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Aboriginal nursing students’ experiences in two Canadian schools of nursing : a critical ethnography 2006

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ABORIGINAL NURSING STUDENTS' EXPERIENCES IN TWO CANADIAN SCHOOLS OF NURSING: A CRITICAL ETHNOGRAPHY by DONNA ELIZABETH MARTIN B.N., The University of Manitoba, 1991 M.N., The University of Manitoba, 1997 THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Nursing) THE UNIVERSITY OF BRITISH COLUMBIA June 2006 © Donna Elizabeth Martin, 2006 A B S T R A C T Motivated by a projected shortage of Aboriginal nurses and recurring difficulties in recruitment and retention of Aboriginal peoples in schools of nursing, a critical ethnography was conducted to examine the construction of undergraduate Aboriginal nursing students' (ANS) experiences in two Canadian schools of nursing. The study was guided by tenets from several theoretical and methodological perspectives: Aboriginal epistemology, decolonizing methodologies for research and Indigenous peoples, cultural safety, and the social organization of knowledge. Data sources included semi-structured interviews with ANS (n=31), Aboriginal nurses (n=5), faculty (n=24), and key informants (n=16) who volunteered to participate. Other data sources were reflexive and descriptive field notes from 200 hours of fieldwork in classroom and laboratory practice sessions. As well, pertinent texts were randomly selected and analyzed. These texts (n=135) included recruitment brochures, nursing textbooks, journal articles, course syllabi, schools' policies and procedures, and websites to further explicate how nursing discourse shaped ANS' experiences. Although ANS described long and arduous journeys to and through the schools of nursing, their major concern was inadequate funding from Band sponsorship, Canada Student Loans or other sources. ANS' stressors were strongly influenced and magnified by the intersectionality of gender, race, culture, economic status, and geographical distance from social supports. ANS' stories illustrated how they used personal agency to ultimately realize their dream of becoming a highly independent and contributing member of society. Ill Different explanatory models about nursing knowledge, practice and environments created tensions between ANS and teachers and sustained the hegemony within the institution rather than empower the student. Key informants identified how colonization and the history of Aboriginal education and nursing education in Canada continued to shape a disconnection in the student-teacher relationship as experienced by both ANS and nurse educators. Although health care needs of Aboriginal peoples are paramount in Canada, nursing curricula lacked the inclusion of information related to promotion of Aboriginal health. In the rare situation where Aboriginal health was addressed, dismal epidemiological statistics were listed and negative stereotypical portrayals were sustained. Curriculum content about historical influences of colonialism and neo- colonialism shaping Aboriginal health and information about diversity with the Aboriginal culture were absent. Based upon these findings, recommendations were made to enhance the educational experiences of ANS in Canadian schools of nursing. Key words: Aboriginal education, critical ethnography, recruitment, retention iv T A B L E OF CONTENTS Abstract ii Table of Contents iv List of Tables Acknowledgments xi Dedication xiv 1 Introduction and Background to the Thesis 1 1.1 Introduction 1 1.2 Purposes of the study 4 1.2.1 Research purposes 4 Research questions 4 1.2.2 Practical purposes 5 1.2.3 Personal purposes 5 1.3 The need for a critical ethnography 7 1.4 Organization of the thesis 9 1.5 Chapter summary 11 2 Review of Existing Knowledge 12 2.1 Introduction 12 2.2 Historical overviews 14 2.2.1 Brief history of Aboriginal education 15 Traditional education: prior to European contact 15 Colonial domination and segregation 16 Assimilation 19 Self-determination 22 2.2.2 History of Aboriginal Peoples in Canadian nursing 24 2.3 The social construction of existing knowledge 27 2.3.1 Struggles 28 Inadequate primary and secondary education 28 Lack of support services 30 Rigid institutional policies and procedures 33 Ethnocentrism... 