Spring Semester Research for Evidence-Based Nursing Practice (PSYN-300-001)
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This document provides an overview of considerations for conducting respectful research with Indigenous communities. It emphasizes the importance of the four R's - Respect, Relevance, Reciprocity and Responsibility. Researchers should work collaboratively with Elders, knowledge keepers and community members. Principles like Ownership, Control, Access and Possession (OCAP) are important to discuss before beginning research. Storytelling approaches and two-eyed seeing can help bring both Western and Indigenous ways of knowing together. Cultural competence, awareness of privilege, and being willing to feel uncomfortable are also discussed as part of being an ally in research.
Spring Semester Research for Evidence-Based Nursing Practice (PSYN-300-001)
- 1. Spring Semester 2020/2021 Research for Evidence-Based Nursing Practice (PSYN-300-001) For: Jill Thomson Psych Nursing Class May 30th, 2021 By: Greg Riehl RN BScN MA – Research Manager NEIHR
- 2. Treaty 4 Territory Land importance and Acknowledgment I would like to begin by acknowledging that we are on the traditional lands, referred to as Treaty 4 Territory and that the city of Regina is located on Treaty 4 territory, the original lands of the Cree, Ojibwe(OJIB-WĒ), Saulteaux (SO-TO),Dakota, Nakota, Lakota, and on the homeland of the Métis Nation. We respect and honour the Treaties that were made on all territories, we acknowledge the harms and mistakes of the past, and we are committed to move forward in partnership with Indigenous Nations in the spirit of reconciliation and collaboration. https://saskschoolboards.ca/wp-content/uploads/Treaty-4-Territory.pdf
- 3. • Who is here today? • I would like to acknowledge the prisoners, vacationers, keeners, and experts to this virtual presentation • Welcome everyone!
- 4. Let’s start with an Icebreaker
- 5. môniya:s or moonias Especially among North American Indians in Canada: a newcomer. Origin - Late 19th century; earliest use found in Dictionary Canadianisms. From Plains Cree môniya:s non-Indian, white person, diminutive of môniya:w from Southern Algonquian mo:niya:winini from mo:niya Montreal + -inini man.
- 6. Perspective
- 8. “If you have come to help me, you are wasting your time; but if you are here because your liberation is bound up with mine, then let us work together.” - Lilla Watson, Aboriginal Elder, activist, educator (Australia)
- 9. Western Medicine Western Research What is the problem, what is the question? How can we get rid of the problem? How can we fix it? What is the answer to the question? Deficit based, linear thinking models
- 11. The Four (or 5) R's - Respect, Relevance, Reciprocity, Responsibility (Relationships) Research with aboriginal communities in Canada has often been conducted by researchers who had little or no understanding of the community in which the research was taking place. This led to 'helicopter' research, which benefitted the researcher but not the community. There has been an exploitative history of research with, on, and for Indigenous Peoples, with an accompanying demand for the decolonization of health research There are special considerations associated with conducting research with Aboriginal populations. The Assembly of First Nations wants researchers to use the Ownership, Control, Access and Possession (OCAP) principles with First Nations data. These principles are restrictive and need to be discussed with stakeholders before research is undertaken.
- 12. The Four R's - Respect, Relevance, Reciprocity, Responsibility RESPECT OF FIRST NATIONS CULTURAL INTEGRITY RELEVANCE TO FIRST NATIONS PERSPECTIVES AND EXPERIENCE RECIPROCAL RELATIONSHIPS RESPONSIBILITY THORUGH PARTICIPATION https://www.afn.ca/uploads/files/education2/the4rs.pdf
- 13. Storytelling approaches within Indigenous health research Collaborating with Elders, Knowledge Keepers, Indigenous patients, administrators, and healthcare professionals will result in better understanding of resilience and strength and will create spaces for diverse voices to inform healthcare research and practices The ultimate goal is to support and advance evidence which meaningfully includes Indigenous Peoples’ perspectives, practices, and priorities into health research to guide health and wellbeing and benefit Indigenous and all communities.
