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Abstract

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

Keywords

Blackness Canada history of nursing nursing theory antiracism arts-based methodology

This paper is a reflection and an extension of the keynote Hannah Panel Presentation, What got us here won’t get us there: Reckoning and Re-Imagining Black Canadian Nursing Histories, given by the authors at a joint conference focused on Canadian health history. The format of our Panel Presentation involved Dr. Geertje Boschma providing an overview and general introduction, followed by the other panelists (Ismalia De Sousa, Kyra Philbert and Dr. Lydia Wytenbroek), then sharing individual contributions relating to their work on Canadian nursing history and Blackness. Subsequently, we engaged the live audience in interactive reflection. The written work aligns with the original patterning of our oral presentation.

At the conference, the audience was composed of scholars engaged in history – first and foremost – so the individuals were not necessarily health care providers. Understandably, this shaped the direction of the conversation following the panelists’ presentations. Purposefully, we opted to submit this written account to a special issue of a nursing journal devoted to anti-racist action with the view that critical history is important to nursing.

As co-authors and nurses, we might have differences¹ in our education, our mother tongues, our practice areas, our sexualities, our life stages, our lifestyles, our skin color, our current roles, and our relationship to the Canadian-nation state, yet we share a core objective. Namely, we want our discipline to value historical knowledge as deeply as we do because we feel history is a disruptive and powerful force to evoke social change. We have adapted the content of our original panel presentation with our target audience in mind.

Collectively, we hold an affiliation with the same institution, the University of British Columbia's School of Nursing located on the unceded,² traditional, and ancestral territory of the xwməθkwəy̓əm (Musqueam) People. In turn, we have overlapping relational connections among us, like colleagues, student-supervisors, and friends. These relationships are made apparent within the course of our narrative. Equally, we have all chosen to follow an academic path, albeit, we are at different stages on that journey. As a “foursome” we can position ourselves relative to our careers: upcoming, junior, and seasoned. The value in that is that we acknowledge the real power differences that exist between us.

Power manifests multifariously; a core dilemma with challenging the dominant operation of power is first and foremost that you must know there is a problem. The Black feminists of the Combahee River Statement (1977) wrote of their simultaneously invisiblizing experiences in liberation movements wherein their embodied interlocking experiences of oppression were discounted. Unpacking their experiences of racism in the white feminist movement, and their experiences of sexism in the Black civil rights movement, the authors emphasize how this led them to the genesis of a Black feminist position. According to these lesbian thinkers, a Black feminist perspective represented simultaneously an anti-racist and anti-sexist positions. Legal scholar Kimberlé Crenshaw (1989) formalized this position in the multiaxial framework of intersectionality. Intersectionality addresses the very dilemma of Black women being rendered invisible in a white patriarchal system that is structured to perpetuate their subordination as something normal.

In advocating for critical history in nursing, we, as scholars, highlight the utilization of history in these renowned Black feminist texts. History is used to explore the conditions of their own present-day oppression, to name how and why the power operates, and to place their own struggle for liberation within a legacy of resistance (Combahee River Statement, 1977; Crenshaw, 1989). Black Canadian nurse researchers focused on anti-racist action have engaged with history for similar reasons (De Sousa et al., 2023; Flynn et al., 2021; Jefferies, 2021; Philbert, 2022). Engaging with critical history becomes a means to make the invisible visible.

Historian Karen Flynn (2018) used a framework of intersectionality to present scholarship about the Black Bajan-born British trained nurse, Gloria Clarke Baylis. Baylis experienced racial discrimination when she applied for a nursing job in a hotel in 1964 Montréal (Flynn, 2018; Wytenbroek et al., 2022). Baylis perused legal action, and was the key witness in the subsequent trial, Her Majesty the Queen, Complainant vs. Hilton of Canada Ltd, Accused. This nurse-centric case marked Canada's first successful discrimination case in employment based on race (Flynn, 2018; Wytenbroek et al., 2022). Yet Flynn (2018, p. 303) remarked that knowledge of Gloria Clarke Baylis’ important contribution to not only nursing history, but Canadian history, is all but invisible,
It is striking that the Black nurse at the centre of Canada's first discrimination in employment case appears only in a paragraph in one book, as an unnamed and faceless woman in The Canadian Nurse, and in brief mentions on the Internet.
Of course, Flynn was able to tell Gloria's story because, in part, it was captured within the archive, something that can be otherwise very challenging (Flynn, 2008). This requirement represents another avenue by which some voices are rendered silent.

Since we are collectively interested in questioning power, the work we present in this paper emphasizes not only how a critical engagement with history is helpful to shift the conversation in nursing towards anti-racist objectives, but also how non-scientific expressions of knowledge contribute to this same aim. We recognize that science is neither apolitical nor ahistorical (Philbert, 2022). According to Archibald et al. (2017), during the twentieth century, nursing turned to science to legitimise its knowledge without a thoughtful examination of the underlying values (positivism, impartiality, objectivity) assumed in scientific inquiry. This focus on science is obvious in our current evidence-based practice nursing culture (Archibald et al., 2017; Garrett, 2018).

Archibald et al. argue that nursing research benefits from arts-based approaches to expand and deepen understanding of phenomena in a holistic way. Arts-based inquiry allows for multiplicity in ways of knowing, encouraging reflective practice and critical thinking. Moreover, arts-based methods democratize research by blurring traditional boundaries, for example, between researcher – participants. This blur facilitates the potential for a co-construction of new knowledge, and a curiosity around what counts as evidence within the discipline. In other words, engaging with artistic inquiry allows nursing to make yet again the invisible visible by deepening comprehension through alternative means (emotional, thought, aesthetic, meaning).

In this text, we have chosen to engage in arts-based approaches (Archibald et al., 2017). We reflect this in our expressive writing style (Archibald et al., 2017) explicitly in infusing metaphoric language relating to a non-hierarchical foursome of classical elements,³ water, fire, air, earth (see Stolder et al., 2007 for another example of this specific metaphor within nursing education). We hope to engage you and, in doing so, illustrate the importance of history, particularly critical lenses in history, as a disruptive force towards anti-colonial, anti-racist ways of thinking.

