Intersectionality in nursing research: A systematic review

Abstract

Aim
This systematic literature review aimed to identify, appraise and synthesize available research studies that apply intersectionality in nursing research.

Design
Systematic review.

Data Sources
Empirical and theoretical nursing studies published before February 2022 were identified from the PubMed and CINAHL databases. Studies were eligible for inclusion if they substantially covered the topics of intersectionality and nursing, had undergone peer‐review, and were written in English.

Review Methods
The PRISMA 2020 statement for reporting systematic reviews was used to report findings. The Joanna Briggs Institute Critical Appraisal tools were used to assess the quality of the included research studies.

Results
Out of 331 identified studies, 60 studies were substantially about nursing and intersectionality, and were included in the review. There are a myriad of ways that the concept of intersectionality has been adopted in nursing research. Furthermore, there was great heterogeneity in the definition and application of the concept of intersectionality, and only a few studies were empirical.

Conclusion
There is a need for robust and clear framing of how the concept of intersectionality is defined and understood in nursing research. There is also a need for more empirical research effectively adopting the concept of intersectionality to enhance our understanding of how health inequities operate within the field of nursing.

No Patient or Public Contribution
No patients, service users, caregivers or members of the public were involved in this work.

Full text

Nursing Open. 2023;00:1–19.
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1wileyonlinelibrary.com/journal/nop2
1 | INTRODUCTIO N
There have been calls to move beyond a patient- dyad perspec-
tive and individual- focused frameworks in nursing to address
peoples' social context, including structural inequalities that con-
tribute to ill health (Tengelin et al., 2019 ; Thurman & Pfitzinger-
Lippe, 2017). Pervasive health inequities exist within and between
countries and can be traced to an unequal distribution of power,
resources and access to services that is sometimes referred to
as social determinants of health (Marmot et al., 2008). Health
outcomes at the individual level are thus linked to unjust social
policies, economic planning and politics, and the World Health
Organization (WHO) has identified, for example, racism as one
social determinant of health inequities (Marmot et al., 2008;
Received: 1 September 2022
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Revised: 14 Septe mber 2023
|
Accepted: 17 September 2023
DOI: 10.1002/nop2.2021
SYSTEMATIC REVIEW
Intersectionality in nursing research: A systematic review
Elin Siira1 | Karolina Lindén2 | Sara Wallström2,3 | Ida Björkman2,3
This is an op en access ar ticle under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provide d the original work is properly cited.
© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd .
1School of Health and Welfare, Halms tad
University, Göteborg, Sweden
2Instit ute of Health and Care Scie nces,
Gothenburg University, Göteborg, Sweden
3Centre for Person- Centred Care GPCC,
Gothenburg University, Göteborg, Sweden
Correspondence
Elin Siira, School of Health and Welf are,
Halmstad University, Göteborg, Sweden.
Email: elin.siira@hh.se
Abstract
Aim: This systematic literature review aimed to identify, appraise and synthesize avail-
able research studies that apply intersectionality in nursing research.
Design: Systematic review.
Data Sources: Empirical and theoretical nursing studies published before February
2022 were identified from the PubMed and CINAHL databases. Studies were eligible
for inclusion if they substantially covered the topics of intersectionality and nursing,
had undergone peer- review, and were written in English.
Review Methods: The PRISMA 2020 statement for reporting systematic reviews was
used to report findings. The Joanna Briggs Institute Critical Appraisal tools were used
to assess the quality of the included research studies.
Results: Out of 331 identified studies, 60 studies were substantially about nursing
and intersectionality, and were included in the review. There are a myriad of ways that
the concept of intersectionality has been adopted in nursing research. Furthermore,
there was great heterogeneity in the definition and application of the concept of in-
tersectionality, and only a few studies were empirical.
Conclusion: There is a need for robust and clear framing of how the concept of inter-
sectionality is defined and understood in nursing research. There is also a need for
more empirical research effectively adopting the concept of intersectionality to en-
hance our understanding of how health inequities operate within the field of nursing.
No Patient or Public Contribution: No patients, service users, caregivers or members
of the public were involved in this work.
KEY WORDS
intersectionality, nursing research, systematic review

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World Health, 2010). There are multiple examples of groups who
are disadvantaged because of their race, gender, age, disability
or socioeconomic status (Hosseinpoor et al., 2015). These social
categories also affect access to and experiences of healthcare
services (Marmot et al., 2008). The literature on social determi-
nants of health has faced criticism for concentrating on a singu-
lar aspec t of health inequality, for example, gender or class, while
disregarding others. Thereby limiting the understanding of how
these factors interact. Introducing intersectionality as a frame-
work for analysing health inequalities is argued to provide a much
more nuanced and precise understanding of their mechanisms
(Sen et al., 20 09). Intersectionality and its focus on several social
categorizations has become an indispensable and extensively used
framework for public health research (Bauer, 2014; Bowleg, 2021;
Hankivsky, 2012; Viruell- Fuentes et al., 2012) Over the last de-
cade, nursing research has increasingly applied intersectionality
theory to analyse and understand health inequalities (De Sousa
& Varcoe, 2022). Although intersectionality is widely regarded as
a useful concept, with nearly universal applicability, which in part
explains its widespread success (Davis, 2008), its value in nursing
research largely depends on how ideas of intersectionality are em-
ployed and defined.
2 | BACKG ROUND
2.1 | Intersectionality and nursing
According to the Oxford English Dictionary, an ‘intersection’ is
where two things cross or intersect (OED Online, ‘intersection,
n.’, 2022a), while ‘intersectionality’ refers to a theoretical ap-
proach from sociology based on the interconnected nature of
social categorizations such as race, class and gender, which cre-
ate overlapping and interdependent systems of disadvantage or
discrimination (OED Online, ‘intersectionality, n.’, 2022b). The
concept of intersectionality emerged in academic discourse dur-
ing the late 1980s through the individual works of legal scholar
Kimberlé Crenshaw (1989, 1991) and sociologist Patricia Hill
Collins (1986). However, its foundational ideas originated in the
1960s and 1970s in the United States and were influenced by the
Civil rights, women of color, Black power, Chicano liberation, Red
power and Asia n- American movem ents, as well as feminist lesb ian
organizations such as the Combahee River Collective (Bilge, 2013;
Collins & Bilge, 2016; Dhamoon, 2011; Hancock, 2016). Apart
from its theoretical and scholarly contributions, the concept has
been closely linked to activism and the empowerment of black
women. For example, combating violence against women of color
constitutes central focus of intersectionality activism. There-
fore, the concept of intersectionalit y serves as a means to both
comprehend and create strategies to combat inequalities (Collins
& Bilge, 2016). Despite its strong connections to feminism and
gender studies, intersectionality does not have to focus solely
on gender (Collins & Bilge, 2016). The intersection that is most
frequently analysed is the one that involves race, class and gender
(Dhamoon, 2011).
In academic writing, intersectionality is of ten presented as
a constantly evolving research paradigm or a framework (Dha-
moon, 2011). What actually constitutes an intersectional analysis
remains a topic of debate, but it can be broken down into six funda-
mental ideas (Collins & Bilge, 2016):
• Complexity
• Power
• Inequality
• Relationality
• Social context
• Social justice
Regarding complexity, intersectionality prompts a view that
gender- related inequality and race- related inequality are not sep-
arate issues. This view involves attending to and making visible
the diversity within groups such as diversity within the group of
women regarding social class, race or sexual orientation (Collins &
Bilge, 2016). Marginalized groups often face skewed representa-
tions in societal discourse, and it is crucial to acknowledge and in-
corporate other perspectives on what it entails to be a black woman,
for instance (Hancock, 2016). When it comes to issues of power, a
postmodern, ‘Foucauldian’, understanding is prevalent within inter-
sectionality. This suggest that power is a constantly shifting and re-
lational concept rather than being attributed solely to individuals or
groups (Hancock, 2016). Individuals can simultaneously occupy the
roles of oppressor and oppressed depending on the circumstances
and therefore, there is no concept of ‘true victims’ (Collins, 2000).
As an example, the nurse may hold power in their interactions with
a patient, yet not in the professional hierarchy of the healthcare in-
stitution. These dimensions of power are interrelated but separate
and relate to interpersonal, disciplinary, hegemonic and structural
domains (Collins, 2000). The first domain addresses how people
are positioned within social interactions, such as nurses' interac-
tions with patients. The interpersonal dimension of power is cen-
tral to nursing and it is often stated that the relationship between
nurse and patient is asymmetrical (Kristoffersen & Friberg, 2017).
The disciplinary and structural domains can also relate to nursing
throu gh th e power of hea lth care in stitutio ns in deciding wh at is ‘nor-
mal’ versus ‘deviant’ as well as being part of the wider web of the
large- scale institutions that reproduce subordination (Collins, 2000).
The dynamics of power in all these domains are relevant to health
(Collins, 2022). Inequality refers to individuals having different posi-
tions in the social hierarchy and therefore unequal access to social
and economic resources and opportunities. This is a result of unjust
social processes and systems (Collins & Bilge, 2016). Relationality
refers to the interplay bet ween various sorts of social inequalities
and systems of power and accounts for multiple identities within
the interpersonal domain. Furthermore, it rejects an either/or think-
ing in favour of relatedness between social positionings (Collins &
Bilge, 2016). For example, a nurse can also be a woman, an immigrant

