A Journey Towards Cultural Competence and Cultural Safety in Nursing Education Hello Everyone. My name is Michelle Su and I am here on behalf of the Langara College Bachelor of Science nursing program, located in Vancouver BC and am  very pleased to have this opportunity to speak with you today.  This presentation is entitled “A journey towards cultural competence and cultural safety in nursing education".  This is based on the work carried out in relation to the implementation of the cultural competence and cultural safety framework into our curriculum  (click) Langara College BSN Program Presented by Michelle Su (Métis) RN, MSN March 1, 2010

Goals for Today's Presentation    Langara College BSN Program  A bit about us Our Starting Point Current Work and Ongoing Endeavors Culturally Safe Decision Making Framework for Nursing Practice New Curriculum Theme Building Connections In terms of goals for today’s presentation they are to… Briefly describe the Langara College BSN program and our starting point in relation to the work with the Cultural competence and cultural safety framework.  Next, I will explain some of  our current work and finish off with our future endeavors. (Click)

Here is Langara College.....opps Sorry about that. Go to next slide.... this is Langara College.   Laugh, laugh.....

Langara College 100, West 49th ave. Vancouver BC Add picture of college. I have one....that would be cool to add if you have one :) We wanted to let you all know a little about the Langara College nursing program before we started to talk about our work. Langara College has been experiencing an increase in the number of student enrolment from fall of 2008 to 2009. The Langara student body consists of a diverse group of students consisting of individuals from a variety of different ethnic backgrounds and age groups.  Full term courses had 9098 students enrolled in fall 2009. Out of 9098, 55.9% were female and 44.1% are male.  Out of 9098 full term students, 115 of them self identified as First Nations. Average age for fulltime students is between 22-29 years old. Interestingly, the predominant two Languages spoken in this area of the city are Chinese at (50.5%) and English at (31.6%) .

Demographics and our Nursing Program's Starting Point Langara Nursing Department Demographics Situated on and also near Traditional Musqueam, Squamish, and Burrard Territories Lack of Aboriginal health and Cultural Safety Content in the Curriculum Here we have a front view of the school The Langara College BSN program is currently a 40 month program leading to a Bachelors of Science in Nursing Degree.  However we are going through a curriculum revision which may include shortening the program. (Add more here)   Importantly, Langara sits on traditional Musqueam Nation territory plus we are also situated closely to Squamish and Burrard traditional territories as well. Despite this...when our curriculum was reviewed, it was found that we had a basic lack of any content related  to Aboriginal health and cultural safety in our curriculum.  This project became a starting point for us to begin making changes... (click)

Strengths that Support Change Supportive Nursing Administration team In process of Curriculum Revision Large Nursing Faculty Increasing level of awareness among faculty of issues Student population eager to learn about Aboriginal health and cultural safety As this signaled a change in direction for the focus of our curriculum content, we have been fortunate within the Langara nursing program in that we posses a variety of strengths that have aided us in supporting this change. First we are very lucky in that we have an administration team that is supports the changes.  We are also in the beginning phases of revising or curriculum so now is a great time to be changing and adding new content.  As well we have a large (add number) and diverse nursing faculty. We have noticed, as we have been incorporating the aboriginal health and cultural safety, that there is an increasing level of awareness and acceptance among faculty. As well, we have found that our nursing student population has a great interest in learning about Aboriginal health and cultural safety. (click)

Challenges and Solutions Takes time for Faculty to recognize significance and importance of cultural safety and Aboriginal health.   Continue to identify importance by way of meetings, emails, presentations. Provide for learning opportunities by way of guest speakers    Faculty resources on E Repository not being utilized     Increase awareness and makes resources more                  accessible.    Create learning activities with resources that can be used                 for each term.                        I think it is also important to acknowledge the difficulties we have encountered while on this journey... as likely other nursing programs have experienced the same.   We have  found that it does take time for Faculty to understand what cultural safety is and realize the importance of understanding the inequities related to Aboriginal health.  There does however appear to be a growing sense of understanding and support.  We are continuing to bring awareness to Faculty through presentations at Faculty meetings, as well as updating faculty through emails about working being done.    Another challenge was having resources accessible for Faculty to use. We initially had an e repository through our Library, but have since moved it to a more accessible venue for Faculty to use.  Our plan is to have learning activities and resources by term.     

