NURS 2016 Week 10 Slides PDF

Week 10 NURS 2016 Issues of Gender and Culture Continued NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 1 Week...

Week 10 NURS 2016 Issues of Gender and Culture Continued NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 1 Week 10 objectives Identify the Indigenous diversity of the Canadian population. Examine the Canadian history of colonization and the historical timeline of key Indigenous events in Canada. Examine the legacy of residential schools and the effects on Indigenous people. Describe the concepts of structural racism, child welfare, poverty and the justice system in relation to nursing practice. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 2 2 Week 10 objectives Differentiate between respect, trust and spirituality when caring for Indigenous people. Describe the components of Indigenous cultural orientation in relation to nursing practice. Compare Indigenous determinants of health and Indigenous health from a Canadian perspective. Discuss the health of Indigenous peoples of Canada. Identify unique health problems and challenges related to the health of Indigenous peoples. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 3 3 Truth and Reconciliation Of Canada: Call to Action #24 “We 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.” Reference: http://www.trc.ca/ NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 4 4 Indigenous Diversity Of Canada’s population, 4.3% is Indigenous. Indigenous groups These groups include First Nations, Métis, and Inuit. Each have their own unique languages, heritages, cultural practices, and spiritual beliefs. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 5 5 Indian Act, 1876 Set forth under the Royal Proclamation and allocating a small land base—a reserve—for the exclusive use of those defined as Indians. Legal term Indian The Indian Act and its subsequent amendments were designed to control every aspect of a Status Indian’s life and to promote assimilation. Status, non-Status, and Treaty Indians  Status Indians needed to have a pass to enter and leave reserves, They were not considered persons, were not allowed to vote, not allowed to express their cultures through dance and ceremonies, and were Prevented from exercising hereditary forms of government. If First Nations individuals wished to own property or pursue a higher education, they were “enfranchised,” losing their Indian Status and their right to live on reserve or to receive any of the few treaty-allocated benefits. First Nations women who married non-First Nations men were also enfranchised, resulting in their loss of Indian Status for themselves and their children. It was also a tool that the government used to access First Nations’ land and resources. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 6 6 Indian Act, 1876 The definition of Indians excluded the two other main groups of Aboriginal peoples, Inuit and Métis. Neither Inuit nor Métis had any recognized title. It was not until the Constitution Act of 1982 that Inuit and Métis peoples were recognized as distinctive groups of Aboriginal peoples in Canada NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 7 7 Indigenous History in Canada European contact Holistic view of health Inuit Includes family, community, nature, Begun to change in response to the and the Creator presence of European whalers in the 1700s.  Health is about how you live and Whalers traded trinkets, tools, and how you connect with others. We food in exchange for assistance. each have the power to live a Intensive whaling quickly depleted the “healthy” life. whale populations, and the Europeans lost interest. Health is achieved by maintaining a Inuit were left without access to the balance of physical, mental, European supplies on which they had become dependent. emotional, and spiritual elements. Beginning of t20th century, the main source of commerce between Inuit and Europeans had moved from whaling to fur trading, with Inuit trading furs for guns, ammunition, tobacco, tea, sugar, cloth, metal tools, and other items. Europeans in the Arctic exposed Inuit to new diseases such as measles and tuberculosis. Because their immune systems were not adapted to these diseases, many Inuit died. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 8 8  Indigenous History in Canada European contact Métis Métis are descendants of European fur traders (largely French, Scottish, or English) and First Nations women. During the 18th and 19th centuries, European fur traders travelled across Canada, sometimes becoming involved with First Nations women for political or strategic reasons. Women began to have children who were half European and half First Nations. Children with French fathers became known as Métis, and those with English or Scottish fathers were known as “countryborn.” These children were often referred to with more offensive terms such as “bois-brûlés,” “mixed-blood,” or “half-breed.” A unique culture, based on a mix of European and First Nations traditions and practices, developed.  During the 19th century, Métis communities continued to grow, with many settling in the Red River area of what is now Manitoba. The Manitoba Act of 1870 laid the foundations for establishing who was eligible to own land. Métis were issued a certificate which was redeemable for land or money. Métis became known as the “Road Allowance People,” living on the edges of towns, with extremely limited economic opportunities, and no access to education or social services. Holistic view of health “we see each other as being related to everything.” –Métis Elder Tom McCallum NAHO Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.2024-2025 NURS 2016 All rights reserved. 