Applying the Concept of Epistemic Injustice as a Philosophical Window to Examine Discrimination Experiences of LGBTQIA+ Migrants With Nurses
Introduction Similar to some Western countries, Canada has become a safe haven for lesbian, gay, bisexual, transgender, queer, intersex, and + (LGBTQIA+) individuals emigrating from countries with discriminatory laws for diverse sexual orientations, gender identities and expressions, and sex characteristics (Gamble et al. ). Before migration, LGBTQIA+ migrants may have experienced degrees of physical, psychological, and/or sexual assaults and discrimination from friends, family, and/or government officials, such as police (73 countries where homosexuality is illegal, ). For some identifying as LGBTQIA+ in their country of birth equated to public humiliation through imprisonment and death penalty (Attia et al. ; Fournier et al. ; Jordan and Morrissey ; Karimi ; Marshall ). Yet, it is found that post migration, LGBTQIA+ migrants continue to experience trauma in the new host country, that is, Canada (Attia et al. ; Fournier et al. ). In this transition to a new host country, LGBTQIA+ migrants may interact with nurses and other healthcare professionals. In this article, I will draw from previous research in which I used intersectionality as an analytical lens with Gadamerian hermeneutics to unravel experiences of LGBTQIA+ migrants with nurses and other healthcare professionals in Canada (Haghiri‐Vijeh , ; Haghiri‐Vijeh and Clark ; Haghiri‐Vijeh and McDonald ). A crucial step in utilising Gadamerian hermeneutics with intersectionality is situating my positionality as the researcher (Collins et al. ; Moules et al. ). I identify as a racialized first‐generation settler, who escaped their country of birth with human smugglers, communicates in English as a fourth language, but now is in a position of power as an academic and researcher. Both stigma and discrimination, defined as a lack of knowledge of and a sense of discomfort in providing care for LGBTQIA+ migrants, was found to manifest in a sample of LGBTQIA+ migrants who received nursing care in Canada (Haghiri‐Vijeh and Clark ). It was found that nurses may continue to have a limited understanding of the experiences of LGBTQIA+ migrants in the Canadian context, and that LGBTQIA+ migrants continue to have troubling 'care' experiences with nurses (Haghiri‐Vijeh ). Epistemic injustice will be utilised to underscore how troubling care experiences manifest and perpetuate. Miranda Fricker, ( ) work on epistemic injustice provides a lens in some of the unique experiences of LGBTQIA+ migrants with nurses and other healthcare professionals and highlights that 'It's a big deal' to be systematically oppressed due to the intersection of social and cultural identities and orientations. By drawing on the narrative of one LGBTQIA+ migrant, I will use window as an analogy and showcase that epistemic injustice helps interpreters to understand how stigma and discrimination is produced in this community by the very nursing profession who ostensibly aim to help them. I will start with positioning the phrase 'LGBTQIA+ migrants', provide a summary of epistemic injustice, follow with threading Fariba's story, and end with implications for nursing education and practice to demonstrate it is a 'big' deal. 

Positioning the Phrase 'LGBTQIA+ Migrants' First, LGBTQIA+ stands for lesbian, gay, bisexual, transgender, queer, intersex, and + stands for identities, orientations, sex characteristics not named in the initialism and + means being inclusive of the 'unsaid in the said' or the unrecognised to be recognised. For example, nonbinary, genderqueer, agender, pansexual and grey orientations and identities are not named in this initialism. The idea of recognising the unrecognised attempts to avoid epistemic marginalisation, a term to be elaborated on in the following section. In this case, + is used intentionally to acknowledge that there are orientations and identities that to this date and time may have not been revealed but may come to manifestation months or years after the publication of this article. Second, the word migrant refers to individuals who relocate, for example, refugees, immigrants, newcomers, new settlers, and/or non‐status residents from other countries or regions. By using the LGBTQIA+ initialism and the word migrants, I do not assume the vulnerability of groups but do categorise individuals for the reason of engaging in a dialogue on epistemic injustices enacted upon this population at the point of access to healthcare (McCall ; Ritzer and Ryan ; Spivak ). The term LGBTQIA+ migrant is not used as a blanket term, and I need to underscore that this language is not meant to dismiss the diverse experiences of migration trajectories within the various LGBTQIA+ communities. Instead, Massaquoi ( ) and Muelle and Ramírez ( ) highlight, it is strategically crucial and advantageous to form LGBTQIA+ migrants as a group, and by drawing from Fricker ( ), I add to an epistemic proliferation of their experiences to inform practice, education, policy, and research. I start this dialogue with delving into the title first, in particular, I will focus on the phrase window to examine discriminations , and here I add misunderstanding . The intent is to illustrate that the epistemic notion of a phenomenon could be interpreted, understood, or even misunderstood as a result of multiple perspectives charged by positionality of knower and hearer. For example, a window becomes a chattel where it is many things to many individuals by the very nature of the word 'window' being open to multiple interpretations. These multiple interpretations without given context may lead to misunderstandings. Therefore, understanding of a window, its location, shape, and purpose, is morphed by the interpreters’ contextualisation in line with a communal understanding of the relevance and purpose of the window. The individuals bring their context, time, and positionality in the interpretations of dialogue. In this case what constitutes an epistemic notion of a window, and its purpose is shaped by how it is taken up by the hearer. Upon this exploration, an overview of epistemic