Dene, métis and inuvialuit peoples' voices on the impact of Canada's perinatal transport and non-medical escort policy in their communities: an outcome assessment approach and narrative literature review.

Historically, there is a documented lack of support for women leaving their communities to give birth. Due to an over-emphasis on risk discourse (no distinction between low- or high-risk pregnancies with options to birth at home, the large geographical distances to regional centres within circumpolar regions, remoteness of communities, lack of qualified staff, and limited resources), women are forced to travel great distances to give birth. In Canada until 2017, women travelled alone or bore the burden of paying out of pocket for someone to travel with them for support with the births of their babies. A recent policy change has allowed for one paid escort to accompany a pregnant woman. The purpose of this paper is to provide an outcome assessment of the perinatal transport and non-medical escort policy implemented by the federal government in Canada. The paper utilises a narrative literature review along with preliminary Indigenous photovoice results to illuminate the perspectives of Indigenous families. There are numerous challenges women face when travelling for birth including feelings of loneliness and fear, stress and separation from their children, lack of community connection, financial concerns, and a loss of self-determination. Women are given an opportunity in decision-making about who will travel with them as an escort. This does little to address the disparity of delivering their babies away from their families and communities, the burden of figuring out who cares for the children at home, and the impact their absences have on health of their families. Although, additional support has been provided for birthing women in northern Canada, there continues to be little effort to return to community birthing creating safety for Indigenous families through traditional practices, Indigenous midwifery, and community ceremonies and changing the disproportionate burden of poor outcomes experienced by Indigenous women.

Intimate Partner Violence and COVID-19 in Rural, Remote, and Northern Canada: Relationship, Vulnerability and Risk.

In rural, remote, and northern parts of Canada, the pre-existing vulnerability and risk for intimate partner violence has been exacerbated by COVID-19. The purpose of this commentary is to identify the unique impact of COVID-19 on intimate partner violence both in terms of the bearing on those experiencing abuse and on the service sector in rural, remote and northern communities where the rates of intimate partner violence and intimate partner femicide pre-pandemic are higher than in larger cities. The recommendations offered in this paper include enhanced safety planning, alternate housing for victims fleeing violence, and suggestions for service providers. We also offer ways to move forward with further research in the COVID-19 era.

Mental health nursing practice in rural and remote Canada: Insights from a national survey.

Access to and delivery of quality mental health services remains challenging in rural and remote Canada. To improve access, services, and support providers, improved understanding is needed about nurses who identify mental health as an area of practice. The aim of this study is to explore the characteristics and context of practice of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs) in rural and remote Canada, who provide care to those experiencing mental health concerns. Data were from a pan-Canadian cross-sectional survey of 3822 regulated nurses in rural and remote areas. Individual and work community characteristics, practice responsibilities, and workplace factors were analysed, along with responses to open-ended questions. Few nurses identified mental health as their sole area of practice, with the majority of those being RPNs employed in mental health or crisis centres, and general or psychiatric hospitals. Nurses who indicated that mental health was only one area of their practice were predominantly employed as generalists, often working in both hospital and primary care settings. Both groups experienced moderate levels of job resources and demands. Over half of the nurses, particularly LPNs, had recently experienced and/or witnessed violence. Persons with mental health concerns in rural and remote Canada often receive care from those for whom mental health nursing is only part of their everyday practice. Practice and education supports tailored for generalist nurses are, therefore, essential, especially to support nurses in smaller communities, those at risk of violence, and those distant from advanced referral centres.

Undergraduate nursing students' perceptions about creating culturally safe classrooms: Living the epistemology, ontology and pedagogy.

Cultural Safety is a means of empowerment through antiracist actions, decolonising praxis, an understanding of the effects of a colonial history, and reconciliation to an equitable and inclusive place. The purpose of this paper is to share the perceptions of undergraduate students in northern Canada about the creation of culturally safe classrooms. A secondary analysis was conducted on archived data from undergraduate nursing student-led research. The findings illuminated four themes: sharing with genuineness, disrupting dissonance, addressing history and transforming through relationality. The themes inform a model that offers a beginning understanding of how culturally safe classrooms transpired in the Canadian north to enable students to become inclusive, relational, critical, and informed.

