PPN 101 Weeks 5-7 Flashcards PDF

PPN 101 | Weeks 5 - 7 Theory and practice are inextricably linked – they inform one another Week 5 LO: Nursing theories are patterns that guide the thinking, being, and doing of nursing. 1. Discuss the They...

PPN 101 | Weeks 5 - 7 Theory and practice are inextricably linked – they inform one another Week 5 LO: Nursing theories are patterns that guide the thinking, being, and doing of nursing. 1. Discuss the They help organize our thoughts, reflections, observations history, purpose, and inferences. and importance of Many describe theories as lenses because they color and theory development shape what is seen. in nursing. (importance) Nursing practice is based on these theories, Purpose and foundational concepts, philosophies, principles, research findings, importance of and practice wisdom theory dev in All disciplines use theories and concepts to illuminate their distinct nursing perspectives (i.e. the metaparadigm of nursing; ways of knowing etc.) Responsible for setting Western nursing on a path toward scientific advancement Defined nursing as “putting the person in the best condition for nature to act,” and established a phenomenological focus of the Week 5 LO human–environment relationship to health Florence Nightingale Was inspired by practice; her Notes on Nursing (1859) described contribution to the conditions necessary to promote health and healing nursing Her observations during the Crimean War led to the first set of principles for nursing practice Systematic thinker; pioneered data visualization of statistics Environmental theory Week 5 LO Viewed the person in constant interaction with a changing environment Sister Callista Roy Drew on Systems Theory to develop the Roy Adaptation Model contributions (1976) Her model depicted four modes of adaptation: physiological needs, self concept, role function and interdependence Believed the goal of nursing was to facilitate adaptation Developed a culture care theory within the broader field of transcultural nursing Strove for cultural sensitivity by attending to patients’ values, Week 5 LO beliefs, attitudes and behaviours Encouraged nurses to recognize the significance of culture when Madeleine Leininger delivering care contributions Emphasized that nurses are also cultural beings Highlighted the intersection of culture and social determinants of health, and how these determinants shape and impact people’s health and lives. Believed the nurse can treat the body, mind and spirit of a person through the establishment of a caring relationship Week 5 LO Argued that nurses do far more than deal with physical illness. Rather, they must attend to their primary function and responsibility, Jean Watson which is caring contributions Developed the Theory of Human Caring (1979), and a model of caring that includes 7 assumptions and 10 carative factors Week 5 LO What is Evidence? Describe evidence Information derived from clinical research informed practice and its relevance to What is Evidence-Informed Practice? nursing theories, models, and frameworks. The best available research evidence that is applied in conjunction with patient preferences, context, available resources and practitioner expertise  Remember: Nursing practice is based on theory, professional values, evidence and clinical reasoning Relevant to nursing theories, models and frameworks because these 3 are based on evidence. Ensures nursing care is based on best available evidence; which improves patient outcomes. Nursing theories, models, and frameworks provide a foundation for evidence-informed practice by helping nurses to understand the complex nature of nursing care and to make decisions about the best course of action. Support for Theories: Nursing theories often provide a framework for understanding patient care. EIP helps validate and refine these theories by grounding them in empirical evidence. Week 5 LO Relationship: Describe Theory generates hypotheses that guide scholarliness in research. nursing. systematic way of thinking about Development of nursing practice and guide the nursing knowledge. decision-making process Research tests these hypotheses, producing Relationship evidence that can either support or challenge between theory, existing theories. practice and Research is the process of research. systematically investigating questions or problems in nursing. It provides evidence to support or refute theories and informs best practices. Research helps to build a solid foundation of knowledge that enhances both theory and practice. It ensures that nursing care is based on the best available evidence, leading to better patient outcomes. Practice applies this evidence in real-world settings, providing further insights and  feedback that can inform both theory and research. application of theoretical principles to real-world patient care. Nursing practice tests and refines theories Although many nursing tasks can be mastered by anyone trained to perform Week 5 LO them, the hallmark of nursing practice is a unique body of knowledge combined with a set of principles that guide the systematic application of Describe that knowledge in an expanding array of contexts. scholarliness in nursing. Role of theory as (Role of theory) Nursing theory aims to organize knowledge about nursing to essential to the enable nurses to use it in a professional and accountable manner AND… nursing profession and nursing practice. Creative nursing practice is the direct result of ongoing theory-based thinking, decision-making, and action Week 5 LO Describe Fawcett’s Metaparadigm of Nursing (1984) was one of the first frameworks scholarliness in that characterized the domain of nursing knowledge. However, ALL nursing. conceptual frameworks, models, grand theories, middle-range theories, and Focus of nursing practice theories that explicate the phenomena within the domain of nursing knowledge contribute to the discipline’s distinct body of knowledge. (metaparadigm concepts). Week 5 Theories What other 1. Florence Nightingale’s Environmental Theory: Focuses on the frameworks, models patient’s environment and how it affects health and recovery. and theories 2. Jean Watson’s Theory of Human Caring: Highlights the distinguish nursing humanistic aspects of nursing and the caring relationship between as a distinct the nurse and the patient. discipline? Can you name and describe 3. Madeleine Leininger’s Culture Care Theory: Focuses on cultural these? competence in nursing and the importance of understanding and respecting cultural differences in patient care. Models 1. Roy’s Adaptation Model: Views patients as adaptive systems and encourages nurses to promote patient adaptation to changes in their health and