34 Inadequate funding 38 2.3.2. Survival 41 Previous life experience 42 Perseverance 42 V TABLE OF CONTENTS (Continued) Interpersonal support 43 Playing the game 43 Desire to make life better 44 2.3.3 What was missing? 44 Intergroup relations 45 Racism 47 Inclusive and anti-racist teaching strategies 48 2.4 Chapter summary 50 3 Theoretical and Methodological Perspectives 52 3.1 Introduction 52 3.2 Aboriginal epistemology 56 3.3 Decolonizing methodologies for research and Indigenous peoples 60 3.4 Cultural safety 63 3.5 The social organization of knowledge 67 3.5.1 Social organization 70 3.5.2 Social relations 70 3.5.3 Ruling relations 71 3.5.4 Texts 71 3.5.5 Experience 72 3.6 Chapter summary -73 4 Method of Inquiry 75 4.1 Introduction 75 4.2 Critical ethnography/Institutional ethnography 76 4.2.1 Sampling 79 Research settings 79 Gaining and sustaining access 81 Advisory council 81 Research setting , 8 2 Aboriginal nursing students 84 Nursing faculty ....88 Key informants 88 Description of the sample 90 Overview of Aboriginal students and nurses 92 Nursing faculty 96 Key informants 96 Texts 97 4.2.2 Relationship between researcher and researched 98 4.2.3 Data collection 103 Interviews with Aboriginal nursing students and nurses 104 vi T A B L E OF CONTENTS (Continued) Interviews with faculty members 108 Interviews with key informants 110 Field notes 110 Texts 112 4.2.4 Data analysis 113 Ensuring scientific quality 117 Triangulation 118 Construct validity 119 Face validity 119 Catalytic validity 120 4.3 Ethical considerations 120 4.4 Chapter summary 124 5 Becoming a Nurse: The Standpoint of Aboriginal Nursing Students 125 5.1 Introduction 125 5.2 Becoming a nurse: A long and arduous journey 127 5.2.1 Journey to the school of nursing 127 A dream to become a nurse 127 Making a better future 129 Alternate pathways 131 Substandard education on reserves .131 Transition and/or access programs 133 5.2.2 Journey through the school of nursing 134 Culture shock 136 Adjustment to urban lifestyle 136 Adjustment to urban campus 137 Informal and formal supports 137 Personal agency 138 Social support 142 Access programs 143 Academic resources 144 Intersectionality 145 Personal issues 145 Lack of social support 146 Lack of childcare 147 Ethnocentrism 149 Racism 155 Conflicts with teachers 160 Inadequate funding 162 Journey's end 167 5.3 Chapter summary 169 vii TABLE OF CONTENTS (Continued) 6 Teaching Aboriginal Nursing Students: The Standpoint of Nursing Faculty 172 6.1 Introduction 172 6.2 Local context 174 6.2.1 Profile of participating faculty 174 6.2.2 Limited experience teaching Aboriginal students 175 6.2.3 Perceptions of Aboriginal students 179 Complex personal lives 179 Students' personal agency 181 6.2.4 Perceived inequalities 182 More funding.... 183 More academic assistance 186 More resources 187 Skepticism about academic standards 188 Differences in academic preparation 189 6.3 Translocal context: Where ANS and faculty meet 191 6.3.1 Student-teacher relationship 191 Disconnectedness 191 Culture clashes 193 6.3.2 Connectedness 196 6.3.3 Pedagogy 197 Philosophies of teaching and learning 199 Outcome-oriented teaching 199 Process-oriented teaching 200 Consequences of outcome-oriented teaching 202 6.3.4 Curriculum 207 Portrayal of Aboriginal Peoples 210 6.3.5 Classroom size 212 6.3.6 Documents, policies and procedures 214 Syllabi 214 Performance improvement plans 215 Clinical evaluation forms 216 Passing a course 217 Leave of absences 217 Permanent departure 219 6.4 The extra local context: Outside the school 220 6.4.1 Standards of practice 220 6.4.2 Nursing shortage 221 6.4.3 Band influences 221 6.4.4 Expectations of Aboriginal community 222 6.5 Chapter summary 222 TABLE OF CONTENTS (Continued) 7 Key Informants' Views about Aboriginal Nursing Students' Experiences 226 7.1 Introduction 226 7.2 Broader historical context 227 7.3 Perceptions of Aboriginal nursing students 229 7.3.1 Critical thinkers 229 7.3.2 Cognitive dissonance 230 7.4 An uneven playing field 232 7.4.1 Entrance requirements 232 7.4.2 Perceptions of nursing faculty 234 7.4.3 Student-teacher relationships 236 7.4.4 Curriculum and pedagogy 237 Clinical courses 240 One-sided "snap shot" clinical evaluations 242 7.4.5 No mentorship programs 244 7.5 External factors 246 7.5.1 Demands from home communities 246 Pull towards families 247 Responsibilities to the Band 248 Returning to