Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.

This research provides a Canadian example of implementing a public health approach to PC in an Indigenous context using PAR. It provides evidence of the effectiveness of a community capacity development as a strategy and illustrates how to implement it. This approach, fully grounded in local culture and context, has potential to be adapted to Indigenous communities elsewhere in Canada and internationally.

This research examined the perspectives and experiences of First Nations community members regarding health and social support for elderly people living in 13 First Nations communities in northwestern Ontario. Surveys (n = 216) and focus groups (n = 70) were conducted in 2005 and 2006 with elderly Aboriginal people and their formal and informal caregivers. Results indicated a strong preference (69%) for helping people to age and die at home; however, barriers and challenges existed at the family, community, health system, and social policy levels. Barriers included a lack of family caregivers and shortage of health care providers and programs; changing community values; and limited access to provincial health services and culturally relevant and safe care, all of which hindered social policy and community empowerment. Enabling elderly people to age within First Nations communities will require multi-level and multi-sectoral system changes.

Providing palliative care in Indigenous communities is of growing international interest. This study describes and analyzes a unique journey mapping process undertaken in a First Nations community in rural Canada. The goal of this participatory action research was to improve quality and access to palliative care at home by better integrating First Nations’ health services and urban non-Indigenous health services. Four journey mapping workshops were conducted to create a care pathway which was implemented with 6 clients. Workshop data were analyzed for learnings and promising practices. A follow-up focus group, workshop, and health care provider surveys identified the perceived benefits as improved service integration, improved palliative care, relationship building, communication, and partnerships. It is concluded that journey mapping improves service integration and is a promising practice for other First Nations communities. The implications for creating new policy to support developing culturally appropriate palliative care programs and cross-jurisdictional integration between the federal and provincial health services are discussed. Future research is required using an Indigenous paradigm.

This paper describes the development and implementation of a community-based palliative care program in Six Nations of the Grand River Territory, Ontario, Canada. Six Nations' innovative program is grounded in a vision to provide access to quality palliative care at home and incorporate Haudenosaunee traditional teachings. A community-based Project Advisory Committee led the development process, and a Leadership Team of local and regional palliative care partners led implementation. Using participatory action research, academic researchers supported activities and facilitated data collection and evaluation. Outcomes included: creation of a Palliative Shared Care Outreach Team, including a First Nations physician, nurse, and social worker; development of a detailed care pathway for clients who need palliative care; increased home deaths (55) as compared to hospital (22) or hospice (6) deaths; access to palliative care education and mentorship for local healthcare providers; incorporation of traditional teachings to support clients and staff dealing with death, dying, grief, and loss; and creation of a palliative care program booklet for Six Nations Health Services. This unique initiative reduces disparities in access to quality palliative home care and demonstrates that First Nations communities can successfully undertake a process of community capacity development to create unique and culturally responsive palliative care programs. Challenges included overcoming federal and provincial jurisdictional issues in provision of health services through collaborative partnerships at the local and regional level.