environment. Frameworks 1. The Nursing Process: A systematic method involving assessment, diagnosis, planning, implementation, and evaluation to provide patient care. 2. Benner’s From Novice to Expert Framework: Describes the stages of clinical competence from beginner to expert, emphasizing the development of nursing skills over time. 3. nursing metaparadigm encompasses four core concepts that define the discipline of nursing and guide its practice Week 5 LO Bridging Science and Art Examine how theory Nursing is both an art and a science. Theoretical frameworks harmonize as the “poetry of these two aspects, ensuring that nursing practice is not only evidence-based science” is essential but also compassionate and holistic. By viewing theory as poetry, nurses can to reconfiguring and appreciate the deeper, more nuanced aspects of patient care, fostering a promoting new more empathetic and personalized approach. ideas about nursing today. viewing theory as the "poetry of science" enriches the nursing discipline by nurturing creativity, guiding practice, promoting research, and reinforcing professional identity. It blends creativity with scientific rigor, inspiring fresh ideas and new approaches to patient care. Theoretical frameworks provide structured guidance while encouraging nurses to think beyond traditional methods. This dynamic interplay fosters continuous improvement, drives research, and strengthens the professional identity of nurses. In essence, it's the creative  spark that propels nursing forward, ensuring it remains adaptive and forward-thinking in today's ever-evolving healthcare landscape. 7 Assumptions: 1. Caring can be effectively demonstrated and practiced only interpersonally. 2. Caring consists of carative factors that result in the satisfaction of certain human needs. 3. Effective caring promotes health and individual or family growth. 4. Caring responses accept a person not only as they are now but as what they may become. 5. The nurturing of sensitivity to oneself and to others promotes Week 5 health. 6. Caring is central to the practice of nursing. Jean Watson Theory 7. Caring promotes health better than curing2. of Human Caring 1979 10 Carative Factors: 7 assumptions and 1. Forming humanistic-altruistic value systems. 10 carative factors 2. Instilling faith-hope. 3. Cultivating a sensitivity to self and others. 4. Developing a helping-trust relationship. 5. Promoting an expression of feelings. 6. Using problem-solving for decision-making. 7. Promoting teaching-learning. 8. Promoting a supportive environment. 9. Assisting with the gratification of human needs. 10. Allowing for existential-phenomenological forces Week 5 Grand Theory Types of Theory Provides a global perspective on nursing practice, education & research (e.g. Nightingale, Roy, Leininger, Watson) Middle-range Theory  Less abstract than grand theory; testable & specific; research links with practice Practice Theory Very specific; limited to specific situations Reflects the day-to-day experience of nurses Week 6 LO Defined as “an ongoing process, whereby Compare and nurses strive to work within the client’s contrast the cultural context” (Potter & Perry, 2024, p. concepts of cultural 158) competence, cultural humility and Key idea: Nurses develop cultural competence rather cultural safety. than possess it Week 6 LO Key idea: Cultural awareness and cultural sensitivity are separate concepts and are not Compare and interchangeable with cultural safety contrast the Achieving cultural safety is a step-wise concepts of cultural progression competence, The outcome of cultural safety is that safe cultural humility and care, defined by clients who receive that care, cultural safety. is provided (Ramsden, 2002, as cited in Potter & Perry, 2024, p. 158-159) Cultural safety: Enables safe care to be defined by those who receive that care, and challenges unequal power relations at the level of the individual, family, community and society Concepts of cultural safety Cultural awareness: A beginning step towards understanding difference that requires self-  assessment and reflection about your own personal biases and feelings Cultural sensitivity: The recognition that there are differences between cultures, and these are reflected in ways that different groups communicate and relate to one another “…[being] flexible and humble enough to let go of the false sense of security that stereotyping brings…to assess anew the cultural dimensions of each Week 6 LO patient…and to say that you do not know when you truly do not know” Compare and (Tervalon & Murray-Garcia, 1998, p.119) contrast the concepts of cultural Principles: competence, cultural humility and Life-long learning and critical self-reflection cultural safety. Recognize and challenge power imbalances Institutional accountability To care for someone, I must know who I am. Week 6 To care for someone, I must know who the other is. Culturally Sensitive care To care for someone, I must be able to bridge the gap between myself and the other. Culture concepts > Cultural safety > Cultural sensitivity Jean Watson Week 6 LO Race is defined as a socially constructed category used to classify humankind according to common ancestry and is reliant on differentiation by physical characteristics Define and describe The concept of race has no basis in biological reality and therefore the concepts of has no meaning independent of its social definitions colonialism, race, The ideology of race has become embedded in our identities, racism and institutions and culture and is used as a basis for discrimination and antiracism and how domination they relate to nursing practice. Week 6 LO Racism as a concept is widely thought of as personal prejudice, but in fact, it is a complex system of racial hierarchies and inequities Define and describe It is “an ideology that either directly or indirectly asserts that one the concepts of group is inherently superior to others.” (Ontario Human Rights colonialism, race, Commission, n.d.) racism and Racialization is the process of categorizing people into categories antiracism and how that are constructed as different and unequal in ways that lead to they relate to negative social, economic and political impacts nursing practice. Week 6 LO No one is born racist or antiracist. These result from the choices we make. Define and describe the concepts of Being antiracist results from a conscious decision to make frequent, colonialism, race, consistent, equitable choices daily. These choices require ongoing self- racism and awareness and self-reflection as we move through life. In the absence of antiracism and how making antiracist choices, we (un)consciously uphold aspects of white they relate