Aboriginal communities 249 7.5.2 Nursing education and population health 250 7.5.3 Portrayal of Aboriginal peoples 251 Government 252 Canadian media 252 7.6 Chapter summary 253 8 How Nursing Discourse Shaped Aboriginal Nursing Students' Experiences 255 8.1 Introduction ....255 8.2 Overview of reviewed texts 255 8.2.1 Recruitment brochures 257 8.2.2 Course syllabi 257 8.2.3 Required readings 262 8.2.4 Textbooks 263 8.2.5 Websites 264 8.3 Linking discourse to experience 265 8.3.1 Relationships between Aboriginal students and faculty 266 8.3.2 The construction of a "good" nurse 274 8.3.3 Absent and/or exclusionary discourse 276 8.3.4 Diversity with Aboriginal nursing students' experiences 280 8.3.5 Hegemony 282 8.4 Chapter summary 283 ix TABLE OF CONTENTS (Continued) 9 Summary and Discussion 285 9.1 Introduction 285 9.2 Thesis summary 286 9.3 Discussion 290 9.3.1 Aboriginal epistemology 291 9.3.2 Decolonizing methodologies 292 9.3.3 Cultural safety 293 9.3.4 Social organization of knowledge 294 9.3.5 Study's contributions to new knowledge 295 Intersectionality 295 Racism exists 298 Equality and fairness versus equity 299 Differing explanatory models 300 Personal agency 301 9.4 Recommendations 302 9.4.1 Professional nursing associations 302 9.4.2 Educational administrators 302 9.4.3 Educators and researchers 304 9.4.4 Aboriginal organizations 306 9.5 Conclusion 306 References 308 Appendices ..325 Appendix A 324 Appendix B 329 Appendix C 330 Appendix D 331 Appendix E 333 Appendix F 334 Appendix G 336 Appendix H 340 X List of Tables Table 1 Commonalities and unique features of theoretical and methodological perspectives 55 Table 2 Profiles of participants 95 Table 3 Profile of texts reviewed 256 A C K N O W L E D G E M E N T S I would like to acknowledge the Aboriginal nursing students and Aboriginal nurses who volunteered to share their experiences in a school of nursing. I was humbled and honored to hear their stories depicting vision and perseverance. I would like to express my gratitude to the Aboriginal nurses who advised and encouraged me during the research process. Many thanks to Lucy Barney, Marie Jebb, Gertie Merasty, Indigo Sweetwater and Dr. Evelyn Voyageur for their time, effort, advice and guidance. Also, I wish to thank Ms. Ardelle Kipling, RN, BN, for her ability to facilitate a connection with ANS, analyzing several transcripts, and participating in the dissemination of study findings. I would like to acknowledge the inspiration of Dr. Barbara Paterson as the original chair of my thesis committee. Dr. Paterson provided me with guidance and encouragement to pursue a project studying the educational experiences of Aboriginal nursing students. By mentoring me and assisting me in writing many grant applications, I received guidance in formulating a research design, affirmation of the importance of this study that enhanced confidence and skills as a nurse researcher and scientist. When Dr. Paterson relocated to another university, I was fortunate that Dr. Joan Anderson agreed to assume the position of chair. I am particularly grateful for witnessing Dr. Anderson's strength and ease at conceptualizing complex social interactions and the social relations identified in this study. Dr. Anderson worked alongside Ms. Kipling and me to assist us throughout the phases of data analysis. As Dr. Paterson and Dr. Anderson were experienced in the method of inquiry, I was privy to Xll acquire advice and guidance from expert researchers, scholars, and in particular, skilled and talented nurse educators. I viewed Drs. Paterson and Anderson as positive role models in that they demonstrated incredible patience and support for me throughout the study. I acknowledge the encouragement and feedback from Dr. Carol Jillings. With her knowledge and expertise in educational administration, curriculum development, and instructional design, I acquired further insight into the construction of Aboriginal nursing students' experiences. Dr. Jillings was an exemplary role model for me in her establishment of a healthy balance between home and work. With Dr. Jillings on my committee, I was encouraged to stay grounded in attending to life's priorities. Dr. Michael Marker provided me with guidance during an independent study where I initially reviewed the literature about Aboriginal peoples' experiences in postsecondary