- 14. Two-Eyed Seeing Etuaptmumk is the Mi'kmaw word for Two-Eyed Seeing. Two-Eyed Seeing, introduced by Mi’kmaq Elders, Albert, and Murdena Marshall, from Unama’ki (Cape Breton), Nova Scotia, Canada, in 2004, This method and way of thinking stresses the importance of viewing the world through one eye using the strengths of Indigenous worldviews and with the other eye using the strengths of Western worldviews thus creating equal space for Western and Indigenous ways of knowing to come together, using the best of both worldviews to see together with both eyes to benefit all
- 17. Cultural Appropriation or Cultural Appreciation “The only route to gaining a better appreciation of the different cultures in Canada is through regular exposure, asking questions and expressing opinions – even if those opinions are wrong. Michael Taube on May 16, 2017 Troy Media
- 18. Cultural Competence in Health Care 1. Provide interpreter services 2. Recruit and retain diverse staff 3. Provide training to increase cultural awareness, knowledge, and skills 4. Coordinate with traditional healers 5. Use community health workers 6. Incorporate culture-specific attitudes and values into health promotion tools 7. Include family and community members in health care decision making 8. Locate clinics in geographic areas that are easily accessible for certain populations 9. Expand hours of operation 10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials
- 19. Cultural Competence in Health Care Awareness of the influences that sociocultural factors have on patients, clinicians, and the clinical and care relationship. Acceptance of our responsibility to understand the cultural aspects of health and illness in context Willingness to make clinical and care settings more accessible to patients Recognition of personal biases against and towards people of different cultures and backgrounds Respect, tolerance, acceptance, and interest for cultural differences Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia, and other kinds of biases and discrimination that occur in health care settings.
- 20. Sex and Gender: there is a difference 'Sex' and 'gender' are often used interchangeably, despite having different meanings:
- 21. Sex Sex refers to a set of biological attributes in humans and animals. It is primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex is usually categorized as female or male but there is variation in the biological attributes that comprise sex and how those attributes are expressed. http://www.cihr-irsc.gc.ca/e/48642.html
- 22. Gender Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender is usually conceptualized as a binary (girl/woman and boy/man) yet there is considerable diversity in how individuals and groups understand, experience, and express it. http://www.cihr-irsc.gc.ca/e/48642.html
- 25. Definition of Family Any combination of two or more persons who are bound together over time by ties of mutual consent, birth and/or adoption or placement and who, together, assume responsibilities for variant combinations of some of the following:
- 26. Chief Jo Mathias “We walk into the future backwards because we are looking to our Ancestors, listening to our Elders, and learning our traditions and cultures”
- 27. “What we see, we do not see.”
- 28. There’s always a reason why a person becomes who they are. The most important decision we can make about every experience in our life is the meaning we assign to those experiences.
- 29. Ally Bill of Responsibility Written by Dr. Lynn Gehl, Algonquin Anishinaabe-kwe How can I be a responsible Ally? http://www.lynngehl.com/uploads/5/0/0/4/5004954/ally_bill_of_responsibilities_poster.pdf
- 31. How to Be an Informed Indigenous Ally Being an ally is not part of my identity but is part of an action or a practice that I take Allies operate behind the scenes, it is not about taking credit, it is about giving and supporting credit by Madison Burns Learn about Treaties Treaty 6 medicine chest clause to supply all that was required to maintain proper health Language is important FSIN AFN ISC FNIHB TC NIHB BCR Red Tape White Tape OCAP TRC UNDRIP TCPS Chapter 9 CIHR
- 32. 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.
- 34. Being an Ally means… shhhhhhhhhhhhhhhh
- 35. Allies in Research Indigenous research will be joined by allied researchers Always include wise people Number of elders on the team >2 Need to link local to national programs if available or possible Ground up, bottom up, not top down Circles, not squares, not lines. The Circle/The Medicine Wheel Indigenous People enjoy a strong affinity with the circle because it symbolizes and resembles many cycles in the natural world. Some Aboriginal people believe the power of the world works in circles such as the shape of the world, sun and the moon, the wind as it whirls in circles, birds as they make their nests in circles etc. In other Aboriginal communities it is also a symbol of equity where no one person has an elevated position at a certain area of the circle. Land based, seasonality, balanced.
