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Advances in Nursing Science Vol. 37, No. 3, pp. 213–223 c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright 

Postcolonial Theory, Nursing Knowledge, and the Development of Emancipatory Knowing Deanna Bickford, MN, RN Nurses must assume a leadership role in confronting inequitable access to health care. This imperative is realizable through contributions to the knowledge of the discipline, reflecting on the profession’s mandate for social justice and elimination of health inequities, as well as embracing the diversity of nursing’s fundamental patterns of knowing. Emancipatory knowing involves critically examining social, political, and institutional structures to uncover social injustices and inequities and disrupt the status quo, as well as asking critical questions. Postcolonial theory, aligned with these foundational principles, can be used to answer such critical questions, thus contributing to the advancement of disciplinary knowledge. Key words: emancipatory knowing, health inequalities, health inequities, nursing, nursing knowledge, nursing research, postcolonialism, postcolonial theory, social justice, ways of knowing

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CCORDING TO the Office of the United Nations High Commissioner for Human Rights and the World Health Organization, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”1(p1) Unfortunately, many people across the globe have been excluded from enjoying this fundamental right and continue to experience avoidable health inequalities.2 Nurses, as global citizens, must take a lead-

Author Affiliation: College of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada. Funding in part by Indigenous People’s Health Research Centre. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Deanna Bickford, MN, RN, College of Nursing, University of Saskatchewan, Regina, Saskatchewan S4T 0H8 ([email protected]). DOI: 10.1097/ANS.0000000000000033

ership role in confronting the issue of inequitable access to health care.3 This leadership role must include contributing to the knowledge of the discipline. Nursing knowledge can contribute to understanding and ultimately changing the way in which these inequities and disparities are perceived and addressed. Carper4 highlighted the importance of creating knowledge of value and not just knowledge for knowledge’s sake. She stated: It is the general conception of any field of inquiry that ultimately determines the kind of knowledge the field aims to develop as well as the manner in which the knowledge is to be organized, tested and applied . . . [this] involves critical attention to the question of what it means to know and what kind of knowledge are held to be of the most value in the discipline of nursing.4(p13)

So what is knowledge “of value” to the discipline of nursing? I propose that it must reflect the professions mandate for social justice and elimination of health inequities, as well as nursing’s fundamental patterns of knowing. Of these patterns of knowing, emancipatory 213

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knowing is the most applicable pattern to contribute to the mandate. Formal expressions of emancipatory knowledge require the use of a theory that aligns with its foundational principles and can address its critical questions. Postcolonial theory aligns with these foundational principles and is appropriate to use and address these critical questions in the development of nursing knowledge. It can contribute to a better understanding of the social, political, and colonial conditions that lead to health inequities and inequalities. The purpose of this article was to explore the contribution of postcolonial theory to nursing knowledge and the evolution of emancipatory knowing. This article defines and discusses emancipatory knowing and postcolonial theory and presents a review of postcolonial theory in the health care– related literature. Finally, it also offers a critical reflection of postcolonial theory focusing on the use of postcolonial theory in nursing and the development of emancipatory knowing.

EMANCIPATORY KNOWING: THE PRAXIS OF NURSING Emancipatory knowing is defined as “the human ability to recognize social and political problems of injustice or inequity, to realize that things could be different, and piece together complex elements of experience and context to change a situation.”5(p64) It involves critical examination of social, political, and institutional structures to uncover social injustices and inequities and disrupt the status quo. There are several dimensions of emancipatory knowing. These dimensions are critical questions, creative processes of critiquing and imagining, formal expressions, authentication processes, and integrated practice expressions.5 Critical questions from the emancipatory perspective ask, “Who benefits?” “What is wrong with this picture?” “What needs to change?” and “What are the barriers to freedom?”5(p64) These questions

