Aboriginal Health Elective: Session 3 January 25, 2013 Cultural Competency and Safety Presented By: Dr. Melinda Fowler Faculty Advisor Aboriginal Students Health Sciences (ASHS) office Family Physician De dwa da dehs nye>s Aboriginal Health Centre Developed By: D. Soucy @ NAHO

Objectives Review the social & broader determinants of health Define Cultural Safety (CS) & Cultural Competency (CC) Disseminate why there is a need for CS/CC Identify Culturally Unsafe vs. Safe educational approaches Identify Learner & Educator responsibilities within a CS environment

Social Determinants of Health Education Income & social status Social support network Social environment Employment & working conditions Physical environment Genetic endowment Healthy child development Gender Personal health practices & coping skills Access to health services Culture

Broader Determinants of Health for Aboriginal Peoples Colonization Globalization Migration Cultural continuity Access Territory Poverty Self-determination Woven together, these factors affect the quality of life for First Nations, Inuit and Métis.

Background: Cultural Safety Developed in the 1980s in New Zealand in response to the Maori people’s discontent with nursing care Maori nursing students & Maori national organizations supported the theory of cultural safety They uphold political ideas of self-determination & decolonization of Maori people & is based within a framework of dual cultures

Cultural Safety CS refers to the patient/learner’s feelings in the health care/ learning encounter CS is crucial to the establishment of trust between health care provider & patient OR the establishment of a productive teaching relationship between educator and learner

Cultural Competency CC refers to the skills required by a provider/educator to ensure that the patient/learner feels safe

Is there a need for CS/CC? Misunderstanding can exist between health professionals & their clients, which can impact the ability of health professionals to achieve the goal of optimizing the health for their clients (Dowling 2002). Adopting a culturally safe approach to health care can benefit individuals, providers & health care systems.

Culturally unsafe educational experiences occur because… Values & ethics for FN/I/M maybe different than mainstream Indigenous knowledge (IK) is not acknowledged, or is treated as inferior to western knowledge Negative portrayal of FN/I/M peoples in curricula Historical experience & effects of colonization on FN/I/M peoples is not acknowledged Basic access (geographic, linguistic, cultural) barriers exist.

Culturally Safe Approaches Cosmology Acknowl- edgement Protection Of IK Quality of Life Reciprocity Intent Respect Integrity/ Honesty Language = Health Western Forms of Health knowledge A CC/CS Space

Culturally Safe Education Learner responsibilities: Self evaluation Identify pre-existing attitudes Transform attitudes Educator responsibilities: Dismantle barriers Honest curricula Recognition/respect of IK

Ensure a CS environment… Learn about health & social challenges facing FN/I/M peoples & expect that these issues maybe of particular interest to Aboriginal students Be aware of the determinants of health that may apply to FN/I/M peoples Learn about the history of colonization and its impact on current health & social status of FN/I/M peoples Be self aware

A CS Approach… Communication Decision-making Understanding/misunderstanding Beliefs

CS/CC Guidelines Create Aboriginal rooms: FN/I/M Ceremony, Song & Prayer Patients’ Sacred/Ceremonial Items Information & Support Family Support Food, Toiletries & Constitutions Body parts/tissues/substances (removal, retention or disposal of, including the placenta & genetic material) Pending & Following Death The following Guidelines are adapted from the Tikanga Best Practice Guidelines produced by the Waikato District Health Board, New Zealand

Accessing Resources and Services for FN/I/M Clients National organizations can provide direction to regional centres/organizations who deal with Aboriginal healing and wellness (western and traditional) NICCHRO National Indian and Inuit Community Health Representative Organizations A.N.A.C Aboriginal Nurses Association of Canada IPAC Indigenous Physicians Association of Canada *NWAC Native Women’s Association of Canada *AFN Assembly of First Nations *MNC Métis National Council *ITK Inuit Tapairit Kanatami *CAP Congress of Aboriginal Peoples NAFC National Association of Friendship Centres AHF Aboriginal Healing Foundation AHRNetS Aboriginal Health Research Network Secretariat IAPH Institute of Aboriginal Peoples Health NEAHR Network Environments for Aboriginal Health Research AWHHRG Aboriginal Women’s Health and Healing Research Group Pauktuutit Pauktuutit Inuit Women’s Association of Canada CAAN Canadian Aboriginal Aids Network AHWS Aboriginal Healing and Wellness Strategy NMHAC Native Mental Health Association of Canada * The five federally recognized national Aboriginal organizations of Canada. Each has regional/territorial offices and health committee’s who can direct query’s regarding their specific populations.

Conclusion Be self aware Be respectful of IK Be willing to transform and adapt Be an active listener

Resource List http://www.naho.ca/english/pub_culturalComp.php http://www.ipac-amic.org/publications.php http://www.anac.on.ca/publications.html http://www.niichro.com/

ASHS Contact Information ASHS Student Space: HSC 2A1E Elders-in-Residence: 3 Aboriginal Mentorship Program: 3 Administrative Assistant: Valerie Pare 905.525.9140 ext: 23935 or ashs@mcmaster.ca ASHS Office: HSC 3H46B Danielle N. Soucy, Director & Program Coordinator: ext: 22824 or soucy@mcmaster.ca Dr. Melinda Fowler, Faculty Advisor ext: 22824 or ashsfa@mcmaster.ca http://fhs.mcmaster.ca/ashs