to supremacy, white-dominant culture, and unequal institutions and society. nursing practice. Being racist or antiracist is not about who you are; it is about what you do “…occurs when a foreign power rules over a nation and attempts to impose their values and beliefs on the people.” (Mallete & Yonge, 2022, p. 113) Week 6 LO “The takeover of a minority population (often indigenous) by Colonialism another nation and the resulting unequal relationships between them.” (Gregory, 2015, p. 216-217) How does colonialism influence our understanding of culture in Canada? Week 6 LO Nurses must take a leadership role to prevent embedded racism from causing further harm to our patients and communities (Thorne, 2017). Define and describe Nurses’ efforts to promote social justice and equity are not just the concepts of about developing policies. Rather, their efforts are accomplished colonialism, race, through day-to-day practices, conversations with one another, and racism and interactions with clients, families, communities and leaders (Varcoe antiracism and how et al, 2014). they relate to nursing practice. Colonialism: Colonialism has historically shaped the structure and practice of nursing, particularly in colonized countries1. It introduced Western medical practices and often marginalized traditional healing methods, leading to a legacy of inequity and cultural insensitivity in healthcare1. Race and Racism: Racism in nursing is a systemic issue that leads to health disparities and discrimination2. It affects both patients and healthcare providers, resulting in unequal access to care and negative health outcomes for marginalized groups2. Nurses must be aware of their own biases and work to provide equitable care to all patients2. Antiracism: Antiracism in nursing involves actively challenging and dismantling racist practices and policies within the healthcare system3. This includes advocating for marginalized patients, promoting cultural competence, and creating inclusive environments that support the well-being of all individuals4. By understanding and addressing these concepts, nurses can work towards a more just and equitable healthcare system that respects and values the diverse backgrounds and needs of all patients. It's about fostering a culture of inclusivity and fairness in every aspect of nursing practice. Week 6 LO Commit to equity, (i.e. that all people should have the same rights, and are deserving of health) Discuss the multiple Seek to understand yourself and others, and the context of people’s contexts of culture lives in relation to health Analyze vulnerability, rather than locating it within individuals or and illness. groups (i.e. “at risk youth”) Promote practices and environments that are appropriate for the MOST marginalized (i.e. signs or brochures that can understood by people with low literacy)  Treat problems as practice problems, not individual problems (i.e. the “difficult patient”) These concepts are crucial in nursing to ensure effective and respectful care: 1. Cultural Competence: This involves understanding and respecting diverse cultural backgrounds and practices in healthcare. Nurses with cultural competence can tailor care to meet the specific needs of patients from different cultures, improving health outcomes and patient satisfaction. 2. Cultural Humility: A continuous self-evaluation process where nurses recognize their own cultural biases and learn from others' cultural perspectives. It encourages an open-minded approach, fostering trust and mutual respect between patients and healthcare providers. 3. Cultural Safety: Creating an environment where patients feel safe and respected, free from discrimination. It goes beyond cultural awareness and competence, ensuring that healthcare practices do not harm or marginalize any cultural group. 4. Cultural Sensitivity: This involves being aware of and respecting cultural differences, including beliefs, values, and customs. It helps nurses communicate effectively and empathetically with patients, leading to better patient care and health outcomes. 5. Cultural Awareness: Recognizing the cultural factors that influence health and illness. This includes understanding how cultural backgrounds affect patients' health behaviors, perceptions of illness, and interactions with healthcare systems. Together, these concepts help nurses provide holistic, patient-centered care that acknowledges and respects the diverse cultural contexts of health and illness. They promote equity and inclusivity in healthcare, ensuring all patients receive the care they need and deserve. Week 6 Equity: the situation in which everyone is treated fairly according to their needs and no group of people is given special treatment Equity, Diversity, Diversity: the fact of there being people of many different groups in Inclusion society, within an organization, etc Inclusion: the act of allowing many different types of people to do something and treating them fairly and equally  Centennial EDI statement Centennial College recognizes and affirms Diversity, Equity, and Inclusion, and Indigenous ways of knowing as central to the vibrancy and uniqueness of its learning and working academic mission. We strongly encourage applications from members of Indigenous communities and all equity- deserving groups including Women, Racialized, Persons with Disabilities, and 2SLGBTQQIA communities. We also recognize that Centennial is situated on the Treaty Lands of the Mississaugas of the Credit First Nation and pay tribute to their legacy as well as that of all First Peoples that have been and remain present here in Toronto. We recognize that First Peoples come from sovereign Nations and that part of understanding our responsibilities of residing on this territory are understanding the true history, circumstances and legacy of the Treaties signed here (such as the Toronto Purchase, Robinson-Huron Treaty and Williams Treaties) and including pre-contact Treaties and Agreements between sovereign Nations and that all peoples in this area are therefore Treaty people with obligations and responsibilities to all our relations. (Collaborative BScN Student Handbook 2024-2025, p. 8) Week 6 LO 1. Equity: Ensures all patients receive fair and just access to healthcare services, regardless of their background. This is Importance of EDI essential for reducing health disparities and improving health (equity, diversity and outcomes for marginalized and underserved populations. inclusion) in nursing 2. Diversity: Reflects the variety of cultures, ethnicities, genders, and experiences among patients and healthcare professionals. Embracing diversity enriches the nursing profession, fostering a deeper understanding of different health needs and perspectives. 