Nursing Inquiry 2003; 10(2): 91 102

Feature
Blackwell Publishing Ltd.

Implementing a postcolonial feminist

perspective in nursing research related
to non-Western populations
Louise Racine
School of Nursing, University of British Columbia, Vaucouver, British Columbia, Canada
Accepted for publication 25 November 2002

RACINE L. Nursing Inquiry 2003; 10: 91102

Implementing a postcolonial feminist perspective in nursing research related to non-Western populations
In this article, I argue that implementing a postcolonial feminist perspective in nursing research transcends the limitations of
modern cultural theories in exploring the health problems of non-Western populations. Providing nursing care in pluralist
countries like Canada remains a challenge for nurses. First, nurses must reflect on their ethnic background and stereotypes
that may impinge on the understanding of cultural differences. Second, dominant health ideologies that underpin nurses
everyday practice and the structural barriers that may constrain the utilization of public healthcare services by non-Western
populations must be further examined. Postcolonial feminism is aimed at addressing health inequities stemming from social
discriminative practices. I will draw on extant literature and data of an ongoing ethnography exploring the Haitian caregivers
ways of caring for ageing relatives at home to unveil how the larger social and cultural world has an impact on caregivers
everyday lives. Marginalized locations represent privileged sites from which health problems, intersecting with power, race, gender,
and social classes, can be addressed. Postcolonial feminism provides the analytic lens to look at the impact of these factors in
shaping health experiences. It also suggests redirecting nursing cultural research and practice to achieve social justice in the
healthcare system.
Key words: cultural nursing research, feminism, home care services, non-Western populations, postcolonialism, social justice.

Over the past few decades, the influence of critical and

feminist theories as alternatives to the Received View1 philosophy of science in expanding the corpus of knowledge,
especially in exploring health issues related to race, gender,
and social classes, is widely acknowledged in the discipline
of nursing (Anderson 1986; Stevens 1989; Jackson 1993;
Anderson 1996; Cheek and Porter 1997; Boutain 1999; Tang
and Anderson 1999; Taylor 1999; Drevdahl et al. 2001). Despite
Correspondence: Louise Racine, University of British Columbia, School of
Nursing, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
E-mail: <loracine@interchange.ubc.ca>
Jacox and Webster (1997) mention that the Received View emerged in the
17th century, as a scientific worldview that conceptualized scientific reality
as a mechanistic and naturalistic entity, about which only God knew
the foundational laws. Scientists aims were to discover these operating laws
to explain and predict natural or physical phenomena. Later, philosophers of
the Vienna Circle introduced the notion of falsification, implying that
scientific reality can only be approximated at best.
1

2003 Blackwell Publishing Ltd

the social significance of these approaches in unveiling

health disparities, needs to address racial inequalities and the
impact on health in pluralist countries prompts developing them further. Nursing research is still perceived as neutral and apolitical, which explains why sensitive issues related
to race, gender, and class need to evolve. As a potential
explanation, Baker, Varma and Tanaka (2001) suggest that
racism is not viewed as a domain of the discipline. This
encourages revisiting ways to tackle health inequities related
to social injustices in nursing.
Critical and feminist approaches represent promising
avenues for eliciting new knowledge to address health
inequities by shifting reflexive thoughts into transformative2 interventions aimed at achieving social justice using
Golding (1988) points out that Antonio Gramscis philosophy of praxis
unifies the theoretical and practical knowledge in science, as a science in action
or praxis-oriented science, aimed at elaborating transformative knowledge.

L Racine

research as a vehicle of social activism (Anderson 2000a;

Drevdahl et al. 2001). Critical and feminist approaches
critique the relevance of culturalist models (Ahmad 1993;
Hall 1994; Culley 1996), the influence of neoliberal
ideologies (Browne 2001), and the utilization of individualistic health frameworks (Anderson 1986; Boutain 1999;
Drevdahl et al. 2001) that crystallize culture into a static
entity. Stuart Hall (1994) defines culture as:
both the meanings and values which arise amongst distinctive
social groups and classes, on the basis of their given historical
conditions and relationships, through which they handle
and respond to the conditions of existence; and as the lived
traditions and practices through which those understandings are expressed and in which they are embodied (527).

The complex interplay between culture and the social

world must be comprehended from a theoretical perspective, which accounts for the multiple contextual layers that
shape culture.
The purpose of this article is twofold. First, I want to
demonstrate the needs for nursing to address health issues
pertaining to race, gender, and class in the healthcare
system. The context of caring for Haitian ageing relatives at
home illustrates that the gendering and racializing of the
healthcare system that stems from the Canadian politics of
multiculturalism is a relation of ruling3 that has an impact
on the health of people of the South.4 To this end, I present
data shared by women and men from an ongoing study that
demonstrates the need to adjust our theoretical lens to
include subaltern5 knowledge, and gain insight that cannot

3 Smith (1987) defines relations of ruling as a set of structured social

practices that organizes, directs, and regulates the social world, based on the
privileged social class agenda.
4 Schutte (2000) and Anderson (2000b) use the words North and South to
describe the countries capital wealth. The aim is to avoid perpetuating the
hegemony of Western feminism by using expressions such as developed or
developing countries, while being committed to adopting an anti-imperialist
feminist discourse. I am aware that using this South-North terminology
introduces a binary opposition, that can be viewed as a new form of cultural
essentialism, that Narayan (2000) points to as being a potential weakness of
postcolonial feminism. In this paper, the expression people of the South
designates immigrants and refugees of Color, who have been racialized in
pluralist Western countries like Canada, where discriminative immigration and
labor policies were used to control the influx of non-European settlers
(Anderson 2000a).

