Running head: EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES

Education and Culturally Competent Care for Natives Student Name: Dermot Connolly Stenberg College Surrey BC

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Abstract This paper explores the importance of nursing education in the role of providing culturally competent nursing care to Native communities. The history of Native healing methodologies is first explored and compared to western methodologies in use today. The role of western methodologies in forming negative Native stereotypes is examined as is the education nursing students receive pertaining to Native traditions. Finally the delivery of care to expectant Native women is discussed and the considerations needed to empower them in the birthing process. This paper makes the determination that Native culturally competent nursing care can only be delivered when nursing students are given significant exposure to Native traditions through their course curriculum and Native interactions. Keywords: Culturally competent nursing care, education, healing.

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Education and Culturally Competent Care for Natives Nursing education plays an important role in Native studies as it helps develop a greater understanding into Native traditions such as healing and birthing practices, which provide Natives with the culturally competent nursing care they are entitled to. The inability to provide this care can have a negative impact on the formation of the nurse / Native patient therapeutic relationship. Instrumental to the success in developing that relationship is the importance placed on Native nursing education and self-awareness training. Weaver, (2001). Traditional nursing education in Canada is formulated to the belief that Western medicine offers the best approach in the treatment of disease. Weaver, (2001). Nursing education gives little consideration to Native healing traditions and the benefits offered by their holistic approach. Weaver, (2001). This gap in education manifests itself in poor quality nursing care and racial stereotyping of Natives, in particularly expectant mothers where tradition rituals exist. Birch, Ruttan, Muth, & Baydala (2009). Native nursing students are also at risk, where they are exposed to a nursing curriculum that reflects only the teachings of western medicine. Weaver, (2001). As a result, nursing education has subjected many Natives to social exclusion and negative stereotyping resulting in an inherited mistrust in western culture, include healthcare. Weaver, (2001). This cultural disparity has had a negative outcome in the provision of competent nursing care towards Natives.

EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES 4 The Native approach to healing has developed from the belief that a person is ill when they have not achieved balance in their lives. Belanger, (2010) p299. This has led Native healers to develop a more holistic approach to the treatment of illness, where the whole person is treated as opposed to the disease. Belanger, (2010) p299. This holistic approach to healing means that the healer must be well versed in many aspects of health and wellness including spiritual, mental, physical and emotional. Belanger, (2010) p 299. In native culture, our world is in a constant state of imbalance, which can cause a person to fall ill. Belanger, (2010) p299. The role of the native healer is to identify the cause of that imbalance and prescribe treatment accordingly Belanger, (2010) p299. Similar to western medical practices, Native healers develop specializations in specific areas of holistic healing Belanger, (2010) p299. Other important aspects of Native healing techniques involve the important distinction between healing and curing and their differences when compared to western medicine Belanger, (2010) p299. In native culture, an individual can be healed but may not be cured Belanger, (2010) p299. The healers concentrates on what aspect of the patients life is in a state of imbalance and then attempts to rectify it. The patient is trained on how to identify their own imbalances and how to transfer energy back to the body and into a state of balance. Belanger, (2010) p300. This approach differs from western medicine, where a lot of emphasis is placed on the importance of developing cures. Belanger, (2010) p 299 - 300. When attempting to develop an understanding of Native healing practices, it is important not only to educate ourselves on the current practices being adopted but also on some of the more historical approaches to Native healing. Many of these traditions are passed down from generation to generation and when first encountered by European settlers; these healing

EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES 5 traditions were considered primitive. Waldram, et al (2007) p 127. Natives considered illness to be closely linked with the supernatural and therefore all healing interventions involved contact or communication with supernatural spirits. Waldram, et al (2007) p 129. Healing practices were not confined to healers however, many illness were been treated in the home, as many Natives possessed a strong knowledge of herbal remedies. Waldram, et al (2007) p 133. Native healing techniques involved the intervention of three types of healers; herbalists, medicine men and shamans. Waldram, et al (2007) p 133. Herbalists were considered to be expects in the application of botanical products in the treatment of disease and their methods were traditionally handed down through the generations. Waldram, et al (2007) p 133. Medicine men were healers who could summon the supernatural to achieve healing whereas the shamen had the ability to fall into a deep trace and enter the spirit world to guide him and empower him with healing. Waldram, et al (2007) p 133-134. As psychiatric nurses it is important for us to develop an understanding into the origins of Native healing as it helps in the education of Native culture and prevents racial stereotyping when comparing Native healing traditions with western methodologies. The role of education in the provision of culturally competent nursing care is an important one. Many nurses will formulate their nursing practices based on the education they receive. It is important therefore that all nursing curriculums include subject material dedicated to the importance of being culturally aware. Education not only promotes cultural awareness but also sensitivity to multicultural concepts through the development of self awareness and reflection on ones values. Weaver, (2001). This is of particular importance in Canada where Natives have struggled with racism and negative stereotyping across all areas of society,

EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES 6 including healthcare. Some of the causes of negative stereotyping stems from the fact that nursing is founded on western and American methods. Weaver, (2001). As a result, many nurses finish their education with the belief that the western approach to healthcare is best employed across all cultures, without understanding that western methodologies have no relevance to some cultures. Weaver, (2001) p253. Another problem with nursing education and culturally competent care include the need to change how the nursing role is depicted, with many seeing the profession as being portrayed by white nurses in their mid thirties. Weaver, (2001). These problems identified in nursing education have led to a disparity in the quality of nursing care delivered to Natives. Weaver, (2001). This disparity is also evident in the education received by Native nurses where many have reported instances where their methods of communicating and interacting with patients were discouraged in favor of western methodologies. Weaver, (2001) p253. It can be argued therefore that nursing education contributes to the loss of native culture nursing practices. Weaver, (2001) p253. Many other Native nurses have reported dissatisfaction with their nursing education where curriculums contain just one subject dedicated to native studies and in some programs, there is no Native content at all. Weaver, (2001) p255. Other nurses have reported feeling isolated in the workforce where they struggle to adjust to a new culture. Weaver, (2001) p256. This problem is exasperated when nurses also face racial stereotyping from fellow nurses. Weaver, (2001) p256. The forms of racial stereotyping experienced by Native nurses include, the belief that Natives were uneducated, that they are all environmentalists or through the devaluation of their tribal education. Weaver, (2001) p 256. With such inequality in Native nursing education, it is not surprising to hear of Native patients report of instances where their cultural wishes were not

EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES 7 respected. Weaver, (2001) p 257. Lack of cultural awareness can increase the level of stress placed on a patient and their families. In her report on culturally competent nursing care, Flowers, reported on an instance where an elderly Native man was admitted to hospital by his wife and children. Flowers, (2004). During his assessment he informed the nursing staff and physician that he was following his Native traditions, was ready to die and wanted his family with him when he did die. Flowers, (2004). The man was given intravenous fluids and a catheter before being transferred to another hospital three hours away. He died 2 weeks later with only his wife by his side. Flowers, (2004) p 49. If proper consideration being given to his cultural needs, this Native gentleman may have been afforded the traditional death he had requested. Delivering culturally competent nursing care to Natives does not only apply at end of one life but also during the beginning of another. With the closure of many rural Native hospitals and the migration of many Native women to more urban areas, the number of Native births in urban areas is growing. Birch, Ruttan, Muth, & Baydala (2009). This has highlighted the need for greater understanding into the needs and birthing practices of Native women. Childbirth is an important event in the life of an aboriginal woman and the quality of nursing care they receive should reflect that importance. Birch, Ruttan, Muth, & Baydala (2009) p 25. While birthing practices differ between cultures, some traditions such as who should be present during the birth and breastfeeding rituals are considered more culturally significant. Birch, Ruttan, Muth, & Baydala (2009) p 26. In terms of Native culture, the relationship between mother and child begins before birth where the spiritual well being of both mother and child is considered very important. Birch, Ruttan, Muth, & Baydala (2009) p 26. Other important values include remaining physically active during pregnancy, avoiding stress and respecting the teachings of

EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES 8 older native women. Birch, Ruttan, Muth, & Baydala (2009) p 26. When discussing culturally competent nursing care it is therefore important to ensure that a holistic approach is tailored to fit with the needs of the Native woman. A Native womans experiences giving birth are enhanced when greater emphasis is placed on respecting their wishes and providing them with a sense of empowerment. Birch, Ruttan, Muth, & Baydala (2009) p 26. Respect for a Native woman is displayed through active listening and the understanding of the patients perspective. Birch, Ruttan, Muth, & Baydala (2009) p 26. Many healthcare providers may not be aware that for some Native families, it is culturally significant for the grandmother to be the first to hold the baby or the differences in beliefs in terms of weight gain during pregnancy and weight loss during breastfeeding. Birch, Ruttan, Muth, & Baydala (2009) p 26. Culturally competent care for Native women must also take into account Native history and the impact of colonization where Native children were removed from their families into Government sanctioned residential schools and foster homes. Birch, Ruttan, Muth, & Baydala (2009). This can have quite a negative impact on a Native woman who must leave her rural community to have her baby in an urban setting. Birch, Ruttan, Muth, & Baydala (2009). The experience of cultural competent nursing care can be enhanced through increased nurse interactions with Natives and by taking part in cultural events. As with all programs, culturally competent nursing care can only be successful if the framework to encourage and support its development in introduced. Birch, Ruttan, Muth, & Baydala (2009) p 30. Such programs must be supported through the implementation of training programs and through the recruitment of healthcare providers with the relevant cultural background and experience. Birch, Ruttan, Muth, & Baydala (2009) p 30.

EDUCATION AND CULTURALLY COMPETENT CARE FOR NATIVES 9 To ensure culturally competent nursing care is delivered to Natives, it is importance that healthcare providers first understand the historical significance of Native healing methods and how those methods have developed into the holistic healing practices being administered today. Education also plays an important role in the delivery of culturally competent care where increased exposure to Native cultures and the reinforcement of the nursing curriculum can not only strengthen the nurse patient relationship, but also eliminate the racial stereotyping reported by many Native nurses. Weaver, (2001). Competent education practices can also improve the nursing experience for the expectant mother whose Native history and birthing rituals need to be taking into consideration when attending to her needs. Birch, Ruttan, Muth, & Baydala (2009). As with all nursing programs, culturally competent nursing care can only be effective if the infrastructure is developed to support it. Such infrastructure includes the development of training programs, conferences and recruitment policies consistent with the successful implantation of cultural competency. Birch, Ruttan, Muth, & Baydala (2009). We can therefore conclude that only through focused attention on Native healing practices and nursing education can true culturally competent nursing be sustained.

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References Belanger, Y., D. (2010). Ways of knowing: An introduction to native studies in Canada. Toronto, Canada: Nelson Education Ltd. Birch, J., Ruttan, L., Muth, T. & Baydala, L., (2009). Culturally competent care for aboriginal women. A case for culturally competent care for aboriginal women giving birth in hospital settings. Journal of aboriginal health. 24-34. Flowers, D., L., (2004). Culturally competent nursing care: A challenge for the 21st century. Critical Care Nurse .24 (4). 48-52. Waldram, J., B., Herring, A.,D. & Young, T., K. (2007). Aboriginal health in Canada, historical, cultural and epidemiological perspective. 2nd Ed. Weaver, N., H., (2001). Indigenous nurses and professional education: Friends or foes? Journal of Nursing Education. (40) 6. 252- 258.

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