In Canada, falls are one of the leading causes of injury and deaths for seniors. These types of injuries can typically be avoided through falls prevention programs, and past studies suggest that these health services have significantly reduced seniors’ falls risk and rates in Canada. Despite the abundance of falls prevention research, practices and programs available in the country, Aboriginal Elders remain overrepresented in fall-related injury and fatality rates. The elevated rates of falls for Aboriginal Elders indicate that current falls prevention programs and standards may not be reaching those most vulnerable to fall hazards and injuries. My thesis is written in the publishable paper format and is comprised of two papers. Using an exploratory case study methodology in paper one, I investigated the social determinants of health that Inuvialuit Elders and LFPPs identify as factors that increase, decrease, or have no effect on the likelihood of an Inuvialuit Elder experiencing a fall. Together, we found that personal health status and conditions, personal health practices and coping skills, physical environments, social support networks, and access to health services increase Inuvialuit Elders likelihood of experiencing a fall, health practices and coping skills and access to health services decrease Inuvialuit Elders likelihood of experiencing a fall, and culture has no affect on the likelihood of Inuvialuit Elders experiencing a fall. In paper two, I used a participatory action research approach informed by postcolonial theory to examine what current falls prevention recommendations are offered by local falls prevention programmers (LFPPs) in order to reduce fall rates among Inuvialuit Elders in Inuvik, Northwest Territories, Canada; and to understand how falls prevention programs for Inuvialuit Elders can be co-created with participants to be culturally safe. In it, I provide the recommended strategies of developing and implementing a culturally safe falls prevention program for Inuvialuit Elders, as suggested by the LFPPs and Inuvialuit Elders who participated in the research. Taken together, the papers in this thesis make it apparent that research concerning falls prevention for Aboriginal Elders and falls prevention programs continues to be influenced by colonial practices. As a result, there is a demonstrated need for program development and research in this area to work towards reducing health disparities and challenging colonial practices.

Bakgrund: I Sverige och globalt rapporteras att minoritetsgrupper med avseende på kultur och språk är socioekonomiskt utsatta och har sämre hälsa än majoriteten. Diskriminering och misstro till hälso- och sjukvården är faktorer som påverkar huruvida individer i dessa grupper söker vård eller ej. I Sverige föreskrivs en hälso- och sjukvård på lika villkor för alla individer. Hälso- och sjukvårdspersonalen ansvarar för att vårdrelationen är respektfull och patientcentrerad. Kulturellt säker vård innebär att patientens kulturella identitet, rättigheter och behov respekteras. Huruvida vården är kulturellt säker definieras av patienten. Syfte: Syftet med studien är att belysa hur patienter som är i minoritetsställning, med avseende på kultur och språk, upplever sig bli bemötta i hälso- och sjukvården. Metod: Studien är en litteraturöversikt av 12 vetenskapliga artiklar med kvalitativ metod. Artiklarna analyserades med avseende på likheter och skillnader i resultatet. Resultat: Tre teman framkom; Välbefinnande, Lidande och Hinder och glapp. Huvudresultatet visar på upplevelser av maktlöshet, stereotypisering och språkliga och kulturella skillnader som skapade svårigheter i mötet med vårdpersonalen. Upplevelser av respektfullt och kompetent bemötande framkom också. Slutsats: I många fall låg missförstånd, oförståelse, stereotypisering och diskriminering till grund för lidandet. Detta visar att den kulturella säkerheten behöver stärkas inom hälso- och sjukvården och att behov av ökad kulturell kompetens föreligger. Klinisk betydelse: Genom diskussion och utbildning med teorin om kulturell säkerhet som utgångspunkt kan den kulturella medvetenheten och sensitiviteten höjas. På så sätt skapas förutsättningar för höjd kulturell säkerhet inom hälso- och sjukvården. / Background: Research both in Sweden and globally shows that members of cultural and linguistic minority groups are socio-economically disadvantaged and have poorer health than the majority. Factors that influence whether individuals in these groups seek care or not are discrimination and mistrust of the healthcare system. In Sweden, the healthcare system is required to provide all individuals with care on equal terms. Healthcare personnel have a responsibility to ensure that the caring relationship is respectful and patient-centered. Culturally safe care involves respecting the patient's cultural identity, rights and needs. Whether care is culturally safe is defined by the patient. Aim: The aim of this study is to explore how patients who are members of cultural and linguistic minority groups experience their treatment within the healthcare system. Method: The study is a literature review of 12 qualitative research papers. The results of the papers were analyzed for similarities and differences. Results: The analysis revealed three themes: Well-being, Suffering and Obstacles and glitches. The main result shows experiences of powerlessness, stereotyping and linguistic and cultural differences that created difficulties in interaction with the staff. In addition perceptions of respectful and competent treatment emerged. Conclusion: In many cases, misunderstandings, incomprehension, stereotyping and discrimination form the basis for the suffering. This shows that the cultural safety needs to be improved in the healthcare system and that there is a need for increased cultural competence. Clinical significance: Discussion and training, based on the theory of cultural safety, create an environment conducive to increased cultural awareness and sensitivity, and thereby enhance cultural safety in healthcare. / <p>Röda Korsets sjuksköterskeförening stipendium 2013</p>