3. Inclusion: Creates a welcoming and supportive environment where all individuals feel valued and respected. An inclusive healthcare setting enhances patient trust, satisfaction, and overall experience, leading to better patient-provider relationships. Commit to equity, (i.e. that all people should have the same rights, and are deserving of health) Seek to understand yourself and others, and the context of people’s lives Analyze vulnerability, rather than locating it within individuals or groups (i.e. “at risk youth”)  Promote practices and environments that are appropriate for the MOST marginalized (i.e. signs or brochures that can understood by people with low literacy) Treat problems as practice problems, not individual problems (i.e. the “difficult patient”) Week 6 LO look at main points of EDI statement of student handbook Week 7 LO In order to redress the legacy of residential schools and advance the process of Canadian reconciliation, the Truth and Reconciliation Commission makes Define the Calls to the following Calls to Action: Action for health in the Truth and Child Welfare Reconciliation Education Commission of Language and culture Canada report. Justice (Health) Calls to Action for health: 1. To recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties. 2. In consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities. Such efforts would focus on indicators such as: 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. 3. To recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples  4. To provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools 5. To 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 6. To increase the number of Aboriginal professionals working in the health-care field, ensure the retention of Aboriginal health-care providers in Aboriginal communities, and provide cultural competency training for all healthcare professionals 7. To call upon medical and nursing schools in Canada to 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. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism. Week 7 LO “…legitimized and normalized spectrum of attitude, practices and policies that consistently results in chronic and continuous Define structural substandard outcomes for…Indigenous peoples.” (Potter & Perry, racism and how it 2024,p.154) can be manifested in the health care Funding & delivery of health care: Jordan’s Principle system. Jordan’s Principle is a child-first approach to funding and delivering health care and social services for First Nations children in Canada1. It ensures that when there is a disagreement between federal and provincial governments over who should pay for services, the child's needs are met first, and the financial issues are resolved later2. This principle aims to provide culturally appropriate and timely services without delay or disruption1. It's a significant step towards addressing health inequities and ensuring that First Nations children receive the care they need when they need it. https://www.cpha.ca/jordans-principle-and-public- health  Equitable access, respect for Indigenous health knowledge: Joyce's Principle Child welfare system: removing children from their families Poverty: low income and related issues, such a poor housing conditions Racist assumptions about Indigenous patients: the story of Brian Sinclair Ignored to death: Brian Sinclair's death caused by racism, inquest inadequate, group says… https://www.cbc.ca/news/canada/manitoba/winnipeg- brian-sinclair-report-1.4295996 in wheelchair- sat unattended for a day and a half; 34 hrs in ER seeking care for bladder infection 45 yo, double amputee, chronic issues inquest- did not look into racism and stereotyping Week 7 LO Relevance for Indigenous people in healthcare Expand on the Cultural Safety and its Relevance for Indigenous Peoples in Canadian concept of cultural Healthcare safety and its relevance for Cultural safety is an important concept in the healthcare of Indigenous Indigenous people in peoples in Canada. You learned about this concept in Week 6. This response Canadian will explore the concept of cultural safety and its relevance to providing healthcare. equitable and effective care for Indigenous peoples. Cultural safety goes beyond simply being aware or sensitive to different cultures. It requires healthcare professionals to acknowledge the power imbalances inherent in the healthcare system and how these imbalances can impact Indigenous patients. Understanding the historical context of Indigenous peoples' experiences in Canada is essential to understanding cultural safety. The Truth and Reconciliation Commission of Canada (TRC) has highlighted the devastating impacts of residential schools on Indigenous communities. These schools aimed to assimilate Indigenous children into Euro-Christian Canadian society, leading to  the suppression of Indigenous languages, cultures, and spiritual practices. This history of trauma and marginalization has significantly impacted the health and well-being of Indigenous peoples. Understanding the Impacts of Historical Trauma The TRC's findings reveal the systemic racism and discrimination that Indigenous peoples have faced, contributing to significant health disparities. The residential school system, in particular, has left a legacy of intergenerational trauma, impacting the physical, mental, emotional, and spiritual health of Indigenous communities. Recognizing and addressing the ongoing impacts of this trauma is crucial to providing culturally safe care. How to Practice Cultural Safety Nurses and other healthcare providers need to adopt a trauma- informed approach that acknowledges the historical and ongoing experiences of Indigenous peoples. Building trust and respect are essential for creating a safe and welcoming environment for Indigenous patients. Active listening and open communication are crucial for understanding the unique needs and perspectives of each individual. Healthcare providers should avoid making assumptions and involve patients in their care decisions. The FIRST approach provides a valuable framework for enhancing cultural safety: Family: Recognize the importance of family in Indigenous cultures. Information: Provide clear and accessible information to patients. Relationship: Build trusting relationships with patients. Safe Space: Create a safe and welcoming environment. Treatment: Ensure that treatment plans are culturally appropriate and responsive to the patient's needs. Additional Considerations for Cultural Safety  Two-Eyed Seeing, an approach that combines Western healthcare knowledge with Indigenous knowledge, offers a valuable perspective for improving the health outcomes of Indigenous