Allies, Advocates and Agents of Change:
Using Brave Spaces to Teach Social Justice in Nurse Education
Welcome to my Doctoral research website, which explores how Brave Spaces can be used as an innovative pedagogical approach to teaching nursing students about social justice and empowering them to challenge health inequalities in their own clinical practice.
Who Am I?
I'm Jude, and I am a registered mental health nurse and a nurse educator. My research looks at how student nurses can best learn about issues of social justice, and how they can address health inequalities in their practice.
My current Doctoral studies are focused on Brave Spaces as a classroom approach to empowering student mental health nurses to recognise and challenge inequalities in clinical practice.
If you are interested in how my research could support your own teaching, please reach out.
What are Brave Spaces?
A Brief Description...
Brave Spaces can be defined as being a space where students engage in discussions which are characterized by respectful challenge and ownership of the impact that their participation has on others. These discussions are often uncomfortable and unfamiliar, and students are encouraged to sit with, and reflect on, this discomfort in order that personal and professional growth is enabled and facilitated (Palfrey, 2018). Brave Spaces move away from the more traditional notion of safe spaces and encourage a more open and honest discourse around individual participants’ perspectives on social justice, power and privilege (Arao and Clemens, 2013). Through participation in Brave Spaces, student nurses are encouraged to examine not just their own biases and prejudices, but also the role which these might play in perpetuating systemic injustices through the influence these biases have on their own clinical practice. Brave Spaces also encourage students to recognise their own privilege and position of status and power which their professional affords them, and to consider how this privilege can be used to challenge the injustice and inequality that can be pervasive in healthcare systems.
Where Brave Spaces differ from other approaches to teaching around health inequalities and social justice in nurse education is that they move learning on from merely awareness-raising. Brave Spaces allow for the kinds of discussions which help student develop the confidence to offer effective challenge and develop the professional language to do so. Thus learning moves beyond the classroom and into clinical practice where students can become allies, advocates and agents of change.
Brave Spaces require robust facilitation and solid ground rules, which can be co-created with your students. One key point to note is that it is not the job of students from marginalised groups to educate the others in the class. Using video resources and case studies can foreground these voices and avoid some students bearing more of a burden and having to be braver than others.
Examples of ground rules are:
- Controversy with civility
- Own your intentions AND your impact
- Challenge by choice, but attend to the reasons for your decision to engage or not
- Respect
- Examine your defensive responses
- Reflect on every Brave Space
Health Inequalities and Social Justice in Nurse Education
Uncomfortable truths, inconsistently taught...
The World Health Organisation defines health inequities as ‘differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age’ (WHO, 2018). This statement expands stating that the lower the social-economic status of and individual, the more likely it is that their health will be poor and this truth is applicable on a global, national and local level.
Literature documents that social disadvantage across the lifespan is linked strongly to an increase risk of ill-health, disability and premature morbidity (Graham, 2019). However, when an intersectional lens is applied to this fact, and factors such as ethnicity, gender and sexuality sit alongside socioeconomic factors, the picture becomes more complex in terms of how people experience accessing healthcare and their ultimate health outcomes (Smith, Bambra and Hill, 2016). As such health inequalities serve to reflect the unequal positions that individuals and groups hold in society, and the social determinants of health then become an issue of social justice.
The seminal work of Dahlgren and Whitehead (1991) outlines that health inequalities are created through a variety of individual, community and structural or societal determinants such as age, lifestyle, support networks, access to nutritious food, clean water and healthcare, the availability of appropriate accommodation and financial means . By situating health inequalities as something more than the result of individual lifestyle choices or the accessibility of healthcare, but rather the result of societal and structural disadvantage, discrimination and marginalisation, Dahlgren and Whitehead present the uncomfortable truth that history, politics and policy are fundamentally unjust and serve only to disadvantage a variety of groups within society, potentially with fatal consequences.
What the literature shows is that health inequalities, alongside other social justice issues is not robustly taught in nurse education. Where most programmes teach aroudn the social determinants of health, without either a mandate to teach beyond this, or teaching staff who are interested enough and have space in the curriculum to bring these topics to their classrooms, it is unlikely that impactful and effective social justice teaching will happen.