Relational and caring partnerships: (re)creating equity, genuineness, and growth in mentoring faculty relationships.

Mentoring in academia has traditionally and currently been prescriptive and institutionally driven. The purpose of this paper is to deconstruct these current mentoring practices with a critical feminist stance. New understandings are shared and gained through dialogue, relevant literature, and performativity to (re)create and name a caring and relational partnership. This caring and relational partnership is grown through a process of mutuality and reciprocity, and based on relational ethics, authenticity, and solidarity. By embracing ideologies of caring and relational ethics, mentoring blurs the lines of mentor/mentee to a perpetual state of walking beside each other in equity to learn and strengthen each other's insights into our worlds. Material realities become illuminated through our shared journeys growing an appreciation and gift of the other. In turn, engaging in meaningful dialogue informs scholarship increasing our understandings of the human condition.

A Web of Disheartenment With Hope on the Horizon: Intimate Partner Violence in Rural and Northern Communities.

Intimate partner violence (IPV) has become a worldwide epidemic, yet little is known about the experiences of women survivors living in rural and Northern Canadian communities. Existing statistics suggest that women living in rural areas of the Canadian Prairie Provinces and Northwest Territories (NWT) are at a significantly higher risk of experiencing IPV. To better understand the experiences of IPV in these regions, qualitative interviews were conducted with service providers, including the Royal Canadian Mounted Police (RCMP), Victims Services, Shelter Services, counselors, and others (e.g., physicians). In total, 122 participants were interviewed. These interviews were analyzed using a grounded theory approach where the data/results were transformed into a pictorial matrix that documents the struggles that service providers endure. The matrix/results highlight how social issues, such as isolation and poverty, contribute to social oppressions, such as lack of resources, transportation, and/or services. As service providers struggle against these forces, they begin to develop feelings of disheartenment. Yet, they continue to fight because there are opposing forces, such as Emergency Intervention Orders, police transportation, and Victim Services, that demonstrate how societal response is improving the lives and increasing safety in rural and Northern communities. Ultimately, the results suggest that to reduce the incidences of IPV, we must go beyond the violent acts and deal with the social contexts in which IPV resides.

Rural and Remote Licensed Practical Nurses' Perceptions of Working Below Their Legislated Scope of Practice.

Over the past two decades in Canada, licensed or registered practical nurses (LPNs) have experienced an extension of their educational preparation and scope of practice. Simultaneously, there has been an increase in the number of LPNs employed in rural and remote communities. These changes have influenced the practice environment and LPNs' perceptions of their work. The aim of this article is to examine what factors predict rural and remote LPNs' perceptions of working below their legislated scope of practice and to explore their perceptions of working below scope. The findings arise from a national survey of rural and remote regulated nurses, in which 77.3% and 17.6% of the LPNs reported their practice as within and as below their legislated scope of practice, respectively. Three factors, age, stage of career and job-resources related to autonomy and control, predicted that LPNs would perceive themselves to be working below their scope of practice. These results suggest that new ways to communicate nurses' scope of practice are needed, along with supports to help rural and remote LPNs more consistently practice to their legislated scope of practice. Without such changes, the LPN role cannot be optimized and disharmony within rural and remote settings may be exacerbated.

Exploring why and how encounters with the Norwegian health-care system can be considered culturally unsafe by North Sami-speaking patients and relatives: A qualitative study based on 11 interviews.

BACKGROUND: Citizens of Norway have free and equal access to healthcare. Nurses are expected to be culturally sensitive and have cultural knowledge in encounters with patients. Culturally safe care is considered both a process and an outcome, evaluated by whether the patients feel safe, empowered and cared for, or not. All patients request equal access to quality care in Norway, also Sami patients. OBJECTIVES: The aim of the study is to identify whether Sami patients and relatives feel culturally safe in encounters with healthcare, and if not, what are the main concerns. METHODS: This qualitative study used semi-structured interviews in the North Sami language, with 11 North Sami participants.The transcribed data were analysed through a lens of cultural safety by content analysis. FINDINGS: Data analysis explicated themes including: use of Sami language, Sami identity and cultural practices, connections to positive health outcomes to enhance cultural safe care and well-being for North-Sami people encountering the Norwegian health-care system. CONCLUSION: Culturally safe practices at the institutional, group and individual levels are essential to the well-being of Sami people. An engagement in culturally safe practices will facilitate (or) fulfil political and jurisdictional promises made to the Sami people, consequently improving positive impact of healthcare.

