword of Academic Freedom:
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“I think one of the things about being an academia is you have so much academic
freedom that if you are so inclined you have the scope to teach from an anti-racist
perspective. But if you’re not so inclined there’s really no checks and balances to
make sure that’s happening other than dictated curriculum. Which you know
[NursMed] has not always attended to those concerns.”
In theory, Academic Freedom affords teachers who are interested in Decolonial,
Intersectional Pedagogies the protection to teach from what Manmeet described as “an antiracist perspective” without being reprimanded by colleagues or students. This is particularly
salient in relation to recent statements on anti-racism released by the Canadian Association of
Schools of Nursing and Association of Faculties of Medicine of Canada. In Chapter 7:
Findings C, I elaborate on how some members of NursMed schools react to these
perspectives in practice. Manmeet suggested that Academic Freedom supports teachers to
instruct students according to the teachers’ own philosophies, at the same time as foreclosing
possibilities for influencing others to adopt critical perspectives. Jagdeep, a teacher in
Nursing also shared:
“We developed a [new] curriculum in [year] and the goal was to ensure that we
incorporate social determinants of health throughout the curriculum. So I’ve asked a
few people how it is going and [they] said it’s not really going. I guess it has a lot to
do with, you know, people … Maybe it’s what you call academic freedom. They feel
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like they have free rein to teach whatever they want, but also some people are just not
equipped to teach it as well.”
Jagdeep had previously recounted how they used to teach a specific elective course
on what pinpointed as the social determinants of health (SDOH), which they described as
relevant to Decolonial, Intersectional Pedagogies in many ways. When their school went
through the most recent process of accreditation, according to the participant, they
“modified” their curriculum to fit the requirements laid out by the relevant regulatory
association. In one of these moves, Jagdeep’s department attempted to spread out teaching
and learning about SDOH across multiple classes. In the excerpt above, Jagdeep stated that
instead of having more opportunities to engage in Decolonial, Intersectional Pedagogies, the
school now has fewer opportunities.
According to Jagdeep, due to Academic Freedom teachers who haven’t had the same
training in critical pedagogies may not feel “equipped” to teach through Decolonial,
Intersectional Pedagogies, which can create a gap in curriculum. This point links to Dion’s
(2007) theorization of the ‘perfect stranger’, whereby pedagogy is “informed simultaneously
by what teachers know, what they do not know, and what they refuse to know” (p. 331).
Based on this quote and the interview excerpt above, some teachers in Canadian NursMed
Education may not include concepts such as social determinants of health in their courses due
to their own fears, reluctance, and/or pedagogical ignorance as conditions of the coloniality
of being. Kulwant, a participant in Medicine echoed Jagdeep’s sentiments:
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“It would be different, for example, if as part of the curriculum of your medical
school you will have the Indigenous knowledge or global health as an important part
where you will actually have a class every year that will allow you to be trained on
those aspects…
So I think that is, I think, the main issue. It hasn’t been incorporated into the main
curriculum. So people that are interested, have some sort of affinity with these topics,
you know, will gravitate to it, but it’s kind of on your own rather than being part of
the mainstream”
Here, Kulwant suggested that some teachers have an “affinity” to topics such as Indigenous
knowledge and global health. However, they also found that these topics are not considered
as part of the standard or “mainstream” curriculum.
On classroom observation suggests recent trends in anti-racism movements,
accrediting associations may suggest the integration of pedagogies such as Decolonial,
Intersectional Pedagogies into their requirements for all courses (Table 3). A quote from my
field notes expands on this claim,
“Two of my participant observations were in new courses, created in the last 2-3
years, specifically addressing the TRC Calls to Action. In their own ways, the classes
I attended explicitly unpacked the impact of settler-colonialism through the use of
particular pedagogies.
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I found that teachers would start by describing key theoretical concepts, then they
provided examples from their own practice and/or life experience, and finally they
asked students to reflect on their own clinical placements and/or learning in the
program to date” (Participant observation. June 4, 2019; September 30, 2019).
Here I noted how some Third Eye Seeing participants employed multiple strategies of
Decolonial, Intersectional Pedagogies. Notable, the teachers specifically centered pedagogies
to critically examine the TRC Calls to Action and their implications for all members of
Canadian NursMed Education. This point will be further analyzed in the next section, as
well as in the following chapters.
Some participants suggest that Academic Freedom blurs the line between Canadian
NursMed Education as employers of teaching faculty on one side, and public institutions
accountable to expressions of free speech. The grey area in between means that it remains
unclear whether senior leadership can dictate training for their teaching staff. For example,
Simranpal, an administrator in Nursing, shares,
“I know there are some people in our diversity group that think we should make it
mandatory that faculty do Equity, Diversity, and Inclusion training, and it is
something I'm exploring. And what I’ve learned to date is there are very few things as
a [member of senior leadership] you can make mandatory.”
Here Simranpal raises one of the most challenging aspects of Academic Freedom. In
the past 5 years, educational institutions and leaders are increasingly interested in creating
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diverse, inclusive and respectful workplaces and classrooms where all people feel valued,
heard, and safe. Yet, as the excerpt above demonstrates, senior leadership typically do not
have the ability to authorize mandatory training for all members of their departments, which
could support the intentions and philosophies behind Decolonial, Intersectional Pedagogies.
Diversity and Inclusion consultant Cicely-Belle Blain explains how training can support
organizations to collectively move past the initial resistance that comes with a more inclusive
work and institutional environment (Blain, 2019).
As the findings above demonstrate, Academic Freedom as an institutional feature can
allow Canadian NursMed Education teachers the flexibility to decide what perspectives they
are going to bring to their courses. The participants describe that ideologically speaking,
Academic Freedom can protect them as teachers from censorship or interference from the
government, the university, the college, the public and more. At the same time, they
summarize that Academic Freedom can work to prevent advances such as Equity, Diversity,
and Inclusion Calls to Action detailed in Chapter 2: Literature Review (Blain, 2019; Maxwell
& Lorello, 2020). In the following section, I examine how policies and actions taken at the
national level in the borders of Canada do have the capacity to intervene in some respects to
direct Canadian NursMed Education pedagogy.
5.3 Having an intervention: Responses to the TRC Calls to Action
Indigenous, settler, and arrivant relations and reconciliation are where many teachers
found themselves in the conversation about Decolonial, Intersectional Pedagogies in
Canadian NursMed Education. Notably, Arneet shares,
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“The real challenge in the system is to get the system to acknowledge Indigenous
specific racism and that really remains one of the biggest challenges as far as I can
see from my area” (Participant Interview, Mar 11, 2019).
Many participants referred to the TRC Calls to Action detailed in Chapter 2 as one
significant intervention that has challenged the settler-colonial institutions of Canadian
universities. As noted in the previous section, some participants described how as a direct
result of the Calls to Action their schools have implemented or are planning to design a
specific course to support Indigenous Peoples’ health and braid Indigenous knowledge and
modalities of healing into their pedagogies. In my view, this is a particularly significant
finding given the challenges of introducing new, mandatory courses, especially in
professionalized programs like Nursing and Medicine.
The Third Eye Seeing course observations demonstrate that there are a plurality of
facilitation techniques that can bring forward the TRC Calls to Action in Canadian NursMed
Education in emerging courses. I observed how one teaching team restructured an entire
series of lectures to mirror the 4 pillars of the TRC: Truth-Telling, Acknowledging,
Restoring, and Relating. Another teaching team hosted their class with an Elder and a
journalist in an earth-centered Indigenous learning center. The educators primarily used the
practice of storytelling, compared to didactic style lecturing as a philosophy of teaching.
Additionally, out of all the physical classroom spaces I visited, I felt the course held in the
Indigenous learning center most embodied the essence of “land based pedagogies” (Wildcat
et al., 2014).
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In the interviews, many participants described how their school responded to the
TRC. Indeed, the TRC Calls to Action provide a well-known reference point for participants
to situate their pedagogical stance. For instance, Kaladhar, an educator in Medicine
recounted,
“The TRC is a self-reflection of what can we be doing better as an institution and so
[NursMed school] engaged an expert panel of Indigenous scholars to do an
environmental scan of how we’re doing, and what we could be doing better. So that
we’re kind of always checking in with what are we doing, how are we doing, so that
we’re never staying stuck in the institutional, oppressive structures”
The participant suggests that the TRC process stimulated their school to engage in a
process of self-reflection. Their leadership drew on the wisdom, time, and energy of a group
of Indigenous researchers to provide input on where the program can improve. Akashpreet, a
teacher in Nursing suggests, “in the last couple of years, since the TRC happened, we've been
much more alert to settler-colonialism and been trying to think of ways to incorporate some
of that learning and that knowledge into the course so that students are aware of it.” In
another case, Prabjot, a teacher in Nursing, shares:
“I would say now it’s our everyday language, but does it mean that people truly
understand what it means? Is it just that some people are buying into the language
because it’s politically correct to pursue this agenda? or have people truly understood
that this is an agenda that we must pursue?
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Like in the TRC…some people truly believe that this is changing times for us in
education, in the work, in our society and some people think ‘oh it’s just, you know, a
transition that will settle’, and we’re giving space for people to grow but nothing
more can come of it. People don’t recognize that the TRC could change our policies
in the communities and in the country that we live in.”
The excerpt implies that Prabjot may have an ambivalent though optimistic
perspective about the TRC. At first, they referred to the people who (ironically) think that
current attention on the Calls to Action will die down and ‘settle’. Then, Prabjot went on to
explain that in their view the TRC has the capacity to shift the entire consciousness of
education, policy, and communities in the borders of Canada and beyond. Gianleen, a
teacher and administrator in both NursMed, echoed Prabjot’s sentiment. From their
perspective, the TRC has made available an abundance of wisdom that allows people to refer
to comprehensive documents when implementing forms of Decolonial, Intersectional
Pedagogies in everyday and institutional life - especially in relation to the impact of settlercolonialism on people’s health. In response to a question about their approach to pedagogy,
Gianleen shared,
“I rely on other thought leaders who have contributed to things like the Truth and
Reconciliation Report. That's representative of international discourse among
Indigenous people that informs the United Nations Declaration on the Rights of
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Indigenous People for example, and the Royal Commission on Aboriginal Peoples in
this country that was released in the early '90s.
So those voices and those stories inform who I am today, and they also inform my
work. So I feel very grateful to the first wave of academics like Marie Battiste and
Sakej Henderson and now we have emerging thought leaders who are blazing trails in
the area of Indigenous health research. You know, Marie Kovach and Shawn Wilson
and others. So I situate myself in my identity and my experience. I draw from my
colleagues and I uphold the voices of Indigenous Peoples around the world through
processes that I trust.”
Gianleen’s discussion above indicates that they have leaned into the expansive
collaborations alongside written, oral, and visual teachings made available through the TRC
process. Their tone and choice of words signal that the TRC has created a larger knowledge
base that can inform Canadian NursMed Education. An analysis of Gianleen’s quote above
suggests that the TRC Calls to Action can be used as stepping stones for multiple pathways
towards “decolonizing the mind” (Barker, 2018), pedagogies, and policy. In contrast, an
excerpt from Jasleen, a participant in Medicine, suggested their caution regarding the
outcomes of the TRC:
“I am deeply skeptical about the TRC. The TRC is not a point of reference in my
ongoing work around issues of colonial violence […] You know [Royal Commission
on Aboriginal Peoples] was around 20 years ago. None of the goddamn suggestions
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were ever followed through on. I’m absolutely convinced unfortunately the TRC will
go the same way.
So, I want to just be very specific that I don’t anchor my work at all in the TRC. I
think it occasionally right now offers some convenient language through which to
enter conversations that have been going on in this country for decades.”
The participant refers to their “work”, which includes teaching, community engagement, and
research. As Jasleen reiterated, conversations and practices of Indigenous sovereignty and
rematriation of land has been happening since the early days of settler-colonialism in Canada
and beyond (Tuck & Yang, 2012; Young Leon, 2017). In the past 150+ years, the material
realization has grown even more complex as people from the Middle World, the Pacific
Islands, and, the Global South/East migrate to Canada on the spectrum of full choice to full
displacement (Ansary, 2009; Dhamoon, 2015; Klassen, 2015).
On the note of global migration, Kirpal, a teacher in Nursing, responded to questions
of Decolonial, Intersectional Pedagogies in Canadian NursMed Education with an example
of how they experience doubt towards the possibilities of operationalizing ‘decolonization’,
as described in the TRC. They shared, “it cannot be, you cannot decolonize. Like, basically,
if you could turn back 500+ years, then that's decolonization. You cannot decolonize.
Right?” Kirpal speaks of seemingly the impossible nature of erasing memories from the land.
However, the TRC Calls to Action describe that some perspectives on decolonization can
also take the approach of healing traumas, pluralizing worldsenses, and evolving into the
future together.
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Part of this evolution and adaptation, as outlined in the TRC, can involve a
decolonization of our mindsets, health care, spiritual practices, and ways of being in relation
to each other’s bodies. Through the mission of the TRC Calls to Action, I notice that
participants refer to an increasing level of time, energy, and financial resources going into
disrupting the didactic, secular style of education that has dominated Canadian NursMed
Education pedagogies in the last 150+ years.
To move beyond epistemological hierarchies, the classroom observations also show
how some participants are braiding some ancestral traditions and ceremonies into their
pedagogies, alongside more biomedically oriented courses. Some participants reported
instances where they themselves and colleagues are bringing the practices of burning herbs,
meditation, and leaving the confines of the physical classroom to go outside – which they
name as part of Indigenous healing modalities - in accessible ways to their programs.
Notably, while there are some mentions of the spiritual connections of these practices, I
observed that they are engaged with in a largely secularized way.
This raises questions and anxieties about where certain practices or even fields of
research fall on the spectrum of cultural appreciation to appropriation. Notably, Manjit, an
educator in Nursing, spoke of the importance of explicitly locating our own names and
positionalities in the classroom in order to address this dynamic. As well as explicitly
honouring the diverse positionalities of the authors, storytellers, healers and artists whose
work we bring into the classroom. They share:
“At the same time there has been a lack of recognition of positionality [of researchers
racialized as White], their power in doing that work, and not explicitly naming that.
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So when I go up I always say, you know, I’m a racialized [as a person of colour]
settler. I was born in the [Global South] and I am here on Treaty [number] territory.
I’m doing research with these groups and this is who I am.
And I did not see that kind of explicit acknowledgement from all researchers working
with Indigenous groups…That’s as explicit as their privilege, in saying I’m a white
settler with a lot of privilege, with a PhD, working in a powerful institution and
working with these organisations, these communities, and I give them money, you
know?”
The seemingly de-politicized, de-identified engagement of research and practice with
Indigenous Peoples’, spirituality, land acknowledgements, and more is an emerging field of
research inquiry (Hurley & Jackson, 2020; Ozano & Khatri, 2018; Shaw et al., 2020). For
now, I posit that, in general, these findings illustrate how the TRC Calls to Action may be
used to contribute to dialogue regarding the ongoing development of Canadian NursMed
Education. In the next section, I pivot from examining barriers and facilitators of Decolonial,
Intersectional Pedagogies for teachers, to an institutional feature that can dictate the
positionalities of people in classrooms, and the possible reception of Decolonial,
Intersectional Pedagogies.
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5.4. Who Gets to be a Nurse or Doctor? Admissions Processes
The Third Eye Seeing participants describe how the receptivity of Decolonial,
Intersectional Pedagogies in Canadian NursMed Education can be strongly influenced by the
social locations and life experiences of students. Moreover, many participants connect social
processes with the people who end up in classrooms. I observed that the presence of multiple
screens and digital technologies may also influence the receptivity of Decolonial,
Intersectional Pedagogies, which is further discussed in Chapter 7: Findings C.
According to some participants, in the current conditions of Canadian NursMed
Education, students’ perceptions of their own privilege can influence their capacities to pick
up teachings from Decolonial, Intersectional Pedagogies. Akashpreet, an educator in
Nursing, shares their experience of exploring pedagogies that support students to learn about
their own privilege and unlearn certain ways of approaching topics in Indigenous Peoples’
health or global health:
“And I've had similar situations where students have thought that for whatever reason
okay, I'm going to write about Indigenous health issues or global health issues and
they do it so poorly. You think what! no, none of that, just no, it's just not okay. And
so that's a challenge.
I then feel as if I need to go back into the classroom and sort of and try and talk about
without belittling, with criticizing, without making, you know, anybody feel small to
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sort of say, you know, this is so important to people's lives and way of being in the
world.
You need to bracket your privileged perspective or whatever perspective you come
from. You know, maybe I need to bracket my perspective as well sometimes when
I'm talking about things. But you need to get out of your head sometimes and stand in
the shoes of the person who you're talking about in order to just fully understand what
it is that you're saying. And that you recognize you're not hurting in your teaching.
That's kind of a challenge. Encouraging, nurturing, mentoring student's young minds
to recognize that their little, tiny kernel of a world, which has been so insular, is about
to be blown to smithereens. And they need to be able to step outside of that in some
way that is comfortable and not terrifying, to be able to sort of start to begin to
understand other people's perspectives.”
From another participant’s perspective, the conventions of medical school admissions
prepare students to feel as if they are already incredibly knowledgeable and reproduce the
image of a medical doctor as an all-knowing expert. Jasleen, a teacher in Medicine, explains:
“If I could wave a magic wand […]I would fundamentally alter the way that
admission processes look to medical schools and I would make it a lottery system. I
would have no emphasis on the kind of rarefication of people who achieve the status
of entry to medical school… People who are admitted into medical school in
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[province/territory] their first lecture, the first sort of hint that they get about the next
four to 10 years of their undergraduate education and residency is you are amazing.
There were 4,000 applicants and you, you beat them all, you're special, you're
amazing, you're into this culture and community that is, you know, hard fought for
and is doing some of the most important work in the world, you're a winner. And that,
to be really frank, makes me want to puke and it makes me want to puke because I
think that kind of messaging is innately tethered to a colonial hierarchization of
professions and careers.”
Here Jasleen describes how medical students are directed towards an ego-centered
mindset from the first day they enter the school. The participant then goes on to state the
uncomfortableness and unease they feel with this model of pedagogy. Jasleen implies that
putting medical students on a social pedestal reproduces hierarchies that situate medical
doctors as the ‘winners’ of our society.
The racialized aspects of admissions and mentorship are definitely one social relation
that impacts the entrance customs and institutional culture of university-based Canadian
NursMed Education. As I have discussed in prior papers (Bhandal, 2016, Bhandal, 2018),
both medicine and nursing have hxrstories of excluding communities racialized as
Indigenous Peoples and/or people of colour from their schools, which in connection with
other exclusionary forces, has hxrstorically meant little to no representation in senior
positions in the profession. There are some teachers racialized as Indigenous Peoples and/or
people of colour who have carved their way into Canadian NursMed Education, and recent
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anti-racism movements have catalyzed the hiring of more diverse teachers. Moreover, there
are also strong allies racialized as White who have worked in solidarity to promote the
representation, hiring, retention, and advancement of teachers racialized as Indigenous
Peoples and/or people of colour.