Aim

The paper aims to demonstrate how critical history is important to nursing. We expand current anti-Black racism nursing scholarship by centering explorations of Blackness, Black nurse history, Black feminist thought, and the Black subject in a Canadian context.

Purpose

The paper will highlight how a collective of nurses have engaged with histories of Blackness in Canada to enact the disciplinary goal of social justice.

Geertje Boschma on “uncharted waters”

I had the opportunity to embark on a new approach when asked to give a keynote lecture in my area of expertise, that is, the annual Hannah lecture in nursing and health history, given at the joint conference of the Canadian Association for the History of Nursing (CAHN-ACHN) and the Canadian Society for Medical History (CSHM-SCHM) at the 2023 Congress.

Still, when I was asked to give this Hannah lecture at a larger Congress focused on “Reckonings & Re-Imaginings,” it gave me time to pause. It felt critical to ensure my contribution held water to that disruptive framing. Although this keynote lecture is traditionally given by one person, I was drawn toward a tide of change in that format. On the one hand, I was motivated to share with the audience, largely existing of historians and professionals in health and health history, that critical new scholarly contributions to Black history in Canada were emerging in the field, with new inputs related to the experience of Black nurses. We currently had several such contributions developing in our program and it seemed valuable to share these.

On the other hand, how better to relate that up-and-coming scholars making these contributions were right in our midst at the School of Nursing at the University of British Columbia in Vancouver (UBC-V), of which I am part as faculty member? Upon reflection, it seemed to me that the best way to do so was to propose inviting them to take part in a panel, and hence a shift in format seemed the direction to flow. Shifting away from a traditional lecture format and presenting as a panel would create space for collaboration and acknowledgment of difference at the same time. Thusly, I extended an invitation to Lydia Wytenbroek, with whom I am co-leading the UBC Consortium for Nursing History Inquiry at the UBC-V School of Nursing, and graduate student nurses Ismalia De Sousa and Kyra Philbert as co-presenters. To give this presentation in the format of a panel and as a “foursome,” was a purposeful decision supported by the conference organizers.

For the four of us, it became an opportunity to consider how to encourage discussion and conversation that would reflect “Reckonings & Re-Imaginings in Health History”, the joint conference theme. The behind-the-scenes work in the lead-up of our presentation, and of this article, became collaborative. We intentionally wanted to share new and emerging work and scholarship in nursing on Blackness and the history of Black nurses, initiated by Ismalia and Kyra. They had developed this work as part of their graduate studies, generating new scholarship and raising new and important questions in nursing and nursing history. Lydia held a key role as advisor and supervisor of their projects, whereas I (Geertje) was a committee member of Ismalia's project, and learned about Kyra's work in the course of her studies. I was not a supervisor of either Ismalia or Kyra's projects, but highly supportive of sharing this work with a wider audience.

Despite my decades of experience, I can occasionally feel like a fish out of water engaging in this work. It has been humbling as well as exciting to join Ismalia in undertaking a project to shift this history by conducting an innovative study of Black women and nursing in British Columbia (BC), Canada, which we have been able to share with the larger nursing community (De Sousa et al., 2023). Ismalia continues to incite us in her expanded reflection on the relevance of Black nurses’ historiographies in this paper.

Similarly, Kyra trod new paths in nursing scholarship with her thesis, inserting reflection on the meaning of Blackness, from Black feminist viewpoints, into the historical scholarship of nursing, using creative, artistic, and historical approaches to question “why is Blackness so surprising in Canadian nursing?”, or for that matter, in Canadian nursing history?. “Nurse Angélique” resists singular categorization, it is the name of the thesis, a play and the play's protagonist, Kyra's drag-burlesque alter ego. So named as homage to the real historical figure of Marie-Joseph Angélique (Cooper, 2006). Her work is deeply inspiring and thought-provoking at the same time. Kyra questions contemporary, as well as historical approaches, of the ways histories of the nursing profession reproduce white cultural norms and exclusionary practices. She again bellows to us, inviting us in with the surprise of Angélique in her section.

We did not only focus the panel on the new scholarship Ismalia and Kyra have generated. As half the panel is composed of white ciswomen historians actively working in schools of nursing, we also reflected more broadly on the possibilities related to histories of Blackness and Black nurses in Canadian nursing history.

In fact, the critical stance of the students and the initiatives they took, resulted in a ripple effect of bringing into my view how, perhaps not intentionally, but neither innocently (Wekker, 2016), it appeared little to no work in nursing history at the UBC-V School of nursing had included a focus on Black nurses’ experiences. Such a fact is not a coincidence, and may reflect or be considered an effect of the wider, historical and systemic exclusion of women of color in the nursing profession. Up until the late 1940s, Black women were commonly not accepted in Schools of Nursing in Canada (Flynn, 2011). They also represented only a small minority in the nursing workforce, reflective of systemic racism that persists to this day (Das Gupta, 2009; Flynn, 2011). To support this point with a local example, despite events and displays regularly organized on the history of nursing at the UBC-V School of Nursing – until recently, never once had one been devoted to the history of Black nurses. Neither had we publicly commemorated Black History Month.

In 2020, Ismalia, together with Eunice Bawafaa, another graduate student, drew attention to Black History Month in the School (De Sousa & Bawafaa, 2020), whereas a year later, in February 2021, Ismalia and Lydia organized a webinar devoted to Black (in)Visibility, Black Nurses in Canada who Paved the Way (Flynn et al., 2021). In her section, Lydia digs into the curricular implications these forms of historical projects offer within schools of nursing.

As we reflected on what to highlight in the presentation, we also experienced the challenges of collaborative writing and working. Whose viewpoints are we reflecting? From whose perspective do we share? In a process of continuous discussion and reflections as a group, we were able to find common ground in framing and organizing the presentation, while we also had to negotiate our different views, perspectives and experiences. Working on this project and presentation reminded me of past work in writing the history of the International Council of Nurses (Brush et al., 1999). In that project, we had to continuously question our own assumptions and negotiate the meaning of differences in the interpretation of our sources as well as in our viewpoints. What we found then, I also found now, that is, that “[…] nursing history scholarship continues to offer further analyses of past experiences in nursing and health care that can help us better understand and think historically about the present” (Boschma, 2014, p. 117).

