Clinical encounters between nurses and First Nations women in a Western Canadian hospital

Abstract

Based on findings from an ethnographic study, this paper explores the sociopolitical context of nurses’ encounters with First Nations women in a Western Canadian hospital. Data were collected using in-depth interviews and participant observation of clinical encounters involving nurses and First Nations women who were in-patients in the hospital. Four themes in the data are discussed: relating across presumed “cultural differences”; constructing the Other; assumptions influencing clinical practice; and responding to routine patient requests. The findings illustrate how discourses and assumptions about Aboriginal people, culture, and presumed differences can become interwoven into routine clinical encounters. These results highlight the importance of analyzing health-care encounters in light of the wider sociopolitical and historical forces that give rise to racialization, culturalism and Othering, and underscore the need for critical awareness of these issues among nurses and other heath-care providers.

Introduction

Inquiry into the dynamics of interactions between health professionals and patients has been a leading topic in social and health research for the past three decades (e.g., Kleinman, Eisenberg, & Good, 1978; Lazarus, 1988; Potter & McKinlay, 2005; Todd & Fisher, 1993; Waitzkin, 1991). Typically, studies of health-care interactions have focused on doctor–patient relationships. Many of these scholars have taken a critical analytical approach by focusing on the social, economic, political, and historical determinants of health care; power differentials and social conflict in health care; the capacity of people to navigate health-care systems; and professional control of health services. From a critical analytical perspective, the factors that influence health-care interactions are understood as occurring within a set of wider social relations that, though often not visible, profoundly influence patient–provider relations.

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, ethnocultural background, and class are considered (Anderson, 1998; Anderson, Dyck, & Lynam, 1997; Reimer Kirkham, 2003). Despite the fact that nurses comprise the largest group of health-care providers, and hospitalized patients interact most often with nurses, few studies have undertaken critical analyses of nurse–patient interactions. Even fewer have examined the dynamics of health-care interactions when Aboriginal patients are involved. This paper aims to 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. The focus on clinical encounters involving First Nations women stems from prior research conducted in partnership with community leaders who identified that women faced particular issues related to gender, class and racializing processes, and that these influenced their health-care experiences in particular ways (Browne & Fiske, 2001; Fiske & Browne, 2006). This study was designed to further explore the contexts and factors shaping women's health-care experiences.

In Canada, the term “Aboriginal people” refers generally to the indigenous groups comprising First Nations, Métis, and Inuit people (Royal Commission on Aboriginal Peoples, 1996). In 2001, people reporting Aboriginal ancestry comprised 4.4% of the total population (Statistics Canada, 2003). These groups reflect “organic political and cultural entities that stem historically from the original peoples of North America, rather than collections of individuals united by so-called ‘racial’ characteristics” (p. xii). Specifically, the term First Nation replaces the term Indian. The labels “Native” or “Indian,” however, continue to be used in federal legislation and policy enshrined in the Indian Act, government reports, and wider public discourses. These shifts in terminology reflect the history of contested relations between Aboriginal people and the Canadian state, and form part of the background against which health-care relations unfold. In this paper, “Aboriginal people” refers generally to the diverse groups within Canada. “First Nations” is used more specifically to refer to the participants who self-identified as First Nations.