The findings suggest that ongoing racialized hierarchies in faculty positions are
examples of continuing settler-colonialism in Canadian NursMed Education today. For
instance, many of the participants I spoke to were the only people racialized as Indigenous
Peoples and/or people of colour in their departments. The institutions are grappling with the
implication of shifting demographics, economic disparities, and politics. In one participant
observation of a virtual classroom in Medicine, I witnessed a slow uptake of critical
pedagogies to address these complex issues in health and social equity. In a field note, I
explained,
“The virtual classroom I observed was broken up into 9 different modules. Each
presented an important aspect of global health including: environment and climate,
health systems and policies; and non-communicable disease.
The information presented provided in-depth knowledge about methods of disease
transmission, sanitation, and even how to conduct research.
I could not help but notice the intersections of racialization and capitalism coming up
in the visual and discursive elements of the classroom. Under the non-communicable
disease module, the header image depicts children sitting in an outdoor classroom,
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cross-legged on the ground, in a South East Asian or East Asian setting. The text also
references high-income, middle-income, and low-income settings.
In another module, the text and images create a clear picture that global health means
that teachers and students from settler-colonial countries like Canada travel to ‘treat’
communities deemed under-served and/or poor, primarily in the African continent
and islands, parts of Asia, and South America.” (Participant observation, September
12, 2019).
In this way, the hierarchies described in the NursMed faculty in the previous paragraph are
reminiscent of global hierarchies across the intersectional relations of racialized identity and
socio-economic status depicted in the global health classroom. These observations are
consistent with emerging evidence in the borders of Canada that show racialized inequities in
academia, particularly across the intersection of financial compensation (Henry et al., 2017,
p. 34).
Student admissions and mentorship can impact who gets into Canadian NursMed
Education, which then can determine who will become an educator in the programs.
Stemming from their own personal experience as a student in nursing, Manjit, a teacher in
Nursing shared,
“I went into nursing and, like, fulfilled the stereotype of being a nurse [racialized as a
person of colour]. What are the odds? It’s so amazing and just, like, so terrible. I just
... anyway, so that really ... that bothered me for a long time. And then now I’m
actually really happy about that
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Where I did all my schooling, I didn’t ever come across a teacher [racialized as a
person of colour] in my program, even though so many are nurses or LPNs. We don’t
see the same representation. And certainly I was never encouraged, in any of my
programs, to pursue leadership. People of colour are socialized to fill the lower ranks,
even in nursing.”
Manjit describes how as a student racialized as a person of colour in a Nursing school, they
felt that they were not mentored to follow a path to being a teacher and/or take a leadership
position in their program. Here it is important to note the legacy of “whiteness” in Canadian
Nursing programs (Puzan, 2003). As I have explored in previous writing, Indigenous
Peoples and people of colour were largely excluded from Canadian NursMed Education for
the first half of the 20th century (Bhandal, 2016). Though admissions processes have
changed over the last 50+ years, Manjit’s comment above alludes to the continued racialized
inequities within nursing schools and health care settings. Premji and Etowa (2014) found
that nurses who identify as visible and linguistic minorities are underrepresented as Nurse
Managers and Head Nurses, and instead are overrepresented as nurse aids, and in more
challenging nursing fields such as long-term care and mental health (p. 82). Despite these
challenges, Manjit, the Third Eye Seeing participant, goes on to say that even just in the last
5 years the approaches to Canadian NursMed Education admissions are shifting and
adapting. For instance, leaders in the field have called on nurses racialized as white to move
beyond performative activism and meaningfully engage with anti-racist and decolonial
allyship in the field (McGibbon, 2014; Thorne, 2022).
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Due to changing political agendas, expansion of patient voices and community
involvement in health care, the impact of the TRC, and interventions by social justice
movements such as Idle No More, Black Lives Matter, and No One is Illegal, the
representation of students and faculty racialized as Indigenous Peoples and/or people of
colour may be increasing. Participants describe that nowadays some schools are taking
affirmative action policies more seriously, with the aim to admit and mentor students from
diverse ancestries. Lavindeep, an administrator in both NursMed described a program at
their school that intervenes at the high school level,
“the idea is to engage high school students to be involved in health programs in
general because there is almost no representation of [people racialized as Indigenous
and/or people of colour] in both [NursMed], and through that [our] work is to make
sure that we increase the numbers, and we have a collaborative relationship with the
community.
We want to make sure that the policies for admissions for instance are equitable so
that they allow a positive experience for the students to come on campus and be able
to be interested in health programs… If a youth wants to be a doctor let’s say for
instance, when they go to their doctor they never see a doctor who is of their
background. So by engaging with the community and trying to promote such
programs we’re trying…It’s a start I would say.”
In this excerpt and in other parts of the interview the participant explained that in
their geography, there is under-representation of nurses and doctors racialized as Indigenous
Peoples and/or people of colour. They recount how their office, which operates with an
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interprofessional global health mandate, is making efforts to work with diverse students at
the high school level to help prepare them to have successful applications to Canadian
NursMed Education. From the perspective of an admissions committee member in Nursing,
Simranpal explained,
“Recruitment and admission policies to the programs are another thing that we’ve had
to take a look at. And needing to realize that not every student that applies has had the
same advantages, right. So it’s not that you're setting a separate standard, it’s that
you're sort of recognising that students may not have had the opportunity to achieve a
certain level.”
Increasing the representation of teachers and students racialized as Indigenous
Peoples and/or people of colour in Canadian NursMed Education does not necessarily
translate to a diversity of critical pedagogies such as Decolonial, Intersectional Pedagogies.
Nonetheless, it does open up the possibility for collaboration, knowledge sharing,
mentorship, and solidarity building. Kulwant, a teacher in Medicine described in detail,
“The issue of diversity makes society advance to a greater degree in all areas of
human activity, you know, and that is it really goes basically to the fundamental
concepts of genetic diversity. When you have genetic diversity the ability to survive
and ability to develop is much greater than when the genetic diversity is poor. And
that is very specifically in plants for example or crops where one type of crop can be
destroyed or completely wiped out by a specific infection for example of a parasite or
climate, but a diverse crop that has really great genetic diversity is able to better
survive all attacks of both nature and climate.
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And it’s the same thing in the culture. Bringing diversity to teaching, understanding
the reality of the world in terms of what happens and how that influences our own
world and our own environment, is an important thing. It actually creates better
physicians. Physicians that have an ample mind, that are able to recognize the value
of different cultures, different races and different traditions are more effective
physicians than physicians that will have a more narrow-minded approach to practice.
In the end, you know, medicine is a profession of service and it’s a service to others,
not to yourself and that’s one of the issues, you know, in terms of what type of people
we choose to admit to medical schools. But overall, as a professional service, your
ability to understand better your environment, to understand diversity, to bring
diversity to your practice makes you overall a more effective physician and I think
that has to be encouraged in traditional curriculums, in all health care professions
from nursing to physicians and that is, I think, very important.”
As participants like Kulwant consider the implications of conventional admissions
processes, some describe how some students are also championing the cause of redressing
health and social inequities. Harpreet, a participant in Nursing, discusses the interest and
drive that some students have in their classes to unpack and address settler-colonialism in
their learning:
“It’s been really wonderful because it’s kind of come from the bottom up. So we had
a group of [NursMed] students that attended one of the Canadian [NursMed]
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Students’ conferences and they met a woman who did this beautiful experiential
workshop…And they came back and they said [name] it was just so amazing. We
have to have this here. Our students need this.
And so I worked with them and we applied for some funding and they were
successful. And so they brought [person], from [place] to [city], on several occasions
to help the [NursMed] students really have that experience of being a member of an
Indigenous village and going through colonialism…And then have conversations
about how, in their future practice, as leaders in healthcare organizations, how they
were going to try and establish relationships and use traditional values.”
In the excerpt, the participant describes how some students are advocating and
prioritizing the need to approach Canadian NursMed Education from the principles of
decolonization, intersectionality, and health equity. Going back to admissions as an
institutional feature of NursMed schools, the story above demonstrates how admission of
students with an interest and passion for social justice can impact how teachers also engage
with Decolonial, Intersectional Pedagogies.
5.5 Summary
Institutional features are factors that influence the environment in which teachers
apply pedagogies such as Decolonial, Intersectional Pedagogies to inform Canadian
NursMed Education. The main features that emerge from the interviews and observations
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include: accreditation and strategic planning; Academic Freedom; TRC Calls to Action; and
student admissions. Each of these elements is interconnected with the others and influences
teaching philosophies. Accrediting associations can dictate which worldsenses on health,
standards of practice, and curricular content are prioritized. Moreover, entrenched
institutional conventions may influence the ideological and demographic make-up of the
faculty and student body. At the same time, community and global movements, such as the
TRC process, generate a public discourse that demands attention to issues of social justice in
everyday pedagogies.
The participants’ stories in the interviews, and observations of classrooms
demonstrate the tensions inherent in the work of transforming how nurses and doctors are
taught to provide health care. The logics of settler-colonialism seem to facilitate the
management of Canadian NursMed Education classrooms which may privilege a single
worldsense of health and education over pluralism. Within this context, teachers and
students attempt to implement Decolonial, Intersectional Pedagogies with the aim of
critically reflecting on health through the lenses of settler-colonialism, health equity, and
social justice.
The interview excerpts and observational summaries in this chapter suggest that the
participants are working within academic structures to: navigate, adapt to, and evolve the
institutional features and modern structures; increase the representation of teachers and
students interested in Decolonial, Intersectional Pedagogies, especially those racialized as
Indigenous Peoples and/or people of colour; and bring forward pluralistic modalities of
healing. In some senses, I posit that Third Eye Seeing participants of all ancestral lineages
are working to “understand and enact their relationships to knowledge and learning as acts of
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a collective countering of coloniality” (Patel, 2016, p. 9). In the next chapter, I will explore
some current efforts being undertaken within Canadian NursMed Education to actualize
critiques of self, critiques of the collective, and the unlearning of coloniality in the classroom.
How teachers incorporate, package, and deliver Decolonial, Intersectional Pedagogies in the
conditions afforded to them will also be discussed further in the following chapter.
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Chapter 6: “We Need to Take Responsibility for Our Own Education”:
The Complexities of Integrating Decolonial, Intersectional Pedagogies
In this chapter, I aim to feature an analysis of the participants’ discussions regarding
the complexities of integrating Decolonial, Intersectional Pedagogies. I also highlight
observational data which provide examples of how teachers’ attempt to engage these
pedagogies in everyday settings. The interviews and observations took place during a
particular period in time (insert dates), and across the participants’ various positionalities and
teaching contexts in Nursing and Medicine.
I share interview excerpts and fieldnotes that represent three keys themes: 1)
circumventing culturalism as a primary pedagogical lens in Canadian NursMed Education; 2)
the impacts of Equity, Diversity, Inclusion and Truth and Reconciliation Calls to Action on
the integration of pedagogies centering critical reflections of settler-colonialism, health
equity, and social justice, and 3) the participants’ attempts and strategies for engaging
Decolonial, Intersectional Pedagogies in practice.
6.1 Struggling with ‘Culture’: Circumventing Culturalism as a Pedagogy
The findings presented in this chapter provide some evidence on the inherent
complexities of approaching pedagogy through Decolonial, Intersectional Pedagogies in
Canadian NursMed Education. As discussed in Chapter 2: Literature review, over the past
four decades of Canadian NursMed Education, the notion of differences in ‘culture’ as the
route to discuss health and social inequities tends to be the primary entry point into dialogues
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about Decolonial, Intersectional Pedagogies in Canada (Bannerji, 2000; Reimer-Kirkham,
2002; Anderson et al., 2003; Haque, 2010; Hilario et al., 2017). Notably, I heard how
participants negotiated and counteracted the ongoing gravitational pull towards ‘culturalism’,
as they sought to focus on critically examining settler-colonialism, social justice, and health
equity in their classrooms.
To begin, Tejbir, an educator in Medicine, responded to a question about culturalism.
The excerpt is illustrative of their struggles to get out of the trap of culturalism in Canadian
NursMed Education,
“I tried to write a critique of transcultural nursing. I’m sure you’re familiar with that
theory. And I sent it off and the reviewers wrote back and said that they doubted very
much that I had even read the articles that I was critiquing because I had missed the
point. And I thought, “Oh my god.”
Since then, I hate the idea of things like cultural competence because it’s like this
checklist that we only apply to other people. It’s like a recipe book because if I know
what somebody from Delhi likes to eat, then I will understand their culture or
something…And yet we talk about cultural safety now and who gets to be safe, we
decide what is safe. So I don’t like culturalism, I don’t like transcultural nursing
theory. I just don’t think we’ve got it yet. I don’t think we have it figured out”
(Participant Interview, Aug 9, 2019).
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The participant expressively refers to the aversion they have towards cultural
competence and transcultural theory, which they believe can often take a checklist approach
to understanding how people’s diverse ancestries and geographical locations influence their
health. An analysis of the excerpt suggests that popular theories in Canadian NursMed
Education have the potential to position one group of people to be the cultural standard that
“other people” are measured against, without understanding the structural components of
health. Anderson et al. (2003) describe how critiques of culturalism can enable teachers and
students to move away from,
“exotic belief system of people from different ethnocultural backgrounds, and treating
each group as a distinct entity, we are challenged instead, to examine the unequal
relations of power that are the legacy of the colonial past and neocolonial present, and
the ways in which the cultures of dominant groups have redefined local meaning, and
dictated social structures, including health care delivery systems ” (p. 197).
In this way, Tebjir’s story conveys a striving to move beyond culturalist understandings of
health and social inequities, towards a “critical analysis of colonialism…and how
conceptions of culture have been constructed within particular historical and colonial
contexts” (Anderson et al., 2003, p. 199).
Kirpal, an educator in Nursing also critiqued the concept of ‘cultural inventories’ to
show the limits of culturalism and how problematic these common place heuristics are,
despite their continued prevalence in mainstream curriculum,
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“We have a [teacher who] did exactly that. Chinese people, there's a list. Indian
people, here is a list. The Arabs, here is a list. This is what you look for—don't do eye
contact, don't do that, don't do this. That was in the '90's, and it, and sadly it's still
being taught. The degree to which I bring stuff like that in is to critique it, to say
here's what we don't do.” (Participant Interview, July 12, 2019).
In the excerpt above, Kirpal described some of the challenges of attempting to
implement Decolonial, Intersectional Pedagogies. From what I understand, the participant
discusses how some teachers in their school continue to approach topics like health equity
through fixed, unchanging beliefs about people from diverse geographies. To intervene,
Kirpal introduces critiques of this way of thinking as a pedagogical strategy.
Turning to another example, Manmeet, an educator in Nursing, recounted their first
attempts to discuss the complexity of Indigenous Peoples’ health in the classroom,
“I learned the secret to teaching from an anti-racist perspective in about [year]. I was
at [school] and I was assigned to teach a course called culture and health. And I did it
poorly and I got incredible backlash.
I did a number of things wrong, the first thing that I did was I really tried to have
diverse voices and so, I made a bunch of mistakes. I invited guest speakers. I wanted
guest speakers [racialized as Indigenous and/or people of colour] and so on, but
because the course was organized around health issues, it ended up not working very
well…
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This was not intentional on my part, but I invited a woman who was a diabetes
educator and an Indigenous person to come and speak about diabetes. And I invited
somebody who was on the HIV team to speak about women or speak about HIV and
she was Indigenous. And so, I inadvertently ended up kind of aligning a lot of the
stigmatizing health issues with Indigenous Peoples. And that created quite a problem,
that was one mistake” (Participant Interview, April 4, 2019)
In the excerpt above, Manmeet names how they used to have colleagues also who
self-identified as Indigenous Peoples come in as diabetes and HIV/AIDS educators, with the
intention of having people with lived experience talk about the topics. However, the
participant very honestly shares how, in hindsight, it was a mistake to bring in guest speakers
who shared knowledge on health conditions that were considered stereotypical of their
racialized identities. According to the literature, Manmeet’s early attempts to support
Indigenous Peoples’ health may have contributed to the ongoing ‘pathologizing’ of
Indigenous communities (Duran & Duran, 1995, p. 21; Hutcheon & Lashewicz, 2020;
Shields et al., 2005; Valencia, 2010). In the interview excerpt, I surmise that inadvertently
pathologizing can take the form of continuously pairing guest speakers from specific
communities with health outcomes that have particular social stigmas and negative
connotations attached.
In these ways, teachers, even those with intentions to find ways of helping students to
grapple with the complexities of health and social inequities, run the risk of unconsciously
portraying Indigenous Peoples as necessarily ‘sick’ without acknowledging colonial legacies
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such as land theft, displacement, and epistemological erasure. The pathologization process
can promote complicity in settler-colonialism by reproducing and reinventing trauma that is a
direct result of colonization experienced by Indigenous Peoples (Linklater, 2014, p. 2). It has
been shown that biomedical models of health in Canada continue to pathologize Indigenous
communities (Ahenakew, 2011). Overall, Manmeet’s narrative illuminates the limitations
and potential for harm caused by culturalism as a lens, and moreover, the potential for
unlearning culturalism and evolving towards Decolonial, Intersectional Pedagogies.
Early on in the fieldwork, I visited a newly offered class on promoting Indigenous
Peoples’ health. Almost identical to Manmeet’s story above, a guest speaker came to share
knowledge about health services provided by the Canadian health care system with and for
Indigenous communities. The fieldnotes conveyed the following narrative,
“The guest speaker is sharing really important information about the relationship
between the Canadian health care system, settler-colonialism, and the role of nurses
in treaty relationships. Their main focus is on outpost nursing in rural communities,
where nurses have more autonomy over meeting community health needs than in a
typical hospital setting.
However, the lecture quickly turns to the impact of settler-colonialism on Indigenous
Peoples’ health in quite a pathologizing way. Without highlighting the strengths,
resilience, and practice of Indigenous ways of healing, the guest speaker lists
pathologies of mental health such as ‘suicide’, ‘fetal alcohol spectrum disorders’,
‘drug abuse’, as common ‘diseases’ in need of health care.
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I physically feel myself contract. I’m acutely aware of how family members cope and
manage embodied trauma and violence with particular medicines. I wonder if the
students are able to sense that part of the work of reconciliation is to unlearn violent
ways of relating to our Indigenous neighbours and hosts?” (Participant observations,
June 4, 2019).