injustice by Fricker is provided next. 2.1 Epistemic Injustice Miranda Fricker ( ) has developed the concept of epistemic injustice in her work by drawing on feminist philosophy and social epistemology. Fricker ( ) asserts, 'For something to be an injustice it must be harmful but also wrongful, whether because discriminatory or otherwise unfair' (p. 97). Epistemic injustice refers to the unfair treatment of a person by judging them as 'not a knower' in communicative and testimonial situations. Communicative situations are an entry point into an exchange of testimonies between the hearer and knower. For testimonies to be heard, there needs to be a communal understanding and interpretation between the knower and hearer; however, as shown in the example above, even speaking about the same phenomenon does not guarantee communal understanding. Communal understanding of an experience may create an opportunity for those within a social setting to have the language needed to share their testimonies. Access to existing communal language and forms of communication are considered resources because it allows a pathway to understanding in the communal spaces. Collective hermeneutical resource refers to a communal understanding of the phenomena that is shared, understood, valued, and deemed credible at all levels of society (Fricker ). Nonetheless, it would be naïve to consider this communal understanding is not impacted by social and systemic forces of society. Fricker underscores that there are areas of exploration where social and systemic levels of society must collectively provide a definition to be communicated for a circumstance or experience. Fricker calls this social and systematic communal understanding as accessible collective hermeneutical resources . To put in another way, Fricker adds when there is a lack of collective hermeneutical resources, the knower is socially and systematically positioned incapable of making their experiences understood by the hearer. This lack of collective hermeneutical resources may in turn cause marginalisation of the knower. This is termed hermeneutical injustice when the knower is marginalised because they are deemed not credible, leading to their expression of their reality seen as unimportant and irrelevant. Fricker ( ) adds, 'A hermeneutical injustice is done when a collective hermeneutical gap impinges so as to significantly disadvantage some group(s) and not others, so that the way the collective impoverishment plays out in practice is effectively discriminatory' (p. 103). Frequently, these discriminatory points of contact lead to severe consequences for the uncredited knower who is socially and systematically marginalised resulting in epistemic injustice. In marginalisation, the knower is also experiencing testimonial injustice because the hearer is not considering the knower's testimony credible because at the very inception of communication the hearer is not accepting the knower as a credible source (Anderson ; Saul ). As an example, Fricker shares Carmita Wood's experience of sexual harassment at the academia in which her boss's sexual harassment caused her to quit her job. She experienced health issues, was not able to return to work, and when she applied for unemployment insurance, her case was denied. Her access to unemployment insurance was denied because she was not able to communicate her situation of sexual harassment to the claim investigator because at that time, socially and systematically, the term ‘sexual harassment’ was not a collective hermeneutical resource. She was marginalised and her marginalisation impacted her and not the predator. To delve deeper, Fricker demonstrates that epistemic injustice occurs as a result of hermeneutical marginalisation and hermeneutic injustice (Fricker ). Hermeneutical marginalisation occurs when the lack of collective hermeneutical resources privileges some and oppresses the other. This hermeneutical marginalisation occurs when there is a collective hermeneutical misunderstanding of that experience that systematically oppresses some and privileges others. Fricker ( ) defines hermeneutical injustice as, 'the injustice of having some significant area of one's social experience obscured from collective understanding owing to a structural prejudice in the collective hermeneutical resource' (p. 100). These structural prejudices are called systematic hermeneutical injustices when they are wide‐reaching inequalities that are braided within the social understanding of an issue and lead to structural discrimination. These systematic hermeneutical injustices may cause individuals, like Carmita Wood, to not recognise their oppressed position. With this summary, as a nurse who has learned social determinants of health (Gustafson ; Stamler et al. ), you may recognise Fricker's theory of epistemic injustice to be relevant in nursing and healthcare practices. 2.2 Epistemic Injustice in Health Research The concept of epistemic injustice has been taken up in healthcare research to explain how injustices and misunderstandings occur between healthcare providers and patients/clients (Byrne ; Carel and Kidd ; Hookway ; Medina ). For example, Carel and Kidd ( ) argue epistemic injustice occurs when there is a difficulty for healthcare professionals to understand the communicated experiences of illness and also when gaps exist in collective hermeneutical resources. I add that gaps may exist when there is consideration for systematic barriers that promote the occurrence of epistemic injustice. In what is to follow, I will elucidate migrant LGBTQIA+ patients experience epistemic injustice when they are in a nontherapeutic relationship with nurses and other healthcare professionals. This is certainly a common experience among migrant LGBTQIA+ patients in hosting countries (Gottvall et al. ; Haghiri‐Vijeh , ; Haghiri‐Vijeh and Clark ; Lee ). For this purpose, a narrative experience of a migrant LGBTQIA+ patient, named Fariba, in the Canadian healthcare system is shared. Fariba's name, sexual orientation, and pronouns have been changed to protect her identity and anonymity. I obtained consent to share this narrative while maintaining anonymity. 

