Nursing research aimed at better health care in remote communities

Mike Youds, January 11, 2019

Joanna Fraser (centre, white sweater), NIC nursing instructor, meets with research team, including representatives of the Ka:'yu:'k't'h'/Che:k'tles7et'h', Wuikinuxv and Dzawada’enuxw First Nations. (NIC photo)

Port Alberni, BC — 

Continuing research involving enhanced training through a Nuu-chah-nulth community-driven nursing approach is expected to lead to better health care in remote First Nation communities.

Joanna Fraser, a nurse educator at North Island College (NIC), is working with the Ka:'yu:'k't'h'/Che:k'tles7et'h' and Huu-ay-aht First Nations with the goal of improving wellness, health services and understanding of Indigenous values in nursing education.

The two-year project — funded by $212,000 from the Social Sciences and Humanities Research Council, a Canadian research funding body — expands on a 10-year partnership between NIC’s bachelor of science in nursing (BSN) program and the First Nations involved.

Under the guidance of Dr. Evelyn Voyageur, a Dzawada’enuxw elder-in-residence and nurse, the BSN program has become a recognized leader in responding to challenges Indigenous people face in obtaining adequate, culturally effective services. The grant has served to expand the college’s reconciliation work and transform the nursing curriculum.

For the past 10 years, third and fourth-year nursing students have done practicums in coastal First Nations. The grant funds provide a head start with immersive learning experiences earlier in their studies.

“Fostering the relationship between nursing students and First Nations communities will help address the communities’ need to recruit and retain culturally effective nurses,” Fraser said. “Another benefit, identified by the Indigenous communities, is improved trust in the health care system and nurses, leading to improved access to health care services for community members.”

Twenty nursing students, working with NIC faculty, elders-in-residence and community mentors, will work to create additional immersion opportunities.

Fraser summarized the program as “creating nurses that come out with the ability to practice in a culturally safe way,” providing lessons that can be shared with other communities.

Life in remote communities presents multiple challenges to health care. Barriers of distance, time and cost are compounded by Indigenous experiences of health care under colonial policies. Substandard practices in the residential school and Indian hospital era led to a lingering distrust of the system.

Going into communities, nurses have been able to develop trust following the Nuu-chah-nulth nursing framework, another project linked to NIC nursing research.

“Community members say they feel more confident in advocating for themselves,” Fraser said. “I feel this is the biggest benefit in terms of community response.”

While inequities continue to exist within the mainstream health-care system, she prefers to focus on the positive.

“We’re looking at what is strong in each community and building from there,” Fraser said, noting that each First Nation has a community health plan to build upon. “It’s the community that is the teacher, and the land,” she said.

Jeannette Watts, NTC manager of nursing services, said the NIC research should help better prepare nurses and ensure more effective recruitment and retention over time.

“The nursing practice in remote First Nations communities is a unique practice. It’s a specialty,” she said.

“We need to make sure these nurses are paid an equitable salary,” she added. “They need more than fair compensation, though. They need to have a passion for the work.”

For those reasons, recruitment can be challenging, particularly if nurses are trained only through the western medical model, she said.

“I think it’s a great idea,” said Robyn Clarke, a community health nurse clinical leader with NTC, commenting on the enhanced training. “I think the challenges are mostly related to travel. It’s hard to get out of there so some people tend to go without services.”

“I think having the experience in the community definitely raises awareness for nurses of where they’re going and the type of work they will be doing,” said Lorraine Harry, NTC home care nurse clinical leader.

They need the firsthand experience of field training but also support of colleagues and peers within the health care system. It helps to know that they are supported through professional connections outside of the community, Harry said.

A dinner celebrating the project, co-hosted by Cliff Atleo, takes place on Friday, Jan. 25, 5-8 p.m., at the Port Alberni campus of North Island College.