In the observations, I noticed how the examples they shared about nurses providing
programming in rural Indigenous communities focused on the topics of taking one’s own life
(worded as suicide), parents use of alcohol (worded as FASD), and some members selfmedicating using cannabis and additional medicines. As someone whose biological family
experiences significant mental health differences and addictive qualities, I was particularly
sensitive to witnessing these examples, as I know that people of all ancestries experience
‘suicide’, ‘FASD’, and ‘drug use’ in their families. In a recent paper, Gray (2016) discusses
how framings of mental health, such as the one described in the fieldnotes above, can be used
to legitimize settler-colonialism by “reinforcing stigma, myths, and stereotypes of Indigenous
Peoples through the deterministic and fatalistic language of ‘mental illness;” (p. 81).
Unintentionally, settler-colonialism can be perpetuated in the classroom through culturalism
and the pathologization of Indigenous Peoples (Duran & Duran, 1995, p, 21; Shields, 2005,
p. 5), drawing into question the limitations of conventional pedagogical approaches
(Ahenakew, 2011).
On a related note, I observed an online classroom in Medicine with a focus on global
health. The following portion of fieldnotes describe a visual narrative being conveyed in the
classroom through photos, videos, and text,
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“Many of my colleagues committed to Decolonial, Intersectional Pedagogies state the
importance of crediting artists, writers, storytellers, content creators in our teaching
practice. Yet, I notice that none of the images list the name of the photographer or
indicate the positionality of people in the photos. Moving past the missing captions, I
start off on the maternal and child health page.
First image: two young adult women racialized as White look over at two girls
racialized as Brown (not sure where they are, could be somewhere in South Asia?)
who are not wearing shoes and reading a book written in English. They sit on steps
made of cracked concrete.
Second image: one young adult woman racialized as White wears a tank top, shorts,
and runners while holding a piece of paper and pen in her hand. She looks like she is
engaged in conversation with an older woman racialized as Brown (maybe from
South America) wearing a long skirt, layers of fabric, with a somber expression.
Almost every single page of the course goes on to look like this” (Participant
observation, September 12, 2019).
In the observation above, the gravitational pull towards culturalism comes through the
implication that people in the Global South/East are poor, unclean, and in need of
intervention from the Global North/West. In this way, the classroom is “inscribed by
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colonial constructions of the non-Western “other” and the Western self…that underpins
popular discourses on culture” (Reimer-Kirkham et al., 2002, p. 224). I suggest that the
choice of images reveal a subtle story about global power relations and health equity. To
further this point, from their experience in the classroom, Harpreet, a teacher in Nursing,
shared,
"Students really talk about why it’s really important to learn and, kind of, navigate
how to communicate with someone who comes from a different culture than your
own, and that the patient is the only one who could declare that yes, that was a
culturally safe encounter.
But I’m still ... I still kind of think of the responses as a little bit naive, because
although they might say, you know, one size does not fit all, they make a lot of
assumptions based on what they’ve read in the textbooks. Students say they’d like to
have more information about various cultures ... so parts of me thinks that they’re still
looking at cultural safety from an essentialist point of view” (Participant Interview,
April 18, 2019).
Here Harpreet brings up the notion of essentialism17 and cultural safety. As defined in
Chapter 2, cultural safety emerges from a lineage of Māori nurses who critically examine
power relations in health care settings. In a review of the excerpt, I believe Harpreet is
17
Essentialism is a framework that depict heterogenous groups as homogenous even though they are made
up of “people whose values, interests, ways of life, and moral and political commitments are internally plural
and diversity” (Narayan quotes in Matthes, 2016, p. 355).
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suggesting that despite their critical pedagogical efforts to go beyond cultural essentialism,
often textbooks and course materials can reinforce a static understanding of culture. As such,
the interplay of lectures, textbook readings, online learning modules, and clinical placements
can increase the complexity of implementing Decolonial, Intersectional Pedagogies in
Canadian NursMed Education.
To counteract the pull towards culturalism in their pedagogy, Jasleen, a teacher in
Medicine, shared their approach to clinical placements,
“So, they are not allowed to prepare, they’re not allowed to go in with their happy
smiling anti-type 2 Diabetes smoking cessation, yoga practice, healthy dietary,
medical student expertise. They’re not allowed to do any of that. They go in
specifically not knowing anything and very poorly prepared.
This causes no end of panic and anxiety for a bunch of principally white, often
racialized of colour, but definitely not Indigenous Type A medical students from
across the province. They are worried shitless and that’s great, that’s actually part of
the process in my mind pedagogically of sort of unhinging them from their
comfortable position of expertise which often involves pathologizing Indigenous
people in communities ambivalently or unconsciously even.
In my mind, that is how power accrues, it’s how things like patriarchy accrues, it’s
how heteronormativity accrues. It accrues by offering itself as a logical coherent set
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of structures and systems. So, to unravel that is actually to come at all of this from a
remarkably uncertain position of not knowing” (Participant Interview, May 7, 2019).
Here Jasleen describes their intentional philosophy of teaching students to go into their
clinical placements without preconceived notions of what health challenges and wellness
successes will be present in communities. Again, the concept of ‘pathologizing’ comes up as
a point of contention for Jasleen. The participant goes on to suggest that “power accrues”
through assumptions made about patients based on nurses’ or doctors’ perceptions. Based on
one understanding, Jasleen approaches Decolonial, Intersectional Pedagogies by promoting
an “unlearning of colonial practices and mindsets” (Kluttz et al., 2020, p. 49).
The literature reveals that unlearning settler-colonialism necessitates taking a political
stance in everyday classroom and health care settings to gesture towards Decolonial,
Intersectional Pedagogies. Akashpreet, a teacher in Nursing, shared,
“I guess it's one of the reasons why I talk about nursing as a political act. I'm not
asking you to be a politician, I'm asking you to think about the position of leadership
that you have as a nurse, the position in society that you have as a nurse to influence
others’ behaviours or to influence what's going on in the world around you.
Yeah and I think that some of them do get it and all I can do is hope that at some
point down the road they go, oh that's what [name] was talking about. They'll start to
see ``oh okay so that is what that's all about, that's that piece that is bigger than just
me, bigger than just me as a nurse” (Participant Interview, Feb 26, 2019).
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In the excerpt above, the participant names the practice of nursing as a “political act”. They
go on to discuss students’ position and the role nurses play in shaping society. In this way,
an analysis suggests that Akashpreet is attempting to move beyond uncritical interpretations
of culturalism in the classroom, and to encourage students to take a politicized approach to
their practice that considers people’s positionalities in society.
Despite all the intricacies and entanglements that arose in the process, overall I
witnessed a strong sense of diligence towards critical perspectives and attempts to implement
Decolonial, Intersectional Pedagogies. The gravitational pull of culturalism continues to
exist, however the capacities of teachers to shift towards critical perspectives are growing. In
the following section, I present an analysis of how two additional commonly circulating
discourses and policy documents, Equity, Diversity, and Inclusion and Truth and
Reconciliation Commission, contribute to dialogues and practices of Canadian NursMed
Education development.
6.2 Equity, Diversity, and Inclusion, and Anti-Racism, and Truth and Reconciliation
shape teachers’ Efforts
I suggest Equity, Diversity, and Inclusion and Truth and Reconciliation Calls to
Action are two distinct fields of policy and practice that influence pedagogies in Canadian
NursMed Education, especially during the time fieldwork for this dissertation was conducted.
As discussed in the literature review, EDI and TRC are interventions and discourses in
Canadian settler-colonial consciousness, whose Calls to Action are taken up from fields
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ranging from health care to post-secondary education (Henry et al, 2017; Million, 2013;
Reading et al, 2016). In this section, I highlight excerpts from the interviews and
observations that demonstrate how pluralistic understandings of EDI and TRC Calls to
Action shape participants’ efforts to integrate Decolonial, Intersectional Pedagogies into their
dialogue and practice. In the year following Third Eye Seeing fieldwork, Anti-Racism has
been added in some aspects of EDIA (Equity, Diversity, Inclusion, and Anti-Racism) work.
Some aspects of the rise of Anti-Racism language is preempted and reflected in the
interviews and classroom observations.
6.2.1 Perspectives on Calls to Action: Equity, Diversity, and Inclusion and Anti-Racism
The participants’ choice of language suggest an emphasis on the three words ‘Equity,
Diversity, and Inclusion’ as verbal placeholders in conversations about pedagogies, program
structure, and student demographics related to the principles of Decolonial, Intersectional
Pedagogies. I notice similar language in the recently released statements from the Canadian
Association of Schools of Nursing: “Nurse educators are called to create inclusive, non-racist
environments for students…to ensure the delivery of equitable healthcare to all” (2020); and
the Association of Faculties of Medicine of Canada: “The AFMC is committed to…ensure
that our environments are diverse, inclusive, culturally safe and foster equity” (2020). In the
two policy excerpts, the reader can see the mix of vocabulary used to describe similar social
processes in Canadian NursMed Education.
Notably, many participants described and taught ‘diversity courses’. The Third Eye
Seeing findings and previous research show that many NursMed schools offer what I refer to
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as ‘diversity courses’ that touch on some aspects of understanding intersecting social
relations and histories in Canada (Guerra & Kurtz, 2017). Many schools have expanded
these courses to include conversations around Reconciliation, health care for refugees, and
other matters of citizenship, border imperialism, and racialization relegated to the seemingly
indefinite category of ‘diversity.’ In the interviews and literature, ‘diversity courses’ are
becoming increasingly mandatory for all students in Canadian NursMed Education,
compared to previous years where they were non-existent or offered as electives (Blackstock,
2017). In the observations, I witnessed the adaptations Canadian NursMed Education has
made in the last several years to attend calls for EDI.
To illustrate the seemingly ubiquitous use of EDI language, I present a few excerpts
from several participants in succession below:
Jagdeep: “I think there are a few people who happen to be members of diversity
groups, myself, you know, people who are from the LGBTQ community, people who
are Indigenous” (Participant Interview, May 7, 2019).
Tejbir: “I never thought strategically about doing this. I just knew that I liked working
with students who were interested in equity and diversity and social justice”
(Participant Interview, Aug 6, 2019).
Harpreet: “We have a course called Human Diversity, we cover health inequities and
the social determinants of health. So the health of immigrants and refugees are
addressed there” (Participant Interview, April 18, 2019).
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Prabjot: “It’s no longer just about colour, it’s about diversity, it’s about gender and
it’s about ethnic, you know, background, it’s about everything. So going back to your
question I don’t think we do as good a job because it’s a topic that people seldom
wanted to touch” (Participant Interview, Feb 15, 2019).
Akashpreet: “I'm generalizing grossly because there is some diversity in the class,
like I have 98% white and 2% other. But, you know, I guess – well when we first
started to see diversity in nursing classrooms it was the male, female kind of
diversity. It was like oh my gosh, we've got men in our classroom, what are we going
to do with this, how do we deal with this?” (Participant Interview, Feb 26, 2019).
Lavindeep: “I find that there’s still – and this is just because of my background as an
immigrant myself, seeing some topics of let’s say colonialism, some topics related to
inclusion, diversity – I find that there’s a lot of discussions going on related to the
topics. There’s not a lot of movement in terms of actions, right?” (Participant
Interview, Feb 21, 2019).
Kulwant: “I think again in a multicultural society the issue of diversity not only in
terms of your ancestry, your race, your culture, it is something that makes society
advance to a greater degree in all areas of human activity, you know, and that is it
really goes basically to the fundamental concepts of genetic diversity.
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And it’s the same thing in the culture. Bringing diversity to teaching, understanding
the reality of the world in terms of what happens and how that influences our own
world and our own environment, is an important thing. It actually creates better
physicians. Physicians that have an ample mind, that are able to recognize the value
of different cultures, different races and different traditions are more effective
physicians than physicians that will have a more narrow-minded approach to
practice” (Participant Interview, Feb 21, 2019).
The participants’ language in the excerpts above affirms that Equity, Diversity, and Inclusion
are terms that invoke dialogue about settler-colonialism, social justice, and health equity.
The excerpts above, especially from Kulwant, also point to the pervasiveness of “raciological
thinking”, even among teachers who are attempting to orient themselves towards Decolonial,
Intersectional Pedagogies (Gilroy, 2000, p. 30). It should be noted that this snapshot of
participant interviews precedes the calls and renewed attentions to anti-racism movement that
occurred in 2020 and continue in the current context. Since the completion of fieldwork
there has been a notable discursive shift in Canadian NursMed Education towards framing
policy and practice as ‘anti-racism’ (AFMC, 2020; CASN, 2020).
6.2.2 Perspectives on Calls to Action: TRC
The Third Eye Seeing findings also feature the Truth and Reconciliation Commission
(TRC) as a policy and discourse used to inform Canadian NursMed Education with particular
attention to the health impact of settler-colonialism on Indigenous Peoples and the land.
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Moreover, the TRC is one avenue through which teachers understand and attempt to integrate
Decolonial, Intersectional Pedagogies in practice. The TRC as an entry point into addressing
the ongoing health impact of settler-colonialism is also supported at the professional
organization level in Nursing and Medicine. For instance, a recently published discussion
paper by CASN is based on actions taken “to provide national support for reconciliation by
fostering reflection related to decolonization and Indigenization, and by offering direction to
schools of nursing in responding to the TRC Calls to Action” (2020, p. 3). The participants
suggest that moves towards decolonization are a direct result of institutional shifts made
possible through the TRC, which was detailed in Chapter 2: Literature Review and Chapter
5: Findings A.
To start with a notable example, Arneet, a teacher in Medicine, recounts a clear
example of how one should not to approach Decolonial, Intersectional Pedagogies. The
participant shared a story of students who self-identified as Indigenous women organizing a
town hall to address Indigenous-specific racism in their department. Arneet disclosed that
members of senior leadership intentionally shielded themselves from having to listen, bear
witness, and create actionable change based on the students’ perspectives. According to this
participant, rather than showing up for the principles of decolonization, the group of
administrators decided to schedule a mandatory meeting at the exact time as the town hall
such that none of their members were able to attend. The participant went on to say,
“So that kind of tells you. Indigenous people are always carrying the load. We
develop things. We do literature searches. We become the experts on how the settler
state wants to kill us and we define it, we articulate equity and we show it in the
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attempt that teaching settlers about their state on our lands and how it affects us will
make them change.
And that's why I eventually [left]... I figured that I could probably do more work
outside here embedded within my own community of Indigenous people rather than
embedded within the system” (Participant Interview, Mar 11, 2019).
The excerpt and narrative above is in congruence with recent literature on settler-colonialism,
which points to the notion that systemic change is only adopted by settlers when convenient
(Elwood, Andreotti, Stein, 2019). The participant also vividly details how settler-colonial
institutions such as Canadian NursMed Education, very often put the onus of implementing
Decolonial, Intersectional Pedagogies on teachers racialized as Indigenous Peoples. A
counter-action and refusal by senior administration to engage with Calls to Action detailed in
the Truth and Reconciliation Commission process marks a significant moment in the turning
point of Arneet’s experience of well-being in their school. The emotional and spiritual costs
of teaching through Decolonial, Intersectional Pedagogies will be further detailed in Chapter
7: Findings C.
In gesturing towards integrating pedagogies that attend to healing intergenerational
trauma and violence, some participants spoke of the ongoing resilience, activism, and deep
considerations of land that are continually embodied in Indigenous worldsenses. Evoking
reconciliation, Gianleen, an administrator in both NursMed, spoke about an Indigenouscentered curriculum that was in development at their school,
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“We developed a process whereby the first year was about relationship building, both
on and off campus. Keeping with a community-based approach, to be inclusive, to
involve diverse groups. We have [a] diversity of Indigenous communities…
[NursMed school]'s in the backyard of those communities if you will.
That kind of comprehensive strategic planning process was needed to establish trust,
further the relationships with our community partners towards the goal of integrating
or informing a curriculum that would make sense to students who attend here.
As part of the reconciliation process, we've developed a [name] working group. And
that is composed of those who have engaged in Indigenous-centric curriculum
development.
In the health science education environment, the clash of worldviews, with respect to
diverse ways of knowing and Western versus Indigenous healing systems, is the focus
of trying to achieve a curriculum and integrate understanding about spirit, Indigenous
ways of knowing, and healing.
So that is what is unique to Indigenous people is that we have a worldview that is
grounded in an acknowledgement in a truth that spirit is integrated in everything that
we do. And it's – it's a worldview that is grounded in the notion of flux and ongoing
evolution and harmony with the world around us. We're not siloed into thinking that
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our spiritual beliefs are something separate from education or any other sector or silo.
It's integrated into everything” (Participant Interview, April 5, 2019).
In the excerpts above, the participant shared the process of building meaningful relationships
with local Indigenous communities and recognizing the politics of land. The language of
decolonization is braided with institutional language like “working groups” and “curriculum
development”, which is reminiscent of a ‘two-eyed seeing’ approach (Martin, 2012). At the
same time, Gianleen also pointed to a “clash of worldviews” within Canadian NursMed
Education that can often create binary divisions between communities.
Pivoting to the responsibility that settlers and arrivants have to support the TRC Calls
to Action, Kirpal, a teacher in Nursing, described the resistance one must overcome in
service of implementing Decolonial, Intersectional Pedagogies,
“I feel like I have little authority over talking about Indigenous-settler relations or
Indigenous-settler discourse […] and there's a counter argument to that that says
enough with tokenizing Indigenous folks, and it's really exhausting for them every
single time, to talk about themselves, to be able to educate us.
We need to take responsibility for our own education and our own ignorance and
historical colonization and the consequences, and we need to just learn about it and
start to teach about it, and shift generations ourselves instead of exhaustingly drawing
on Indigenous folks and Indigenous resources to be able to educate us, because it's
been 500 years. Like, hello” (Participant Interview, July 12, 2019).
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The participant started off by sharing how they feel that they have very little
command to teach what they described as Indigenous-settler relations. However, they also
recognize how tiring it can be for teachers racialized as Indigenous Peoples are always tasked
with the work of decolonizing Canadian NursMed Education. Kirpal ruminates on the idea
that ‘settlers’ must take responsibility for un-learning colonial ways of being and learning,
and forming meaningful relationships with Indigenous communities.
On a similar note, I observed a class in nursing with a focus on decolonization. Two
teachers co-taught the course. The fieldnotes reveal the types of pedagogical tools the
teaching team used to encourage teachers and students to reflect on their roles in
reconciliation,
“After the guest speaker, we took a break and moved from a large lecture hall to a
smaller classroom with about 20 students.
The teacher Manjit begins with reflecting on the local context of their school in
relation to the United Nations Declaration on the Rights of Indigenous Peoples
(UNDRIP), which was adopted by the Canadian federal government one year after
the release of the TRC Calls to Action. Students are asked to read and review one
particular ‘right’ from UNDRIP and come up with an action they would take as
nurses to uphold the right.