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and a mother. Social context plays an important role in shaping peo-
ple's experiences, influenced by the time and place in which they
live. Social justice refers to promoting fairness in the allocation and
availability of social and economic resources and opportunities in
society occur (Collins & Bilge, 2016). Combating inequality in care,
the social justice mandate and a focus on peoples' social context
have been suggested as fields where nursing can make advances
(Tengelin et al., 2019).
Finally, there are differe nt types of analy tical foci withi n intersec-
tional research such as identities, categories of difference, processes
of differentiation and systems of domination. For example, black is
an identit y belonging to the categor y race that arises through racial-
ization, with the racism as the linked system of domination. Other
systems of domination are sexism, ableism, classism, heterosexism,
etc. (Dhamoon, 2011).
There is extensive literature from different disciplines on the
potential and pitfalls of applying the ideas of intersectionalit y in
research (Anthias, 2013; Bilge, 2013; Collins, 2015; Davis, 2008;
Knapp, 2005). Apart from scholarship, intersectionalit y is also
prevalent within popular culture as a ‘buzz word’ or meme (Han-
cock, 2016). The literature contends that the popularity of
intersectionality also creates issues, including misinterpretation, dis-
placement and disarticulation or presenting it as a formula without
regard for the concept's origins (Bilge, 2013; Knapp, 2005; Moradi
et al., 2020). There is also some ambivalence as to how intersec-
tionalit y, as a theoretical concept, can be incorporated into empirical
research (Hancock, 2016).
2.2 | Borrowed theory in nursing
Drawing on feminist standpoint theory, Risjord (2010) contends that
nursing research occupies a distinct position as an ‘oppressed role’
that enables access to knowledge that is not readily available from
other perspectives. Since intersectionality theory was not formu-
lated within the nursing discipline it may be regarded as a ‘borrowed
theory’. A borrowed theor y is a theory, which is derived from disci-
plines outside of nursing (such as sociology, psycholog y or physiol-
ogy), and adopted into the nursing discipline (Risjord, 2 010). Despite
some nursing theorists' concerns about the potential negative im-
pact of borrowed theories on nursing research, they have nonethe-
less become an integral aspect of nursing research (Risjord, 2010 ).
Borrowed theories, including intersectionality theory, require adap-
tion to fit the nursing context and the defining characteristics of
nursing research. Nursing research aims to address questions that
are relevant to nursing practice in a direct or indirect manner (Forss
et al., 2013). The idea of borrowed theory (Risjord, 2010) also im-
plies that the adoption of intersectionality theory within nursing
will have a substantial influence on both nursing research and the
conceptualization of intersectionality. Therefore, the notion of bor-
rowed theory in nursing emphasizes the interaction between disci-
plines and concepts that transpires when disciplinary boundaries are
crossed, and concepts or theories are employed in novel knowledge
contexts. This process of adoption will have an impact on the poten-
tial and possibilities of intersectionality in nursing. Thus, a critical
examination of the practical application of intersectionality and its
outcomes, rather than only its potential benefit s, is necessary.
This systematic literature review aims to identify, appraise and
synthesize available research studies that apply intersectional-
ity in nursing. We examine the characteristics of nursing research
that apply intersectionality, definition of intersectionality in this
research and the rationale for its application. Additionally, we con-
sider the implications of applying intersectionality for nursing edu-
cation, scholarship and practice as identified by the authors. It has
been argued that incorporating intersectionality into research can
enhance theoretical and methodological work rather than practice
(Moradi et al., 2020). Nursing is a practice- based discipline, and thus,
acknowledging practice is critical to it. Our over view will give the
reader a sense of the many ways to conduct research using inter-
sectionality theory in nursing. Thereby, this paper also provides a
toolbox for nursing scholars aiming to adopt the concept of intersec-
tionality in their research.
3 | THE REVIEW
3.1 | Aim
This systematic literature review aims to identify, appraise and syn-
thesize available research studies that apply intersectionality to
nursing. For this purpose, we aim to answer the following research
questions:
• What are the characteristics of nursing research applying
intersectionality?
• How is intersec tionality defined in nursing research?
• What are the arguments for applying intersectionality in the con-
text of nursing research?
• What are the author- identified implications of applying intersec-
tionality in nursing research?
3.2 | Design
A systematic review (Grant & Booth, 2009) was undertaken to iden-
tify, appraise and synthesize available research studies that apply
intersectionality to nursing. Guidelines on the general steps required
for a systematic review by the Joanna Briggs Institute (JBI) guided
the design of the review. These steps were: (1) formulating a review
question, (2) defining inclusion/exclusion criteria, (3) identifying
studies through searching, (4) selecting studies for inclusion, (5) as-
sessing the quality of included studies, (6) extracting data, (7) analys-
ing included studies and (8) interpreting and reporting results (see
Aromataris & Munn, 2020). The review followed the Preferred Re-
porting Items for Systematic Reviews and Meta- Analyses (PRISMA
2020) guidelines (Page et al., 2021) (see Table S1).

