1. 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. NAHO

2. 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

3. 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

4. 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.

5. 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

6. 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

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

8. 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.

9. 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.

10. 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

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

12. 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

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

14. 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

15. 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.

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

17. Resource List http://www.naho.ca/english/pub_culturalComp.php

18. ASHS Contact Information
ASHS Student Space: HSC 2A1E
Elders-in-Residence: 3
Aboriginal Mentorship Program: 3
Administrative Assistant: Valerie Pare
ext: or
ASHS Office: HSC 3H46B
Danielle N. Soucy, Director & Program
Coordinator:
ext: or
Dr. Melinda Fowler, Faculty Advisor
ext: or