Manjit goes on to direct students to read two articles on ‘decolonization’ during class
time, and highlights the key points raised. Namely, that settlers must dismantle
implicit biases and acknowledge that the Canadian health care system was established
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on the basis of racism. Moreover, biomedicine is not the only way to practice health
care, and in order to promote reconciliation nurses can unlearn assumptions about
biomedical intellectual superiority” (Participant observation, June 4, 2019).
In the description of observations above, I highlight the ways in which teachers may
support practices of Decolonial, Intersectional Pedagogies by taking a critical pedagogical
approach. Rather than employing the language of ‘Equity, Diversity, and Inclusion’, Manjit
uses powerful words to invoke dialogue such as ‘human rights’, ‘racism’, and ‘settlers’.
Here, the everyday use of critical philosophies of teaching such as Decolonial, Intersectional
Pedagogies draw attention to and practice the unlearning, scarring, and counter-storytelling
necessary for health equity and social justice (Ahenakew, 2019; DiAngelo, 2011; Sólorzano
& Yosso, 2002).
Overall, I suggest that Third Eye Seeing participants describe and practice various
ways they align their practice of applying Decolonial, Intersectional Pedagogies within the
context of national Calls to Action. According to an analysis of interviews and classroom
observations, the languages of EDI and TRC are commonplace within Canadian NursMed
Education. I observe that the terms are applied as pedagogical tools to contribute to dialogue
and efforts to redress deepening, intersecting health and social inequities.
6.3 Attempts to Integrate Decolonial, Intersectional Pedagogies in Practice
In the previous two sections of this chapter I shared excerpts from the participants’
stories and observations to illustrate the complexities of evolving pedagogies in Nursing and
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Medicine. Namely, the gravitational pull of culturalism is an ongoing challenge to critically
examining health equity, social justice, and settler-colonialism in these fields of education.
At the same time, the discourses of EDI and TRC Calls to Action influence pedagogies in
Canadian NursMed Education. In the final section of this chapter, I share examples of
strategies that participants employed with the intention of integrating Decolonial,
Intersectional Pedagogies in practice. An analysis shows that participants' attempts included
a) making linguistic and philosophical connections between intersecting health and social
inequities; and b) expressing empathy and exploration of multiple worldsenses across social
differences.
To begin, Gurneet, an educator in Nursing, shared a specific example of how they
pedagogically ‘wake-up’ students to the political, economic, and social context of people in
Canada,
“I would try to have case studies that were more around multicultural populations or
populations from diverse cultural backgrounds and try to get them to see and
understand.
So I can give you an example of one case. I had this case study where I have it as a
newcomer mom, she has a language barrier. And so she’s had a baby and you’re the
community health nurse and you go to visit and realize she’s isolated. You want
students to then look at the prevention of postpartum depression.
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So how are you going to help create some broader social networks for her? And it’s
been so fascinating, all this talk about is, ‘Oh, we’ll get her to come to the
[parent/infant] group.’
Well, if you go to a [parent/infant] group, it’s all done in English. It’s a very Western
kind of occasion. Not that they’re all—but a lot of [parent/infant] groups are educated
families who understand English and it’s very easy to get there, and so she’s not
going to be feeling comfortable. She’s not going to be able to access that.
And in my case, I have another child. So you’re talking about her having to get on a
bus, in the winter months, with a newborn baby and a child and go and attend this
[parent/infant] group which might be across the town for her.
Like how realistic is that and can you see her really accessing that. And there’s
nobody that looks like her and the facilitator is English-speaking—how does that
work? So really trying to get them to go into that again thinking outside the box and
saying, ‘Okay, put yourself in that situation’” (Participant Interview, Aug 8, 2019).
Gurneet’s case study asks students to think about the accessibility of preventative therapy –
in this case a parent/infant group – in relation to considerations of ability (using the bus),
language (beyond English), sex (childbirth), gender (mothering) and citizenship (a
newcomer). In this way, the participant aims to raise nursing students’ consciousness and
instructs them to consider patients’ intersectional identities when creating health care plans.
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Gurneet’s strategy connects to the perspective that Decolonial, Intersection Pedagogies can
support students to understand, “greater levels of complexity because they are iterative and
interactional, always examining the connections among seemingly distinctive categories of
analysis” (Hill Collins, 2019, p. 47). In the excerpt above, the participant demonstrates how
they are able to encourage students to reflect on the multiple contexts of patients.
Manjit, a teacher in Nursing, details their approach to navigating conversations
related to migration. They described how the attempt to convey the complexities of human
migration and the impact on health in classrooms,
“In the context of what’s happened in the history of the world, of settler-colonialism,
of imperialism, of capitalism, neoliberalism. It’s made it very difficult to ... and
perhaps limiting to think of categories of migration, in terms of forced or involuntary;
because all of these factors shape what folks’ lived experiences are and all of the
reasons they choose to migrate.
So somebody, you know, choosing to migrate, you know, with a stronger sense of
urgency than others. It might be more generative to think of all transnational
migrations as being interrelated. And not to undermine folks who really are ... you
know, where that sense of urgency is quite strong. It’s a different constellation of
conditions that are happening around that. So a lot of my work is around migration
and health” (Participant Interview, April 9, 2019).
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In the interview excerpt, Manjit is describing migration beyond the binary ideas of forced
migration and voluntary migration. They point towards pedagogically ‘gesturing towards’
understanding global movements of people across a spectrum or “constellation of
conditions”. The participant also names several processes of modernity such as “settlercolonialism, imperialism, capitalism, and neoliberalism” as factors that may influence
people’s experience of health and wellbeing. Based on an analysis, both Gurneet and Manjit
describe what they hope to achieve through engaging ‘wokeness18’ in their classrooms as a
strategy to evoke a conscious use of Decolonial, Intersectional Pedagogies.
In terms of the impact of Decolonial, Intersectional Pedagogies on learners, Prabjot, a
participant in Nursing, shared an instance of receiving student feedback,
“So the student says, ‘I went home and I finally had the courage to talk to my family
about who we are and just the skeletons out of the closet just came and came and
came’, and she says, ‘I had no idea’.
She says, ‘I knew we had a history but my parents did not talk about it. Today at class
or yesterday at class or last week at class, you raised my consciousness and gave me
18
The term ‘woke’ is a term from African-American vernacular used to refer to people who are “aware of and
actively attentive to important facts and issues (especially issues of racial and social justice)” (MerriamWebster, 2020). In the words of US Congresswoman Barbara Lee, “we will only succeed if we reject the
growing pressure to retreat into cynicism and hopelessness. … We have a moral obligation to stay woke, take
a stand and be active; challenging injustices and racism in our communities and fighting hatred and
discrimination wherever it rises” (Merriam-Webster, 2020). The term ‘woke’ is a term from African-American
vernacular used to refer to people who are “aware of and actively attentive to important facts and issues
(especially issues of racial and social justice)” (Merriam-Webster, 2020). In the words of US Congresswoman
Barbara Lee, “we will only succeed if we reject the growing pressure to retreat into cynicism and hopelessness.
… We have a moral obligation to stay woke, take a stand and be active; challenging injustices and racism in our
communities and fighting hatred and discrimination wherever it rises” (Merriam-Webster, 2020).
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clarity and I was clear enough to ask the questions’, and I said, ‘Thank you, thank you
for letting me know’. I said, ‘This is what the purpose of this course is so you’re now
on a different journey’” (Participant Interview, Feb 15, 2019).
Here Prabjot paraphrases the experience of instilling “raised consciousness” through their
pedagogy. The participant recounts an example of how Decolonial, Intersectional
Pedagogies can allow students to reflect on their own positionality and context. The concept
of ‘reflexivity’ can be applied here to unpack the student’s response described by Prabjot
above. In Chapter 4: Methodology and Research Design, I discussed the importance of
paying attention to how my own epistemology and social location influences the research
encounter and analysis. Similarly, several of the participants described how reflexivity can
be invoked as a pedagogy to support students to, “understand the conceptual limits of their
own thinking [and] hold complex understandings constructed through their own lived
experiences, through family, work, and/or social groups” (McDowall, 2020, p. 7). According
to one interpretation, Prabjot’s strategic use of Decolonial, Intersectional Pedagogies allowed
one student to engage reflexivity in their own learning journey in the excerpt above.
When it comes to consciousness raising, Kulwant, an educator in Medicine, suggests
that the concept of ‘two-eyed seeing’ (Martin, 2012) is one important theory and practice
from which to approach teaching in medical education. They described,
“One of the concepts that would be very interesting to be incorporated is the concept
of two-eyed seeing. We see medicine only in one eye, the Western eye, and we feel
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that this is where the knowledge of medicine and the science of medicine are the main
focus of our schools.
We rarely open the [Indigenous] eye which is something that has been advocated
[for] by some of the Elders in some of the Indigenous nations. To be able to open the
[Indigenous] eye and see the patient, seeing the knowledge in medicine with two eyes
– which again will be maybe not even complementary, maybe synergistic. Maybe
seeing with two eyes will be, you know, not one plus one [equals] two but it will be
maybe 1,000” (Participant Interview, Feb 21, 2019).
Kulwant’s comments reveal that space for Decolonial, Intersectional Pedagogies is
possible if Canadian NursMed Education can attend to the recommendations of two-eyed
seeing as described in Chapter 3: Theoretical Perspectives. According to one interpretation,
Kulwant shared the belief that drawing on the wisdom, ideas, and practical suggestions from
the communities most affected by settler-colonialism can have a “synergistic” impact on
health and wellness for all.
Arneet, a teacher in Medicine, responded to a question about implementing
Decolonial, Intersectional Pedagogies in classrooms. They shared,
“You can embed things within where people actually have to start using words like
racism, oppression, and look at homophobia, Islamophobia and all of these kinds of
things, as well as gender violence and other forms of misogyny and do it in an
experiential way” (Participant Interview, Mar 11, 2019).
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Here the participant refers to inserting lessons and practices where students are
encouraged to physically and materially practice saying words like “racism”, “oppression”
and “Islamophobia”, and identify connections between them based on their own positionality
and intersecting identities. Based on the excerpt above, I understand that Arneet engages in
Decolonial, Intersectional Pedagogies by facilitating conversations among students using
language that explicitly names forms of discriminations such as ‘Islamophobia’ that lead to
health and social inequities. In another case, Manmeet, a participant in Nursing, suggested
creating spaces where students have the time, space, and energy to unpack their own
privileges:
“I take the onus off the individual. I try to make it very clear that a racist is not
something you are, it’s something that you do and it’s a choice. You’re not
responsible for the fact you’re born with whatever skin, or that you were born into a
wealthy highly privileged family or whatever your situation is. You’re not responsible
for that.
You’re responsible for your behaviour. You’re responsible for what you do with your
privileges and you have choices about what you do with your privileges. The more
privilege you have the more choices you have.
So, you know, I try to give people context because I find that the majority of students
are not, they’re not committed to race-based privilege, they’re not. They want to
practice in a socially just, anti-racist way [but] they just don’t know how to get out of
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their own privilege, and they don’t know how to be allies…they don’t know how to
get around their defensiveness” (Participant Interview, April 4, 2019).
According to the excerpt above, Manmeet’s approach was not to shame people, instead to
emphasize that with more privilege comes more choice. Manmeet uses the concepts of
‘privilege’ and ‘allyship’ as indicators of how Nursing students understand their own
positionality in health care. This language stems from a growing field of scholarship in
Decolonial, Intersectional Pedagogies. In particular, I am drawn to making connections
between Manmeet’s story above and the conceptualization of ‘pedagogies of discomfort’
(Boudreau Morris, 2017; Zembylas & Papamichael, 2017). According to an interpretation of
the data, Manmeet is strategically using Decolonial, Intersectional Pedagogies to de-center
student’s experiences of “guilt, anxiety, certainty, and challenges to identity” in order to
unsettle how they co-create relationships of allyship and solidarity building (Boudreau
Morris, 2017, p. 469).
In summary, the interview excerpts above provide glimpses of some strategies used
by participants to attempt to integrate Decolonial, Intersectional Pedagogies. Using the
power of hindsight, I notice that the teachers and administrators provided examples of
navigating institutional features and the gravitational pull of ‘culturalism’ to bring forth
critical perspectives such as Decolonial, Intersectional Pedagogies. According to an
understanding, the participants’ words and choices of expression signify their commitments
to raising consciousness. Moreover, they encourage students to go beyond surface-level
understandings of colonialism and related modern processes, with the intention of
transforming future nurses’ and doctors’ conceptions of practicing health care.
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6.4 Summary
To conclude, in this chapter I shared three important considerations that add to the
complexity of integrating Decolonial, Intersectional Pedagogies in Canadian NursMed
Education. First, culturalism continues to maintain a stronghold as a primary lens through
which deepening, intersecting health and social inequities are explained. Second,
understandings of Equity, Diversity, and Inclusion and Truth and Reconciliation Commission
Calls to Action influence participants’ philosophies of teaching, especially in relation to
settler-colonial, health equity, and social justice. Finally, there are multiple ways in which
the educators and administrators attempt to incorporate Decolonial, Intersectional Pedagogies
into their classrooms. In Chapter 7: Findings C, the final findings chapter, I present stories
and observations that illustrate some of the health impacts on participants of teaching through
Decolonial, Intersectional Pedagogies.
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Chapter 7: “I Don’t Feel Safe”: The Emotional and Spiritual Costs of
Implementing Decolonial, Intersectional Pedagogies
Perhaps the most common and potentially concerning findings of the Third Eye
Seeing project are the emotional and spiritual19 costs of engaging Decolonial, Intersectional
Pedagogies. I notice that a focus on teaching settler-colonialism, health equity, and social
justice can influence participants’ mental, emotional, spiritual, and potentially even physical
health. Going beyond the individual, the findings presented in this chapter also unveil how
systemic patterns of settler-colonialism are reproduced to perpetuate intersecting health and
social inequities. Canadian NursMed Education is positioned to train the next generation of
nurses and doctors who are learning skills to provide health care. Yet, the interviews and
classroom observations suggest that the institutions themselves are also sites of pain,
suffering, and tests of resilience for participants. In Chapter 7, I share stories and data that
illustrate four themes: 1) the limitations of distracting technologies on learning and
unlearning 2) resistance to and support for Decolonial, Intersectional Pedagogies from
participants’ colleagues; 3) student responses to Decolonial, Intersectional Pedagogies and;
4) adaptations participants have made to promote their wellbeing while using Decolonial,
Intersectional Pedagogies.
19
As shared in Chapter 2: Literature, in this dissertation I use a definition of health from the First Nations
Health Authority, which states, “the importance of Mental, Emotional, Spiritual and Physical facets of a
healthy, well, and balanced life. It is critically important that there is balance between these aspects of
wellness and that they are all nurtured together to create a holistic level of well-being in which all four areas
are strong and healthy.” (First Nations Health Authority, 2021).
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7.1 The Limitations of Distracting Technologies
In the first section of this Chapter, I wish to address a new consideration for the
emotional and spiritual costs of integrating Decolonial, Intersectional Pedagogies in
Canadian NursMed Education: the rapid inclusion of digital technologies in pedagogy. The
Third Eye Seeing course observations suggest that the significant presence of digital
technologies is experienced in the classroom in nuanced ways. It should be noted that the
fieldwork for this dissertation was completed prior to the COVID-19 pandemic, and the
massive movements towards online education. Further research will likely be required to
induce how all members of universities experience learning and unlearning in the current
paradigm of online education.
Namely, I suggest that the emergence of digital technologies in classrooms can serve
as a distraction to students and hinder their capacity to critically examine settler-colonialism,
health equity, and social justice, and may harm teachers’ and students’ wellbeing. This may
at first glance stand in contrast to the current ubiquitous use of devices like laptops and
smartphones, and the abundance of online programs considered benchmarks of innovative
education in the modern world (Ghimire, 2019; Valle et al., 2017). I recognize that in 2021,
due to the COVID-19 pandemic, most programs are operating online. However, while
research shows some benefits to the use of technology in classrooms, the Third Eye Seeing
observational data indicates that the vast majority of computer, tablet, and smartphone use by
students seemed to be distracting.
This is a troubling finding given that over 90 percent of the students in classrooms I
observed were situated with laptop screens (and sometimes also tablets and smartphones) in
front of them. While attempting to pay attention to teachers’ presentations (usually in a
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slideshow format), I found myself unavoidably glancing at students’ screens. I found that
some students took notes, however, the majority used their devices for connection outside of
the particular classroom I was observing. Fieldnotes from an observation in a medical school
classroom illustrates my visceral reaction towards the use of digital devices,
“I still can’t get over the looming presence of phones and laptops in the class. After
my first classroom observation, I notice that the students are switching between the
teacher’s presentation (which is already on the big screen) and so many other
applications and assignments.
Rather than providing a way to capture their notes on the class topic, and teachers’
instruction, the tech seems to be detracting student’s attention by promoting doubleand triple-screening.
The glowing displays feel like spiritual vampires leeching onto the students’ mindset,
body, and focus. I can’t believe I’m thinking this but I’m kind of missing the days of
overhead projectors, chalkboards, and mechanical pencils” (Participant observation,
Sept 19, 2019).
Another excerpt from the fieldnotes during a Nursing school classroom visit further
illustrates this claim,
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“I’m so grateful that Manjit, a teacher in Nursing, is engaging with the article
‘decolonization is not a metaphor’. The authors are so crisp in their analysis of settler
complicity in ongoing colonialism. Manjit reminds the students of how nurses are
implicated as well.
I wonder if they are even listening? At this point, I look around to see some students
on message groups presumably chatting with friends.
Some are working on assignments for other classes. Others are scrolling through
social media feeds. I take one more peek, and see one student frantically clicking
through various recipe websites.
Is this what Eve Tuck and Wayne Yang had in mind when they wrote about
reconciling our guilt? Are we all just masking our bodies’ reactions to settler guilt
through digitally-induced serotonin hits?” (Participant observation, June 4, 2019).
The excerpts above are just two examples of teachers in Nursing and Medicine attempting to
integrate Decolonial, Intersectional Pedagogies, only to be met with subconscious (and
maybe even conscious) resistance in the form of distracting technologies. The use of laptops,
smartphones, and tablets are one seemingly inescapable yet increasingly invisible example of
what some scholars call ‘modernity’s shine’ that came up in the fieldwork (Andreotti, 2015).
As detailed in Chapter 2: Literature Review, the term ‘modernity’ encompasses the nexus of
colonialism, heteropatriarchy, neoliberal capitalism, and environmental extraction. As such,
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even if Third Eye Seeing participants aimed to expose students to Decolonial, Intersectional
Pedagogies and critiques of coloniality, their teachings may not be receivable due to learner’s
entanglements and addictions to their digital devices. In this case, “when exposed to
critiques that implicate modernity’s shine in the creation of its shadow, those enchanted with
the shine tend to resist and deny their complicity in harm.” (Andreotti et al., 2015, p. 24). By
their very nature, laptops, phones, and tablets (literally) symbolize the shiny side of
modernity, and members of Canadian NursMed Education, might be using them to escape
critical reflections on settler-colonialism, health equity, and social justice.
