Background

Access to healthcare is a fundamental human right that is often influenced by social norms and power structures. Implicit biases in society, healthcare, and education contribute to health inequalities. Incorporating equity and social justice into nursing and healthcare education, through norm-critical pedagogy can empower learners to address and promote social justice and health equity in patient care and community health.

Methods

The aim of the study was to describe characteristics and recurring elements of norm-critical literature in published research. This study followed Arksey and O’Malley’s scoping review framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews to report the findings. A search was conducted in across five scientific databases – CINAHL, APA PsycINFO, ERIC, Medline, and Web of Science – limiting results to English language articles. Two authors independently screened, extracted, and analysed the data, guided by selected key concepts based on the population, concept, and context framework. The included articles were condensed according to specific characteristics and analysed thematically.

Results

Sixteen articles were included in the review, and all published from 2017 onwards, primarily in nursing journals. Most of these articles employed qualitative methodologies. A thematic analysis generated three themes: ‘Redesigning education toward norm-critical pedagogy’, ‘Redefining one’s positionality as a teacher’, and ‘Transforming education for a norm-conscious sustainable healthcare future’.

Conclusions

This scoping review concludes that the characteristics of norm-critical literature, primarily centred on Western nursing education, has limited applicability in other healthcare educations. The literature describes key challenges in integrating norm-criticism into educational structures, often placing undue responsibility on individual teachers to adopt a norm-critical pedagogy. This review calls for further empirical research on norm-criticism to advance its use as a pedagogical model in nursing and healthcare education.

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus‐based clinical learning environment for nursing education. By analyzing documents and interviews with the help of reflexive thematic analysis three themes were generated: “Intention to educate beyondnursing education,” “Educating in alliance with society,” and “The educative ambiguity of the Clinical Learning Centre. ”The case study indicates that the incorporation of norm criticism into a campus‐based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus‐based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics.

Nursing education plays a pivotal role in shaping future nurse professionals who contribute to social justice and health equity. To achieve this goal, nursing teachers must employ effective learning strategies. One such strategy is norm-criticism, which promotes a critical reflection of the normative preconceptions that impact health equity. This study aimed to identify how nursing teachers approach norm-criticism during learning activities in a campus-based clinical learning environment with a norm-critical profile. Employing an ethnographic approach, we analyzed participant observational data using reflective thematic analysis. Our results revealed three overarching themes: “Teaching nursing disengaged from norm-criticism,” “Teaching norms and deflecting norm-criticism,” and “A hesitant norm-critical teaching.” This study concludes that the teachers did not have the tools or lacked knowledge in norm-critical teaching strategies, likely as consequence of inadequate faculty support and guidance. Ultimately, teachers should have access to norm-critical education and opportunities to learn how to carry out norm-critical teaching.

Background

Nursing education institutions have sought to incorporate health equity and social justice into curricula. However, nursing students report limited opportunities to engage with these perspectives during their studies. In a campus-based clinical learning environment, efforts have been made to support students in the advancement of health equity and social justice by integrating a norm-critical approach.

Aim

This study aimed to explore how nursing students made sense of norm-criticism in a campus-based clinical learning environment.DesignThe design of the study was qualitative, informed by narrative inquiry and a Goffmanian theoretical framework.

Setting

The study was carried out in a campus-based clinical learning environment for nursing education in a mid-sized university college.

Participants

The participants of the study consist of 14 undergraduate nursing students.MethodsThis study adopted a narrative methodology where the data was analyzed both structurally and thematically.

Results

This study demonstrates that students made sense of norm-criticism by framing it in three distinct phases. First, students encounter norm-criticism through norm-critical photographs, then they engage in critical reflection on norm-criticism, both in collaboration with peers and through personal reflection on their own positionality, and lastly, they find meaning in norm-criticism as a tool to change unequal nursing practices and provide person-centered nursing care.

Conclusion

This study highlights that, by mechanisms of impression management and reframing, nursing students regard and use norm-criticism as a reflective tool that empowers them to change healthcare structures and supports them in understanding how to provide person-centered care.