Publications
NES Annual Conference Presentation - April 2025:
From Awareness Raising to Transformational Agency: pedagogical approaches to tackling health inequalities in nurse education
Vignettes
Students' Stories - in their own words...
These vignettes are based on participant narratives and describe students' experiences of learning in a Brave Space classroom.
Vignette 1
Casey
I quite enjoyed the Brave Spaces. I think I prefer it when they are in person rather than online as I didn’t really add anything to than one. It feels quite impersonal just sitting behind a computer. I did find it very informative to hear peoples’ points and views though. I like the idea of being able to speak openly and without judgement in a Brave Space, and of bouncing off one another in the group. I think its important to be able to do that with your peers.
The Brave Space felt more open than the usual class discussions. Everyone seemed to be aware that there was a different kind of discussion going on, and were speaking more openly and freely. It didn’t feel like a usual lesson because the boundaries were set out at the beginning of the conversation and it was kind of free flowing after that. It wasn’t like being taught with a PowerPoint.
I think the Brave Space discussions would encourage people to speak up more when they’re on placement. I’ve had a few instances on placement where I’ve not felt comfortable with how things were being handled, but I didn’t feel like I was in a position to say anything at the time – I was in year one and didn’t feel confident enough, even though morally I knew that some of these things were incorrect. I didn’t have the confidence to say anything. I do still think about that, and I feel that I really should have said something, but the nurses were qualified and it was kind of a cliquey placement and I still had several weeks left. I didn’t want to create any issues although at the time, my moral standing said otherwise. I feel like I should have maybe just listened to myself and said something. I feel that if it had happened this year, I maybe would say something because I’ve got more knowledge and I’m more aware of right and wrongs and of the nursing code. I think I’d be able to back up what I’m saying now.
It never seems to be newly graduated nurses – its mostly people who have been there a while and have got comfortable where they are and forget that they’re dealing with people, they’re treating people, they’re caring for people and that those people have got feelings.
I saw racism once on placement. It was a general ward and there were a few patients there who couldn’t speak good English. I witnessed a sort of bullying I would call it. Nurses were openly speaking about the patient, even though they were right there in front of them. He could have understood and they were having a joke about him.
I think when I’m qualified I’d feel like I was on an equal stance with nurses like that and I could just voice my opinion and call them out and be listened to more.
Vignette 2
John
I’ve quite enjoyed being part of the Brave Space discussions. I quite like the idea that people are expected to try and challenge some of their own perceptions and ideas, and I think that it's quite a useful thing.
Both topics that we've had a Brave Space on are things that you know I’ve either had experience in or had thoughts about previously so its been good. I think people are quite receptive to the Brave Space concept and it's always managed to be quite civil. I've never seen it in any of the situations kind of descend even where there's quite opposing opinions like in the assisted dying one. There's areas where it could have lurched into conflict on account of people's particular religious beliefs and whatnot. But never did, and I think being in a professional setting with people prepared to participate helped that. I find they tend to be quite a receptive bunch, quite an understanding group of people that are quite tolerant of others and others ideas.
There are two sides to having these kinds of discussions with people you know well. On one hand people can feel quite comfortable because they’ve spent a lot of time with the people around them and that might empower them to engage and interact. But on the other hand, there might be a thought that they need to maintain their relationships over the longer term and don’t want to challenge them or risk upsetting them too much.
I think there’s lots of reasons why people might not participate. Maybe they’re not fully engaged or maybe they aren’t confident in their ability to articulate the ideas that they have, or maybe they worry that they might be chastised by the group for expressing their ideas. I don’t mind and I can usually see both sides of things, but you do tend to be mindful of how you’re coming across and you don’t want to be forceful in putting your ideas out there because it might dissuade people with opposing thoughts to come forward.
From a nursing perspective, these Brave Spaces might help people to be more confident in challenging things that they see that aren’t right. Sometimes on placement you see subtle things, like you can tell if the nurses have got less time for a certain patient and they’re perhaps more flippant or dismissive of them. They usually still put on a professional face and act as they should though. I wonder if some nurses just become a bit jaded and lose the idealism that they once had. Maybe they start to feel beat down and crushed by the system. Or maybe some nurses start to think that they know more than they do and are over-confident in their own abilities and think that because they’ve seen something 10000 times before that they know what to do on this occasion. They get complacent.
