Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline. Journal of Obstetrics and Gynaecology Canada - PDF

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Journal of Obstetrics and Gynaecology Canada Journal d obstétrique et gynécologie du Canada Volume 35, Number 6 volume 35, numéro 6 June juin 2013 Supplement 2 supplément 2 Abstract...S1 Introduction...S

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Journal of Obstetrics and Gynaecology Canada Journal d obstétrique et gynécologie du Canada Volume 35, Number 6 volume 35, numéro 6 June juin 2013 Supplement 2 supplément 2 Abstract...S1 Introduction...S S7 Chapter 2: Demographics...S9 Skywoman Simon Brascoupé, Haudenosaunee/Anishinabeg Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline Chapter 3: Social Determinants of Health Among First Nations, Inuit, and Métis....S13 Chapter 4: Health Systems, Policies, and Services for First Nations, Inuit, and Métis....S24 Chapter 5: First Nations, Inuit, and Métis Women s Sexual and Reproductive Health....S28 Chapter 6: First Nations, Inuit, and Métis Maternal Health....S33 Chapter 7: Mature Women s Health....S37 Chapter 8: Changing Outcomes Through Culturally Competent Care S38 Chapter 9: Conclusion....S42 Chapter 10: Case Studies....S44 Appendix....S48 Publications mailing agreement # Return undeliverable Editor-in-Chief / Rédacteur en chef CPL Editor / Rédactrice PPP Translator / Traducteur Martin Pothier Assistant Editor / Rédactrice adjointe Editorial Assistant / Adjointe à la rédaction Bureau de la rédaction Women's Health Centre Building published by the Canadian Psychiatric Le Journal d obstétrique et gynécologie des obstétriciens et gynécologues du Return undeliverable Canadian copies and change of address notices to locations. Return other undeliverable Retourner toutes les copies canadiennes non livrées et les avis de de poste. Retourner les autres copies ISSN Skywoman In this image created for the Society of Obstetricians and Gynaecologists of Canada SOGC CLINICAL PRACTICE GUIDELINE No. 293, June 2013 Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline This consensus guideline has been prepared by the Aboriginal Health Initiative Committee and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. PRINCIPAL AUTHORS Don Wilson, MD, FRCSC (Co-chair), Heiltsuk Nation, Comox BC Sandra de la Ronde, MD, FRCSC (Co-chair), Ottawa ON Simon Brascoupé, Kitigan Zibi Anishinabeg (acting Chief Ottawa ON Alisha Nicole Apale, MSc, Ottawa ON Lucy Barney, RN, MSN, Lillooet Nation, Vancouver BC Bing Guthrie, MD, FRCSC, Yellowknife NT Ojistoh Horn, MD, CCFP, Mohawk, Kahnawake QC Robin Johnson, MD, FRCSC, Esdilagh First Nation, Williams Lake BC Darrien Rattray, MD, FRCSC, Tahltan, Halifax NS Nicole Robinson, MA, Ottawa ON ABORIGINAL HEALTH INITIATIVE COMMITTEE Natsiq Alainga-Kango, Inuk, Iqaluit NU Gisela Becker, RM, Fort Smith NT Vyta Senikas, MD, FRCSC, MBA, Ottawa ON SPECIAL CONTRIBUTORS Annie Aningmiuq, Ottawa ON Geri Bailey, RN, Ottawa ON Darlene Birch, RM, Norway House MB Katsi Cook, Aboriginal Midwife, Mohawks of Akwesasne, Washington DC Jessica Danforth, Toronto ON Mary Daoust, MSW, Ottawa ON Darlene Kitty, MD, Chisasibi Cree Nation, Chissasibi QC Jaime Koebel, BA, Métis, Ottawa ON Judith Kornelsen, PhD, Vancouver BC Audrey Lawrence, MA, BA, MBA, Métis, Ottawa ON Amanda Mudry, BAFN, Cree and Haudenosaunee, Whitehorse, YT Vyta Senikas, MD, FRCSC, MBA, Ottawa ON Gail Theresa Turner, RN, Happy Valley-Goose Bay NL Vicki Van Wagner, RM, Toronto ON Eduardo Vides, Ottawa ON Fjola Hart Wasekeesikaw, RN, MN, Fisher River Cree Nation (Ochekwi-Sipi), Winnipeg MB Sara Wolfe, RM, Toronto ON ENDORSING ORGANIZATIONS Aboriginal Nurses Association of Canada Canadian Association of Midwives Canadian Association of Perinatal and Women s Health Nurses Indigenous Physicians Association of Canada Inuit Tapiriit Kanatami Métis National Council Key Words: Aboriginal, First Nation, Inuit, Métis, Social Determinants of Health, indigenous health, women, maternal/child health, health inequity, culturally-safe care, cultural competence, health service, delivery, life-cycle, traditional practices, rural health, urban, sexual health, reproductive health J Obstet Gynaecol Can 2013;;35(6 esuppl):s1 S52 This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC. JUNE JOGC JUIN 2013 S1 Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline Minwaashin Lodge National Aboriginal Council of Midwives Native Women s Association of Canada Native Youth Sexual Health Network Pauktuutit Inuit Women of Canada Royal College of Physicians and Surgeons of Canada Society of Rural Physicians of Canada Disclosure statements have been received from all contributors. The literature searches and bibliographic support for this guideline were undertaken by Becky Skidmore, Medical