education. Dr. Marker encouraged me to examine existing knowledge for what was present and what was missing. Dr. Marker graciously introduced me to his expertise in the area of white-Indian relations and Linda Smith's work - decolonizing methodologies for research and Indigenous peoples (1999). Taking the liberty of speaking on behalf of the rest of the committee members, we all had the pleasure of working with Dr. Michael Marker who encouraged me to stay "true" to my data despite its sensitive nature and the forthcoming challenges of dissemination of findings and knowledge translation. Dr. Marker stimulated many provocative discussions about social relations at committee meetings. Xll l The study was funded by a doctoral fellowship from the Social Sciences and Humanities Research Council and by a doctoral trainee award from the Michael Smith Foundation for Health Research. I would like to thank all my family members, especially Kim Orris, my husband for supporting and encouraging me to pursue my dreams. I realize that attending to the doctoral research meant that sometimes, I was absent physically, mentally, and emotionally. Finally, I would like to thank my parents who somehow instilled in me that learning was a valuable lifelong process. xiv In loving memory of Beth Martin, my mother who told me that the knowledge isn't from you - it comes through you 1 1 INTRODUCTION AND BACKGROUND TO THE THESIS "I don't think anyone is brave enough to write on this, otherwise, we would be penalized for stating the truth" (Anonymous Aboriginal nurse, 2001). 1.1 Introduction Despite a growing Aboriginal population in Canada, recruitment and retention of Aboriginal1 peoples2 continues to be problematic in Canadian schools of nursing. The percentage of Aboriginal peoples in some Western provinces currently approaches 13.6%, while the overall percentage of Aboriginal peoples in Canada was 3% in 1996. In an ideal world, the student nurse population mix would reflect the overall population mix of the region. Nurse educators must ensure that nurses - the largest group of health care providers - reflect Canada's rapidly changing demographics and have the experience, research expertise, and professional socialization to address the critical health care issues facing Aboriginal peoples (Griffiths & Tagliareni, 1999). "A priority, then, for nursing is the need to prepare nurses who are qualified to address biophysical and psychosocial issues germane to a growing minority population" (Griffiths & Tagliareni, 1999, p. 291). Unfortunately, the percentage of Aboriginal peoples in nursing education remained less than 1% in 2002 with only eight Aboriginal individuals enrolled in 1 1 use the term, Aboriginal, to refer to Indigenous peoples of Canada. Aboriginal peoples include First Nations People, Status and Non-Status Indians, Metis, and Inuit as reflected in the current historical, social, cultural and political context (Health Canada, 2002). Indigenous peoples in North America refer to themselves as Indian, Native, First Nations, and Aboriginal when they are talking about Indigenous peoples in a general fashion. You will see a variety of these terms used in quotations throughout the dissertation. 2 "Peoples" is intentionally plural to reflect the right of self-determination and to acknowledge the great diversity among Aboriginal individuals, families, and communities in the vast geographical span of Canada (Castellano, 2000; L. Smith, 1999). Although it is more accurate and respectful to use the name of each tribe such as Lakota, Plains Cree, or Salish, I refer to participants as Aboriginal to protect their identities. 2 graduate nursing education (0.4%). Of approximately 35,730 undergraduate and diploma nursing students in Canada in 2002, there were approximately 240 Aboriginal nursing students (ANS) - a mere 0.7% of the total undergraduate nursing student population (Canadian Nurses Association & Canadian Association of Schools of Nursing, 2004; Health Canada, 2002). A study by Health Canada proclaimed that 800 new Aboriginal nurses were needed for the near future (Aboriginal Nurses Association of Canada, 2004b). The supply of 240 ANS will not meet the demand for 800 Aboriginal nurses. Therefore, actions were urgently required to improve recruitment and retention of Aboriginal peoples in nursing education (Aboriginal