A well-developed professional identity enhances nursing as a profession, contributing towards better healthcare delivery and outcomes. It is critically important how professional values are learnt within the culture of nursing. Tensions in clinical practice need to be understood better to avoid moral distress caused by dissonance between expectation and experience. It is advantageous to increase early positive socialisation.

BackgroundSocioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives of health care providers to understand and address this problem. The purpose of this study was to elicit the experiential knowledge of PNC providers in inner-city Winnipeg, Canada regarding their perceptions of the barriers and facilitators to PNC for the clients they serve and their suggestions on how PNC services might be improved to reduce disparities in utilization.MethodsA descriptive exploratory qualitative design was used. Semi-structured interviews were conducted with 24 health care providers serving women in inner-city neighborhoods with high rates of inadequate PNC. Content analysis was used to code the interviews based on broad categories (barriers, facilitators, suggestions). Emerging themes and subthemes were then developed and revised through the use of comparative analysis.ResultsMany of the barriers identified related to personal challenges faced by inner-city women (e.g., child care, transportation, addictions, lack of support). Other barriers related to aspects of service provision: caregiver qualities (lack of time, negative behaviors), health system barriers (shortage of providers), and program/service characteristics (distance, long waits, short visits). Suggestions to improve care mirrored the facilitators identified and included ideas to make PNC more accessible and convenient, and more responsive to the complex needs of this population.ConclusionsThe broad scope of our findings reflects a socio-ecological approach to understanding the many determinants that influence whether or not inner-city women use PNC services. A shift to community-based PNC supported by a multidisciplinary team and expanded midwifery services has potential to address many of the barriers identified in our study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0431-5) contains supplementary material, which is available to authorized users.

In the Canadian context, the persistence and growth of Aboriginal health and social inequity signals that we are at a critical public health policy juncture; current policy reflects an historic relationship between Aboriginal people and Canada that fails the contemporary health needs of Canada’s Aboriginal peoples. In this review, we highlight the need for healthy public policy that recognizes and prioritizes the rights of Canada’s Aboriginal people to achieve health equity. Drawing from a structural approach, we examine the historical scope and comprehensive breadth of the Indian Act in shaping modern Aboriginal health and social inequities. Canada’s failure to implement a national public policy for Aboriginal health reflects the proliferation of racism in modern day Canada, and a distinctly lacking political will at the federal level. Despite these structural challenges, there is great promise in community self-determination in health care and the role of community-led research as advocacy for policy reform. In our conclusion, we turn to the Report on the Truth and Reconciliation Commission of Canada (2015) and draw upon the concept of reconciliation as a fundamental precursor for Aboriginal health equity. The burden of systemic change needed to promote healthy public policy cannot be carried by any single group of advocates; it is a shared responsibility that will require the collaboration and integration of various actors and knowledges.

This exploratory study investigates gender-specific differences in the challenges of the doctoral experience through the observations of a counsellor working with doctoral students. The article first contextualises the study within the literature investigating doctoral attrition and gender equity, showing that identity transformation over the doctorate is problematic in particular aspects for women. We confirm that cultural expectations regarding women passivity, family nurturance and (at least symbolic) subordination to male authority can cause tensions between women's social relationships and academic performance which values assertiveness, clear communication and confident management of power relationships. We identify various conflicts between the female roles of the social sphere and the academic arena that problematise the identity transition of the doctorate from student to independent researcher. Context: doctoral attrition and gender equityDoctoral attrition is under scrutiny. Relatively few fail a doctorate once they submit a thesis, yet literature testifies to doctoral attrition rates as high as 50% (McAlpine and Norton 2006;Mendoza 2007). Attrition is the real failure for students and for institutions. It causes considerable costs to the institution or faculty's reputation; institutions are, therefore, keen to improve their statistics. At the ground level, failure to complete often results in financial, emotional and social costs to the doctoral candidate, leading to disruption of identity.There is also awareness of a history of gender inequity in education and desire to improve the balance. Recent UNESCO statistics obtained from mainly Western countries showed the traditional gender gap in higher education closing, with women making up 50% or more of overall university students (Mastekaasa 2005). However, a report from the European Union found that women were less likely to advance from undergraduates to doctoral candidates (Mastekaasa 2005), and it was reported that only 25Á45% of all female undergraduates proceed towards a Ph.D. Furthermore, there is evidence that more male academics hold doctorates than females (Brown and Watson 2010). The gender gap is nonetheless closing at doctoral level: more recent figures from the USA suggest for the first time show 50.4% of