Epistemic Injustice Miranda Fricker ( ) has developed the concept of epistemic injustice in her work by drawing on feminist philosophy and social epistemology. Fricker ( ) asserts, 'For something to be an injustice it must be harmful but also wrongful, whether because discriminatory or otherwise unfair' (p. 97). Epistemic injustice refers to the unfair treatment of a person by judging them as 'not a knower' in communicative and testimonial situations. Communicative situations are an entry point into an exchange of testimonies between the hearer and knower. For testimonies to be heard, there needs to be a communal understanding and interpretation between the knower and hearer; however, as shown in the example above, even speaking about the same phenomenon does not guarantee communal understanding. Communal understanding of an experience may create an opportunity for those within a social setting to have the language needed to share their testimonies. Access to existing communal language and forms of communication are considered resources because it allows a pathway to understanding in the communal spaces. Collective hermeneutical resource refers to a communal understanding of the phenomena that is shared, understood, valued, and deemed credible at all levels of society (Fricker ). Nonetheless, it would be naïve to consider this communal understanding is not impacted by social and systemic forces of society. Fricker underscores that there are areas of exploration where social and systemic levels of society must collectively provide a definition to be communicated for a circumstance or experience. Fricker calls this social and systematic communal understanding as accessible collective hermeneutical resources . To put in another way, Fricker adds when there is a lack of collective hermeneutical resources, the knower is socially and systematically positioned incapable of making their experiences understood by the hearer. This lack of collective hermeneutical resources may in turn cause marginalisation of the knower. This is termed hermeneutical injustice when the knower is marginalised because they are deemed not credible, leading to their expression of their reality seen as unimportant and irrelevant. Fricker ( ) adds, 'A hermeneutical injustice is done when a collective hermeneutical gap impinges so as to significantly disadvantage some group(s) and not others, so that the way the collective impoverishment plays out in practice is effectively discriminatory' (p. 103). Frequently, these discriminatory points of contact lead to severe consequences for the uncredited knower who is socially and systematically marginalised resulting in epistemic injustice. In marginalisation, the knower is also experiencing testimonial injustice because the hearer is not considering the knower's testimony credible because at the very inception of communication the hearer is not accepting the knower as a credible source (Anderson ; Saul ). As an example, Fricker shares Carmita Wood's experience of sexual harassment at the academia in which her boss's sexual harassment caused her to quit her job. She experienced health issues, was not able to return to work, and when she applied for unemployment insurance, her case was denied. Her access to unemployment insurance was denied because she was not able to communicate her situation of sexual harassment to the claim investigator because at that time, socially and systematically, the term ‘sexual harassment’ was not a collective hermeneutical resource. She was marginalised and her marginalisation impacted her and not the predator. To delve deeper, Fricker demonstrates that epistemic injustice occurs as a result of hermeneutical marginalisation and hermeneutic injustice (Fricker ). Hermeneutical marginalisation occurs when the lack of collective hermeneutical resources privileges some and oppresses the other. This hermeneutical marginalisation occurs when there is a collective hermeneutical misunderstanding of that experience that systematically oppresses some and privileges others. Fricker ( ) defines hermeneutical injustice as, 'the injustice of having some significant area of one's social experience obscured from collective understanding owing to a structural prejudice in the collective hermeneutical resource' (p. 100). These structural prejudices are called systematic hermeneutical injustices when they are wide‐reaching inequalities that are braided within the social understanding of an issue and lead to structural discrimination. These systematic hermeneutical injustices may cause individuals, like Carmita Wood, to not recognise their oppressed position. With this summary, as a nurse who has learned social determinants of health (Gustafson ; Stamler et al. ), you may recognise Fricker's theory of epistemic injustice to be relevant in nursing and healthcare practices. 

Epistemic Injustice in Health Research The concept of epistemic injustice has been taken up in healthcare research to explain how injustices and misunderstandings occur between healthcare providers and patients/clients (Byrne ; Carel and Kidd ; Hookway ; Medina ). For example, Carel and Kidd ( ) argue epistemic injustice occurs when there is a difficulty for healthcare professionals to understand the communicated experiences of illness and also when gaps exist in collective hermeneutical resources. I add that gaps may exist when there is consideration for systematic barriers that promote the occurrence of epistemic injustice. In what is to follow, I will elucidate migrant LGBTQIA+ patients experience epistemic injustice when they are in a nontherapeutic relationship with nurses and other healthcare professionals. This is certainly a common experience among migrant LGBTQIA+ patients in hosting countries (Gottvall et al. ; Haghiri‐Vijeh , ; Haghiri‐Vijeh and Clark ; Lee ). For this purpose, a narrative experience of a migrant LGBTQIA+ patient, named Fariba, in the Canadian healthcare system is shared. Fariba's name, sexual orientation, and pronouns have been changed to protect her identity and anonymity. I obtained consent to share this narrative while maintaining anonymity. 