Symposium on "parental education" at the ICCH17.

This symposium report provides a brief overview of the six programmes and studies on parental education and maternal health services within the circumpolar region presented in the symposium "parental education" at the 17th International Congress of Circumpolar Health in Copenhagen, Denmark, August 2018.

Nurses who work in rural and remote communities in Canada: a national survey.

BACKGROUND: In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions. METHODS: A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada. RESULTS: Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region. CONCLUSIONS: The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Creating exclusive breastfeeding knowledge translation tools with First Nations mothers in Northwest Territories, Canada.

BACKGROUND: Breastfeeding is an ideal method of infant feeding affecting lifelong health, and yet the uptake of breastfeeding in some Indigenous communities in Canada's north is low. OBJECTIVE: The aims of this project were to determine the rate and determinants of exclusive breastfeeding in a remote community in the Northwest Territories and to create knowledge translation tools to enhance breastfeeding locally. METHODS: The study methodology followed three steps. Firstly, a series of retrospective chart audits were conducted from hospital birth records of Tlįchǫ women (n=198) who gave birth during the period of 1 January 2010 to 31 December 2012. A second follow-up chart audit determined the rate of exclusive breastfeeding and was conducted in the local Community Health Centre. Chart audit data included the following factors related to breastfeeding: age of mother, parity, birthweight and Apgar scores. Secondly, semi-structured interviews with a purposive sample of Tlįchǫ mothers (n=8) and one Elder were conducted to identify breastfeeding practices, beliefs and the most appropriate medium to use to deliver health messages in Tlįchǫ. Third, based on the information obtained in Step 2, two knowledge translation tools were developed in collaboration with a local community Advisory Committee. RESULTS: The rate of exclusive breastfeeding initiation in the Tlįchǫ region is less than 30%. Physiological and demographic factors related to breastfeeding were identified. Thematic analysis revealed two overarching themes from the data, namely, "the pull to formula" (lifestyle preferences, drug and alcohol use, supplementation practices and limited role models) and "the pull to breast feeding" (traditional feeding method, spiritual practice and increased bonding with infant). CONCLUSION: There are a myriad of influences on breastfeeding for women living in remote locations. Ultimately, society informs the choice of infant feeding for the new mother, since mothers' feeding choices are based on contextual realities and circumstances in their lives that are out of their control. As health care providers, it is imperative that we recognize the realities of women's lives and the overlapping social determinants of health that may limit a mother's ability or choice to breastfeed. Further health promotion efforts, grounded in community-based research and a social determinants framework, are needed to improve prenatal and postnatal care of Indigenous women and children in Canada.

Recruitment and Retention in Rural Nursing: It's Still an Issue!

A perennial issue for rural and remote communities in Canada and in other parts of the world is access to a healthcare delivery system including healthcare personnel to provide care to their residents. In total, 18% of Canadians live in rural locations but by proportion have fewer healthcare providers compared with urban settings. Relying on a recently completed documentary analysis of published reports and grey literature on rural and remote nursing practice from Canada and around the world, we recognize that recruitment and retention will be a recurring issue. However, a variety of programs and initiatives have been developed to address this age-old problem. A discussion is provided about educational opportunities, financial incentives and enhanced infrastructure that have been developed to address recruitment and retention challenges. Ongoing evaluations of each of these areas are necessary but require cooperation across provincial and national settings.

Informed advocacy: rural, remote, and northern nursing praxis.