This presentation made me reflect on my position as a white person and my positionality of white privilege. Opting to present as a panel what typically had been an individual scholarly presentation, opened new ways of engagement. We shared and presented a discussion and a “work in progress” rather than a traditional keynote. Interestingly, several people from the audience later on mentioned this point, noting how they appreciated that we presented this talk as a collective. “It really has given us some new ways to think about how we can do these type of lectures in the future,” one of the participants said to me later during the conference. Indeed, the standards of historical scholarship “guided us to question our assumptions, to ask for critique, and to use historical concepts and categories to frame – in this case our presentation - and to become aware of our own diversity in the process of interpretation” (Boschma, 2014, p. 117). Swimming as a fish in “uncharted waters” once again reminded me how reflecting, learning, questioning, collaborating and exploring difference is what we have to do in a school, obligated as we are – as nurses and health professionals – to expand our capacity in conscious relational inquiry (Doane & Varcoe, 2021).

Ismalia De Sousa on “igniting the fire within us to imagine (re)new(ed) possibilities in Black nurses’ historiographies”

I received the invitation from Geertje and Lydia to take part in the Hannah Panel Presentation at the CSHM-SCHM and CAHN-ACHN joint conference at a critical time in my doctoral program and a crucial juncture in our discipline. Having had the opportunity (and privilege) to engage with nursing history and conduct historical research during my doctoral journey, I was cognizant of the tremendous possibilities of historical knowing to illuminate the origins of our discipline and the most pervasive problems in healthcare and societies. In particular, how racism structures opportunity by assigning social value based on one's physical characteristics (Jones, 2002) and is inextinguishable within nursing since the dawn of professionalization.

As I considered the (re)emergent discourses present today, such as the wildfire of calls for social justice and decolonizing nursing (see for e.g., Canty, 2023; Moorley et al., 2020; Suárez-Baquero, 2023), and the persistent silence of Black nurses’ history under the auspices of anti-Black racism – or, as I have argued somewhere else, our collective complacency in protecting whiteness (Dillard-Wright et al., 2023) –, I decided to center my contributions on what I have come to believe are some of the burning questions we (nurses) need to be asking ourselves to forge radical imaginations⁴ for new or renewed possibilities in nursing: what can Black nurses’ historiographies do for us? How do we continue to reckon with anti-Black racism to deconstruct the collective Western white Eurocentric thinking in nursing? How do we contest the histories of resistance toward Black nurses’ historiographies? In other words, what harmful constructs do we need to gather up as kindling to ignite in our hearts toward new Black futures? As Dillard-Wright (2022) posited, “what nurses understand as their professional history has a critical influence on nursing ontology and epistemology precisely because it impacts the ways in which nursing co-creates the world it inhabits” (p. 8); history augments our understanding of the meaning of health and how healthcare is provided (Foth et al., 2018).

In this post-conference reflection, I return to and extend my arguments shared during the panel presentation. From this vantage point, I assert that reckoning with Black nurses’ historiographies can prompt critical self-reflexivity about the constructs we (nurses and nursing) have created in our discipline and, if we are genuinely invested in a path of collective radical (re)imaginations in nursing, we ought to liberate Black nurses’ histories from the shackles of nursing history itself. Departing from my reflections during and after conducting historical research about Black nurses in BC between 1845 and 1910 (for the findings and reflections see De Sousa et al., 2023), I highlight the role of Black nurse historiographies in problematizing anti-Black racism and whiteness and offer a concrete example of the dehistoricization of Black nurses in Canadian nursing history. I conclude my remarks with unfinished thoughts to act as a springboard to the reader about the liberation of Black nurses’ historiographies.

Black historiography augments our understanding of racism and how racism operates. The literary works of Deidre Cooper Owens (2017), Jarvis R. Givens (2021) and Karen Flynn (2011) are only a handful of examples of how Black historiography can create memories of the untold pasts about reproductive health, education and nursing, respectively, and deepen our understanding of racism. The storytelling of the past fills the memories of who, how and why we are and who we can become. It explicates current socioeconomic and political conditions that affect the health of individuals with a promise of a future shaped by the learnings instead of the harms of the past. These narratives fan the flames of revolutionary possibilities. Searching for what nursing and a nurse are and how we came to be, I have fallen prey to this desire to “cocreate something more expansive, inclusive, visionary, transformative for nursing” (Dillard-Wright, 2023, p. 9).

As a Black European (Afro-Portuguese) doctoral student researching stroke and health inequities, beginning to create a legacy about the history of Black nurses in BC was a serendipitous moment. But unlike some of the existing scholarship on Black nurses’ history, I did not seek to convey another history of exclusion of Black nurses, their absence in the archives of nursing history or the silence of Black nurses in the history of Canada. I also did not intend to offer an account of how Black nurses in BC endured anti-Black racism in the immediate aftermath of colonialism for its risk of perpetuating the continuous stereotype of the “Strong Black Woman”.⁵ That framing, I attest, is all just smoke and mirrors! Instead, I was interested in deconstructing Western white Eurocentric thinking in nursing about Blackness and Black womanhood during a period in history (between the abolition of chattel slavery and the rise of dictatorships/beginning of World War II, which coincides with the emergence of the professionalization of nursing), which I believe, shaped what nursing became and is today. Exploring and describing the role that the Black nurses in BC played in disrupting whiteness during this period, that is, the late nineteenth and early twentieth century, is of value to Black nurses’ historiography and nursing history in its quest for social justice, understanding racism and decolonizing the mind. I invite the reader to engage with Reflections on Black nurses’ invisibility: Exploring the contributions of Black nurses to British Columbia (Canada), 1845–1910 (De Sousa et al., 2023).

Who is a nurse? Who can be a nurse?