I draw on Spivak (1988) to define subaltern knowledge as the knowledges

that were muted by the epistemic violence of colonization. Also the word
subaltern designates the silenced, the oppressed, the nonelite classes, the
proletariat, the third-world women, the economically dispossesed, and/or
any social group marked by colonizations essentialism. In this article, the
subaltern designates the racialized and silenced immigrants and refugees of
Color, to whom I refer as people of the South.
5

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be obtained from centered or dominant locations. Second,

I want to demonstrate the appropriateness of implementing a postcolonial feminist perspective in nursing research
to explore the social, political, economical, and cultural
contexts that construct experiences of caring for ageing
relatives at home, and which constrain the accessibility to
healthcare services. Finally, I discuss the implications of
applying postcolonial feminism in nursing research and
practice.

THE GENDERING AND RACIALIZING OF THE

CANADIAN HEALTHCARE SYSTEM
To begin, I will sketch out the Canadian politics of multiculturalism upon which the gendering and racialization of
the nation has been constructed. Ng (1993) states that, by
drawing on systems of domination based on race and gender, multiculturalism essentializes the culturally different
Other. The upshot is to create patterns of social exclusion
based on peoples skin color, named visible minorities
while using gender to ascribe non-Western women into
categories such as women of Color or visible minorities
women (Ng 1993; Carty and Brand 1993; Frankenberg
1993; Lee and Cardinal 1998; Bannerji 2000; Foster 2002).
This ideology of multiculturalism arises from Canadas
colonial past that led to the coexistence of the English and
French populations, the so-called two-founding peoples
of the nation.6 Therefore, the politics of multiculturalism
serves to ground the white Eurocentric ideology7 of the
Canadian state. Hall (1997) defines ideology as the mental
frameworks, the languages, the concepts, imagery of thought,
and the systems of representation, which different classes
and social groups deploy in order to make sense of,
define, figure out and render intelligible the way society
works (26). Ahmad (1993) uses the term racialization to
describe an ideology by which populations are categorized
by their real or imagined phenotypes (18). Racialization
becomes the ideological ground from which individual and
institutional racism are developed, and within which culture
is conceptualized, as a biologically determined and static
entity (Ahmad 1993).
For a fuller discussion of Canadian multiculturalism, see for example,
Anderson and Reimer Kirkham (1998), Bannerji (2000), Eisenberg (1998),
Eller (1999), Foster (2002), and Ng (1993). This brief listing does not give
credit to the richness of materials related to this topic.

I also use the term as it was suggested by Foucault (1980) to define

ideology as regime of truths which is defined as normalizing discourses
produced by dominant political and economic apparatuses to govern societies
according to the privileged class agenda.

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Postcolonial feminism and nursing

The impact of the gendering and racializing of the

Canadian healthcare system on immigrants and Aboriginal
peoples health has been scrutinized in previous studies
(Ng 1993; Tator 1996; Brown and Brown 1996; Anderson
and Reimer Kirkham 1998; Eisenberg 1998; Smith 1999;
Bannerji 2000; Baker et al. 2001; Browne and Smye 2002;
Smye and Browne 2002). Anderson and Reimer Kirkham
(1998) state that the gendering and racializing of the health
system has an impact on healthcare policies that are tailored
to the Eurocentric cultural beliefs on health and illness of
the two founding peoples thus silencing the voices of
Aboriginals, Metis, and people of the South in the shaping
of the Canadian healthcare landscape.

SETTING OUT THE CONTEXT OF CARING

FOR HAITIAN AGEING RELATIVES AT HOME
Previous studies were carried out in the Haitian Canadian
community. For instance, Mass (1983) explored Haitian
immigration to explain the construction of Haitian ethnicity
in the Province of Quebec. The underutilization of public
healthcare services by Haitian Canadians was also studied
(Mass 1995; Guberman and Maheu 1997). Guberman and
Maheus inquiry is of particular interest since it was the first
to be conducted on Haitian caregivers in Canada. Nevertheless, this research raises some issues because the experience of caring for an ageing parent at home is presented as
being culturally determined. Focusing on Haitian culture to
explain ways of caring overlooked the influence of sociopolitical forces in constructing caregivers experiences, and
constrained the interventions to challenge social discrimination. Cultural essentialism erases the impact of social, political, and economic factors in Othering Haitian caregivers.
My preliminary results illustrate how the broader social
context influences Haitian caregivers perceptions about
mainstreams nurses and home care services. The following
interview excerpt was obtained from a caregiver who spoke
about racism at his workplace:

Interviewer: May I ask the nature of the problems you

encountered? Please feel free to answer or not. (She nodded her head for yes.)
Interviewer: Was it related to your cultural background?
Woman: Yes. It was related to that. I had so many problems.
He said things to me ( ).
Interviewer: What did he say?
Woman: He said: People who come to this clinic are very
educated, very educated. and you cant work here. He even
said that I was chasing clients away.