9 9 Colonialism Diseases (such as influenza, smallpox, measles, polio, diphtheria, tuberculosis and later, diabetes, heart disease and cancer); The destruction of traditional economies through the expropriation of traditional lands and resources; The undermining of traditional identity, spirituality, language and culture through missionization, residential schools and government day schools; The destruction of indigenous forms of governance, community organization and community cohesion through the imposition of European governmental forms; The breakdown of healthy patterns of individual, family and community life. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 10 10 Indigenous History in Canada Summary: Post-European contact Colonialism Institutions and policies concerning Indigenous peoples developed by European imperial and Euro-American settlers Reserve system Governance structure Historical trauma NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 11 11 Indigenous History in Canada Post-European contact Residential schools After Confederation, the education of Aboriginal children became a federal responsibility and was subcontracted to Christian churches. Canadian residential schools were the “ultimate tool of assimilation” and aimed at “killing the Indian in the child”. From the mid-1800s until as late as 1996 an estimated 100 000 Aboriginal children aged 4 to 18 were removed from their families and placed in residential schools. Most children attending residential school were kept at school the whole year. At these church-run schools, children had their hair cut short, were forbidden to speak their language, were forced to convert to the religious denomination of the school, were subjected to corporal punishment, and were often sexually abused. The rates of infectious diseases due to the unsanitary conditions resulted in high mortality rates. The children rarely had opportunities to see and experience normal family life. Residential school survivors grew up never having known affection from their parents, and often they only recalled cruelty and abuse at the hands of people in positions of power at various residential schools. Residential school survivors grew up to have families of their own, they did so without having learned parenting skills from their own parents. Copyright © 2019 NURS 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 2024-2025 12 12 Indigenous History in Canada Post-European contact Cultural genocide Between 1937 and 1972, thousands of forced sterilizations occurred among Aboriginal women in Alberta and British Columbia. As a result there is a wariness on the part of Aboriginal women when it comes to any discussion about contraception. Fear that there is a relation between routine Pap smear testing and sterilization makes some women wary of having this testing done NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 13 13 Indigenous History in Canada Summary: Post-European contact Residential schools Intergenerational trauma Cultural genocide Delays in service for on-reserve First Nations children Assault of Indigenous women Child welfare and Sixties Scoop Indigenous child poverty The justice system and incarceration of a disproportionate number of Indigenous people CopyrightNURS 2016 2024-2025 © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 14 14  Indigenous History in Canada Post-European contact Truth and Reconciliation Commission Mandate is to reveal complex truth about the history and ongoing legacy of the church-run residential schools Guide and inspire a process of truth and reconciliation within Aboriginal families and between Aboriginal peoples and non- Aboriginal communities, churches, governments and Canadians. Established 2008 94 “Calls to Action” NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 15 15 Indigenous History in Canada Cont’d Truth and Reconciliation Commission: Indigenous Nursing Truths Invisibility of Indigenous knowledge in nursing Health disparities continue to widen Voices of Indigenous Nurses were silenced Many barriers to accessing nursing education NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 16 16 Indigenous History in Canada Cont’d Nursing in the Post Truth and Reconciliation Commission Era: Reconciliation: an ongoing process of establishing and maintaining respectful relationships at all levels of Canadian Society UNDRIP: United Nations Declaration the Rights of Indigenous Peoples CINA (Canadian Indigenous Nurses Association): “Authentic Indigenous Partnerships” NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 17 17 Indigenous History in Canada Cont’d Nursing in the Post Truth and Reconciliation Commission Era: UNDRIP: United Nations Declaration the Rights of Indigenous Peoples The UN Declaration ensures that indigenous peoples' rights to cultural integrity, education, health, and political participation are protected. The UNDRIP also provides for the recognition of indigenous peoples' rights to their lands and natural resources, and the observation of their treaty rights NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 18 18 Indigenous History in Canada Cont’d Nursing in the Post Truth and Reconciliation Commission Era: CINA (Canadian Indigenous Nurses Association): “Authentic Indigenous Partnerships” Inclusive of values grounded in diverse Indigenous philosophies Collegial, national provincial and local nursing partners Advance ongoing nursing policy, research, practice and education goals NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 19 19  Indigenous History in Canada Post-European contact Truth and reconciliation Truth and Reconciliation Commission Common Experience Payment Financial settlements for those who had suffered abuse or neglect Commemoration initiatives E.g. proposed statutory holiday, National Day for Truth and Reconciliation Funding to support the Aboriginal Healing Foundation NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 20 20 Settler Ally Settler ally: someone who collectively