peoples. This approach recognizes the strengths of both knowledge systems and aims to find a balance that meets the unique needs of Indigenous patients. The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) provides a universal framework for the survival, dignity, and well-being of Indigenous peoples worldwide. It elaborates on existing human rights standards and applies them to the specific situation of Indigenous peoples. Canada officially endorsed UNDRIP in 2016, signaling a commitment to upholding the rights of Indigenous peoples. Understanding the social determinants of health through an Indigenous lens is crucial for addressing the underlying factors that contribute to health disparities. These factors include access to appropriate and adequate housing, income, education, and healthcare. Historical colonialism and present-day racism have created barriers to these resources, impacting the health and well- being of Indigenous communities. By adopting a culturally safe approach, healthcare providers can work towards achieving health equity for Indigenous peoples in Canada. Explanation #2 Cultural safety is a framework that goes beyond cultural awareness and sensitivity. It involves recognizing and addressing power imbalances, institutional discrimination, and the broader social determinants of health that impact Indigenous people. It's about creating an environment where Indigenous people feel respected, valued, and safe to express their cultural identity without fear of discrimination or harm. In the context of Canadian healthcare, cultural safety is crucial because Indigenous people have historically faced systemic racism and discrimination, which have led to significant health disparities. By implementing culturally safe practices, healthcare providers can help to bridge these gaps and improve health outcomes for Indigenous communities.  This approach requires healthcare professionals to engage in self-reflection, continuous learning, and the willingness to change their practices to better meet the needs of Indigenous patients. It's about building trust and fostering a sense of belonging, which can lead to better patient engagement and adherence to treatment plans. In essence, cultural safety is about ensuring that Indigenous people receive equitable and respectful care that acknowledges and respects their unique cultural needs and experiences. Week 7 LO Fundamental aspects of nursing practice can be related to Indigenous people’s values, health and well being Describe Important values include: 1) Respect 2) Trust 3) Spirituality fundamental Although there may be similarities, different Indigenous groups have aspects of nursing their own interpretations and may emphasize unique beliefs, world practice related to views and theories of Indigenous health. Indigenous people’s values, health and In caring for Indigenous people, nurses must work cooperatively and well-being. in balance with Indigenous ways of knowing. Fundamental Aspects of Nursing Practice Related to Indigenous Peoples' Values, Health, and Well-being When it comes to nursing practice related to Indigenous peoples, there are some fundamental aspects that are rooted in their values, health, and well- being. These aspects are crucial for providing culturally safe and effective care: Respect: Respect is a core value in Indigenous cultures. It encompasses respecting individuals, families, communities, Elders, knowledge keepers, traditions, and the interconnectedness of all living things. This includes acknowledging the historical and ongoing impacts of colonialism and racism and recognizing the inherent rights of Indigenous peoples. Trust: Building trust is essential for establishing therapeutic relationships with Indigenous patients. Given the history of mistreatment and cultural insensitivity within the healthcare system, Indigenous peoples may approach healthcare settings with apprehension and distrust. Nurses can foster trust by demonstrating empathy, active listening, and a willingness to learn  from their patients. Open and honest communication is vital for building rapport and ensuring that patients feel heard and understood. Spirituality: Spirituality plays a significant role in Indigenous cultures, often encompassing a holistic view of health and well- being that connects the physical, emotional, mental, and spiritual realms. Recognizing and respecting the spiritual beliefs and practices of Indigenous patients is essential for providing culturally safe care. Nurses should create space for patients to express their spiritual needs and support their engagement in traditional healing practices. Understanding the Diversity of Indigenous Cultures While these values are common across Indigenous cultures, it's crucial to remember that distinct Indigenous groups have their own unique interpretations, beliefs, worldviews, and theories of health. Nurses must approach each patient as an individual, recognizing the diversity within Indigenous populations and avoiding generalizations. Working in Balance with Indigenous Ways of Knowing Caring for Indigenous peoples necessitates collaboration and balance with Indigenous ways of knowing. This includes incorporating traditional healing practices, collaborating with Elders and knowledge keepers, and acknowledging the importance of community-based approaches to health and well-being. Two-Eyed Seeing The concept of Two-Eyed Seeing, as mentioned in our previous conversation, offers a valuable framework for integrating Indigenous knowledge and Western healthcare practices. This approach emphasizes the strengths of both knowledge systems, working together to better serve the needs of Indigenous patients. Addressing the Social Determinants of Health Nurses must understand the social determinants of health through an Indigenous lens. This includes addressing the historical and ongoing impacts of colonialism and racism, which have resulted in significant health disparities for Indigenous peoples. Advocating for equitable access to healthcare, education, housing, and economic opportunities is essential for improving the health and well-being of Indigenous communities. Fundamental aspects of nursing practice tailored to Indigenous people’s values, health, and well-being involve several key principles: 1. Holistic Care: Recognizing that health encompasses physical, mental, emotional, and spiritual dimensions. This aligns with many Indigenous worldviews that see health as a balance among these interconnected aspects. 2. Cultural Competence: Nurses need to develop an understanding and respect for Indigenous cultures, histories, and traditions. This involves ongoing education and self-reflection to avoid biases and stereotypes. 