Joanne M. Hall

In 1994, the concept of marginalization was explored in an article inAdvances in Nursing Science. This is a revisitation of the concept incorporating new scholarship. This update is founded on feminism, postcolonialism, critical race theory, and discourse deconstruction, all viewpoints that have been explicated in nursing. The purpose of this analysis is to look at new scholarship and concepts useful to applying marginalization in nursing knowledge development from the standpoint of Bourdieu's macro, meso, and micro levels. New scholarship includes globalization, intersectionality, privilege, microaggressions, and implicit bias. Implications for decreasing health disparities through this new scholarship are discussed.

Perceived racism contributes to persistent health stress leading to health disparities. African American/Black persons (BPs) believe subtle, rather than overt, interpersonal racism is increasing. Sue and colleagues describe interpersonal racism as racial microaggressions: “routine” marginalizing indignities by White persons (WPs) toward BPs that contribute to health stress. In this narrative, exploratory study, Black adults (n = 10) were asked about specific racial microaggressions; they all experienced multiple types. Categorical and narrative analysis captured interpretations, strategies, and health stress attributions. Six iconic narratives contextualized health stress responses. Diverse mental and physical symptoms were attributed to racial microaggressions. Few strategies in response had positive outcomes. Future research includes development of coping strategies for BPs in these interactions, exploration of WPs awareness of their behaviors, and preventing racial microaggressions in health encounters that exacerbate health disparities.

Race is a social environmental element in many nursing knowledge contexts. We explore how race and racism have been conceptualized in nursing research and theory, situating these issues in the debate between Critical Race Theory and postracialism. Contemporarily, racism is more subtle than overt. Subtle racism takes the form of microaggressions in everyday discourse and practices by whites toward African Americans. This occurs with little to no awareness on the part of whites. Using this concept, practice and education are explored. We hold that microaggressions contribute to stress for the target person, which may partly account for racial health disparities.

Mental health nurses need to know their clients at depth, and to comprehend their social contexts in order to provide holistic care. Knowing persons through their stories, narratives they tell, provides contextual detail and person-revealing characteristics that make them individuals. Narratives are an everyday means of communicating experience, and there is a place for storytelling in nearly all cultures. Thus narrative is a culturally congruent way to ascertain and understand experiences. This means the nurse should ask questions such as “How did that come about?” versus why questions. A narrative approach stands in contrast to a yes/no algorithmic process in conversing with clients. Eliciting stories illustrates the social context of events, and implicitly provides answers to questions of feeling and meaning. Here we include background on narrative, insights from narrative research, and clinical wisdom in explaining how narratively understanding the person can improve mental health nursing services. Implications for theory, practice, and research are discussed.

Multiple narrative perspectives can guide narrative research. The complexity of health narratives presents a significant challenge. Trauma recovery accounts are health narratives demonstrating successes as well as struggles. In this article, I describe a large-scale narrative study in which specific qualitative methods were combined to fit research aims, stories elicited, and emergent questions in the analysis process. Under my direction, an interdisciplinary team conducted this constructivist, feminist, narrative study describing the trauma recovery process. The study was focused on success or thriving in women surviving childhood maltreatment. I took an advocacy stance in favor of participants’ interests, as is commensurate with a critical feminist standpoint. Through initial analyses the research team constructed a trauma recovery process termed “becoming resolute.” Subanalyses were focused on key relationships, life trajectories, self-strategies, and perceptual changes. My purpose is to explain the various kinds and levels of analysis used here to provide options for others studying recovery narratives.