In the Brave Spaces, you have your ideas challenged and you can test your ideas and that helps them to develop and evolve into something a little bit more worthwhile. People are quire conflict averse generally in the classroom, which can come at the expense of a bit of healthy debate and discussion and I think that having the Brave Space opens the classroom back up to that. You can debate whether or not there's any sort of legitimate basis to say that people can't say what they want, you know, whether or not that's really a legal reality. But irrespective, it seems to be a social reality. People genuinely do worry that they can't speak their mind. It feels like there's an erosion of the acceptance that there's a complexity to the human condition and things have become a bit too binary - you said a bad thing, so you must be bad. It's not necessarily a reflection of who that person is, it just happens to be one tiny element of something they think. I’m quite at home with my flaws – its other people that have the problem (laughter).
It would be interesting to see when you start to take Brave Spaces to some of the more sensitive topics. I think the dynamics might then start to change because there's quite a few topics now where people are very embedded in one side of the argument where they live in an echo chamber and only hear one side of the story. I think it'd be interesting to see when you start to have those Brave Spaces, can they remain civil when you start to go into those realms?
Vignette 3
Sarah
I found the experience of reflecting on Brave Space discussions really useful. I was a bit uncomfortable after the first one which was on assisted dying because I’m from a Catholic background and this was something I thought I had a very strong opinion about. Hearing other peoples’ views really made me think, especially when I was on placement on an older adults ward and I kept being reminded of what people had said. I struggled a little bit to accept that other people has as strong an opinion as myself.
When we did that Brave Space, I thought that I might just not participate because I didn’t feel comfortable enough to be brave, but there was someone who had the opposite opinion to myself and I did say something, but I didn't realise that maybe what I said didn't come across exactly as I meant to the first time, so we had a little bit of a heated discussion. Maybe it was an experience for myself to understand what you say, if that has that meaning, if that has such an impact, make sure that you say it properly. So it's not about not saying it, it's about maybe think about saying it a bit better and maybe calming down a little bit. Afterwards it was fine, but it was unexpected and I think that created the space to reflect about what had been discussed on placement, and what I feel more comfortable now doing is separating what I would do from what other people would do. I think what started to happen in that conversation was almost a separation of my personal opinions and values, and a professional kind of understanding of that whole ethical dilemma.
The Brave Spaces have grown my understanding of what we can do because I took it as the question being, ‘so what can you do as a student and then a nurse in the future to tackle health inequalities’ and I got something out of it which was practical, and now I've heard about a couple of services I did not know existed, so it helped inform my practice going forward.
When we talked about discrimination and inequality, I struggled a little with that. I’m part of a group that might be discriminated against and I was here in the UK when Brexit started to be discussed and then voted for. I had to stop reading the news because it made me afraid. Nothing bad ever happened, but I experienced things that people shouldn’t, and still I am white, I’m educated, I have means, so I don’t feel like part of a marginalised group, even though theoretically I am, but I still feel privileged. So sometimes I don’t think I should talk when people mention marginalised groups because I am actually marginalised. Or maybe I am just in a position where I can decide which boxes I want to tick. It’s like a sort of borderline marginality.
In our cohort, you find all of the non UK students sitting by themselves in two rows. It’s not that people exclude us but I think we tend to cluster ourselves together because we think that other people don’t understand what we go through. One of the lecturers who is also not from the UK tells us stories about her experiences of adjusting to things in the UK and its funny and makes difficult conversations lighter but you learn something without even realising it and I think hearing those stories almost prepared us for the Brave Space discussions where you have to confront uncomfortable things.
I’m discriminated against as much as everybody else, because there's always something to discriminate about, there's always something that people would not like, and especially when you are being evaluated, especially when you're being judged just because they have an idea of what the perfect student would look like depending on their own values, even if they think that they're really open minded… But people are people… They can be open minded on paper, but they do have unconscious biases. I think sharing a little bit of one's experience can help building the right mind frame for a brave space because you go into the brave space thinking about not yourself, but thinking about the actual issue.
Information and Recommendations for Nurse Educators
My research has suggested a number of ways that Brave Spaces can be valuable in nurse education, and some ideas to guide their effective use
Tips for an Effective and Inclusive Brave Space Classroom
My research has shown that there are a number of factors which are important when facilitating a Brave Space to ensure that students have a positive learning experience and feel empowered to take their learning with them into clinical practice.
