College of Nursing, Seattle University Washington.
ANS Adv Nurs Sci. 2020 Jan/Mar;43(1):86-100. doi: 10.1097/ANS.0000000000000283.
Epistemology is the study of the grounds of knowledge. We illustrate through case studies how epistemic injustice is manifested in the delivery of reproductive health care services for women from Somalia, even though it may not be intended or recognized as injustice. Testimonial injustice occurs when women are not believed or are discredited in their aim to receive care. Hermeneutic injustice occurs when a significant area of one's social experience is obscured from understanding owing to flaws in group knowledge resources for understanding. For example, women from Somalia may not receive full disclosure about the diagnostic or treatment services that are recommended in the reproductive health care setting. We explore how the many intersections in a person's identity can give rise to epistemic injustice and we suggest more expansive ways of evaluating the validity of diverse epistemologies in patient-centered care. Structural competency is recommended as a way nurses and other health care providers can mitigate the social determinants of health, which contribute to epistemic injustice.
认识论是对知识基础的研究。我们通过案例研究说明了认识论不公正如何在为来自索马里的女性提供生殖保健服务时表现出来，尽管这种不公正可能不是故意的，也没有被认为是不公正的。当女性在寻求护理时不被相信或被诋毁时，就会发生证言不公正。当由于群体知识资源理解上的缺陷而使一个人社会经历的重要方面无法被理解时，就会发生解释学不公正。例如，来自索马里的女性可能无法充分了解在生殖保健环境中推荐的诊断或治疗服务。我们探讨了一个人的身份中的许多交叉点如何导致认识论不公正，并提出了更广泛的方法来评估以患者为中心的护理中不同认识论的有效性。建议护士和其他卫生保健提供者采用结构性能力，以减轻导致认识论不公正的健康的社会决定因素。