ABSTRACT This thesis represents a two phase, qualitative study using both Expert Review Panel and Delphi Panel research methods. The two research questions guiding this study were: 1) Phase I: What does culturally safe nursing practice mean, and how do we know when it is being practiced; and 2) Phase II: Can proposed culturally safe nursing practices be coded through use of International Classification for Nursing Practice (ICNP®) and/or Nursing Intervention Classification (NIC)? Originating from the field of nursing in New Zealand, there is interest in adopting cultural safety in Canada to support culturally safe nursing care for Canada’s Indigenous people (Canadian Nurses Association, 2009). A synthesis of the literature was conducted in Phase I of this study revealing six hallmarks of culturally safe nursing care. Those are: 1) Creating trust; 2) Relinquishing power over relationships; 3) Approaching people with respect; 4) Seeking permission; 5) Listening with your heart and ears; and 6) Attending to those who’s beliefs and practices differ. Representing culturally safe care of an Indigenous elder, a case scenario, developed by the principle investigator (PI), was presented to cultural safety experts (n=3) participating on an Expert Review Panel (ERP). The results of ERP showed that all six culturally safe nursing practices were represented in the case scenario. Validating that culturally safe nursing practices could be succinctly defined contributes to new knowledge, and most importantly informs nurses how to practice in a culturally safe nursing way. The purpose of using a Delphi panel method in Phase II was to see if culturally safe nursing practices in the case scenario could be represented in the ICNP® and NIC nursing languages by experts in those particular languages. To explore this two groups of subject matter experts in ICNP® (n=3) and NIC (n = 3) were invited to participate in separate Delphi panels. Overall, the Phase II Delphi panel results reflected the divergent way ICNP® and NIC are structured, in that terms alone do not provide enough contextual meaning to support clinical practice. The results of the ICNP® Delphi Panel showed that one ICNP® nursing intervention could represent culturally safe nursing care: Establishing Trust. Otherwise, the abstract composition of ICNP® terms affected the study results. The NIC Delphi panel results reflect the content and structure of NIC, and as such the experts identified the following four NIC nursing interventions that reflect culturally safe nursing care, they are: 1) Culture Brokerage, 2) Complex Relationship Building, 3) Emotional Support, and 4) Active Listening. Succinctly defining what nurses do is important; therefore, nursing languages need to be unambiguous, contextual so they are accurately and consistently documented. Validating culturally safe nursing practices exist—and further ensuring they are represented in standardized nursing languages and terminology sets and thus coded for use in an electronic health record (EHR)—ensures that culturally safe nursing care data is captured in the EHR. / Graduate

While the uptake of cultural safety initiatives is increasing in professional environments, literature on cultural safety lacks reference to the lived experiences and demands of facilitating Indigenous cultural safety training. Using a qualitative and Indigenous approach, this study examined the various challenges and successes involved in facilitating Indigenous cultural safety and anti-racism training from the perspective of facilitators. The diverse sample comprised of 11 facilitators and included those who identified as Indigenous, non-Indigenous or mixed; those who identified as male or female; and those who have worked in post-secondary, healthcare and/or private sector environments. Findings indicate that facilitators, typically highly skilled and perceptive individuals grounded in their identity and critical race analyses, used affect and affective activities that challenge participants to interrogate the ways that power and privilege influence their everyday interpersonal and professional relationships. Affect theory describes the ways in which our bodies have the potential to be creative and respond in new ways; affect and affective activities in Indigenous cultural safety training increased the likelihood of a bodily emergence among participants, which is a necessary and critical turning point to create new relationships to land, others and self. Furthermore, the findings suggest that cultural safety training represents potentially risky spaces, as facilitators must constantly assess and manage the risks of harm, emotional distress and/or taxation for participants and themselves. Finally, the findings reveal possible supports necessary for facilitators to continue this important work. Overall, the findings demonstrate how affect and emergence is foundational to decolonialization and sustainable social change. / Graduate / 2021-04-22