Pace your Brave Space
The findings of my research showed that at times, Brave Space discussion moves too quickly for some students, including those from minority ethnic backgrounds, to keep up and find a way of contributing. Well-paced Brave Space discussions, with regular pauses for reflection will require confident and skillful facilitation, and as such it will be important that teaching staff are adequately prepared and supported in holding these spaces. In my own programme, staff have their own Brave Spaces in which facilitation is rotated and feedback offered afterwards. This allows staff to gain experience of holding this kind of space and also an opportunity to debrief, learn from constructive feedback and also from the facilitation styles of colleagues.
Start Brave Spaces Early
Findings showed that the value of Brave Spaces can be diminished for some students by the constraints of their peer relationships. It is best that this approach learning is introduced early in students’ programmes of study so that they can get used to being an active part of Brave Spaces before friendships are formed which may get in the way of willing participation. In this way, Brave Space learning can become part of the culture and fabric of a nursing programme, and students can learn to manage their friendships around this.
Foster Curiosity not Confrontation
facilitators should coach students from an early point in their studies to approach Brave Spaces with an attitude of curiosity rather than confrontation or combat. Facilitators have a responsibility to ensure that challenge is meaningful and something which can be learned from rather than something which is divisive or damaging to an individual or whole cohort. This requires careful classroom management and good interpersonal skills from the facilitator and indicates a need for robust preparation for this role with a space to debrief and reflect on each Brave Space session.
Facilitators need to be mindful of the feelings which are likely to be present within the cohort before, during and after a Brave Space. Students may feel uncomfortable, apprehensive, worried and fearful or any repercussions. It is the role of the facilitator to support the students in managing these feelings, and one way to do this may be to offer time at the start of the session to share feelings, and an opportunity at the end to debrief and reflect on the session and how it has left people feeling.
Encouraging Participation
How best to encourage participation in Brave Spaces is something for facilitators to consider carefully. Active participation is important to create a meaningful learning environment, and this can be supported through reinforcement of ground rules and sensitive encouragement. Using regular pauses to slow discussion down and encourage short periods of thinking time and reflection may also support participation across the cohort. This may be in the form of a brief ‘time out’. However, facilitators need to remember, and to remind students that a lot of the work of a Brave Space consists of internal work by the students, and pauses may also support this. Facilitators need to be very familiar with the ground rules of a Brave Space and have the confidence to enforce these with the group. They also need to be sensitive and mindful of the role of reflection and more internal work and to create space and permission for this to happen.
On campus or Online?
Brave Spaces can be facilitated both on-site and on online in virtual classrooms, however there are implications for academic practice of the latter. It is well documented that the effectiveness of online classrooms can be influenced by the IT skills and confidence of the academic staff who facilitate them (Bollinger and Halupa, 2022). In order to ensure that the online Brave Space is as effective, inclusive and dynamic as its on-site counterpart, staff must ensure that they have the necessary facilitation skills to hold this online space and pursue opportunities for learning and development in this area.
Be Prepared and Check in
It is vital to be prepared for this approach to teaching - Brave Spaces can and should be challenging, uncomfortable and difficult - for staff as well as students. It is important that you are familiar with the concept and able to manage your own discomfort whilst supporting your students. Being able to set robust ground rules is essential in a Brave Space.
In my own programme, staff have their own Brave Spaces in which facilitation is rotated and feedback offered afterwards. This allows staff to gain experience of holding this kind of space and also an opportunity to debrief, learn from constructive feedback and also from the facilitation styles of colleagues.
Allow for Reflection
Central to participation in a Brave Space is the reflective activity which accompanies the discussion. Students may choose not to actively participate in discourse, however they are asked to reflect on their reasons for this – whether they be linked to a lack of confidence to speak up, uncertainty about their position, worry about offending others, or a sense that their views and values do not align with their peers. This reflection which students can do either internally, or through the use of a reflective model asks students to undertake self-examination which can lead to personal and professional growth, and this can be done quietly and privately, or can be shared with the Brave Space facilitator after the session, or taken forward in a reflective practice session within the programme.
Results of this study show that there is still some misunderstanding around participation and non-participation and an underestimation of the value and potential of quiet reflection in these classrooms.