Nurses Association of Canada, 2005). Furthermore, some administrators and researchers identified that Aboriginal communities received more appropriate health care when Aboriginal nurses were the care providers (Hart-Wasekeesikaw, 1999; Indian and Northern Affairs Canada, 2004; Keitner, 1999; Martin, 1997; Martin & Gregory, 1996; Weaver, 1999). In contrast to Euro-Canadian or Non-Aboriginal nurses, Aboriginal nurses were more likely to: • understand and speak the language of the community, • be knowledgeable about the health beliefs of the community, • integrate Traditional healing with Western Medicine, and • participate in community development (Martin, 1997). Currently, the supply of Aboriginal nurses is not meeting the demand. Aboriginal communities are experiencing the worst nursing shortage in 30 years with a nurse vacancy rate of 40% (Aboriginal Nurses Association of Canada, 2002b; MacLeod, Kulig, Stewart, & Pitblado, 2004; "Natives face," 2001). Given the dire need for Aboriginal 3 nurses to work in Aboriginal communities and the lack of ANS, Canada's Aboriginal communities may experience an even bleaker nursing shortage (Aboriginal Nurses Association of Canada, 2004b). Additionally, Aboriginal and non-Aboriginal nurses voiced concerns about the educational experiences of ANS (Aboriginal Nurses Association of Canada, 2002a, 2002b, 2004a, 2004b; Health Canada, 2002; Martin, 1997; Walsch, 1995; Weaver, 2001; Womack, 1997; Yurkovich, 1997). In light of this concern and a projected worsening of the nursing shortage, health care administrators announced an urgent need to improve recruitment and retention of Aboriginal peoples in nursing education (Indian and Northern Affairs Canada, 2004). Health Canada and First Nations and Inuit Health Branch (FNIHB) are committed to increasing the presence and participation of Aboriginal registered nurses within their respective organizations. Aboriginal communities, the Aboriginal Nurses Association of Canada, and the "Royal Commission of Aboriginal People" (1996) have also expressed the need for more nurses of Aboriginal ancestry (Health Canada, 2002, p. 5). To improve recruitment and retention of Aboriginal peoples in nursing, nurse educators and educational administrators required more information about factors that enhanced or hampered the educational experiences of ANS. A study that examined how ANS experience their nursing education and how contextual factors shape or influence their experiences was warranted. 4 1.2 Purposes of the study Maxwell (1998) identified three types of purposes for a study: research, practical, and personal. Using Maxwell's framework (1998), I outline my story of why I studied ANS' experiences. 1.2.1 Research purposes Research purposes are focused on developing knowledge (Maxwell, 1998). By answering the research questions, this dissertation will contribute to the development of nursing knowledge. I designated three main purposes of the dissertation: (a) describe the experiences of ANS - the local3, (b) explicate tensions between social groups within a school of nursing - the translocal4, (c) and illuminate hidden or embedded messages within the texts and discourse of nursing education that influence the social relations - the extra local5. Research questions Stemming from these purposes, I formulated five relevant research questions. These questions were: 1. What are some of the everyday/every night experiences of ANS in Canadian schools of nursing? 2. What are the similarities/differences between the experiences of ANS who originated from an urban versus a northern community? 3 The term, local, is synonymous with the everyday/everynight world of ANS (D. Smith, 1987). The local setting is the starting point for explicating how activities within the school of nursing are shaped by 'outside influences' (Grahame & Grahame, 2000/2001; D. Smith, 1987). As poignantly stated by Geertz (1983), critical ethnography is a craft of place; it works "by the light of local knowledge" (p. 167). The term, translocal, reflects the social relations between ANS and other groups occurring within the school of nursing (D. Smith, 1990). Translocal refers to the processes of administration and governance that serve to organize and control the local or the everyday world (DeVault & McCoy, 2001). 