Module 7 - Cultural Safety and Indigenous Populations

Question 1

What are the 3 Indigenous groups

Answer 1

First Nations, Inuit, and Métis

Question 2

Three indigenous Canadian groups, the unique nature of all subgroups

Answer 2

• The Métis are a distinct Indigenous group borne from the union of Indigenous women and European men during the fur trade era, post-European contact but pre-colonization. Métis communities became established and remained distinct from other Indigenous communities, with their own culture and way of life, including unique language (Michif), music (fiddling), dance (jigging), transportation (the Red River cart), and clothing (woven Métis sashes)
• The Inuit have inhabited northern Canada for over 5000 years. More than two-thirds of Inuit live in the northern part of Canada, in four territories (Inuit Nunangat)
• First Nations people, the groups of people who were the original inhabitants of Canada before European explorers began to arrive in the 1600s (pre-European contact).

Question 3

Who is legally called Indian and the legal definitions for Indigenous peoples in Canada

Answer 3

• The Government of Canada uses the legal term Indian to describe all Indigenous peoples in Canada who are not Inuit.
• The legal definitions used to describe Indigenous peoples in Canada include Status Indians, non-Status Indians, and Treaty Indians.

Question 4

What are status

Answer 4

• Status Indians are individuals registered under the Indian Act, the legislation that regulates the management of reserves and sets out certain federal obligations.

Question 5

What is a Treaty Indian

Answer 5

• A Treaty Indian is a Status Indian who belongs to a First Nation that signed a treaty with the Crown

Question 6

Colonialism as a theoretical framework & it’s relationship to historical trauma

Answer 6

o Colonialism is the ongoing policy of domination that begin with the age of European imperialism in the fifteenth century, during which the monarchs of Europe strove to expand their empires and wealth
o Colonization is the purposeful practice of settling invaders onto foreign lands, plundering the land’s resources, and exploiting and marginalizing the inhabitants.
o Colonialism resulted in overwhelming historical trauma (the nature of trauma as experienced over many years) for Indigenous peoples.
o Responding to the health challenges that Indigenous peoples experience requires an understanding of the historical, social, and economic contexts in which Indigenous families and communities are situated.

Question 7

Residential schools

Answer 7

o Indigenous children as young as 4 years old were separated, often forcibly, from their parents and sent to residential schools to board year-round in order to sever the link between their Indigenous identity and culture as a part of colonialism.
o It was the government’s plan to eliminate Indigenous peoples as a distinct cultural group and make them assimilate into society
o Indian day schools were similar except the kids went at home at night. Indian Day Schools were cheaper to run and operated in a greater number and for a longer time period than Indian residential schools. Part of the mandate of Indian Day Schools was to assimilate the community as well as the student.
o The government funded various churches to run the schools. Lots of abuse, physical and sexual, as reported at the schools. Badly built buildings, harshly disciplined for speaking their own language
o As a result of this upbringing, they did not learn how to be parents themselves. Descendants of residential school survivors recall being harshly disciplined by their parents in abusive homes, with minimal affection—experiences similar to those of residential school survivors. This is known as intergenerational trauma. The shared collective experiences of sustained and numerous attacks on a group that may accumulate over generations.
o Cultural genocide is defined as the “destruction of those structures and practices that allow the group to continue as a group” which Canada is guilty to doing to Indigenous peoples

Question 8

What is the Sixties scoop

Answer 8

o The Sixties Scoop refers to the apprehension of thousands of Indigenous children from their families and reserves “on the slightest pretext” from the 1960s to the 1990s
o These children were often placed in non-Indigenous homes; however, the devastating effects of removing children from their families and culture were not considered. Some First Nations lost nearly an entire generation of children in this way
o It was a way to continue the colonization and assimilation of Indigenous peoples, as the children were put into non-Indigenous homes were they often faced abuse and many left. Children also experienced the loss of culture and identity, racialized power dynamics, and struggles with identity and low self-esteem, resulting in self-harm and suicide in some cases.

Question 9

What are Settler Allies

Answer 9

o A settler ally is someone who collectively considers what steps they can take to advance the Truth and Reconciliation process
o All Canadians have been invited by the Truth and Reconciliation Commission of Canada to become settler allies—teachers and learners who want to be informed of Indigenous–non-Indigenous historical relations; of Indigenous world views related to treaties, economic development, environment, community, and negotiations; and of instructional holistic approaches that are inclusive and safe, such as smudging, talking circles, and Indigenous teachings.

