Assignment: Health care needs of Indigenous Cultures

Indigenous peoples and communities across Canada are charting a path forward in transforming their systems of health and wellness based on holistic and culturally based world views along with many years of experience as health service providers. Robust and well-supported healthcare human resources are core to moving the transformation agenda forward, and nurses, specifically Indigenous nurses, are the foundation of much of the community health services (AFN 2017).

Indigenous nurses have a long history of service in this country, from the early days of the twentieth century when most nursing schools barred Indigenous

Commentary: Indigenous Nursing – Learning from the Past to Strengthen the Future of Healthcare Lea Bill, RN President Canadian Indigenous Nurses Association Ottawa, ON

Leila Gillis, RN, MN Director, Primary Health Care Systems Division Indigenous Services Canada Ottawa, ON

SPECIAL FOCUS ON INDIGENOUS NURSING

Abstract Nurse leaders, educators and employers work to address the challenges of provid- ing optimal care to Indigenous people and communities in Canada, which is often further complicated by geography and isolation. The Canadian Indigenous Nurses Association (CINA) has responded to the Calls to Action of the Truth and Reconciliation Commission of Canada through partnerships with various levels of government, including the First Nations and Inuit Health Branch of the new federal department of Indigenous Services Canada, to increase and better support Indigenous nurses in the healthcare system. Grounding nursing practice with the wisdom and strength of Indigenous knowledge, balanced with the perspectives of western ways of knowing is further facilitated when nursing students can be educated and supported closer to home. Learning in a supportive way, closer to where one lives, can allow for important family ties, cultural supports and practices to improve experiences and outcomes for students.

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students, to when nurses were invited to study but faced discrimination in other forms. Today, Indigenous nurses are increasing in number and work tirelessly to reform the profession to recognize the cultural needs and intellectual goals of Indigenous nurses and communities (ANAC, 2007). The Canadian Indigenous Nurses Association (CINA) has developed partnerships with various levels of government, professional associations and universities to respond to the 2015 Calls to Action of the Truth and Reconciliation Commission (TRC). Specific focus has been on increasing Indigenous professionals working in the healthcare field and the overall enhancements to the provision of cultural competency training for all healthcare professionals (TRC 2015).

The necessity of collaborative partnering and community-based approaches have been part of Indigenous and government dialogue for many years and are well defined within the findings of the TRC. An important approach to professional learning for nursing is building partnerships and grounding them in best practices related to everyday work (practicum). This is even more effective when this learn- ing is conducted in collaboration with peers, communities and Elders. There is also an importance for nursing curricula to focus on the learning of all students, and for those students to seek relevant knowledge and skills to be safe practi- tioners in their work context. Supporting Indigenous students to learn closer to home can be done by using innovative teaching tools, such as remote presence technologies, that allow health professionals, educators and students to interact in a new and exciting way and increasing the comfort of all nurses by incorporat- ing such supportive tools in the practice setting. Distributed learning also allows for traditional health teachings to be incorporated into mainstream curricula. Within Indigenous communities, such professional learning is optimized when it is blended with traditional knowledge/medicine/well-being.

The First Nations and Inuit Health Branch (FNIHB) of Indigenous Services Canada has deployed a nurse-led model of care for generations, and a properly educated, well supported, adequately staffed, registered nurse workforce can indeed provide a valuable return on investment in rural and remote settings. That being said, the reality is that recruitment and retention of nurses remain a constant challenge. As a national employer, FNIHB has great interest in strength- ening and diversifying the workforce with complementary skill sets to that of the registered nurse; however, nurses remain a significant provider of primary care services in FN communities (FNIHB 2012). Innovative approaches to educating nurses in more rural and remote settings such as those described in the previous articles are welcomed, as they support nurses in learning and practicing closer to home. A 2011 study of facilitators and barriers to nurse recruitment and retention in Newfoundland and Labrador identified factors that attract people to work in rural and remote settings; however, there are also many inhibiting factors that are Assignment: Health care needs of Indigenous Cultures

Commentary: Indigenous Nursing – Learning from the Past to Strengthen the Future of Healthcare

30 Nursing Leadership Volume 31 Number 1 • 2018

difficult to overcome including no family ties in the area, limited opportunities for spousal employment and the limited services and resources that often come with geographic isolation (Aylward et al. 2011). Supporting local community members to study closer to their home community and families may indeed enhance the number of nurses in the healthcare system with the knowledge, skills and abilities to both practice and live at home.

