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The Role of Nursing in Promoting the Health of Indigenous Peoples

Indigenous Cultural Safety Strategic Initiatives

On March 26, 2019, guests gathered in the Sty-Wet-Tan Great Hall at the First Nations Longhouse at UBC to consider and discuss the role of nursing in the promotion of health for Indigenous peoples.
Helen Brown, the chair of the newly minted Indigenous Cultural Safety and Strategic Initiatives (ICSSI) committee at the School of Nursing, introduced Elder Thelma Stogan and her brother, Arthur, who attended on behalf of the Musqueam Band. They revealed how their memories of family and tradition weave into the fabric of the land and the history of the building. They reminded us to raise our hands in recognition of and honour to the Squamish, Musqueam, and Tsleil-Waututh First Nations on whose unceded territories the people at Point Grey live, meet, work, and play.

Margaret Moss, our newest associate professor and Director of the First Nations House of Learning, gave a detailed description of the Sty-Wet-Tan Great Hall and its remarkable house posts (see inset). The carvings bring a sense of history and tradition to a relatively new building. A place of awe, strength, and respect, it was a fitting venue for the members in the circle of voices to speak their truths and be heard.

Elizabeth Saewyc, Director of the School, underscored the importance of sharing all perspectives, not only those voices in praise of nursing, but also those offering first-hand knowledge of how health systems have impaired the promotion of health among Indigenous peoples.

Elder Roberta Price united the attendees and speakers in a traditional blessing and then joined the Circle of Voices for the dialogue. Seated with her were Dawn Tisdale, RN, UBC MSN student; Margaret Moss, UBC Faculty; Tania Dick, RN MSN-NP, UBC Alumni; and Becky Palmer, RN, PhD and Chief Nursing Officer for First Nations Health Authority.

Prompted by a single question, the stories came: hesitant at first, testing, and then pouring forth. Dawn spoke of justice, action, and global initiatives for anti-racism. She spoke of hope, confidence, and the power of 20 million nurses worldwide, learning from the intimate relationships they build with people. The opportunities exist, she believes, to open the practice of health care to new ideas. Instead, those who attempt to reform and redefine health care practices to reject stigma and prejudice, face walls of suspicion and habit, opposition to change, and resistance to cultural safety.

Margaret compared American and Canadian health care and told stories from the perspective of both patient and nurse. As a patient in the United States, her self-identity was not merely unrecognized, but replaced. On admission forms she had identified as an enrolled Tribal member but her discharge papers claimed she was “White.” “We are not just invisible,” she said, “we are erased. That is important because it means we are denied ‘culturally competent care.’”

Margaret went on to elaborate that this idea of competency “needs to be flushed from the literature.” As a nurse, she has been required to take courses to gain competence for caring for people of “other cultures.” The materials presuppose a classroom filled with all-white nurses, but she has already gained those skills from lived experience. “Do I feel competent to care for white people? No one ever asks. If a professional is following the tenets of nursing, they look at the whole – mind, body, and spirit – that is how Indigenous cultures all over the world already approach health care.”

Tania opened her dialogue by stating “It’s hard to find positives.” She needed to look no further than the story of Brian Sinclair to illustrate the problems infecting the health care process for Indigenous people. And, unfortunately, she was also able to relate the tale of an aunt whose story echoed Brian’s. In both cases, and countless others, they were labelled “drunken Indians” and ignored, failing to receive the treatment that would have saved them, and dying in the waiting room as health professionals passed by, or at home where they were sent to ”sleep it off.” “Every community has this story,” she added, calling for “changing the heart of society, one nurse at a time.”

Tania recognized that “pockets of champions” exist, but they are too few and often absent from the field where support is required for Indigenous nurses and patients. Every day, Tania said, she is “pushed back and down and space is taken away.” She noted that the first step in achieving Truth and Reconciliation is for each Canadian to recognize their own role.

Becky reflected on the challenges currently in place for nurses, nurse educators, and researchers. She promoted “nothing about us without us” in which Indigenous representatives sit in partnership with others to plan ways of “shifting the mental map.” Learners must be leaders, open to a new way that invites the holistic method of health care, incorporating it at a systems-level to end discrimination.

Elder Roberta told the story of how, while watching a documentary about Nanaimo Indian Hospital, awful memories of being in that hospital—memories she did not even know she had—resurfaced. Over the years, as she transformed from stolen child to respected elder, her relationship to hospitals also changed, but not without continuing challenges. Having an elder present at the bedside of a patient at one time involved a complicated process that sometimes took so long the patient was discharged before the elder had arrived. Elder Roberta has been part of necessary changes in hospital systems so that now, as part of a spiritual care team, she receives calls directly whenever needed. However, even that advancement is not absolute. She explained that once, she had been wandering the hospital halls looking for a patient. No nurse engaged with her, but rather, viewed her with suspicion. Finally, a non-Indigenous person recognized and affirmed her right to be there. Only then was she seen as beloved Elder Roberta. Looks of suspicion changed to welcome, and reticence changed to helpfulness.

Each speaker in the Circle of Voices expressed the value and necessity of an Indigenous perspective in the health care system. However, confidence in that value is challenged by the harsh inequities in the field. Despite little evidence of moving forward, these nurses constantly endure, challenge, and resist. Their difficult work is more disheartening when their own likeness is rarely mirrored back in the faces of colleagues, mentors, co-workers, or authorities. These leaders are tired, but strong. They have to be. They devote themselves to blazing the trail, uplifted by the hope that in doing so, others may walk behind with less effort.

In closing their session, members of the Circle of Voices expressed gratitude for the opportunity to speak their truths, but made it clear that this is only the beginning. Not only do Indigenous patients suffer indignity in the health care system, but Indigenous health care professionals also face significant barriers to success and progress. Those barriers need to be recognized before they can be removed.

Every day, racism undermines workplace comfort for nurses and prevents proper care for patients, yet it goes unnoticed and unchallenged. The voices from this circle call on nurses to recognize and address such conduct. Stories such as theirs are the stories that need to be heard, believed, and acted upon. “There can be no reconciliation without truth.”