Research Analyst, Society of Obstetricians and Gynaecologists of Canada. Abstract Objective: Our aim is to provide health care professionals in Canada with the knowledge and tools to provide culturally safe care to First Nations, Inuit, and Métis women and through them, to their families, in order to improve the health of First Nations, Inuit, and Métis. Evidence: Published literature was retrieved through searches of PubMed, CINAHL, Sociological Abstracts, and The Cochrane Library in 2011 using appropriate controlled vocabulary (e.g.,cultural competency, health services, indigenous, transcultural nursing) and key words (e.g., indigenous health services, transcultural health care, cultural safety). Targeted searches on subtopics (e.g., ceremonial rites and sexual coming of age) were also performed. The PubMed search was restricted to the years 2005 and later because of the large number of records retrieved on this topic. Searches were updated on a regular basis and incorporated in the through searching the websites of selected related agencies (e.g., Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement). Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task force on Preventive Health Care (Table 1). Sponsors: This consensus guideline was supported by the First Nations and Inuit Health Branch, Health Canada. Summary Statements 01. Demographically, First Nations, Inuit, and Métis people are younger and more mobile than non-aboriginal people. This requires extra effort on the part of health care professionals to establish an environment of trust and cultural safety in their workplaces as the opportunity to provide care may be brief. (III) 0 Human Development Index;; however, the First Nations rank 68th. (II-3) 03. There have been centuries of formal agreements between European governments and First Nations. They were initially conducted in the spirit of friendship and cooperation, but later became centred on land ownership and resource extraction. Since they have been repeatedly dishonoured, there is an environment of mistrust in First Nations towards governments, their representatives, their policies, and anyone perceived to have authority. (III) 04. The Indian Act and its subsequent amendments were designed to control every aspect of a Status Indian s life and to promote assimilation. It was also a tool that the government used to access First Nations land and resources. (III) 05. The intergenerational trauma experienced by First Nation, Inuit, of government policy towards First Nations, Inuit, and Métis that have created intergenerational post-traumatic stress and dysfunction. However, they continue to be a resilient people. (III) 06. Most Canadians are unaware that a large proportion of Canada s gross domestic product is funded by monies garnished from natural resources extracted from Aboriginal lands, while transfers from the Federal government. (III) 07. Multinational companies extract resources from lands that are often on or adjacent to Aboriginal communities, or lands that are under land claims negotiations. The management of lands and resources by the provinces in some regions and by the territorial for First Nations, Inuit, and Métis communities to communicate with multinational corporations, especially where land claim negotiations are ongoing or non-existent. Multinational corporations do not provide revenues to these communities. Most Aboriginal communities are impoverished without adequate public health infrastructure, and without economic capital to improve their condition. (III) 0 take care of the land, and promote healthy communities. (III) 09. Eating traditional country foods helps to preserve cultural identity, but increasing environmental contaminants such as lead, arsenic, mercury, and persistent organic pollutants may compromise food safety. (II-3) 10. Given demographic shifts such as rapidly growing populations Nations, Inuit, and Métis in Canada, it is an important reality that most clinicians will encounter First Nations, Inuit, and Métis in their practice. (II-3) 11. Traditionally, men and women in First Nations, Inuit, and Métis First Nations women in particular lost their voices and powers within their communities, including their role in promoting traditional health and education. (III) 12. The unemployment rate is much higher in Aboriginal communities than in those of non-aboriginal Canadians. This is a major contributor to the gaps in socioeconomic status and access to equitable and quality health care. (II-3) 13. The language of health outcome measurement often perpetuates negative stereotypes towards First Nations, Inuit, and Métis because outcomes are reported out of the context of the social, political, and economic circumstances. (III) public health and health services to First