Fariba's Story The purpose of sharing Fariba's experiences is not to conclude that the experiences of migrant LGBTQIA+ patients result only from their diverse identities but to show with a detailed case study on how epistemic injustice happens. Fariba's experiences demonstrate that intersecting oppressed identities influencing her health go beyond migration and sexual orientation. Fariba was born in the Islamic Republic of Iran. While growing up, Fariba became aware of gender discrimination in her society. As well, Fariba feared for her life since her parents were practicing the Baha'i Faith, which the Islamic government aimed to extinguish. Fariba experienced oppression both as a Baha'i and as a lesbian. Fariba still remembers the written signs on the streets against Baha'is and Bahaism, and anthems that were sung on television and in schools to turn people and even children against the Baha'is. One of the common signs and anthems was, 'Marg bar Baha'i—marg bar Baha'i najes' (which translates to: Death to the Baha'i, death to the dirty Baha'i). She remembers being physically and emotionally discriminated against due to her parents’ faith. Several years ago, Fariba fled Iran at a young age due to religious persecution. Fariba fled to a transition country as a refugee and later immigrated to Canada. Like Fariba, many Baha'is escaped and continue to flee Iran for fear of religious persecution and look for asylum in developed countries (Shishehgar et al. ; Talebi and Desjardins ). Few years ago, Fariba was admitted to a psychiatric unit with suicidal ideation related to stress and duress of stigma and discrimination she experienced because of how diverse sexual orientation and gender identities and expressions are conceptualised in both her cultural and religious communities. During her stay at the psychiatric unit, Fariba encountered nurses and other healthcare professionals who were aware of neither her complex experiences of persecution due to her religion nor her internal conflict with identifying as an immigrant lesbian Baha'i. A physician and nurses in a psychiatric unit made the following comment to her upon discharge: 'So, you are gay, what's the big deal?' As I will elucidate, this statement reflects the nurses and other healthcare professionals’ lack of cultural safety as well as trauma‐ and violence‐informed practices and was perceived as callous inconsideration. Underpinned by Fricker's work on epistemic injustice, Nielsen and Utsler ( ) identify this notion of dismissal an example of impossible dialogue in which the hearer is not hearing what is needed to be heard and recognising the speaker as a 'credible source of knowledge, insight, and truth' (p. 18). 3.1 It Is a 'Big Deal'! Unlike other religions that criminalise homosexuality, the Baha'i faith calls for tolerance and acceptance of homosexuality but defines it as an illness requiring compassion (Bahá'u'lláh and Effendi ). In the Baha'i faith, same‐sex marriage is not allowed, and nonheterosexual people must not act upon 'unnatural sexual desires' (Universal House of Justice ). Even though the Baha'i faith urges followers not to show prejudice and discrimination against LGBTQIA+ people (Bahá'u'lláh and Effendi ; Universal House of Justice ), Fariba has heard voluminous comments where the followers continue to act otherwise. Some may argue that Baha'i faith's view on LGBTQIA+ people cannot be categorised as intolerance and criminalizing. However, Fariba has experienced oppression and fears being stigmatised by the Iranian and religious communities in Canada and being ostracised by family and friends due to her sexual orientation. For Fariba, being lesbian was a 'big deal' and given her culture, religion, and relocation to Canada, one that led to suicidal ideation. Subsequently, while still experiencing suicidal ideations, Fariba was discharged without a client‐centred plan of care. Fariba shared her difficult transition to accepting her identity as an Iranian‐born Canadian Baha'i lesbian. Only a few of her family members in Canada are aware that she is a lesbian, and her parents in Iran have never been told. The notion of intolerance and criminalisation of LGBTQIA+ identities and orientations and for those who are also experiencing forced migration has been delved into by law, psychology, and sociology scholars (D'Orsi ; Jordan and Morrissey ; Munir and Noor ). Fariba's experience is validated by other members of the Iranian LGBTQIA+ community in Toronto (Keung ). Despite being persecuted for her faith and sexual orientation, Fariba also feels privileged due to living in an urban area in Canada, but still does not feel safe to disclose her sexual orientation to most friends and family. In this example, I aimed to elucidate how gap in therapeutic practices occurred when there were nurses’ and healthcare professionals’ lack of shared understandings of the experiences as well as the needs of migrant LGBTQIA+ patients when they were accessing healthcare services. This relates to Miranda Fricker's explanation which has resulted from, 'an acute cognitive disadvantage from a gap in the collective hermeneutical resource' (p. 97). It took years for Fariba to discuss her experience of interacting with nurses and psychiatrists. This unsaid in her experience—this uncovered as Moules et al. ( ) would say, this inability to find words to legitimise her experience aligns with Fricker's statement, 'They are unable to render their experiences intelligible by reference to the idea that they have a disorder, and so they are personally in the dark, and may also suffer seriously negative consequences from others’ non‐comprehension of their condition' (pg. 98). This means that identifying as LGBTQIA+ migrant is not a disorder, however the inner experiences rendering oneself wrong as a result of years of stigma, discriminations, and injustices, has led to experiences of mental health challenges and for some suicidal ideation. Alas, when they were in a place where it should have been safe, affirming, and acknowledging their unique complex experiences, they were dismissed, were made cynical comments to, or ridiculed (Haghiri‐Vijeh ). Emanating with Fricker, José Medina asserts: Poorly understood and inchoate meanings, interpretations, and expressive styles are the site of hermeneutical struggles, struggles in which there are interpretative achievements and break‐throughs (new experiences are named, new phenomena understood), but also struggles in which people become silenced, misunderstood, and hermeneutically marginalised. (Medina , p. 43) Many participants in my previous research shared that some nurses and other healthcare professionals missed opportunities to open the window to have a shared understanding of the complexity of intersecting identities of culture, migration status, religion, language, stigma, sexual orientation, gender identity and expression (Haghiri‐Vijeh , , ; Haghiri‐Vijeh and Clark ). Drawing from Fricker, Anderson ( ) asserts, 'Contributions to interpretations of those experiences by members of marginalised groups are excluded or evaded through misinterpretation' (p. 140). This misinterpretation is an example where implicit bias, as discussed by Saul ( ), has led to actions, or more specifically verbal and explicit actions in leading to testimonial injustice. Fariba's experience was not accepted due to nurses’ inability to recognise her experience as significant and dismissing its importance. In other words, abolishing and erasing Fariba's internal struggle for identifying as a migrant lesbian Baha'i (Anderson ). 