In this article, we share words spoken by Aboriginal elders from Saskatchewan, Canada, in response to the research question, "What would you like non-Aboriginal health care providers to know when providing end-of-life care for Aboriginal families?" Our purpose in publishing these results in a written format is to place information shared by oral tradition in an academic context and to make the information accessible to other researchers. Recent theoretical work in the areas of death and dying suggests that cultural beliefs and practices are particularly influential at the end of life; however, little work describing the traditional beliefs and practices of Aboriginal peoples in Canada exists to guide culturally appropriate end-of-life care delivery. Purposive sampling procedures were used to recruit five elders from culturally diverse First Nations in southern Saskatchewan. Key informant Aboriginal elder participants were videotaped by two Aboriginal research assistants, who approached the elders at powwows. Narrative analysis of the key informant interview transcripts was conducted to identify key concepts and emerging narrative themes describing culturally appropriate end-of-life health care for Aboriginal families. Six themes were identified to organize the data into a coherent narrative: realization; gathering of community; care and comfort/transition; moments after death; grief, wake, funeral; and messages to health care providers. These themes told the story of the dying person's journey and highlighted important messages from elders to non-Aboriginal health care providers.
The objective of this study was to examine factors associated with HIV testing among Aboriginal peoples in Canada who live off-reserve. Data were drawn for individuals aged 15-44 from the Aboriginal Peoples Survey (2001), which represents a weighed sample of 520,493 Aboriginal men and women living off-reserve. Bivariable analysis and logistic regression were used to identify factors associated with individuals who had received an HIV test within the past year. In adjusted multivariable analysis, female gender, younger age, unemployment, contact with a family doctor or traditional healer within the past year, and "good" or "fair/poor" self-rated health increased the odds of HIV testing. Completion of high-school education, rural residency, and less frequent alcohol and cigarette consumption decreased the odds of HIV testing. A number of differences emerged when the sample was analyzed by gender, most notably females who self-reported "good" or "fair/poor" health status were more likely to have had an HIV test, yet males with comparable health status were less likely to have had an HIV test. Additionally, frequent alcohol consumption and less than high-school education was associated with an increased odds of HIV testing among males, but not females. Furthermore, while younger age was associated with an increased odds of having an HIV test in the overall model, this was particularly relevant for females aged 15-24. These outcomes provide evidence of the need for improved HIV testing strategies to reach greater numbers of Aboriginal peoples living off-reserve. They also echo the long-standing call for culturally appropriate HIV-related programming while drawing new attention to the importance of gender and age, two factors that are often generalized under the rubric of culturally relevant or appropriate program development.
The challenge to transfer the health care of Aboriginal peoples of Canada from non-Aboriginal to predominantly Aboriginal health professionals, requires preliminary innovative approaches in post-secondary education. Described in this paper, is the background, development and progress to date of the Integrated Nursing Access Program (INAP) for Aboriginal students, and its phenomenological approach to curriculum design. Traditional indigenous knowledge and methodologies are embedded in process learning and university-level program activities. Learning in this INAP Bachelor of Nursing program occurs over three years, during which time students complete high school requirements together with some first year nursing courses. The program is followed by three additional years of exclusive baccalaureate level nursing education. To date, students have successfully completed the first half of this program.
Research among cancer patients has shown that emotional support in informal relationships may be difficult to access because of a fear or lack of knowledge about cancer. Consequently, formal relationships with healthcare professionals may be important sources of support.
This study explores needs for and experiences with emotional support provided by nurses as well as prerequisites for the provision of support among Danish-born and migrant cancer patients.
We conducted narrative interviews with 18 adult Danish-born and migrant cancer patients. Patients were recruited from a variety of places in a purposive strategic sampling process. Analysis was inspired by phenomenological methods and Simmel's theoretical concept of "the stranger".
Both Danish-born and migrant patients perceived the support delivered by healthcare professionals as available, empathic and valuable. Prerequisites for providing emotional support were 1) setting aside time for the patient to feel safe and able to verbalise emotional concerns, 2) continuity in relationships with healthcare professionals, and 3) nurses' ability to understand the patient's emotional reactions without creating additional distress.
Being positioned as a stranger to the patient gives nurses a unique position from which to provide emotional support during cancer treatment. Thus, formal relationships with healthcare professionals are of great importance for many cancer patients.
Department of Medicine, Faculty of Medicine & Division of Health Care Communication, College of Health Disciplines, The University of British Columbia, 3250-910 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E3. email@example.com
Aboriginal people in Canada have poorer health than the rest of the population. Reasons for health disparities are many and include problems in communication between doctor and patient. The objective of this study was to understand doctor-patient communication in Aboriginal communities in order to design educational interventions for medical students based on the needs and experiences of patients.