considers how steps taken can advance the truth and reconciliation process Steps to becoming a settler ally Self-awareness Self-education Creating an open and supportive environment Action NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 21 21 World Health Organization’s Human Development Index Quality of life calculation that measures life expectancy, education, standard of living, and gross domestic product collected at a national level. Canada ranks 6th out of 187 countries, pointing to a quality of life that is celebrated and cherished by many Canadians. When calculated using statistics from First Nations communities in Canada, we see gross disparity First Nations rank 68th on the Index. Life expectancy for First Nations is 5 years less than for non-Aboriginal people. Métis live an average of 1 year longer than First Nations. Inuit showed a 12- to 15-year lower life expectancy than Canadians as a whole during. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 22 22 World Health Organization’s Human Development Index A holistic view of health recognizes that health is a state of complete physical, mental, and social well-being, and that “health inequities arise from the societal conditions in which people are born, grow, live, work and age.” The social conditions in which many Aboriginal people live have a significant influence on their disproportionate rates of illness and disease and are referred to as the social determinants of health. Copyright © 2013 Society of Obstetricians Copyright © 2019and Gynaecologists Elsevier Canada, of a Canada Terms NURS 2016 division ReedandElsevier Conditions of 2024-2025 Canada, Ltd. All rights reserved. 23 23 Social Determinants of Health To consider health from a social determinants perspective requires shifting considerations away from individual subjects to both the social contexts in which that subject works, plays, loves, and experiences life and to the social factors which impact that subject, including (amongst other things) economics, education, early childhood development, access to healthcare services and housing. (Reference: Anderson et al 2002; Marmot 2005) Indigenous population has lower levels of education, income, and employment NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 24 24 Illness Experiences—Chronic Diseases Social determinants of health with historical and contemporary inequities rooted in: Proximal determinants of health – (e.g. income, education, gender. 50% of the on-reserve First Nations population aged 25 to 64 did not complete high school, compared with 15% for other Canadians.) Intermediate determinants of health - (e.g. health care and education systems. The rate of tuberculosis among Inuit is 185 times the rate of non-Inuit Canadians.) Distal determinants of health – (e.g. colonialism, racism, self ‐ determination) NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 25 25 Some Prominent Inequities Indigenous peoples in Canada For example: continue to suffer greater Drinking water inequities on a number of Food insecurity factors that impact their lives. Poverty As a result they bear a greater Chronic conditions e.g. diabetes burden of ill health compared to Alcohol and drug misuse other Canadians. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 26 26 Cultural Orientations Indigenous worldviews In Canada Connection to the land Diversity Collective cultures, focused on Connection between physical the good of the people, not on and spiritual the individual Many matriarchal cultures Elastic sense of time Everything is related and interconnected NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 27 27 Cultural Orientations Theories of Indigenous Indigenous health: health balance among emotional, physical, The Medicine Wheel spiritual, and mental teachings dimensions Circular Modes of treatment: representation of the include ceremonial, herbal and medicinal, interconnectedness and storytelling of life Core belief of sacredness NURS 2016 2024-2025 Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 28 28 Cultural Orientations Theories of Indigenous health Seven Grandfathers Teachings (Seven Sacred Values) Learning about wisdom, love, respect, bravery, honesty, humility, and truth Correlation between health and Indigenous identity NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 29 29 Nursing Considerations and Indigenous Health Respect Reciprocal process Vulnerability, dependence, Trust risk taking Traditional Indigenous Spirituality faiths and healing NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 30 30 Illness Experiences—Chronic Diseases Implications for nursing Cultural competence Cultural safety For individuals and at the institutional and policy levels Humility NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 31 31  Illness Experiences—Chronic Diseases Implications for nursing (cont’d) Social determinants of health with historical and contemporary inequities rooted in: Proximal determinants of health – (e.g. income, education, gender. 