3.2 Positionality of Nurses and Other Healthcare Professionals To these experiences, let us now consider the positionality of nurses and other healthcare professionals. Nurses may hold both positions of being oppressed when they have equity‐deserving identities and also in position of privilege when they are situated in power to provide nursing care for the person deserving it. On one hand, there are nurses with non‐privileged identities by the virtue of being nonwhite (Gustafson ), being Black (Cooper Brathwaite et al. ), migrants, or LGBTQIA+ (Lim, Johnson, and Eliason ). On the other hand, could it be that nurses in Fariba's experience had safe and privileged identities. These positions of safety and privilege may be due to nurses’ secure migration status, sexual orientation, gender identity and expression, and sex characteristics or a combination of these. From these positions of privilege, the nurses may have been looking from such safe spaces through a window with a lack of transparency upon their patients or clients on the other side of the window. In these positions, the LGBTQIA+ migrant is recognised as uncredible; consequently, they are not heard, and their experiences are not rendered valid. This lack of shared understanding, because of the locality of the knower and the hearer, shapes a finitude formation in hermeneutical meaning making and engenders in epistemic injustices. Moreover, institutional power structures and structural systems of power at macro, meso, and micro levels influence how the next line of communication in dialogue occurs for those at the intersection of identity, and in particular for individuals who have and continue to experience injustices, oppression, stigma, and discrimination. In line with Dougherty ( ), I argue that there are real‐life consequences for patients when epistemic injustices occur in nursing practices within the healthcare setting. Despite education on cultural safety and competence, there may be other nurses and healthcare professionals in educational, practice, policy making, and administrative roles across various organisations and institutions whose views on LGBTQIA+ people may be clouded by their prejudices, including unintentional biases based on religion and culture (Brown et al. ; Dinkel et al. ; Henriquez, Hyndman, and Chachula ; Lim and Hsu ; Morris et al. ; Papadaki et al. ; Rowniak ; Sachdej, ; Unlu, Beduk, and Duyan ). 

It Is a 'Big Deal'! Unlike other religions that criminalise homosexuality, the Baha'i faith calls for tolerance and acceptance of homosexuality but defines it as an illness requiring compassion (Bahá'u'lláh and Effendi ). In the Baha'i faith, same‐sex marriage is not allowed, and nonheterosexual people must not act upon 'unnatural sexual desires' (Universal House of Justice ). Even though the Baha'i faith urges followers not to show prejudice and discrimination against LGBTQIA+ people (Bahá'u'lláh and Effendi ; Universal House of Justice ), Fariba has heard voluminous comments where the followers continue to act otherwise. Some may argue that Baha'i faith's view on LGBTQIA+ people cannot be categorised as intolerance and criminalizing. However, Fariba has experienced oppression and fears being stigmatised by the Iranian and religious communities in Canada and being ostracised by family and friends due to her sexual orientation. For Fariba, being lesbian was a 'big deal' and given her culture, religion, and relocation to Canada, one that led to suicidal ideation. Subsequently, while still experiencing suicidal ideations, Fariba was discharged without a client‐centred plan of care. Fariba shared her difficult transition to accepting her identity as an Iranian‐born Canadian Baha'i lesbian. Only a few of her family members in Canada are aware that she is a lesbian, and her parents in Iran have never been told. The notion of intolerance and criminalisation of LGBTQIA+ identities and orientations and for those who are also experiencing forced migration has been delved into by law, psychology, and sociology scholars (D'Orsi ; Jordan and Morrissey ; Munir and Noor ). Fariba's experience is validated by other members of the Iranian LGBTQIA+ community in Toronto (Keung ). Despite being persecuted for her faith and sexual orientation, Fariba also feels privileged due to living in an urban area in Canada, but still does not feel safe to disclose her sexual orientation to most friends and family. In this example, I aimed to elucidate how gap in therapeutic practices occurred when there were nurses’ and healthcare professionals’ lack of shared understandings of the experiences as well as the needs of migrant LGBTQIA+ patients when they were accessing healthcare services. This relates to Miranda Fricker's explanation which has resulted from, 'an acute cognitive disadvantage from a gap in the collective hermeneutical resource' (p. 97). It took years for Fariba to discuss her experience of interacting with nurses and psychiatrists. This unsaid in her experience—this uncovered as Moules et al. ( ) would say, this inability to find words to legitimise her experience aligns with Fricker's statement, 'They are unable to render their experiences intelligible by reference to the idea that they have a disorder, and so they are personally in the dark, and may also suffer seriously negative consequences from others’ non‐comprehension of their condition' (pg. 98). This means that identifying as LGBTQIA+ migrant is not a disorder, however the inner experiences rendering oneself wrong as a result of years of stigma, discriminations, and injustices, has led to experiences of mental health challenges and for some suicidal ideation. Alas, when they were in a place where it should have been safe, affirming, and acknowledging their unique complex experiences, they were dismissed, were made cynical comments to, or ridiculed (Haghiri‐Vijeh ). Emanating with Fricker, José Medina asserts: Poorly understood and inchoate meanings, interpretations, and expressive styles are the site of hermeneutical struggles, struggles in which there are interpretative achievements and break‐throughs (new experiences are named, new phenomena understood), but also struggles in which people become silenced, misunderstood, and hermeneutically marginalised. (Medina , p. 43) Many participants in my previous research shared that some nurses and other healthcare professionals missed opportunities to open the window to have a shared understanding of the complexity of intersecting identities of culture, migration status, religion, language, stigma, sexual orientation, gender identity and expression (Haghiri‐Vijeh , , ; Haghiri‐Vijeh and Clark ). Drawing from Fricker, Anderson ( ) asserts, 'Contributions to interpretations of those experiences by members of marginalised groups are excluded or evaded through misinterpretation' (p. 140). This misinterpretation is an example where implicit bias, as discussed by Saul ( ), has led to actions, or more specifically verbal and explicit actions in leading to testimonial injustice. Fariba's experience was not accepted due to nurses’ inability to recognise her experience as significant and dismissing its importance. In other words, abolishing and erasing Fariba's internal struggle for identifying as a migrant lesbian Baha'i (Anderson ). 

