Unfortunately, I’m starting this post with some disturbing anecdotal evidence of treatment of indigenous persons when they present to the emergency department. In 2008, Brian Sinclair, an aboriginal man who presented to an ED for help and died in the waiting room, 34 hours later. Staff in the emergency department assumed that he was there to “sleep it off” and these incorrect assumptions, partially based on his being aboriginal were listed as part of the reason for his death in the courts ruling on the case (Dehaas, 2012). The judge in the case also highlighted the lack of communication between Sinclair’s support system and the healthcare system responsible for managing his multiple medical conditions including substance abuse, communication challenges, housing and a complex physical condition including bilateral leg amputations (Dehaas, 2012).
In urban settings across Canada, Aboriginal persons are more likely to use emergency departments for primary care requirements due to an inequity of access to primary care for Aboriginal people (Browne, Smye, Rodney, Tang, Mussell, & O’Neil, 2010). Creating access to appropriate and cultural relevant primary health care for Aboriginal persons in Canada is one of the goals of Health Canada for improving Aboriginal health (Health Canada, 2012). If accessible, relevant and supportive primary care initiatives focus on Aboriginal persons equal access to these services, not only will they receive more comprehensive care, but may ultimately decrease their dependence on emergency room settings that may not have sufficient resources to provide the collaborative care required to meet the complex medical and social needs of this vulnerable population.
As emergency department practitioners we also need to be aware of our own failings in providing care to Aboriginal persons. Studies have highlighted the perceived inequities that Aboriginals face when presenting to emergency departments including; feeling they are being judged on the bases of being Aboriginal, using the ED for inappropriate reasons (Browne et al, 2010), practitioners lack of knowledge of Aboriginal health, history and cultural practices, and the presence of overt racism from healthcare staff (Levin & Herbert, 2005). The Canadian Nurses Association [CNA] supports nurses efforts to provide culturally appropriate care to Aboriginal persons by providing a framework outlining six core competencies for Aboriginal nursing (Aboriginal Nurses Association of Canada, 2009) and by supporting nurses to incorporate indigenous knowledge into practice (CAN, 2014). Despite these recent efforts to improve nursing care for Aboriginal persons in Canada, there is still a demonstrated lack of understanding in health care, the impact of this lack of knowledge surrounding Aboriginal history and its relation to health is discussed in this Ted Talk by a student nurse, Dawn Tisdale.
As healthcare practitioners we can provided better care to our clients if we are aware of our own gaps in knowledge, and reflect on the unintentional bias we may portray in our practice. By educating ourselves Aboriginal persons experience with the healthcare system we can be better prepared to serve this vulnerable population.
References
Aboriginal Nurses Association of Canada. (2009). Cultural Competence and Cultural Safety in Nursing Education: A framework for First Nations, Inuit and Metis Nursing. Retrieved from https://www.cna-aiic.ca/-/media/cna/page-content/pdf- en/first_nations_framework_e.pdf?la=en&hash=DEE45D341B96BDA653C57B7737AE 6E300C708 C42
Browne, A. J., Smye, V. L., Rodney, P., Tang, S. Y., Mussell, B., & O'Neil, J. (2010). Access to Primary Care From the Perspective of Aboriginal Patients at an Urban Emergency Department. Qualitative Health Research, 21(3), 333-348. Retrieved from https://doi.org/10.1177/1049732310385824
Canadian Nurses Association. (2014). Aboriginal Health Nursing and Aboriginal Health: Charting Policy Direction for Nursing in Canada. Retrieved from https://www.cna- aiic.ca/-/media/cna/page-content/pdf-en/aboriginal-health-nursing-and-aboriginal- health_charting-policy-direction-for- nursing-in- canada.pdf?la=en&hash=59F4641D59EBDE29D9CC573CAF19FA8706647625
Dehaas, J. (2012, December 12). Death after 34-hour ER wait was preventable: judge. CTV News. Retrieved from https://www.ctvnews.ca/health/death-after-34-hour-er-wait-was- preventable-judge-1.2144671
Health Canada. (2012). First Nations and Inuit Health Strategic Plan: A shared path to improved health. Retrieved from https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/fniah- spnia/alt_formats/pdf/pubs/strat-plan-2012/strat-plan-2012-eng.pdf
Levin, R. & Herbert, M. (2005) The Experience of Urban Aboriginals with Health Care Services in Canada. Social Work in Health Care, 39(1), 165-179, DOI: 10.1300/J010v39n01_11
Tedx Talks. (2015, June 4). Dawn Tisdale: The Impact of Residential Schools on Aboriginal Healthcare [Video File]. Retrieved from https://www.youtube.com/watch?v=kMvn_mSsykE
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