Beyond an understanding of racism, Black historiographies and Black nurses’ historiographies can prompt critical self-reflexivity about the constructs we have created. Similarly to the argument put forward by Roldão et al. (2023) when excavating the silenced history of the Black movement in Portugal between 1911 and 1933, I agree that reparation and reconstruction of the past and historiography are needed for their role intersecting the present. Thus, rethinking and reconceptualizing nursing constructs is a critical guiding light toward reparation, and an analysis of the discourse on Black nurses’ history in Canada offers such a vehicle. For instance, it has been largely acknowledged in the scholarship of Canadian nursing history (and Geertje Boschma has also posited earlier on in her remarks) that until the mid-1940s, Black women were prohibited from entering nursing schools to become trained nurses (Calliste, 1996; Flynn, 2008, 2009, 2011) as a result of anti-Black racism imposed by chattel slavery ideology. Often, this exclusion is deployed as a point of departure in the Canadian nursing history literature when referring to Black nurses. While it is a fact that Black nurses were denied entry to Canadian nursing schools, and the implications of such absence compounded with racism are heavily felt today (in the lack of Black ways of thinking in the cannon of nursing philosophy and theory, to mention one of the many examples), we fail to see that this rhetoric (Black women prohibited from entering nursing schools) frames nursing and who can be a nurse as intrinsically connected with nursing schools and thus, teaching institutions. Because nursing schools (at least the Anglophone ones in Canada) are associated with Florence Nightingale and the Nightingale nurse apprenticeship model during the era of the modern nurse (McPherson, 2005; Philbert, 2022), this rhetoric then “whitewashes” nursing, dehistoricizes and depoliticizes the Black subject. Unintendedly, the discourse of refused admission of Black women in nursing schools emphasizes that only the white woman who has attended a nursing school is a nurse and can be a nurse in Canada.

But we can cast different questions toward this construct through the lens of Black historiographies and Black nurses’ historiographies. In Fugitive Pedagogy, Givens (2021) underscored Black folk's politics of dissent in response to the persistent exclusion of Blackness, Black subjectivities and Black knowledges in academic and teaching institutions. Underpinned by chattel slavery ideology that Black folk were objects and not rational beings, Givens reminded us that teaching institutions were designed without envisioning Black folk as belonging to the system.

In Reflections on Black nurses’ invisibility: Exploring the contributions of Black nurses to British Columbia (Canada), 1845–1910, colleagues and I excavated the names of Black women doing nursing and midwifery work in the community before and independent from Nightingale's nursing school reform. And so, if educational systems were not created with the Black person in mind and if Black women were doing nursing and midwifery work in the community before the nursing schools’ reform, it seems illogical to continuously use nurse training schools as the backdrop to frame Black nurses’ history in Canada and as its point of departure. From the standpoint of the Black nurses living in BC between 1845 and 1910 (and likely many others across the African Diaspora), education occurred in relationship with and resulting from community, lived experience and African oral traditions. In this line of thinking, then, to think afresh is to re-imagine a more inclusive and transformative nursing history, questioning whether, from the standpoint of Black nurses, arguments in nursing history about the “ideal nurse”⁶ ring true: is becoming a nurse a profession for middle-class white women when Black nurses become a central subject in the reconstruction and reparation project of nursing history? Is nursing then really tied to the ideals of Victorian womanhood? Whom do we continue to center and place at the margins when perpetuating these discourses? And what are the repercussions of such thinking to nursing, nursing education and healthcare in Canada?

The calls to decolonizing nursing and healthcare in Canada cannot be devoid of an understanding of racism. But understanding racism requires a journey through history to unpack how power intersects with nursing and healthcare and shed light on health inequities. Yet, to do so, we ought to first shift how history is being told to be then able to shift minds. That is the anti-racist spark: an engagement in critical history supplies to set the world on fire.

Re-imagining Black nurses’ historiographies in Canada demands rethinking nursing history and its white dominance. In other words, Black nurses’ historiography requires urgent liberation, thinking anew, outside the boundaries of Western European white nursing and “whitewashed” Canadian nursing history. This liberation is only possible if we reject Black nurses as the passive receptacle in Canadian nursing history, as being there but not central to its history. And in the quest for this liberation, we may well need to bring Black nurses’ historiographies outside of the academy, publish these histories outside nursing history journals, rewrite nursing textbooks, and find ways for our research products to be more visible and tangent to nurses and healthcare today. I invite the reader to engage with this idea and continue to re-imagine what this liberation could look like.

Kyra Philbert on “Surprise! Turbulence up ahead.”

Her ashes are cast to the four winds ⁷ . It is not enough for the Catholic authorities to merely punish her physical body. Angélique's soul must be condemned as well;

how dare she dream of being free!

Although my research uses history, and I was co-supervised by a historian (Lydia Wytenbroek), it in and of itself is not historical research. I did not turn to old documents, go searching in the archives or reproduce the biographies of now-dead, once-living humans. Instead, following the examples of Black feminist thinkers before me (Combahee River Statement, 1977; Crenshaw, 1989; Davis, 1981; Hill Collins, 2000; McKittrick, 2006; Walcott, 1997), I turned to history to understand and unpack my own embodied experiences as a contemporary Black Canadian nurse. I relied on the work of historians like Afua Cooper, Karen Flynn, Kathryn McPherson, and Pauline Paul, to weave together this living inquiry. My living inquiry was guided by the methodology of a/r/tography (Irwin & Springgay, 2008). History serves to contextualize my reality: how everyday anti-Black racism is embedded into the very foundations of our profession. History – or rather, the revision of history – interrupts the denialism and invisibility of Canadian nursing's deep reliance on white cisfemininity (De Sousa & Varcoe, 2021).