Question 10

Holistic and circular view of health

Answer 10

o Globally, Indigenous world views tend to include a strong connection to the land; millennia-old knowledge of the land and its uses; collective cultures focused on the good of the group, not the individual; and an elastic sense of time focused on seasons rather than hours
o Historically, Indigenous communities experienced healing and well-being through a holistic view of health that considered the physical, emotional, mental, and spiritual dimensions of illness and treatment. Poor health results from disharmony or imbalance among the four components
o In Canada, there are several ways of viewing health and healing. The Medicine Wheel Teachings and the Seven Grandfather Teachings (or Seven Sacred Values)— theories of Indigenous health —can be used as a framework when contemplating health and healing strategies
o The circle is an important symbol in Indigenous healing that represents the interconnectedness of all beings. The Medicine Wheel , otherwise known as the Wheel of Life, the Circle of Life, the Hoop, or the Pimatisiwin Circle is a symbolic circular representation of the interconnectedness of life that denotes a philosophical foundation of an Indigenous world view.
o In the middle there is balance then the top is north: white, winter, elder, sweetgrass, mental; bottom is south: red, summer, youth, cedar, emotional; left is west: black, autumn, adult, sage, physical; the right is east: yellow, spring, child, tobacco, spiritual.
o Indigenous health is traditionally understood to be a balance among the emotional, physical, spiritual, and mental aspects of a person.

Question 11

Where does learning takes place (Indigenous)?

Answer 11

• Indigenous peoples learn from culture and spoken word, elders speaking to others. Teachings are passed down by words.

Question 12

What is the meaning and significance of the circle?

Answer 12

• in a circle when having a conversation or asking for a prayer you are able to make eye contact and see their body language. You can tell if they are being truthful, if they hurt or upset, if they are strong, or if they have resources to help you

Question 13

What does a sacrifice of children can mean to a society or a people?

Answer 13

o “You want to kill a people, take the kids away”
o If the children are taken away the culture is lost, everyone suffers, the parents, the grandparents, and the children
o Cutting of the children from away from their roots/network. They will not know who to parent as a result and that creates generation trauma

Question 14

What does trauma informed mean?

Answer 14

• Trauma informed mean recognizing the link the trauma has with substance abuse, mental illness, stigma, barriers to healthcare, and other challenges, along with making sure that people feel safe and are not re-traumatized during their care.

Question 15

The 4Rs

Answer 15

o Realization: An organization-wide realization, or understanding, of how trauma affects people
o Recognize: The ability to recognize the signs of trauma
o Response: A system-wide response to trauma that informs all behaviours, language, programs, and policies
o Resisting: Resisting re-traumatization of patients, clients and staff. Organizations can unintentionally create conditions that will re-traumatize people

Question 16

Trauma informed practice - the 6 principles

Answer 16

o Safety
o Trust and transparency
o Peer support
o Collaboration and mutuality
o Empowerment, voice, and choice
o The importance of cultural, historical, and gender issues

Question 17

What does cultural safety mean to you in the context of nursing?

Answer 17

o Be aware of biases of other cultures
o Know that western practices may be seen differently in other cultural
o Still giving care even if they do not want to go through western care/medicine
- Cultural safety is the responsibility of the healthcare sector to provide care to anyone despite their culture

Question 18

What is cultural safety?

Answer 18

• Cultural safety was introduced in 1990 by Irihapeti Ramsden (Māori nurse). It’s an outcome based on respectful engagement – an environment free of racism and discrimination, where people feel safe when receiving healthcare. Focuses on the outcome

Question 19

What is cultural sensitivity and cultural competence?

Answer 19

• Cultural Sensitivity (taking in consideration the cultural background and experiences of Indigenous peoples)
• Cultural competence (refers to the knowledge, skills, and attitudes of practitioners which revolve around empowering clients

Question 20

What is intersectionality”

Answer 20

• Intersectionality is about how different identities face discrimination and are a vehicle of vulnerability

Question 21

Tree of Injustices and inequalities

Answer 21

o Leaves – visible outcomes e.g. Racial slurs, tokenism, and other forms of individual/personal racism
o Trunk – culture and practices (that lead to the “leaves” or visible outcomes) e.g. Institutional hiring practices
o Roots – Inequities and injustices e.g. racism, sexism, ableism, etc.

Question 22

Navigating Biases

Answer 22

o Our brains tell stories based on very little information
o We make assumptions based on the world around us
o Frame of reference: the ways in which aspects of our identity impact the way we see and experience the world around us.

