Cultural Competence for Registered Nurses

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Laurie Dokis

Editor’s Note: Laurie Dokis is an Ojibwa woman and registered nurse who was transplanted to the Northern Alberta community of Westview. While there, she saw non-Aboriginal nurses struggling with differences between their own attitudes about health and those of their Aboriginal clients. Both needed to develop more understanding about each other’s ideas about health and community. While not planning to become an expert, she found herself in the role of middle person between the two cultures.

Laurie has come a long way. Now in the Master’s program in the Health Sciences Department at the University of Alberta, she is working on her thesis examining the subject of cultural competency of the registered nurses in her district.

Last fall in Calgary, Laurie gave a workshop on the topic at the National Aboriginal Health Conference, well-attended by health practitioners, policy makers and Aboriginal people. Not following the usual lecture format, the workshop started as a sharing circle, in which each participant spoke about where they had come from and what they wanted to learn about cultural competence. Laurie answered their questions and then everyone listened as an Aboriginal elder talked about her own difficulties with the health system.

I asked Laurie about her study. The following is a summary of recommendations and findings.

Cultural competence is important for registered nurses working in culturally diverse populations. Awareness and understanding of cultural differences strengthens and broadens the measurable outcomes of nursing services, contributes to cost-effective programming and enhances the best practices of the profession.

Experts in the field of Aboriginal health recognize the need for culturally competent nursing care as documented by the Inuit Regional Health Survey, the Royal Commission on Aboriginal Peoples, the Canadian Medical Association’s Bridging the Gap and the Aboriginal Women’s Health Report.

Increasing the cultural competence of registered nurses is a priority for Aboriginal organizations, practising nurses and nursing management of the Westview Regional Health Authority (WRHA) in Northern Alberta.

Evaluative criteria for this initiative include understanding how disparities between Aboriginal and non-Aboriginal health beliefs impact on the planning and delivery of nursing services, increasing Aboriginal access to mainstream health services, improving the quality of nursing service and health outcomes for Aboriginal people, and increasing financial resources to provide specialized health services to Aboriginal populations.

Achieving cultural competence for registered nurses, fostering increased understanding between Aboriginal and non-Aboriginal parties, and fulfilling the evaluative criteria are the goals of this four-phase policy recommendation.

The first two phases would take place over a three-to-five year period with funding provided by non-Aboriginal sources.

During the initial phase, a mandatory cultural training program for nurses would be planned and implemented. Because of the informal nature of their relationships to each other and the limited resources of the Aboriginal organizations in the district, the WRHA would fund this training. Such input of resources would signify its good will and begin the process of establishing a cooperative partnership.

In the second phase, a Cultural Advisor would be hired to provide continued resources for ongoing professional development.

During phase three, the cultural training program would continue as a mandatory employment requirement, and would be supported by regional education funding for nurses.

At this time, a transfer of the initiative to Aboriginal organizations would occur, with the formation of an Aboriginal Cultural Advisory Council. It would be responsible for the ongoing development, delivery and evaluation of the training program.

Developing and maintaining an effective partnership of Aboriginal and non-Aboriginal organizations throughout this initiative is critical. The experience gained from such a relationship could then be extended to include the Department of Advanced Education with the purpose of achieving a longrange goal to increase the number of Aboriginal nurses, making it possible to hire Aboriginal nurses proportional to the Aboriginal population.

The short-term benefits of cultural training and access to a Cultural Advisor would contribute to ensuring the longterm benefits of Aboriginal self-determination in the area of health, as well as increased representation of Aboriginal people in the field of nursing.

Health is not the outcome of services alone. The ability of Aboriginal people to participate equally in decisions affecting them translates into their political and economic renewal, with benefits to the whole society.