The Aboriginal Cultural Safety Initiative: An innovative health sciences curriculum in Ontario colleges and universities

Abstract

Objectives: The Aboriginal Cultural Safety Initiative (ACSI) created at Anishnawbe Health Toronto offers an innovative curriculum to address gaps in postsecondary health sciences curricula in this area for future healthcare providers. Participants: Evaluations were collected from 1,275 students in health sciences programs in colleges and universities in Ontario. Setting: Trained volunteer Aboriginal instructors were invited as guest speakers to college and university classes in various health science disciplines. Intervention: Our instructors offered a 2-to 3-hour teaching session to health sciences students that included 3 modules on the health of Aboriginal peoples: (a) The impact of colonial and postcolonial policies on social determinants of health, (b) Contemporary health determinants and health outcomes, and (c) Aboriginal concepts of health and healing practices. Outcomes: The ACSI was able to impart the intended learning objectives to a wide array of students across health sciences disciplines, as demonstrated in the student evaluations. A significant number of students reported that their knowledge of, and interest in, Aboriginal health increased substantially when compared to their prior knowledge and interest. Conclusion: The success of this program suggests that, in the absence of Aboriginal faculty members in postsecondary health sciences departments, a committed cadre of volunteer Aboriginal instructors can improve student knowledge around issues related to Aboriginal health and can influence student attitudes through the inclusion of personal experiences in the teaching session. A lack of availability in curriculum time continues to be the largest obstacle to including content on Aboriginal cultural safety in health sciences programs.

A “two-eyed seeing” approach to Indigenizing nursing curricula

“…The content and delivery of program materials needs to align with how students will process and apply theories to become competent practitioners. [9,39] As mentioned earlier, current educational systems are predominantly posited in a Eurocentric (Western) worldview. [12] Knowledge of colonial practices, treaties, acts, residential school, power imbalances, and intergenerational trauma has not been included in mainstream learning or dialogues.…”

“…Each learner is challenged in their own way, and attempts are made to bridge the knowledge gaps for those not informed of Indigenous ways of knowing and being. [39] Similarly, sensitivity to the acculturation of Indigenous students must occur, and care must be taken to prevent assumptions that all Aboriginal peoples are aware of their ancestors' history, while still eliminating barriers to holistically support Indigenous learners. [41] The TRC (2015) [13] addresses disparities in health outcomes recommending that society ".…”

'Experience talks, resilience shapes' revisiting historic trauma: impact on treatment in indigenous males living with HIV/AIDS in British Columbia

“…Cultural safety recognises that there exists established paternalistic relations of power and authority within healthcare policies and practices, as well as prejudice, discrimination, and racism lead to inequities in healthcare outcomes for Indigenous peoples in Canada (Adelson, 2005;Baba, 2013;Browne, 2009;Gerlach, 2012;Hart-Wasekeesikaw & Gregory, 2009). The concept then helps us understand power differentials operating within healthcare delivery (National Aboriginal Health Organization, 2008b;Shah & Reeves, 2015;Spence, 2001) and enables us to: expose the historical, social, and political contexts of healthcare; consider the effects of racism, discrimination, and prejudice; acknowledge that recipients of care determine cultural safety; acknowledge the limitations of 'culture' in terms of access to care; and, challenge and balance power relations to enable patients' access and safe navigation through the healthcare system (Baba, 2013;Gerlach, 2012;Smye, Josewski, & Kendall, 2010 (Baba, 2013;Gerlach, 2012;National Aboriginal Health Organization, 2008b). In Canada, in contrast to multicultural approaches that tend to ignore power differentials among different groups, in a culturally safe environment healthcare providers are expected to embrace self-reflection (on a foundation of a clear understanding of differentials of power) to advance trusting relationships with Indigenous peoples (Baba, 2013;Lavallee et al, 2009 (Browne & Varcoe, 2006;Gerlach, 2012;Shah & Reeves, 2015).…”

“…As this definition suggests, however, the concept of cultural safety may potentially be of huge importance in the development and implementation of policies and services for healthcare in Indigenous peoples beginning from a systemic process of conversion undertaken by the dominant healthcare culture with meaningful participation of Indigenous peoples as decision-makers or valid and respected self-advocates freely exercising their power to determine cultural safety in their care (Baba, 2013;Brascoupé & Waters, 2009;Lavallee et al, 2009;National Aboriginal Health Organization, 2013;Shah & Reeves, 2015).…”

“…This mandatory training in cultural safety will hopefully increase the number of non-Indigenous organizations that are delivering services in a culturally safe manner and reduce hesitation on the part of the Indigenous community to seek medical advice as they will now feel they are going to be treated properly. Since cultural safety is an active, ongoing and evolving process it will be necessary for healthcare providers to evaluate modes of services and reflect on health policies over time in order to remove barriers and meet the needs of Indigenous peoples by providing culturally safe care across multiple visits (National Aboriginal Health Organization, 2013;Shah & Reeves, 2015). Healthcare providers should focus on resolving today's misunderstandings of the past through the maintenance and sharing of Indigenous narratives.…”