Positionality of Nurses and Other Healthcare Professionals To these experiences, let us now consider the positionality of nurses and other healthcare professionals. Nurses may hold both positions of being oppressed when they have equity‐deserving identities and also in position of privilege when they are situated in power to provide nursing care for the person deserving it. On one hand, there are nurses with non‐privileged identities by the virtue of being nonwhite (Gustafson ), being Black (Cooper Brathwaite et al. ), migrants, or LGBTQIA+ (Lim, Johnson, and Eliason ). On the other hand, could it be that nurses in Fariba's experience had safe and privileged identities. These positions of safety and privilege may be due to nurses’ secure migration status, sexual orientation, gender identity and expression, and sex characteristics or a combination of these. From these positions of privilege, the nurses may have been looking from such safe spaces through a window with a lack of transparency upon their patients or clients on the other side of the window. In these positions, the LGBTQIA+ migrant is recognised as uncredible; consequently, they are not heard, and their experiences are not rendered valid. This lack of shared understanding, because of the locality of the knower and the hearer, shapes a finitude formation in hermeneutical meaning making and engenders in epistemic injustices. Moreover, institutional power structures and structural systems of power at macro, meso, and micro levels influence how the next line of communication in dialogue occurs for those at the intersection of identity, and in particular for individuals who have and continue to experience injustices, oppression, stigma, and discrimination. In line with Dougherty ( ), I argue that there are real‐life consequences for patients when epistemic injustices occur in nursing practices within the healthcare setting. Despite education on cultural safety and competence, there may be other nurses and healthcare professionals in educational, practice, policy making, and administrative roles across various organisations and institutions whose views on LGBTQIA+ people may be clouded by their prejudices, including unintentional biases based on religion and culture (Brown et al. ; Dinkel et al. ; Henriquez, Hyndman, and Chachula ; Lim and Hsu ; Morris et al. ; Papadaki et al. ; Rowniak ; Sachdej, ; Unlu, Beduk, and Duyan ). 

Epistemic Ignorance Nurses may contemplate speaking up to advocate for LGBTQIA+ migrants, as they may identify with the shared reality of othering and discrimination. Some may be unaware of how to advocate because they may still have a lack of knowledge and confidence about people who identify as LGBTQIA+ migrants. In Fariba's scenario, sadly, nurses who did not speak up were bystanders when they heard the other nurses’ derogatory and discriminatory comments about the client at the nursing station and did not advocate for the client (Fitzgerald, Myers, and Clark ). For example, LGBTQIA+ people experience stigma and discrimination in Iranian culture, so some Iranian or Baha'i nurses may avoided using any evidence‐informed resources to educate themselves. After all, their religion also taught them that to identify as LGBTQIA+ meant to be a 'human failing'! This sheds light on stigma harboured and perpetuated by culture, religion, and nursing education leading to epistemic ignorance. Drawing from Mills (1997) as cited in Mason ( ), 'ignorance of this kind, [what I now call Hetero‐cis‐ignorance] is the product of an epistemic agreement among [hetero‐cis individuals] to see the world wrongly‐that is, to cultivate and sustain a system of false beliefs' (Brackets added, p. 302). Mason strengthens Fricker's discussion and underscores: The circumstances in which powerful rather than marginalised groups can fail to understand through the epistemically irresponsible and ethically reprehensible practices of misinterpretation, misrepresentation, evasion, and self‐deception. On this view, the privileged social location occupied by powerful groups occludes their understanding of the world in which they live and obscures their understanding of their own and others’ social experiences. (Mason , p. 302). The inability to comfortably engage in discourse about LGBTQIA+ people's health could be the result of complex institutional, cultural, and social stigma, as well as discrimination against people with diverse sexual orientation, gender identity and expression (Hatzenbuehler, Phelan, and Link ; Logie et al. ; Stangl et al. ; Whitehead, Shaver, and Stephenson ). Stigma is closely linked to discrimination and can be conceptualised as the lack of full social acceptance. (Goffman ). These stigmatising perspectives in addition to the conversations with Fariba obligates nurses to question systemic processes of understanding and to read the literature on gaining confidence in advocating for the rights of LGBTQIA+ migrants in practice and policy. Both stigma and discrimination, including a lack of knowledge of and a sense of discomfort in providing care to LGBTQIA+ migrants, manifested themselves in their encounters with nurses. Comments such as, 'They are in Canada now. It is safe here!' were made. This statement and consequent dismissing of LGBTQIA+ migrants’ experiences is an example of epistemic ignorance of hetero‐cis nonmigrant nurses and other healthcare professional who have unearned privileges simply as a result of their entitled intersecting social locations. 