Reframing Equity: A Participatory Mixed-Methods Approach to Disparities and Discrimination in Nursing Education

Background: Racism and structural inequities remain deeply embedded in nursing education, shaping the experiences, safety, and success of Black, Indigenous, and other racialized students. Despite increased attention to these issues, few studies centre student voices or integrate participatory and decolonial approaches. This study aimed to identify patterns of exclusion and belonging within one undergraduate nursing program through a collaborative, equity-oriented, mixed-methods design. Methods: This study was grounded in Community-Based Participatory Action Research (CPAR), Indigenous methodologies, and decolonial theory. Across all phases—from design to dissemination—the project engaged Indigenous and racialized students as co-researchers, integrating ceremony, shared meals, research retreats, and participatory theatre to foster relational accountability and collective knowledge generation. A total of 280 undergraduate students completed an anonymous online survey, which included validated scales and custom items co-developed with Indigenous undergraduate research assistants to reflect the nuanced experiences of exclusion, belonging, and identity. Five sharing circles were held with 33 undergraduate nursing students, facilitated by an Indigenous sharing circle leader. Analysis of both data strands was conducted by the research team—including BIPOC research assistants, the principal investigator, and co-investigator—through an iterative and community-based process. Results: Findings revealed consistent patterns of racial exclusion, microaggressions, cultural erasure, and institutional silence across classroom and clinical environments. Students described a lack of safety and support, but also shared powerful forms of resistance, mutual care, and collective advocacy. Their calls for change included faculty diversification, anti-racist and Indigenous curriculum reform, and mechanisms for sustained institutional accountability. Conclusions: This study illustrates how racism operates structurally and relationally within nursing education and affirms the value of participatory, culturally grounded research approaches. By engaging racialized students not only as participants but as co-creators of knowledge, this project offers a model for how nursing education can move beyond tokenism toward transformative equity.