Indigenous Nurses Research Articles

Indigenous Model to Support Nursing Student Success, Cultural Identity and Workforce Diversity.

Indigenous nurses are underrepresented in the nursing workforce. Important strategies have been developed to increase the diversity of the future nursing workforce; however, unique cultural needs of Indigenous students must be addressed to provide holistic support while maintaining and strengthening cultural identity. The Niganawenimaanaanig (We Take Care of Them) Indigenous Nursing Education Model was developed based on the Medicine Wheel and previous diverse nursing education models. This model supports the cultural, social, academic, and financial needs of Indigenous nursing students throughout recruitment, enrollment, retention, graduation, and licensure and specifies eight essential resources necessary for success. Lessons learned from implementing the Niganawenimaanaanig Model are shared. The Niganawenimaanaanig Model may be employed in nursing schools to guide educators and universities in promoting the success of Indigenous nursing students. [J Nurs Educ. 2023;62(9):523-527.].

Decolonization the what, whyand how: A treatieson Indigenous nursing knowledge.

Decolonization the what, whyand how: A treatieson Indigenous nursing knowledge.

Introduction to decolonizing nursing.

The fact that racism and other forms of discrimination and injustice have persisted in our own nursing communities despite our rhetoric of caring and compassion can no longer be denied. This fact gave rise to a webinar in which the scholars represented in this issue of Nursing Philosophy appear. The webinar centered on the philosophy, phenomenology and scholarship of Indigenous nurses and nurses of color. The authors of the articles in this issue are giving us the precious gift of their ideas. All of us, white scholars and scholars of color, must come together to receive this gift, learn from their words and their insight, debate the ideas, honor the perspectives, and consider ways that we can move this discourse forward to create new possibilities for nursing, new possibilities to shape the future development of our discipline.

Pathways for Healthcare Organizations to Strengthen Indigenous Nurse Retention.

Call to Action #92 encourages corporations to apply the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) as an organizational framework and provides concrete strategies to guide policy and operational activities to increase Indigenous participation in the economy (Truth and Reconciliation Commission of Canada 2015b; UN 2007). Call to Action #92 and the UNDRIP are explored to provide strategies to decolonize mainstream healthcare organizations and promote workplace structures that assist Indigenous nurses in thriving in the work setting. The recommendations in this synthesis paper can be used by healthcare organizations to support Indigenous reconciliation in Canada.

Processus collaboratif menant à un portrait de la formation infirmière initiale au Québec et perspectives de développement au regard de la sécurisation culturelle auprès des Premières Nations et des Inuit

INTRODUCTION. In recent years, several provincial and national reports have highlighted the need for more cultural safety education for health care professionals to ensure safe equitable care for Indigenous people. In the province of Quebec, the death of Joyce Echaquan has been a key lever for diverse health organizations and teaching institutions in order to take concrete actions against health inequities and systemic racism experienced by Indigenous people within the health care system. In response, the Order of Nurses of Quebec officially recognized the existence of systemic racism within the health care system and initiated actions to promote cultural safety and to engage against systemic racism within the nursing profession. Among the actions, the Order of Nurses of Quebec mandated a working group to address an advisory to evaluate if the entry-to-practice nursing education in Quebec was sufficient to provide culturally safe, relevant and equitable care to Indigenous individuals. We are the authors who carried out the collaborative process leading to the advisory. From this collaborative process, we believe that our approach, our findings and our reflections are relevant to share with those who are involved in nursing education in Quebec and Canada. OBJECTIVE. This discussion paper aim to describe the collaborative process leading to the advisory which was divided into four iterative stages : 1) a narrative literature review, 2) a short online survey, 3) discussions sessions, and 4) consultations. It also aim to discuss the main findings and reflections regarding the cultural safety competencies in initial nursing education in Quebec. DISCUSSION AND REFLECTIONS. We believe that our collaborative process was a strength of the main findings and reflections that are described in this discussion paper. The results of the survey showed that Indigenous cultural safety content and time allocation was insufficient and varied greatly between teaching institutions in Quebec. No institutions offered electives or specific courses on Indigenous cultural safety; however cultural safety was addressed in a cross-cutting manner by the majority of institutions. As for the narrative literature review and the discussions sessions, numerous strategies are outlined to guide educators in further developing the Indigenous cultural safety content in their nursing programs. These strategies highlight the need to work with Indigenous communities to decolonize and indigenize the nursing profession and education and the need to focus on faculty development including, hiring Indigenous nurses. CONCLUSION. Within our collaborative process, we consider that we have succeeded in bridging together reflections to support teachers and professors in Quebec and Canada to develop and integrate Indigenous cultural safety content in nursing programs. We also agree that is necessary for all Canadian provinces to initiate a reflection about Indigenous cultural safety in entry-to-practice nursing programs in order to ensure culturally safe, relevant and equitable care to Indigenous individuals.