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3.3 | Search methods
Research published before February 2022 was identified within the
PubMed and The Cumulative Index to Nursing and Allied Health
Literature (CINAHL) databases. The two databases PubMed (which
includes citations for literature from MEDLINE) and CINAHL were
selected as they encompass studies specifically related to nursing.
No publication date limit ations were considered as we wished to
identif y any available research articles that applied intersectionality
in nursing.
Given the breadth of nursing research, we anticipated that stud-
ies would be heterogeneous in terms of focus, research purposes,
methods, participants and context. Furthermore, we anticipated
that appropriate studies would be scarce. To account for broad in-
dexing for intersectionality and nursing, we used intersectional* and
nurs* as search terms. For details, see Table S2. Search strategy and
database selection were determined in consultation with a medic al
librarian who specialized in information science at the Biomedical
Librar y at Gothenburg University in Sweden.
3.4 | Study selection process
A study was eligible for inclusion if it was (a) substantially about in-
tersectionality and nursing, (b) peer- reviewed and (c) written in Eng-
lish. Studies were not excluded based on study design, for example,
both empirical and theoretical studies were included, but editorials
and commentaries were deemed ineligible because they are not
peer- reviewed. As we aimed to identify available research articles
that apply intersectionality in nursing, theses, book chapters and
grey literature were excluded. First, at least two of the authors in-
dependently screened titles and abstracts of the retrieved sources.
Studies were later screened in full text if they (a) matched the in-
clusion criteria or if (b) the relevance of a study was unclear when
screening its abstract/title. We also (c) screened all studies that were
substantially about intersectionality and published in a nursing jour-
nal in full text, even if the abstract was not substantially about nurs-
ing. The latter was done to assure all articles with potential relevance
for nursing were identified. Studies that met the inclusion criteria
when screened in full tex t were included in the review. To screen
for additional studies, we manually searched the reference list of the
included studies. No additional studies were identified in this way.
Disagreements concerning the screening process were discussed
among the authors until a consensus was reached.
3.5 | Quality appraisal
The quality appraisal was conducted to assess the overall methodo-
logical quality of the included studies, not as an inclusion/exclusion
criterion. At least two authors independently assessed the studies'
quality using the critical appraisal tools from the JBI (2022). Ac-
cording to the article's design, the appropriate checklist was used:
qualitative research (Lockwood et al., 2015), text and opinion papers
(McAr thur et al., 2015), system atic reviews, meta- synthesis (Aroma-
taris et al., 2015), cross- sectional studies (Moola et al., 2020), case
reports or quasi- experimental studies (Tufanaru et al., 2020). Exam-
ples of questions included in the critical appraisal tools are: (1) Were
the criteria for inclusion in the sample clearly defined? (2) Is there
congruit y between the research methodolog y and the research
question or objectives? and (3) Is the review question clearly and
explicitly stated? Disagreements were discussed until a consensus
was reached. An over view of which tool was used for each article
and their scores can be found in the appendix for Table S3– S8 .
3.6 | Data extraction
Data relevant to answering the research questions were extracted
independently by at least two of the authors using a data- extraction
sheet. The data- extraction sheet was first piloted with five studies
to ensure the usefulness of the groupings for answering the research
questions. The sheet included: (1) study characteristics (i.e. publi-
cation year, country, author(s) and title), (2) methods and focus of
the studies (i.e. aim, patient group/group/phenomenon of interest,
setting, design/method), (3) features of the studies concerning ap-
plying intersectionality (i.e. definition of intersectionality, arguments
for applying intersectionality) and (4) author- identified implications
for nursing education, scholarship and practice. All ex tracted data
were entered into Microsoft Excel according to these specific areas
in order to construct a table for analysis.
3.7 | Data synthesis
The included studies comprised a diversity of study designs. Thus, it
was not possible to conduct a meta- analysis of the included studies.
We, therefore, conducted a narrative synthesis. The extracted data
on study characteristics and methods and focus were deductively
grouped and clustered to answer research question 1. To answer re-
search questions 2– 4, we first grouped and clustered the extracted
data on features of the studies concerning the concept of inter-
sectionality. Second, we deductively established the main themes
related to the research questions from each of the studies and juxt a-
posed it to identify patterns in the extracted material. At least two of
the authors were involved in the data synthesis and disagreements
were discussed until a consensus was reached.
4 | RESULTS
In total, 4 04 citations published between September 1997 and Feb-
ruary 2022 were identified. After removing any duplicates (n = 73),
331 records remained. 228 records were excluded with reason by
screening titles and abstracts. Thereaf ter, the full text of 103 re-
cords were screened and assessed for eligibility. An additional 43

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SIIRA et al .
articles were excluded with reasons after a full- text review. In total,
60 articles were included in the review (Figure 1).
4.1 | Characteristics of studies
The general characteristics (i.e. publication year, country, aim,
patient group/group/phenomenon, setting, design/method) of
the studies are outlined in Table 1. Most studies were published
after 2010 (n = 55). A few were published bet ween 2000 and
2009 (n = 4) and one was published before 2000. The most com-
mon countr y of origin was the United States (n = 26), followed by
Canada (n = 22). Other countries of origin were Sweden (n = 5), the
United Kingdom (n = 3), New Zealand (n = 2), Australia (n = 1) and
Brazil (n = 1). The most common design was theoretical (n = 27),
followed by empirical with a qualitative approach (n = 19), em-
pirical with a quantitative approach (n = 3) and different types of
reviews (n = 8). Two studies were quasi- experimental (Henriquez
et al., 2019; Höglund et al., 2016) and one study was a c ase report
(McCall & Lauridsen- Hoegh, 2014).
There was a collection of different set tings: nursing education
(n = 7) (e.g. Höglund et al., 2016), the work environment of nurses
(n = 7) (e.g. Aspinall et al., 2019), mental health nursing (n = 5) (e.g.
Benbow et al., 2011), community nursing (n = 4) (e.g. Van Herk et al.,
2011), home care (n = 2) (e.g. Giesbrecht et al., 2015) and oncol-
ogy nursing (n = 2) (e.g. Damaskos et al., 2018). For one study re-
spectively, the settings were nursing homes, public health nursing,
transition from paediatric to adult care, hospital outpatient nursing,
transitional care and school nursing. The majority (n = 27) of the re-
viewed articles did not concern any specific setting but concerned
all nursing (e.g. Wesp et al., 2018). An overview of set tings can be
seen in Table 1.
There was heterogeneity in the patient group/group/phenome-
non of interest in focus in the studies. A large group of the studies
focused on race, people with immigrant/refugee status or people of
racial or ethnic minority (n = 20) (e.g. Caxaj & Berman, 2010; Clark &
Saleh, 2 019; Henderson, 1997), women and/or mothers (n = 18) (e.g.
Benbow et al., 2011; McCall & Lauridsen- Hoegh, 2014; Wardlaw &
Shambley- Ebron, 2019) and/or the nursing profession (n = 11) (e.g.
Aspinall et al., 2021; Jones et al., 20 09; Qureshi et al., 2020). Many
of the studies focused on all three of these patient groups/groups/
phenomena of interest. Other patient groups/groups/phenomena of
interest in focus in the studies were persons with HIV (n = 5) (e.g.
Chulach & Gagnon, 2013), LGBT and transgender persons (n = 5) (e.g.
FIGURE 1 Flow chart. Search and
retrieval results. From: Page MJ, McKenzie
JE, Bossuyt PM, Boutron I, Hoffmann
TC, Mulrow CD, et al. The PRISMA
2020 statement: an updated guideline
for repor ting systematic reviews. BMJ
2021;372:n71. doi: 10.1136/bmj.n71.
Records identified from:
Databases (n = 404)
CINAHL (n = 207)
Pubmed (n = 197)
Records removed before
screening:
Duplicate records removed
(n = 73)
Records screened
(n = 331)
Records excluded
(n = 228)
Reports sought for retrieval
(n = 103)
Reports not retrieved
(n = 0)
Reports assessed for eligibility
(n = 103) Reports excluded (n=43)
No focus on nursing (n = 24)
No focus on intersectionality
(n = 10)
Not peer-reviewed (n = 9)
Studies included in review
(n = 60)
Identification of studies via databases and registers
Identification
Screening
Included

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SIIR A et al.
TABLE 1 Characteristics of included studies sorted per year of publication from oldest to most recent.
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
1997 US Henderson
Intersecting Race and Gender in Feminist
Theorie s of Women's Psychological
Development
Critique and develop psychoanalytic theory on
women's psychological development and
discuss implications for mental health nursing.
Women and race Mental health
nursing
Theoretical
2004 Canada Guruge & Khanlou
Intersectionalities of influence: researching
the health of immigrant and refugee
women
Theorize and operationalize the concept
[intersectionalities of influence] in mental
health promotion research with immigrant and
refugee women
Women with immigrant/refugee
status
Mental health
nursing
Theoretical
2009 UK Jones et al.
Caribbean nurses migrating to the UK: a
gender- focused literature review
Explore the significance of gender in the contex t
of the migration of nurses from the Caribbean
region to the United Kingdom.
Caribbean Nurses migrating to t he
United Kingdom
Work
environment
of nurses
Review
2009 US Kelly et al.
Integrating I ntersectionality and
Biomedicine in Health Disparities
Research
Discuss feminist intersectionality and biomedical
approaches, their contributions to research,
and integration in the research process
Latino women who experience
intimate partner violence
All nursing Theoretical
2010 Canada C axaj & Berman
Belonging Among Newcomer Youths
Intersecting Experiences of Inclusion
and Exclusion
Explore newcomer youths' gendered, racialized,
and class experiences of inclusion and sense of
belonging in their country of resettlement
Newcomer youths All nursing Empirical
– qualitative
2010 Canada Van Herk et al.
Identity matters: Aboriginal mothers'
experiences of accessing health care
Explore the implications of how service providers'
perceptions of Aboriginal women's identities
influence their experiences of care access
Aboriginal mothers Community
nursing
Empirical
– qualitative
Secondary
analysis
2011 Canada Benbow et al.
Mothers with mental illness experiencing
homelessness: a critical analysis
To examine existing oppression and ongoing
resistance in the lives of homeless mothers
with ment al illness and to learn from these
women what is conducive to their health.
Mothers with mental illness
experiencing homelessness
Mental health
nursing
Empirical-
qualitative
2010 Canada Guruge et al.
Intimate male partner violence in the
migration process: intersections of
gender, race and class
Report Sri Lankan Tamil Canadian immigrants'
perspectives on factors that contribute to
IMPV in the postmigration context.
Intimate male partner violence
among immigrants
All nursing Empirical
– qualitative
2011 US Rogers & Kelly
Feminist intersectionality: Bringing social
justice to health disparities research
Provide an ethical approach to health disparities
research that simultaneously describes and
seeks to eliminate health disparities.
Health disparities research All nursing Theoretical
2011 US Kelly
Theorie s of Intimate Partner Violence:
From Blaming the Victim to Ac ting
Against Injustice Intersectionality as an
Analytic Framework
Describe and expose the complexity of life
experiences within intersecting oppressions in
the contex t of intimate partner violence
Women who experience intimate
partner violence
All nursing Theoretical