Question 23

Barriers in Healthcare

Answer 23

o Lack of cultural knowledge
o Personal biases/stereotypes
o Power imbalances
o Lack of time and resources
o Communication barriers
o Institutional and systemic barriers
o Patient hesitation or distrust
o Social determinant of health

Question 24

Addressing Barriers In Healthcare

Answer 24

o Promote ongoing cultural safety training

Question 25

Inclusive Practices

Answer 25

o Community agreement
o Familiarizing with resources (ex. Languages)
o Give an indicator of safety
o Show interest, compassion, care
o Recognizing our own lenses and positionality
o Commit to do better and to self-reflection
o Preparing: knowledge and content; sense of agency: experience practice

Question 26

The Role of the Nurse and Educator

Answer 26

o Racism is a major challenge. Overcome this by being courageous and relentless in addressing it, identifying it when we see it, and teaching our children well. Model a better way to behave, take individual responsibility to improve self and the area around you. Address racism through cultural teachings of respect, patience, and self-regulation.
o Racism is an on-going challenge for our students and our teachers. We need to see it, respond proactively to it and overcome it through education. This topic surfaced at every gathering and we can make the difference by modeling and teaching more inclusively and designing our curriculum and learning experiences with this in mind.

Question 27

What is colonialism and why is it important to understand the history?

Answer 27

o Colonialism – is the term for theoretical framework for understanding the complexities of the Indigenous and European relationships; specifically it is the development of institutions and policies by European settler governments towards Indigenous people.
o Understanding the history of Colonialism is important to be able to embrace an Indigenous healing journey.

Question 28

What is the purpose of the Indian act?

Answer 28

o 1876 – Indian Act first passed (amended many times since); main purpose to assimilate and regulate reserves, money, and resources

Question 29

What is a reserve?

Answer 29

o Reserve – pieces of land set aside by the federal government for indigenous populations. Governance structure imposed by federal government.

Question 30

What was the pre-contact Indigenous health?

Answer 30

o Holistic view of health, illness, and treatment consist of physical, emotional, mental, and spiritual dimensions.
o Research indicates Indigenous people were generally very healthy, well nourished.
o Minimal diseases
o Death through accidents, injury, warfare.

Question 31

What were the effects of colonialism?

Answer 31

o Europeans introduce disease: small pox, tuberculosis, measles
o Resources are depleted – diminishing Indigenous livelihoods.
o Malnutrition, starvation
o Alcohol introduced
o Canadian Government:
o Displace Indigenous people from traditional lands
o Isolate and assimilate
o Colonialism as the theoretical process
o Involved much trauma

Question 32

Isolate and Assimilate

Answer 32

o Residential schools - “left a legacy over several generations resulting in physical and psychological abuse that is reflected in the significant educational, income, health, and social disparities between aboriginal people and other Canadians”
o The slogan was “Kill the Indian – save the child. Kill the Indian – save the Christian”

Question 33

Residential Schools History

Answer 33

o Last residential school closes in 1996 (Gordon Indian Residential School, Punnichy, Saskatchewan)
o Indigenous children, as young as 5 years old, removed from families
o Year round boarding, severing family link
o Severed link to culture and identity (policy & purposeful)
o Government avoids legal and financial obligations and gains control over land and resources
o Minimal regulation of schools
o Malnourishment and death, mistreatment and abuse.
o Indigenous children, as young as 5 years old, removed from families - sometimes (most times) with force!
o Meant to assimilate Indigenous people – remove them as a distinct group and make them Canadian.
o It is estimated that as many as 3200 children died in residential care – malnourishment, TB, abuse and running away (freezing to death)
o Very poor record keeping and the numbers are likely much higher – 5 – 10 times higher.

Question 34

Trauma: Colonialism, and the legacy of residential schools

Answer 34

o Residential schools left one of the most long lasting effects of colonialism – intergenerational trauma:
o Institutionalized children
o No experience being parented
o No experience in how to parent
o No family interactions
o Therefore….children and grandchildren of residential survivors experienced: Abusive homes, minimal affection, severe strict discipline as they grew up. Much like the residential institutions (cycle).

Question 35

Legacy of Residential Schools - Still today:

Answer 35

o Loss of self-identity
o Alcohol abuse as a coping strategy… alcoholism
o Significant health disparities
o Educational disparities
o Income disparities
o Children also developing addictions (cycle)
o Children also developing abusive behaviours (cycle)

Question 36

Truth and reconciliation

Answer 36

o 1970’s – 1990’s
o Residential school survivors wrote memoirs, accounts and histories
o Royal Commission on Aboriginal Peoples (RCAP) was established
o Final report from RCAP, 1996
o Full chapter on residential schools
o Federal response: Action plan includes apology & healing fund

Question 37

Truth and reconciliation cont.