- 37. Feeling Uncomfortable This may mean I am not invited, or I am asked to leave… and sometimes that is hard… but that means I have done my job as an ally. This means constant education, and constant reflection, and allowing time…
- 38. The Nightmare Before Christmas “If you’re going to learn about other people’s cultures and traditions, approach it from a place of respect. Go to the people who live that life and treat them as the experts. Listen to others if they say you’re stepping over your bounds. Show humility. Ask questions in a respectful way. Don’t try to “improve” cultural elements just because that’s easier than understanding it fully. Above all, practice empathy. And that’s a pretty good lesson for us at any age.” Katie Schenkel
- 39. Best or Wise Practices Indigenous Knowledge Transfer (IKT) Indigenous Knowledge (IK) Knowledge Translation (KT) Need to support Indigenous ways of knowing, need to link to ceremony/s Wellbriety versus sobriety, wholistic… Nutritional harm reduction Community Identifies needs: system or institution identifying needs, points to consider as opposed to weaknesses UNDRIP principles – how to evaluate IK using Indigenous frameworks – needs specificity, # of interviews, # of interventions Informed by the TRC and community consultations
- 40. How to Build and Support Trust Three biggest institutions of historical trauma and mistrust Justice, health, education Honorariums – clarity/equity between all participants’ youth to elder, childcare, transportation Indigenous students traumatized and suffering, deficit based Partners - is the partner Indigenous? A University, or a polytech, is not Indigenous.
- 41. Traditional Questions Stigmatizing disease, illnesses, Western medicine always wants to FIX something What are you trying to fix? Lateral violence as opposed to lateral kindness - Lateral violence focuses on deficits not strengths Advisory board oversees what? Terms Of Reference (TOR) needs to indicate what? Do you even need a TOR Good governance structure or model developed and supported by elder and community input
- 42. Strength Based Research Strengths based as opposed to deficit based approaches Interviews – How are the interviews being conducted, sharing circles, elder involvement, shared power, equal voice, Knowledge gaps, what is being addressed, be specific, need to identify Responding to suicide through community and culture Responding to communities and families with low or no self harm Researchers receive training from the community, focus on a balanced team Support for non – Indigenous mentors, all mentors receive support
- 43. To For With Western thought – increase awareness of effects of colonialism BUT most Indigenous populations already know about the effects Resiliency – bouncing back hopefully more than that – thriving, striving, more than just surviving Means, variable, and interests need to be defined Actively recruit the underrepresented – gender, sexuality, those with low opportunity hard to reach, often this population is not represented Avoid Broad statements – this will benefit a lot of people and be used with other people – need to be more specific
- 44. What about Research - Methods Decolonizing Methodologies vs Indigenous Methodology – Indigenizing vs reconciling, deliberate dialogue Two-eyed Seeing approach, good to add to this Multi directional learning KTE throughout the process/phases Code of ethics practice working with Indigenous researchers CMT Bidirectional Knowledge exchange between mentors and mentees, both have knowledge, culturally grounded mentorship – Four pillars of CIHR Teaching into action, How will it be delivered and translated out, catalyst for the future
- 45. So what about Research? Knowledge Generation (KG) –local elders, scholars, knowledge keepers, KT are articles co-authored with community members What are you going to evaluate or inventory Knowledge Holder (KH) for anything document versus Knowledge User Ethnography – who owns our observations? OCAP – ownership, control, access, possession Sharing circle – how will this be evaluated
- 46. Now what is my role in research? I need to understand myself, my place, my invisible knapsack or worldview, my assumptions and understanding of myself and of others and relationships and power dynamics. What is the goal of research? as a Moonias it is often about learning more about myself as opposed to the outcomes, results, the data or findings of the other. We all need to be a bit more self-reflexive what so what now what….. Tell me more about ________ Recognize that communities maintain data sovereignty