FNIHB directly employs approximately 600 nurses across the country with nearly a quarter self-identifying as Indigenous. While recruitment and retention of all nurses is important along with educating them to provide culturally safe care, it cannot yield the level of insight possessed by someone who is from an Indigenous commu- nity themselves. The concept “Learn Where You Live” is innovative and supportive of Indigenous family structures and lifelong learning. Supporting both Indigenous and non-Indigenous nursing students to practice competently in rural and remote settings is to support a generation of nurses whose professional education is embed- ded in community and who are best prepared to work safely within this unique practice setting. This in turn contributes to rural and remote areas having sustained access to the presence of Indigenous nurses in the healthcare delivery.

Engagement opportunities for Indigenous communities to contribute to policy- making around the support of Indigenous nursing students is an important element for consideration in planning sustainability of healthcare services and successful ongoing partnership with Indigenous groups. Shifting from campus- based education delivery modeling to a distributed model has several potential benefits including balancing the humanization of knowledge transfer with the science focus on objectivity within nursing. This education model may also enhance and augment learning and knowledge development of faculty to improve recruitment and retention of Indigenous students.

Decades ago, respected Mi’kmaq Elder Dr. Albert Marshall introduced the concept of Two-Eyed Seeing to describe the benefit of seeing from one eye with the wisdom and strength of Indigenous knowledge, and from the other eye, with the strength of western knowledge. Key concepts within Two-Eyed Seeing include: co-existence, interrelatedness, interconnectedness and community spirit. Elder Marshall further emphasized that these four ideologies apply to relationships with each other and with Mother Earth (Institute for Integrative Science and Health, 2018). This gift of multiple perspectives describes the potential synergies when partnering with First Nations communities to educate students in the delivery of safe, compassionate, competent and ethical nursing care.

Transformation of Indigenous healthcare requires both internal and exter- nal changes to the healthcare system. Important steps in this journey include

development of authentic partnerships with Indigenous communities to learn and best support the education of the next generation of healthcare professionals. These health professionals will then continue the important work in closing the gap in Indigenous health outcomes and protect the health of future generations of Indigenous children. Assignment: Health care needs of Indigenous Cultures

Correspondence may be directed to: Leila Gillis, 200 Eglantine Driveway, 19th Floor – AL 1919D, Ottawa, ON, K1A 0K9: e-mail: Leila.gillis@canada.ca.

References Aboriginal Nurses Association of Canada (ANAC). 2007. Twice as Good: A History of Aboriginal Nurses. Ottawa, ON: Author.

Assembly of First Nations (AFN). 2017. The First Nations Health Transformation Agenda. Ottawa, ON: Author. <https://www.afn.ca/uploads/files/fnhta_final.pdf>.

Aylward, M., A. Gaudine and L. Bennett. 2011. “Nurse Recruitment and Retention in Rural Newfoundland and Labrador Communities: The Experiences of Healthcare Managers.” Online Journal of Rural Nursing and Health Care 11(1): 54–69.

First Nations and Inuit Health Branch (FNIHB), Health Canada. 2012. Recognizing Strengths – Building for the Future: Primary Health Care Service Delivery Models in Remote and Isolated First Nation Communities. Final Report and Recommendations (p. 13). Ottawa, ON: Author.

Institute for Integrative Science and Health. 2018. “Two-Eyed Seeing”. Retrieved March 26, 2018. <http://www.integrativescience.ca/Principles/TwoEyedSeeing/>.

Truth and Reconciliation Commission of Canada (TRC). 2015. Truth and Reconciliation Commission of Canada: Calls to Action (p. 3). Winnipeg, MB: Author.

Commentary: Indigenous Nursing – Learning from the Past to Strengthen the Future of Healthcare

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mailto:Leila.gillis@canada.ca
https://www.afn.ca/uploads/files/fnhta_final.pdf
http://www.integrativescience.ca/Principles/TwoEyedSeeing/
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