4.1 Implication for Nursing and Other Healthcare Professionals With the above narrative, some migrant LGBTQIA+ patients are positioned in epistemic injustice situations when they are marginalised by their nurses and other healthcare professionals due to the lack of collective hermeneutical resources. The migrant LGBTQIA+ patients not only suffer from epistemic injustice when they fail to recognise their oppressive situation but are also prevented by their nurses and other healthcare providers from accessing the collective hermeneutical resources that might help them conceptualise their circumstances. In these cases, the migrant LGBTQIA+ patients’ conceptual deficiency is the result of an individual agent's actions. I pause to underscore that I do not attempt to situate migrant LGBTQIA+ patients as 'ignorant' or 'incapable of recognising' as many of the participants in my previous research wanted me to share their resilience for overcoming many burdens. However, what has occurred is the structural systems of power that have not created affirming spaces in nursing practices within the healthcare for migrant LGBTQIA+ patients to safely express their experiences. Thus, it can be said that some nurses and other healthcare professionals with epistemic ignorance are engaged in hermeneutical marginalisation leading to epistemic injustice. This injustice is often further compounded by different intersecting axes of oppression that exacerbate the migrant LGBTQIA+ patients’ marginalisation and may even make existing resources available to migrants and LGBTQIA+ people inaccessible. The LGBTQIA+ migrants, as epistemic agents, have an informational perspective that requires healthcare providers to see them as potential recipients or sources of information (Hookway ). 'When we take this perspective, we encounter people making assertions, recognising (or failing to recognise) other people's authority to make assertions, and so on'. (Hookway , p. 4). By sharing Fariba's narrative, I have underlined how Fariba is wronged, not only because nurse and healthcare professionals denied giving credence to her testimony, but rather because they renounced to recognise her as a participant in prioritisation of her health concern. In some current nursing programs, nursing students are taught to recognise the priority needs of the clients, with an emphasis on disease and pathology care. Many programs may lack the emphasis on relational practices with clients at the intersecting social determinants of health (Dosani, Etowa, and van Daalen‐Smith ). However, this limited focus may position the nurses as possessing epistemic privilege and ignorance with a lack of attention to the needs of equity‐deserving communities. Miranda Fricker, in her discussion of epistemic injustice, shares that discriminations, injustices, and misunderstandings may occur when there is a gap in epistemic understanding, and I add that this gap may be in the care provider, meaning nurses, understanding the care needed by the care‐receiver. Therefore, epistemic injustices have been as a result of hermeneutical marginalisation (Byrne ). To elucidate the experiences of the knower by bringing these to the centre, it is time for nursing education to intentionally use a social justice lens by threading experiences of equity‐deserving communities, that is, LGBTQIA+ migrants, in their education. Hence, consider, how often and meaningfully have nursing educators and leaders integrated the complex experiences of LGBTQIA+ migrants in education, practice, and policy? Often, these intersecting identities, such as migration status and LGBTQIA+ people, are taught in silos and when taught there is a lack of in‐depth epistemic understanding. For example, do academic and practice educators dive into various experiences of newcomers, refugees, and those with experiences of trauma and violence or simply group them as 'immigrants' and 'newcomers'? How often do educators engage in a counternarrative to highlight the resilience and strength of those who nurses have marginalised unintentionally, or even at times intentionally? Nurses need continuous education within an organisational culture that is oriented towards acceptance and celebration of the intersectional identities of LGBTQIA+ migrants (Angeles and Roberton ; Braun et al. ; Dosani, Etowa, and van Daalen‐Smith ; Morris et al. ). It is time to see the gap between the knower and hearer as a window—an opening—an opportunity—to bring to attention to existing prejudices while being reflexive in how nurses and other healthcare professionals’ positionality informs the care provided to those forced to the margins of society (Hookway ). In nursing education and practice we need to open the window to hear LGBTQIA+ migrants’ experiences and amplify the already existing voices. Their voices needed to be recognised as credible source of information and inform the care provided (Byrne ; Rosen ). This implication for critical praxis is highlighted by scholars who use intersectionality as a lens, and who call for a change in healthcare practices (Clark and Vissandjée ; Haghiri‐Vijeh and Clark ; Hankivsky et al. ). For change to occur in practice and education, at a systemic level, explicit policy as a hermeneutical conversation is required from federal and provincial governments as well as nursing regulatory and association bodies. To improve LGBTQIA+ migrants’ well‐being and a sense of belonging, nurses can advocate for policy changes (Lee and Brotman ; MacDonnell and Daley ), create positive spaces for LGBTQIA+ migrants by training staff, and organise support groups (Logie et al. ; Massaquoi ). 