These interview excerpts illustrate the impact of racism on

health through the prism of labor relations. Whether racist
remarks are subtly or ruthlessly addressed, they are devastating on peoples health and social integration. Racism shapes
Haitian caregivers perceptions about mainstream society by
reinforcing feelings of social rejection. It also influences
Haitian caregivers perceptions of healthcare practitioners
coming from the dominant ethnic group. The next two
excerpts show that contextual factors related to a gendered
and racialized healthcare system construct the experience of
caring and have an impact on the utilization of healthcare
services. The woman talks about nursing homes and the
fears of institutionalization:
Woman: Anyway, nursing homes arent prepared. Ive
visited some nursing homes and I found that ethnic groups
have no place there. I dont see them in these places.
Perhaps Ive visited the wrong ones but the quality is not
the same [as in the home setting]. As well, there are ways of
doing things; its just not the same. I find that if a person is
unconscious its fine since we have no choice. But when
people are conscious and they have to go there In these
places, you have to be Sometimes, even if the person
speaks French But those who dont speak French, they are
completely powerless. Those who speak Creole theyre
powerless. They cant be understood.

She also talks about the public home care services

offered by CLSC8 and explains why she cannot rely on CLSCs
services to support her caring commitment:
Interviewer: So, you find that nursing homes have to be
readjusted to the cultural differences of the population

Man: One day at work, a woman told me: Youre just a

Negro. It doesnt matter since I know I am a Black man, a
Negro, and I dont care about it. It doesnt matter if you
are Indian or Black because I didnt choose the color of my
skin. I had no choice.

Woman: Its coming, its coming extremely fast. It must be

organized. Otherwise, well be up against it. And for these
reasons, Haitian elders dont use CLSC services or attend
CLSC social activities. They just dont go there. Sure, we can
still use Haitian community centres and all that. But in the
CLSC, will Haitian elders find somebody to understand
them? Of course, if they speak French they wont have any
problems being understood. But for those who only speak
Creole, who can speak Creole to them? Nobody there can
speak Creole.

A middle-aged woman caregiver who juggles the triple tasks

of working in the labor force, looking after her family, and
caring for ageing relatives at home, describes how racism
operates at work:
Woman: While working at ( ), I had a few problems with
a healthcare provider and this was extremely difficult. It was
almost a disaster. I was very depressed. ( )

2003 Blackwell Publishing Ltd, Nursing Inquiry 10(2), 91102

CLSC is the acronym of Quebecs community centres, which translates into

English as Local Community Service Centres.

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The barrier of language and the lack of adapted services in Creole seem to explain why public services are underutilized despite some caregivers needs to access these
services. Although Haitians are one of the larger groups of
new Canadian citizens, Torczyner and Springer (2001) report
that their demographic representation has been underestimated by 40%. This skewed representation, perhaps
related to some extent to illegal immigration, affects claims
or demands for health and social services since it minimizes
the Haitian demographic weight. Therefore, Haitian caregivers experiences of caring for ageing relatives at home
cannot be dissociated from the ideology of whiteness
(Frankenberg 1993) and its dominant effects (Lewis 2000)
in Othering people of the South. Frankenberg (1993)
defines whiteness as a set of locations that are historically,
socially, politically, and culturally produced and, moreover,
are intrinsically linked to unfolding relations of domination
(6). As well, the impact of nursing professional practice in
shaping caregivers experiences must be examined. This interview excerpt illustrates how a woman caregiver perceives
home visiting nurses:
Interviewer: Can you tell me if you consider home care
nurses as support resources? I mean, for caregivers like you,
who care for ageing relatives at home?
Woman: Actually, I cant say this since nurses are not
supportive. Psychologists and social workers are the only
professionals from whom I can get support.

While observing participants during home care visits, I

noticed that some nurses rely on biomedical jargon to communicate with both caregivers and care receivers casting
the expert role by exposing scientific knowledge. Lyotard
(1984) states that knowledge and power are simply two sides
of the same question: who decides what knowledge is, and
who knows what needs to be decided? (8). As well, Smith
(1987) asserts that professional practice represents a system
of ruling that organizes the social world. It can be assumed
that Haitian caregivers experiences are embedded in a
constellation of social, political, cultural, and economic
factors that constantly interact with mainstream societys values.
It seems that the more likely caregivers are to encounter
racism at school, at work, or in the civil society, the less likely
they are to rely on public home care services. Caregivers do
not want to expose ageing relatives to racial discrimination;
therefore, keeping them at home shields ageing parents
from institutional racism. This does not imply that culture
has no role in modeling Haitian ways of caring. Data show
that cultural beliefs related to respect of elders and the past
experiences in a country where state resources are unavailable to support caring activities have an impact on Haitianborn caregivers ways of caring in the host country. Although
94

postmodernism9 constitutes a relevant theoretical framework from which to assess ways of caring, its limitation in
exploring how the everyday world of Haitian caregivers is
embodied in a complex nexus of social and cultural forces a
turn towards postcolonial feminism.