Our Current Work and Ongoing Endeavors CURRICULUM The Marriage of our Nursing Decision Making Framework with the Cultural Competence Cultural Safety Framework Cultural Safety/Aboriginal Health thread throughout the curriculum Post Colonialism as a theory that informs our nursing philosophies   FACULTY:   Faculty workshop Ongoing educational sessions. Faculty resources STUDENTS:  Recruitment(SFU Aboriginal pre health program) Retainment     So now onto our current work and ongoing endeavors... Just list off the slide... Next I will begin with our newly developed culturally safe decision making framework

Here is a slide of our nursing decision making framework that we presently use.  This framework (2005) is an interactive, reciprocal, caring process in which the nurse and client actively participate in the creation of an action plan to achieve mutually desired health outcomes. The framework supports student learning and application of the complex skill of decision making in practice.  As you can see, the original core of the framework is client centered caring, which is central to all the decision making that is done within our nursing practice. By client we mean…an individual, a family, a group, or community.  The framework of decision making is similar to the nursing process, however with a bit more detail. It includes coming to know the client...Salience...Pattern recognition...Healing initiatives...and reflection (click)  

Here we have a diagram of the combined Decision Making for Nursing Practice Framework and the Cultural competence and Cultural Safety framework. The  We have given you a copy of our draft document.  We believe by marrying the cultural safety cultural competence framework into our already exisiting decision making framework, we can assure that we incorporate the core competencies for our students, our faculty, and our curriculum. We then create a culturally safe learning envirornment and ensure client centered care is practiced through the lens of cultural safety for Aboriginal people in the health care system.   This new framework has recently been released to faculty for their input.  The plan is to ratify and gain approval for this document at our next faculty meeting in late March.  We hope to begin a trial usage of this framework with faculty and students this summer term. (click)

here is a closer slide of our new  core of our decision making framework...as you can see the core competencies have been added to the client centered caring which ensures our decision making for nursing practice is enacted within the lens of cultural safety. (click)

(Original) COMING TO KNOW THE CLIENT The nurse comes to know the client by  learning of the client’s lived experience of health and healing through in­ depth caring interactions. Questions the student will ask: What is the client’s story?  What is the client telling me?  What do I know?  How do I know it?  How will I learn more?  What are my resources?    We took each section of our previous nursing decision making framework and changed it according to how we felt it could fit with the cultural competence and cultural safety framework. This is an example of  "coming to know the client" - with the definition being: the nurse comes to know the client by learning of the client's lived experience of health and healing through in depth caring interactions... As you can see , the student nurse is in a position of power in relation to the patient and the focus is primarily on the student nurse obtaining information from the patient. (click)

Coming to Know the Client (Revised) Coming to Know the Client The student with Faculty support within a culturally safe curriculum comes to know the client by learning of the client’s lived experience of health and healing through in-depth, culturally safe, caring interactions. STUDENT   The student will: Respect the client’s culture, age, and beliefs  Recognize that he or she brings his or her own culture and attitudes to the relationship  Communicate competently with the client in that person’s social, political, linguistic, economic, and spiritual real  Pay close attention to and not negatively judge verbal and non-verbal information that clients provide  Be aware of the needs the client may have and the issues he or she may face    Questions the student will ask: What is happening in your life? What is the most important thing right now? What are the client behaviors that can add to my assessment? Besides my client, what are my resources? FACULTY The Educator will:   role model culturally safe practice for the student, to the patient support the student to come to know the client through respecting both the client and the student's culture and attitudes brought into the helping relationship. support the student to identify the client's unique health needs.  must have awareness of the issues themselves and then can provide the student with knowledge pertaining to the core competencies  Educator questions: Questioned the student about:  - reviewing what is the client's story. - identifying the plan of care? - identifying student learning  needs? -reviewing resources identified by the client and student.    CURRICULUM The curriculum: Will include concepts and content related to: cultural safety a critical understanding of culture post colonial understanding -respecting culture Communication - relational and caring practice Respect - relational and caring practice Inclusivity - developing trusting relationship Indigenous knowledge Mentoring and supporting students for success Now here is the newly revised coming to know the client.  As you can see the definition itself has changed. (The student with faculty support within a culturally safe curriculum comes to know the client by learning of the client's lived experience of health and healing through in-depth, culturally safe, caring interactions.) As well - you can now see that coming to know the client through a culturally safe perspective entails the student, the faculty, and the curriculum participation.   To begin,  suggestions are provided to the student for ways of interacting with the client in a culturally safe manner. Second the faculty need to have  knowledge pertaining to cultural safety and Aboriginal health in order to role model culturally safe care for the student. Finally  there needs to be cultural safety and Aboriginal health content embedded within the curriculum.