Unlike Ismalia De Sousa's work which focused on uncovering the stories of early Black caregivers in British Columbia to challenge the social construct of the nurse, I do not present an argument that the Black figure I pick up is a nurse or could have been a nurse. Instead, I continuously connect, complicate, and challenge the telling of our shared Canadian nursing history through the historical figure of Marie-Joseph Angélique. Angélique was a 29-year-old enslaved Black woman born in Portugal and killed in Montréal in 1734 (Cooper, 2006). This is relevant only insofar some of the critique I received when submitting scholarship applications was because my subject was not a nurse, my work did not align with the funding's eligibility criteria. This rejection only put wind in my sails as much of my academic focus is around questioning these limits, what scholarship counts as nursing history? My work was highly supported in other places, namely by the humanities, and I even received a public humanities grant to present the artistic component of my work. The experience only indicated that my work was not understood as nursing history…then. And in that space, became possibility. Undoubtably my work is viewed as contributing to nursing history now, as evidenced by the tremendous support, interest, and engagement I’ve encountered when sharing my work including at the joint conference. After all, it is disruptive (?radical!), and does not follow or fit neatly into the grooves of the conservatism of nursing scholarship.

Nevertheless, it is clear the winds of change are upon us. It was an intentional choice by Geertje Boschma to invite me, a scholar hell-bent on airing out our profession's dirty laundry, to be a co-panelist at this conference. I happened to be attending Congress 2023 anyways, showcasing the artistic component of my work, a drag-burlesque act. I developed it in my thesis research a/r/tographic process and was performing it at the Black Canadian Studies Association Conference. This theater piece reimagines Angélique as a contemporary nurse working in the context of the Covid-19 pandemic. The dirty laundry becomes literal: stripping is an integral part of the performance to ask larger questions about the moralistic division of body work (Toman, 2005). Angélique repeatedly strips off her nursing uniform; in Canada, the introduction of the standardized uniform was intentional to contain the sexuality of the female worker and differentiate the trained nurse from a sex worker⁸ (McPherson, 1996a, 1999). Although protesting the sex worker stigma is fundamental to my larger ethical inquiry, that is not the focus of this piece. This is about racism.

Racism is a “problem” in Canadian nursing. I first became acquainted with Ismalia from shared anti-Black racism discipline-specific work. Naturally, as nurse clinicians, we are heavily invested in finding solutions for problems. If a patient has a low pulse oximeter reading (problem!), we want to slap on some oxygen (solution!). We want these solutions to be evidence-based (Garrett, 2018). The call for this paper reads in part, “We also seek articles that provide concrete evidence-based strategies on how to address racism in health and nursing policy, practice, education, research, and administration” (Salami & Wong, 2023, p. 3). We want the answers to be straightforward, cost-effective and tool-like (easy to use)…

This framing of racism as a “problem” requiring “solutions” denies the creativity of the art of nursing (Archibald et al., 2017; Carper, 1978). The over-reliance on scientific evidence might obscure the possibilities of alternative truths. For instance, pulse oximeters are unreliable for Black skin (Sjoding et al., 2020). If a Black patient has a normal pulse oximeter reading, and we do not know that it is possibly inaccurate, the locus of the (problem) has shifted. Occult hypoxemia. The solution might still be to put on oxygen, but the critical timing of the solution could be delayed enough that someone has a significant and negative health outcome (Sjoding et al., 2020). What then is the larger problem? The low oxygen or the systemic erasures of certain forms of experience…

Meaning you cannot provide a consequential solution if you don’t first actually and fully acknowledge the problem… and the problem might be denial.

Case in point, clear solutions to the “problem” of racism already exist! In fact, they have existed for some time. The work of Agnes Calliste dating from mid-1990s clearly demonstrates that anti-Black racism is a problem for African diasporic nurses in Canada (1996). Not only that, that African diasporic nurses have been organizing against racism by taking collective action since the 1940s! Concrete and practical solutions, like creating schools exclusively for Black nursing students, to address the issue have been offered (Calliste, 1996) but not enacted. So, at what point do we acknowledge that more “evidence” of a problem is not required?

Black nurses in Canada are experiencing racism. Full stop. Racism is an occupational violence for Black Canadian nurses. We are suffocating without adequate oxygen! Perhaps the bigger problem is that when there is a focus on evidence, we are signaling a never-ending state of surprise. When is that shock understood as deliberate denial?

I term my inquiry an ethical intervention for this exact reason. We, as a nursing profession, must explore the emotionality of confronting these systems of racism at the very heart of our supposedly caring profession. To that end, in this work, I have a constantly consistent chorus…

What makes Blackness surprising in Canadian nursing?

My thesis project used the methodology of a/r/tography (Irwin & Springgay, 2008). A/r/tography is an emerging qualitative methodology growing out in the field of education. Co-developed by Rita Irwin, a/r/tography is concerned with process (Irwin & Springgay, 2008). This art-based methodology is an ongoing living inquiry, so every presentation/ discussion/reflection/ conversation/ continues to shift understandings. The interactive presentation I gave during my portion of the panel cannot be replicated here as the medium has shifted now to text. Nevertheless, it lingers into expansion on my masters of nursing thesis work.

A/r/tography can be measured through the 6 renderings: excess, reverberations, openings, contiguity, living inquiry and metaphor/metonymy (Irwin & Springgay, 2008; Lea et al., 2011; LeBlanc et al., 2015; Schultz & Legg, 2020). In my work, I focused my intention into the specific rendering of openings. Openings are messy! Described as “cuts, tears, ruptures or cracks that resist predictability, comfort, and safety” (Irwin & Springgay, 2018, p. 174), openings may facilitate the relational and emotional connection between the a/r/tographer and the audience (Schultz & Legg, 2020).

The audience holds certain obligations in a/r/tography, namely, to join into the process and co-construct meaning (Schultz & Legg, 2020). Openings provide a clear opportunity for this engagement. Here I call to you – yes, you. This is your official invitation into my work: please come join me. These openings make space for multiplicities within knowledge to blow in the wind in our collective professional imagination.

Just who is responsible for this “problem” of racism?

Returning to the framing of racism as a “problem” in Canadian nursing, I wish to interrupt not only the expectation that there will be solutions but even further that the solutions will be provided neatly. Here specifically I want to ask: why am I⁹ still expected to provide a “solution” to you?

