Cultural Safety Assignment

Cassidy Faulkner
Practical Nursing Program Okanagan College
PNSG 215 Professional Communication
Sonum Woit
May 1, 2024
How did you feel after working through the Remembering Keegan case study?
After reading Keegan Combes story, I had many emotions that consisted of sadness, anger, and

disappointment for how badly the healthcare system failed Keegan. His caregiver, Rhianna, found him

incoherent and slumped but I believe she found him at the right time. There was time for healthcare

professionals to save Keegan, provide him with a diagnosis and a treatment. As a result of immense lack

of cultural safety, humility and assumptions amongst healthcare staff, Keegan lost his battle to

accidentally consuming windshield wiper fluid (methanol). My question while reading this case study,

would Keegan have received quicker, more compassionate and patient focused care if he did not have

disabilities or was indigenous. Sadly, I think there would have been a difference in the care he would have

received if he wasn’t any of those. It was highlighted in the case study that patients with complex needs

should be treated exactly the same as everyone else. I believe that is extremely important to keep in mind

during my career in healthcare. I think to myself, how would I be treated in today’s healthcare system if I

had disabilities or was indigenous?

While working through Keegans case study, I expanded my knowledge and awareness on the

racism and dismissal of First Nations in BC’s healthcare system. Reading Keegan’s story reminds me of

Brain Sinclair, the indigenous Canadian man who spent 34 hours in 2008 in the hospital but then

succumbed to his condition due to receiving zero care (Browne, 2017). This incident sparked realization

on the systemic effects of lack of culturally safety and humility in Canadas healthcare system. There is a

large connection to this story as well. While Brian was waiting in the Manitoba ER, a triage nurse came to

check on the patients’ who were waiting in the ER. The triage nurse checked to see if Brian was wearing a

wristband which indicates he has been triaged. It was noted Brian was not wearing a wristband and the

triage nurse then assumed he was discharged. Brain was sleeping at the time; the triage nurse did not

attempt to wake Brian up to check on his wellbeing (Browne, 2017). This relates back to Keegans story

because emergency responders already knew of Keegan due to his past interactions with them. This
resulted in assumptions made of Keegan by the emergency responders which right off the bat, started the

issue of lack of attention and compassion Keegan received.

Once Keegan was finally admitted and lab tests were completed, there a situation of negligence

that occurred in my eyes. When the lab results were ready and which the results indicated severe

metabolic acidosis, this was missed completely by multiple physicians. This brought an array of emotions

to me. How can they miss this? It truly displayed impersonal and insensitive care. As mentioned in

Keegan’s story, if these medical professionals thoroughly investigated the lab results, a diagnosis and

treatment could have been implemented immediately. The negligence that occurred right away was

simply heartbreaking and inhumane.

The resident’s suggestion to Rhianna regarding implementing a do-not-resuscitate (DNR) order was

beyond disgusting to me. In the beginning, you can recognize that the medical professionals displayed

lack of urgency in Keegan’s medical distress. This aspect of the story simply displays culturally unsafe

and insensitive care. Keegan’s caregiver, Rhianna did an incredible job advocating for Keegan. She

fought for Keegan right at the beginning when the hospital was hesitant to take Keegan in. She also made

striking points to the resident suggesting a DNR order. She truly wanted Keegan to be saved like how

everyone else would be in this situation.

In conclusion to my overall thoughts and feelings of Keegan Combes story, it brought heart

wrenching and frustrated emotions due to the obvious culturally unsafe encounters like delay in diagnosis,

lack of communication, neglect and more.

Pages referenced: 9,11,13,15 - 20

2. Identify 3 examples from the case study where the sharing of information with Keegan and his
family was not provided in a respectful manner. Identify how this information could have been
delivered in a respectful way.
 The first time where the information was not provided in a respectful manner was when the

caregiver, Rhianna, adamantly asked the physicians what was wrong with Keegan. The resident

responded to Rhianna and said Keegans “liver enzymes were elevated.” This statement displayed that the

resident did not take the time to investigate Keegans lab results and brushed Rhianna off by providing a

unspecified answer. The resident should have taken the time to investigate Keegans lab results and give

Rhianna a more detailed answer that avoids using any complex medical jargon (Sharkiya, 2023).