Cultural Safety and Aboriginal Health Curriculum Theme   Aboriginal Health and Cultural Safety as a Thread Year Learning Outcomes Concepts/ Content Resources Assignments     Year 1 Term 1 (Wellness) Examine the process of cultural safety.  Explain how cultural safety can be achieved. Describe how this process relates to a population’s health Differentiate between the concepts of: race, ethnicity and culture. Begin to understand: cultural awareness, cultural sensitivity, cultural competence, cultural safety Browne, A. J., & Varcoe, C. (2006). Critical cultural perspectives and health care involving Aboriginal peoples. Contemporary Nurse, 22(2), 155-167. (more but did not fit on slide) Case story approach, reading circle approach As mentioned earlier, the langara nursing program is currently in the process of curriculum revision.  One of the measures we have taken to ensure cultural safety and aboriginal health content is included in the curriculum - is creating a thread that will go throughout the terms.  here is an example of what we have developed for term 1.  We have developed a thread that goes through term 1 - 9.  We are in the process of creating learning activities that pertain to each term.

The Importance of Building Connections   Aboriginal Advisory Committee Aboriginal Student Services   Aboriginal nursing students/past students  Simon Fraser University Aboriginal Pre-health Health program   Vancouver Coastal Health Aboriginal Patient Navigator Program      The importance of building connections can not be underestimated when doing this work. First, we have created a Langara Aboriginal advisory committee with external members that provides input and feedback to our ongoing work.  We are also working with the Aboriginal student services manager. We recognize the importance of staying in contact with past Aboriginal students from the program and are also connecting with current self identified Aboriginal students.   We have been working with the Simon Fraser University Aboriginal Pre-Health Prgoram (which prepares Aboriginal students to enter a chosen health career). I went as a guest speaker to their class and spoke to the benefits of choosing nursing as a career and answered questions the students had about the nursing program.  We also invited the students to spend an afternoon with us at the college to get a feel for what our nursing program was like. We have also been working with the team lead of the Vancouver Coastal health Aboriginal Patient Navigator Program and now have term 7 students spending a clinical day with one of the Aboriginal Patient Navigators

Faculty Development for Cultural Safety and Aboriginal Health   Spring Faculty workshop presentation - Colleen Varcoe Interactive workshop on dealing with racism  Faculty development committee - Elder from Residential school survivor society.   Aboriginal Patient Navigator Vancouver Coastal Health Speaker         As mentioned previously, having speakers come in and present on cultural safety and ABoriginal health is a great way to enhance the faculties knowledge.   We are currently in the process of organizing a spring faculty workshop.  We have  booked and confirmed Dr. Colleen Varcoe as one of speakers who will come and talk to the importance of understanding cultural safety as health care providers and how this relates to Aboriginal health.  As well we will be conducting an interactive workshop with the faculty on approaches for dealing with racism. We also have an elder coming from the residential School Survivor Society to speak to the faculty on the experiences of residential school survivors and also the strengths of Aboriginal people.  He also comes and speaks to the term 1 students each year as they enter the program. Finally we are having the team leader of the Aboriignal patient navigator come and talk to faculty about their role within hte health care team and also  about the barriers Aboriignal people face within the health care system.

  References Aboriginal Nurses Association of Canada (2009). Cultural Competence and Cultural Safety in Nursing Education, A framework for First Nations, Inuit and Metis Nursing.  Decision Making for Nursing practice. Collaborative Curriculum Guide (May 2004 Revised) Collaborative Nursing Program in BC: Summary of the Collaborative Nursing Program in BC.  The Indigenous Physicians Association of Canada and the Royal College of Physicians and Surgeons of Canada ( 2009).  Cultural Safety in Practice; A Curriculum for Family Medicine Residents and Physicians, Winnipeg & Ottawa, IPAC-RCPSC Family Medicine Curriculum Development Working Group