3. Relationship-building: Establishing trust and rapport with Indigenous patients by showing respect, listening actively, and being genuinely present. Relationships and community are central to many Indigenous cultures. 4. Trauma-informed Care: Acknowledging the historical and ongoing trauma experienced by Indigenous communities and incorporating this awareness into care practices. This helps in avoiding re- traumatization and in providing more compassionate care. 5. Patient-centered Communication: Ensuring that communication is respectful and tailored to the patient’s preferences and needs. This may involve incorporating Indigenous languages, using interpreters, and being mindful of body language and cultural protocols. 6. Advocacy: Nurses often play a crucial role in advocating for Indigenous patients’ rights and access to equitable healthcare. This includes addressing systemic barriers and supporting policies that promote health equity. 7. Community Involvement: Engaging with Indigenous communities and collaborating with traditional healers and community leaders. This helps in creating healthcare solutions that are culturally relevant and supported by the community. 8. Empowerment: Encouraging and supporting Indigenous patients to be active participants in their healthcare decisions. This involves  respecting their autonomy and promoting self-efficacy. By integrating these principles into their practice, nurses can provide more culturally safe and effective care for Indigenous patients, ultimately contributing to better health outcomes and well-being. A perspective that utilizes both Western health care knowledge and Indigenous knowledge, combining the strengths of each to better meet the health care needs of indigenous people. Week 7 LO Grounded in nurturing positive relationships; a relational approach that focuses on building trust. Discuss the The FIRST approach: practices to enhance cultural safety relevance of two- Family eyed seeing for Information nursing care in Canada. Relationship Safe Space Treatment United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) “It establishes a universal framework of minimum standards for the survival, dignity and well-being of the indigenous peoples of the world… Week 7 LO … it elaborates on existing human rights standards and fundamental Describe the freedoms as they apply to the specific situation of indigenous UNDRIP and its peoples.” (Source: United Nations Declaration on the Rights of relevance to nursing Indigenous Peoples | United Nations For Indigenous Peoples practice. Adopted by the UN General Assembly on 13 September 2007 Canada voted against it in 2007 (1 of 4 countries who did so) but officially endorsed it in 2016. Countries who voted against UNDRIP in 2007: Australia, Canada, New Zealand and the United States Week 7 LO A History of Harm: Residential Schools and Their Lasting Impact Understand the The residential school system in Canada represents a dark chapter in the history of nation's history. Established with the aim of assimilating Indigenous children Residential Schools into Euro-Christian Canadian society, these schools operated for over a and the impact on century, causing profound and lasting harm to Indigenous communities. The survivors today. Truth and Reconciliation Commission of Canada (TRC), formed to investigate and document the experiences of residential school survivors, has described the system as "cultural genocide". The Goals of Residential Schools The primary goal of these institutions was to sever the ties between Indigenous children and their families, cultures, and traditions. This was achieved through various means, including: Forced Removal of Children: Indigenous children were forcibly taken from their homes and communities and placed in residential schools, often far away from their families. Suppression of Indigenous Languages and Culture: Students were forbidden from speaking their native languages or practicing their cultural traditions. Indoctrination into Euro-Christian Culture: The curriculum focused on assimilating children into the dominant Canadian culture, with a strong emphasis on Christianity. The Horrors of Residential Schools The TRC's work has brought to light the horrific abuses endured by Indigenous children within the residential school system. The Commission collected over 6,000 testimonies from survivors, revealing the extent of the physical, sexual, and emotional abuse that occurred within these institutions. The conditions in many schools were appalling, with overcrowding, inadequate food and healthcare, and rampant neglect contributing to the suffering of the children. The death rate in residential schools was shockingly high, with many children succumbing to disease, malnutrition, or abuse. The Legacy of Trauma  The trauma inflicted by the residential school system continues to reverberate through generations of Indigenous families and communities. The TRC's findings detail the long-term impacts of this trauma, including: Intergenerational Trauma: The effects of abuse, neglect, and cultural dislocation have been passed down through generations, impacting the mental, emotional, and physical well-being of Indigenous peoples today. Loss of Identity and Culture: The suppression of Indigenous languages, traditions, and spiritual practices has resulted in a loss of cultural identity and connection for many Indigenous people. Health Disparities: Indigenous populations experience significantly higher rates of chronic diseases, mental health issues, substance abuse, and suicide compared to non- Indigenous populations. Distrust of Institutions: The legacy of abuse and neglect in residential schools has fostered a deep distrust of government and authority figures, particularly within healthcare settings. Addressing the Impacts of Residential Schools The TRC has issued a series of Calls to Action aimed at addressing the legacy of residential schools and promoting reconciliation between Indigenous and non-Indigenous Canadians. These calls include recommendations for improving the health and well-being of Indigenous peoples, promoting cultural revitalization, and fostering greater understanding and respect between cultures. Cultural Safety in Healthcare Understanding the history and legacy of residential schools is paramount to providing culturally safe care for Indigenous patients. Nurses and other healthcare providers must approach their Indigenous patients with sensitivity, respect, and a deep awareness of the historical trauma that continues to impact their lives.  