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Rhetoric, Racism, and the Reality for the Indigenous Maori Nursing Workforce in Aotearoa New Zealand

Indigenous Māori nurses in Aotearoa are a critical part of the health workforce. They know their communities and are trusted. But rather than being valued, they are often silenced, rendered invisible, and oppressed, driven by unfilled rhetoric in the Māori nursing workforce and endemic racism within nursing that other colonized Indigenous nurses also experience. Despite inequities within the Māori nursing workforce and Māori health outcomes in general, nursing within Aotearoa, New Zealand has yet to meaningfully increase and value the role of Māori nurses. In this article, we discuss the history and impact of the concept of Kawa Whakaruruhau, a term to describe cultural safety. We also critique the rhetoric, racism, and reality of the Indigenous Māori nurses and discuss its significance as is relevant to the international Indigenous nursing workforce and minority nursing populations.

Indigenous social exclusion to inclusion: Case studies on Indigenous nursing leadership in four high income countries.

This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes. Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change. A Kaupapa Māori case study design. Using a Kaupapa Māori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce. These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism. In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models. Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples.

Do We Need More Indigenous Nurses?

Data collected over the past four decades show the life expectancy of indigenous Taiwanese to be 8 to 10 years lower than the general, predominantly Han Chinese, population. This suggests the persistence of inequities in the public health system in Taiwan. Several facets of this issue, including lack of consideration of the characteristics and lifestyle of ethnic populations in health policy planning and implementation work and the continued location-based focus of medical care resource distribution policies, are being actively discussed. However, investigations of factors related to the relatively poor health status of indigenous Taiwanese have not considered the traumatic and lingering effects of colonisation. This article briefly introduces the health status of indigenous Taiwanese and the indigenous nursing workforce and then presents a review of the literature on factors related to the under-representation of indigenous Taiwanese in nursing programs and the nursing workforce. Indigenous Taiwanese were found to be absent from public-health policymaking. Moreover, indigenous-related traditional knowledge and values are not being effectively transmitted to younger generations. A diverse nursing workforce should reflect and respond to not only indigenous peoples but also the general population in Taiwan.

Gorgeous Colorful Rainbow: The Beauty and Sorrow of Indigenous People`s Health

Residing across this island for over 8,000 years, Taiwan`s indigenous people represent the world`s northernmost population of Austronesian islanders. Although Taiwan`s more than 500,000 indigenous citizens today account for only 0.11% of the 300 million Austronesians worldwide, Taiwan and Taiwan`s long-thriving Austronesian culture played an indispensable role in the historical migrations of ancient Austronesian peoples from Mainland Asia and their proliferation throughout the Pacific (Council on Indigenous Peoples, n.d.). The cultural diversity of Taiwan`s indigenous people allowed their many ethnic groups to adapt to the island`s climatic and environmental diversity, ranging from high, temperate mountains to tropical coastlines, for thousands of years. These groups have adapted well to local conditions, developing living habits, livelihood patterns, life customs, and ceremonies suited to their lives. Traditional wisdom and knowledge, like a colorful rainbow, have shone from ancient times up through the present and are woven deeply through the unique life values of the 16 ethnic tribal groups on Taiwan Island. However, the modernization and transformation of Taiwan`s economy during the past three decades have left indigenous citizens significantly behind mainstream society in many important aspects, including average lifespan, income, education level, and access to medical resources, with mainstream society enjoying more social advantages and a longer average life span (Health Promotion Administration, 2017). Thus, social determinants have promoted various inequalities in health, and the rainbow is no longer beautiful under the impact of modern values. The inequitable distribution of healthcare resources and inadequate human resources have cast a shadow of sadness over this originally beautiful rainbow. Some scholars have raised the cultural security model as a possible framework for formulating policies and regulations to protect the health rights of disadvantaged groups (Coffin, 2007). Using knowledge and values to emphasize cultural safety in the health field and cultural awareness holds the potential of reversing the role of traditional wisdom and knowledge transmitters to gain a deep understanding of the health needs of ethnic groups and of implementing related strategies in acute, chronic, and long-term medical care. This issue is rooted in the current, inequitable deployment of long-term care resources and provision of policy recommendations. In this paper, we discuss strategies for considering and actualizing the main concerns and priorities of ethnic groups, cultivating long-term care 2.0 cultural safety seed tutors, and employing ethnically indigenous nurses in their hometowns / communities. Furthermore, in terms of caring for minorities, we also discuss the long-term care needs of disadvantaged groups such as individuals with mental health needs to achieve the goal of holistic care. We look forward to seeing the bright and colorful rainbow once again. From systemic, educational, and practice perspectives, we will jointly promote public health for all and work to let the beauty of the rainbow surpass the traces of sorrow.

