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• Culture is a pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values
• These patterns occur among those who speak a particular language or live in a defined geographic region

Enculturation

• The process by which a person learns the norms, values, and behaviors of another culture
• Example: A high school student from Canada spends a summer abroad with a family in Switzerland

Assimilation

• The process by which a person gives up their original identity, developing a new cultural identity by becoming absorbed into the dominant cultural group
• Example: An Anishinaabe man loses his Indigenous cultural identity after living in Chicago for 10 years

Acculturation

• The process of acquiring new attitudes, roles, customs, or behaviors
• Example: An immigrant from China develops a preference for Western foods and music

Biculturalism

• A dual pattern of identification
• Example: A woman of Christian faith married to a Muslim adopts some Muslim practices and also maintains some traditional Christian practices

Cultural Diversity

• Multiculturalism, with over 200 ethnic groups reported in Canada, immigration, refugees, and displaced persons make up the Canadian population
• Culture is shared patterns of learned values and behaviors transmitted over time
• Culture distinguishes the members of one group from another
• Culture can encapsulate language, ethnicity, spiritual and religious beliefs, socioeconomic class, gender, sexual orientation, age, group history, geographic origin, education, and childhood/life experiences

Cultural Concepts include:

• Ethnicity
• Subcultures
• Cultural Pluralism
• Cultural Relativism

Ethnocentrism

• Leads to stereotypes, discrimination and racism

Cultural Imposition

• Using one's own values as a guide to understanding others' behavior and provision of services

Cultural Assessment

• A systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities
• It gathers information to enable nurses to provide culturally congruent care
• Elements to assess include ethnohistory, social organization, status, biocultural ecology, health risks, language and communication, religion and spirituality, caring beliefs and practices, and experience with professional health care

Spirituality

• It is an elusive concept to define
• It can affect the quality of life, meaning, purpose, health, and sense of wholeness/connectedness
• There is no universal definition
• It is unique to each person, representing a personal experience
• Spirituality includes principles, experiences, attitudes, and beliefs regarding transcendence and the inner person
• It is a, dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence
• It expresses a relationship to self, family, others, community, society, nature, and the significant or sacred through beliefs, values, traditions, and practices

Ethnicity and Ethnic Identity

• Ethnicity and ethnic identity includes common ancestry that leads to shared values and beliefs
• Ethnicity is influences by culture and common ancestry
• Ethnicity is a powerful determinant of one's identity, known as Ethnic Identity

Race

• Influenced by physical or biological characteristics and genetics

Global Health

• The optimal well-being of all humans from the individual and collective perspective (CNA, 2009)
• It encompasses prevention, treatment, and care, while focusing on health improvement for all and health equity (Koplan et al., 2009)

Global Burden of Disease

• It is important to have access to reliable data
• GBD is a metric that quantifies the health of populations at regional or national levels
• Examples: morbidity and mortality, death rate, disability-adjusted life year

Global Health Issues

• Can include chronic illnesses (noncommunicable diseases) and neglected tropical diseases (NTDs)
• Links regarding neglected tropical diseases: https://www.who.int/neglected_diseases/diseases/en/

Global Health Nursing

• Includes interprofessional education, collaborative practice-ready workforce, global health competencies, and national and international organizations for global health

Environmental Sustainability

• Requires an intact and healthy ecosystem
• Disease can be prevented by a healthy environment
• There is an interdependence of humans, plants, and animals (One Health)
• Planetary health involves the health of human civilization and the natural systems on which it depends

Health Equity

• Environmental health contributes to the achievement of health and wellness and the prevention of illness and injury from exposure to physical or psychosocial environmental hazards
• It includes health disparities, health inequities and social determinants of health

Cultural Competence

• Involves Cultural awareness, knowledge, skills, encounters, and desire
• People must genuinely desire to understand a culture, not feel obligated to
• Cultural competence is an ongoing process where health care professionals respect, accept, and apply knowledge and skill appropriate to client interactions without allowing their personal beliefs to influence clients' differing views
• Principles useful in developing cultural competence are maintaining a broad, objective, and open attitude toward individuals and their cultures and avoiding seeing all individuals as alike