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(Continues)
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
2011 US Shade et al.
A Conceptual Model of Inca rcerated
Adolescent Fatherhood: Adolescent
Identity Development and the Concept
of Intersectionality
Present a model to guide research on adolescent
fatherhood, in the context of incarceration,
and suggest clinical intervention to improve
outcomes for the young father and his child
Adolescent, incarcerated fathers and
their children
Mental health
nursing
Theoretical
2011 Canada Van Herk et al.
Examining our privileges and oppressions:
incorporating an intersectionality
paradigm into nursing
Discuss the hegemony of the white, middle- class
perspective in nursing
Oppression and privilege within t he
nursing profession and practice
All nursing Empirical
- – qualitative
2012 Canada Guruge
Intimate Partner Violence: A Global Health
Perspective
Summarize literature on health consequences,
costs, prevalence, risk factors, perceptions,
and manifestations of intimate partner
violence, and women's responses to it
Women who experience intimate
partner violence
All nursing Review
2012 Sweden Saarnio et al.
Power relations in patients experiences of
suffering during treatment for cancer
Examine how patients who have cancer
experience suffering in the context of power
relations
Patients undergoing cancer
treatment
Oncology
nursing
Empirical
– qualitative
2013 Canada Chulach & Gagnon
Rethinking the experience of HIV- positive
refugee wom en in the context of
pregnancy: using an inter sectional
approach in nursing
Briefly overview the origins and evolution of
intersectionality, describe levels of analysis
and usefulness for nursing
Pregnant refugee women living with
HIV
All nursing Theoretical
2013 Canada McCall & Lauridsen- Hoegh
Trauma and cultural safety: providing
quality care to HIV- infected women of
aboriginal descent
Describe the case of a 52- year- old, HIV- infected
Aboriginal woman in relation to colonization,
intersectionality, post- traumatic stress
disorder, depression, revictimization, and
substance use
Women of aboriginal descent living
with HIV
All nursing Case report
2013 Canada Giesbrecht et al.
Identifying socio- environmental factors
that facilitate resilience among
Canadian palliative family caregivers: A
qualitative case study
Identify socio- environmental factors that
contribute to palliative family caregiver
resilience in the Canadian homecare context
Palliative family caregivers Home care
nursing
Empirical
– qualitative
Secondary
analysis
2013 US Green
Application of the Self Ca re Deficit Nursing
Theory: The Community Context
Establish the usefulness of Orem's Self- Care
Deficit Nursing Theory in application to
disabled children in the school setting and
link it to social determinants of health and
intersectionality
Schoolchildren with disabilities School nursing Theoretical
TABLE 1 (Continued)

8
|
SIIR A et al.
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
2014 Canada Choby & Clark
Improving health: structure and agency in
health interventions
Critique liberal individualist assumptions of
health and propose steps for critical realist
intersectional interventions research
Structure and agenc y in health
interventions
All nursing Theoretical
2014 US Caiola et al
Using an Intersectional Approach To Study
the Impac t of Social Deter minants of
Health for African American Mothers
Living with HIV
Broaden the discussion about conceptual
approaches which can be used to address
health and health inequities in nursing
African American mothers living with
HIV
All nursing Theoretical
2014 Sweden Holmgren et al.
Intersectional perspectives on family
involvement in nursing home care:
rethinking relatives' position as a
betweenship
To understand, in the context of intersectional
theor y, the roles of family members in nursing
home care
Relatives' involvement in nursing
homes
Nursing homes Empirical
– qualitative
2014 Canada Reimer- Kirkham
Nursing Research on Religion and
Spirituality Through a Social Justice
Lens
Critically analyse nursing discourses on religion
and spirituality
Religion and spirituality in nursing All nursing Theoretical
2016 Sweden Cuesta & Rämgård
Intersectional perspective in elderly care
Contribute to staff well- being in elderly c are
by asking in what way an intersectional
perspective can contribute to increased
knowledge of power structures
Employees at a nursing home with
immigrant status
Work
environment
of nurses
Empirical –
qualitative
2016 US Hall & C arlson
Marginalization A Revisitation With
Integration of Scholarship on
Globalization, Intersectionality,
Privilege, Microaggressions, and
Implicit Biases
Examine and discuss recent scholarship on
marginalization and building the knowledge
base in nur sing while respecting diversity.
All marginalized groups/
marginalization
All nursing Theoretical
2016 Sweden Höglund et al.
Impact of telephone nursing education
program for equity in healthcare
Investigate if and how an educational intervention
can improve awareness of equity in healthcare
among telephone nurses
Telephone nurses and education Nursing
education
Quasi-
experimental
2017 Canada Blanchet Garneau et al
Drawing on antiracist approaches toward
a critical antidiscriminatory pedagogy
for nursing
Propose a critical antidiscriminatory pedagogy
and thus translate social justice into nursing
practice and education
Social justice and nur sing Nursing
education
Theoretical
2017 Sweden Holmström et al.
Nursing s tudents' awareness of inequ ity
in healthcare — An intersectional
perspective
Explore awareness of inequity in healthcare and
the intersection between different structures
of power among nursing students
Nursing students Nursing
education
Empirical
– quantitative
descriptive
TABLE 1 (Continued)

|
9
SIIRA et al .
(Continues)
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
2017 Canada Kellett & Fitton
Supporting transvisibility and gender
diversity in nursing practice and
education: embracing cultural safety
Raise awareness about the problems inherent to
transinvisibility and propose interventions to
increase the recognition of gender diversity in
nursing education and practice
Transvisibility and trans gender
clients
Nursing
education
and working
conditions of
nurses
Theoretical
2018 US Damaskos et al.
Intersectionality an d the LGBT patient
with cancer
Discuss c ancer risk factors, health care access
and treatment for lesbian, gay, bisexual, and
transgender patients
LGBT patients with cancer Oncology
nursing
Review
2018 Canada Elliott et al.
A focused eth nography of nursing team
culture and leadership on a transitonal
care unit
Explore how a new staf fing model impact the
team dynamics within the socio- political and
sociocultural context of a transitional care unit
Nurses working environment and
teamwork
Transitional care
nursing
Empirical
– qualitative
2018 US Wesp et al.
An Emancipatory Approach to Cultural
Competency: The Application of
Critical Race, Postcolonial, and
Intersectionality Theories
Critique Guidelines regarding Culturally
Competent Care
Marginalized groups and nurses
cultural competency
All nursing Theoretical
2019 New Zealand Aspinall et al.
Intersectionality and Critical Realism: A
Philosophical Framework for Advancing
Nursing Leadership
To develop an approach that addresses how the
multiple social positions nurses hold an impact
on their opportunities to develop as leaders
Nurses as leaders Work
environment
of nurses
Theoretical
2019 Canada Campbell et al.
Nurse- family partnership and geography:
an intersectional perspective
Explore the influence of geography on the
deliver y of the public health program Nurse-
Family Partnership.
Nurse- family partnership, maternal/
child health and geogr aphy
Community
nursing
Empirical
– qualitative
2019 Canada Clark et al.
Applying Critical Race Feminism and
Intersectionality to Narrative Inquir y. A
Point of Resistance for Muslim Nurses
Donning a Hijab
Explore racism within nursing and build a case for
examining the experiences of Muslim nurses
donning a hijab
Female Muslim nurses donning a
hijab
Work
environment
of nurses
Theoretical
2019 US DeWilde et al.
Structural Stress and Otherness: How Do
They Influence Psychological Stress?
Explore the impact of structural stressors and
otherness on psychological stress. Determine
if the cultural distress model aligns with
definitions of culture among the participants.
Cultural distress and psychological
stress
Hospital
outpatient
nursing
Empirical
- quantitative
2019 US Engelman et al.
State of the Profession The Landscape of
Disability Justice, Health Inequities,
and Access for Patients With
Disabilities
Provide an overview of disparities faced by people
with disabilities and recommendations for
nursing curriculum and practice
People with disabilities All nursing
Nursing
education
Theoretical
TABLE 1 (Continued)