Cultural and clinical practice realities of Māori nurses in Aotearoa New Zealand: The emotional labour of indigenous nurses

In Aotearoa New Zealand there is limited research exploring the tensions for Indigenous Māori nurses when integrating cultural priorities into clinical practice. This study explores how Māori nurses navigate delivering culturally responsive care to iwi, hapū, and Māori whānau across different healthcare settings. A qualitative Indigenous narrative inquiry was used to obtain data. Semi-structured interviews were conducted with 12 Māori registered nurses and nurse practitioners. The thematic analysis was both inductive and deductive. The narratives provide insight into the nurses’ holistic Indigenous world view by contextualising their professional practice experiences. Four main themes were derived from data: te tuakiri Māori - cultural identity; kawenga taumaha - bearing the burden; te kaikiritanga - racism; and tauutuutu - reciprocity. Māori practitioners routinely experienced compromises within biomedically oriented healthcare services. Practitioners witnessed discriminatory practices that may negatively impact on healthcare outcomes. Sustained cultural dissonance may also negatively impact on retention of Māori nurses. Māori practitioners value tauiwi colleagues who work as allies and affirm culturally shaped care for Māori.

Disrupting dominant discourse: Indigenous women as trained nurses and midwives 1900s–1950s

ABSTRACT Background The history of Indigenous nurses and midwives in Australia is yet to be fully examined. There is a dearth of Indigenous-led research that identifies the rich and complex involvement of Indigenous women in Australia’s nursing and midwifery labour force. Aim This paper contributes to the history of Indigenous women’s participation in nursing and midwifery in Australia by examining how it was possible for some Indigenous women to pursue nursing and midwifery qualifications when this was not widely acceptable. The paper specifically seeks to investigate the enablers and limitations placed on Aboriginal women in accessing training. Methods Underpinned by historical methods and using an Indigenous lens for interpretation, this paper adopts a descriptive case study methodology to make visible the little-known yet important contributions of Indigenous nurses and midwives before 1950. It positions the case studies within the context of the Acts of Administration that controlled the lives of Indigenous Australians. Findings Through three case studies, this paper exposes the consequences of the debilitating, racialised laws of the time, which rendered Indigenous people invisible. The case studies demonstrate that Indigenous women did train as nurses and midwives in the early 1900s, even though they are largely absent in the historical record. Discussion Writing historical accounts of Indigenous Australian nurses and midwives is challenging, partly because they are largely excluded from the historical record, and partly because of the normalised technique used to frame history in Australia. Much historical discussion fails to account for Australia’s racialised biases and produces (race) obstructionist histories. An alternative approach is offered, centred on Indigenous women’s work to meet the individual, institutional and ideological racialised limitations set by context (nursing and midwifery history), historical period (1900s–1950s) and place (Australia). Conclusion Obstructionist histories mean that the history of Indigenous nursing and midwifery in Australia has not been well researched, interrogated or published. There is a need to document these histories and recognise the Indigenous women of the era who, in spite of the challenges they faced, forged careers in nursing and midwifery and laid the foundations for the Indigenous nurses and midwives who followed.

Indigenous nurses' practice realities of cultural safety and socioethical nursing.

