1. Challenging Stigma HEAL 7012 Primary Health Praxis HEAL 6024/HEAL 6012 Nursing in the Community Aotearoa Assoc. Prof Dianne Roy 2015

2. Stigma “Defining people as abnormal if they do not meet an expected norm, is related to being different” (Giddings & Roy, 2014, p. 102). Pervades all levels of society Crosses all cultures We are all affected by it We are all part of the problem But….. We can also make ourselves part of the solution

3. Stigmatising processes Stereotyping: Categorising and prejudging (prejudice) individuals based on an oversimplified set of beliefs about the nature and characteristics of particular groups Labelling: Applying negative stereotypes by naming individuals and their identified group as problematic Othering: Socially constructing people with certain characteristics into named groups that are viewed as ‘different’ in some way from what is widely believed in society to be ‘normal’. Giddings and Roy (2014, p. 103 )

4. Deconstructing societal stigmatising processes Deconstructing (identifying and naming) First step in challenging processes of stigmatisation E.g. identifying and challenging the labelling of people by their condition (diabetic, lunatic, epileptic) Be aware of protective responses some people may use in response to marginalising and discriminatory practices in society It is important to challenge stigmatising processes, they effect us all

5. Why is it important? Negative consequences Discrimination Powerlessness Social isolation Inadequate or inequitable access to resources and services Decreased quality of care Health disparities

6. Group Exercise Read the case study provided then: 1.Identify and name stigmatising processes Stereotyping Labelling Othering Other discriminatory or judgemental processes 2.Evidence of when these were challenged In what way were they challenged? 3.Report back to class

7. Know Ourselves Am I acknowledging my position of power and privilege in relation to clients? Am I actively trying to understand and accept the validity of clients’ experiences? Am I recognising clients’ [expertise/developing expertise] in [relation] to their illness and/or disability? Am I working with [and supporting] clients’ personally developed strategies of care? (Giddings & Roy, 2014, p. 102)

8. Principles of nursing practice Work with people in context Partnership Recognise and value expertise and resourcefulness Support rights to self-determination Be aware of the potential for social isolation

9. Conclusion Nurses can maintain status quo of marginalisation and discrimination (do nothing) OR Challenge it (do something) at a: Personal level Professional level Socio-political level

10. References Giddings, L. S. (2005). Health disparities, social injustice, and the culture of nursing. Nursing Research, 54(5), 304-312. Giddings, L. S. (2005). A theoretical model of social consciousness. Advances in Nursing Science, 28(3), 224-239. Giddings, L. S., & Roy, D. E. (2014). Stigmatisation of people living with a chronic illness or disability In E. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (2 nd ed., pp. 101-114). Sydney: Elsevier. Giddings, L. S., Roy, D. E., & Predeger, E. (2007). Women's experience of ageing with a chronic condition. Journal of Advanced Nursing, 58(6), 557-565. doi: 10.1111/j.1365- 2648.2007.04243.x

11. References (cont) International Council of Nurses. (2011). Closing the gap: Increasing access and equity. International Nurses Day, 2011. Retrieved from http://www.twna.org.tw/TWNA_BACKEND/upload/web/home_00/News New/2802/IND%20Kit%202011.pdf Oliver, M. (2009). Understanding disability: From theory to practice, (2 nd ed.) Basingstoke, UK: Palgrave Macmillan. Peters, K., & Cotton, A. (2015). Barriers to breast cancer screening in Australia: Experiences of women with physical disabilities. Journal of Clinical Nursing, 24(3-4), 563-572. doi: 10.1111/jocn.12696 Roy, D. E., & Giddings, L. S. (2012). The experiences of women (65–74 years) living with a long-term condition in the shadow of ageing. Journal of Advanced Nursing, 68(1), 181-190. doi:10.1111/j.1365-2648.2011.05830.x