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Health Studies
Denis Maxwell

HLTC02 WINTER 2013 Week # 9: “Clinical Encounters between nurses and First Nations women in a Western Canadian Hospital” by Annette J. Browne Abstract  Ethnographic study explore the sociopolitical context of nurses‘ encounters with First Nations women in a Western Canadian hospital  Method: In-depth interviews, participant observation of clinical encounters involving First Nations women and nurses  Four themes: relating across presumed ―cultural differences‖; constructing the Other, assumptions influencing clinical practice, and responding to routine patient requests  Finding demonstrate how discourses assumptions about Aboriginal people, culture and presumed differences can influence routine clinical encounters  It is important to analyze these health encounters with respect wider sociopolitical and historical forces that give rise to racialization, culturalism and Othering Introduction  Recent research suggests that the power relations within the doctor-patient relationship also influence nurse-patient relations, and these power differentials are magnified when gender, ethno cultural background and class are considered.  Few studies on nurses clinical encounters AND the dynamics of health care interactions with Aboriginal patients  Purpose of paper is address this gap by discussing findings from an ETHNOGRAPHIC study that explored the SOCIOPOLITICAL context of health care encounters involving nurses and First Nations women in a Canadian hospital setting  Aboriginal people refers to indigenous groups comprising of First Nations, Metis, and Inuit people  First Nations is used more to specifically to refer to the participants who self-identified as First Nations Health Status, Health Care and Aboriginal People  The historical relations and internal colonial politics, policies and practices between Aboriginal people and the nation state – characterized by wardship, welfare colonialism, the creation of reserves, the appropriation of Aboriginal lands, the forced removal of children into residential schools, discriminatory attitudes toward Aboriginal people, and a continued lack of vision in terms of the effects of these relations continue to exert their influence in terms of health, social, economic and political disparities  Colonial legacy of subordination has resulted in multiple jeopardy for Aboriginal women who continue to face individual and institutional discrimination on the basis of ―race‖, gender and class.  Aboriginal women experience a disproportionate burden of ill health compared to both Aboriginal men and other Canadian women, live in extreme poverty as well and experience he concomitant social and health effects due to long standing economic, social and political disparities  These findings remind us that the micro- politics of health-care encounters cannot be separated from the sociopolitical and historical contexts in which they occur, and highlight the need for analyses that link the dynamics of patient–provider relations to these wider contexts. Methods  The objectives that guided this aspect of the study were to (a) examine patterns of interaction between nurses and First Nations women in the hospital, and (b) analyze these interactions within a wider sociopolitical context to understand how these contexts shape relations between nurses and First Nations women.  These issues are particularly relevant given the historically mediated relations of power and paternalism that continue to shape health-care policies and practices affecting Aboriginal people  Ethnographic research design with in-depth interviews and participant observations of clinical encounters between nurses and First Nations women in a Western Canadian city HLTC02 WINTER 2013  35 participants – 14 First Nations Women, 14 Nurses, 2 RNs and community health worker, all women, all in English  Reflexive analyses of how researcher may have been affecting the dynamics of nurse-patient interactions were also recorded in field notes  Used interpretive thematic analysis Results and Discussion Relating across presumed ―cultural‖ differences  Consistent with commonly held assumptions about culture or ‗‗cultural characteristics‘‘ as fixed traits that exist outside of wider social and political dynamics, the nurses tended to interpret differences in communication styles as ‗‗cultural issues.‘‘  Nurses remarked that First Nations women were quiet, reticent or passive patients – this may be to due patterns of paternalism and authority of health care relationships of past, a product of the power inequities that may be shaping how some patients relate to providers who are in positions of influence  It takes on a whole new level of significance if the presumed cultural artifact of quiet patients is actually a result of the historical context and impact of colonialism and ongoing power inequities and how these influence social relations – including clinical encounters, just thinking of Native women as ―quiet‖ overlooks the significance of the burden of history shaping everyday interactions and experiences  Extra effort may be required to ensure that nurses remain attuned to patient‘s needs and issues despite some patients‘ apparent reticence or passivity  Miscommunications or difficulties communicating have significant implications in the clinical arena. In the hectic climate of the hospital setting, patients whose relational approaches differ from what is expected by health-care providers—for example, those who do not speak up or pose frequent questions—risk having their needs over- looked. o 67 year old First
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