This study highlights the voices of six Indigenous graduate students (including the author) currently and previously enrolled in counselling psychology through a collective narrative that tells the stories of our educational experiences and dream for the future of counselling psychology education. The significance of this research lies in its unique methodological considerations and expansion of existing literature from professional perspectives. Indigenous methodology and qualitative organizational tools were used to explore the study’s research questions. The six kʌtyóhkwa who engaged in this study came from diverse backgrounds and lived experiences and had attended one of three educational programs: 1) mainstream counselling psychology; 2) Indigenous communities counselling psychology; and 3) Aboriginal communities counselling psychology. We explored the research questions through one-on-one storytelling visits, talking circle facilitation protocols, and dreaming for the future – all grounded in Indigenous principles of relationality. Findings demonstrate themes of: relationality, experiential learning, diversity in knowledge sharers, and relevancy of program members, as well as the importance of mandatory Indigenous pre-requisite courses, cultural humility, teachings about how to be a good person, rather than how to be a good counsellor, and interviews for program entry are part of the collective dream for the future. Areas of further research include: 1) a larger study with a broader circle of participants; 2) the prevalence of cultural isolation or fulfillment amongst Indigenous graduate students and their supervisors in counselling psychology; 3) in-depth exploration of programmatic policy changes necessary within counselling psychology programs; and 4) development of measures to assess the effectiveness, strengths, and areas for growth of a national Indigenous faculty and student mentorship pilot program in counselling psychology. / Graduate

In Middle Eastern countries the authority of male guardians means women often endure significant social and gender inequalities, which can contribute to mental health problems, and impact on the mental health care received. This exploratory, qualitative study investigated mental health care delivery to Middle Eastern women in Riyadh, Saudi Arabia. Nurses (7), psychiatrists (3) and clinical psychologists (3) from a mental health hospital, student nurse interns (6) from a public women’s university and mental health care service users (5) and their family members (7) from a charitable organisation underwent semi-structured interviews. Their mental health beliefs, views and perceptions regarding the provision of mental health care to Middle Eastern women were explored. Transcripts were analysed using grounded theory, underpinned by the theory of intersectionality. Social identities of culture, religion and gender emerged as particularly important intersecting influences. Social class was less prominent. Gender inequalities and family control significantly impacted on women’s mental health and the care they received. Women violating cultural norms risked psychiatric labelling, and being interned, whilst those with genuine mental health problems were stigmatised and sometimes rejected by families. Most health care professionals voiced frustration over cultural norms, which compromised the care they provided. Nevertheless, they respected service users’ behaviours to earn trust and facilitate a therapeutic relationship. They appeared to be subconsciously tailoring the biomedical model of care to ensure appropriate and effective, culturally competent and culturally safe care. Gender inequalities, marital stress, polygamy, supernatural beliefs, folk/faith healing, lack of knowledge, compassion fatigue and custodial versus therapeutic care also emerged as important themes. These findings informed recommendations for best practice in the care of women with mental health problems in Saudi Arabia.