Implication for Nursing and Other Healthcare Professionals With the above narrative, some migrant LGBTQIA+ patients are positioned in epistemic injustice situations when they are marginalised by their nurses and other healthcare professionals due to the lack of collective hermeneutical resources. The migrant LGBTQIA+ patients not only suffer from epistemic injustice when they fail to recognise their oppressive situation but are also prevented by their nurses and other healthcare providers from accessing the collective hermeneutical resources that might help them conceptualise their circumstances. In these cases, the migrant LGBTQIA+ patients’ conceptual deficiency is the result of an individual agent's actions. I pause to underscore that I do not attempt to situate migrant LGBTQIA+ patients as 'ignorant' or 'incapable of recognising' as many of the participants in my previous research wanted me to share their resilience for overcoming many burdens. However, what has occurred is the structural systems of power that have not created affirming spaces in nursing practices within the healthcare for migrant LGBTQIA+ patients to safely express their experiences. Thus, it can be said that some nurses and other healthcare professionals with epistemic ignorance are engaged in hermeneutical marginalisation leading to epistemic injustice. This injustice is often further compounded by different intersecting axes of oppression that exacerbate the migrant LGBTQIA+ patients’ marginalisation and may even make existing resources available to migrants and LGBTQIA+ people inaccessible. The LGBTQIA+ migrants, as epistemic agents, have an informational perspective that requires healthcare providers to see them as potential recipients or sources of information (Hookway ). 'When we take this perspective, we encounter people making assertions, recognising (or failing to recognise) other people's authority to make assertions, and so on'. (Hookway , p. 4). By sharing Fariba's narrative, I have underlined how Fariba is wronged, not only because nurse and healthcare professionals denied giving credence to her testimony, but rather because they renounced to recognise her as a participant in prioritisation of her health concern. In some current nursing programs, nursing students are taught to recognise the priority needs of the clients, with an emphasis on disease and pathology care. Many programs may lack the emphasis on relational practices with clients at the intersecting social determinants of health (Dosani, Etowa, and van Daalen‐Smith ). However, this limited focus may position the nurses as possessing epistemic privilege and ignorance with a lack of attention to the needs of equity‐deserving communities. Miranda Fricker, in her discussion of epistemic injustice, shares that discriminations, injustices, and misunderstandings may occur when there is a gap in epistemic understanding, and I add that this gap may be in the care provider, meaning nurses, understanding the care needed by the care‐receiver. Therefore, epistemic injustices have been as a result of hermeneutical marginalisation (Byrne ). To elucidate the experiences of the knower by bringing these to the centre, it is time for nursing education to intentionally use a social justice lens by threading experiences of equity‐deserving communities, that is, LGBTQIA+ migrants, in their education. Hence, consider, how often and meaningfully have nursing educators and leaders integrated the complex experiences of LGBTQIA+ migrants in education, practice, and policy? Often, these intersecting identities, such as migration status and LGBTQIA+ people, are taught in silos and when taught there is a lack of in‐depth epistemic understanding. For example, do academic and practice educators dive into various experiences of newcomers, refugees, and those with experiences of trauma and violence or simply group them as 'immigrants' and 'newcomers'? How often do educators engage in a counternarrative to highlight the resilience and strength of those who nurses have marginalised unintentionally, or even at times intentionally? Nurses need continuous education within an organisational culture that is oriented towards acceptance and celebration of the intersectional identities of LGBTQIA+ migrants (Angeles and Roberton ; Braun et al. ; Dosani, Etowa, and van Daalen‐Smith ; Morris et al. ). It is time to see the gap between the knower and hearer as a window—an opening—an opportunity—to bring to attention to existing prejudices while being reflexive in how nurses and other healthcare professionals’ positionality informs the care provided to those forced to the margins of society (Hookway ). In nursing education and practice we need to open the window to hear LGBTQIA+ migrants’ experiences and amplify the already existing voices. Their voices needed to be recognised as credible source of information and inform the care provided (Byrne ; Rosen ). This implication for critical praxis is highlighted by scholars who use intersectionality as a lens, and who call for a change in healthcare practices (Clark and Vissandjée ; Haghiri‐Vijeh and Clark ; Hankivsky et al. ). For change to occur in practice and education, at a systemic level, explicit policy as a hermeneutical conversation is required from federal and provincial governments as well as nursing regulatory and association bodies. To improve LGBTQIA+ migrants’ well‐being and a sense of belonging, nurses can advocate for policy changes (Lee and Brotman ; MacDonnell and Daley ), create positive spaces for LGBTQIA+ migrants by training staff, and organise support groups (Logie et al. ; Massaquoi ). 

Conclusion Through Fariba's story, I strived to share that similar to the lack of freedom of expressing one's sexual orientation, gender identity, and gender expression, in some countries, such as in Iran and Saudi Arabia, religious persecution against individuals who follow a belief system different from the dominant religion is also practiced. These multiple experiences of sexual orientation, gender identity, and gender expression, race, culture, migration status, religion, and mental health are socially constructed identity categories that are intertwined with structures of power. These are communal hermeneutical resources that need to be added to the nursing care. The notion of epistemic injustice is shaped by the context and situationality of the knower and hearer. Hermeneutical marginalisation has resulted when the knower's knowledge of their experience is dismissed by the hearer. I will conclude that in order for change to occur to address epistemic injustices, public policies and governmental agencies, as structural systems of power, need to collaborate with individuals who are affected by intersecting forces of oppression. The hearers at all levels of healthcare, from micro to macro, need to recognise the knowers as the credible source of information. This credibility is crucial because the needs of LGBTQIA+ migrants are required to be named by them and in turn heard as well as understood by nurses and other healthcare providers. Through this process of LGBTQIA+ migrants’ acknowledgement and recognition of their credibility as the knowledge holder, and an emphasis on their needs, resources must be allocated and prioritised in healthcare services and policies. 

The author declares no conflicts of interest. 