FROM POSTMODERNISM TO
POSTCOLONIALISM
Smith (1999) points out that feminist inquiries must be
directed at investigating how society organizes and shapes
the everyday world of experience (74). She argues that inquiries
must be grounded in peoples experiences to uncover
the relations of ruling into which, these experiences
are socially and culturally constructed (Smith 1999).
Reinharz (1992), while acknowledging different strands10 of
feminisms, states that feminist research must be grounded in
a common struggle, which is to unmask womens oppression
and develop emancipatory knowledge towards achieving
social justice.
For postcolonial scholars, the notion of subjective
experience or subjectivity is not without its problems.
Hall (1997) states that, despite the positive aspects of
learning about peoples subjective experience or subjectivity, the focus on subjective experience overlooks the
collective effects of social, political, economical, and social
forces in shaping identity. Lewis (2000) points out that
white feminists notion of subjectivity erases the sociality
of peoples experiences to universalize peoples and
especially womens identity without acknowledging the
multifaceted and complex differences of locations11 in
modeling peoples lives. According to Lewis (2000), the very
notion of subjective experience has to be broadened to
account for the meanings attached to race, gender, and
social class occurring in various historical moments.
Subjects are constituted through experiences of

I draw on Lather (1991) to use the terms postmodern and

poststructuralism interchangeably to describe the set of strategies aimed at
deconstructing metatheories, and at developing a Foucauldian awareness of
oppression and power, to elicit transformative knowledge (see Lather 1991,
1213).

Many strands or currents of feminisms coexist such as radical, liberal,

socialist/Marxist, African-American, postmodern, and postcolonial feminisms
(Schutte 2000), depending on how womens oppression is conceptualized. In
this article, I refer to postmodern feminist assumptions as defined by Fraser
and Nicholson (1990).

10

Lewis (2000) defines location as referring to the historical, geographical,

cultural, psychic, and imaginative boundaries that provide ground for political
definition and self-definition (173).

11

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Postcolonial feminism and nursing

oppression, gendering, and racializing, which characterize

the multiplicities of locations or positions from which
people of the South speak creating multiple subjectivities
or positionalities (Lewis 2000). Hence, race, gender, and
social class interlock as systems of oppression in defining
the multiple identities or multiple selves of people of the
South.
Postmodern feminism opens up alternatives to essentialization by correcting the failure of Western science to
properly address the complexities of health problems
(Fraser and Nicholson 1990; Lather 1991; Anderson 1991a;
Anderson 1991b; Harman 1996; McCormick and Roussy
1997; Cheek 1999; Herdman 2001; Stevenson and Beech
2001). Far from rejecting theorization, these authors suggest
that postmodern approaches create new ways of doing
research to sort out ideologies influencing nursing practice.
Moreover, these approaches question the status quo that
impinges on the integration of marginalized knowledge
in nursing theories (Anderson 1990; Allen 1992; Cheek and
Porter 1997; Im and Meleis 1999; Cheek 1999; Meleis
and Im 1999; Tang and Anderson 1999; Anderson 2000a;
Anderson 2000b; Herdman 2001; Im and Meleis 2001;
Stevenson and Beech 2001).
Some postcolonial scholars contend that postmodernism should not be uncritically applied; arguing that postmodernism is just a mere extension of Western science. This
crisis occurs as the logical consequence of the deification of
reason and objectivity, which would not affect ways of
conceptualizing reality of non-Western cultures (Said 1979;
Mohanty 1988; Bhabha 1994; Hall 1997; Gandhi 1998;
Quayson 2000). Bhabha (1994) asserts that postmodernism
can be a useful discursive practice, if it counteracts the hegemonic effects of colonization. Hall (1997) agrees with some
elements of postmodern thought but is critical of the
postmodern refusal to account for history. Quayson (2000)
argues that, the two may be brought together in common
thematic, rhetorical, and strategic concerns, especially as
these are brought to bear on questions of marginality (133).
This suggests an examination of how postcolonialism
transcends postmodern limitations to guide nursing cultural
research.

DEFINING POSTCOLONIALISM
What is postcolonialism and how can it be articulated
in nursing research? Postcolonialism challenges Western
science as the unique source of knowledge production and
uncovers healthcare inequities related to gender, race, and
class resulting from the process of colonization and postcolonization. Said (2000) defines colonization as:
2003 Blackwell Publishing Ltd, Nursing Inquiry 10(2), 91102

the expansive force of a people; it is its power of reproduction;

it is its enlargement and its multiplication through space; it
is the subjugation of the universe or the vast part of it to that
peoples language, customs, ideas, and laws (135).