Recommendations for Health Care The TRC Calls to Action for Health highlight the need for: Recognizing and respecting Indigenous health knowledge and practices. Increasing the number of Indigenous healthcare professionals. Providing cultural competency training for all healthcare providers. Reconciliation Reconciliation requires a collective effort to acknowledge the past, address the ongoing impacts of colonization and racism, and work towards a future based on mutual respect and understanding. It is a journey that requires Canadians to confront uncomfortable truths and actively engage in dismantling systems and structures that perpetuate inequality and injustice. Cultural awareness: attitude that incl awareness of diff between cultures Cultural…..approach to healthcare bsased- humble acknowlegement of one self as a learning understanding vs experience Week 7 Cultural sensitivity- an attitude that recog diff between cultures and that its Class notes important to acknowledge Terms and examples Cultural safety: approach- considers social and historical context and structural and interprofessional power imbalances that shape health and healthcare experiences Cultural competence: approach- focuses on obtaining practitioners skills knowledge and attitudes to work with Indigenous clients Week 7 *Video in slides* Class notes https://www.canada.ca/en/public-health/services/health- promotion/population-health/what-determines-health.html Which social Social determinants of health refer to a specific group of social determinants of and economic factors within the broader determinants of health are most health. important- relate to These relate to an individual's place in society, such as income, Brian Sinclair education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ and Black Canadians. 1. Income and social status 2. Employment and working conditions 3. Education and literacy 4. Childhood experiences 5. Physical environments 6. Social supports and coping skills 7. Healthy behaviours 8. Access to health services 9. Biology and genetic endowment 10. Gender 11. Culture 12. Race / Racism Week 5 slides Theory guides assessments, nursing diagnoses & nursing actions Theory to practice Renders practice more efficient & more effective Facilitates common language labels & defines phenomena articulates / describes nursing practice Enhances professional autonomy & accountability Guides research helps nurses to formulate research questions research findings may validate or lead to modification of theory, which then impacts on nursing practice and can generate ideas for further research  Nursing scholarship is evolving to include stronger philosophical and scientific inquiry. As a result, nursing practice must also be conceptualized with increasing clarity. Nurse philosophers and scientists are using a range of theories Week 5 Slides across disciplines to tackle new ways of thinking about complex health problems. Theorizing into the Refining our thinking as nurses will include the challenge of future integrating Indigenous Ways of Knowing into current practice models and education. The ultimate goal for nurses today is to create a coherent foundation to build, challenge and integrate a range of new ideas, new forms of knowledge, and new paths towards action. Week 6 Slides Culture is the context in which groups of people interpret and define their life Cultural context of experiences. It is the system of meanings by which people make sense of health and illness these experiences. “a dynamic relational process of selectively responding to and integrating particular historical, social, political economic, physical and linguistic Week 6 Slides structures and processes….culture is relationally determined and contextual.” Doane & Varcoe, 2015, p.139 How is culture understood in nursing? “…a process that happens between people. We continuously participate in and create culture, and culture is constantly in flux. No two persons share any given cultural affiliation in identical way.” Week 7 Slides Residential schools were created for the purpose of separating Aboriginal children from their families, in order to minimize and Summary of the weaken family ties and cultural linkages, and to indoctrinate children Final Report of the into a new culture - the culture of the legally dominant Euro- Truth and Christian Canadian society. Reconciliation That experience was hidden for most of Canada’s history, until Commission of Survivors of the system were finally able to find the strength, Canada, 2015 courage, and support to bring their experiences to light in several thousand court cases that ultimately led to the largest class-action lawsuit in Canada’s history. For over a century, the central goals of Canada’s Aboriginal policy were to eliminate Aboriginal governments; ignore Aboriginal rights; terminate the Treaties; and, through a process of assimilation, cause Aboriginal peoples to cease to exist as distinct legal, social, cultural, religious, and racial entities in Canada. The establishment and operation of residential schools were a central element of this policy, which can best be described as “cultural genocide.” The Truth and Reconciliation Commission of Canada was a commission like no other in Canada – spending 6 years travelling to all parts of Canada to hear from the Aboriginal people who had been taken from their families as children, forcibly if necessary, and placed for much of their childhoods in residential schools. The Commission heard from more than 6,000 witnesses, most of whom survived the experience of living in the schools as students. The stories of that experience are sometimes difficult to accept as something that could have happened in a country such as Canada, which has long prided itself on being a bastion of democracy, peace, and kindness throughout the world. Children were abused, physically and sexually, and they died in the schools in numbers that would not have been tolerated in any school system anywhere in the country, or in the world. Getting to the truth was hard, but getting to reconciliation will be harder. It requires that the paternalistic and racist foundations of the residential school system be rejected as the basis for an ongoing relationship. Reconciliation requires that a new vision, based on a commitment to mutual respect, be developed. It also requires an understanding that the most harmful impacts of residential schools have been the loss of pride and self-respect of Aboriginal people, and the lack of respect that non-Aboriginal people have been raised  to have for their Aboriginal neighbours. Reconciliation is not an Aboriginal problem; it is a Canadian one. Virtually all aspects of Canadian society may need to be reconsidered. Reconciliation will take some time. WHO’s (2007) understanding of Indigenous includes people who: Identify themselves and are recognized