Important Cultural Concepts

• Cultural Safety is an outcome that recognizes and strives to address power imbalances inherent in the healthcare system, resulting in an environment free of racism and discrimination, where people feel safe when receiving health care
• Cultural Humility is a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust, it involves humbly acknowledging oneself as a learner when understanding another's experience

Indigenous Diversity

• 1.8 million Indigenous people in Canada, the fastest growing population makes up 5% of Canadian population
• Categories: First Nations (58%), Métis (34.5%), Inuit (3.9%), Multiple Indigenous identities (1.6%), Another Indigenous category (1.9%)
• The population’s average age is 33.6 years old (vs. Canada at 41.8) and ~3/4 live in urban areas

Indigenous Peoples in Canada

• There is a focus on self-government and self-determination for all Indigenous people
• Ongoing governmental and non-governmental efforts
• Inuit mostly reside in arctic and subarctic regions of northern Canada
• The majority (over 80%) live in 53 communities accessible by air only
• A Métis person self-identifies as Métis of historic Métis Nation Ancestry, is distinct from other Aboriginal Peoples, and is accepted by the Métis Nation
• Métis are of mixed First Nations and European Heritage, primarily descendants of the 18th century fur traders and in area near Métis homeland
• Indigenous people of mixed blood (e.g., parents of both Indigenous and European ancestry)
• They have their own dialect but are diverse linguistically, depending on the combination of ancestry (e.g., Cree, Dene, English, and French)

Rights ensured by the Declaration

• Addressing individual and collective rights, cultural rights and identity, rights to education, health, employment, language, and others
• Indigenous peoples have the right to fully enjoy as a collective or as individuals, all human rights and fundamental freedoms
• Indigenous peoples have the right to be free from discrimination in the exercise of their rights
• Indigenous peoples have the right to self-determination to freely determine their political status and economic, social and cultural development

Indigenous Worldviews

• There is a connection to the land
• Collective cultures are focused on the good of the people, not on the individual
• There is an elastic sense of time
• Includes Diversity, Connection between physical and spiritual, many matriarchal cultures and everything is related and interconnected

Cultural Orientations

• Medicine Wheel teachings are used to represent the interconnectedness of life and a core belief of sacredness
• Indigenous health includes balance among emotional, physical, spiritual, and mental dimensions
• Modes of treatment: ceremonial, herbal and medicinal, and storytelling
• Seven Grandfathers Teachings are Seven Sacred Values
• Includes learning about wisdom, love, respect, bravery, honesty, humility, and truth
• Nursing considerations include; respect, Trust, and Spirituality
• There the reciprocal process, vulnerability, dependence, risk taking, and traditional Indigenous faiths and healing

Declaration on the Rights of Indigenous Peoples (UNDRIP)

• A comprehensive statement addressing the human rights of Indigenous peoples
• UNDRIP was drafted and debated for over 20 years, adopted in 2007
• The document emphasizes the rights of indigenous peoples to live in dignity, to maintain and strengthen their own institutions, cultures and traditions and to pursue their self-determined development, in keeping with their own needs and aspirations

Truth and Reconciliation, Calls to Action

• Addresses child welfare, education, language and culture, health and justice
• Nurses in Canada require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices
• Healthcare professionals must recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders, where requested by Aboriginal patients

Recognizing Aboriginal Health in Canada

• A direct result of previous Canadian government policies involving residential schools
• Measurable goals are needed to identify and close the gaps in health outcomes
• Focus indicators should be assessed with emphasis on: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services

Truth and Reconciliation includes:

• The Truth and Reconciliation Commission
• A common Experience Payment
• Financial settlements for those who had suffered abuse or neglect
• Commemoration initiatives
• Funding to support the Aboriginal Healing Foundation