An integrative review of Indigenous informal caregiving in the context of dementia care.

AIMS: To appraise the empirical literature on the needs of Indigenous informal caregivers caring for people living with dementia in Indigenous communities. DESIGN: Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines, and CASP checklists for narrative analysis were followed. DATA SOURCES: A systematic search of published empirical literature from January 2010 to August 2020 was undertaken in six databases. REVIEW METHODS: Fifty-one studies met the research question and the inclusion criteria. RESULTS: Five themes describe the findings: Decolonizing Western perspectives on dementia, the centrality of cultural safety, caregivers' experiences, pre-dementia community education and family and community-centred care emerged from the thematic analysis. Most of the studies used quantitative methodologies, and few studies were conducted using community-based approaches. CONCLUSION: This review shows that Indigenous caregiving represents an emerging field in nursing and health sciences in a context of a global crisis. Researchers need to focus on Indigenous values and voices to adapt care and support informal caregivers. Our review emphasizes that working with Indigenous communities will likely translate into new care delivery models, policies and practices to support Indigenous informal caregivers and address the specific social determinants impacting caregivers' roles and tasks. IMPACT: This review highlights the necessity of having community and family-based discussions on enhancing the delivery of dementia care for Indigenous peoples in Canada and worldwide. Decolonizing Western perspectives of dementia translate into culturally safe approaches that aim to integrate Indigenous cultural perspectives of holism, reciprocity, wisdom, respect of older people and relationality into nursing practice. The support of Indigenous informal caregivers requires future studies to address the stigmatizing Western views of dementia.

Filling the Gap between Metropoles and Peripheries: Insights about Hospital Standardization from the British Columbia Hospital Association Conferences, 1918-30.

In this study, we examine British Columbia's Hospital Association conference records (1918-31) to understand how place, gender, and profession shaped debates about hospital standardization during the interwar period. The conference records reveal that hospital standardization was conceptualized as the conformity of smaller, peripheral hospitals to larger metropolitan ones. Arguments about how to best address the gaps in small hospitals were often directed to elite nursing leaders, who suggested improved nursing education as a solution. Hospital affiliation was recommended to ensure adequate training for rural nurses by moving trainee nurses from rural to urban hospitals during the last year of their education. Yet the way that affiliation was conceived was more aligned with the professional goals of the nursing elite, rather than the needs of rank-and-file nurses in small hospitals. These ideas ultimately worked to support the goals of standardization, but obscured the divergent needs of small community hospitals.

An integrative review of empirical literature on indigenous cognitive impairment and dementia.

AIMS: To synthesize research findings about Indigenous perspectives on cognitive impairment and dementia. DESIGN: Whittemore and Knafl's updated approach to integrative review and PRISMA guidelines for narrative analysis was followed. DATA SOURCES: A systematic search of the published literature from 2010-June 2020 was undertaken in four databases and complemented by supplementary searches. REVIEW METHODS: Thirty-four studies met the research question and inclusion criteria. RESULTS: Four themes describe the findings. Most of the studies were conducted by non-Indigenous researchers and may reflect Western perspectives on dementia rather than Indigenous views. A majority of the studies report epidemiological data or the testing of clinical tools. CONCLUSION: The review indicates a dearth of knowledge about Indigenous perspectives on ageing and understanding of cognitive impairment and dementia. Researchers need to draw on Indigenous traditional knowledge, culture, and traditions through a meaningful engagement with Indigenous communities and Elders to indigenize and decolonize dementia care. IMPACT: This integrative review highlights the need for community-led discussions and community engagement around Indigenous perspectives, needs, and understandings of ageing, cognitive impairment, and dementia care.

The case of Dr Masajiro Miyazaki: Japanese-Canadian healthcare in World War II.

The forcible relocation of Japanese-Canadians (Nikkei) during World War II has been widely examined; however, little scholarly attention has been paid to the impact of relocation on the medical services provided to, and by, the Nikkei. This article highlights the issue of providing sufficient medical care during forcible relocation and the experiences of one Nikkei physician, Dr Masajiro Miyazaki. His story illustrates both the limitations in the healthcare provided to the Nikkei community during relocation and the struggle for Nikkei medical professionals to continue their practice during the war. The agency of the Nikkei-who constantly balanced resistance and adaptation to oppressive conditions-comes to the forefront with this case study. Dr Miyazaki's personal records of forcible relocation, as well as his published memoir, reveal aspects of the lived reality of one Nikkei physician who was not included in the government discourse, or in the dialogue among his fellow Nikkei physicians, such as inter-racial medical care. It is evident through this case that there was great diversity in the level of medical care which the Nikkei received during their relocation in Canada. Furthermore, Dr Masajiro Miyazaki's story proves that healthcare professionals, from doctors to nurses' aides who were both Nikkei and white, provided extraordinary medical services during the forcible relocation, despite significant constraints.