assume that not all options are available to all peoples and that there need to be changes that would provide new options that are available to all. It also assumes that freedoms and the possibilities for freedoms are determined by one’s situation, which is constructed through social practices that create these unequal possibilities.5 The creative processes of critiquing and imagining involve analyzing the situation and imagining possibilities that would make that situation more equitable and just.5 This process may intersect with processes from the other 4 patterns of knowing and create a synergetic relationship for knowledge development. From the perspective of emancipatory knowing, critiquing, imagining, and action are not imposed on those experiencing the situation but must come from the insights and interpretations of those who are affected in the manner they choose. Formal expressions include but are not limited to action plans, manifestoes, critical analysis, and visions for the future.5 Ideally, these expressions would be grounded in critical social theories because of their potential to make visible the processes that produce social injustices and create action based on these discoveries. Praxis is the integrated expression of emancipatory knowledge in practice and is a culmination of all of the other dimensions of emancipatory knowing.5 This cyclical process begins with reflection on situations one perceives as unjust or unfair and moves onto action, which aims at eliminating these unjust or unfair situations, and continues back to reflection. Authentication processes for emancipatory knowing and knowledge involve assessing the sustainability of changes, the extent to which empowerment and social equity occurred, and the demystification of conditions that led to injustices.5 It is these authentication processes that are used to determine the “worth and validity of emancipatory knowledge.”5(p83) Emancipatory knowing envelops all of the patterns of knowing, providing a critical lens to examine the practice and development of

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Postcolonial Theory and Nursing Knowledge knowledge in nursing.5 It acknowledges and questions how knowledge and power and the context of the production of knowledge contribute to social injustices.6 In the health care system, this hegemony is created when the dominant ideologies, beliefs, and values are accepted as truth and are perpetuated in practices and policies.6 Emancipatory knowing is developed when one explores and discovers the inequities related to the hegemonic practices and policies and realizes that there are alternatives that may reduce the inequities and lead to better health outcomes. Postcolonial theory aligns with the fundamental beliefs of this pattern of knowing and can enhance the development of emancipatory knowing.

POSTCOLONIAL THEORY Postcolonial theory has been defined as “theoretical and empirical work that centralizes the issues stemming from colonial relations and their aftermath . . . its concern extends to the experiences of people descended from the inhabitants of those territories and their experiences within ‘firstworld’ colonial powers.”7(p3) Postcolonialism focuses on disrupting race-thinking, uncovering structural inequities that have resulted from colonization, as well as the neocolonial practices that are present today.8 Despite the temporality of imperialist regimes, there is clear evidence of prevailing, persistent, and, at times, pervasive power structures and assumptions actively marginalizing people economically, politically, and socially. Postcolonialist thinkers recognize that many of the assumptions, which underlie the “logic” of colonialism, are still active forces today. Postcolonial theory as a critical theory “provides a theoretical lens that allows access to everyday experiences of marginalization, as structured by the micro-politics of power in the macrodynamics structural and historical nature.”7(p2) This theory is about deconstructing the colonial past and its aftermath, decentering the dominant culture, and constructing knowledge from the voices of the

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marginalized.9 It involves the re-creation of knowledge through analysis of the systems of exclusion, politics, science, languages, acts of opposition, representation, and marginalization, which becomes an instrument against colonial essentialisms.10 Conceptualization and applicability of postcolonial theory are dependent on the positionality or discipline of the researcher.9,11 No single definition of postcolonialism exists; it encompasses a variety of “historically situated theoretical orientations, representations, values, and activities” that are committed to explicating history and its effects.10(p100) What these theoretical orientations have in common are their focus on how people’s lives and life opportunities have been shaped by a history of colonialism.9 The purpose of postcolonial theory, as it is applied to health care, is to challenge the Western scientific sources of knowledge that have been long held as superior to discover health inequities that are linked to colonialization and neocolonialization.12 It is about analyzing relations of power,13 examining structural factors and challenging the status quo, decentering knowledge production, contesting totalizing ideologies,3 and analyzing conditions in health care that continue to oppress certain groups because of their race, class, or gender.10 Postcolonial theory asks “What are the rules that allow certain statements to be made and not others?” “Which rules order these statements?” “Which rules allow the development of a classificatory system?” and “Which rules allow us to identify certain players as leaders?”14(p44) A significant feature of postcolonial theory, especially to the discipline of nursing, is its commitment to praxis.9 Many disciplines and theorists have been involved in the development of postcolonial theory, but none have explicitly identified and organized the assumptions or propositions. The “central underlying assumption is that a focus on the discourse and ideology of colonialism is as important as one on the material effects of subjugation under colonialism and after.”15(p2) When one examines the major theoretical influences, other tentative