10
|
SIIR A et al.
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
2019 US Fitzgerald & Campinha- Bacote
An Intersectionality Approach to the
Process of Cultural Competemility
– Par t II
By using an intersectionality approach, of fer
strategies that nurses and other healthcare
professionals can use to challenge and address
inequalities.
Nursing practice, organization and
cultural humility
All nursing Theoretical
2019 Canada Henriquez, et al.
It's Complicated: Improving Undergraduate
Nursing Students' Understanding
Family and C are of LGBTQ Older
Adults.
Articulate a teaching approach and methodology
of an unfolding LGBTQ family c ase study for
undergraduate nursing students.
Undergraduate Nursing Student s and
LGBTQ Older Adults
Nursing
education
Quasi-
experimental
2019 Canada Reimer Kirkham
Complicating nursing's views on religion
and politics in healthcare.
Complicate nursing's views on religion and politics
in healthcare
Nursing's views on religion and
politics
All nursing Theoretical
2019 Canada Straus & Brown
The potential contribution of critical
theories in healthcare transition
research and practice
The aim is to examine the potential contributions
of intersectionality and critical discourse
analysis to healthcare transition research and
practice
Youth transitioning from childhood to
adulthood and paediatric to adult
health care
Transition from
paediatric to
adult care
Theoretical
2019 Canada Thandi & Browne
The social context of substance use among
older adults: Implications for nursing
practice.
To critically analyse the social contex t of
substance use among older adult s and to offer
strategies to support the health of older adults
experiencing problematic substance use.
Older adults with problematic
substance use
All nursing Theoretical
2019 US Wardlaw & Shambley- Ebron
Co- cultural Communicative Practice s of
African American Women Seeking
Depression Care.
Explore the co- cultural communicative practices
that African American women use when
seeking depression care
African- American women with
depression
Mental health
nursing
Empirical
– qualitative
2020 US Armour- Burton & Etland
Black Feminist Thought: A Paradigm to
Examine Breast Cancer Disparities.
Examine how the intersection of race, gender, and
class influences ment al and physiological well-
being among African American Women with
breast cancer
African American Women with
cancer
Community
nursing
Empirical
– qualitative
2020 US Griswold & Pagano- Therrien
Women Living With HIV in High Income
Countrie s and the Deepe r Meaning
of Breast feeding Avoidance: A
Metasynthesis.
Describe social and emotional experiences of
infant feeding for women living with HIV
in high- income countries and raise ethical
considerations surrounding the clinical
recommendation to avoid breastfeeding.
Breast feeding women living with HIV
in high- income countries
All nursing Review
2020 Australia Ogrin et al.
The inter- relationship of d iversity principles
for the enha nced participation of older
people in their care: a qualitative study.
Explore how five diversity principles are
considered by older people
Older people Home care
nursing
Empirical
– qualitative
TABLE 1 (Continued)

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11
SIIRA et al .
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
2020 UK Qureshi et al.
British South Asian male nurses' views on
the barriers and enablers to entering
and progressing in nursing careers.
Ascer tain British South Asian male nurses' views
on the barriers and enablers to entering and
progressing in nursing education and career s.
British South Asian male nurses Work
environment
of nurses
Empirical
– qualitative
2020 New Zealand Aspinall et al.
The impact of intersectionality on nursing
leadership, empowerment and culture:
A case study exploring nurses and
managers' perceptions in an acute care
hospital in Aotearoa, New Zealand.
Exploring intersectionality and nursing leadership
in the context of the social environment
Nurses and managers in an acute
care hospital
Work
environment
of nurses
Empirical
– qualitative
2020 US Weitzel et al.
The Role of Nu rses as Allies Against Racism
and Discrimination: An Analysis of Key
Resistance Movements of Our Time.
Offer nurses new epistemologies informed by
intersectionality, critical race
theor y, and historic al trauma to use in practice
Nurses' role in relation to
marginalized populations
All nursing Theoretical
2021 US Burger et al. Reproductive justice and
black lives: A concept analysis for
public health nursing
To analyse the concept of reproductive jus tice
as used in peer- reviewed publications with
the aim of reframing black maternal health in
public health nursing
Black maternal health Public he alth
nursing
Review
2021 US Crooks et al. Black Female Sexuality:
Intersectional Identities and Historical
Contexts
Explain how a secondary analysis of a study
about Black female sexual behaviour supports
intersectionality theory, describe an expanded
model of intersectionality theory and discuss
implications for nursing
Sexual health of Black women All nursing Empirical –
qualitative
secondary
analysis
2021 US Ramos et al. Intersectional Effects of
Sexual Orientation Concealment,
Internalized Homophobia, and Gender
Expression on Sexual Identity and HIV
Risk Among Sexual Minority Men of
Colour: A Path Analysis.
Examine how intersecting identities, in aggregate,
contribute to HIV risk in sexual minority men
Minority men and HIV risk and
gender expression
All nursing Empirical
– quantitative
2021 US Webster et al. The Concept of
Vulnerability Among Black and Latina
Transgender Women in the United
States.
Review the current body of knowledge on
vulnerability among Black and Latina
transgender women
Black and Latina transgender women All nursing Review
2021 US Ruiz et al. A His torical Analysis of the
Impact of Hegemonic Masculinities on
Sexual Assault in the Lives of Ethnic
Minority Women: Informing Nursing
Interventions and Health Policy
Deepen the unders tanding of how hegemonic
masculinity shapes minority women's
experiences of sexual assault
Minority women's experiences of
sexual assault
All nursing Review
(Continues)
TABLE 1 (Continued)

12
|
SIIR A et al.
Year Country Author & title Aim
Patient group/group/phenomenon
of interes t Setting Design
2021 US Ruiz et al. An integrative literature
review and critical reflection of
intersectionality theory
Critically reflec t on intersectionality by
considering the semantic and structural
consistency, generalizability, simplicity and
complexity, and the utility and value to nursing
science and practice
Utility of intersectionality theory in
nursing
All nursing Review
2022 Canada Al- Hamad et al. The Potential of
Merging Intersectionality and Critical
Ethnography for Advancing Refugee
Women's Health Research
Outline the potential of using the blended
theoretical approach in advancing refugee
women's health research and to inform a
particular methodological approach for nursing
research and health care practice
Refugee women All nursing Theoretical
2022 US Bergman et al. Reframing Intersectional
Stigma for a South African Context
Integrating Tuberculosis, HIV a nd
Poverty Stigma
Reframe intersectionality by considering a new set
of stigmatized identities and create a situation-
specific framework
Intersectional stigma in South Africa All nursing Theoretical
2022 Brasil Souza & Tanaka Healthcare: Action
research with trans people living on the
streets.
To analyse the representations of healthcare
provided to trans people living on the streets.
Trans people living on the streets Community
nursing
Empirical –
qualitative
2022 US Schmit t et al. Adverse childhood
experiences among previously homeless
African American women.
The aim was to examine the role adverse
childhood experiences played in life course
trajec tories of previously homeless Afric an
American women.
African American women who have
previously been homeless
All nursing Empirical-
qualitative
2022 US Schoon & K rumwiede
A holistic health determi nants model for
public health nursing education and
practice.
Propose a model for population health assessment Health determinants Nursing
education
Theoretical
2022 UK Qureshi et al.
Understanding the disproportionate effects
of COVID- 19 on nurses from ethnic
minority backgrounds
Define intersectionality and outline intersecting
factors contributing to disproportionate
effec ts of COVID- 19 on nurses from ethnic
minority backgrounds
Nurses from ethnic minority
backgrounds
Work
environment
of nurses
Theoretical
TABLE 1 (Continued)