The second inappropriate example of sharing information was when the resident suggested to

Rhianna that Keegan’s file should have do-not-resuscitate (DNR) order in place. Prior to this, you can see

that the healthcare professionals did not have urgency in Keegans case. I believe this suggestion can be

avoided if they took Keegans condition seriously. If the healthcare professionals did all they for Keegan

and a DNR order was suggested, they can have done it in a culturally sensitive way by providing

evidence-based information and necessary information on why they believe implementing a DNR order

will be needed. The resident displayed no empathy or support for his inappropriate suggestion. If the

suggestion was needed, they should have been these attributes and remained open-minded for Keegan’s

culture needs (Monk, 2024).

The third example is when the fourth MRP asked Rhianna if there were any possibilities that

Keegan consumed methanol. It was not suggested in the case study if the MRP elaborated on why he was

asking this question. The MRP should have explained what methanol is and what it is found in.

Throughout this case study you can observe the lack of detailed communication. If the healthcare

professionals provided Rhianna more answers and backup information on Keegans state, there could have

eased anxiety and confusion (Riley, 2020).

In addition, the healthcare professionals should have taken in Keegans cultural and put into

practice any traditional practices that aligned with Keegan and Rhianna. The dismissal of Keegans

cultural became obvious and resulted in negligence as well as assumptions. The healthcare professionals

also should have involved Keegan significantly in his own care. It seemed to appear that there was lack of
involvement with Keegan which resulted in discrimination and alienating due to cultural needs and

preferences being dismissed.

Pages referenced: 9, 17-22.

3. Describe potential challenges that may arise when communicating with cultures outside
of our own (reference required). What communication challenges did you identify in this case
study? How might those communication challenges have been better addressed? (Specific
strategies)
One major challenge that came to mind for me is language barriers. I think that can be difficult to

navigate as you may run into challenges like misunderstandings and unanswered medical questions.

Another important example is lack of trust. Different cultures have their preferences or experiences when

it comes to receiving healthcare. The negative experiences cultures have faced in the healthcare system

could result in a barrier of difficulty establishing trust (Basu, 2023).

The first communication challenge was overall inadequate explanation on Keegans condition.

The healthcare providers did not appropriately give Keegan or his caregiver important updates on the

situation or any information on possible treatment. The multiple physicians that did not investigate the lab

results further left multiple unanswered questions and resulted in frustration from the caregiver. Another

challenge I identified was when the resident suggested a DNR order. I believe that was very insensitive to

Keegans culture and displayed a lack of respect for Keegans autonomy. One strategy to this could have

been the resident using effective communication with Keegan and Rhianna about their cultural beliefs and

if they had any traditional practices that can positively impact Keegans hospital stay (Fletcher, 2007).

Pages referenced: 9, 17-21.

4. Reflect on the section Culturally unsafe encounters surrounding Keegan’s death (p.22-34). What
are 2 things you will do in your own practice to maintain cultural safety and humility?
Keegan endured multiple inhumane and unfair culturally unsafe encounters. Since working in the

healthcare system, I have noticed the positive impact of patient advocacy. Keegan’s caregiver Rhianna

advocated for Keegan numerous times. She fought for him not to be discharged when Keegan was

obviously unwell, did not agree that Keegan should have a DNR order and worked hard to figure out what
is wrong with Keegan. I think her efforts are inspiring and all healthcare workers should recognize that. In

my practice, I will most definitely acknowledge and listen to individuals’ cultural perspectives, values,

and preferences of their own care or their loved one’s care. Rihanna’s advocacy efforts lacked

acknowledgment while in the hospital with Keegan which led to even more culturally unsafe practice and

dismissal of concerns. Taking the time in my practice to understand and work with a family member who

is advocating for their loved one can be beneficial to reach optimal care for my patient.

The ongoing assumptions regarding Keegan was extremely inappropriate and neglectful. The

assumptions made by the emergency responders “knew Keegan” already set a negative standpoint for the

type of care Keegan is about to receive. Indigenous people have experienced systemic racism and

discrimination for year in Canadas history. This has resulted in ongoing assumptions made about

indigenous peoples in the healthcare system (Thompson, 2018). As a future nurse, to retain cultural safety

and humility its important I self reflect and erase any negative thoughts or assumptions I may have for

patients. It’s vital I maintain an open mind when incorporating a patient cultural into their care.

