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UBC Theses and Dissertations

Nurses' enactment of equity-promoting practices in the emergency department : a discourse analysis Slemon, Allie


In Canadian emergency departments (EDs), there are significant and persistent inequities in the provision of health care, which both reflect and perpetuate structural inequities. Nurses are the largest group of health care providers in the ED and with the nursing profession recognizing equity as a core value, nurses are ideally positioned to remediate structural inequities and promote equity within this setting. However, this potential is hindered by limited empirical research examining how nurses enact equity-promoting practices within everyday work in direct care settings. This Foucauldian discourse analysis explores how discourse shapes nurses’ enactment of equity-promoting practices in the institutional context of the ED. Data were collected through individual interviews (N=33) with nurses, nurse leaders, and other key ED health care providers intersecting with nursing work, as well as nursing professional and institutional texts (N=31) that illuminate how discourse shaped ED nurses’ practices. Findings illustrate that discursive power operated within the ED to facilitate nurses’ practices that upheld dominant discourses and to constrain nurses’ enactment of equity-promoting practices. As such, equity-promoting practices constituted subversive action, with nurses drawing on key contradictory discourses of equity and relational engagement to subvert discursive power. However, persistent tensions between power and equity in the ED institutional context ultimately limited nurses’ potential for promoting equity, which was positioned as optional, a matter of knowledge and awareness as opposed to practice, and outside of core ED nursing work. These findings highlight how intersecting dominant discourses constrained nurses’ enactment of equity-promoting practices within the ED. Further, despite claims of equity as a central guiding principle within the nursing profession, equity was not institutionally or professional positioned as a nursing practice. To remediate inequities in health and health care, equity must be reframed as a dominant discourse, enacted practice, and core competency within the nursing profession and across the health care system. Institutional and educational supports may additionally facilitate and guide nurses’ enactment of equity-promoting practices in complex contexts in which equity is devalued. Further empirical research is needed that examines nurses’ enactment of equity-promoting practices across diverse health care settings and explores institutional strategies for promoting equity.

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