Persistent healthcare emphasis on universal moral philosophy has not advantaged indigenous and marginalised groups. Centralising cultural components of care is vital to provide ethical healthcare services to indigenous people and cultural minorities internationally. Woods' theoretical explication of how nurses can integrate cultural safety into a socioethical approach signposts ethical practice that reflects culturally congruent relational care and systemic critique. To demonstrate the empirical utility of Woods' ethical elements of cultural safety within a socioethical model, through analysis of indigenous nurses' practice realities in Aotearoa New Zealand. The study used a qualitative indigenous narrative inquiry. Participants were recruited nationally. Twelve Māori registered nurses and nurse practitioners were interviewed. All participants provided direct care in either primary or secondary health services. Research approval was gained from the Human Ethics Committee of the lead author's tertiary institution. Participation was voluntary, and written informed consent was obtained. Analysis highlighted the following: (1) cultural needs, which for Māori were integral to care, were easily subsumed by clinical care being prioritised; (2) ethical care by non-indigenous nurses requires critical reflection about broader equity issues that impact Māori disengagement from healthcare; (3) retention of indigenous nurses was seen as essential because their advocacy and the cultural 'fit' for Māori contributed to positive healthcare outcomes; and (4) committed leadership ensured culturally safe care was not eroded through workplace efficiencies. The data provide rich representation of Woods' model. The data indicate that nurses must engage reflexively with a relational ethic of care and social justice dimensions in order to deliver culturally safe care. Woods' model provides a critical lens for nurses to examine their relational practice and systemic factors that enhance or detract from culturally safe care when caring for members of any indigenous group.

Challenges in the training of indigenous nurses in Mato Grosso, Brazil.

The training of nurses in Brazil remain a challenge for the university, given the existing ethnic diversity and regional particularities. Thus, the aim of this study was to identify the challenges in the training process of indigenous nurses in Mato Grosso, Brazil. It is an exploratory and qualitative study, carried out with 11 indigenous nurses. Data analysis was based on Paulo Freire's interculturality. It was verified that both participants sought the integration of indigenous traditional knowledge with scientific technical knowledge during their practices, which facilitates a satisfactory interaction with the community. During nursing undergraduate school, they had little or no contact with contents related to indigenous health and at the end of the training they observed they were not prepared to meet the diverse health demands. Historically, they are subordinated in relation to non-indigenous people, which manifests as disadvantages in the teaching-learning process, related to technical / technological as well as social aspects.

Perceptions of Academic Supports for Indigenous Nursing Students

Given the education completion gap between Indigenous students and non-Indigenous students and the need for more Indigenous nurses, support for Indigenous nursing students is imperative for academic success. Indigenous nursing students face a number of barriers to success and struggle with the demands of the university setting. Academic, financial, personal, and cultural supports may assist students to successfully adapt and overcome these barriers. Educational institutions, such as Saskatchewan Polytechnic, have recognized barriers to Indigenous student success and have put a variety of measures in place to assist students. This paper aims to examine the current literature on Indigenous nursing student perception and academic support staff perception of available supports. The literature suggests that facilitative factors such as collaborative relationships between support services, individual supports, the learning environment, financial supports, and student characteristics all play a role in the academic success of students. Stressors, health, institutional racism, and feelings of shame and self-doubt are some barriers students must overcome. Within the larger context, students’ pre-university educational experience, the academic environment, and program characteristics impact the effectiveness of support services. Indigenous nursing students and Indigenous students from other programs share similar perceptions as to the effectiveness of support services. The perception of academic staff is that the needs of both Indigenous nursing and non-nursing students are similar. Although there is little research in the area of library services in relation to how they support Indigenous nursing student success, student perceptions of other support services are positive when students use them...

The experiences of Australian indigenous nursing students: A phenomenological study

• The experience of Indigenous nursing students was influenced by three factors titled, The Significance of Culture, Mystification and Same-Same. • There is a shortage of Indigenous nurses however, a cultural specific healthcare workforce is needed to improve health outcomes for Indigenous people. • Indigenous nursing academics strongly communicates to new students that successfully completing their studies is achievable. • The lack of preparedness and academic skills is not unique to Indigenous tertiary students as non-Indigenous may encounter the same experiences.

