Presented By: Dr. Melinda Fowler Faculty Advisor

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

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. Language Cosmology Integrity/ Honesty Acknowl- edgement Respect IK = Health Protection Of IK Intent Quality of Life Reciprocity Culturally Safe Approaches 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 • http://www.ipac-amic.org/publications.php • http://www.anac.on.ca/publications.html • http://www.niichro.com/

18. 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