Answer 37

o In meantime:
o Survivors turn to court system – many lawsuits
o Response by federal government (2000) – began talks leading eventually to Truth & Reconciliation Commission (TRC) (among others)
o Monies paid
o Point system for abuses
o National apology
o TRC final report 2015
o TRC finds that Canada is guilty of Cultural Genocide
o TRC encourages citizens to become settler ally
o Cultural Genocide – destruction of those structures and practices that allow a group to continue as a group.
o settler ally – teachers and learners that question how non indigenous people can change as opposed to just indigenous people changing.
o ACTION # 24 - All medical and nursing students are to take courses – should RCMP, Lawyers, firefighters, first responders also take courses?????

Question 38

What is structural racism?

Answer 38

o …is the legitimized and normalized spectrum of attitudes, practices and polices that consistently result in chronic and continuous substandard outcomes for Indigenous peoples.
o Example: Federal government funds reserves, but provincial governments regulate reserves. When Indigenous children require health services – the complex nature of funding delays the process. (denied, delayed, disrupted).
o Jordan’s Principle: the agency with first contact must pay for services without delay.
o Jordan River Anderson – died in a hospital never having lived in a home (5 years old) due to complex nature of health services and no one taking ownership (governments)

Question 39

Structural racism examples

Answer 39

o Example: assaults of Indigenous women & lack of government response.
o 1200 Indigenous women missing/ murdered (RCMP)
o Government ministers report number is much higher than 1200
o December 2015 – National Inquiry into Missing and Murdered Indigenous Women and Girls, after much public pressure

Question 40

Child Welfare

Answer 40

o 1955 – fewer than 1% Indigenous children in welfare system
o 1964 – Sixties Scoop – Indigenous children apprehended on slightest pretext, placed in non –Indigenous homes (continuation of assimilation process – not compassion of social workers). Most children did not fare well.
o Indigenous children are over-represented in the welfare system

Question 41

Poverty

Answer 41

o Indigenous children experience higher rates of poverty.
o 2010, 60% indigenous on reserve children live in poverty compared to 17% non-Indigenous children

Question 42

Justice system and Gladue Report

Answer 42

o Indigenous population over-represented.
o Residential schools, intergenerational trauma and poor legal counsel has resulted in high numbers.
o indigenous fear and mistrust of legal system. Jails full of racism and lack of cultural programming. No one goes to jail and becomes better. FASD is high is Indigenous people and the FASD rate in jails is high (between 10 – 25% of those incarcerated have FASD). Coping strategy from Trauma.
o Gladue Report is a report that can be written by a social worker that explains their life story to explain why they did an action/crime. Report written prior to sentencing that details contextual information for sentencing. Would detail trauma etc.
o Possible solutions: Use Gladue report, have cultural programs in jails, stop the cycle (education and knowledge), Indigenous people organize own legal systems - restorative justice?

Question 43

Reclaiming Indigenous Identity

Answer 43

o Past:
o Strong connection to land
o Focus on good of people not the individual
o Elastic sense of time, based on seasons, not on hours
o Everything is connected spiritually and physically
o Knowledge is passed orally
o Elders (not necessarily old)- known for extensive knowledge, are highly respected
o Everything is relational and connected, humans are not the most important component.
o Pimatisiwin Circle: Meaning – the good life, in Cree but no meaning in the English Language.
o Reclaiming Indigenous Identity –
o Learning about cultures
o Traditions
o Traditional knowledge
o Languages
o Medicines
o Research shows a direct correlation between a decrease in Indigenous suicide rates and an increase in identity- preserving practices in Indigenous communities.
o Important work.

Question 44

The Medicine Wheel

Answer 44

o The medicine wheel – emotional, mental, physical and spiritual. – in balance and in harmony. Then you are healthy or well. The land is also important and connection to the land. A sense of peace on the land. When harmony is not there you are ill.
o When relationships with the land are lost…disorientation and disconnection happen and a lesser sense of belonging and wellness happens.
o A holistic perspective – something we all need to acknowledge – and learn from. This holistic way of thinking is coming full circle…..we know that grounding ourselves to living in the moment and being connected with nature is soothing and mindful practice.