The findings from the fieldwork presented above demonstrate how distracting
technologies can act as a significant challenge to the health of educators (and perhaps
students as well). I suggest teachers and administrators may feel a sense of disconnection
from their students due to the limitations posed by the presence of laptops, tablets, and
smartphones. Moreover, the participants may find that students are unable to grasp key
concepts due to the trends of multi-tasking, double- and triple-screening, and mental
absenteeism from the classroom. In this way, I posit that digital technologies may divert
attention away from Decolonial, Intersectional Pedagogies in Canadian NursMed Education
in some cases.
7.2 Resistance and Support from Colleagues
Drawing on the principles of ‘critical’ perspectives, the social environment in which
Decolonial, Intersectional Pedagogies are applied can influence their pedagogical uptake and
reception in Canadian NursMed Education. Notably, an analysis of the findings shows
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participants received resistant and ambivalent responses from colleagues while teaching
through philosophies of decolonization and intersectionality.
To note some of the points of resistance, a participant in Nursing, described a
situation where their colleagues racialized as Indigenous Peoples experienced ‘burnout’ from
the demands of engaging with Decolonial, Intersectional Pedagogies in the university.
‘Burnout’ can be defined as “a multifaceted condition of overwhelming exhaustion,
interpersonal detachment, or cynicism toward one’s job, and a sense of reduced professional
efficacy, driven by long-term workplace stress” (Hewitt et al., 2020, p. 2). As described in
Chapter 4: Methodology, the pace of work in academia has significantly increased in recent
years, which can also influence experiences of burnout (Aquino et al., 2018; Sabagh et al.,
2018). Harpreet described some of their sentiments on burnout in their interview,
“We’ve had a lot of our Indigenous scholars exiting from the university with claims
of being really frustrated, that they are so tired of having to justify everything in a
colonial system.
For example, there was a dean that I worked under recently who asked me if racism
still occurs today.
It’s so frustrating that they’ve moved elsewhere…”
(Participant Interview, April 18, 2019).
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The participant points to the exasperation felt by their Indigenous colleagues. They go on to
describe how their colleagues have eventually run out of resources, energetic capacity, and
empathy for attempting to change a settler-colonial system. Harpreet goes on to say,
“I think the Elder actually was really hurt by something, you know, and it had to do
with pay or hours or, you know, something really significant to the Elder, so that
person left.
And so we’ve been without an Elder for, I think, over 12 months; and, you know, I
think the word is out that, you know, we’re kind of a little bit difficult to work with”
(Participant Interview, April 18, 2019).
The participant described how an Indigenous Elder felt disrespected by members of the
school, especially in relation to the financial worth of their labour, and went on to share how
the Elder decided to quit their post. According to one reading of the excerpt, Harpreet’s
explanations above are reminiscent of claims made by Henry et al. (2017) in a recently
published longitudinal study of racialization and Indigeneity in Canadian academia. The
authors explain that faculty who self-identified as Indigenous Peoples and/or people of
colour, “have developed various coping strategies to confront a lack of departmental support
and aggressive behaviours designed to push them out or keep them down including
institutional departure” (Henry et al., 2017, p. 29). In the excerpt above, the participant uses
the language of ‘exiting from the university’ to describe how their colleagues were pushed
towards institutional departure.
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Another example illustrates how participants and their colleagues permanently left
situations that felt unsafe for them. Arneet, an educator in Medicine, shared their analysis of
why teachers who self-identify as Indigenous Peoples may leave their positions in
universities,
“Because when you open their eyes, like in this conscientization process, when you
realize on a deep level that you are complicit, it's a hell of a thing to take on and then
to teach that. Even the people who one might identify as the most solid allies, still fall
back and they have to be supported to look at what they're doing or saying.
And that sounds like a bit of a hopeless statement, but it's not a hopeless statement.
All it is, is a statement that the structures, the institutions in [the] broadest sense
propagate that behaviour and they want you to do that behaviour and so when you
fight it, you're fighting something that's far greater than you.
Unless you have some incredible community of change that supports you almost on a
daily basis to be able to finally see Indigenous Peoples with all the rights associated
with being human in Canada, and that is one of the biggest challenges” (Participant
Interview, Mar 11, 2019).
Here Arneet described the challenges of braiding Indigenous worldsenses into Canadian
NursMed Education. The participants used terms such as ‘allies’, ‘fighting
something...greater than you’, and ‘fall back’ to represent the challenges of working with
colleagues towards the integration of Decolonial, Intersectional Pedagogies. These terms
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invoke a sense of battle and violence. They are also in alignment with scholars who detail the
necessary steps to counteract hundreds of years long ‘epistemicides’ or killing off of
knowledge and ways of being through the colonization of thought, education, and the
university (de Sousa Santos, 2015, p. 2; Grosfoguel, 2013, p. 74).
Notably, Arneet suggested that having a ‘community of change...on a daily basis’ is
what may be needed as an adaptation to support the revitalization of worldsenses and overall
efforts of Indigenous faculty members. At the same time, an analysis of the participant’s
narrative above suggests that the institutions of Canadian NursMed Education (and
universities more broadly) is itself a product of colonialism. As such, the individual
experiences of Third Eye Seeing participants are couched within structures of knowledge and
education built through “regimes of epistemic racism” (Grosfoguel, 2013, p. 84).
In another case, Jagdeep, a teacher in Nursing, described a situation where they were
similarly challenged by the lack of support they received from colleagues. The participant
shared a story from a recent faculty meeting:
“I wish I hadn’t been as explosive, but we were talking about protecting students of
colour. Students of colour…have formed these groups now. This is a new thing. They
all have these groups because they don’t feel safe and I was like okay, well I don’t
feel safe either.
Like it’s not just about the students. You’ve got one faculty [racialized as a person of
colour]...Does anybody care about the fact that I don’t feel safe? Like I may not be a
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student, but I still have emotions and I don’t consider the students any more important
than me.
You know, my wellbeing and my rights on campus are just as important as the
students.
But it’s like, well, [name]’s faculty so we don’t have to care about [them]. So, I had
to say it in a faculty meeting last year and I said you also have to protect faculty who
are here and who are being dumped on by the students” (Participant Interview, May
7, 2019).
Jagdeep starts their story by expressing guilt about their reaction in a meeting. I notice that
they use the phrase ‘I wish I hadn’t been so explosive’, which I understand to symbolize a
“negative, affective response to their actions” (Bynum & Goodie, 2014, p. 1046). Jagdeep
then went on to explain how students racialized as people of colour are forming groups
within their programs with the intention of creating a ‘safe’ place to learn. The participant
suggests that, in addition to considering the safety of students, universities must consider the
health of faculty racialized as Indigenous Peoples and/or people of colour as well. From one
view, the notion of feeling safe goes back to the concept of “cultural safety” presented in
Chapter 2: Literature Review. I believe that Jagdeep is referring not only to physical safety,
but also their mental, emotional, and spiritual safety and wellbeing. Jagdeep is presenting the
idea that they have not always received protection from fellow teachers or administrators,
which may have made them vulnerable to ‘being dumped on’ by the students in their classes.
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The excerpt above highlights the prevalence of ongoing systemic racism and settlercolonialism which act to deny or hide the emotional and spiritual costs to faculty racialized
as Indigenous Peoples and/or people of colour (Ahmed, 2012; Henry et al, 2017; Mohamed
& Beagan, 2019).
Gurneet, an educator in Nursing, shares similar sentiments about their own
experience as one of the only teachers racialized as a person of colour in their faculty. In
contrast to Jagdeep, they describe not feeling as open to bring the issues up with their
colleagues,
“When you look at other places [such as colleges], their faculty is not so
homogenous, they have a variety of people on the faculty of the School of Nursing. I
have several colleagues who are teaching there.
And so, you have a very mixed faculty that is teaching, so why is it there and why not
here? Is it because the university is this ivory tower place? So, is it okay to hire
people from different cultural backgrounds at the college-level? That’s what they
used to be at one time, right? So, it was okay to hire them at the college-level and not
okay to hire them here at the university-level.
It’s interesting when you begin to try and unpack, and try to understand, what has
gone on before and why are we still here with this sort of a narrow focus of [the]
population that teaches in terms of faculty? [However]… I’m not sure how safe I feel
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to bring those kinds of conversations very strongly” (Participant Interview, Aug 8,
2019).
In the excerpt above, I infer that Gurneet is hesitant to bring forth their perspectives on
addressing inequities in hiring and pedagogy at their school. I found that some of the
participants in Third Eye Seeing described a reluctance in speaking out loud about aspects of
settler-colonialism, health equity, and social justice such as racialized inequities in faculty
meetings or other places that they designate as unsafe.
When asked about the implications of Decolonial, Intersectional Pedagogies for their
school, Akashpreet, a participant in Nursing, reported on a faculty meeting related to
teaching Indigenous knowledges and modalities of healing,
“The discussion that we had, it was very interesting. A lot of it is about privileged
white women feeling that they're not sure whether we have the right to teach this kind
of topic or this topic because how dare we?...
It's interesting because yeah, do I have the right to teach this stuff and do I have the
knowledge to teach this stuff?...Our [Indigenous program] director said absolutely
you have the right to teach it and absolutely you can gain the knowledge for sure.
This knowledge isn't held by any one person, that it's a collective… And it's not that it
has to be delivered by any one person or a person with a certain background”
(Participant Interview, Feb 26, 2019).
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One reading of the excerpt above, points to the need to alleviate guilt that teachers
identified settlers and arrivants might feel when tasked to teach about settler-colonialism and
Indigenous worldsenses. I believe the story above represents what some scholars of
decolonization refer to as “moves to innocence” which problematically work to absolve
teachers of their complicity in ongoing settler-colonialism (Tuck & Yang, 2012, p. 9;
Macoun, 2016, p. 86). An analysis suggests that this may allow for a continued affective
investment in settler-colonial innocence. The excerpt above can be interpreted as an example
of one way in which faculty members who self-identify as Indigenous Peoples are tasked
with ‘including’ Indigenous knowledges in academia “in ways that do not make their nonIndigenous colleagues uncomfortable” (Stein, 2020, p. 162). As Arneet’s interview excerpts
emphasized at the beginning of the chapter, this has the potential to put “less emphasis on
changing the structures that have made universities hostile places for Indigeneity to begin
with” (Gaudry and Lorenz, 2018, p. 220).
In the observations, I witnessed two classes that were new additions to Nursing
programs. In our discussions, prior to my visit, the teachers stated that the courses emerged
out of the TRC Calls to Action (TRC, 2015). The fieldnotes below expand on the analysis
above, to share cases of two teaching teams I observed as existing in the tensions of
innocence and acknowledging complicity,
“I’m so thrilled to see Sukhi and Anandkaur, and Manjit and Karmveer working
together. Though the two teaching teams exist in different institutions, likely don’t
know each other, and have developed their courses independently, I see some parallel
themes and commonalities.
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Both teams include faculty members who identified as Indigenous Peoples and nonIndigenous Peoples (to use this common binary). Moreover, they all are attempting to
approach their pedagogy through the lenses of decolonization and intersectionality.
In both classes, I did notice a hesitation to make connections between ongoing global
migration, the wider context of colonialism, and the importance of rematriating
Indigenous land and life on Turtle Island.
I also observed varying levels of familiarity in making connections out loud in the
classroom to the land on which their schools are based and their own social locations”
(Participant observation, Jun 4, 2019; Participant observation, Sept 30, 2019).
I share the fieldnotes excerpt above to suggest that working in teaching teams with
colleagues may support the uptake of Decolonial, Intersectional Pedagogies in Canadian
NursMed Education. At the same time, I observed feelings of doubt around uncomfortable
conversations that would allow participants, especially those racialized as white and/or
people of colour, to acknowledge their own complicity in settler-colonialism. This aligns
with what Tuck and Yang (2012) assert as “strategies or positionings that attempt to relieve
the settler of feelings of guilt of responsibility without giving up land or power or privilege,
without having to change much at all” (p. 10). I suggest that some participants’ apprehension
towards naming their own individual ancestry and links to land (as opposed to a blanket land
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acknowledgement) could be read as a ‘move to innocence’. This can take place whether a
teacher is working by themselves or as part of a teaching team.
It could be suggested that without significant institutional change and official
mandates, moves to innocence can continue to add to the emotional and spiritual costs of
gesturing towards decolonization and intersectionality. In this way, they present a challenge
and complexity to integrating Decolonial, Intersectional Pedagogies in Canadian NursMed
Education. Almost all participants agreed that their departments lacked a clear mandate that
required all members to take seriously the actualization of Decolonial, Intersectional
Pedagogies. One exception was Kaladhar, a participant in Medicine, who shared,
“I was once told when I was starting at [NursMed school] that if you ever…encounter
dissension or, you know, encounter [any] kind of conflict, always come back to the
mission that we’re all here for this and I think it stands true.
I think everyone who works here very much believes in the mission and believes in
what we’re doing at [NursMed school]. So I think it really is kind of the core of what
everyone is about here which is, I think, unique” (Participant Interview, Mar 6, 2019).
Kaladhar’s narrative demonstrates the real potential when the discursive elements of social
justice – a strong mission, value, and strategic intentions – are center points for the decisionmaking process in Canadian NursMed Education. Kaladhar’s school has a strong, politicized
set of guiding documents that foster epistemological pluralism and solidarity among teachers,
senior leadership, students, staff, and community. The excerpt above suggests that having a
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mission statement and set of guiding policies centering decolonization and intersectionality
may alleviate some of the emotional and spiritual cost on teachers. Taking it one step
further, I suggest that institutional recognition of land theft, epistemic erasure, and concrete
actions towards rematriation of land are necessary for the integration of Decolonial,
Intersectional Pedagogies (Gaudry & Lorenz, 2018; de Sousa Santos, 2015; Henry et al.,
2017). As the participant Kaladhar details above, these principles can be constructed as the
“core of what everyone is about ''. In light of recent waves of social justice movements, the
agendas of participants’ departments may be advancing in this direction as I write this
dissertation.
7.3 “It’s a difficult place for safe conversations”: Student Responses to Decolonial,
Intersectional Pedagogies
Third Eye Seeing participants recounted stories of feedback, struggle, and pushback
received from students, which in turn may have affected teachers’ health and wellbeing. This
was especially notable when the teacher was racialized as Indigenous Peoples and/or a
person of colour. For instance, to share a particularly stark example of students’ reactions to
teachers who implement Decolonial Intersectional Pedagogies, Jagdeep, an educator in
Nursing, described,
“In terms of the students, well, that’s a whole other kettle of fish. The students have
been extremely hostile to me and to my course since I arrived at the School of
Nursing…
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I was the only [person racialized as Indigenous and/or person of colour] and I’m
teaching courses on diversity and in a school of nursing [where] 80 percent of our
students are [racialized as] White…and [have] never been taught by a [racialized as
Indigenous and/or person of colour] professor…
One student…asked me why I was teaching a sociology course…in front of 200
students and [the student was] actually screaming. And then when I walked back to
my office [the student] walked with me. [They were] crying.
I should have been crying, but [the student was] crying. They said, “I’m so sorry,
Professor [name], and [they’re] crying because of the comment that [they] made in
my class that was hostile towards me. So [the student] became the victim”
(Participant Interview, May 7, 2019).
An interpretation of Jagdeep’s memory points to experiences of racism and hostility that the
participant faced, especially from students racialized as white, when attempting to bring
critical perspectives to their classroom. This example is illustrative of what DiAngelo (2018)
describes as ‘white fragility’, the perception of “any attempt to connect us to the system of
racism as an unsettling and unfair moral offence, that often triggers a range of defensive
responses” (p. 2). Jagdeep went on to share,
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“So, they actually – they sent a collaborative email to my director probably trying to
get rid of me, I don’t know, complaining about me. When my director received that
email [my director] actually supported me outright.
[My director] sent an email to my whole course, that whole class and [it] said what
[name] is doing is extremely significant and I would like the bullying to stop”
(Participant Interview, May 7, 2019).
This account demonstrates how the process of unsettling settler-colonial dynamics and
systems can take a significant psychological toll on faculty, especially those racialized as
Indigenous Peoples and/or people of colour. Jagdeep’s story is in line with recent literature
on racialization and settler-colonialism in Canadian academia, which finds “anti-racism
models of knowledge are often met with resistance and hostility from students [racialized as
white]” (Henry et al., 2017, p. 129). In this way, the negative reactions from students signify
an ongoing structural issue that repeatedly infringe on teachers’ capacities to integrate
Decolonial, Intersectional pedagogies.
In another case, Manmeet, a teacher in Nursing, conveys their role during a similar
experience in their department:
“The person who was assigned to [the diversity course] was one of the very few
racialized persons of colour in the entire school. And so, [they] received the brunt of
unfettered racism by students so it was all not good.
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And you know, because I’m… not obviously or immediately visible as [Indigenous
and/or person of colour] to people, when I took over teaching it, it changed the
dynamic” (Participant Interview, April 4, 2019).
The participant’s narrative holds the idea that students behave and receive learning
differently according to the skin colour and perceived positionality of the teacher. This
finding is reminiscent of recent literature detailing backlash against teachers racialized as
people of colour who also teach through Decolonial, Intersectional Pedagogies (Hartland &
Larkai, 2020; Henry et al., 2017). The literature also suggests that student patterns of
resistance and/or different interests can go on to influence teachers’ feelings of self-worth
and wellbeing in Canadian NursMed Education (Henry et al., 2017, p. 305).
Providing another perspective, Prabjot, a participant in Nursing, described their own
experience of teaching a course with attention to settler-colonialism, social justice and health
equity,
“We were accused of reverse discrimination [laughs] that we had an agenda in
running this course. It was quite eye-opening and enlightening that we never thought
about it that way, that by introducing particular topics we would be vulnerable as
persons of colour teaching the topic.
So we [the teachers] often reflected on it and talked about how we would share
information and how we would deliver the content…It’s a difficult place for safe
conversations. I think if classes were smaller and we had seminar groups and the
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groups were a lot more mixed I think we would have a more robust conversation
around that particularly when we’re living in such a diverse community” (Participant
Interview, Feb 15, 2019).
Here Prabjot speaks to how the positionalities and number of students in classrooms can
make a significant impact on how teaching from Decolonial, Intersectional Pedagogies is
received. The large cohorts of learners sitting in massive lecture halls are suggested to hinder
the capacity to have ‘safe conversations’. This notion is supported by recent studies on class
size and student engagement (Fukuzawa & Boyd, 2016; Rissanen, 2018). From one
worldsense, the participant’s story may explain why critical pedagogies may not be
integrated by students even if teachers’ put forth concerted efforts to advance courses
through decolonization and intersectionality. Moreover, the excerpt above also demonstrates
how teachers may face challenges to their emotional and spiritual health based on student
responses (or lack thereof) in large lecture halls. As such, the growing size of classrooms
(whether in person or online), which can be linked to the corporatization of the university
(Brownlee, 2015), represents an additional consideration for pedagogy and the ongoing
development of Canadian NursMed Education.