Nations. (III) 15. The harmony of First Nations, Inuit, and Métis societies was century, causing widespread effects on the sexual health of First Nations, Inuit, and Métis women and men. (III) S2 JUNE JOGC JUIN 2013 ABSTRACT Table 1. Key to evidence statements and grading of recommendations, using the ranking of the Canadian Task Force on Preventive Health Care Quality of evidence assessment* controlled trial II-1: Evidence from well-designed controlled trials without II-2: Evidence from well-designed cohort (prospective or retrospective) or case control studies, preferably from more than one centre or research group II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees A. There is good evidence to recommend the clinical preventive action B. There is fair evidence to recommend the clinical preventive action recommendation for or against use of the clinical preventive action;; D. There is fair evidence to recommend against the clinical preventive action E. There is good evidence to recommend against the clinical preventive action decision-making *The quality of evidence reported in these guidelines has been adapted from The Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care. on Preventive Health Care. Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2003;;169: Research has shown that where cultural competency strategies have been implemented, health outcomes and patient satisfaction have improved. (II-3) 17. Subtle racism may occur without conscious intent, and is therefore Recommendations 01. Health professionals should have an understanding of the terms by which First Nations, Inuit, and Métis identify themselves. (III-A) 02. Health professionals should have an understanding of the terms cultural awareness, cultural competence, cultural safety, and First Nations, Inuit, and Métis may have different perspectives about what culturally safe care is and should seek guidance on 03. Health professionals should be aware of the limitations of statistics collected with respect to First Nations, Inuit, and Métis morbidity risks when comparing First Nations, Inuit, and Métis with one another and with non-aboriginal populations. (III-A) 04. Health professionals who wish to conduct research with frameworks that include the OCAP (ownership, control, access, and possession) principles, the Tri-Council Policy 0 impact of residential schools as one of the root causes of health and social inequities among First Nations, Inuit, and Métis, with important implications for their experiences and practices surrounding pregnancy and parenting. (II-3A) 06. Health professionals should be aware that the discourse on health care policy and land claim negotiations often perpetuates negative stereotypes and often occurs without accurate 07. Health professionals should be aware of ongoing debates regarding jurisdictional responsibilities that impede access to good quality, timely, and culturally safe health care for First Nations and Inuit, and of Jordan s Principle. Jordan s Principle children get necessary and timely care by paying for services immediately and seeking reimbursement from the appropriate agency later. (III-A) 08. Health professionals who provide care to First Nations and Inuit its eligibility and coverage requirements, and the exceptions and special permissions needed in some cases. Health professionals their First Nations and Inuit patients and assisting with obtaining face unique challenges accessing health care. (III-A) 09. All health professionals should acknowledge and respect the role that Aboriginal and Traditional midwives have in promoting the sexual and reproductive health of women and should be aware that this role is not limited to pregnancy and delivery, but often extends beyond the birth year. (II-2A) 10. Health professionals should inquire about their patients use of Traditional medicines and practices as part of routine health practices, including prenatal care. (III-A) 11. Health professionals should be aware that each First Nations, Inuit, and Métis community has its own traditions, values, and communication practices and should engage with the community in order to become familiar with these. (III-A) 12. Health professionals should be aware of Canadian laws governing sexual activities in minors, including those under the age of 12, those between 12 and 16 years old, and those with a much older partner. (III-A) 13. Given the prevalence of sexual abuse and exploitation, health professionals must address the possibility of sexual abuse or JUNE JOGC JUIN 2013 S3 Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline exploitation once a trusting relationship has been established. All gynaecologic and obstetric examinations must be approached sensitively, allowing the patient to determine when she feels comfortable enough