Question 45

Nursing Considerations - Respect

Answer 45

o Fundamental to nursing
o Acknowledging and appreciating others in an active and authentic way
o Respect = Listen, try to understand, explain, allow autonomy
o Lack of Respect = no privacy, negative comments and non verbal, discriminatory actions

Question 46

Nursing Considerations - Trust

Answer 46

o Essential to nursing
o Allows vulnerability, dependency and risk taking
o Need to understand power shift and balance
o Indigenous – tend to relationship first, keep word, be confidential, reliable, kind and nonjudgmental

Question 47

Nursing Considerations - Spirituality

Answer 47

o Not all indigenous people follow Indigenous ways
o Allow patients to practice spirituality as completely as possible

Question 48

Nursing Considerations - Overall

Answer 48

o In caring for Indigenous peoples, nurses must work cooperatively and in balance with Indigenous ways of knowing.
o These ways of knowing have developed over tens of thousands of years, and their use and sustenance are vital to the well-being of Indigenous people.
o This sums it up.
o Although we cannot always know the ways of knowing …we need to ask, and discover where our patients (clients) are on the continuum of Indigenous practice. AND not all will practice the same beliefs…..lots of variety in different Indigenous groups and people.
o Some ways have been lost due to colonialism.
o ASK - be respectful.

Question 49

Reflection

Answer 49

o As a Nurse….
o Check your own personal and cultural history, values and beliefs
o Situate those understandings within a framework of:
o Power imbalances
o Institutional discrimination
o Colonizer-colonized relationship

Question 50

Older Adult – Aboriginal Heritage

Answer 50

o A shorter life expectancy than non-Aboriginal older adults
o Difficulty accessing health care (rural living and past conditions)
o Lack of access to primary physicians and specialists
o Chronic conditions such as obesity, diabetes and heart disease are more prevalent among Aboriginal Canadians
o Complications related to chronic diseases may not be diagnosed, treated or screened
o Added From Older adults lesson: A really difficult history that has left many older aboriginal adults vulnerable. Reconciliation is meant to correct this present day but cannot change this poor Canadian history

Question 51

Diabetes Mellitus (type 2) and Indigenous Populations

Answer 51

o Previously unknown prior to 1940s
o Epidemic in progress since the 1970s
o 3-5 times higher in Indigenous Populations
o At a younger age, increasing numbers for young children
o More with rural than urban dwellers
o Barriers are sometimes distance to travel, no comprehensive primary care
o Contributing factors:
o Genetic susceptibility
o Lifestyle going from active to sedentary
o Change in diet – high intake of fats, sugars and salt
o Inequities in DOH & barriers to adequate health care
o Why? – Indigenous perspective:
o Impact of colonialism – intergenerational trauma, poor coping strategies and patterns of food use.
o Residential survivors – eating is associated with abuse, trauma and powerlessness
o Wild meat as food is removed from diet.

Question 52

Cancer and Indigenous Populations

Answer 52

o Relatively unknown in Indigenous populations until a few generations ago
o Dramatic # increases in recent years
o Poorer survival rate
o Indigenous Perspective:
o Example – cervical cancer
o Fearful of screening (residential school)
o Great responsibility – family caretaker
o Lack of female physicians
o Transportation issues, employment factors, health literacy
o Mistrust of health care workers

Question 53

Tuberculosis

Answer 53

o Tuberculosis (TB) is an infection caused by slow-growing bacteria (most often lungs)
o Treatment is often successful, but a long process. 6 to 9 months to treat TB. Some TB infections need to be treated for up to 2 years.
o Tuberculosis is either latent or active.
o Test:
o TST – Tuberculin skin test
o TB antigens injected under skin
o In 2 days – a red bump, means you have TB bacteria in your body
o Blood test
o Pulmonary TB – sample of mucus
o Chest x-ray
o Treat:
o Active TB = a combination of antibiotics for 6 months, and longer if found still positive
o Important to take properly (resistance)
o DOT – Direct Observational Treatment
o If active TB is not treated, it can damage your lungs or other organs and can be deadly. You can also spread TB by not treating active TB.

Question 54

Latent TB

Answer 54

TB bacteria in body, but immune system is keeping it from turning into active TB. No symptoms of TB and can’t spread the disease to others. It can become active TB.

Question 55

Active TB

Answer 55

means that the TB bacteria are growing and causing symptoms. If your lungs are infected with active TB, it is easy to spread the disease to others.
First infected – mild symptoms
o Symptoms of active TB may include:
o A cough that brings up thick, cloudy, and sometimes bloody mucus (sputum)from the lungs for more than 2 weeks.
o Tiredness and weight loss.
o Night sweats and a fever.
o A rapid heartbeat.
o Swelling in the lymph nodes of neck
o Shortness of breath and possible chest pain

Question 55

Tuberculosis and Indigenous Populations

Answer 55

o In 2011 Active TB incidence for Indigenous populations was 34 times higher that non-Indigenous
o Over all rate of TB is 6 times higher than average Canadian population
o Contributing factors to high rates:
o Historical context with colonialism
o Over-crowded housing
o Insufficient venting systems
o Poor access to health care for diagnosis and treatment
o Limited knowledge