Based on the analysis conducted for this dissertation, the gap in integration of
Decolonial, Intersectional Pedagogies can also go on to influence how graduates of Canadian
NursMed Education approach their clinical practice. Moreover, it can influence the ways in
which this can be interpreted by their teachers as reflecting students’ capacities for learning
and unlearning. To provide an example, Harpreet, an educator and administrator in Nursing,
recounted an instance of meeting a recent graduate in a hospital setting. The participant
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shared that the new nurse expressed their satisfaction at being placed on the oncology ward
rather than on the dialysis ward. The recent graduate went on to discuss their (mistaken and
problematic) assumptions that patients requiring dialysis have a tendency towards
alcoholism, and are often racialized as Indigenous Peoples. In our interview, Harpreet
recognized the extent to which this graduate was influenced by one of the most pernicious
stereotypes operating in healthcare regarding Indigenous Peoples whose health issues are
assumed to be linked to alcohol use (BC Ministry of Health, 2020; Browne, 2017), The
graduate shared their relief towards not having to working with such patients. Harpreet
lamented,
“I was so sad. I thought, you know, you’ve really only been socialized into this
practice for ... to me it looked like under five years and already those comments are
coming out, and it was just like, oh my gosh, that’s so sad to me” (Participant
Interview, April 18, 2019).
They used the language of ‘sadness’ to describe their reaction to nursing graduates being
coached into assumptions of racialization and stereotyping when entering into practice. In
the excerpt above, Harpreet shares their disappointment in hearing how painfully common it
is for students and new graduates to reproduce settler-colonialism in clinical settings. This
finding is in line with recent events and reports on Indigenous-specific racism as a systemic
issue in the Canadian health care system (BC Ministry of Health, 2020). Namely, it provides
further evidence for the reality of “extensive profiling of Indigenous patients based on
stereotypes about addictions'' (BC Ministry of Health, 2020, p. 7). In the story above, the
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student is engaging in the, “cumulative and historical measurements that have the effect of
pathologizing the life-words of entire communities” (Ahenakew, 2011, p. 22). The excerpt
portrays how depleting it may be for teachers to witness students’ moves towards
‘pathologization’ and the perpetuation of health and social inequities. In this way, students’
dismissal of Decolonial, Intersectional Pedagogies after graduating can influence the
emotional and spiritual health of teachers.
In a final example, Simranpal, an administrator in Nursing, recounts some comments
they received from students about their tensions with faculty members in the last year:
“It’s been helpful. Hard, because you hear some really, you know, how hurtful some
of the things that are – that go on in the classroom. And so I think that is part of the
journey to creating programming and curriculum that is inclusive, respectful of
diversity, and begins by actually listening to people who are affected.
Our Diversity Committee, it has always included faculty and then an alumni and
students, and staff, and so we’ve invited the leaders of these student groups to attend
the Diversity Committee, to try to work together. And again, they come and go as
they choose. They're not voting members, but perspective is important.
So I think there is a phase, and it’s probably ongoing, where you have to really start
to understand what the issues are at a very personal level. And really making it more
visible. When I hear the things that are happening in the classroom, things that
professors are saying that are extremely hurtful – I'm almost 100% sure they have no
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idea that they're hurtful – because of, you know, just a lack of understanding of what
the reality is for people who are not in sort of the dominant cultural group”
(Participant Interview, Aug 7, 2019).
The participant detailed how groups of students at their school disclosed that they were being
verbally harmed by specific teachers’ pedagogies and comments in the classroom. Further in
the interview, Simranpal defined these groups as: international students, LGBTQ students,
‘visible minority’ students, and Indigenous students. Hill Collins (2019) asserts that
intersectionality focuses on the “interconnectedness of categories of race, class, gender,
sexuality, ethnicity, nationality, age, and ability sheds new light on how local and social
inequities articulate within global social phenomena” (p. 22). As such, it should be noted
that students (and teachers) do and can exist at the intersections of these multiple identities.
After hearing from students, Simranpal felt compelled to invite them to participate in their
department’s “Diversity Committee”. Simranpal’s intention was to provide the student
groups a platform to voice their perspectives on addressing health and social inequities
within their own program. Here, my analysis suggests that the use of the term ‘diversity’
may be invoked to signify a collective of department members tasked to address the
representation of students and faculty and worldsenses across the intersections of racialized
identity, gender, citizenship, sexuality, and more. This is in line with Ahmed’s (2017)
assertions that “diversity is a human resource…and complaint is diversity work: what we
have to do to dismantle the structures that do not accommodate us” (p. 4). In the narrative
above, the ‘diverse’ students are invited (presumably unpaid) to participate as non-voting
members. Their involvement on the diversity committee can be interpreted to represent the
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work of diversity and complaint. The excerpt above also addresses the teachers against
which students lodged complaints. From their perspective, Simranpal posits that some
teachers do not realize how much hurt and pain they are inflicting on students when evoking
particular pedagogies in classrooms. One analysis could suggest that the participant is
attempting to empathize with all members of their department involved in this ‘complaint’
process.
The interview passages detailed above demonstrate resistance from students that
some participants faced when attempting to apply Decolonial, Intersectional Pedagogies in
their practice. They also demonstrate the harm that can be created when some faculty
members unintentionally ignore the need for Decolonial, Intersectional Pedagogies in their
own teaching. In the following section, I briefly examine some adaptations teachers and
administrators have made over time to navigate the emotional and spiritual cost of
implementing Decolonial, Intersectional Pedagogies.
7.4. Detecting, Interpreting, and Preparing for the Emotional and Spiritual Costs
In the Third Eye Seeing project, participants described various ways to cope, adapt,
with and engage with the exhaustion, burnout, and challenges of attempting to implement
Decolonial, Intersectional Pedagogies within institutions. The following paragraphs give a
glimpse into how the participants detect, interpret, and prepare for the embodied pain
associated with using Decolonial, Intersectional Pedagogies to inform Canadian NursMed
Education. To begin, Simranpal, an administrator in Nursing, shared perspectives on
addressing the mental health impact on faculty members,
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“So we’re trying to do stuff in our own school and I think part of it is also addressing
the mental health of the faculty. We are trying to do some work with our own faculty
and recognizing there are some issues, challenges that we need to better understand
and address” (Participant Interview, Aug 7, 2019).
In the statement above, the participant expresses their need to ‘recognize...some issues’ and
make changes in their human resources practices, pedagogies, and workplace culture to better
support teachers. In Simranpal’s department, the two main teachers who practiced
Decolonial, Intersectional Pedagogies were racialized as Indigenous Peoples and/or people of
colour. This finding is consistent with recent research that demonstrates how everyday forms
of racism and racialization can influence physical, emotional, mental, and spiritual health, as
well as faculty members' capacities to pursue their pedagogical practices and research (Henry
et al., 2017, p. 116).
Gianleen, an educator and administrator in both Nursing and Medicine, shared their
interpretations of wellness and preparing for the emotional and spiritual costs of approaching
teaching through Decolonial, Intersectional Pedagogies,
“It's always a work in progress. The life-long process. And so, what's important is
situating yourself as a teacher of whatever it is you're teaching. For me, about
combining that orientation of who I am, reclaiming and also giving myself permission
to my Indigeneity…
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So, I think we're doing the best we can. We're moving and in this state of flux
together. You know, thank goodness for thought leaders who share their amazing
work with us, right?” (Participant Interview, April 5, 2019).
Here Gianleen shared their perspective of ‘moving…together’ as colleagues in a university
department. The participant describes the importance of turning to ‘thought leaders’ as a
practice they use to stay grounded in their role. In an earlier part of the interview transcript,
Gianleen referenced Marie Battiste (2016), Shawn Wilson (2020), Margaret Kovach (2019),
Sakej Youngblood Henderson (2019), and contributors to the TRC Calls to Action (2015)
and the United Nations Declaration on the Rights of Indigenous Peoples (United Nations,
2007) as thought leaders. I sensed that Gianleen builds up motivation and replenishes their
health by reading teachings passed down in the form of scholarly literature, policy
documents, and creative writing.
From another perspective, Jagdeep, a participant in Nursing, shared their own
experience of extending empathy and compassion towards colleagues as a necessary
adaptation in their practice of Decolonial, Intersectional Pedagogies,
“Maybe that’s happening now but when many of these professors in Nursing that I
work with were trained in Nursing school they were not trained on this. So, you
know, you can’t really be upset that people just don’t feel prepared. It’s not the
people who are resistant but the people who don’t feel prepared because they did not
get that education.
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I mean of course, I got that education. I’m a [social scientist]. This is what we do. So
you know, I can’t be upset if other people don’t understand it. Nursing doesn’t train
you around race, scholarship and settler colonialism. So I also have to be patient. I
don’t take the approach of blaming. I have to be patient that this is not what they were
trained to do. Can’t blame them for that” (Participant Interview, May 7, 2019).
Here Jagdeep suggested that many current educators in Canadian NursMed Education are
often not trained in theories, epistemologies, and ontologies beyond the fields of Nursing and
Medicine. The participant describes how, knowing this, they use patience and avoid ‘the
approach of blaming’ to gently promote a wider acceptance and application of Decolonial,
Intersectional Pedagogies among their colleagues. Here I suggest that Jagdeep evokes the
principles of “gentle pedagogy” which can be used in settings where the environment in
which one is teaching is “substantially more conservative” than one’s own perspectives
(Michalowski, 1977, p. 69). At the same time, it could be interpreted that Jagdeep uses this
strategy to shield themselves from colleagues’ reactions that may include blaming “others
with less social power for their discomfort” (DiAngelo, 2018, p. 113). In this way, the
participant could be changing their approach to pedagogy to soften the emotional and
spiritual costs of implementing Decolonial, Intersectional Pedagogies.
Excerpts from participant observations of classrooms also illustrate how a change in
physical location can mitigate some of the emotional and spiritual pain of teaching through
Decolonial, Intersectional Pedagogies,
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“I briefly chatted with Sukhi and Anandkaur at the end of class today. I thanked
them for allowing me into space and hosting the day at the [Indigenous learning
center] on campus, which has such a strong, positive spiritual energy. They told me
how they had Elder [name] and [journalist] who visited today come last year and do a
similar presentation, only the class was held in one of the big medical school lecture
halls.
Sukhi mentioned how different the atmosphere and engagement with the topic was
just based on the space they were in. Moreover, they shared that Elder [name] was, in
their view, so much more reserved the previous year. Sukhi describes that Elder
[name] shared that they felt so triggered by being a settler-colonial style lecture hall at
[university]. It reminded them of the traumas their families have absorbed in the walls
of Residential and Day Schools as described in the TRC.
Interestingly, just a few weeks before, I was in one of those big lecture rooms
observing a medical school class. I noticed how sterile and energetically neutral the
physical classroom felt. As if the land and spirits were not allowed in. This feeling
was further signified by a printed sign on the lecture hall doors that advertised
‘absolutely no food or drink allowed’… apparently water and plants, our life-sources,
are not welcome inside” (Participant observation, Sept 30, 2019; Participant
observation, Sept 9, 2019).
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In the field notes above, the participants, and myself as the researcher, comment on how the
physical layout and design, as well as the spiritual tone and energy of a classroom, can
influence teacher’s capacities to engage with Decolonial, Intersectional Pedagogies. I
propose that the physical learning space in Canadian NursMed Education can work towards
healing or aggravating the ‘soul wound’, especially for Indigenous Peoples (Duran and
Duran, 1995; Duran, 2006; Ahenakew, 2019). Through the oral stories of Elders, Duran
(2006) describes the ‘soul wound’ as,
“the ancestral wounding that occurred in the community passed down through the
generations. Between the years of 1870 to 1900, at least 80% of the population had
been systematically exterminated. In addition, [The Elders] explained how the earth
had been wounded and how, when the earth is wounded, the people who are
caretakers of the earth also are wounded at a very deep soul level” (p. 16).
The quote above specifically addresses the impact of settler-colonialism on Indigenous
Peoples, humans as caretakers of the Earth, and the health of the Earth. In the field notes
excerpt above, both of these aspects of the soul wound are represented through the change in
the Nursing classroom, and the sign on the doors of the Medical classroom.
The observation above also links to pedagogical movements of ‘land-based learning’
which emphasizes embedding learning in the ecologies, materials, and spiritual energies of
particular geographies (Simpson, 2014; Mashford-Pringle & Stewart, 2019). Land-based
learning highlights a return to land, such as in learning spaces, as a necessary pedagogical
step towards decolonization. Decolonial, Intersectional Pedagogies also emphasize
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incorporating the return of land stewardship to Indigenous Peoples and moves away from the
concepts of land ownership. In this way, re-imagining the space in which teaching takes
place can influence Canadian NursMed Education as an upstream determinant of health.
However, it also raises the issue of applying land-based learning and spaces in
crowded curriculums and in universities as institutions that are complicit in land theft and the
displacement of Indigenous Peoples (Tuck & Yang, 2012, Youngblood Henderson, 2019).
The fieldnotes excerpt above also highlights the spiritual dimensions of teaching, and
questions the place of concepts such as ‘open secularism’ and fostering connections to
Consciousness or Goddexx or Universe in Canadian NursMed Education (Colorado, 2020). I
will elaborate on this point further in Chapter 8: Discussion.
In brief, attention to the physical, mental, emotional, and spiritual needs of teachers is
one of many conditions necessary to engage Decolonial, Intersectional Pedagogies. In this
way, the participants demonstrate that consciousness-raising is not only about the readings or
theories shared in the curriculum. Decolonial, Intersectional Pedagogies also necessitate
conscious attention to how bodies, minds, and spirits react to and with the teachings. In the
interview excerpts and fieldnotes above, I have attempted to share examples of what I
understood to be adaptations made by participants to navigate the emotional and spiritual
costs of ‘gesturing towards’ Decolonial, Intersectional Pedagogies (Ahenakew, 2019;
Elwood et al., 2019).
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7.5 Summary
In summary, the Third Eye Seeing project findings presented in this chapter provide a
starting point to examine the emotional and spiritual costs of teaching through Decolonial,
Intersectional Pedagogies. The sets of stories and data elaborate on the physical, mental,
emotional, and spiritual challenges of applying critical pedagogies in modern Canadian
NursMed Education. I highlighted how some participants, especially those that self-identify
as Indigenous and/or people of colour, are faced with the task of receiving negative reactions,
and prodding at and making visible individual and collective ‘soul wounds’. I also suggest
that digital technologies (laptops, phones, tablets, etc.) may undermine teachers’ capacities to
integrate Decolonial, Intersectional Pedagogies. By creating extra noise, distracting
technologies can act as vehicles for constant advertising, and divert students (and faculty)
from critically examining settler-colonialism, health equity, and social justice. In Chapter 8,
the Discussion, I analyze some of these findings in the context of emerging literature, and the
implications for attempting to integrate Decolonial, Intersectional Pedagogies in Canadian
NursMed Education.
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Chapter 8: Discussion & Implications: Opening up the Third Eye
The purpose of the Third Eye Seeing project is to contribute to the ongoing
development of Canadian NursMed Education and efforts to redress deepening, intersecting
health and social inequities. In this chapter, I draw on an analysis of the findings presented
in Chapters 5, 6 and 7 to inform the advancement of pedagogy, or philosophies of teaching,
in service of the purpose above. As detailed in the methodology, I conducted a thematic
analysis informed by ‘colonial power relations’ (Gunaratram, 2003) and ‘interpretive
description’ (Thorne, 2016) of interviews with participants and select classroom
observations. In particular, based on critical literature in nursing, medicine, and educational
studies, this dissertation focuses on possibilities for implementing the niche of Decolonial,
Intersectional Pedagogies in Canadian NursMed Education.
Decolonial, Intersectional Pedagogies are not a catch-all for all theories related to
social justice. For instance, in this manuscript, I have intentionally chosen to limit the use of
frameworks such as whiteness, anti-oppression, or race-based theories for two reasons.
Firstly, there is a wealth of scholarship currently being conducted through these lenses in
Canada and beyond (Annamma et al., 2018; Campbell, 2020; Johnstone & Lee, 2020). The
scholarship of critical race studies and its applications with regard to higher educational
contexts has a robust lineage in Canadian borders, and continues to receive important
attention in 2020 and beyond (Razack, Smith, Thobani, 2010; Scholar Strike, 2020).
Secondly, I explore the research questions through the lenses of decolonization and
intersectionality in an effort to create worlds where racialization has been fully composted as
a process (Gilroy, 2000; Brown, 2017). Gilroy (2000) shares, “the idea that action against
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racial hierarchies can proceed more effectivity when it has been purged of any lingering
respect for the idea of race is one of the most persuasive cards in this political and ethical
suit” (p. 13)20. In my case for instance, in as many instances as possible, I aim to compost
any notion of my own “Brown-ness”, as I find the color line forecloses any possibility of
nuance. Moreover, race necessarily requires a comparison to someone outside of ‘us/me’
(Who am I ‘Brown’ in relation to? Who else is ‘Brown’ in this space and who are their
ancestors? Are we creating a silence and erasure?). As such, in this dissertation, I aim to
cycle away from race as a social concept. Nonetheless, terms like ‘people of colour’ are still
commonly circulating raciological terms, used by participants, researchers, and everyday
discourse, that the reader will come across in the dissertation.
In Chapter 5, the interview and observations revealed four common ‘institutional
features’ that many participants referred to as influencing pedagogical approaches in
Canadian NursMed Education: Crowded Curriculum, Academic Freedom, Truth and
Reconciliation Commission Calls to Action, and Admissions. In Chapter 6, I explored the
participants’ attempts to apply Decolonial, Intersectional Pedagogies in everyday classroom
settings. Finally, in Chapter 7, the emotional and spiritual costs of integrating Decolonial,
20
It should be noted here that the argument of moving away/gesturing away from race, racism, raciological
thinking, and racialization is a controversial one. These four concepts are complex and deeply engrained in the
make-up of our societies and social framing (especially in relation to health care). For instance, Gilroy himself
has spoken about the challenge of ‘removing’ race altogether in public consciousness – primarily due to the use
of race as a founding principle of white supremacy and the transatlantic slave trade in settler-colonial nations
like the US (Koshy, 2021). I certainly echo the understanding that race and racism is still the dominant way in
which many people living in the borders of Canada make sense of social differences. Moreover, race is still an
organizing principle in legislation (e.g. use of ‘visible minorities’) and colloquial lexicon. However, in general,
I find in my practice and in research I am leading, after acknowledging the presence of racialized hierarchies in
colonial institutions, ancestral lineage becomes a more useful framework to move towards decolonial,
intersectional pedagogies.