to proceed. (III-A) 14. Health professionals should be aware of the increased prevalence of HIV/AIDS among First Nations, Inuit, and Métis and should offer HIV counselling and screening to women who are pregnant or of child-bearing age. Culturally safe approaches to HIV and other hematogenously transferred disease counselling, testing, diagnosis, and treatment should be supported and adopted. (III-A) 15. Health professionals should be aware of the high rates of cervical cancer and poorer outcomes once diagnosed for First Nations and Inuit patients. Health professionals should strive to limit the disparity between their Aboriginal and non-aboriginal patients by promoting culturally safe screening options. (I-A) 16. Health professionals must ensure that First Nations, Inuit, and Métis women have access to services for all their reproductive health needs, including terminations, without prejudice. Health reproductive health rights, values, and beliefs of First Nations, Inuit, and Métis women. (III-L) 18. Health care providers should ask about, respect, and advocate for institutional protocols and policies supporting the wishes of individuals and families regarding disposal or preservation of tissues involved in conception, pregnancy, miscarriages, terminations, hysterectomy, and other procedures. (III-A) as mood disorders, anxiety, and addictions are a major public health issue for many First Nations, Inuit, and Métis. (II-3B) Use of mood-altering substances that lead to addiction is often a mechanism for coping with the pain of their intergenerational culturally safe harm reduction strategies that can be used to support First Nations, Inuit, and Métis women and their families struggling with substance dependence. (II-2A) 20. Health professionals should support and promote the return of birth to rural and remote communities for women at low risk of complications. The necessary involvement of community in decision-making around the distribution and allocation of resources for maternity care should be acknowledged and facilitated. (III-A) 21. Health professionals should be aware that there is a great lack of research, resources, and programming about mature women s Nations, Inuit, and Métis. Health professionals should advocate for further research in this area. (III-A) 22. Health professionals should seek guidance about culturally patients. (III-A) 23. Health professionals may express to their patients that they wish to establish a respectful rapport through listening, acknowledging differences, and encouraging feedback. (III-L) 24. First Nations, Inuit, and Métis should receive care in their own language, where possible. Health care programs and institutions and Métis should have interpreters and First Nations, Inuit, and Métis health advocates on staff. (III-A) This document s Abstract was previously published in: J Obstet Gynaecol Can 2013;;35(6): S4 JUNE JOGC JUIN 2013 INTRODUCTION Introduction First Nations, Inuit, and Métis in Canada are diverse population groups making up nearly 4% of the nation s population. In a landmark summary published by the SOGC in 2000, in collaboration with the SOGC s Aboriginal Health Issues Committee, Dr Janet Smylie co-authored a comprehensive overview of the historical and modern challenges faced by Aboriginal peoples in their search for health, social justice, equality, education, and freedom from poverty. 1 The guidelines were ground-breaking and have proved to be a valuable document for health care professionals working with Aboriginal people. Over the years there have been a number of important changes and advances regarding health care knowledge, policy, programs, and services in Canada. It is the intention of this document to provide an update on the key developments affecting First Nations, Inuit, and Métis in Canada. This document will build on the foundation of the original guideline, and being of First Nations, Inuit, and Métis in Canada. inequities has evolved considerably. The Public Health health: income;; social support;; education and literacy;; employment and working conditions;; social environment;; physical environment;; personal health practices and coping skills;; healthy child development;; biology and genetic endowment;; health services;; gender;; and culture. 2 The National Aboriginal Health Organization has likewise to Aboriginal people, highlighting the interactive nature of contextual factors, such as geography and access to basic health services. 3 Awareness of the social determinants of health as a root cause of poor health outcomes among Aboriginal people has also improved. As the social and economic realities that underlie health have become better recognized, efforts to change the way health care is delivered have gain
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