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assumptions and propositions can be found. The 3 major theorists who contributed to the development of postcolonial theory are Edward Said, Gayatri Spivak, and Homi Bhabha. In 1978, Said wrote Orientalism, which was the catalyst and first phase of postcolonial theory.16,17 He was influenced by Foucault’s ideas about the relationship between power and knowledge, the political climate and colonization of Palestine, and troubled about his own identity and that of Palestinians in general.16 His core argument focused on the link between knowledge and power and how knowledge was created outside of and about the Orient by Europeans as a way of asserting the supremacy of European civilizations and creating “others.”16 For centuries, a binary division of the world into the East and the West had been undertaken, with the West having the power to establish the realities of the West as well as the East.16 Spivak introduced the concept of the gendered subaltern in her essay Can the Subaltern Speak, where she challenged representational systems that she believed displaced and silenced this figure.17 Spivak maintained that the gendered altern does not speak about herself and therefore disappears and becomes the “medium through which competing discourses represent their claims; a palimpsest written over with the text of other desires, other meanings.”17(p89) She also questioned the relationship in research between the “knowing investigator and the (un)knowing subject of subaltern histories,”17(p15) and the notions of representation and representability in research. Spivak coined the term “othering” to describe how colonial discourse creates its subjects.18 Bhabha introduced the notion of “ambivalence” into colonial discourse analysis with his book Difference, Discrimination, in the Discourse of Colonialism.19 Mimicry is the term used to describe the ambivalent relationship between the colonizer and the colonized.18 Colonial discourse encouraged mimicking of the colonizers’ cultural habits, which reproduced subjects as “almost the

same, but not quite,” and exposed the limitations in colonial discourse and the authority of the colonizers.18(p140) Another concept introduced by Bhabha was that of a “Third Space,” where there is a co-construction of subjectivities derived from the interdependent relationship between the colonizer and the colonized, which lead to the creation of a hybridity of the two.18 Bhabha questioned the idea of a single colonial intent and the direct association between knowledge and power.20 He rejected Said’s idea of “representation for consumption by the West” and explored the role of Orientalism “as an instrument of colonial power.”19(p31) According to Bhabha, “At one time the colonizer and the colonized, or the discourses running within and between them, are absolutely formed in one way, later absolutely and irreconcilably another.”19(p34) Key concepts There are a great number of key concepts in postcolonial theory that are applicable to different disciplines and contexts.9,18 Concepts that are the most pertinent in the context of health and health care are race, racialization, culture, and othering.8 Essentialism hegemony and subaltern will also be defined, as they are pertinent to this discussion. Race This term is used to classify human beings into physical, biologic, and genetic categories, which assumes humanity can be separated into distinct groups, recognizable by their physical features.18 It assumes that there is a distinction between pure and mixed races and suggests that mental and moral behavior and individual personality, ideas, and capacities are a consequence of one’s racial origin.18 The concept of race was used during the rise of colonialism to show one’s place on the hierarchy of human civilization and to create the “other.”8,18 An ethnographic study in Western Canada found that the concept of

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Postcolonial Theory and Nursing Knowledge “race” is firmly entrenched in the health care environment and that exclusionary and racializing practices do occur, although the health care professionals were aware of ethics and stated that they treated everyone equally.8

Racialization This concept refers to the “process of attributing social, economic, and cultural differences to race. Racialization may be conscious and deliberate (an act of racism that discriminates openly) or unconscious and unintended.”9(p21) Racialization is a process that assumes that one’s behavior is a product of his or her race and that human beings can be separated into distinct categories based on race.20 Within this process, “societies construct races as real, different and unequal in ways that matter to economic, political, and social life.”21(p33) It is entrenched in the broader historical, social, cultural, and political contexts of Western health care systems12 and is revealed in “institutionalized policies and practices that marginalize individuals and collectives on the basis of presumed biological, physical, or genetic differences.”9(p21)

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Essentialism This is the assumption that there are defining features, or a group of defining features, that can be assigned to all the members of the group, category, or class.18 This view is often present in cultural awareness training in the health care environment, where participants are presented with a stereotypical understanding of the culture, and it is assumed that culture can be described and taught.23

Hegemony This concept refers to the process through which the ruling classes continue to dominate others “by consent.”18 This process does not involve force but is accomplished through ensuring that the interests of the ruling classes are believed to be the interests of all classes and through continuing to control the economy, educational, and social institutions, as well as the dominant values of that society. In health care, hegemony is exemplified through the unquestioning acceptance of the superiority of Western scientific methods and thoughts.