Pages reference: 22 - 34

More about assumptions in indigenous peoples care in the healthcare system:

May 28, 2024, at BCNU conference, I was honoured to watch a two amazing indigenous

Canadian speak about the generational trauma indigenous peoples face. Dr. James Makoski and Anthony

Johnson are a married couple that won Amazing Race Canada. While competing, the couple included

awareness and advocacy for indigenous Canadians that face generational trauma and difficulties

navigating the Canadian health care system. I was truly moved by their stories and there were some

connections in this presentation that relates to Keegans story.

Anthony Johnson had a younger brother that passed away at the age of 9 due to cancer. Before his

brother passed away, the doctor said “Well, we all know what’s going to happen to him so why treat

him?”. This is clearly another assumption made by a physician that has the skills to help indigenous
peoples access treatment for their diseases. With the power of advocacy, Anthony Johnson’s mother did

all she could to get help for her child. The 9-year-old boy has an ostomy and a trach, so his mother wrote

index cards of step-by-step ways to care for his conditions. Anthony then talked about how the healthcare

professionals did not put in practice the family’s traditional ways of healing or practice. I wanted to share

this glimpse of the presentation I saw because I did not know that in our healthcare system, there are so

many assumptions and lack of detailed care for our indigenous peoples. This presentation taught me to

listen to those advocating, work with the families in the patients care and align the care with the patient’s

cultural beliefs, values, and preferences. More about Dr. James Makoski and Anthony Johnson here:

https://speakerscanada.com/keynote-speaker/amazing-two-spirit-couple/

References:

Balzer-Riley, J. (2021). Communication in nursing. (9th Edition). Elsevier

First Nations Health Authority (2022). Remembering Keegan; a BC First Nations Case Study Reflection.
https://www.fnha.ca/Documents/FNHA-Remembering-Keegan.pdf

Out of sight - WRHA professionals.

https://professionals.wrha.mb.ca/old/professionals/files/OutOfSight.pdf

CBC/Radio Canada. (2023, August 29). Barriers like racism, distrust may be main cause of health-care
disparities for indigenous women, study says | CBC News. CBCnews.
https://www.cbc.ca/news/health/indigenous-women-health-care-inequities-1.6949274

Fletcher, K. (2016, May 14). Are you practicing cultural humility? – the key to success in cultural
competence. California Health Advocates. https://cahealthadvocates.org/are-you-practicing-
cultural-humility-the-key-to-success-in-cultural-competence/

Hilo, A. H. • The importance of cultural competence: Nursing made incredibly easy. LWW.
https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2011/03000/
The_importance_of_cultural_competence.1.aspx

Cragg, S. (n.d.). Supporting cultural diversity in long-term care - Ontario CLRI.

https://clri-ltc.ca/files/2018/04/CLRI-on-Supporting-Cultural-Diversity-Long-Term-Care.pdf
 Module 1 Questions
Question #1 - How did you feel after working through Remembering Keegan case
study?

 Rational provided in response (2)

 Clear link to the case study (1) /3

Question #2 - Identify 3 examples from the case study where the sharing of
information with Keegan and his family was not provided in a respectful manner.
How could this information have been delivered in a respectful way?

 3 examples provided (3)

 3 strategies for respectful communication provided (3)
 Reference provided for strategies (1)
/7
Question #3 – Describe potential challenges that may arise when communicating with
cultures outside of our own. What communication challenges did you identify in this
case study? How might these communication challenges have been better addressed
i.e., specific strategies?

 Potential cultural challenges identified (2)

 2 case specific challenges identified (2)
 Specific strategies provided (2)
 Reference provided for potential challenges (1) /7

Question #4 – Reflect on the section Culturally unsafe encounters surrounding

Keegan’s death (p.22-34). What are 2 things you will do in your own practice to
maintain cultural safety and humility?

 2 examples provided (2)

 Rational provided (2) /4

Follows APA Formatting

 Title page, reference list, page numbers, in-text citations /3

Indigenous Competencies - Self-Assessment

 ADD 4-5 entries to your existing document
/2
 Dates provided with each new entry
/1
 Clearly identifies how previous personal, professional experience or learned
materials apply to the competency
/3
Total/Summary
/30