Everyday nursing practice grounds nursing ethics (Doane & Varcoe, 2007, 2015; Lamb & Storch, 2013; Varcoe et al., 2014; Wright & Brajtman, 2011). So, let's start at the foundation of nursing practice: the nurse-patient relationship.
“Where are you from?

No, really

Where are you from?”

what is the most professional response to racism?
In my body, I experience the nurse-patient relationship as site of quotidian racism.

This racism is not unique to Black diasporic nurses. In her doctoral research, Andrea Monterio (2018) terms the probing done by patients to her research subjects, racialized nurses, “the wave of questions” (p. 49). The wave can happen to anyone who might be viewed as Other within the context of Canadian nursing practice (De Sousa & Varcoe, 2021; Hamzavi, 2021). Ahmed (2006) reflecting on the specific inquiry, where are you from, suggests it is employed as a method to uncover the strangeness of the brown body in the milieu of whiteness. The wave of questions gives a similar and clear signal: there is something suspicious about your presence here. You do not belong.

So if some – like me - do not belong, who does? According to historian Kathryn McPherson (1996a), the modern Canadian nurse and all her knowledge was generated in the bodies of white middle-class females during the Victorian Era. In the words of Karen Flynn (2011, p. 10), “Constructed on middle-class ideals of white womanhood, nursing remains a contested space for Black women”. Flynn is reflecting on her research subjects, the first cohort of Black women responsible for integrating the previously white-only Canadian profession sometime after the inclusion of Black bodies in the late 1940s. Yet this sentiment—nursing as a contested space— remains experientially true for me generations later.

What makes Blackness surprising in Canadian nursing?

This repeating refrain is an adaption of Katherine McKittrick's query around the realities of Black Canada (2006). McKittrick (2006) positions Marie-Joseph Angélique as a surprise: an outcome of wonder. McKittrick, like other scholars of Black Canada, are perplexing the myth that Blackness is new or foreign to the [white] Canadian nation state (Cooper, 2022; Flynn, 2011; Nelson, 2020; Walcott, 1997). It stimulates larger punctures into a shared national identity based on benevolence towards Black bodies (Razack, 2007; Walcott, 1997).

In 1734, the ashes of Marie-Joseph Angélique were picked and “flung […] to the four winds” (Cooper, 2006, p. 22). Angélique was tortured, paraded through town in a tunic labeled with arsonist, and then publicly executed after a months-long trial. The Black woman was convicted of setting a fire in the merchant's quarter of Montreal. The blaze was significant and destructive. As the townsfolk, including Angélique, took shelter at the Hôtel Dieu, the gossiping began. Soon it was evident that in the court of public opinion, the enslaved 29-year-old woman was considered guilty of this inferno.

Although she is known in Canadian history as Marie-Joseph Angélique, the Portuguese-born woman's real birth name is unknown. Like many enslaved people subjected to the process of dehumanization, Angélique's true name was stripped from her (Cooper, 2006; Nelson, 2020). Angélique is the name assigned to her by her white widow mistress Thérèse de Couagne de Francheville (Cooper, 2006).

Angélique is a critical figure in contemporary Black Canadian scholarship for three reasons. First, the severity of her crime necessitated a trial. The resulting legal documents provide historians, like Afua Cooper (2006), the ability to reconstruct Angélique's biography from her own recorded words. This documentation also provides colonial proof that slavery was an accepted practice on lands now known as the Canadian-nation state. Second, the French Catholic authorities ascribed to Angélique a motive for setting a fire, a fire she repeatedly denied igniting, until a forced confession under torture. The authorities believed Angélique started the fire as a diversion for her to leave the colony and return to her homeland of Portugal. A present-day reinterpretation of her “crime” is an act of resistance. Finally, Angélique's undeniable presence reaffirms the realities of 400 years of Black Canada (Cooper, 2006, 2022; McKittrick, 2006; Walcott, 1997).

In 1737, the first Canadian-born saint, Marguerite d'Youville founded an order of nursing-nuns known today as the Grey Nuns (Paul, 1994, 2021). Across Canada, d’Youville's ongoing influence is vast (Paul, 1994). More broadly, consciously, or not, the Canadian nursing profession senses the chill of the work of the nuns in New France (McPherson, 1996b; Paul, 1994, 2021; Violette, 2005). According to McPherson (1996b) the genesis of contemporary nursing practice was positioned by early Canadian nurse leaders in the labor of these caring Francophone sisters. This is reflected in myriad of ways, including the honor we bestow to these women. Their experience is celebrated and upheld as our collective nursing history. We work, learn and practice in institutions endowed with their names (Paul, 1994). The most prestigious accolade granted by our national professional association is the Jeanne Mance Award (Canadian Nurse Association, 2023).

What makes Blackness surprising in Canadian nursing?

Jeanne Mance, co-founder of Montreal. Founder of the Hotel-Dieu¹⁰

Hotel-Dieu where years later, Suzanne de Couagne, worked as a nursing nun¹¹

Nursing nun: “young women of good character from reputable families”¹²

Suzanne de Couagne, a sister¹¹

Sister of Madame Francheville¹¹

Madame Francheville, a widow¹¹

A widow, Marguerite d'Youville¹³

D’Youville, a resident of Montréal^11,14

A resident of Montréal, Madame Francheville. Angélique's enslaver¹¹

An enslaver, Marguerite d'Youville¹²

D’Youville starting the Grey Nuns in Montreal in the 1730s¹¹

In Montreal in the 1730s, Angélique's fire. Ashes cast to the four winds.¹¹

What makes Blackness surprising in Canadian nursing?

Occult hypoxemia. Clear the air of Angélique's discarded remains. The evidence is all right here.