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Intersectional Pedagogies in Canadian NursMed Education were made apparent through the
interview excerpts and the observational field notes.
Overall, an analysis of the Findings in Chapters 5, 6, and 7 suggests that the
development of Canadian NursMed Education likely requires unlearning patterns of
modernity, especially settler-colonialism, and moving towards decolonial, intersectional
futures. This shift necessarily includes a significant examination of biomedical dominance
and the expectations of constant growth in Canadian NursMed Education. The work I did
during the dissertation illuminated the extent to which the majority of Canadian NursMed
Education still operates largely within the biomedical model of health. Biomedicine is,
obviously, highly effective and essential for addressing some very important aspects of
health (e.g. reducing maternal mortality, generating a COVID-19 vaccine, and more lifesaving interventions). However, in the coming decades there is a great need for the
revitalization of Indigenous and diasporic modalities of healing that integrate holism and tend
to the soul wound.
As many scholars have discussed, it can be said that the biomedical model of health
takes a secular, individual-centric approach, in which illness or ‘disease’ is caused by
microorganisms and/or biochemical imbalances in the body. On this basis, disease is often
defined as a biophysical malfunction and the goal of treatment is to correct the malfunction
to cure the disease. This model can tend to stress pathophysiology and focus solely on the
treatment of the specific disease/symptom with little scope for the role of relationality,
addressing the soul wound, or seeing the larger structures of society that shape health
(Ahenakew, 2011; Lock & Nguyen, 2010).
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Part of redressing health inequities involves re-imagining pedagogy in Canadian
NursMed Education from critical epistemological and practical perspectives. At the present
moment, while writing the Third Eye Seeing manuscript, I do observe some aspects of
modernity beginning to wilt, ferment, and ready to be broken down organically. In Chapter
8, I discuss Third Eye Seeing as a heuristic tool to conduct an analysis of the findings
presented above, salient literature, and the current context of surges in social justice
movements, the COVID-19 pandemic, and the potential “end of the [modern] world” (Brown
et al., 2019; Stein et al., 2020). My aim for this chapter is to highlight opportunities for
deepening into Decolonial, Intersectional Pedagogies and share hopeful examples of cycling
into decolonial, equitable, and socially just futures in Canadian NursMed Education.
8.1 Third Eye Seeing as heuristic in Canadian NursMed Education.
As stated in Chapter 3, Third Eye seeing is conceptualized in this dissertation as being in
direct solidarity with Two-Eyed Seeing. The pedagogies are synergistic, and in my view,
one must deeply connect Two-Eyed Seeing and Third Eye Seeing together. Third Eye
Seeing puts extra emphasis and evolutionary pressure on members of settler and arrivant
diasporas (myself included) to drastically change out of settler-colonial relationships with
land that exist in institutions, communities, and everyday life. From the learnings of project
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participants, my teachers, mentors, and ancestors, one conceptualization of Third Eye Seeing
in Canadian NursMed Education is one where:
-
Indigenous communities are financially, politically, ecologically, and spiritually
supported to direct approaches to health education, and human progress, success, and
development. Through Third Eye Seeing, one can include meaningful input from
Indigenous, settler, and arrivant diasporas in Canada and globally.
-
Teachers, students, and researchers go beyond binary categorizations of people (e.g.
Racialized as White/Racialized as BIPOC, Indigenous/Settler, Religious/Secular,
Citizen/Non-Citizen) to consider how intersectionality and multiple positionalities of
people can be approached pedagogically in critical ways. In this way, we can open
up two, three, and even more eyes.
-
Many ancestral health modalities are accessible, approached critically through
Decolonial, Intersectional Pedagogies, and accompany biomedical approaches to
community health and wellness. Moreover, there is room for ‘braiding’ multiple
perspectives together through mutual respect.
-
Indigenous Peoples and nations are supported in continued land sovereignty, (which
can include the yielding of land titles of universities in which Canadian NursMed
Education is based).
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In short, Third Eye Seeing is a heuristic that can be applied in solidarity with Two-Eyed
Seeing. After doing the basics of opening up two-eyes, Third Eye Seeing can support
teachers, students, and institutions of education and health care to imagine what futures are
possible through decolonial, intersectional pedagogies. Finally, Third Eye Seeing can make
space for and serve as a reminder to consider worldsenses from the Global South/East that
are considered neither Western medicine, nor Indigenous knowledges. In the following
pages, I present an analysis of findings in Chapters 5, 6, and 7. I pay particular attention to
the presence of and space for Third Eye Seeing in Canadian NursMed Education. I begin
each section with a personal story that contextualizes the discussion of findings based on my
positionality below.
8.2 Third Eye Seeing and the Institutional Features of Canadian NursMed Education
8.2.1 Examining the implications of Crowded Curriculum, Academic Freedom,
Admissions, and TRC Calls to Action
The research suggests that certain institutional features contribute to the struggles,
complexities, and adaptations of integrating Decolonial, Intersectional Pedagogies or ‘Third
Eye Seeing’ in Canadian NursMed Education. I also find that the institutional features
identified (Crowded Curriculum, Academic Freedom, Admissions, and TRC Calls to Action)
are in a state of rapid flux as departments are quickly adapting to social justice led Calls to
Action and teaching primarily online during the COVID-19 pandemic. In the following
section, I weave together an analysis of the findings in Chapter 5: Institutional Features of
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Canadian NursMed Education through the lens of Third Eye Seeing described above. This
project calls attention to pedagogies in Canadian NursMed Education as upstream
determinants of health for individuals, communities, nations, and the planet.
8.2.2 Crowded Curriculum & Constant Consumption
Crowded curriculum is a main institutional feature of Canadian NursMed Education.
It can be interpreted as a symptom of settler-colonialism, and may contribute to growing,
intersecting health and social inequities. Based on one analysis of the findings, a crowded
curriculum is one aspect of the “epistemic privilege of modernity” (Mignolo, 2002, p. 927).
One assumption of modernity is that consuming knowledge, technology, and resources in an
increasing, exponential, linear time-based trajectory is the ‘right way’ to engage in pedagogy
within Canadian NursMed Education. This approach can reproduce pedagogies of
memorizing ‘objective’ scientific facts and the measurement of knowledge through
examination. In this way, there can be a privileging of rationalistic knowledges that view the
body as a machine, and health care provision as mechanical (rather than social, healing,
spacious, collaborative, etc.) act. The Third Eye Seeing findings demonstrate that the
epistemological underpinnings of modernity show up in many ways in Canadian NursMed
Education, including hierarchies of healing modalities and ongoing burn out in faculty and
students due to the daily demands of a crowded curriculum in nursing and medical programs.
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8.2.3 Academic Freedom and Admissions
The racialized, ancestral, spiritual, and bordered divisions of labour in Canadian
NursMed Education are also shifting. Since the start of the Third Eye Seeing project in 2015,
universities in Canada have seen a significant increase in calls for diversifying the 1)
ancestral and racialized make-up of faculty, 2) approaches to pedagogy, and 3) approaches to
student wellbeing and participation. In Chapter 5, Findings A, the participants’ stories and
classroom observations point to features of the university and Canadian NursMed Education
such as Accreditation and Crowded Curriculum that pose significant challenges to the second
of the two calls – pluralism in pedagogy, especially from decolonial, intersectional
perspectives. One of the leading Canadian scholars on anti-Blackness and anti-racism in
Canadian universities writes, “Canada is in the midst of a demographic revolution, one that is
ushering in a great social transformation in the constitution of Canadian society…what
remains remarkably resistant to change…is its major governing institutions” (Smith, 2018, p.
43).
An evolution towards more ‘diverse’ faculty may facilitate change through the
integration of Decolonial, Intersectional Pedagogies, especially if teachers have had previous
education in social justice, health equity, and critiquing settler-colonialism. At the present
moment, some researchers and faculty members posit that “academic freedom itself is seen
as one of the practices that “reinforce[s] an ‘institutional culture of denial’ that promotes
resistance to equity programs and practices (198).” (Henry & Tator in Grayson, 2010, p.
1019). One aspect of the Third Eye Seeing findings support the notion that due to Academic
Freedom, the burden of teaching through Decolonial, Intersectional Pedagogies often falls on
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one or two faculty members per nursing or medicine school who show dedication to the work
of social justice, and who are often the one of the few faculty racialized as Indigenous
Peoples and/or people of colour.
Yet, the findings also reveal that Academic Freedom allows teachers in Canadian
NursMed Education to largely determine their own syllabus, choice of readings, format (and
sometimes location) of the class, and more aspects of pedagogy that foster understandings of
privilege, power, creativity, empathy, perception, and co-operation – all aspects of Third Eye
Seeing. In my own experience as a new sessional instructor teaching in Social Justice and
Health Professions Education departments, I notice freedom to re-invent syllabi and
pedagogy based on current social and ecological conditions, which affords a malleability and
agility in negotiating the changing terrain of teaching in Canadian NursMed Education. I
suggest that the positive implications of Academic Freedom as an institutional feature may
outweigh the sedimentation of pedagogy that can come from allowing teachers to dictate
their own curriculum and approaches to teaching. There are emerging trends in policy and
practice that supplement Academic Freedom to increase the potentials of Decolonial,
Intersectional Pedagogies. At the same time, Academic Freedom is in conversation with
federal, provincial (or state), and municipal educational policies. As mentioned in Chapter 2:
Literature Review, government legislation can mandate the inclusion to exclusion of
particular pedagogies from nursing and medical schools (State of Washington Senate, 2021;
Williams, 2021).
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8.2.4 Punctuated Equilibrium and TRC Calls to Action
Some ways to alleviate the pain of crowded curriculum and Academic Freedom is
institutional adoption of Indigenous sovereignty and social justice activist initiated living
policy documents such as the Truth & Reconciliation Commission Calls to Action. The data
and stories in this dissertation point to the ways that interventions such as the TRC catalyze
evolutionary leaps towards Decolonial, Intersectional Pedagogies through a process that
political scientists and biologists alike call “punctuated equilibrium” (Durnova et al., 2016;
Wosniack et al., 2017).
In political economy theory, punctuated equilibrium is used to characterize, “the
policy process as abrupt shifts and long periods of stability or incremental change separating
the shifts” (Durnova et al., 2016, p. 96, emphasis added). In this dissertation, the participant
stories and classroom observations demonstrate how the Truth and Reconciliation
Commission Calls to Action publication in 2015 a trauma-induced abrupt policy shift that, in
some ways, marks the beginning of the current period of social change culminating in
2021. The Third Eye Seeing data shows an increase in institutional actions that have been
seemingly impossible in previous years. Some examples from the Third Eye Seeing findings
include brand new course creation, cluster hiring of faculty racialized as Indigenous Peoples
and/or people of colour, movements towards land-based pedagogy, and diversification of
worldsenses.
In evolutionary biology theory, researchers find that most species (including humans
homo sapiens) also exhibit a punctuated equilibrium approach to change, formation, and
diversification in their terrestrial evolution. Wosniack et al. (2017) share,
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“data seem to indicate that long-term evolution is characterized by bursts of high
evolutionary changes followed by metastable configurations. Such intermittency is
known as punctuated equilibrium, with the punctuation corresponding to high activity
(hectic) phases followed by periods of stasis” (p. 113)
What I notice from Third Eye Seeing participant interviews, classroom observations, and the
current state of flux in humanity, is a moment of ‘high activity’ towards Decolonial,
Intersectional Pedagogies. In this way, Third Eye Seeing takes a ‘long view/sense’ of how
intersecting health and social inequities manifest across space and time. The implications of
Third Eye Seeing for Canadian NursMed Education include teachers witnessing the need for
rapid adaptation through meta-level thinking and practice. Meta-level praxis using Third Eye
Seeing pays attention to the implementation of everyday classroom pedagogy in relation to
social processes such as the slow death of modernity (Brown et al., 2019; Maynard, 2017;
Mignolo, 2002; Stein et al., 2020). On a hopeful note, across the duration of the Third Eye
Seeing project, I have witnessed larger cohorts of teachers in Canadian NursMed Education
exhibiting moves of radical action toward health equity and social justice.
8.2.5 Recommendations based on Chapter 5 Findings.
Based on the data and literature reviewed for this dissertation, I suggest the following
recommendations for Canadian NurMed Education:
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-
Cultivate inner conscious awareness, partnerships, and pedagogies that integrate
multiple worldsenses of health and healing through Third Eye Seeing among faculty,
staff, and students. This can look like supporting all members of Canadian NursMed
Education to explore their own ancestral lineages. This exploration can lead to a
deeper awareness of our own complicities in settler-colonialism, and reveal ways of
being that can promote decolonization and intersectional collaboration in health care.
-
Providing additional departmental support to mitigate effects of burn-out. This can
take the form of: hiring experts outside of the department, paying members of the
department financial honorariums and/or financial resources and related support for
engaging in Decolonial, Intersectional Pedagogies; moving past predominant reliance
on the most visible advocates of Decolonial, Intersectional Pedagogies, to structural
integration across the institution, such that the work load is shared and held by
everyone. Examining the circulation of money, time, and energy is one aspect of
unlearning settler-colonialism.
-
Continually construct strategic plans in Canadian NursMed Education and action
steps that go beyond modern epistemologies and meaningfully integrate living policy
documents such as the TRC Calls to Action (and now the wide range of statements
and reports on dismantling structural racism, ecological destruction, and border
imperialism).
-
Take rapid action towards the rematriation of land that Canadian NursMed Education
campuses are on to the local Indigenous nations and communities, especially now
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while the majority of campus visitors are working from home. As shared in Chapter
3, decolonization refers to the rematriation (giving back) of Indigenous land and
life21.
8.3 Third Eye Seeing and the Complexities of Integrating Decolonial, Intersectional
Pedagogies in Canadian NursMed Education
In the present moment, during the course of the Third Eye Seeing project, my
homelands of Punjab and South Asia have in general has seen a rise in polarization, COVID19 oxygen crisis, increase in pollution, and a rise in political unrest in part due to the
continued suppressed of minority religions (with similar movements happening across the
globe including the borders of Canada). This present moment builds on experiences of
settler-colonialism in South Asia, most recently with the fall of the British Raj in 1947.
Hxrstorically, the Punjab region of modern day India and Pakistan is known as the
Land of 5 Rivers, (Punj – Five, Aab – Water). The 5 rivers Sutlej, Beas, Ravi, Chenab, and
Jhelum flow through, forming braids of fresh water used for drinking, ceremony, and
healing. Along the waterways of Punjab, my ancestors have lived in various states of
pluralism and spiritual cohesion with the land. In the coming pages, I draw inspiration from
the braided rivers and spiritualities of Punjab to illustrate how the participants I interviewed
and observed attempt to integrate Decolonial, Intersectional Pedagogies in Canadian
NursMed Education.
21
Currently, there are precedents of Canadian municipalities and private developers transferring land title to
local Indigenous nations. For instance, in my home university of UBC located in Vancouver, the City of
Vancouver rematriated the village of Cpəsnaʔəm in South Vancouver to the Musqueam First Nation.
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A main purpose of the Third Eye Seeing project is to highlight Canadian NursMed
Education as an upstream determinant of health. Notably, this manuscript suggests that the
integration of Decolonial, Intersectional Pedagogies can positively impact teachers and
students capacity to understand and attend to the root causes of health and social inequities.
The research suggests that project participants aimed to circumvent culturalism as a
primary pedagogical lens in Canadian NursMed Education; implement recommendations
from Equity, Diversity, Inclusion, Anti-Racism, and Truth and Reconciliation Calls to
Action, and attempted to engage Decolonial, Intersectional Pedagogies in practice. In the
following section, I highlight key analytical insights into the complexities of Third Eye
Seeing in everyday classroom settings. Notably, as highlighted in the story of Punjab above,
I foreground the concept of “braiding” (Elwood et al., 2019), and its significance for
interpreting the findings in this dissertation.
8.3.1 Pathologization and Culturalism
The Third Eye Seeing research draws attention to a major need to problematize the
pathologization of Indigenous Peoples to diasporic peoples from the Global South/East in
Canadian NursMed Education (Ahenakew, 2011; Browne, 2005; Gray, 2016; McGibbon et
al., 2014; Shields et al., 2005). Many research participants discussed how the case examples
and/or guest speakers they have used in classrooms have potentially served to re-inscribe
colonial, culturalist ways of treating people racialized, bordered, and religiously categorized
as ‘the Other’ (Linklater, 2014; McConaghy, 2000; Said, 1985). This claim is further
evidenced through the deaths of Brian Sinclair and Joyce Echaquan and ongoing Indigenous
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specific systemic racism at hospitals and additional health care settings (Brian Sinclair
Working Group, 2017; Dion Stout et al., 2021; McCallum & Perry, 2018). An analysis of
the observational field notes shows that conscious, subconscious, and unconscious
pathologization and the gravitational pull of culturalism still continues in Canadian NursMed
Education today.
8.3.2 Pluralism and Collective Awareness
I observed and noted that some teachers strategically used the radical integration of
pluralism and multiple worldsenses of health to gesture away from pathologization and
culturalism and towards Decolonial, Intersectional Pedagogies. In the Third Eye Seeing
project, radical action was taken by holding classes in physical spaces that have been
designed through decolonial, and trauma-informed practices. Some teachers also used the
practice of locating their own positionality and privileges before jumping into the class
content, drawing on the concepts of subjectivity, power, and critical epistemology from
intersectionality praxis. Additionally, many participants aimed to “nourish the learning
spirit” in their students, which Battiste (2013) describes as,
“Self-reflection and emerging from the chains of the oppressive situations one has
been conditioned to be in. Some of the most important work…is found in the selfreflective narratives that help [students] understand their own situation and what has
held them there” (p. 71).
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In this way, I witnessed Third Eye Seeing participants set intentions and use pedagogies in
service of ‘consciousness raising’ (Brown et al., 2017), a common tool in social justice
activism. In observing, listening to, and analyzing teachers experiences of integrating
Decolonial, Intersectional Pedagogies, I also notice the significant tensions in some aspects
of the work, such as the place of spirituality in Canadian NursMed Education in relation to
shifting knowledges and Third Eye Seeing (Ahenakew, 2011; Battiste, 2013; Colorado, 2020;
Dei & Jaimangul, 2018; Kaur Singh, 2005; Prabhakar, 2018; Reimer-Kirkham, 2019).
