Critical consciousness is a concept that deserves more attention in nursing, especially for nurses who are interested in ideas and actions around nurse activism and actions for social justice. Critical consciousness refers to the idea of “waking up the self” to the fact that, as nurses and as humans, we bring inherent biases, prejudices, attitudes, beliefs systems, internal stories and preconceived judgments to every interaction with every patient. Nursing is a powerful, human-centered, relationship-based practice, rooted in caring and healing. It is crucial for nurses to understand how unrecognized and unacknowledged prejudices influence our practice and our relationships with patients and families of color.
I know.
You think this doesn’t apply to you because you are an open-minded, progressive, kind, empathic nurse; and you certainly are not racist. As a white nurse, I thought that way too, until I started to critically examine myself. As Boston College Psychology Professor Brinton Lykes (2018) frames it: “as white people in a race-based society, it’s the water we swim in and the air we breathe.” If you are a white nurse who is reading this now, I ask you to reconsider the ways that this may apply to you in your practice as a nurse in a society and healthcare system founded on a race-based society. We need to actively and critically examine ourselves in order to become more human, both as nurses and as people.
My own path to critical consciousness began when I entered doctoral program in nursing and was exposed to the principles of liberation philosophy from Brazilian scholar and educator Paolo Freire (2000). Freire’s Pedagogy of the Oppressed examines the power structures behind the oppression of people of color, specifically the colonialist and imperialist structures within education that work to keep people of color oppressed. Freire’s work woke me up to the power that language holds in perpetuating racism. Racist language becomes part of the mainstream way of describing realities that affect people of color. Examples of oppressive language from the book include use of the term “ethnic cleansing” instead of genocide; “marginalized populations” or “disenfranchised groups” instead of people who are oppressed. The book points out how use of the word “cleansing” implies filth, and the words “marginalized” and “disenfranchised” conjure up ideas that could lead to a “blame the victim” mentality. These sanitized terms that white people use become “linguistic distortions that disfigure reality” and fail to point to oppressive systems and structures as the root cause (In the forward by Donaldo Macedo, Freire, 2000, p.21). I fear that the current term “health [care] disparity” is one such term. I have come to believe that we shouldn’t discuss health care disparities without pointing to the oppressive structural and systemic inequities which form the root cause of the outcome inequalities.
Critical consciousness is more than awareness to language. Well-intentioned white nurses may not think they “see color” in their patients. When white people and nurses fail to acknowledge how they unconsciously react to patients of color we are denying the daily indignities and injustices that make up the everyday lived experiences of people of color. We are reinforcing an inherently racist idea of “white as default” and certainly failing to understand the construction of our own race. If you are still with me then I ask you to consider the following: refusing to admit you see color in patients is actually the first barrier to overcome if you are interested in becoming less racist. If you do not admit you see color, how can you critically examine what that means to you? When we deny the presence of our own inherent biases, we become complicit in perpetuating racism and oppressive power structures that maintain the status quo, knowingly or unknowingly.
No progressive white person wants to consider themselves racist. But this is the critical first step. This big idea was a turning point in my critical awakening. White people have to redefine our relationship to racism and acknowledge racism in ourselves in order to change it. We have to speak about racism and examine it. We have to speak up and speak out. White people are the only ones that can actually change racism.
In White Fragility: Why It’s So Hard for White People to Talk About Racism, Diangelo (2018) explains that the way we white people define racism makes it impossible for us to understand it. I recommend this book as a starting point for anyone interested in joining me on this path. The chapters cover topics like white supremacy and whiteness, the good/bad binary, and the idea of white fragility and white woman’s tears. This book helped me to understand the pushback I received when I started to talk about racism. White privilege means not having to talk about racism. Not talking about it perpetuates racism.
My critical awakening, a work currently and always in progress, has also included participation in an Undoing Racism Workshop by trainers from The People’s Institute for Survival and Beyond (https://www.pisab.org/) and free webinars from www.everydayfeminism.org . My teachers would say that becoming completely non-racist is impossible, but we can become less racist. The way to do this is by confronting racism by talking about it, and by critically examining self. This is the first step and it can be the foundation for becoming more human and having real relationships with people of color. By collectively becoming less racist, one could envision this as a foundation for beginning to dismantle the structural and systemic bias that perpetuate societal, health and healthcare inequities. As a white nurse activist interested in social justice, I invite you to join me on this journey today. If not now, when?
References
DiAngelo, R. (2018). White Fragility: Why It’s So Hard for White People to Talk About Racism. Beacon Press.
Freire, P. (2000). Pedagogy of the Oppressed 30th Anniversary Edition with an introduction by Donaldo Macedo. New York: Continuum.
Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). (2014). Philosophies and practices of emancipatory nursing: Social justice as praxis. Routledge.
Lykes, Brinton (2018). Personal communication in class entitled participatory action research: gender, race and power, Boston College, Chestnut Hill, MA.
Jane Hopkins Walsh is a Spanish speaking pediatric nurse practitioner at Boston Children’s Hospital. She is also Ph.D. student and Jonas- Blaustein Scholar at Boston College. At Boston College, she is also enrolled in a certificate program at the Center for Human Rights and International Justice at the Lynch School of Education.
Jane is a volunteer and board member for the longest-serving NGO in Honduras called Cape CARES (www.capecares.org). Jane is passionate about social justice and immigrant rights and volunteers for Project Reunify (www.reunify.org), the Dilley Pro Bono Project (https://www.immigrationjustice.us/volunteeropportunities/dilley-pro-bono-project) and The Center for Human Rights and Constitutional Law (www.centerforhumanrights.org).
Radical Nurses 
Thank you Jane for this important, timely and thoughtful post! very single resource you mention are terrific resources, – I am especially so impressed with the work that the “Everyday Feminism” women are doing – and so glad ou mention them here! And your words here chart a path for nursing – thank you! Peggy
Lots of thought provoking ideas. I need to read and absorb this more before commenting much more, but appreciate you putting this out there and making me think.