Apr 01, 2016
Indigenous nurse leaders share success stories
Nurse Trailblazers: Primary Health Care in Action
June 22, CNA biennial convention
Working with communities to help families navigate the heath-care system, to revive traditional practices, to support self-management of chronic disease and to increase food security
When Sherri Di Lallo first met the young parents from Little Red River Cree Nation at Edmonton’s Stollery Children’s Hospital, she could see their fear and anxiety.
The couple had travelled almost 1,000 kilometres from their fly-in community of 1,800 people in northern Alberta to learn how to change their eight-month-old’s feeding tube. The baby, who had survived meningitis, needed ongoing care back on the reserve, where there were few resources or supports. But the size of the hospital alone was overwhelming for the shy young couple; the number of staff was nearly three times the population of their community.
Until they met Di Lallo, a Métis RN and the hospital’s first Aboriginal child health nurse coordinator, no one had taken the time to explain to the parents, in terms they could understand, the importance of keeping the area around their son’s feeding tube clean and free of infection.
Di Lallo will be speaking about her role at the hospital on a panel of Indigenous nurse leaders at CNA’s biennial convention in Saint John, N.B.
In the case of these young parents, Di Lallo’s help was critical. First, she sat with them and asked how they were doing, with the help of a Cree-speaking social worker. Then, Di Lallo and a home nutrition nurse took them through the steps they needed to learn. They practised, and she reassured them that their parenting skills were up to the task.
“By us helping them, they were able to hear us,” says Di Lallo. “They became more relaxed. They were talkative — friendly — the stress went away.” Most importantly, the baby’s care improved.
In this new position, Di Lallo will be liaising and advocating for children and their families while they are at the hospital and then coordinating better followup care in First Nations and Métis communities when the families go home.
The hospital created the role following concerns from families and staff that patients were falling through the cracks when they returned to their communities. Discharge planning had not been completed. For example, nurses in many of the communities can’t access electronic patient records, so they didn’t know what services to provide returning patients. Hospital staff were not aware of the limited resources in the communities.
Now, Di Lallo telephones the nurses to discuss home care before children are discharged and she is educating staff at the hospital. The result is better communication, continuity of care and improved service for patients, she says.
The Aboriginal child health nurse coordinator role is an example of community-driven innovation emerging in Indigenous communities across the country, supported by Indigenous nurses whose own experiences inform their leadership. Those developments are the reason Dawn Tisdale, who will chair the panel at the convention, believes it’s important that the panellists share their stories.
“We’re the fastest growing population in Canada, and the health disparities that Indigenous people face are not acceptable,” says Tisdale, who is past president of the Canadian Nursing Students’ Association and a fourth-year nursing student at North Island College on Vancouver Island. “It’s time for nurses to advocate for the health of Indigenous people.”
An important aspect of that advocacy is to showcase the positive changes Indigenous nurses and communities are developing together, rather than focusing only on the challenges, she says. “These communities are a tremendous source of strength and wisdom, and they have Indigenous knowledge that should be cherished, respected and supported.”
Tisdale, who is of Mi’kmaq ancestry, hopes the practices the panellists describe will help non-Indigenous nurses increase their understanding and compassion and cultural sensitivity to the impact that historical trauma and the residential school experience has had on the health of Indigenous people.
Awareness of the impact of historical trauma is a critical component of Shelley Francis’s role as a diabetes community consultant serving 12 First Nations communities in New Brunswick. Francis, a Maliseet woman originally from the Tobique First Nation, will describe her work with the national Aboriginal Diabetes Initiative when she joins Di Lallo and Cheyenne Mary on the panel. One of the critical realizations Francis has made in her role of helping First Nations people manage their diabetes is that success rests on addressing their concurrent health concerns, including mental health and addiction.
She explains that in community diabetes clinics, she sees people whose illness is out of control at the same time as their mental health is unstable, often as a result of trauma. “While my primary objective would be to help them manage their blood glucose, they are much more likely to respond to my help if I try to understand any other personal struggles and focus on what they need.”
Lack of transportation and lack of cultural competence in non-Indigenous health-care professionals — and a fear of being judged by them — are just a few of the factors that discourage First Nations people from attending diabetes clinics off reserve. Working with three other diabetes educators in New Brunswick and Nova Scotia, and with the help of a Mi’kmaq elder, she developed the Diabetes Self-Management Journey. This program brings together 30-40 people from First Nations communities to learn culturally safe diabetes management techniques (such as building relationships, understanding what food is readily available and focusing on individuals’ strengths and abilities), to support traditional practices and to build a network of people who are struggling to manage the disease.
Taking the lead from communities about their health priorities governs how she works, Francis says. People tell her what kind of care they need, and she works alongside them to deliver it. That’s an approach more nurses should follow, she believes. She hopes her presentation will help convention attendees begin to understand why many aspects of the health-care system fail to provide culturally safe and competent care for Indigenous peoples in Canada.
Cheyenne Mary is another New Brunswicker who promotes overall good health in First Nations communities. In addition to teaching community health in the University of New Brunswick’s faculty of nursing, she is the Canadian Feed The Children program advisor in the province. In this role, she helps communities increase food security, supporting breakfast and lunch programs and gardens at local schools as well as Good Food box programs that supply produce to participants at wholesale prices.
All the children at schools on the Eel Ground, Tobique and Elsipogtog First Nations receive free breakfasts and lunches through universal school feeding programs that are models for a growing movement in Canada. At a November 2015 conference to promote national school food programs, a representative from Elsipogtog described its program, which feeds 300 children and incorporates traditional foods, including moose meat, fish, fiddleheads and luskinikn — a Mi’kmaq bread.
“Here we have an initiative that’s looking to First Nations communities as a path forward. What a great message for them,” says Mary.
Because so many people in these communities rely on social assistance, the school programs are critical to ensure children get healthy meals that set them up for successful learning and celebrate their culture, she says. “Our elders would say that food is medicine; so when we’re eating the food that’s local to us and is what our bodies were built to digest, we will be healthier and happier for it.”
One of the legacies of residential schools was the eradication of knowledge concerning food harvesting and preparation. Today, elders are teaching young parents and children how to dress and cook game and prepare other traditional food. Mary is another resource to call on, providing guidance on planting gardens and on setting up collective kitchens and passing on recipes and basic cooking tips on her website, Mi’kmaq Mama.
“In teaching someone how to fish or hunt or prepare the moose meat, you are passing on our culture. Many of our social and health-related issues come from losing our cultural identity, so bringing it back is part of the solution. That, in and of itself, is healing.”
These nurses hope the healing they are a part of will spread to help non-Indigenous nurses be better prepared to deliver safe, culturally appropriate care to the First Nations, Métis and Inuit patients they serve.