50% of the on-reserve First Nations population aged 25 to 64 did not complete high school, compared with 15% for other Canadians.) Intermediate determinants of health - (e.g. health care and education systems. The rate of tuberculosis among Inuit is 185 times the rate of non-Inuit Canadians.) Distal determinants of health – (e.g. colonialism, racism, self ‐ determination) Copyright © 2019 NURS 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 2024-2025 32 32 Illness Experiences—Chronic Diseases Health disparities Diabetes mellitus HIV and AIDS Cancer Tuberculosis Chronic obstructive pulmonary disease; asthma Cardiovascular disease Otitis media Rheumatic disease Addictions NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 33 33 Review: Cultural Safety The person delivering care should reflect on their practice and their own cultural identity Recognise that personal culture has an impact on professional practice Culturally safe health services are free of racism and discrimination. People are supported to draw strengths from their identity, culture and community. Unsafe cultural practice compromises any action, which diminishes, demeans or disempowers the cultural identity and well-being of a person NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 34 34  Cultural Safety The Aboriginal Nurses Association of Canada (2009) states that it is important to address inequities through the lens of cultural safety, which enables healthcare providers, including nurse to: Improve healthcare access for patients, aggregates and populations; Acknowledge that we are all bearers of culture; Expose the social, political and historical contexts of healthcare Enable practitioners to consider difficult concepts such as racism, discrimination, and prejudice; Acknowledge that cultural safety is determined by those to whom nurses provide care; Understand the limitations of “culture” in terms of having people access and safely move through healthcare systems and encounters with care providers and; Challenge unequal power relations Reference: Aboriginal Nurses Association of Canada. (2009). Cultural Competence and Cultural Safety in Nursing Education: A Framework for First Nations, Inuit and Métis Nursing - https://www.cna- NURS 2016 of 2024-2025 aiic.ca/en/policy-advocacy/indigenous-health#sthash.kNnA0P19.dpuf Copyright © 2019 Elsevier Canada, a division Reed Elsevier Canada, Ltd. All rights reserved. 35 35 Review: Cultural Safety Cultural safety is achieved when the recipients of care believe the care being given to them meets their cultural needs Cultural competence is a process, not an endpoint, in which the carer can continuously strive to achieve the ability to work within the cultural context of an individual, family or community from a diverse cultural/ethnic background NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 36 36  Cultural Assessment: Indigenous Peoples of Canada First Nations, Métis, Inuit Unique language, heritages, cultural practices, spiritual beliefs Implications for nursing practice Cultural safety originated with Aboriginal peoples Nurse scholars researching health challenges faced by Aboriginal peoples Relational practice Nursing obligation to examine relationships, ethics, and effective nursing practice and the personal and contextual elements that continuously shape and influence nursing relationships NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 37 37 Truth and Reconciliation Of Canada: Call to Action #22 “We call upon those who can effect change within the Canadian health-care system 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.” NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 38 38  Ask the CNO: Indigenous Cultural Care I work in an Indigenous community in northern Ontario. How can I support my patients and what resources are available to address the unique health needs of the Indigenous community? Response: Partnering with patients and providing culturally sensitive care are important components of patient centered-care. You are accountable for discussing with your patients, your and your patient’s roles in achieving the care plan’s desired goal. You also must ensure you are sharing nursing knowledge with patients and promoting the best care possible. A nurse’s commitment to patient-centred care as outlined in the practice standard, Therapeutic Nurse-Client Relationship, Revised 2006, outlines ways of meeting the patient’s and community’s unique needs. A nurse meets the practice standard, Professional Standards, Revised 2002 by collaborating with their manager and other colleagues, and determining how to fulfill the patient’s and community’s needs. There is more information and helpful resources on the Government of Canada’s Indigenous Health page. NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 39 39  Summary Indigenous diversity Indian Act Pre-European contact Post-European contact Colonialism Residential schools Truth and reconciliation Structural racism Indigenous worldview Theories of Indigenous health Chronic diseases and health disparities NURS 2016 Copyright © 2019 Elsevier Canada, a division of 2024-2025 Reed Elsevier Canada, Ltd. All rights reserved. 40 40  References Aboriginal Nurses Association of Canada. (2009). Cultural Competence and Cultural Safety in Nursing Education: A Framework for First Nations, Inuit and Métis Nursing - https://www.cna-aiic.ca/en/policy-advocacy/indigenous-health#sthash.kNnA0P19.dpuf Arnold, E. C. & Boggs, K. U. (2016). Interpersonal relationships: Professional communication skills for nurses (7th Ed.). St. Louis, MO: Elsevier Canada. Blackboard (BB) Resources for NURS 2016 Burkhardt,M.A., Nathaniel, A.K., & Walton, N. (2018). Ethics and Issues in Contemporary Nursing (3rd Canadian ed.). Toronto, ON: Nelson Canada. College of Nurses of Ontario. (2009). Culturally sensitive care. Retrieved from www.cno.org College of Nurses of Ontario. (2013). Therapeutic nurse-client relationship (Revised, 2009). Retrieved from www.cno.org Journal of Obstetrics and Gynaecology Canada 2013 35, S13-S23DOI. Chapter 3 Social Determinants of Health Among First Nations, Inuit, and Métis. Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. Potter, P. A., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2019). Canadian Fundamentals of Nursing (6th Canadian ed.) (J. C. Ross- Kerr, M. J. Wood, B. J. Astle & W. Duggleby, Canadian Adapt.). Toronto, ON: Elsevier Canada. Stamler, L. L. & Yiu, L. (2012). Community health nursing: A Canadian Perspective (3rd ed.). Toronto,ON: Pearson Canada Inc. NURS 2016 Course Outline and as specifically indicated on PPT slides NURS 2016 2024-2025 Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 41 41