Subaltern Culture Culture is defined as the learned and shared values, beliefs, and practices of a particular group.7 It has been represented as a fixed, stereotypical representation that does not allow for actual variations that exist within cultures.18

This concept means “of inferior rank” and is associated with groups subjected to the hegemony of the ruling classes and denied access to hegemonic power.18 These groups are also been denied control of their own representation, as well as access to cultural and social institutions.18

Othering

POSTCOLONIAL THEORY IN THE HEALTH LITERATURE

This is the process through which “imperial discourse creates its others.”18(p171) An “‘other’ is any person who is separate from one’s self,”18(p169) who belongs to a group that one does not, and is used to define one’s own place in the world.22 It involves projecting assumed characteristics onto people, based on their membership of a certain group.9

Postcolonialism has been used in nursing to address issues of race and culture, as well as throughout the world for the study and analysis of “discursive operations of all types of empires.”14(p44) It is often combined with feminism in nursing research and scholarship to examine how race,3,24-26 ethnicity,24,26,27

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social class,24,25,28,29 and gender11,28,30 intersect with health. When used on its own, postcolonialism is still valid for examining the issues related to colonialism and the ensuing discourses. It clearly has the constructs and intentionality, and the ultimate goal is to address the residual effects of colonialism, which focus and/or extend the dialogues differently from postcolonial feminism. This theory has been used across the globe in research with Aboriginal and Indigenous peoples. In the context of nursing research with Aboriginal communities in Canada, postcolonial theory has guided the research process and focused on maintaining partnership and giving voice to participants.9 Mohammed10 used postcolonialism as a framework to guide design and methods decisions in her study exploring historical, social, cultural, political, and economic factors that shaped interpretations and representations of diabetes for group of American Indians. She found that using postcolonial theory opened “up a space for us to see the process of gazing, versus only the ‘object’ of the gaze.”10(p107) Postcolonial theory has been used to explore the health care system and the historical context that has led to poor health for the Aboriginal peoples of Australia.31 Sherwood and Edwards31 asserted that a postcolonial approach was critical to this exploration of health care systems that have historically been guided by Western ideologies and the biomedical model of health and illness. Similarly, postcolonial theory has been used in Norway to explore the experiences of health for elderly Sami people. As a framework in this study, postcolonial theory was used to highlight the impact of historical and socioeconomic factors that were present in the narratives of the participants.32 Smith et al33 used postcolonial theory to explore the experiences of Aboriginal peoples in Canada who were accessing care while pregnant and parenting. Implications from this study suggest that the times of pregnancy and parenting “represent a culturally and developmentally significant opportunity for Aborigi-

nal people to heal from and resist the ongoing impacts of colonialism.”33(pE41) Findings also suggested that colonial legacies must be considered when developing policies and programs to develop culturally safe spaces and places. Access to preventative care in Canada has been explored.34 This study used postcolonial theory to bring a critical perspective on the influence of the colonial past and neocolonial present on current health status and health care services for urban Aboriginal families. Postcolonial theory provided the framework for a study on the views on health, healing, and disease of Mayan-T´zutujil women in Guatemala within the context of changes in the national health policy.35 This study gave voice to women who have traditionally been marginalized along with their traditional (Mayan) beliefs about health, healing, and illness. Framed through a postcolonial lens, the researchers observed hybridity, a space where certain Western/biomedical health care practices were incorporated into the health care practices of the Mayan-T´zutujil women. Globally, this theory has been used in research in a variety of disciplines with a variety of populations. Postcolonialism provided the lens to explore theoretical and methodological implications of diverse ethnocultural populations in Canada in relation to hospitalization and hospital discharge.36 These authors emphasized that a postcolonial lens would highlight power differences, racial prejudices, discrimination, unequal health outcomes, structural disadvantages, as well as the distinct historical conditions faced by Aboriginal peoples and racialized immigrant groups in Canada. Using postcolonial theory, Lavoie37 examined the community organizing practices in one low-income, multiracial neighborhood in Quebec, Canada, to understand the construction of race, the link between race and power, and the potential for social action. Sastry and Dutta38 used a postcolonial theory to critically examine how meanings of HIV/AIDS were constructed in a large global

