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Answering the Call
Exploring Canadian Indigenous History and Culture from a Nursing Perspective with a Focus on Promoting Culturally Competency.
#24
Reflection on Learning: Exploring Elements of Providing Culturally Competent Care
Key learning objective: Describe a conceptual awareness of: culture, cultural diversity, culturally sensitive care, transcultural nursing, and multiculturalism in a Canadian context.
Reflecting on where I was at the beginning of this program, I realized my entire views of culture care have changed. I had always had a realistic concept of culture itself, but what I realized is that I was not as flexible in my sensitivity. I prided myself on being very empathetic, but it wasn’t until I really started my research into indigenous culture that I realized I still had the mindset that it was my job to fix people's problems and my responsibility. I had not taken the time to consider, culturally, what it would mean to the patient to have me take control. On my discussion board, I had the opportunity to talk a bit about what culture means. I explained that culture is not the same as ethnicity (Srivastava, 2007). What I was most surprised about was that it is very difficult to have a conversation about culture with people. I found it especially difficult when the topic was indigenous relations. Through research I have learned a lot about culturally sensitive care for indigenous people. The Canadian government has not been honest or fair in the past and has been manipulative and controlling. As health care is regulated through the government, we are part of that system. We need to come in with an awareness of the past trauma.
Srivastava, R.H. (Ed.). (2007) The Health care professional’s guide to clinical competence. Toronto,
Reflection on Learning: Developing Methods Towards Cultural Competency
Key learning objective: Utilize theoretical frameworks and models to perform cultural assessments.
I had never really considered assessing culture prior to this class. In my job as a community nurse, I do intake assessments regularly. After reflecting on our assessment tool, I have created my own set of questions to add to the basic assessment. I have now used this on 3 clients I admitted for care, 1 was palliative.
1. Do you identify with a particular culture (I never assume)
2. Would you prefer that I ask questions with your spouse present?
3. I ask about the family, and work, I ask if there are any concerns
4. I ask them about nutrition and what a typical day's meal plan would be
5. I assess for any high risk behaviours.
6. I discuss spirituality. (This one was a hard one for me)
I will start off using low context communication, but I have found people who are used to high context will get frustrated, or impatient, then I adapt to their needs
I address wishes around death and pregnancy as appropriate. Being a palliative nurse, death was one of the easier things to discuss (NASN, 2013).
I was surprised at the response I got from clients. The frequent comment was “Wow you are thorough”. There was also a comment that no one had ever bothered to ask a client her preferences before. I adapted these questions from the Purnell Model and will continue to use them as I felt by the end, my clients and I had a stronger connection.
National Association of School Nurses. (2013) Purnell model for cultural competence by Larry Purnell. Retrieved from: https://www.nasn.org/nasn/nasn-resources/practice-topics/cultural-competency/cultural-competency-purnell-model
Reflection on Learning: Applying Culturally Competent Health Care Practices
Key learning objective: Explore sources of discord within the health care experience of clients and among healthcare teams as opportunities for leadership in cultural competence.
When I started exploring the topic of indigenous health, I decided that I needed to produce something more than just an average assignment. I wanted to ensure other nurses had easy access to what I had learned. The amount of literature about the social and health inequities of indigenous people is overwhelming. I have had open discussions on Facebook with people willing to discuss what is going on. For each conversation I had, 10 others were turned down. I contacted multiple indigenous health centers. No one was willing to talk with me. When I reflect, I see why. For non-indigenous Canadians, what is happening is hard to accept, and easier to ignore; it is sad, and shameful. I can only guess why indigenous groups choose not to talk to me, but from what I have learned, the most important thing they want is autonomy. They do no need or want non-indigenous people “fixing” what is happening. History has shown that each time we interfere, indigenous people suffer more. I completely understand, and so I did not pursue this line of research. Other than the Facebook conversations I had this website is my evidence I have explored discourse in the health care experience. (to clarify my stance, I follow the biopsychosocial model for care and include social determinants of health in my health assessments). My opportunity for leadership will be to advocate for Call to Action #24, Requiring all medical and nursing students to take an aboriginal health course (TRCC, 2015).
Truth and Reconciliation Comission of Canada. (2015) Truth and reconciliation commission of canada: Calls to action. [PDF] Retrieved from: http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf
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