Cultural understanding in the provision of supportive and palliative care: perspectives in relation to an indigenous population
- 1School of Health Administration, Dalhousie University, Halifax, Canada
- 2School of Nursing, Dalhousie University, Halifax, Canada
- 3Department of Health and Social Services, Government of Yukon, Whitehorse, Canada
- Correspondence to Grace Johnston, School of Health Administration, Dalhousie University, 5161 George Street, Suite 700 - Royal Centre PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada;
Contributors GJ was responsible for overall conceptualisation of the paper and guidance especially in relation to palliative and end of life care for vulnerable populations as well as critical reflection, interpretation and editing. AV advised on Mi'kmaq information sources, conceptualisation and design, and assisted with the critical review, understanding of the Mi'kmaq culture, liaison with Mi'kmaq consultants and editing of the manuscript. SP carried out the initial literature review and meetings with strategic informants, prepared the first draft of this paper and contributed to revisions. All authors contributed to the literature review and have read and approved this final manuscript. GJ and AV jointly are the guarantors for the content of this paper based on their respective areas of expertise and through ongoing consultation with two Mi'kmaq consultants.
Objectives The provision of supportive and palliative care for an indigenous people in Nova Scotia, Canada, was examined to further our understanding and thereby improve cultural competency. Most of Nova Scotia's indigenous people are Mi'kmaq. The Mi'kmaq Nation lives in Atlantic Canada as well as New England in the eastern USA.
Methods Themes were identified in the literature and through discussion with seven experts who have Mi'kmaq health and cultural research expertise. This paper has been reviewed and approved by two Mi'kmaq consultants who frequently speak on behalf of the Mi'kmaq people in relation to health and cultural understanding. Recommendations for non-indigenous care providers are presented.
Results The themes identified focused on jurisdictional issues and cultural understanding. They are interconnected and grounded in the historic Mi'kmaq context of colonialism. Jurisdictional issues experienced by the Mi'kmaq affect access, continuity and appropriateness of care. Cultural concepts were associated with worldview, spirituality, the role of family and community relationships and communication norms, and thereby with the alignment of values and language in the provision of care. Three Mi'kmaq concepts are noted: apiksiktatulti, nemu'ltus and salite.
Conclusion Through reflection on the situation of Nova Scotia's Mi'kmaq, non-indigenous healthcare providers can assess how they might increase their cultural understanding in the provision of supportive and palliative care. Recommendations relate to the health system, relationships with individual persons and direction for research.
Funding This report was carried out with support from a Canadian Institutes for Health Research Interdisciplinary Capacity Enhancement for vulnerable populations grant number FRN-80067.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
- Accepted 24 February 2012.
- Published Online First 3 May 2012
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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