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Postcolonial Theory and Nursing Knowledge public health intervention. They examined policy documents and found that meanings of HIV/AIDS were constructed in a context that portrayed the Third World as the site for intervention and the United States as altruistic and urged the inclusion of the “subaltern voices” that were clearly absent in the discourse. A critical review of research on Arab families was conducted using postcolonial theory.39 The aim of this review was to examine research conducted over the previous 36 years in Africa, Asia, Europe, and North America for themes that were characteristic of the discourse and to uncover gaps in the knowledge about Arab families. Beitin et al39 found that generally the research about the Arab peoples was influenced by current world events and political environments, was problem-focused, presented a homogeneous “other,” interpreted findings from a Western perspective that did not account for cultural contexts, and clearly placed Western societies as morally and socially superior.39 Postcolonial theory provided the vocabulary for bioethicists to “articulate how relationships between past trends in pathogenesis and disease susceptibility can be epidemiologically and clinically relevant to the care of present-day individuals, families, and children” and to examine marginalization in mental health care services.40(p366) It was also used as the framework to examine the sociopolitical dynamics of medical tourism in postcolonial regions.41 In the United States, postcolonial theory was used to critically analyze and reinterpret the conceptualization of culture in occupational science.42 This study framed the historical context of today’s black American youth and the historical social and political factors that have influenced the development of rap music. Nursing education has been examined using postcolonial theory. Racine and Perron43 explored the risk of reproducing colonialist practices for nursing students in international clinical placements. Guided by postcolonial theory, they reflected on the possible impacts of clinical placements for nurses in develop-

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ing countries such as recreating colonial practices and discourses about health, as well as constructing racialized views of the “other.” The limitations of Indigenous cultural training as it is commonly conceptualized in Australia were highlighted using postcolonial theory.23 They found that several issues arose when this type of training was provided, such as the essentializing of the Indigenous culture, creating “others,” and a lack of responsibility at the systems level for the provision of culturally safe care.

CRITICAL REFLECTION OF POSTCOLONIAL THEORY In this critical reflection, I will ask the following questions, with a focus on the use of postcolonial theory in nursing and the development of emancipatory knowing. Guided by the framework from Chinn and Kramer, I will ask the following: (a) How clear is this theory? (b) How simple is this theory? (c) How general is this theory? (d) How accessible is this theory? and (e) How important is this theory?5 I will also consider other questions of importance to the use of postcolonial theory for the development of nursing knowledge. Clarity of this theory is limited. Semantic clarity and consistency, which include definitions of concepts and the clarity of those definitions, are low. Definitions of concepts in postcolonial theory generally have broad meanings that use challenging language and terminology that may not be applicable to all contexts or disciplines. Some concepts may have more than 1 definition. There are no explicit statements about which concepts are critical to the theory or which clarify its assumptions and propositions. Instead, one must piece together this theory using the writings of many scholars from a variety of disciplines to arrive at satisfactory explanation of what it is that postcolonial theory or postcolonialism is. Because postcolonial theory evolved from a wide body of scholarship and has been influenced by a variety of

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disciplines, it cannot be conceptualized into one single theoretical construct. Perhaps, this is the reason for the limited clarity of this theory. This limitation affects the application of this theory for nursing research, education, and practice by reducing its usability. Simplicity is related to the “number of elements within each descriptive category.”5(p201) This theory is very complex, and relationships between the concepts have not been well developed. Perhaps, as postcolonial theory continues to be used in nursing research, relevant concepts and their relationships in this context will evolve. Simplicity is also related to the accessibility of this theory. Accessibility refers to the degree to which concepts “are grounded in empirically identify phenomena.”5(p205) Concepts in this theory have complex definitions that often include a number of different theoretical perspectives, which have been added as the concepts have evolved. Simplicity and accessibility reduce the usability of this theory for nursing education, research, and practice. Although postcolonial theory is complex and has low accessibility, it nonetheless has high generality and importance to nursing, as evidenced by its use. The generality of postcolonial theory is high; it can and has been applied to a wide array of situations, and it contains broad concepts. Its purpose is applicable on a global scale and has been used by a variety of disciplines. The importance of this theory is based on whether or not it is forward-looking, practical for practice, education, and research, as well as assessing its value for creating understandings that are important to nursing.5 For nursing, this theory has been offered as a means to address health disparities,12 as an alternative to transcultural theories in nursing,3,43 as a theory that is congruent with nursing’s mandate for social justice,9 as well as a theory to provide nurses with the context for analysis of social inequities7,8 and analytic framework9 to understand health inequalities. In the context of globalization, the use of postcolonial theory in research “becomes a social and moral imperative of nursing.”3(p3) This