Lydia Wytenbroek on “planting new curricular roots: black history month projects at UBC nursing”

Nurse historian Patricia D’Antonio argues that history is one of the most critical methodologies available to us to address the complexities we face in healthcare today (D’Antonio, 2022). Numerous studies and articles demonstrate the value that a grounding in knowledge from the humanities (broadly) and history (specifically) can assist in the development of core skills for healthcare practitioners like empathy; interpersonal, communication, and analytical thinking; and more (Banner et al., 2019; D’Antonio & Fairman, 2010; Grypma, 2017; Nelson, 2009; Smith, 2016). The uptake of medical humanities in medical schools has led to a renewed emphasis on history in medical education. For example, Johns Hopkins University offers a variety of history of medicine courses geared toward MD students. In Canada, there is an endowed Hannah Chair in the History of Medicine in six different medical schools in Ontario with the goal of prioritizing history in medical education. Unfortunately, breaking this new ground in nursing education has proven more challenging.

While some nursing schools have created elective or required nursing and health history courses (for example, see Wytenbroek, 2022), nurse historians frequently publish articles about their attempts to integrate history into the curriculum, which is too often viewed as non-essential content (Matthias & Hundt, 2023). In my experience, when students have the opportunity to engage with critical history they realize the potential it offers to disrupt and challenge established ways of knowing, as indicated by Ismalia and Kyra. Critical history addresses power and privilege.

As a nurse and a historian (with three degrees in history), and an Assistant Professor in Nursing, I argue that understanding historical context is necessary for addressing racism and advancing social justice in nursing. In my experience, students find history a valuable way to understand practice, which includes greater insight into the histories of racism that shape our healthcare institutions. When I started teaching at UBC-V, I realized there were several ways I could work with students on history projects. I can teach a directed study in the history of nursing (like I did with Ismalia De Sousa) or supervise students who wish to focus on history or incorporate a historical lens into their research (like Kyra Philbert). I can also incorporate historical content into existing courses. For example, in teaching an adult health course, I was able to incorporate history in discussions about social determinants of health and the structural racism that gives rise to health disparities. None of these ways in and of themselves are earth-shattering, and most of my focus is on fulfilling my role as an assistant professor in a nursing school. Yet cumulatively, my expertise in critical history methods provides an academic grounding for students like Ismalia and Kyra to challenge oppressive hegemonic nursing knowing. My enrichment of the standard nursing education through a deliberate scattering of the seeds of historical knowledge sows the growth of antiracist knowledge to entire crops of students within my institution. The historical projects that have involved the largest number of students have all occurred outside the formal curriculum. This section describes Black History Month Projects at UBC-V School of Nursing from 2021–2023, the subject of my portion of the Hannah Lecture, all of which occurred outside the formal curriculum, seed planting new possibilities for nursing education.

The Consortium for Nursing Historical Inquiry at UBC (which Geertje Boschma and I co-lead) has sponsored an annual Black History Month project since 2021. In February 2021, the Consortium hosted a zoom panel, titled “Black (in)visibility: Black nurses in Canada who paved the way” (Flynn et al., 2021). During this panel, invited speaker Dr. Karen Flynn gave a keynote address about the experiences of Black Canadian and Caribbean nurses and the systemic racism that they faced during their nursing education in twentieth-century Canada. Ismalia then shared the results of her directed study on the history of Black nurses and midwives in colonial British Columbia. And Dr. Dzifa Dordunoo provided concluding remarks about Black nurses’ experiences of racism in healthcare today. This talk was widely attended by nurses and historians from across North America, and globally. The recording of the talk is available online and has to date received 3338 unique views and been downloaded 115 times. The success of this event speaks to the critical need for further and ongoing conversations about racism in nursing, and it spurred Ismalia and I to undertake a project the following year.

In 2022, Ismalia and I asked first-year undergraduate (BSN) nursing students if they would like to be involved in an extracurricular Black History Month Project that would highlight the stories of Black nurses historically. Five undergraduate students signed up, and we worked collaboratively to create an online flipbook, an online walk-through of the flipbook, and a physical display in our nursing school. Ismalia and I guided the students to research the histories and experiences of Black nurses, which we then published in the form of an online fifty-five page flipbook (now available online as a PDF download) (Wytenbroek et al., 2022). The flipbook tells the stories of ten Black nurses, and we brought these stories together in a compelling narrative that is interspersed with photos, historical context, and reflective questions. The overarching theme of the flipbook is that racism is a structural determinant of health. At the end of the flipbook, we include a set of reflective questions that encourage the reader to think about how they can engage in anti-racism work in nursing.

This past year, in 2023, I worked with 22 undergraduate (BSN) students to produce a Black History Month Project. Black and Brown nursing students do not always see themselves reflected in imagery or narratives about professional nursing and the students were keen to participate in a project that addressed racism. We collectively decided to explore the history of Black student nurses within our own nursing school. Students examined graduation photographs, hanging in the hallways of our school, to try and identify when and how many Black students were admitted into our programs. They then delivered a presentation, now available online, which explored the way that whiteness historically shaped access to nursing education in our institution and in Canada more broadly (Wytenbroek et al., 2023).

This project has many benefits, such as expanding our understanding of whiteness and racism in nursing education and considering the contributions of Black nurses to nursing practice. For example, one student commented: “Being part of the Black History Month project has given me great context and new understanding about the history of nursing within my own community…As a new nursing student, as well as a person of color, I am better able to appreciate the feats and challenges that nurses before me have faced in order for me to be able to immerse myself in this field with support and confidence” (“Historical Considerations,” 2023). Beyond the content, there is value in the process. Black, Brown, and white students worked collaboratively with a shared commitment to anti-racism. As another student member commented: “The project was a great way to learn as a group and collectively produce knowledge that can be shared broadly with other learners” (“Historical Considerations,” 2023). It is also salient to note that none of these projects would have been possible without student involvement, investment and interest.

The harvest of critical history yields an invaluable resource for nursing students who wish to contextualize contemporary practice issues and racism. Recently, a graduate nursing student wrote in my history of nursing course evaluation: “As a result of [this course], I truly believe that I am now a better nurse and educator than when I started, and more importantly, a more empathetic and curious human being.” Finding ways to incorporate history into nursing curricula without structural support remains a challenge but it is clear that students find value in pursuing historical projects whether they are done inside or outside of the formal curriculum. My academic positioning ensures the propagation of historical knowing grounded within the discipline of nursing, but for these antiracist ideals to truly take root, we need a clear investment in critical history.

