DEVELOPING WISE PRACTICES AT THE STRUCTURAL LEVEL TO SUPPORT EQUITY-PROMOTING AND CULTURALLY SAFE HEALTH CARE
Project in progress
As a co-investigator
Study of cultural safety practices developed jointly with stakeholders in educational environments located north of the 49th parallel, to support school retention and educational success of Aboriginal students
This project relies on the complementarity of different partners (UNESCO Chair in Cultural Transmission among First Peoples as a Dynamic of Well-Being and Empowerment, Nikanite First Nations Centre of the UQAC, Tshakapesh Institute, Boîte Rouge VIF, UNESCO Chair Reorienting Education towards Sustainability and the Canadian Commission for UNESCO) to highlight and develop examples of cultural safety practices in different contexts (school, classroom, social and educational services, family, community) that will be disseminated to actors working with Indigenous students, in communities or in urban areas. The development of examples of cultural safety practices will be carried out with teachers and stakeholders working in the North of the 49th, the St. Lawrence River and the Gulf of St. Lawrence, in a coaching process that will call upon the expertise of researchers and trainers in education, social work, health, psychology and the arts. The accompaniment platform developed at the Nikanite First Nations Centre will be used to carry out this collaborative work according to the steps planned in action research. The examples of practices documented and developed jointly will then be formatted by the Indigenous non-profit organization (NPO) La Boîte Rouge VIF for dissemination in practice and research environments. The analysis of these examples of practices will make it possible to produce knowledge on the potentialities and pitfalls of the cultural safety approach, from the perspective of school perseverance and educational success. The creation of a website to make the examples of practices accessible is planned as a transfer strategy to ensure a return to the practice environment but also, a wide dissemination to all practice environments that welcome Indigenous students or wish to open up to Indigenous issues.
This project (2020-2023) is funded by the Concerted Action-Cultural Safety Approach to Support Academic Perseverance and Educational Success of Indigenous Students program of the Fonds de recherche du Québec – Société et culture (FRQSC).
Principal investigator : Christine Couture
Co-investigators : Anne Marchand; Catherine Duquette; Élisabeth Jacob; Élisabeth Kaine; Jacinthe Dion; Loïc Pulido; Mathieu Cook; Sylvie Pinette;
Collaborator : Charles Hopkins; Claudia Néron; Marco Bacon; Marjolaine Tshernish; Sébastien Goupil
Promoting health equity for Indigenous and non-Indigenous people in emergency rooms (2016-2021)
Emergency Departments (EDs) in Canada often operate over-capacity and are under significant pressures. In this environment, particular groups of people experience inadequate and inequitable treatment in EDs. These groups include Indigenous people, racialized newcomers, people with mental illnesses, those living in unstable housing or facing homelessness, experiencing interpersonal violence or using substances, and people involved in sex work. Stigma and discrimination in health care deter people from accessing care, interfere with effective care delivery, increase reliance on EDs, and increase human and financial costs.
This project funded by the Canadian Institutes of Health Research (CIHR) examines the feasibility, process, and impact of implementing an evidence-informed framework for interventions to improve the capacity of Emergency Departments to provide high quality care to people at greatest risk of experiencing health and health care inequities. Through collaboration among Indigenous leaders, ED staff and leaders, and researchers, the project aims to improve care, safety, access, and decrease adverse events for patients and staff.
- Engage EDs in a participatory process to enhance capacity for Equity-Oriented Care (EOC)
- Examine impacts of EOC initiatives on:
- organizational policies and quality of care
- patient experiences of care and selected outcomes
- staff engagement and team effectiveness
- Analyze cost-effectiveness and scale-up potential
Principal Investigators : Annette Browne, Victoria Bungay, David Byres, Colleen Varcoe
Co-investigators : Emily Jenkins, Erin Wilson, Dr. Amélie Blanchet Garneau
Co-applicants : Agnes Black, Martha Cloutier, Francine Darroch, Margo Greenwood, Leanne Heppell, Harminder Bindy Kang, Roberta Price, Heather Smith, Janet Smylie, Leslie Varley, Cheryl Ward
Collaborators : Paula Foster, Lynn Gifford, Olive Godwin, Tracie Jones, Pat Munro, Christine Predy, Jeff Reading
As a co-investigator
Evaluation of the implementation of a competency framework for nurses working with First Nations communities in the province of Quebec 2018-2020
Nurses in First Nations communities have developed a Competencies Reference Guide, specific to their nursing practice in the communities (RéPIC-PN) . This guide was developed in collaboration with nurses from several communities, a team from FNIHB-Quebec and consultants from the Centre d’innovation en formation infirmière (CIFI). It establishes what nursing practice should be in First Nations communities, from beginner to expert, with individuals, families and the community.