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13
SIIRA et al .
Webster, 2021), victims of intimate partner violence (n = 4) (e.g. Gu-
ruge, 2012), youth/adolescents (n = 4) (e.g. Shade et al., 2011) and
older adults (n = 3) (e.g. Ogrin et al., 2020). A few art icl es did no t con -
cern any specific patient group/group/phenomenon, but focused on
research or the nursing discipline (n = 5) (e.g. Choby & Clark, 2014).
An overview of patient groups/groups/phenomena of interest in
focus in the studies can be seen in Table 1.
4.2 | Definitions of intersectionality
Common references for intersectionality in the included studies
were, for example, Hancock (2007), Hankivsky (2012), Collins (2000)
and Crenshaw (1991). In the included studies, intersectionality was
defined as a theoretical or refractory lens (e.g. Benbow et al., 2 011;
Reimer- Kirkham, 2 014; Van Herk et al., 2011), a tool (Kelly, 2011),
a framework (e.g. Crooks et al., 2021; Guruge, 2012; Holmgren
et al., 2014), a concept (e.g. Aspinall et al., 2021), a means of explain-
ing (e.g. Jones et al., 2009), a perspective (e.g. Saarnio et al., 2012), a
research method (e.g. Clark & Saleh, 2 019; Crooks et al., 2021) and
finally, a paradigm (e.g. Van Herk et al., 2011). A few studies did not
clearly define intersectionality (e.g. Elliott et al., 2018; Henriquez
et al., 2019; Qureshi et al., 2020).
There was generally an acknowledgment among the included
studies on the interrelationship of processes at the micro, meso
and macro levels in intersectional analysis, but the foci of atten-
tion differed between studies. For example, the oldest study by
Henderson (1997), who was concerned with women's psychologi-
cal development, focused on the micro level and argued that inter-
sectionality could help us understand identity formation. Identity
formation was also the subject of the paper by Shade et al. (2 011),
which discussed the identities available for adolescent boys in hy-
permasculine spaces such as criminal gangs and juvenile incarcer-
ation. Several studies explicitly mentioned processes at the micro,
meso and macro levels (e.g. Blanchet Garneau et al., 2018; Choby
& Clark, 2 014; Guruge & Khanlou, 2004). Griswold and Pagano-
Therrien (2020) argued that intersectionality referred to how ‘social
and politic al landscapes’ intersect with social locations, in their case,
gender.
Intersectionalit y was described as linking to power struggles
described as oppression (e.g. Wardlaw & Shambley- Ebron, 2019),
forces (e.g. Thandi & Browne, 2019), subordination (e.g. Kelly, 2009),
inequalities and injustice (e.g. Damaskos et al., 2018), discrimination
(e.g. Green, 2013), disenfranchisements (e.g. Choby & Clark, 2014),
marginalization (e.g. Hall & Carlson, 2016), hierarchies and inclu-
sion and exclusion (e.g. Höglund et al., 2016). Sometimes specific
structures of power were called out as sexism, racism, colonialism
(Henderson, 1997), ageism and classism (Guruge, 2012), and seen
as being mutually constructed (e.g. Cuesta & Rämgård, 2016). The
power struggles supposedly oper ated on micro, meso and macro lev-
els as there were ‘multiple sites’ for them to play out (Guruge, 2012),
for example, in the therapeutic encounter between the patient and
the nurse (Van Herk et al., 2011).
Intersectionalit y was described as an anti- reductionist concept
(e.g. Giesbrecht et al., 2015) that aimed to capture the complexity of
people's lives and experiences and put illness and health into context
(e.g. Campbell et al., 2020; Reimer- Kirkham, 2 014). At the centre of
analysis was what was described as social c ategories (e.g. Giesbrecht
et al., 2015), social locations (e.g. Straus & Brown, 2021), social po-
sitions and relationships (e.g. Elliott et al., 2018) categories of differ-
ence (e.g. Clark & Saleh, 2 019), dimensions of social life (e.g. Höglund
et al., 2016), being ‘other’ (e.g. Hall & Carlson, 2016), social gradients
(e.g. Kellett & Fitton, 2017), characteristics (e.g. Ogrin et al., 2020)
or social divisions (e.g. Campbell et al., 2020). Such categories of in-
terest were gender, race, age, sexual orientation and identity, eth-
nicity, culture, socioeconomic status, social class and ableness (e.g.
Van Herk et al., 2010). These were all dynamic constructions in the
sense that their meaning changed with time and place (e.g. Holmgren
et al., 2014).
Van Herk et al. (2010) described race and gender as not being
separate categories but as ‘interrelated and entangled’, i.e. they in-
teract and intersect (e.g. Höglund et al., 2016), are indivisible (e.g.
Wardlaw & Shambley- Ebron, 2019) and interconnected (e.g. Dam-
askos et al., 2018). Identities were described as multiple and over-
lapping (e.g. Damaskos et al., 2018), simultaneous (e.g. Fit zgerald &
Campinha- Bacote, 2019), multiplicative (e.g. Kelly, 2009) and what
Riemer- Kirkham (2014, 250) described as a ‘hybrid’. Thus, the com-
bination of t wo or more categories was suggested to invoke forms
of oppression and experiences that were distinct from any of them
standing alone (Green, 2013). Furthermore, no single categor y could
or should be privileged according to several of the inuded studies
(e.g. Henderson, 1997; Ogrin et al., 2020; Reimer- Kirkham, 2014;
Van Herk et al., 2011). Intersectionality was por trayed as capturing
the nuances of individualized experiences (e.g. Hall & Carlson, 2016),
and it was pointed out that there were differences among the group
‘women’ as there are diverse and shared experiences (e.g. Chulach &
Gagnon, 2013; Guruge, 2012; Henderson, 1997).
4.3 | Arguments for applying intersectionality in
nursing research
Arguments for applying the concept of intersectionality were often
to be able to consider the multiple natures of identities (e.g. Gu-
ruge & Khanlou, 2004), social locations (e.g. Giesbrecht et al., 2015;
Straus & Brown, 2021) or categories such as race, gender and class
(e.g. Ogrin et al., 2020), and migration (e.g. Guruge et al., 2010 ).
Some studies argued that intersectionality was useful for analysing
how disadvantages intersect with a specific phenomenon such as
geographical contexts (Campbell et al., 2020) or religious signifiers
such as the hijab (Clark & Saleh, 2019).
Several studies argued that intersectionality was useful for
addressing issues concerning oppression and power (e.g. Aspi-
nall et al., 2021; Griswold & Pagano- Therrien, 2020; Holmgren
et al., 2014). For example, by raising awareness and strengthen-
ing the understanding of how intersecting factors (e.g. Höglund