- 47. OCAP What happens after the program, intervention? Cultural Teachings – drumming, singing, smudge, tobacco, whole family, storytelling, sharing/talking circles, Cultural lens – more Indigenous and cultural approaches Cultural Continuity & Transformation Research, Social Continuity, and Change Do not focus on the development of the research; do focus on the development of the members of the Indigenous people Project Scope, ultimate benefits, Data collection, how to analyze multi methods of collection modalities GIS – mapping – OCAP , community should get software and own it and use it and maintain this data and tools Indicators or markers of success – what will the program add to
- 48. Trends Cultural Awareness and Competency is out, Cultural Safety yes, Cultural Humility very good Cultural competence focuses on service provider’s cultural safety and humility focuses on clients Humans not at the top of the hierarchy, focus on balance with all creatures land based programs and interventions Mentors mentees (the land is a mentor) are co-learners Cultural and ecological wellness need to be defined
- 49. Outputs Tri Council Statement Chapter 9 https://ethics.gc.ca/eng/tcps2-eptc2_2018_chapter9- chapitre9.html Community Oversight committee very important BCR – Band Council Resolution Village of wellness methodology http://thevillagemethod.org/our-method/ http://vchnews.ca/across-vch/2016/10/12/n%D3%99camat-2016-downtown-eastside-aboriginal- womens-village-wellness/#.WMr9Wbi1vRY Direct money and funding toward the community Interdisciplinary, intra-professional, interprofessional
- 50. Dos and do nots (mmmmmm donuts!) Budget describes activities; these activities need to be in the proposal Separation between those providing services and those evaluating, separate implementers from evaluators From the community for the community Can we come up with a different term/inology for train-the-trainer Concern that $ is going directly to grad students, PIs, etc Letters or interest, support from the community, not a form letter, letters of support need to focus on the project not the institution or researcher 350 page submissions, 20 years of research, uhmmm no…
- 51. Examples Angela Snowshoe and Noel Starblanket 4 blankets of Indigenous Horse-Based Healing framework http://journalindigenouswellbeing.com/media/2016/12/50.43.Eyininiw-mistatimwak-The-role-of-the- Lac-La-Croix-Indigenous-Pony-for-First-Nations-youth-mental-wellness.pdf Traditional Environmental knowledge (TEK) http://nafaforestry.org/forest_home/documents/TKdefs-FH- 19dec06.pdf Miro Matisiwin http://www.rcaaq.info/images/M%C3%A9moire_RCAAQ_inclusion_sociale_anglais.pdf & http://www.pimatisiwin.com/uploads/jan_20112/10ManitowabiShawande.pdf Network Environments for Indigenous Health Research (NEIHR) National Coordinating Centre https://research-groups.usask.ca/neihrcoordcentre/ Kotawe (start a fire)Igniting cultural responsiveness through community-determined intervention research – https://allnationshope.ca/userdata/files/594/Newsletter/March%202021.pdf
- 52. “Reconciliation is about forging and maintaining respectful relationships. There are no shortcuts.” Justice Murray Sinclair
- 53. Lastly, my move to Lateral Kindness Please be kind to each other Respectful and responsible relationships, there are no apps for that. Be Grateful Be Great!
- 54. Risk and Rewards We often face a risk acting, and we also face a risk when we do not act.
- 55. & DonT be arfaid to kame mit sakes Ask questions, listen, and then ask more questions.
- 56. Do you have any questions?
- 57. Contact information Greg Riehl RN BScN MA Research Manager NEIHR National Coordinating Centre 203 – 1120 20th Street West Saskatoon, SK S7M 0Y8
Editor's Notes
- #3: https://en.wikipedia.org/wiki/Treaty_4 https://www.webcitation.org/query?url=http%3A%2F%2Fwww.ainc-inac.gc.ca%2Fai%2Fscr%2Fsk%2Ffni%2Fpubs%2Ffnl-eng.pdf&date=2009-12-02 Treaty 4 is a treaty established between Queen Victoria and the Cree and Saulteaux First Nation band governments. The area covered by Treaty 4 represents most of current day southern Saskatchewan, plus small portions of what are today western Manitoba and southeastern Alberta. “When working on or within the traditional territory of a First Nation there is protocol to follow. It can be customary between one First Nation and another to acknowledge the host First Nation Peoples and their traditional territory at the outset of any meeting…it follows then, that if you want to [work] with a First Nation, one of the best ways is to show respect to the Nation by following traditional territory protocol.” Joseph, “First Nation Protocol on Traditional Territory.”
