Culturally safe dementia care: Building nursing capacity to care for First Nation Elders with memory loss

Abstract

Background Nursing staff require culturally relevant and dementia‐specific education to care for the increasing number of First Nation Elders experiencing memory loss. The culturally safe dementia care (CSDC) research team, composed of researchers, decision makers and Secwepemc Elders, was formed to address this. Objectives To increase the capacity of nurses to care for First Nations Elders with memory loss in a culturally safe way. Methods Our community‐based research used purposive sampling and mixed methods to create, implement and evaluate an education programme for nurses. Thirty‐four Elders from six Secwepemc communities participated in roundtables to share views and stories of dementia and nursing care. These data were used to create four teaching stories for the storytelling sessions and talking circles with Elders which, together with the Indigenous Cultural Competency (ICC) training, comprised the CSDC education programme. Thirty‐eight nurses (healthcare aides, licensed practical nurses and registered nurses) working in Central British Columbia began the CSDC study and 15 nurses took part in the education programme, evaluated the storytelling session and completed the three pre‐ and post‐measures (Approaches to Dementia Questionnaire (ADQ), ICC knowledge quiz and self‐assessment, and Care Plans). The pre‐ and post‐tests were scored, and the data were analysed statistically. The data from the roundtables and talking circles were analysed thematically through a collaborative process. Results The scores for the ADQ Hope sub‐scale, the ICC knowledge quiz and the Care Plans increased from pre‐ to post‐test. All nurse participants judged the storytelling session to be effective and their learning outcomes reflected culturally safe dementia care. Conclusions This programme can improve the knowledge, skills and values of nurses to provide culturally safe dementia care.

Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature

“…A total of 46 documents were analysed, describing 43 different educational interventions. The majority ( n = 35) of documents described university-based educational interventions [ 16 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 38 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 68 , 69 , 70 , 73 , 80 , 81 , 83 , 84 ], with one set of documents describing a short vocational training course [ 85 , 86 , 87 ], and the remainder ( n = 8) describing continuing professional education (CPE) courses for practicing health professionals [ 17 , 19 , 20 , 36 , 69 , 73 , 88 , 89 ]. Just over half of the documents analysed ( n = 28) were from Australia [ 17 , 18 , 20 , 22 …”

“…While an exploration of cultural safety definitions was not a central aim of this study, it was notable that several definitions included did not contain any reference to reflexivity or similar processes, such as critical reflection or self-awareness. Six of the documents included for analysis made no reference to reflexivity or similar in either the definition of cultural safety or in the educational intervention [ 19 , 24 , 27 , 28 , 73 , 88 ]. One of these documents referred to practicing cultural safety skills learned in a previous topic via structured simulation workshops [ 28 ], but the cultural safety skills are not outlined so it is unclear whether this includes reflexivity.…”

“…Thirty-five of the documents analysed described the sub-theme of held beliefs, where learners were required to identify and articulate their current knowledge, attitudes, biases, power, and privilege specifically in relation to Indigenous peoples [ 16 , 17 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 29 , 30 , 31 , 33 , 36 , 38 , 54 , 55 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 73 , 80 , 81 , 83 , 87 , 90 , 91 ]. In most of these educational interventions, learners were required to reflect on both self-identity and held beliefs, and these were conceptualised as related.…”

“…The importance of cultural safety as an approach to healthcare provision is now well established, with a substantial body of literature exploring the application of cultural safety across a range of health professions, including nursing and midwifery [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], medicine [ 24 , 25 , 26 , 27 , 28 ], psychology [ 29 ], physiotherapy [ 30 ], occupational therapy [ 31 , 32 ], and nutrition [ 33 ]. As such it is increasingly being included in health sciences curricula at the tertiary level in Australia, Aotearoa New Zealand, Canada, and the United States [ 34 ] and developed as short continuing professional education courses (for example, [ 35 , 36 , 37 ]).…”

“…While there is a growing body of literature on cultural safety education, at present, there is little guidance on the best approach to teach or assess reflexivity in the context of cultural safety. Currently, most cultural safety education literature falls into three broad categories: qualitative explorations of student learning experiences [ 18 , 22 , 30 , 54 , 55 , 56 , 57 , 58 ], evaluations of student learning outcomes [ 17 , 19 , 23 , 26 , 29 , 32 , 33 , 50 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], and descriptions of curricula development and delivery [ 16 , 20 , 21 , 25 , 28 , 31 , 38 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. In evaluations of curricula and learning outcomes, student reflective journals are a common source of data.…”