The use of the competency framework was facilitated by the development of a self-assessment tool and a professional development guide that allows each nurse to situate her professional development under one of the four levels from beginner to expert, to set professional development objectives and to engage in learning strategies. In this way, each nurse can, in a structured way, pursue the development of her/his competencies in harmony with the health priorities of the community. This tool also allows for the development of a structured continuing education program.
This project, the last phase of a series of five, took place from October 2018 to June 2020 and aimed to support the implementation of the Competency Framework for Nurses in Quebec First Nations Communities and the resulting self-assessment tool, while documenting both the strategies used by the communities to facilitate this implementation, as well as the benefits for nursing practice and for these communities. In this final phase of the project, interviews were conducted in three First Nations communities (Kanesatake, Lac Rapide and Wemotaci) during 2019. Three nursing leaders and ten nurses were interviewed. These meetings allowed us to identify the issues, challenges and strategies in the implementation of the Competency Framework for Nurses in these First Nations communities in Quebec.
Next, we facilitated two workshops with nursing leaders from English-speaking First Nations communities (January 8, 2020) and French-speaking First Nations communities (January 20-21, 2020) in which officials from the First Nations and Inuit Health Branch, Quebec Region (FNIHB-QR) participated. This second part reached nurses from 8 communities (Kahnawake, Kitigan Zibi, Lac-Rapide, Manawan, Obedjiwan, Pessamit, Wemotaci and Wendake). The purpose of these workshops was to present and discuss strategies for implementing the competency framework, the self-evaluation tool and the professional development guide. For the community participants, they allowed them to reinforce their knowledge of the concepts underlying the appropriation of the documents and to update their respective implementation plans, and for the FNIHB-Quebec team, to write its own implementation plan. In addition, the workshops made it possible to identify the support that can be provided by FNIHB-QC to the First Nations communities as well as between the communities. The documents produced with the support of FNIHB-QC over the years were sent to all 26 communities by electronic and postal means.
Co-leaders : Amélie Blanchet Garneau, RN, PhD and Jacinthe Pepin, RN, PhD.
Research professionals : Vanessa Sit, MScN, Dominique Boucher, MScN, Catherine Laurent-Sédillot and Kathryn Verville-Provencher
CIFI Coordinator: Ginette D. Brunelle, N.M.Sc.
As a collaborator
Pathways to care for people facing the stigma of drug use
EQUIP Health Care is partnering with people with lived experience of drug use stigma (PWLEDUS), and people who provide health care services to them, to develop better pathways to care. People who use drugs (PWUD) face significant stigma and discrimination. Because trauma, violence and chronic pain are often intertwined with substance use (SU) and mental health issues, SU stigma is often deeply entwined with mental health stigma. Structural violence and inequities (systemic racism, poverty) disproportionately impact PWUD. Not surprisingly, these intersecting forms of stigma, discrimination and structural barriers prevent accessible and effective service delivery. Specific groups, such as women and trans* people experiencing violence, Indigenous people, people using stimulants and/or injecting, people doing sex work, and those living in poverty, endure the most SU stigma and the greatest barriers to effective and appropriate health care.
We will improve pathways to care for PWUD by: a) examining how to effectively engage PWLEDUS, including people actively using, and the possible processes required to foster meaningful input from PWLEDUS; and b) developing tools and resources to effectively support organizations and health care providers in serving PWUD.
EQUIP articulates three key dimensions of equity-oriented health care: Culturally Safe Care (mitigating the harms of inequitable power relations, racism, and discrimination on health and health care) , Trauma- and Violence-Informed Care [TVIC] (creating safe, respectful and person-centred care by understanding the impacts of structural and interpersonal violence), and Harm Reduction (a philosophy and approach to practice that mitigates harms, including those from inequities related to SU and from historical, socio-cultural and political determinants of health).
Through this project we will develop a) a process for effective, meaningful engagement with PWLEDUS; b) enhanced EQUIP resources for PWUD, c) a plan for ongoing development, scale up, sustainability and measurement of EQUIP, including considerations for translation into French and d) an e-learning curriculum tailored to PWUD.
Funded by : Public Health Agency of Canada (PHAC): Supporting Pathways to Care for People Who Use Drugs (2020-2022)
Principal investigator : Colleen Varcoe
Co-investigator : Annette Browne; Nadine Wathen; Victoria Bungay;