Indigenous Peoples Key Terms

Key Terms

• Aboriginal: A colonial term by the Canadian federal government, encompassing First Nation, Métis, and Inuit peoples.
• Colonial: The power exerted by the dominant culture of settlers over Indigenous peoples, aiming to maintain authority and replace the original population.
• Indigenous: Refers to the original peoples of a land and their descendants, used by the UN to uphold the human rights of Indigenous peoples globally.
• First Nations: Original nations of inhabitants below the Arctic in Canada, showing great diversity. Members are legislated as "status Indians" or "non-status Indians" under the Indian Act.
• Inuit: Indigenous peoples of the Arctic, meaning "the people".
• Métis: Mixed-race descendants of unions between First Nation and European settlers during the 18th and 19th centuries with a distinct culture recognized by the Canadian Constitution in 1982.

Chapter Focuses

• Chapter 22 focuses on Indigenous Health
• Chapter 24 focuses on Rural and Remote Health

Cultural Safety

• Community Health Nurses need to have reflective and culturally safe practices through a strength-based approach by honoring Indigenous cultures and health
• The health of many Indigenous communities links to their distinct culture and their worldview - believing that all beings are connected to each other and to the land
• Indigenous individuals have the right to access all social and health services without any discrimination
• Nurses need to support the rights, health, and well-being of indigenous cultures by respecting their dignity
• Nurses can help in stopping colonial narratives and ongoing stigmatization

Health Care Delivery Systems

• The federal government and the First Nations and Inuit Health Branch (FNIHB) deliver health services to First Nation and Inuit peoples living on reserves.
• First Nations are gaining local control via health service transfers.
• For acute care, First Nation healthcare systems connect with the Canadian healthcare system, as hospitals are a provincial matter
• Various funding options exist for First Nation groups to manage their community health programs.

Social Determinants of Health

• Indigenous populations have disparities in virtually all areas of health determinants
• Regardless of location, low socioeconomic status is present in all indigenous populations
• First Nation communities are reclaiming education by creating culturally relevant curricula and training Indigenous teachers
• On-reserve housing is often subpar in Canada
• Tuberculosis rate in Indigenous populations is six times higher than in non-Indigenous populations; the highest rate is among Inuit.
• Trauma and injury whether accidental or intentional, are related to physical environments and are high on the list of health issues of Indigenous populations
• Healthy child development is an important health indicator for Indigenous populations; the birth rate is almost twice that of the general Canadian population
• Indigenous people are represented in all occupations
• Changes have to be made to the social determinants of health to overcome the poverty and third-world conditions in many First Nation communities

Healthcare access inequalities

• Participants report racism, stigmatization, language difficulties, intimidation, harassment, and fear
• Participants describe limited access to specialized care, long waiting times, communication barriers due to jargon, and other barriers
• The health care that participants received was judgemental, there were inadequate assessments, and health care needs were not well met.

Culture, Self-Governance & Policies

• Nurses need to develop culturally appropriate nursing care, keeping in mind the historical, cultural, and changing clinical healthcare delivery system
• Indigenous populations are a distinct part of Canadian society, and some First Nation peoples have traditional, holistic health beliefs
• Nurses moving between cultures need to know the values and norms of the society they are entering
• Nurses must know about competing policies and jurisdictions.
• Health education and promotion are part of daily community contact, and nurses need to ensure these activities are culturally appropriate.

Rural and Remote Communities

• 95% of Canada’s land is considered rural and remote.
• Technical definitions of "rural" include the location of hospitals, roads, or political areas
• Social definitions refer to the nature of the rural community with specific services for larger populations
• 90% of the population of Canada lives within 100 miles (161km) of the U.S. border
• Canadian rural and remote communities are diverse and their economies are impacted by geographic features
• The socioeconomic status of these communities is not static
• There is unequal access to employment and post-secondary education
• Health education alone cannot change the social determinants of health in these locations
• Health-related factors like smoking and obesity are elevated in rural areas of Canada
• It is important to note that there is variety among people in rural and remote communities in order to avoid generalizations
• Studies found variations of prevalence, incidence, and risk for specific diseases
• Disease prevention and health promotion are important

Challenges and Rewards

• A greater proportion of rural residents reported a strong sense of community belonging compared to their urban counterparts
• Out-migration from distant rural to more-urban areas is a challenge
• Population is increasing for rural communities within a commuting distance of urban areas
• Rural residents working and socializing outside their community challenge community infrastructure and services
• The rural poor travel longer distances and pay more for services in their communities

Health Inequities

• A smaller proportion of small town, rural, and northern regions rated their health as excellent
• There are a significant proportion of low-income people with less than a secondary education level
• Life expectancy at birth was significantly higher in urban areas

Caring for Rural and Remote Areas

• Nurses face a broad range of practice demands, requiring them to be generalists.
• There are half as many nurses per 100,000 people in rural and remote areas, compared to urban areas
• Rural nurses often work in remote communities and clinics and encounter various health policies based on urban perspectives
• Limited access to nursing education is a concern

Community Health Nurses' Role

• The context of rural communities shapes nursing practice with limited transportation, communication, and resources
• Rural nurses deal with multi-faceted and complex practices, significant decision-making, and few resources with little support
• Rural nursing requires a broad knowledge base and skills to be responsive to community needs
• Vast distances separate team members and limit collegial communication to provide high-quality care
• Telehealth is increasingly being considered to improve access and comprehensiveness of care
• Providing primary healthcare can be challenging and turnover rates can be high

Inequity and Technology

• Technology includes internet connectivity, health informatics, and telehealth
• Unfortunately, telehealth is not a solution to the needs of remote populations
• One major area of inequity is limited access to reliable internet, which impacts educational and communication opportunities

Traditional Knowledge

• Indigenous worldviews emphasize interconnectedness, forming the basis of the medicine wheel framework
• Medicine wheels represent four quadrants: emotional, physical, mental, and spiritual aspects of health and wellness
• Elders teach the medicine wheel philosophy to youth in Indigenous populations
• The medicine wheel philosophy is adapted to issues including HIV/AIDS, diabetes, family violence, and addictions