Postcolonialism is the process of postcolonializing. Quayson

(2000) mentions:
To understand this process [postcolonializing], it is necessary to disentangle the term, postcolonial, from its implicit
dimension of chronological supersession, that aspect of its
prefix, which suggests that the colonial stage has been surpassed and left behind. It is important to highlight instead
a notion of the term as a process of coming-into-being and
of struggle against colonialism and its after-effects (9).

Quayson (2000) proposes the following working definition:

[Postcolonialism] involves a studied engagement with the
experience of colonialism and its past and present effects,
both at the local level of ex-colonial societies as well as at the
level of more general global developments thought to be
the after-effects of empire (2).

More succinctly, the postcolonial approach is directed at

uncovering the exclusionary effects of dominant ideologies
in Othering other forms of knowledge the subjugated
knowledge. I refer to Foucault (1980) to define subjugated knowledges as a whole set of knowledges that have
been disqualified as inadequate to their task or insufficiently elaborated: nave knowledges, located low down on
the hierarchy, beneath the required level of cognition
or scientificity (82).
Inspired by a poststructuralist framework, Said coined
the word Orientalism to describe the domination of one
part of the world (the East-South) by the other (the WestNorth). Orientalism also expresses the political process
of colonialism per se, as well as the scientific school of
thought that governs how non-Western cultures were mostly
perceived and studied by Western scientists. Orientalism is
a paradigm of thought that describes the domination of
Western culture over non-European cultures and peoples.
Homi Bhabha (1994) states that:
postcoloniality, for its part, is a salutary reminder of the persistent neo-colonial relations within the new world order
and the multinational division of labour. Such a perspective
enables the authentication of histories of exploitation and
the evolution of strategies of resistance (6).

Bhabha points to the failure of capitalism and class, in

documenting the intersectionality of the social world with
historical, political, economic, and cultural factors where
racism, sexism, and classisms have an impact on the health
of people of the South, under new forms of colonialism.
Tuhiwai Smith (1999), a Maori scholar, argues that research
is the process by which the imperialism of Western science is
legitimized and regulated through academia by scholarly
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disciplines and paradigms of inquiry that were, and are still,

used to dehumanize non-Western cultural groups. Thus, postcolonialism cannot be conceptualized as a single theoretical
entity but instead as a set of ontological and epistemological
assumptions used to disenfranchise the knowledge of
people of the South.
Finally, Quayson (2000) asserts that postcolonialism
focuses on dominant discourses and ideologies that
shape the social world to look at the material effects of subjugation. Subjugation is the process by which imperialism
and colonialism impose a condition of positional superiority
over the colonized (Said 2000). The process is to ground
contemporary world phenomena like immigration, unemployment, health problems, and healthcare reforms into
the real world to unmask the interrelations between these
phenomena and new colonial ideologies. Consequently, the
researchers aim is to relate modern-day phenomena to
their explicit, implicit, or even potential relations, to the heritage of colonialism (Quayson 2000, 11) while decolonizing
methodologies and methods (Tuhiwai Smith 1999), to
critique the marginalizing effect of Western science on subjugated knowledge.
Applying postcolonialism to nursing research unveils the
reductionist Western discourse of essentializing the Other
in a unique, crystallized, neutral, rational, and objectivist
cultural entity. As well, decolonializing methodologies and
methods is directed at disrupting the power relations to
voice subjugated knowledge. Subjectivities emerge from:
the different constellation of social, cultural and economic
forces ( ) since we are, in part, constructed as subjects
through the particular layering of historical discourses,
which we inhabit, then new kinds of sensibilities begin to be
clearly discernible (Hall 1997, 247).

TOWARDS A DEFINITION OF
POSTCOLONIAL FEMINISM
I draw on Anderson (2000a,b), Meleis and Im (1999),
Quayson (2000), Smith (1987), and Schutte (2000) to define
postcolonial feminism as a critical perspective aimed at
addressing health inequalities related to asymmetrical
power relations, at disrupting the relations of ruling that
silence culturally different Other voices; at integrating subjugated knowledge in nursing theorization; at developing
transformative knowledge directed at achieving social
justice by correcting health inequities arising from social
discrepancies affecting people of the South.
Anderson (2000b) urges nurses to hear the silenced
subaltern voices as a means to generate transformative
knowledge that will, in turn, call for the implementation
96