- #4: 1) Prisoner: this participant is there because they have been “told” to attend. They don’t want to be there and don’t see why they need to be there. They don’t want to contribute and they will lower the energy levels in the room. 2) Vacationer: the person who’s attending because it’s an excuse for a “day off ” from their normal job. They will get involved, but are not really interested in learning anything – more about having fun and avoiding the work they left behind on their desk. 3) Keener: this participant is there to genuinely learn as much as they can from the session. This type of learner is attentive during the session, gets actively involved in group work and brings high levels of energy into the room. 4) Expert: you clearly know more than I do, http://www.clomedia.com/2008/06/17/engaging-the-prisoner-the-vacationer-the-expert-and-the-explorer/
- #5: http://www.afn.ca/honoring-water/
- #6: Sharing what I have learned as a moonias working with Indigenous people on Indigenous research projects, some advice of the Do’s and Do nots, and White Privilege. What is an Indigenous Community? How do you find, and work with Elders? What is two-eyed seeing and why does OCAP matter? The platinum rule and wise, not best, practices in research. Knowing where you are and where you come from is vital to establish positive, meaningful relationships as research is all about relationships.
- #9: https://www.groundworkforchange.org/what-is-an-ally-what-is-a-settler.html
- #12: https://pubmed.ncbi.nlm.nih.gov/25059087/ https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01503-6
- #14: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01503-6
- #15: https://journals.sagepub.com/doi/10.1177/1609406919869695
- #16: https://health.metisportals.ca/images/PDF/2019/MN_S_Presentation_Research_Governance_Framework.pdf
- #17: https://health.metisportals.ca/images/PDF/2019/MN_S_Presentation_Research_Governance_Framework.pdf
- #18: http://troymedia.com/2017/05/16/cultural-appropriation-controversy-is-entirely-about-free-speech/
- #19: “Understand the differences; act on the commonalities.” Andrew Masondo, African National Congress https://hpi.georgetown.edu/cultural/# Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)
- #20: “Understand the differences; act on the commonalities.” Andrew Masondo, African National Congress https://hpi.georgetown.edu/cultural/# Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)
- #24: http://lgbtq2stoolkit.learningcommunity.ca/wp/wp-content/uploads/2014/12/LGBTQ2S-Definitions.pdf
- #25: http://lgbtq2stoolkit.learningcommunity.ca/wp/wp-content/uploads/2014/12/LGBTQ2S-Definitions.pdf
- #26: https://vanierinstitute.ca/definition-family/
- #28: Gossip…
- #29: https://www.psychologytoday.com/us/blog/in-it-together/201809/the-neuroscience-feeling-safe-and-connected
- #36: http://ipsociety.ca/2017/04/ http://www.lynngehl.com/uploads/5/0/0/4/5004954/ally_bill_of_responsibilities_poster.pdf https://talentegg.ca/incubator/2017/06/19/aboriginal-allies-mind/ https://unsettlingamerica.wordpress.com/allyship/ https://www.groundworkforchange.org/what-is-an-ally-what-is-a-settler.html https://www.edu.gov.mb.ca/k12/abedu/perspectives/concepts.html
- #37: Exercise, listening,
- #39: https://www.themarysue.com/nightmare-before-christmas-cultural-appropriation/
- #40: KT in Aboriginal contexts is: sharing what we know about living a good life.1 This is quite different from the Canadian Institutes of Health Research (CIHR), which defines KT as: a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system http://www.cihr-irsc.gc.ca/e/41392.html
- #41: http://www.cbc.ca/news/canada/thunder-bay/colonization-health-care-1.3966069 "The reality is that historically, we've experienced, as Indigenous people, a host of bad outcomes from the initial engagement," Crowshoe said in an interview with CBC News. "All that historical stuff that tends to be outside of what we learn as health practitioners is deeply embedded in the nature of how health care is organized," he added. "The institutions of health care services arise from a dominant society and those can be experienced in a very negative way [by Indigenous people]." "This idea of working together also really came through," she said, "where the provider wasn't just coming across and saying 'this is what you have to do'. They had a relationship, saying, 'what can we do right now, what's manageable in your circumstances in life?'“
- #47: https://www.nature.com/articles/d41586-021-00022-1