A final note on positionality. We began this article by asking the question: How does engaging with histories of Canadian Blackness serve as an anti-racist strategy? I hope at this point we have answered that question, and now I would like us to consider a different one: Who can engage with histories of Canadian Blackness? Whenever I write on topics related to racism in nursing, I am asked to define my commitment to anti-racism. Let me assure you from the outset, that I am committed to and bring an anti-oppressive, decolonizing, and antiracist lens to my teaching and research. I am a white scholar and I have never experienced racism. Yet, I hope(!) that my commitment to anti-racism is evident through the projects that I pursue with students and the way that I support and mentor BIPOC students. It is my work with BIPOC nursing students that has propelled me into this work. Do I always get it right? Absolutely not. I have not addressed the challenges – and there have been many – of pursuing these projects. My whiteness offers me the privilege to “opt out” of this work, but the detrimental impact of racism on BIPOC students, colleagues and patients is too great not to engage.

I did not set out to purposely undertake Black History Month projects at our School of Nursing. Every year, it is students that have pushed for greater visibility of Black nursing history and greater awareness about Black nurses and historians and their work. It is through our collaborative work that these projects have been successful. It is one of the greatest privileges and joys of my academic career to work and learn alongside brilliant students like Ismalia and Kyra. History has been cultivated at UBC-V School of Nursing through the work of historians and nurse historians like myself and Geertje, but largely it has been transformative because of the furrowing work of passionate students who have pursued historical projects that are often extracurricular or “in addition to” their other studies and academic work. They are pusing the boundaries of discplinary knowledge and paving the way for other students to take up this work in new and creative ways.

Conclusion

Nursing has a disciplinary need to bring in voices from the margins to challenge its overreliance on the ideologies of whiteness and cisheterofemininity (De Sousa & Varcoe, 2021). In our text, we have demonstrated the boundless potential of critical history as an anti-colonial, anti-racist intervention within Canadian nursing. We have showcased diverse perspectives in critical history and the possibilities in nursing when we center Black life. From Ismalia's traditional historical approach to uncover examples in the archive of nursing work by Black women in the 19 century to Kyra's radical use of history, reimaging French Catholic nursing to engage with Angélique's story of Black Canadian resistance. Of course, Ismalia De Sousa and Kyra Philbert benefited from the mentorship, guidance, and resources of Geertje Boschma and Lydia Wytenbroek. As Lydia's section reveals, history in schools of nursing has been tragically overlooked. Structural support by means of electives in nursing and health history, opportunity to engage in nursing history projects and inclusion of history in graduate and undergraduate courses work provide rich opportunities to critically reflect on nursing and the social and political forces shaping it. We encourage faculty and students to consider inclusion of history in teaching and learning in both undergraduate and graduate curricula.

Our sharing is just the tip of the iceberg! Engaging with critical history works by eroding the boundaries of nursing knowledge from a mindless reproduction of white cisfeminine violence, by sparking radical imagination into fiery new constructs through a recentering of Black subjects, and by nourishing new growth in our shared disciplinary aim of social justice.

We hope you are curious around the power of critical history. Due to current limits of our experiential realities vis-à-vis the time-space continuum, we cannot hold a real-time discussion with you. Consider how the opportunity for interactive reflection is scaffolded within our unconventional writing. The metaphoric writing itself representing an arts-based disruption to the politically and historically shaped science dominated nursing knowledge generation (Archibald et al., 2017; Philbert, 2022). Ponder how you might incorporate knowledge of history into your daily nursing practice. Perhaps your school of nursing might engage with the strategies presented by Kyra. Certainly, if you engage in this work, return to the importance of an ethics of incommensurability (Tuck & Yang, 2012), and as relevant, your relationship to settler colonialism. Finally, consider again, critical history is a site for liberation!

Footnotes

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

J. Kyra Philbert

Ismalia De Sousa

Notes

Author Biographies

J. Kyra Philbert is a registered nurse, scholar, and artist. Graduating with a Bilingual (French/English) BSc in Nursing from UAlberta, she received her MS in Nursing and a BA in Gender, Race, Sexuality and Social Justice from the University of British Columbia. Philbert believes in pleasure-focused interventions for a more socially just future.

Ismalia De Sousa is a Registered Nurse and a Ph.D. candidate at the School of Nursing at the University of British Columbia (Canada). She received her BSN at Escola Superior de Enfermagem de Lisboa (Portugal) and her MSc in Advanced Practice Nursing Neuroscience Care at King's College London (United Kingdom). De Sousa's substantive area of research focuses on health inequities in stroke care. She also pursues subsidiary interests in critical theories, critical pedagogies, and Black nurses’ historiographies.

Lydia Wytenbroek PhD, RN, is an Assistant Professor at the School of Nursing at the University of British Columbia (Vancouver campus). She received her PhD in History from York University, and her research focuses on the history of nursing internationalism, specifically the history of American nursing imperialism in Iran. She also writes about racism in healthcare. She is co-lead of the Consortium for Nursing History Inquiry at UBC.

Geertje Boschma PhD, RN, is a Professor at the School of Nursing at the University of British Columbia (Vancouver campus). Her research focuses on the history of nursing and healthcare, with an emphasis on the history of mental healthcare. She is a co-lead of the Consortium for Nursing History Inquiry at UBC.

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

Abstract

Keywords

Aim

Purpose

Geertje Boschma on “uncharted waters”

Ismalia De Sousa on “igniting the fire within us to imagine (re)new(ed) possibilities in Black nurses’ historiographies”

Who is a nurse? Who can be a nurse?

Kyra Philbert on “Surprise! Turbulence up ahead.”

What makes Blackness surprising in Canadian nursing?

What makes Blackness surprising in Canadian nursing?

What makes Blackness surprising in Canadian nursing?

What makes Blackness surprising in Canadian nursing?

Lydia Wytenbroek on “planting new curricular roots: black history month projects at UBC nursing”

Conclusion

Footnotes

Declaration of conflicting interests

Funding

ORCID iDs

Notes

Author Biographies

References