Multi-Dimensional Cultural Safety in Academic Libraries

Over the past decade, the field of Library and Information Studies (LIS) has promoted cultural competence as a means of improving services to multicultural or traditionally underserved populations. However, critical LIS scholars have noted that cultural competence and diversity are viewed predominately as a matter of skill acquisition on the part of the library worker, rather than as one that involves a critique of the forces of structural racism, discrimination, and colonialism in society. In response, this paper proposes adapting frameworks from other professions for the library context: Multi-Dimensional Cultural Competence (MDCC) from counselling psychology, and cultural safety (CS) from Indigenous nursing. The former views cultural competence in terms of diversity factors, components, and multiple levels of foci, while the second is premised in postcolonial understandings and respect for Indigenous knowledges. The proposed synthesis, Multi-Dimensional Cultural Safety (MDCS), is established by first identifying the epistemological and ideological shortcomings of cultural competence, focusing on the need for institutional critiques as well as a recognition of racialization and power structures. Next, the two existing frameworks are explained in terms of their origins, content, and professional contexts, noting how each addresses the shortcomings of cultural competence as well as each other’s shortcomings. The proposed framework is then elaborated upon in an LIS context and illustrated with hypothetical examples.

Commentary: Indigenous Nursing - Learning from the Past to Strengthen the Future of Healthcare.

Nurse leaders, educators and employers work to address the challenges of providing optimal care to Indigenous people and communities in Canada, which is often further complicated by geography and isolation. The Canadian Indigenous Nurses Association (CINA) has responded to the Calls to Action of the Truth and Reconciliation Commission of Canada through partnerships with various levels of government, including the First Nations and Inuit Health Branch of the new federal department of Indigenous Services Canada, to increase and better support Indigenous nurses in the healthcare system. Grounding nursing practice with the wisdom and strength of Indigenous knowledge, balanced with the perspectives of western ways of knowing is further facilitated when nursing students can be educated and supported closer to home. Learning in a supportive way, closer to where one lives, can allow for important family ties, cultural supports and practices to improve experiences and outcomes for students.

Choosing a nursing career: Building an indigenous nursing workforce

Introduction: This paper provides an overview of the impact of government policy in supporting the growth of an Indigenous nursing workforce in New South Wales and Australia.Methods: Publically available nursing workforce performance reports along with current literature were reviewed to provide a perspective on the current situation.Results and discussion: The National partnership agreement on closing the gap in Indigenous health outcomes indicated that to improve Indigenous health outcomes, significant investment is required with particular reference to increasing an Indigenous workforce. As nurses comprise the majority of the health workforce a number of strategies and initiatives have been put in place to support this agreement. Even though there has been commitment through government policy and funding initiatives it is questionable if this is having any real impact on growing an Indigenous nursing workforce.Conclusions: Recruitment strategies that will increase the number of Indigenous nurses within the health workforce requires a multilevel approach. Despite efforts to increase Indigenous nursing workforce numbers, there has been limited impact to any real successful gains since 2008. Building and growing an Indigenous nursing workforce that will support the “Closing the Gap” initiative will require significant continuing effort.

Mâmawoh Kamâtowin, "Coming together to help each other in wellness": Honouring Indigenous Nursing Knowledge

This paper is the result of coming to know and better understand Indigenous nursing experience in First Nations, Inuit and Métis communities. Using an Indigenous research approach, I (first author) drew from the collective experience of four Indigenous nurse scholars and attended to the question of how Indigenous knowledge manifests itself in the practices of Indigenous nurses and how it can better serve individuals, families, and communities. This research framework centered on Indigenous principles, processes, and practical values as expressed in Indigenous nursing practice. The results were woven from key understandings and meanings of Indigeneity as a way of being. Central to this study was that Indigenous knowledge has always been fundamental to the ways that these Indigenous nurses have undertaken nursing practice, regardless of the systemic and historical barriers they faced in providing healthcare for Indigenous people. The results of this research demonstrated how Indigenous nurses consistently drew on their inherited Indigenous knowledge to deliver nursing care to Indigenous people. Their identity as Indigenous persons was integral to their identities as Indigenous nurses. Of significance is the personal and particular description of how these Indigenous nurse scholars developed their nursing approaches in relevance to how health and healthcare delivery must be integrated into healthcare systems as a pathway to reducing health disparities.