According to the Canadian Encyclopedia (2018) there are thirteen First Nation
communities, spread over forty-two reserves and settlements in Nova Scotia, all of which are Mi’kmaq. The Canada 2016 census determined that Indigenous people represent 5.7% of Nova Scotia’s total population of 923, 598 (Statistics Canada, 2016). This report also denotes that the majority of the Nova Scotian indigenous population is First Nations.
Figure 1
Mi'kmaw Communities in Nova Scotia
Note: Mi’kmawey Debert Cultural Centre (2022). Communities Today. https://www.mikmaweydebert.ca/sharing-our-stories/communities-today/
In my previous role as an Emergency Department nurse, I cared for many First Nations people, many of which were impacted by housing insecurity, mental health challenges, and issues with addictions. I worked with nurses with a range of attitudes toward this population. Generally (though not exclusively), I found the senior nurses tended to be more discriminatory than the junior nurses who were inclined to be more empathetic. I am unsure if actual racism is the underlying reason for this or if the actual bias is toward those who were frequent visitors to the ER, often considered “difficult” or a “waste of time.” I can only speak from my experience, but the most common presentation of a First Nations patient appeared to be one who suffered from housing insecurity and addiction. In a sense, the more vulnerable you were, the less tolerant some of the nurses were. Humbly and honestly, I will add that until recent events came to light, I had no knowledge of the history of residential schools. My primary education did not include much in regards to the history of the indigenous people in Canada. I believe strides are being taken to close this gap, but there is still work to be done.
On a more positive note, when I entered the workforce as a novice nurse, I worked on a vascular surgery unit. I had a First Nations patient whom I was preparing for a lower leg amputation. He had concerns regarding what would become of the amputated limb. “Health for many First Nations and Inuit individuals focuses on wholeness: achieving balance, strength and interconnectedness of body, mind, emotions and spirit.” (Indigenous Services Canada, n.d.). He educated me on his cultural beliefs and I was able to advocate
for him. In the end, his lower leg was sent for cremation post operatively and the ashes returned to him. I was also fortunate to have been able to partake in a smudging ceremony before his surgery. This experience was invaluable to me and was the beginning of my path to becoming culturally competent.
Figure 2
A Smudging Ceremony
Note: Leblanc, T. (2018). What is Smudging? Converging Pathways https://convergingpathways.ca/post/?ID=31
In 2016, the Nova Scotia Health Authority (NSHA) released the NSHA Diversity Lens Toolkit, a document that provides cultural competence self-assessment tools and outlines some cultural considerations for care. The Canadian Nurses Association released a position statement (Bill et al., 2018) that discusses Canadian health and inequities, culture and cultural competence. It identifies that nurses need to pay closer attention to social policy and that nurses are in an ideal position to play a leadership role as health care and public health advocates. The Nursing Declaration Against Anti-Indigenous Racism in Nursing and Health Care (Canadian Association of Schools of Nursing et al., 2021) is a document composed by several provincial and national level Canadian nursing organizations. It outlines the long-term impact of racism within health systems and provides statements describing a commitment to combatting bias, developing a strategic plan to close the gaps between Indigenous and non-Indigenous communities, promoting cultural competence, and advocating for policies at all levels that address health and social inequities. These documents are great steps forward, but I believe there is more that can be done by integrating cultural competence into primary and secondary education.
References
Bill, L., Debs-Ivall. S., Etowa, J., Haines, M., Letendre, A. (2018). Promoting Cultural Competence in Nursing. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/Position_Statement_Promoting_Cultural_Competence_in_Nursing.pdf
Canadian Association Schools of Nursing, Canadian Black Nurses Alliance, Canadian Black Nurses Network, Canadian Federation of Nurses Unions, Canadian Nurses Association, Canadian Nursing Students’ Association, Clinical Nurse Specialist Association of Canada, Nurse Practitioner Association of Canada, Association of Regulated Nurses of Manitoba, Quebec Nurses Association, British Columbia Nurses’ Union, Coalition of African, Caribbean and Black Nurses in B.C., Nurses and Nurse Practitioners of British Columbia, & WeRPN Registered Practical Nurses Association of Ontario. (2021). Nursing Declaration Against Anti-Indigenous Racism in Nursing and Health Care. https:// www.cna-aiic.ca/en/policy-advocacy/advocacy-priorities/indigenous-health
Government of Canada. Indigenous Services Canada (n.d.). Introduction to the Clinical Practice Guidelines. Retrieved March 14, 2022 from https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/health-care-services/nursing/clinical-practice-guidelines-nurses-primary-care/introduction-clinical-practice-guidelines.html
Government of Canada. Statistics Canada (2018, June 21). Aboriginal Population Profile, 2016 Census. Retrieved March 15, 2022 from https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/abpopprof/search-recherche/lst/results-resultats.cfm?Lang=E&G=1&Geo1=&Code1=&GEOCODE=12&SEX_ID=1&AGE_ID=1&RESGEO_ID=1
Leblanc, T. (2018). What is Smudging? [Online image]. Converging Pathways https://convergingpathways.ca/post/?ID=31
Marshall, T. (2005). Mi'kmaq Universe [Acrylic on Canvas]. Resilience. https://resilienceproject.ca/en/artists/teresa-marshall
Mi’kmawey Debert Cultural Centre (2022). Communities Today. https://www.mikmaweydebert.ca/sharing-our-stories/communities-today/
Nova Scotia Health Authority (2016). Diversity Lens Tool kit. Retrieved March 15, 2022 from https://library.nshealth.ca/ld.php?content_id=34810800
The Canadian Encyclopedia. (2018). Reserves in Nova Scotia. Retrieved March 15, 2022, from https://www.thecanadianencyclopedia.ca/en/article/reserves-in-nova-scotia
Comments