and accepted by their community as indigenous. Week 7 Slides Demonstrate historical continuity with pre-colonial and/or pre- settler societies. WHO’s (2007) Have strong links to territories and surrounding natural resources. understanding of Have distinct social, economic or political systems. Indigenous includes people who: Maintain distinct languages, cultures and beliefs. Form non-dominant groups of society. Resolve to maintain and reproduce their ancestral environments and systems as distinctive peoples and communities. Week 7 Slides Health is a concept that has multiple meanings. It is related to quality of life, is individually defined and is in dynamic interaction Indigenous People with the environment. Individuals, families, groups, communities and and the society share responsibility for health. The major principles of Metaparadigm primary health care: health promotion, accessibility, public concept of Health participation, appropriate use of technology and multi-disciplinary collaboration, are seen as fundamental in achieving health for all. Week 7 slides It is imperative that nurses understand the social determinants of health though an Indigenous lens, which helps to explain the Social Determinants underlying economic and social conditions that shape health / of health (intro) health concerns. Social determinants of health refer to a specific group of social and economic factors within the broader determinants of health.  These relate to an individual's place in society, such as income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ and Black Canadians. For example, impaired access to appropriate and adequate housing, income, education and health care, as a result of historical colonialism and current day post-colonial racism – significantly contributes to these health concerns. 1. Proximal determinants: direct influence on health, e.g. poor diet / limited access to nutritious food; lack of exercise; substance abuse; smoking 2. Intermediate determinants: indirect influence on health, e.g. Week 7 slides poor community infrastructure, resources and underfunded education systems (leading to lower education and income levels; Social determinants poorer living conditions) of Health through an 3. Distal determinants: MOST influence on health, e.g. historical, Indigenous Lens political, social and economic contexts from which intermediate and proximal social determinants of health are constructed, such as stable governance, competent leadership, and fair distribution of power and resources. Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Week 7 slides Eliminating racism is therefore central to achieving health equity, but Racism and impact this requires new paradigms that are responsive to structural on racism's contemporary influence on health, health inequities, and health and well research. being Think about what’s happened, and what’s happening in our world today. Are we on the cusp of a new paradigm?? What does this mean in terms of equitable health care – for all? Week 7 slides What may have kept Mr. S. from attending his procedure? Working with Mr. S.'s absence may stem from several factors: Canada’s Indigenous people 1. Fear and Anxiety: The procedure could have triggered deep- Case study: seated fears, possibly linked to a lack of understanding, past medical trauma, or mistrust in the healthcare system. You are the 2. Cultural and Historical Context: Indigenous Canadians have coordinator for a experienced systemic racism and discrimination in healthcare. This liver transplant team. Mr. S. comes 3. history can lead to mistrust and fear of medical institutions. Communication Gaps: Despite appearing to understand the to see you for his procedure, Mr. S. might have had lingering doubts or questions he pre-evaluation. He is didn't feel comfortable expressing. an Indigenous man with liver cancer 4. Logistical Issues: Living on a reserve far from Toronto might pose who lives on a transportation or financial challenges that he found overwhelming. reserve a couple of hours drive away What could you, as a nurse, do to encourage Mr. S. to follow through from Toronto. Over with treatment plans? the course of a few months, you meet 1. Build Trust: Establish a rapport based on respect, listening, and with him three times empathy. Acknowledge any historical injustices and demonstrate a to explain the commitment to culturally safe care. process for a liver 2. Clear Communication: Ensure all explanations are clear and transplant and jargon-free. Encourage questions and check for understanding. answer any 3. Support Systems: Offer resources like patient navigators, questions. He especially those who are Indigenous, to assist Mr. S. through the attends all process. appointments and appears to 4. Holistic Approach: Respect traditional Indigenous healing understand your practices and consider integrating them with Western medical explanations. On the treatments. day of a procedure 5. Flexible Scheduling and Transportation: Help coordinate to place radiation transportation and appointments that fit his schedule better. beads into his liver to combat the liver What other concerns do you have about Mr. S., beyond his health cancer, he does not needs? What questions would you ask? show up and you cannot reach him. Beyond his immediate health needs, consider: He calls you 2 weeks later, saying 1. Mental and Emotional Well-being: The impact of his diagnosis and that he was too treatment on his mental health. scared to come in 2. Social Support: Does he have a support network, such as family or for the procedure. community members? 3. Cultural Practices: Are there cultural practices or beliefs that need Using the concepts to be considered in his care plan? of cultural safety 4. Access to Care: The availability and accessibility of follow-up care and humility, and and support services on his reserve. considering the historical context Questions to ask: of Indigenous Canadians’ experiences, How are you feeling emotionally and mentally about the treatment? discuss the Do you have family or community support during this time? following: Are there any cultural practices or beliefs you would like us to respect or integrate into your care? What may What specific concerns or questions do you have about the have kept procedure or treatment plan? Mr. S. from attending The goal is to approach Mr. S. with empathy, respect, and an understanding his of his unique context, ensuring he feels supported and valued throughout his procedure? treatment journey. What could you, as a nurse, do to encourage Mr. S. to follow through with treatment plans? What other concerns do you have about Mr. S., beyond his health needs? What questions would you ask?