8.3.3 Braiding Multiple Worldsenses
Scholars who have significantly informed the Third Eye Seeing project refer to this
apparent incommensurability of worldsenses as the difference between ‘brick and thread
sensibilities’ in Canadian NursMed Education (Elwood et al., 2019). To support the
revitalization of Decolonial, Intersectional Pedagogies the authors point to the process of
‘braiding’, which was introduced in Chapter 1. They write,
“Braiding is not a form of synthesis in which two approaches are combined in order
to create a new possibility to replace them both…nor is it the result of an antagonism
in which one side emerges triumphant over the other. Instead, braiding is premised
on respecting the continued internal integrity of both the brick and thread
orientations, even as neither side is static or homogenous, and even as both sides
might transform in the process of braiding.” (Elwood et al., 2019, p. 21)
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According to one analysis of the Third Eye Seeing findings, in Canadian NursMed
Education brick sensibilities take the shape of perspectives such as biomedical dominance,
‘inclusion’ frameworks, crowded curriculum, and culturalism. Thread sensibilities emerge
through the presence of Indigenous ways of knowing, solidarity building, and attention to
dismantling settler-colonialism. I suggest that one can add in a third sensibility, beads, to
represent epistemologies of the Global South/East that represent a third strand of ‘braiding’
Decolonial, Intersectional Pedagogies in Canadian NursMed Education. For instance,
Ayurveda is an epistemology of health born in South Asia that is neither biomedicine, nor an
Indigenous knowledge system. Ayurveda emerged through the fusion of Dravidian
Indigenous knowledges originating in East Africa and what’s now South India and Sri
Lanka; with Aryan settler knowledges from Central Asia (LaFleur-Gangji, 2020). In this
way, Ayurveda represents a fused sensibility (or bead) from the Global South/East which
offers complimentary perspectives on health and wellbeing. Moreover, the philosophies of
Ayurveda may be integrated as pedagogies in Canadian NursMed Education to help heal the
soul wound within health care institutions.
In this way, I build on the concept that,
“Braiding opens up different possibilities for engagement, without guarantees about
what might emerge from those engagements. Braiding is not an endpoint, but rather
an ongoing and emergent process” (p. 21).
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Given that braiding is something ongoing, Third Eye Seeing can support the process through
the use of the imagination energy center of our collective consciousness as teachers in
Canadian NursMed Education.
8.3.4 Recommendations based on Chapter 6 Findings
Based on the Third Eye Seeing findings in Chapter 6, I share the following recommendations
for Canadian NursMed Education:
-
Move toward using ‘ancestral lineage’ (e.g. Sikh-Punjabi from modern-day India and
Pakistan) and away from ‘racialized identity’ (e.g. Brown) and ‘culture’ (e.g. Indian
culture) in pedagogy and classroom settings. In my view, a shift towards sharing our
ancestral lineages may allow for the disintegration of the human (racialized as White)
vs. non-human (racialized as an Indigenous person and/or person of colour) binary
created by settler-colonialism in Canada.
-
Teach and facilitate pedagogies that allow teachers and students to release their own
trauma and collective trauma, in service of training the next generation of nurses and
doctors who will be caring for the Canadian population. My observation is that
healing the trauma of settler-colonialism is often considered something one does
privately in their home or with a therapist. Classrooms and teaching can be seen as
“official” or “formal” spaces in which emotions and feelings are to be suppressed in
service of learning from the mind. Instead, I am suggesting that collective trauma
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healing can happen safely in classrooms, and can complement mind and/or theory
based discussions of health and social inequities.
-
Continue to update physical and virtual Canadian NursMed Education classroom
spaces, through working with and paying Indigenous architects, interior designers,
and online course designers, and approaching classroom spaces. During the project, I
heard from several participants about the importance of feeling comfortable and safe
in classrooms. Moreover, participants shared how the recognition of multiple
worldsenses in physical spaces acted as a facilitator of Third Eye Seeing.
8.4 (Ad)dressing and Healing the Soul Wound in Canadian NursMed Education
During the course of starting and completing my doctoral work, I had my own
experiences with healing the “soul wound” of settler-colonialism and deepening, intersecting
health and social inequities in my personal and professional lives (Ahenakew, 2019; Duran
and Duran, 1995). Throughout the project, I have also been teaching in Social Justice and
Health Professions Education departments, experiencing first-hand the emotional and
spiritual costs of implementing Decolonial, Intersectional Pedagogies. In the following
paragraphs, I present an analysis of this phenomenon in Third Eye Seeing participants’
stories and the classroom observations.
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8.4.1 Examining Resistances and Supports to Third Eye Seeing
The purpose of the Third Eye Seeing is to investigate the potentials and complexities
of implementing Decolonial, Intersectional Pedagogies in Canadian NursMed Education. In
the following section, I situate the Third Eye Seeing findings from Chapter 7 in relation to
the wounds of settler-colonialism and modernity more broadly, which have implications for
Canadian NursMed Education. The research suggests that participants are engaged in a
spectrum of teaching approaches that can align with Decolonial, Intersectional Pedagogies.
However, the more educators put energy into this work, the more likely they are to
experience an emotional and spiritual cost to their own wellbeing. Notably, this manuscript
is written during a time where the traumas of the collective soul wound are erupting and
triggered on a national and global scale. At the same time, the COVID-19 pandemic is acting
as a force on our species and calling on teachers in Canadian NursMed Education to adapt to
a new paradigm of pedagogy, health care, and social justice.
8.4.2 Conscious Use of Digital Technologies
For much of Canadian NursMed Education, digital technologies hold bright promises.
Yet, a closer look “under the surface” (Song, 2002, p. xi) at the shadow reveals a possible
reproduction of colonial hierarchies. I argue that digital technologies, especially when acting
as a distraction, can limit the reach of Decolonial, Intersectional Pedagogies in Canadian
NursMed Education. This can also extend more broadly to the entire institution of
universities.
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For instance, it would be incredibly challenging for Canadian universities to divest
from their mining interests (one of many calls to action from social justice movements),
because without precious minerals (of the 17 rare Earth metals, 16 are included in
smartphones, laptops, and tablets (Nield, 2015)) the modern university ostensibly cannot
function. In this way, the use of laptops, smartphones, and tablets are one seemingly
inescapable yet increasingly invisible example of “modernity’s shine” (Andreotti et al., 2015,
p. 24), that came up in Third Eye Seeing findings.
The vastness of the digital world has also only come about in the last few decades and
is symbolic of the particular point in humanity’s existence at the present moment. In my
observations of Canadian NursMed Education, I found that many participants aimed to
expose students to decolonial, intersectional praxis and critiques of coloniality, however,
their teachings may not have been received due to learners’ entanglements and addictions to
their digital devices. In this case, “when exposed to critiques that implicate modernity’s
shine in the creation of its shadow, those enchanted with the shine tend to resist and deny
their complicity in harm.” (Andreotti et al., 2015, p. 24). By their very nature, laptops,
phones, and tablets (literally) symbolize the shiny side of modernity, and students in
Canadian NursMed Education may be using them to escape their own involvement in the
modern system (DiAngelo, 2018).
During the current age of online teaching implementation, it can be suggested that the
radical integration of ancestral healing modalities such as meditation and mindfulness (such
as the practices taught in Buddhism and Ayurveda) can support focused attention among
teachers and students. Not only are these practices helpful for teachers to share in relation to
peoples’ health and wellbeing, they also work to raise consciousness, self-awareness, and
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ability to stay present with pedagogy. Moreover, some research suggests that contemplative
practices can “inspire an ethic of universal compassion” (Walsh, 2006, p. 32), which is a key
tool in engaging in the long-term unlearning of settler-colonialism across lifetimes.
8.4.3 The Soul Pain of Settler-Colonialism and Student Reactions
An analysis of the Third Eye Seeing findings, especially in relation to colonial power
relations, reveals how participants’ positionalities influenced students’ reactions to
Decolonial, Intersectional Pedagogies. Writing on the process of decolonizing Canadian
education as a whole, scholars note that,
“There are long-standing colonial practices that remain deeply entrenched with the
educational system and there are significant challenges and complexities in bringing
about meaningful change…If we do not talk about debwewin, the truth, we will not
get to a place of reconciliation. The truth is in the difficult stories, the harder ones to
speak out loud. They are the more difficult ones to hear and listen to because they are
stories about injustices, abuse, and genocide. They are painful. Importantly, these
stories also lay the basis for understanding why we have so much work to do” (CoteMeek & Moeke-Pickering, 2020, p. xi-xiii).
Several times throughout the study, different participants spoke their truths about how
their racialized identity, ancestral lineage, and even citizenship (e.g. immigrant status)
impacted reception to their approach to teaching. In particular, teachers racialized as
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Indigenous Peoples and/or people of colour noted some negative responses from students
when speaking the truth about settler-colonialism that impacted the teachers’ wellbeing.
This finding is in-line with emerging research on the intersections of racialization,
decolonization, intersectionality, and pedagogy in Canadian universities. For instance, Wong
(2018) shares her own experience implementing Decolonial, Intersectional Pedagogies and
the adaptations she has integrated to reduce the emotional and spiritual costs of doing the
work,
“Not only did I interrupt the assumptions they would normally attach to the
constructed identities of “Asian woman”, I also hoped to prepare them for the
challenge and discomfort they would experience when their own self-identities and
implication in power imbalances were deconstructed in the course. Indeed, this was
what first brought me to a mindfulness-based pedagogy: I needed to sustain my
spiritual, emotional, and mental well-being if I were to continue teaching critical
social work” (Batacharya & Wong, 2018, p. 258).
According to my understanding, the excerpt above paired with the findings of Chapter 7,
exhibit examples of how teachers in Canadian NursMed Education notice, scar, and healing
parts of the ‘soul wound’ accessible to them in the everyday classroom setting.
199
8.4.4 Linking Roots with Colleagues
When it comes to resistance and support from colleagues, an analysis of Third Eye
Seeing findings points to the ambivalence of colleagues to Decolonial, Intersectional
Pedagogies. In a few cases, Third Eye Seeing findings point to some teachers being the only
ones carrying the load of teaching through Decolonial, Intersectional Pedagogies, without
consideration or notice from their colleagues.
Some participants found members of their department incredibly supportive,
exhibiting what hooks (1994) describes as “critically examining their standpoints and
transforming their consciousness as a first stage in the process” (hooks, 1994, p. 117). As we
cycle into a new paradigm of social justice, leading activists and organizers continue to share
their perspectives on the importance of working in cohesion and collaboration with each
other,
“Instead of digging its roots deep and solitary into the earth, the oak tree grows its
roots wide and interlocks with other oak trees in the surrounding area. And you can’t
bring down a hundred oak trees bound beneath the soil! How do we survive the
unnatural disasters of climate change, environmental injustice, over-policing, massimprisonment, militarization, economic inequality, corporate globalization, and
displacement? We must connect in the underground, my people! In this way, we shall
survive” (Penniman quoted in Brown, 2017, p. 54).
200
The need to form underground connections also resonates with the perspectives of the
research participants as well as the observational field notes. The participants also discussed
how the ongoing publication of Calls to Action such as the TRC and anti-racism statements
act as linkage points between themselves and their colleagues in Canadian NursMed
Education. Overall, an analysis of the findings reveals that deep and meaningful
collaboration, and sharing of the load can mitigate the emotional and spiritual costs of
implementing Decolonial, Intersectional Pedagogies in Canadian NursMed Education.
8.4.5 Recommendations based on Chapter 7 Findings
Based on the Third Eye Seeing findings in Chapter 7, I suggest the following
recommendations for Canadian NursMed Education:
-
Spreading the load of teaching through Decolonial, Intersectional Pedagogies across
faculty members, outside experts, guest speakers, sessional instructors, clinical
instructors, etc. rather than just one or two teachers in a department. This can allow a
sharing of the necessary work across many perspectives, bodies, minds, and energetic
fields.
-
Integrating ‘land as pedagogy’ and the interconnection between achieving social
justice and living in meaningful, healthy relationships with each other and the Earth
(Simpson, 2014; Mashford-Pringle & Stewart, 2019; Tuck et al., 2014). Land as
pedagogy is considered a practice of Indigenous resistance and learning. I see it as a
201
way of revitalizing ways of being in relation to land with honour and mutual respect,
and as a way of expanding the range of pedagogies that can address the “soul wound”
in Canadian borders and beyond. The Third Eye Findings show that some dominant
pedagogies of Canadian NursMed Education view land as something from which to
extract more and more ‘resources’ to make medical devices, new pharmaceuticals,
and the ‘properties’ on which universities exist. Land as pedagogy is what Simpson
(2014) calls a “Nishnaabeg intelligence” that “generates…inter-dependent, selfregulating community minded individuals” (p. 7). In this way, Canadian NursMed
Education can make paradigm shifts towards land as pedagogy that are necessary
adaptations to survive as a species and humanity in the coming years.
202
8.5 Summary
In this dissertation I examined change in a particular critical issue in Canada:
deepening, intersecting health and social inequities that are reflective of modernity.
Canadian NursMed Education institutions lay the theoretical and practical foundation for the
health care labour force and are therefore implicated in the widening gap in inequities.
Social justice organizers, policy makers, and researchers alike agree that change takes time
and foresight. Canadian NursMed Education can play a role in influencing social change.
Drawing on Decolonial, Intersectional Pedagogies and ‘Third Eye Seeing’, Canadian
NursMed Education could ostensibly prepare learners to evolve the current paradigm of
thinking about human healthiness, success, progress, and development – as processes,
conditions and contexts to foster health equity (and mitigate the harms of ongoing inequities).
Building on the important work of all the scholars, activists, and community leaders cited in
this dissertation, Third Eye Seeing can focus attention on the value of meaningful and
respectful engagement with ancestral healing modalities on a global scale, and address
intersecting health and social inequities.
Through these diverse lenses teachers and students can recognize the intersecting
processes that shape the social, natural, metaphysical, and spiritual world with the aims of
health equity, social justice, and unlearning/undoing settler-colonialism. Moreover, Third
Eye Seeing necessarily requires increased representation of marginalized communities and
worldsenses in Canadian NursMed Education. With this context or ‘problematic’ in mind,
this dissertation project intended to generate new knowledge that aims to stimulate dialogue
and action regarding the role of Canadian NursMed Education as an upstream determinant of
health in the borders of Canada and beyond.
203
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Appendix: Interview Guide
For my PhD dissertation project, I am investigating if and how decolonial,
intersectional pedagogies inform Canadian nursing and medical (NursMed) education. The
purpose of this study is to contribute to the ongoing development of NursMed education and
national efforts to redress health and health care inequities. Briefly, decolonial, intersectional
pedagogies are philosophies of learning that encourage teachers and students to reflect on
health through the lenses of settler-colonialism, health equity, and social justice.
Decolonial, intersectional pedagogies align with recently published strategic frameworks that
serve as guide posts for MedNurs education written by organizations such as the Canadian
Association of Schools of Nursing (2015), the Association of Faculties of Medicine of
Canada (2015), Public Health Agency of Canada (2018), Truth and Reconciliation
Commission on Indigenous Residential Schools (2015), and Universities Canada (2017). The
goals of decolonial, intersectional pedagogies are to influence MedNurs education as an
upstream determinant of health, with the aim of contributing to the education of future health
care leaders and professionals with a particular focus on strategies that promote social justice,
equity, and Indigenous sovereignty.
251
References:
-
Association of Faculties of Medicine of Canada. (2015). The future of medical education in Canada
(FMEC): A collective vision for MD education 2010-2015. Ottawa, ON.
-
Canadian Association of Schools of Nursing. (2015). National nursing education framework: Final
report. Ottawa, ON: CASN.
-
Public Health Agency of Canada. (2018). Key health inequalities in Canada: A national portrait.
Ottawa, ON: PHAC.
-
Truth and Reconciliation Commission of Canada. (2015). Truth and reconciliation commission of
Canada: Calls to action. Winnipeg, MB.
-
Universities Canada. (2017). Universities Canada principles on equity, diversity, and inclusion.
Ottawa, ON.
I am asking key informants who are faculty and in key leadership positions in various
Canadian MedNurs schools to participate in an in person or virtual interview with me,
whichever may be more convenient. I am interested in learning about your perspectives on
the role of MedNurs education with respect to addressing social processes that lead to health
inequities.
[I will describe myself, my position at UBC, and my professional experience].
[Land acknowledgement]
This project is supported by funding from the Canadian Institutes of Health Research. Your
responses are confidential and your real name will not be used in the reporting of findings.
252
My goal is to create an interview process that is non-judgmental, and rather, reflects an
opportunity for learning and being curious.
[read out consent form and gain verbal consent]
1. How does [NursMed school] highlight the following topics in curriculum: Ethno-cultural
diversity? Learning words or phrases in multiple languages? Immigration & Citizenship?
Racism? Colonialism?
2. With the exception of a few new schools, the majority of [NursMed] schools in Canada
were founded when settlers from Europe starting building cities, urban centers, and public
institutions like universities. Can you tell me a little about how you see [NursMed school] as
being part of ongoing colonialism in Canada?
3. What are some of the challenges that you’ve faced in talking about ethnocultural diversity,
racism, or colonialism in your teaching? PROMPTS: personal, professional, institutional,
structural
4. In the last 5 years, activist movements like Black Lives Matter, Idle No More, Justice for
Murdered and Missing Indigenous Women, and No One is Illegal have gained momentum.
a) Are there efforts is [NursMed school] making to include Indigenous perspectives in
curriculum designing?
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b) Are there efforts is [NursMed school] making to include diverse diasporic perspectives in
curriculum designing?
5. When you are writing a syllabus, how do you approach equitable representation of
scholars racialized as Black, Indigenous Peoples, and People of Colour scholars as the
authors of assigned readings?
6. As you know, everyday there are more and more people immigrating to Canada from
across the world. As globalization continues to happen, people tend to migrate along
religious lines. This religious diversity is reflected in students, teachers, families, and more.
In the interviews I’ve done so far, I notice that people are unsure or don’t have space to talk
about the connection between religion & teaching [medicine or nursing]. In your experience,
how is religion talked about in [NursMed] school faculty meetings, trainings, or classrooms?
PROMPT: news media coverage of Islamophobic terrorism?
7. Canada is an incredibly multicultural country. People with ancestors from over 150+
countries live here today, not to mention the diversity of Indigenous communities. However,
for the most part public institutions like universities tend to have Euro-centric philosophies
on teaching. In [NursMed education] this can look like curriculum & pedagogies that only
teach from a biomedical perspective. Can you tell me a little about how Traditional Chinese
Medicine, Ayurveda & Yoga from South Asia, Indigenous healing traditions, African
Traditional Medicine, or any additional diverse worldview on health are incorporated into
[NursMed school] education?
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8. No one’s name or identifying information will be published in my dissertation. However,
for the purposes of understanding the context of our discussion, can I ask how you would
describe your ethno-cultural background?
9. How do you think your ethno-cultural background influences your approach to pedagogy?
PROMPTS: Could you share a particular story or example?
10. Finally, how long have you had a career in [NursMed] higher education?
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