A holistic, collaborative and innovative approach

By Marney Vermette

Inspired by our roots and our vision to “honour the human face of health care,” Saint Elizabeth’s First Nations, Inuit and Métis (FNIM) Program is an important initiative that demonstrates how we live out this vision. The program works through partnerships and collaboration to enhance the capacity of FNIM communities to find solutions to complex health care issues and to improve access and address barriers to care. Activities include provider partnerships, action-based research, knowledge exchange and mobilization, and online learning.

The program harnesses the collective knowledge and wisdom that exists across a vast network of communities and organizations to positively impact health care delivery at the local level. Currently, more than 1,700 health care providers from more than 400 FNIM communities and organizations across Canada are actively participating in knowledge-exchange initiatives, including:
• 12 health-related courses available through our award-winning e-platform, @YourSide Colleague
• First Nations courses developed with and for community health care providers to ensure the content is culturally relevant and meets community needs
• more than 1,500 e-learning events delivered to thousands of community health care providers on topics such as elder care, cancer control, chronic disease prevention and management, diabetes care and wound management
• a national portal for community sharing of best practices and information offered in both official languages Health care providers in First Nations communities receive free access to courses and e-learning events.

Responding to need
FNIM seniors are among Canada’s most vulnerable citizens. Their health needs are magnified by determinants of health such as poverty, poor housing, racism, language barriers and cultural differences. Over the past 12 years, the vast majority of First Nations communities across Canada have received funding for program-development activities under the First Nations and Inuit

Home and Community Care Program
Now that more elders are remaining in their communities, there is an increased need for health care provider competencies in caring for the unique needs of FNIM seniors. A recently released report by the Health Council of Canada noted that a significant proportion of health care workers serving FNIM communities do not have enough training or experience to meet the complex needs of these seniors Capacity to respond to these training needs is impacted by geographic isolation—more than 60 per cent of First Nations communities are remote or fly-in with no road access.3 This presents significant challenges for health care providers in accessing continuing education, including high travel costs and time away from families, communities and positions.

The Saint Elizabeth FNIM Program has worked in partnership with health care providers living and working in First Nations communities to address these barriers, providing accessible education and training through our award-winning e-learning program, @YourSide Colleague. Developed with and for community health care providers, the recently released First Nations Elder Care Course (ECC) is helping elders to remain in their homes and communities for as long as possible.

Approach
The Saint Elizabeth FNIM Program incorporates a unique model involving First Nations health care providers in the development and review of courses, with a focus on building relationships through mutual trust and respect. The initial phase of development of the First Nations ECC involved subject-matter experts to develop the clinical content and the FNIM Program Elder Advisors to inform the cultural components of the course. Course topics were based on a national survey of community health care providers to identify their learning needs related to providing elder care. The course is structured around the components of the medicine wheel to reinforce the importance of holistic client care. It provides evidence-based, culturally sensitive education about First Nations history and culture, as well as clinical information on health topics related to elder care such as falls, medication, nutrition, depression, Alzheimer’s disease, elder abuse and caring for yourself as a health care provider.

A key message throughout the course is the importance of understanding that each First Nations community is unique, and that health care providers need to build relationships and learn about community-specific cultural practices and protocols. The final phase of development of the First Nations ECC included a call for community reviewers. Respondents from across the
country, including elders, provided valuable feedback to ensure the course was culturally sensitive, relevant and responsive to First Nations community needs. The reviewers’ feedback was then incorporated into the First Nations ECC.

“I was very excited to take part in the Elder Care Course review. As the primary health care provider (community health representative) in the community, it is important that our elders are being looked after with the utmost care we can provide. This course can provide our workers with understanding and knowledge to provide a safe environment, along with respect and protocols in caring for the elders. The goal in our community is to keep our elders in their homes for as long as possible, instead of them being put in a long-term facility.”
— Frances Kabatay, CHR, Seine River First Nation, Ontario

An elder care webinar series was offered in addition to the online course, which was officially launched in January 2013. Webinar session titles included: “Medicine Wheel Teachings,” “Defining an Older Person,” “Historical and Intergenerational Trauma—Indian Residential School Effects on Elders,” “Common Illnesses in the Elderly,” “Elder Abuse” and “The First Nations ReAct Tool.” These webinars were held in real-time to provide learning from a distance to health care providers in FNIM communities. Each session was recorded and is housed within @YourSide Colleague for future viewing. More than 87 participants from across the country, including rural, remote and isolated communities, attended the webinar series.

Impact
Saint Elizabeth continually evaluates knowledge-exchange initiatives such as this one through course use statistics and surveys. The release of the First Nations ECC was met with an enthusiastic response from across the country. A survey was distributed to participants to identify how the course and webinar series impacted health care providers’ practice and client care in FNIM communities. The survey asked participants to rate their knowledge, skill and comfort level in providing elder care prior to and after completing the course or webinars. Respondents reported that the course stimulated discussion and program planning for elders in their communities, directed curriculum changes at a school of nursing and reinforced the importance of holistic approaches to care.

“It is important to incorporate cultural practices in our health and wellness [activities]. Most of the mainstream non-Indigenous health and wellness practices focus mainly on physical health, not what are you doing for mental, spiritual or emotional health”
—Anonymous

The First Nations ECC has recently been recognized as a leading practice for creating culturally safe care for First Nations seniors by the Health Council of Canada. Elders are integral to the wellbeing of communities, and the First Nations ECC is supporting health care providers in keeping elders in their homes and communities for as long as possible.

For more information visit saintelizabeth.com. References available upon request.

Marney Vermette, RN, is an Anishinaabe-qwe nurse living in Red Lake, Ontario. She belongs to the Lac Seul First Nation. Marney has more than 9 years experience in the home care sector. She is currently the Engagement Liaison for the Saint Elizabeth FNIM Program and plays a critical role in supporting the professional development of health care providers in First Nations communities through knowledge-exchange activities.