of social actions to democratize the healthcare system

and improve the quality of care. Meleis and Im (1999) assert
that despite the usefulness of nursing cultural theories in
understanding immigrants health beliefs and practices,
the extent to which healthcare experiences have been stereotyped, rendered voiceless, silenced, not taken seriously,
peripheralized, homogenized, ignored, dehumanized, and
ordered around needs to be questioned (96). To this end,
postcolonial feminism explores oppression from a broader
theoretical platform to assess how subordination is intertwined with patriarchy, traditionalism, and modernity in
affecting the everyday lives of people of the South. The key
point is that postcolonial feminist epistemology not only
focuses on patriarchy as a source of oppression, but also
examines how social inequalities are located and constructed within a political, historical, cultural, and economic
context, since facts cannot be studied out of these realities
(Quayson 2000).
In using a postcolonial feminist perspective, nurse
researchers integrate the knowledge of people of the South
to look at health problems differently, to give a voice to
racialized women who have been silenced, and provide the
analytic lens to examine how politics and history have variously positioned us [racialized women], and shaped our
lives, knowledges, opportunities, and choices (Anderson
2000b, 145). The purpose is to counteract the hegemonic
practices of Western science in marginalizing other forms of
knowledge.
Nevertheless, Spivak (1988) cogently asks: Can the subaltern speak? She points out that subalterns must speak for
themselves, instead of relying on Western intellectuals to
speak for them. Can Western academics speak for the subalterns, without misrepresenting them? McLaren (1992, 80)
argues that if researchers engage in academic decolonization, a process described as a critical way of unlearning
accepted ways of thinking and of refusing to analyze subalterns in the mode of the dominator, then the concerns
of the subalterns can be conveyed. Researchers of the dominant group must recognize how institutionalized whiteness
confers upon Whites (both individually and collectively)
cultural, political, and economic power (Roman 1993, 72).
As well, Alcoff (1991) urges researchers to examine their
social location since they speak from a particular embodied
position that cannot be erased in the inquiry.
To hear the subaltern voices, nurses need to question
their everyday practice to see how healthcare programs
have an impact on the health of people of the South. Nurses
also need to reflect on the impact of imposing their cultural
and biomedical interpretative frameworks on health and
illness (Good 1994). Negative racial stereotypes underlying
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Postcolonial feminism and nursing

culturally unsafe12 nursing practices and their deleterious

effects on health have been documented (Maeda Allman
1992; Papps and Ramsden 1996; Polaschek 1998). Tang and
Anderson (1999) suggest re-writing nursing professional
practice by engaging practitioners in a reflexive process, to
understand peoples lived experiences from a broader social
and cultural context, and to examine the effects of power in
encounters between clients and healthcare providers. Postcolonial feminism is a means to grasp cultural differences
by decentering knowledge production, where the culturally
different Other is heard and understood from standpoints
located at the margins, and not from centered position also
defined as the culturally dominant position.

Strengths of the postcolonial feminist perspective

In using a postcolonial feminist perspective to strengthen
nursing cultural research, the aim is fourfold. The first aim
is to address the neocolonial structural barriers that might
impinge on or constrain the Haitian caregivers access to
home care services. Postcolonial feminism rejects the totalizing and essentialist discourses on the health of people of
the South. At the theoretical level, subjectivities are acknowledged from a perspective where cross-cultural comparisons
need to be carefully made since the cultural, economic,
political, religious, and social contexts within which health
problems related to gender, race, and class inequities vary
according to geopolitical areas.
The second is to avoid reframing or re-presenting
current injustices and social inequalities in a white Western
hegemonic postmodern feminist discourse. The researchers
commitment is to re-present data, not to contribute to
Othering the marginalized knowledge in an alternative
dominant discourse. The process of essentializing characterizes what Alcoff (1991) points to as the problem of speaking for, or about others. Bell Hooks (1989) invites women of
the North, who study people of the South, to be aware of
their social locations to avoid essentializing the culturally
different Others in new, normative or authoritative dis-

The concept of cultural safety was developed in the late 1980s in New
Zealand by a group of Maori nurses. Cultural safety is defined as actions
which recognize, respect, and nurture the unique cultural identity of the
Tangata Whenua [or Maori] and safely meet their needs, expectations, and
rights (Polaschek 1998, 453) The concept of cultural safety is an analytic
framework that serves to examine health policies and programs offered to
members of minority groups by a dominant group (Polaschek 1998). For a
fuller discussion of the concept of cultural safety and its methodological
implications in nursing research, see for example, Papps and Ramsden
(1996), Polaschek (1998), Smye and Browne (2002), Browne and Smye
(2002), Reimer Kirkham, Smye and Tang et al. (2002).

12

2003 Blackwell Publishing Ltd, Nursing Inquiry 10(2), 91102

course. This requires the researcher to move back and forth

from data to participants, to validate the data interpretation.
The third point is to re-present data in a non-nomothetic
way while recognizing that racism, gender discrimination,
and classisms are not mere constructions of the mind, but
really exist in the world. Bannerji (2000) points out that the
category, Canadian, is clearly applied to people who had
two things in common: their white skin and their European
North American (not Mexican) background (64). The
fourth point is to avoid the pitfalls of pure relativism, since
nursing interventions are developed to address issues of
race, class, and gender affecting the health of people of
the South. I will now shift the discussion to introduce ways
of implementing a postcolonial feminist approach in nursing research and how this perspective can advance nursing
knowledge and practice.