Experiences of good and poor communication were studied by semi-structured interviews or focus groups with 22 Aboriginal community members, 2 community health representatives and 2 Aboriginal trainee physicians. Transcribed data were coded and subjected to thematic analysis.
Positive and negative experiences of communicating with physicians fell into three broad and interrelated themes: their histories as First Nations citizens; the extent to which the physician was trusted; time in the medical interview.
Aboriginal peoples' history affects their communication with physicians; barriers may be overcome when patients feel they have a voice and the time for it to be heard.
Physicians can improve communication with Aboriginal patients by learning about their history, building trust and giving time.
To identify the types of resources used to acquire information or assistance in the management of diabetes, and to identify persons who are more or less likely to use a variety of diabetes resources.
Through the use of a questionnaire and review of patient records, sociodemographic, clinical, and health care service utilization characteristics were obtained for 267 individuals with type 2 diabetes from a culturally diverse diabetes education centre. Descriptive analyses were performed to provide information on the types of diabetes resources used by age, sex and primary language spoken. Multivariable Poisson regression was used to predict low from high users of a variety of diabetes resources.
On average, most patients used four different resources. The most commonly cited were physicians or endocrinologists; diabetes educators; and magazines, newspapers, books or television. Those who did not speak English, were born outside of Canada, had a lower level of education, or who were older used fewer diabetes resources.
Notably, the characteristics of individuals who are less likely to use resources or a variety of resources reflect the basic determinants of health (i.e., age, sex, ethnicity or primary language spoken, and education).
We need to develop resources that are equitably accessible and of interest to all patients, particularly for individuals who do not speak English, who have lower education and literacy levels, and who are older. Furthermore, imparting the skills on how to find and utilize currently existing resources to assist in chronic disease self-management should be promoted as a core aspect of self-management education.
The objectives of this article are two-fold: (1) to gather in one place reliable information about Russian-Americans' past medical practices and their current outlook on health care and to provide health care professionals with an overview of the major afflictions suffered by this ethnic group; and (2) to educate Russian-speaking patients about the American heath care system and social services geared towards immigrants by locating and evaluating free, culturally appropriate patient education Web sites available in Russian.
In order to draw data on specific diseases and conditions affecting the Russian-speaking population, the author searched various scholarly health-related electronic databases. A number of well-established U.S. government consumer-health Web sites were searched to locate patient education resources that can be utilized by recent Russian immigrants.
The author provides an overview of the major health problems encountered by the Russian-speaking population before emigration and potential health concerns for Russian immigrant communities. In addition, the author provides a scholarly exploration of patient education materials available in Russian.
In this increasingly diverse society, physicians are faced with the challenge of providing culturally sensitive health care. Multicultural Web-based health resources can serve as a valuable tool for reducing communication barriers between patients and health care providers, thus improving the delivery of quality health care services. Recommendations for further research are indicated.
The author offers recommendations for practitioners serving Russian-speaking immigrants. Suggestions on utilization of Web resources are also provided.
The impact of HIV on tribal populations has received little attention. Often living in remote areas, further isolated by language, tradition and endogamous marriage patters, members of such communities have been assumed to be at lower risk for HIV. However, there is growing awareness that tribal peoples are sometimes at considerable risk for HIV, as well as other sexually transmitted infections. Young people in such communities may be particularly vulnerable. Traditional practices may forbid discussion of sex at the same time as increasing exposure to outside influences bring new attitudes and expectations about sex and sexuality. Concerned about the implications of the HIV epidemic on tribal populations, a review was conducted of available data on the HIV epidemic within tribal groups. Based on findings from this review, we propose a largely unexplored avenue for reaching tribal populations: namely, the incorporation of the HIV and AIDS related messages into traditional coming of age ceremonies. Such an intervention however can be one component of a comprehensive approach to reaching these often hard-to-reach populations but it may be an especially effective way to reach young people within these communities.
This exploration of the racial power dynamics in a participatory action research project with women who had experienced intimate partner violence discusses the challenges inherent in doing participatory action with antiracist intent and offers suggestions for overcoming these challenges. To engage in this type of research, explicit commitment to the goals of an antiracist intent needs to be shared as widely as possible. Fostering such shared commitment demands that the social locations of all involved be interrogated continuously. Such interrogation, however, needs to be prefaced with understanding that individuals are not representative of particular power positions or social identities or locations and with critical attention to how language and social structures shape racism and other forms of dominance. Being inclusive must be understood as complex and the influence of diverse agendas and perspectives acknowledged and taken into account. In the face of such complexity, "success" in research may need redefinition.
Effectively and holistically addressing the health-care needs of aboriginal people living in First Nations and nuit communities requires an understanding and a valuing of the cultural richness of the people. This article examines the programs and services provided in First Nations and Inuit health centres in Atlantic Canada and the support available for nurses working in First Nations and Inuit communities.