14
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SIIR A et al.
et al., 2016; Thandi & Browne, 2019), social determinants (e.g. Caiola
et al., 2014; Damaskos et al., 2018) or power structures (e.g. Holm-
ström et al., 2017; Ruiz, Luebke, Hawkins, et al., 2021; Ruiz, Luebke,
Klein, et al., 2021), contributed to inequities in health and affect
health care delivery or how identity- based structural oppressions
functioned within an organization (e.g. Aspinall et al., 2019, 2021;
Saarnio et al., 2012). Two studies specifically pointed out intersec-
tionalit y as a means to investigate oppression and corresponding
acts of resistance (Benbow et al., 2011; Caxaj & Berman, 2010).
Intersectionalit y was argued to enhance concepts or theories
such as Orem's conditioning factors (Green, 2013), the concept of
marginalization (Hall & Carlson, 2016), cultural safety (Kellett &
Fitton, 2017), perspectives on cultural competency (Fitzgerald &
Campinha- Bacote, 2019; Wesp et al., 2018) and feminist theories of
women's psychological development (Henderson, 1997). Adding to
this, intersectionality was argued to inform narrow biomedical con-
ceptualiz ations of health (Kelly, 2009), link ethical considerations and
social justice concerning health disparities (Rogers & Kelly, 2011), in-
form understandings of religions and spirituality or politics (Reimer-
Kirkham, 2014 , 2019), or simply forwardin g analyses of stru cture and
domination (Ruiz, Luebke, Hawkins, et al., 2021; Ruiz, Luebke, Klein,
et al., 2021) or health disparities in nursing (Crooks et al., 2021). It
was also put forward as a way to understand that nurses may be in
positions of privilege and oppression at the same time depending on
social conditions (Blanchet Garneau et al., 2018).
Several studies argued that intersectionality was suitable for
understanding health- related experiences and/or positions of spe-
cific groups. For example, African American women (Wardlaw &
Shambley- Ebron, 20 19), HIV- positive pregnant refugee women
(Chulach & Gagnon, 2013), women experiencing intimate partner
violence (Kelly, 2011), Aboriginal mothers (Van Herk et al., 2010),
people with disabilities (Engelman et al., 2019) or American African
women with breast cancer (Armour- Burton & Etland, 2020).
In some studies, the arguments for applying intersectionality
were not clearly artic ulated but rather ex plained by stating the prem-
ises of the theory/concept (DeWilde et al., 2019 ; Elliott et al., 2018;
Jones et al., 2009; McCall & Lauridsen- Hoegh, 2014). While most
studies advocated for using intersectionality in nursing, a few
pointed to difficulties or shortcomings with its application. These
studies highlighted the ambiguity and inconsistency of the defini-
tion or application of intersectionality (e.g. Aspinall et al., 2019; Ruiz,
Luebke, Hawkins, et al., 2021; Ruiz, Luebke, Klein, et al., 2021), the
philosophical and practical problems of categorizing social groups
(Ke lly, 2009) and the difficulties in applying the concept concerning
the method and measurements of outcomes (DeWilde et al., 2019;
Green, 2013).
4.4 | Author- identified implications of applying
intersectionality in nursing research
The author- identified implications of applying intersectionality in
nursing research were grouped into four categories: for research
(e.g. how the application could enable the advancement of knowl-
edge and theory within nursing research), for prac tice (e.g. how the
application could influence the interaction bet ween nurses and pa-
tients as well as nurses' career paths), for education (e.g. how the
application could endorse pedagogical approaches that increase
awareness of privilege, oppression, and the experiences of diverse
groups among nursing students) and for society (e.g. how the ap-
plication could emphasize concerns surrounding injustice and health
disparities from a structural perspective within society).
4.4.1 | For research
The authors of the included studies identified several implications of
applying intersectionality for research. Commonly, intersectionality
was understood as allowing nursing research to advance the under-
standing of the role that social context and social processes played
in influencing health and well- being in dif ferent groups of people
(e.g. Caxaj & Berman, 2010). For example, the understanding of how
mechanisms and effects of social determinants influenced health-
care (Damaskos et al., 2018) or health inter ventions for different
groups of people (e.g. Choby & Clark, 2014), or how other condition-
ing factors linked to race, gender and class (Armour- Burton & Et-
land, 2020) affect health outcomes and how people experienced and
dealt with their health in relation to these mechanisms and effects
(Giesbrecht et al., 2015; Green, 2013). Intersectionality was also sug-
gested to advance development of existing theories within nursing,
for example, Orem's theory on conditioning factors (Green, 2013),
theoretical understanding of religious and spiritual traditions
(Reimer- Kirkham, 2014), conceptual understanding of adolescent fa-
therhood (Shade et al., 2011), vulnerability (Webster, 2021) and the
experiences of vulnerable groups (Saarnio et al., 2012).
4.4.2 | For practice
Several studies argued that nurses have a unique position to ad-
vocate for the health needs of populations and promote social
justice in healthcare (e.g. Benbow et al., 2011; Blanchet Garneau
et al., 2018). Intersectionality was suggested to promote a bet-
ter understanding among health professionals of how structural
issues could impact peoples' decisions regarding health and give
a shared understanding of which healthcare goals are realistic
and should be prioritized (Caiola et al., 2014). Advancement in
knowledge on intersecting factors and health outcomes was sug-
gested to re- direct the focus of nursing practice (Armour- Burton
& Etland, 2020). For example, by helping nurses to better under-
stand structural causes for why some persons are ill- equipped to
prioritize their health (Thandi & Browne, 2019) and refrain from
blaming individuals for risky behaviours (Crooks et al., 2021). By
understanding and respecting the cultural and societal milieu of
marginalized communities, it was argued that the nurse could pro-
vide compassionate care (Schmitt et al., 2022). Intersectionality

|
15
SIIRA et al .
was suggsted to have implications for the therapeutic encoun-
ter between nurses and patients by acknowledging its inherent
power dynamics (Van Herk et al., 2010) and by guiding nurses in
communicating more respectfully and avoiding pejorative labels
(Ogrin et al., 2020; Thandi & Browne, 2019). Knowledge informed
by intersectionalit y was argued to be a helpful tool to act on in-
justice in practice and create inclusive healthcare institutions
(Reimer- Kirkham, 2019; Weitzel et al., 2020) and support nurses
in self- reflection regarding their own biases and how to avoid
stigmatizing patients (Ogrin et al., 2020; Thandi & Browne, 2019).
Some authors suggested that intersectional nursing research
should combine scholarship with activism (Caiola et al., 2014 ;
Souza & Tanaka, 2021). Finally, intersectionality was suggested as
useful for understanding how intersecting social identities could,
for example, prevent some nurses from being leaders (Aspinall
et al., 2019, 2021) or how gender and ethnicity influence the deci-
sion to enter the nursing field (Qureshi et al., 2020).
4.4.3 | For education
Several authors argued that intersectionality could be applied in the
educational field to promote, for example, antiracist education and
critical antidiscriminatory pedagogical approaches (e.g. Blanchet
Garnea u et al., 2018; Caio la et al., 2014; C lark & Saleh, 2019). Some of
the studies suggested training to enhance nursing students' aware-
ness of the experiences of specific groups such as transgender per-
sons (Webster, 2021) or people with disabilities (e.g. Green, 2013).
Clark and Saleh (2019) pointed out the underrepresentation of ra-
cialized and indigenous people among faculty members in institu-
tional places of learning while Kellett and Fitton (2017) called for
more trans visibility in academia through features such as gender-
neutral washrooms and allowing students to use their preferred
pronouns. Adding to this, authors suggested that nursing education
could engage the different communities as a source of knowledge,
including the trans community (Kellett & Fitton, 2017) and older
people (Ogrin et al., 2020). Intersectionality was also argued to in-
form nursing to reflect on issues of power and privilege (Wardlaw &
Shambley- Ebron, 2019) and help students become more aware of
their social position and the privilege that comes with the nursing
role (Crooks et al., 2021). One way this was implemented was by
supporting discussions on health equity (Höglund et al., 2016).
4.4.4 | For society
Authors stated that intersec tionality calls for social change
(Ke lly, 2009), as one must question (Elliott et al., 2018) and chal-
lenge injustice (Aspinall et al., 2019) upon discovering its prevalence.
Henderson (1997) argued that intersectionality could illuminate how
white women become complicit in racism by replicating images of
themselves as nurturing and ethical. Intersectionalit y was also sug-
gested to highlight the structural issues related to health, such as the
need to increase oppor tunities for employment, housing and finan-
cial support (Webster, 2021). This could inform nursing by address-
ing social injustice (Reimer- Kirkham, 2014). Finally, intersectionality
was argued to shed light on nurse migration as an issue in need of
a more gender- centred approach to recruitment and policy where
the well- being of migrant nurses might be undermined through dis-
crimination even when their financial situation is improved (Jones
et al., 2009).
5 | DISCUSSION
The application of intersectionality in nursing research has primarily
emerged since 2010, originating from nations like Canada and the
United States, and is non- empirical. Our review identified a broad
variation in the definition and use of intersectionality in nursing re-
search. What constitutes an intersectional analysis is debated, and
there is a broader lack of consensus on the definition of intersection-
ality (Bilge, 2013; Collins, 2015; Davis, 2008). Together, the stud-
ies included in this analysis cover all of the six fundamental ideas of
intersectionality: complexity, power, inequality, relationality, social
context and social justice (Collins & Bilge, 2016). They highlight the
diversit y present among various groups (e.g. women), the impact of
power structures and relations on specific groups (e.g. trans per-
sons), unequal access to opportunities and resources (e.g. among
groups of nurses), the interrelation between social inequalities and
systems of power (e.g. concer ning race and gender) a nd the influence
of social context on people's experiences (e.g. concerning migration).
Ultimately, they advocate for equitable distribution of resources and
opportunities related to healthcare. However, when considered as a
whole, these studies demonstrate numerous approaches to defining
intersectionality such as using it as a tool, lens, paradigm or method.
Similarly, intersectionality is put forward to enable the study of mul-
tiple dimensions, but the units of analysis vary between the stud-
ies. Many of the cases in our review focus on units of analysis that
are commonly centred in intersectional analyses such as identities
(e.g. black women), categories (e.g. gender), processes of differen-
tiation (e.g. gendering) and systems of domination (e.g. patriarchy)
(Dhamoon, 2011), but several studies also focus on other aspects
such as geographical contexts, being other and social gradient s. For
intersectionality— a borrowed theory— to enrich nursing research
and issues relevant to nursing practice, it must be adapted to fit the
nursing context (Risjord, 2010). For the promises of intersectional-
ity to be realized, there is also a need for nursing research to make
clear distinctions between levels of analysis and to provide robust
and clear framing of what is intersecting and what this means in dif-
ferent cases (cf. Anthias, 2013).
A common argument among the studies for using intersec-
tionalit y is to raise awareness and broaden the understanding of
health- related experiences and inequities in health and healthcare
deliver y. Most of the studies in this review focus on marginal-
ized groups. Several of the studies in this review do not discuss
how, when or where intersecting processes of discrimination/