IMPLEMENTING A POSTCOLONIAL FEMINIST

PERSPECTIVE IN NURSING RESEARCH
In an earlier section, some interview excerpts were used to
demonstrate the importance of shifting our theoretical lens
to explore and understand how caring experiences are culturally, socially, and historically constructed in a gendered
and racialized society. Postcolonial feminism provides the
critical13 epistemological platform to address health problems pertaining to race, gender, and class that intersect with
historical, economical, political, social, and cultural factors
impacting on the healthcare system. Carspecken (1996) states
that critical inquiry attempts to clarify how and where
oppression works (8). Nevertheless, the challenge in implementing postcolonial feminism in nursing research is to avoid
marginalizing people of the South by usurping the meanings
and producing ideologically disfiguring effects (McLaren
1992, 78). In relying on some methodological assumptions,
this drawback can be minimized (Reimer Kirkham, Smye and
Tang 2002). These assumptions establish a critical methodology in which the process of unlearning, as Spivak puts
it, is directed at critiquing postcolonial and neocolonial
practices in the healthcare system, without substituting new
forms of essentialization to the hegemonic nativist discourse.
13 Kincheloe and McLaren (1994) mention that a critical researcher attempts
to use her or his work as a form of social or cultural criticism and who accepts
certain basic assumptions: that all thought is fundamentally mediated by
power relations that are social and historically constituted; that facts can never
be isolated from the domain of values or removed from some form of
ideological inscription; ( ) that certain groups in any society are privileged
over others ( ) that oppression has many faces, and that focusing on only
one at the expense of others often eludes the interconnections among them
(13940).

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Designing postcolonial feminist methodology

The first methodological assumption consists of critiquing
the practices of the dominant culture by relying on the
marginalized knowledge. The process of critique is turned
against the domination and exploitation of culturally differentiated others (Schutte 2000, 59). This process is closely
linked to the concept of cultural safety that implies, as
Bhabha puts it, the recognition of cultural differences as
opposed to cultural diversities. Polaschek (1998) points out
the need to move beyond modernist cultural theories to
examine structural elements by which nursing practice
diminish, demean, or disempower the cultural identity and
well-being of an individual (453). On the other hand, Papps
and Ramsden (1996) define cultural safety as the effective
nursing of a person/family from another culture by a nurse
who has undertaken a process of reflection on her/his own
cultural identity and recognizes the impact of the nurses
culture on her/his own nursing practice (491). Cultural
safety deals with racism since negative stereotypes impinge
on the quality of nursing care. Notions of cultural sensitivity
and cultural awareness derived from cultural theories are
not sufficient to provide culturally safe nursing care, since
the relationships between colonialism, neocolonialism,
dominant ideologies, and nursing practice are either underestimated, overlooked, or left aside (Papps and Ramsden
1996).
The second methodological assumption is to explore
dominant ideologies that underpin home care services and
how these relations of ruling have an impact on the accessibility to home care services. To this end, data collection
and analysis are aimed at gathering evidence to explore the
impact of social and political forces in constructing caring
experiences. The process is directed at allowing the expression of the everyday world of Haitian caregivers. These
voices must be heard and understood otherwise the
inquiry will not influence nursing practice and will fail to
challenge the status quo.
In applying a postcolonial feminist perspective, the
process is directed at contrasting the native and the host
countrys history, politics, colonial influences, patterns of
immigration, division of labor, and gender relations that shape
caregivers everyday lives and influence the accessibility
to home care services. Keeping in mind feminist assumptions, intensive reflexivity is required when it comes time to
equalize power differentials, to understand the researchers
racial biases, and to negotiate meanings with participants.
Postcolonial feminism influences data analysis to reinscribe otherwise, as Lather (1991) suggests, the process of
caring for ageing relatives at home in the Haitian commu98

nity. Macro social elements like the state disengagement, the

healthcare reform, the shifting of caring responsibilities to
families, the womens invisible and unpaid work in caring for
the elderly, have to be scrutinized to explain ways of caring.
As well, issues pertaining to the healthcare system per se, such
as the lack of organizational structures to support caring
commitment, the chronic underfunding and understaffing
of home care services, and the absence of national health
policies on home care must be examined, to determine the
real accessibility to these programs.
Finally, adopting a postcolonial feminist perspective
influences data analysis, since the fact cannot be avoided
that the researcher comes from a social and cultural
location. During fieldwork, I constantly face my identity as a
white Canadian woman. Participants report explicit messages about their wounded and split cultural identity during
interviews and participant observation sessions as well as
the sense of being socially excluded from the mainstream
society on the basis of their skin color or political allegiances.14 Participants speak from locations that inform on
the process of Othering. In turn, integrating subjugated
knowledge also calls for unraveling the incommensurability
of cultural differences leading us to explore what Bhabha
(1994) describes as the third space. The notion of third
space is the point of departure from which the exploration
of cultural differences unveils the illusion of multiculturalism and minimizes the pitfalls of social exclusion in pluralist
countries (Bhabha 1994). The very notion of cultural diversity embedded in Western multiculturalism is based on
competing ideologies of both encouragement and containment. These politics result in the ghettoization of
cultural differences while opening the door to cultural
assimilation (Bhabha 1990).
Bhabha (1994) points out the need to explore the
contingencies and polarities of both Haitian and Canadian
cultures as the platform from which to construct cultural
hybridity. Cultural hybridity acknowledges peoples multiple subjectivities or positionalities through processes of
negotiation about cultural meanings. In nursing practice,
the notion of third space moves us away from cultural
comparativism rooted in the ideology of whiteness and the
discourse of Western biomedicine. The home clinical
encounter is a privileged site where cultural differences and
contradictions have to be negotiated. Prior to this, the
During fieldwork, some participants expressed concerns about being viewed
as second order citizens. One informant said: If youre not white, youre not
Quebecer. If youre not nationalist, youre not Quebecer. Haitian immigrants
and their children born in Canada are neither considered as complete
strangers nor as full citizens which is similar to the social status of Maghreb
immigrants in France, as Kristeva (1991) reports .