Ce mémoire présente les résultats d’une recherche qualitative menée auprès de six femmes autochtones montréalaises, ayant pour but de documenter leur expérience avec les services hospitaliers dans la ville de Montréal. En effectuant avec chacune un entretien semi-dirigé, nous avons été en mesure de dresser le tableau de ces expériences. Le modèle écologique de Bronfrenbrenner nous a permis de situer les expériences d’hospitalisation dans un contexte social et politique spécifique, en explorant certains éléments de cet ordre qui pourrait influencer la manière dont l’hospitalisation est vécue. L’expérience des femmes autochtones avec les services hospitaliers est analysée selon trois dimensions. Premièrement, les éléments relevant des interactions entre les patientes et les professionnels de la santé sont présentés. Cette section permet de faire état de l’impression partagée, parmi les femmes rencontrées, que les interactions avec les professionnels de la santé sont marquées par la présence de stéréotypes et de préjugés négatifs. Deuxièmement, les éléments relevant du contexte social et politique, qui exercent une influence sur la manière dont les femmes vivent l’expérience d’hospitalisation sont à leur tour présentés. Cette section aborde les lacunes dans la formation des professionnels, ainsi que l’influence du discours médiatique sur l’image des femmes autochtones. Troisièmement, nous présentons différents moyens et stratégies mis en place par les femmes autochtones pour faire face à leur expérience de soins, parmi lesquels on retrouve l’utilisation du rire et le recours à la communauté d’appartenance. Finalement, cette dernière section rend compte des conséquences de l’expérience d’hospitalisation des femmes sur l’utilisation qu’elles font des services de santé. Ce mémoire se conclut en présentant certains enseignements que nous pouvons tirés de l’expérience des femmes autochtones rencontrées afin d’améliorer la qualité des soins de santé qui leur sont destinés. / This thesis presents the results of a qualitative study conducted with six indigenous women living in the city of Montreal. The goal of the study was to document their experience with the city’s hospital services. A semi structured interview was held with each of the women in order to gain access to these experiences. Bronfrenbrenner’s ecological model allows us to position the hospital experience within a social and political context by exploring external factors that might influence the way the hospitalization was experienced by the women. The women’s experiences are analysed by exploring three dimensions. First, we present elements surrounding the interactions between the patients and the health professionals. This section reveals the women’s shared perception of stereotypes being present. Second, we present elements belonging to the social and political context. This section shows the gap in the professionals' training on indigenous issues, as well as the influence of media representations on the way they perceive native women. Third, we present different ways and strategies the women have developed in order to confront their experience, such as the use of laughter and invoking the community they belong to. Finally, this section shows the repercussions of negative experiences on the way native women use health services. We conclude by exploring what can be learned from the women’s experiences, with the goal of improving the quality of health services that are being offered.

En collaboration avec Anita Rousselot Dir. adj. SSS, Inf., B. Sc. chef en soins de 1ère ligne du Centre de Santé et des Services Sociaux de Pessamit / Les populations autochtones doivent avoir des ressources pour la petite enfance culturellement sécurisantes, qui soient respectueuses de l’identité culturelle des autochtones, qui visent l’équité et promeuvent l’autonomisation, car la colonisation a créé dans ces populations une méfiance due au racisme et à la discrimination vécus. Dans la communauté de Pessamit, située sur la Côte-Nord du Québec, une étude qualitative descriptive a été réalisée. Dans une perspective de « sécurisation culturelle » et d’acceptabilité des soins, le but de cette étude était d’explorer les barrières et les facilitants influençant la participation et l’engagement des familles autochtones avec des enfants âgés de 0-5 ans dans les ressources de la communauté. Quinze entrevues semi-dirigées ont été réalisées. De l’analyse thématique se dégagent divers thèmes comme « les défis liés à la parentalité avec un enfant », « le soutien des proches et de la famille » et « le développement personnel des parents ». Plusieurs barrières ont été identifiées, entre autres, « la méconnaissance et le manque de cohérence » et « les besoins non comblés ». Nombreux facilitants ont également été relevés comme « les services accueillants et sécuritaires » et « la disponibilité et l’accessibilité des intervenants et des ressources ». Une des recommandations était une table de concertation pour la petite enfance afin de développer et de renforcer les ressources communautaires pour les familles. Ces nouvelles connaissances aideront le centre de santé de Pessamit à promouvoir la participation et l’engagement des familles dans les ressources. / Indigenous peoples need to have culturally safe early childhood resources (i.e., respect the cultural identity of the indigenous peoples and promote empowerment and equity), since these populations have significant mistrust due to a long history of racism and discrimination associated with colonization. In Pessamit, an Indigenous community located on the North Coast of Québec, a descriptive qualitative study was conducted. Using the perspectives of cultural safety and acceptability of care, the aim of this study was to explore the facilitators and barriers of Indigenous families with children 0 to 5 years old participating and engaging in the community’s early childhood resources. Fifteen semi-structured interviews were conducted. Using thematic analysis various themes were identified, such as “the challenges of parenthood with a child”, and “support from friends and family” “the personal growth of parents with a child”. Several barriers were named, including “lack of knowledge and consistency” and “unmet needs”. Many facilitators were also named like the “friendly and safe services”, and “the availability and the accessibility of care-providers and resources”. One key recommendation made was to implement an early childhood round Table to further develop and strengthen the community resources for young families. This new knowledge will help the Pessamit Health Centre to promote the participation and engagement of families in the community’s early childhood resources.