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SIIR A et al.
subordination are significant for the specific individuals or groups
of study. Rather, they assess such a process by the gender, race,
sexua lit y, et c., of th ese ind ividuals and grou ps. A com mon pit fa ll in
making intersectional analyses is listing these categories that in-
tersect rather than analytically attending to them (Anthias, 2013).
Such assumptions risk treating identities or categories as given
and rigid rather than constructed. Thereby, they risk an over-
determinate understanding of difference and re- producing ex-
isting hegemonies (Dhamoon, 2011). This, we argue, also risks
leading to victimization. Benbow et al. (2011) and Caxaj and Ber-
man (2010 ) specific ally point out resilience and acts of resistance
by marginalized groups as one way to counteract this.
Nursing studies that apply intersectionalit y will benefit from
reviewing how analytical assumptions are empirically addressed
and operationalized. Rather than searching for defining oppression
and power structures with specific groups and their characteris-
tics as a st arting point, research should focus on the mechanisms
that produce results like oppression and discrimination. This would
allow for analysis of the functions of the mechanisms of power and
oppression rather than attributing its negative consequences to
specific groups.
Only a few studies point to difficulties or shortcomings with
operationalizing the concept of intersectionalit y. Nursing studies
should take a nuanced and explicit position concerning intersec-
tionality. Hence, when conducting studies adopting intersection-
ality, there should also be room for addressing the approach's
shortcomings. By ‘explicit position’ we mean that researchers
should aim to be clear about what they refer to as intersectionality
and how their use of the concept is linked to theorists and previ-
ous research.
Finally, this review points to the limited number of empirical
nursing studies that address intersectional analysis. Previous re-
search has pointed to ambivalence in how intersectionality can be
integrated with empirical projects (Hancock, 2016). The question
of how to design empirical studies in nursing that conduc ts inter-
sectional analysis is something that needs to be fur ther explored in
future research. There is a need for more studies that effectively
combine theoretical insights from intersectionality with empirical
observations from the nursing field.
5.1 | Strengths and limitations
To the best of our knowledge, this is the first systematic review of
using intersectionality in nursing. This study is warranted by the
need for theory development in nursing, especially concerning so-
called ‘borrowed theories’ (Risjord, 2010). Such theory development
will benefit from a description of the myriad of ways that intersec-
tionalit y is adopted in nursing research. The review followed an
extensive search strategy to cover a maximum amount of nursing
research. For example, the full text of all studies published in a nurs-
ing journal were screened regardless of whether the abstract or title
mentioned nursing. We did not include grey literature, theses, or
studies not published in English, but regard the included studies as
representative of the field of peer- reviewed nursing studies applying
intersectionality.
The rigour of any systematic review should be addressed,
and researchers should carefully consider, justify and adhere to
their choice of methods for doing a literature review (Aveyard
& Bradbury- Jones, 2019). In this paper, a systematic review was
deemed appropriate as we aimed to identif y, appraise and syn-
thesize all nursing research adopting intersectionality. Due to the
heterogeneity of the design of the included studies, we did not
conduct a meta- analysis. Instead, we conducted a narrative syn-
thesis by deductively and iteratively summarizing the data from
the articles. A critique of na rrative s ynthesis is its lack of tra nspa r-
ency. To increase transparency, the approach taken in this paper
is described in the method section. Nevertheless, there is always
a risk of bias when conducting a narrative synthesis. This should
be taken into consideration. To meet the aim of this systematic
review we included both empirical studies and review articles.
This resulted in that in some cases result s of the original article
were repeated in the included review article introducing a risk of
bias. However, since this narrative synthesis did not quantify find-
ings but describe the variation in how intersectionality has been
applied in nursing research the risk of such bias is minimized. To
assess the overall methodological quality of the included studies,
we conducted a quality appraisal, but we did not exclude articles
based on methodological quality, which could be interpreted as a
possible limitation (see Aveyard & Bradbury- Jones, 2019). How-
ever, the aim of this review was to identify, appraise and synthe-
size all available research articles that apply intersectionality in
nursing, not solely studies deemed to be of good qualit y.
6 | CONCLUSION
Intersectionality can help develop understandings of the workings
of power and oppression in nursing research by, for example, mov-
ing beyond the patient- dyad perspective and individual- focused
frameworks in nursing to address peoples' social context, which has
been called for by previous studies (Tengelin et al., 2019; Thurman
& Pfitzinger- Lippe, 2017). This review identifies a myriad of ways to
define and use intersectionality in nursing research. While diversity
per se is not a problem, there is a need for nursing research to pro-
vide robust and clear framing of how intersectionality is understood,
how analy tical assumptions are addressed and how the concept is
empirically operationalized. Finally, there is a lack of nursing stud-
ies that combine theoretical insights from intersectionality with em-
pirical observations. Therefore, there is a need for more empirical
research that effectively adopt s the concept of intersectionality to
develop the understanding of the workings of health inequities and
issues of power and domination in nursing.
ACKNO WLE DGE MENTS
None.

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SIIRA et al .
FUNDING INFORMATION
No funding was received for the work with this paper.
CONFLICT OF INTEREST STATEMENT
Nothing to declare.
DATA AVAIL ABILI TY STATEMENT
Data sharing not applicable to this article as no datasets were gener-
ated or analysed during the current study
ETHICS STATEMENT
Ethical approval was not required as the systematic review was per-
formed on published data.
ORCID
Elin Siira https://orcid.org/0000-0002-3097-9147
Karolina Lindén https://orcid.org/0000-0002-2792-3142
Sara Wallström https://orcid.org/0000-0001-7579-4974
Ida Björkman https://orcid.org/0000-0003-3171-683X
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How to cite this article: Siira, E., Lindén, K., Wallström, S., &
Björkman, I. (2023). Intersectionality in nursing research: A
systematic review. Nursing Open, 00, 1–19. ht t p s: //d o i .
org/10.1002/nop2.2021