Varcoe, Colleen

Toward a better understanding of the chronic pain experiences of Indigenous women who experience violence : implications for nursing education, practice and research

Digital Document

Problem/Issue and significance: Intimate partner violence [IPV] is a critically urgent public health issue worldwide. Violence and trauma have multiple short- and long-term health effects including pain, which is a complex, highly subjective experience that can have profoundly negative impacts on both “body and soul.” Untreated pain can become chronic and debilitating, leading to a lower quality of life, decreased employment opportunities, and increased mental health concerns. Addressing pain is an important aspect of the health care professional’s role, and the failure to do so can exacerbate existing health disparities and worsen health outcomes. Current approaches to understanding and managing pain are primarily based on a Westernized view of health and illness. Diversity in knowledge and perspectives is missing from clinical practice, nursing education, and research, and is needed to improve pain assessment and management practices. Approach or innovation: While health care practitioners recognize that more holistic approaches to understanding, assessing, and treating pain are required, the significance of women’s chronic pain experiences in the context of IPV has been largely unexplored. This paper proposes the creation of “pain profiles” using an approach that draws of multiple sources of information and types of knowledge to gain new insights and to develop a richer understanding of women’s pain experiences. The unique circumstances and experiences of Indigenous women are used to illustrate the usefulness of the pain profiles as a case in point. In Canada, Indigenous women experience higher levels of violence and trauma as a result of interpersonal violence, historical trauma, and ongoing socioeconomic inequities and systemic racism than non-Indigenous women. When Indigenous women seek health care for pain, they often report a lack of culturally safe and appropriate services and are often labeled as “drug-seeking” which can cause further delays or avoiding seeking care. Few existing health services address pain arising from violence and trauma for women, especially services that focus on cultural safety and trauma-and-violence informed care. Lessons and implications: Pain profiles provide a novel and more nuanced approach to understanding, and addressing, pain in women who have experienced violence by using a holistic approach that draws on various perspectives and multiple sources of information, including the women’s own words. This approach may help to guide the implementation of more culturally safe, trauma-and-violence informed health practices and services, strengthen nursing curriculum around pain assessment and management, and help improve the overall well-being and quality of life of all women who have experienced violence.

Reclaiming our spirits: development and pilot testing of a health promotion intervention for Indigenous women who have experienced intimate partner violence

Digital Document

Indigenous women are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), in the context of ongoing colonization and neo‐colonization. Health promotion interventions for women who experience violence have not been tailored specifically for Indigenous women. Reclaiming Our Spirits (ROS) is a health promotion intervention designed for Indigenous women living in an urban context in Canada. In this paper, we describe the development of the intervention, results of a pilot study, and the revised subsequent intervention. Building on a theory‐based health promotion intervention (iHEAL) showing promising results in feasibility studies, ROS was developed using a series of related approaches including (a) guidance from Indigenous women with research expertise specific to IPV and Indigenous women's experiences; (b) articulation of an Indigenous lens, including using Cree (one of the largest Indigenous language groups in North America) concepts to identify key aspects; and (c) interviews with Elders (n = 10) living in the study setting. Offered over 6–8 months, ROS consists of a Circle, led by an Indigenous Elder, and 1:1 visits with a Registered Nurse, focused on six areas for health promotion derived from previous research. Pilot testing with Indigenous women (n = 21) produced signs of improvement in most measures of health from pre‐ to post‐intervention. Women found the pilot intervention acceptable and helpful but also offered valuable suggestions for improvement. A revised intervention, with greater structure within the Circle and nurses with stronger knowledge of Indigenous women's experience and community health, is currently undergoing testing.

Exploring the promises of intersectionality for advancing women's health research

Digital Document

Women's health research strives to make change. It seeks to produce knowledge that promotes action on the variety of factors that affect women's lives and their health. As part of this general movement, important strides have been made to raise awareness of the health effects of sex and gender. The resultant base of knowledge has been used to inform health research, policy, and practice. Increasingly, however, the need to pay better attention to the inequities among women that are caused by racism, colonialism, ethnocentrism, heterosexism, and able-bodism, is confronting feminist health researchers and activists. Researchers are seeking new conceptual frameworks that can transform the design of research to produce knowledge that captures how systems of discrimination or subordination overlap and "articulate" with one another. An emerging paradigm for women's health research is intersectionality. Intersectionality places an explicit focus on differences among groups and seeks to illuminate various interacting social factors that affect human lives, including social locations, health status, and quality of life. This paper will draw on recently emerging intersectionality research in the Canadian women's health context in order to explore the promises and practical challenges of the processes involved in applying an intersectionality paradigm. We begin with a brief overview of why the need for an intersectionality approach has emerged within the context of women's health research and introduce current thinking about how intersectionality can inform and transform health research more broadly. We then highlight novel Canadian research that is grappling with the challenges in addressing issues of difference and diversity. In the analysis of these examples, we focus on a largely uninvestigated aspect of intersectionality research - the challenges involved in the process of initiating and developing such projects and, in particular, the meaning and significance of social locations for researchers and participants who utilize an intersectionality approach. The examples highlighted in the paper represent important shifts in the health field, demonstrating the potential of intersectionality for examining the social context of women's lives, as well as developing methods which elucidate power, create new knowledge, and have the potential to inform appropriate action to bring about positive social change. [ABSTRACT FROM AUTHOR]

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