14

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Postcolonial feminism and nursing

effects of racial biases on health have to be acknowledged as

well as the impact of preconceived ideas on nurses everyday
practice when it comes to care for culturally different
Others. The third space could be, if misinterpreted, translated
into a new form of Othering people of the South, by
fragmenting nursing care in ethnic boundaries as the
outcome of mutual disagreement on the meanings of cultural
differences.

THE IMPACT OF POSTCOLONIAL FEMINISM

IN NURSING RESEARCH AND PRACTICE
The future of postcolonial feminist scholarship in nursing
depends on our abilities to define new theories and methods
to explore and understand cultural differences, and to challenge dominant culture stereotypes instead of trying to
change the subaltern, as proposed by culturalist models.
Also, health issues related to racial, gendered, and class discrimination need to be part of the nursing social mandate.
Given this era of increasing cultural intolerance, the
harmful effects of racial, gendered, and social discrimination on health must be recognized. Postcolonial feminism is
a theoretical perspective that moves us away from the shortcomings of cultural essentialism, since culture cannot be isolated from the broader social context within which it comes
into play together with a constellation of other structural
factors. This theoretical approach provides the analytic lens
to examine the extent to which nursing research and practice
perpetuate dominance through our everyday practice. Holmes
and Gastaldo (2002) mention that research cannot be
neutral, apolitical, or ahistorical since nursing is governed
by normalizing discourses and practices. Furthermore,
Lather (1991) points out the complex question of political
commitment and its relation to scholarly inquiry (14).
Undoubtedly, it is a core issue to be addressed in nursing,
and postcolonial feminism provides the analytical
framework to perform such reflection.
Nevertheless, postcolonial feminism warns us to distance
ourselves from the expert role in acknowledging clients
anthropological construction of health, illness, ageing, and
caring. Democratization of nursing research can be realized
by recognizing subjugated knowledge as a legitimate source
of theorization, adapting nursing interventions to meet the
health needs of people of the South, located at the margins
of pluralist societies. If social justice is ever to be achieved
in the healthcare system, voices of the subaltern have to
be heard. Also, the influences of whiteness and relations
of ruling on nursing practice must be considered. In this
sense, implementing postcolonial feminism questions the
appropriateness of culturalist theories to correct health
2003 Blackwell Publishing Ltd, Nursing Inquiry 10(2), 91102

imbalances stemming from social discrepancies and

neocolonial ideologies. Finally, postcolonial feminism is
not specifically directed at developing knowledge for the
sake of knowledge. Giroux (2002, 98) describes this strategy
as the most retrograde academic use of knowledge since it
evacuates the possibilities of challenging the status quo.
Anderson (2000a) emphasizes that deconstructing and
rewriting taken-for-granted (145) knowledge, and redefining
relations of power and privilege is a step towards achieving
social justice. The next step consists of applying Gramscis
philosophy of praxis or science in action to nursing, by
integrating marginalized knowledge in research endeavors.
To this end, social activism becomes a means to address
health problems stemming from socio-economic and racial
inequities.

CONCLUDING REMARKS
In this paper, I have attempted to demonstrate that nursing
cultural research is at a crossroads of its development since
research has to espouse the health concerns of the people of
the South. At the same time, the limitations of culturalist
theories to address racial, gendered, and class social discrimination in achieving social justice must be acknowledged. In
articulating Bhabhas notion of third space to nursing, the
aim is to demonstrate that the negotiation of cultural differences and meanings is the basis upon which culturally safe
nursing care can be designed. The issue is to adapt nursing
practice to the needs of people of the South by integrating
marginalized knowledge in nursing scholarship. Postcolonial feminism provides the analytic lens to critically assess
the effects of power, race, gender, and social class on health;
to democratize nursing research and practice; to bridge
theory and practice by generating transformative knowledge;
and to sensitize policy-makers to the experiences of people
of the South in the health system.

ACKNOWLEDGEMENTS
I am indebted to the Haitian caregivers who helped me while
doing this study and who welcomed me into their homes. I
thank the National Health Research and Development Program of Canada, Canadian Institutes of Health Research
Doctoral Fellowship for the financial support. I express
my deepest gratitude to Joan Anderson, of the School of
Nursing, University of British Columbia, for the mentoring
provided in exploring issues related to race, gender, class,
and postcolonial feminism. I am grateful to the reviewers
whose thoughtful comments have helped me to strengthen
the paper.
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