theory has the potential to disrupt the postcolonial discourses that influence the health system policies and practices that are at the heart of inequities.9 Postcolonial theory is relevant and pertinent to nursing science; it sheds light on processes that throughout history have led to human suffering, contexts in which health inequalities occur, and the social construction of race and how that social construction affects one’s life and life opportunities.8 Postcolonial scholarship offers “a theoretical perspective—another lens, so to speak— for insights into the contours of social life” and gives “voice to those who were silenced.”8(p243) There are several limitations inherent in the use of postcolonial theory in nursing scholarship and research. These limitations include the potential for creating binary discourses, essentialism, racialization, and othering. Because of the subjects that are explored and examined using postcolonial theory, these limitations can be related to both the subject of the inquiry and the revealing nature of this theory. Nurse researchers must be aware of these potential limitations and practice reflexively to reduce the risk of colonizing the research and the research process. Another limitation maintained by several nurse scholars is that postcolonial theory lacks the analytic dimension of gender analysis and have proposed that feminist theory be used in conjunction with postcolonial theory8,9,44 Although using feminism may add another layer of inquiry, it does not preclude the use of postcolonial theory in nursing inquiry without feminism. There is one important question that has not been answered or even asked in the literature. Terminology for postcolonial theory or postcolonialism in the literature is not consistent, nor is discussion around whether or not it is a theory. So, now I ask: Is postcolonial theory a theory, a philosophy, a theoretical or conceptual framework, or paradigm? A theory has been defined as “one or more concrete and specific concepts that are derived from a conceptual model, and the

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Postcolonial Theory and Nursing Knowledge propositions that state relatively concrete and specific relations between two or more of the concepts.”45,(p496) A philosophy is “a statement encompassing ontological claims about the phenomenon of central interest to a discipline, epistemic claims about how those phenomenon come to be known, and ethical claims about what members of a discipline value.”45(p496) A theoretical or conceptual framework is defined as “a logical grouping of related concepts are theories that usually is created to draw together several different aspects that are relevant to a complex situation, such as a practice setting or an educational program,”5(p158) and a paradigm is “ a worldview or ideology . . . [which] implies standards or criteria for assigning value or worth to both the processes and the products of a discipline as well as the methods of knowledge development with in a discipline.”5(p158) When one considers these definitions, postcolonial theory best fits the definition of a theoretical or conceptual framework. Its concepts do draw together different aspects of the impact of colonialism on groups that may be considered marginalized or oppressed as a consequence of colonialism. Because the concepts and their relationships are not well developed and further study is required to define the assumptions and propositions, it does not fit nursing’s definition of a theory. But does this mean that it cannot contribute knowledge of value for nursing? I don’t believe so. I believe this theory, as a conceptual or theoretical framework, can contribute to nursing’s

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fundamental patterns of knowing, specifically emancipatory knowing.

CONCLUSION I began by asking what is knowledge of value for nursing and proposed postcolonial theory aligned with the foundational principles of emancipatory knowing and could address its critical questions. Emancipatory knowing focuses on uncovering social injustices and inequities in disrupting the status quo to make changes that will address these injustices and inequities. Postcolonial theory also focuses on highlighting the injustices and inequities that have resulted from colonial relations and their aftermath. Postcolonial theory has been used globally with different populations by different disciplines and has been of value for health care research in understanding the contexts in which health care is provided. Although there are limitations to postcolonial theory such as limited clarity and simplicity, and lack of clarity for its definition, assumptions, and propositions, its importance for nursing is high. Postcolonial theory aligns well with emancipatory knowing for the creation of knowledge of value to nursing, but further development in the nursing context is needed. Using postcolonial theory to build knowledge offers insights into present-day issues within the context of the colonial past, with the goal of achieving social justice and health for all.

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Postcolonial theory, nursing knowledge, and the development of emancipatory knowing.

Nurses must assume a leadership role in confronting inequitable access to health care. This imperative is realizable through contributions to the know...
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