Rural and remote nursing, working with diverse people and places in Canada

1. CANADIAN NURSING
STUDENTS' ASSOCIATION
WESTERN-PRAIRIE REGIONAL
CONFERENCE 2018
BREAKING BARRIERS: EXPLORING THE FUTURE IN RURAL AND COMMUNITY
NURSING
WHAT I LEARNED WORKING IN RURAL AND REMOTE LOCATIONS IN CANADA
Greg Riehl RN MA October 26 2018

2. “as long as the sun shines, the grass grows and rivers/water flows.”

3. Let’s start with an Icebreaker

4. What kind of learner are
you?

5. Stories
 I will use my experiences working in rural and remote areas, in the
north, and as a nurse, often an outsider, working in different
situations, as someone with a lot of privilege.
 You are a part of the story.

6. I come from a small town

7. Invisible Backpack
“All of us carry an invisible ‘backpack’ of our
culture, experiences, beliefs, values and morals.
Whenever we encounter another person, our
backpack is present with us and influences how
we interact with our patients and their families”.
Scott Harrison
Invisible Knapsack Peggy McIntosh

8. Recognizing my Privilege.
 Firstly, to be an effective ally I need to recognize the privileges I may
(unknowingly) be benefitting from.
 As a true ally I am aware of my privilege and I am willing to speak up
about it without taking attention away from those who are marginalized.
 As a true ally this can only be decided by those who I am working with,
that is, it is not up to me at all.
 Really, I am aligning myself with others, it is an action, and an act of
doing something, and not something to be turned on or off when it is
convenient.

9. What is Rural and What is
Remote? AND IS THIS ABOUT YOU OR YOUR CLIENT?

10. Remote

12. RURA

13. How to sustain Rural and
Remote Indigenous
Communities
CULTURAL CONTINUITY - THE INTEGRATION OF PEOPLE WITHIN
THEIR CULTURE AND THE METHODS THROUGH WHICH
TRADITIONAL KNOWLEDGE IS MAINTAINED AND TRANSMITTED.

14. Where do Indigenous people
in Canada reside?
 Nearly half of First Nations people with registered
Indian status live on a reserve
 Four in ten Inuit living outside Inuit Nunangat live
in a large urban population centre

15. Issues Involved with rural and
remote health for Indigenous
Peoples
 Health care practitioners – are you ready?
 I was not….
 Cultural competence, awareness, safety, humility………
 Scope of practice
 Physical, mental, emotional, spiritual, …
 Cultural continuity

16. Everything is about CULTURE!
 Behaviour is what you do…
 Culture is how you do it…
Culture
 Everybody knows about it
 Everybody does it
 Nobody talks about it
 Kathleen Bartholomew, RN, MN

17. An environment that is safe for people; where there is no assault, challenge or denial of
their identity, of who they are and what they need. It is about shared respect, shared
meaning, shared knowledge and experience, of learning, living and working together
with dignity and truly listening.
(Health Q. F., 2012)
Cultural Safety

18. Cultural Continuity
 Components of cultural
connectedness and
continuity
 Practicing spirituality,
respect, connections,
relationships, holism,
attending cultural events,
participating in activities,
importance of traditional
healing practices,
connection to home.
 Barriers to Cultural
continuity
 Historical trauma,
pressure or institutions
that impose acculturation
(post-secondary),
discrimination, lack of
support for cultural
programming/services,
youth apathy,

19. • Cultural safety
stresses the
importance of
reflection &
acceptance of
differences.
• We should not
treat everyone
same.
• We do need to
recognize and
acknowledge our
blind spots.

22. Good Hunters or Bad Tipi
Builders

23. • Do not look at health issues as a single category
• Our clients/students are culturally diverse
Diversity is a factor in care

24. What are some of the issues
that need to be addressed?

25. What is “it”?

26. “It” is often the story.
 “It” is mistrust
 Education
 Health
 Justice
 Church

27. Statistics? Or Stories?

28. HIV IN SASKATCHEWAN

29. HIV IN SASKATCHEWAN

30. Determinants of Disease? Or
health?
 Focus on health and healing as opposed to treatment
 What is wrong with you? Is not the best approach
 What is working?
 Let’s build on that.
 Aging population

31. “We are like trees. Our roots are put down very
deep. And we take things from the four directions
and we take them into our lives. And if you pull us
up by the roots, we are lost. We have to go back
and find those roots, find those beginnings that are
strong so that we can live a good life”.
Elder Betty McKenna, 2005.

32. To For With
 How do we build Trust?
 Do not repeat mistakes of the past
 One size does not fit all.
 Needs based, deficit based, disease based models do
not cross all borders, esp into rural, remote, northern,
isolated, or cross cultures.

34. Physical Mental Emotional
Spiritual Health
 My perspective is that each of these four parts can be treated
as its own body.
 Each requires its own form of sustenance and exercise to be
healthy
 Half of Aboriginal children live with both parents
 More than half of Métis children live with both parents
 About six in ten Inuit children live with both parents

35. Let me tell you a story …
 This is a story about a mom and a dad, and a child, and a the child’s
grandparents…

36.  Bronze rule
 Do unto others as they have done unto you
 Silver
 What you do not want done to yourself, do not
do to others
 Gold
 Do unto others as you would have them do unto
you
 Platinum
 Do unto others as they want done unto them

38. THE PLATINUM RULE
TREAT OTHERS
HOW THEY WANT TO BE
TREATED

39. Advocacy
 Advocacy refers to the act of supporting or
recommending a cause or course of action,
undertaken on behalf of persons or issues. It relates to
the need to improve systems and societal structures to
create greater equity and better health for all. Nurses
endeavour, individually and collectively, to advocate
for and work toward eliminating social inequities.

40. CNA CODE OF ETHICS -
Advocacy
 Nurses should endeavour as much as possible,
individually and collectively, to advocate for and work
toward eliminating social inequities by:
 iii. In collaboration with other health-care team members
and professional organizations, advocating for changes
to unethical health and social policies, legislation and
regulations.

41. Restoring Balance
 North American culture looks at problems of
substance abuse as individual problems rather than
looking at the larger societal picture.
 In individualistic societies we blame the individuals,
often missing the larger patterns and forces at work.
 Most social ills are seen as the result of actions by
people who are “bad”.
 The individualistic perspective frequently narrows
the ethical discussions to consideration of individual
rights rather that collective goals and
responsibilities.
 We are far too focused on individual behaviour to
see the larger context that encourages people to act
ethically.

42. Advocacy
 Not always about solving a problem or
‘fixing’ something
 It is about change, or sparking the
conversation
“Make them smart before you make them mad”

43. Who should advocate for
whom/which group when?
And when do we stop…
What will stop you from being an advocate?
When is it time to let ‘the other’ advocate for themselves?

44. “Reconciliation is about forging
and maintaining respectful
relationships.
There are no shortcuts.”
JUSTICE MURRAY SINCLAIR

45. Rural and Remote
Recommendations
 Listen (listen and the word silent have the same letters
 Let the community take the lead
 Focus on a balanced approach
 You may not be the expert, often you are not, if you are, you
should help the community become the expert
 Build from within
 Bring care and services to the community in a culturally
responsive way that supports cultural continuity
 Leave your knapsack at home
 You are not in Kansas anymore, and this is a good thing

46.  Ask questions, listen, and then ask
more questions.

47. QUESTIONS

48. Contact information
Greg Riehl RN BScN MA
Indigenous Nursing Student Advisor
Saskatchewan Polytechnic Indigenous Nursing
Saskatchewan Polytechnic
Regina Campus
Email: greg.riehl@saskpolytech.ca

49. Star Blanket - Symbol