To explore what we have learned about informed advocacy from and with nurses working in rural, remote, and northern communities. Focuses on registered nurses who work in geographically isolated communities in Canada. A synthesis of the work of 2 nurse researchers drawing on critical feminist, postcolonial, and social justice theories. The following 4 types of advocacy are discussed: (1) ensuring that people's concerns are heard, (2) contextualizing practices, (3) safeguarding, and (4) addressing systemic health inequities. An informed advocacy perspective helps registered nurses make an important contribution toward improving the health of people living in rural, remote, and northern communities.

Intimate partner violence in the Canadian territorial north: perspectives from a literature review and a media watch.

INTRODUCTION: Family violence is a complex, multidimensional and pervasive presence in many Aboriginal communities. Although practitioners acknowledge that intimate partner violence (IPV) is a grave concern in the North, as in other jurisdictions in Canada, there is a paucity of literature about IPV and the local response to that violence. OBJECTIVE: The purpose of this study is to report on a synthesis of Northern Territorial literature and a 3-year media watch conducted in the Canadian territories. DESIGN: This review is part of a multidisciplinary 5-year study occurring in the Northwest Territories (NT) and northern regions of the Prairie Provinces of Canada. The methods included a review of the literature through CINAHL, PubMed, Academic Search Complete, Social Sciences Index and JSTOR (1990-2012) combined with a media watch from 2009 to 2012. A thematic content analysis was completed. RESULTS: THEMES INCLUDED: colonization; alcohol and substance use; effects of residential schooling; housing inadequacies; help-seeking behaviors; and gaps within the justice system. Identified themes from the media watch were: murders from IPV; reported assaults and criminal charges; emergency protection orders; and awareness campaigns and prevention measures. CONCLUSION: When synthesized, the results of the literature review and media surveillance depict a starting context and description of IPV in the Canadian territories. There are many questions left unanswered which build support for the necessity of the current research, outline the public outcry for action in local media and identify the current published knowledge about IPV.

At what cost to health? Tlicho women's medical travel for childbirth.

Medical travel policies are instituted in all rural and remote areas of Canada as a means of providing universal health care services to residents. These policies are framed, developed and implemented from a colonial perspective and require re-examination through a more inclusive and collaborative postcolonial lens. The purpose of this paper is to discuss the medical travel policy for childbirth in Canada's Northwest Territories from a postcolonial perspective and in consideration of the cultural safety of pregnant Tlicho women. The context within which Tlicho birthing and this policy thrives is reviewed along with the exploration of future possibilities. Personal, socioeconomic, political and legal factors surrounding birthing are highlighted. It is anticipated, that by illuminating the oppressive and paternalistic nature of this childbirth policy, there will be heightened awareness that fosters transitions within the system to transform current risk discourse creating new possibilities for Tlicho women in the birth of their babies.

Colonialization: a health determinant for pregnant Dogrib women.

Childbirth for many Aboriginal women living in remote communities of the Northwest Territories, Canada, includes separation from their family and community for weeks at a time. This colonialization of childbirth, enforced for decades, is true for Dogrib Dene. Colonialization produces serious social consequences on the everyday lives of pregnant Aboriginal women, which results in lower health outcomes. This article provides a literature review of colonialization in Canada's far north establishing the position that colonialization is a determinant of health. The purpose of this article is to generate knowledge that will inform health professionals and ultimately reduce health disparities as experienced and evident among Dogrib women. By highlighting the concept of colonialization and establishing this concept as a determinant of health, nurses and midwives will identify disparities created through stressors of power and control. From there, culturally meaningful health promotion strategies will be developed and implemented within their nursing practice.

Spirit of the drum: the development of cultural nursing praxis.

The integration of culture is essential for nursing education and practice with diverse populations. Educators and students in the multicultural classroom must adopt culturally responsive behaviours that validate cultural identity and enhance cultural caring both in the classroom and in clinical areas. Fourth-generation evaluation as described by Guba and Lincoln was used to evaluate the cultural curriculum of a nursing program in northern Canada. The findings suggest that we should adopt a process of integrating difference through the nurse-client relationship and ways of being. Implications for including the traditional knowledge policy of the government of the Northwest Territories in nursing education and practice, as depicted in the Northern Knowledge Model, are discussed.