5 The phrase, extra local, refers to operations occurring beyond the local and translocal but work alongside the translocal to function as forms of ruling (D. Smith, 1999). 5 3. How are the experiences of ANS determined? 4. What are the social relations that generate the experience of ANS? 5. What are the ways in which the sociocultural, political, historical, and ideological construction of nursing education shapes ANS' experiences? 1.2.2 Practical purposes By grasping a better understanding of ANS' experiences and building supports and diminishing barriers, nurse educators will enhance ANS' educational experiences and increase recruitment and retention of ANS in Canadian schools of nursing. Based on the recommendations of this study, nursing education administrators can develop policies and implement recruitment and retention strategies to graduate a number of Aboriginal nurses that more closely matches the service needs of urban, rural, and northern Aboriginal communities. Improving recruitment and retention of Aboriginal peoples will increase the number of graduating Aboriginal nurses. Applying Archibald and Urion's (1995) finding that two thirds of Aboriginal graduates returned to work in Aboriginal communities, many graduating Aboriginal nurses would seek employment there. 1.2.3 Personal purposes From the standpoint of a second-generation Euro-Canadian woman from a working class family, I entered graduate nursing education in the early 1990s. For my thesis, I conducted an ethnographic study that examined outpost nurses' worklife6 in My interest in the worklife of northern outpost nurses was stimulated in 1992 at a conference in Thompson, Manitoba (north of the 53 r d parallel). From the standpoint of a critical care nurse at a tertiary care hospital located in an urban centre (close to the 49 t h parallel), the stories from various northern outpost nurses inspired me. I found these nurses incredibly brave, adventuresome, and independent. As an urban nurse, I could not imagine how these people managed their worklives. 6 remote northern First Nations communities in Manitoba 7 (Martin, 1997; Martin & Gregory, 1996). Of the participating nurses, five identified themselves as Aboriginal. Four embraced the biomedical viewpoint about health, illness, and health care; the fifth, however, discussed the importance of incorporating the Medicine Wheel8, Aboriginal spirituality, and the Aboriginal traditional ways of healing into aspects of her nursing care. This finding caused me to question what social factors in nursing education influenced some Aboriginal nurses to highly regard the western biomedical viewpoint of health, illness, and health care. There may have been many reasons why those four Aboriginal nurses did not tell me about other health care beliefs and methods. Perhaps they were reticent to tell a white, middle-class, middle-aged woman in nursing academia about different worldviews and different ways of being a nurse. On the other hand, they may have assumed that I defined nursing from a western biomedical viewpoint and they wanted to please the researcher by telling me what they thought I wanted to hear. Whatever the reasons, my interest was further stimulated to understand how Aboriginal peoples learn how to become a nurse by studying their experiences from a local, translocal and extra local viewpoint. During the late 1990s, I was a nurse educator in a baccalaureate-nursing program with ANS. I was poised to juggle culturally sensitive teaching with standards established by the school and professional nursing associations. I became interested in learning more about ANS' experiences, specifically (a) how ANS experience education 7 According to the 2001 census, Manitoba had the highest percentage of Aboriginal population (13.6%) among the provinces. 8 Please note that the Medicine Wheel originated in Southern Alberta, Wyoming, and the Dakotas. The Medicine Wheel illustrated the belief systems of some Aboriginal peoples and provided a framework for a balanced and healthy life. Although the Medicine Wheel is commonly acknowledged as a Pan-Aboriginal or Pan-Indigenous theoretical perspective for health beliefs and health promotion, all Aboriginal people do not rely upon it. For example, West Coast tribes did not use the Medicine Wheel in their teachings. 7 in a predominantly Euro-Canadian institution, and (b) what factors enhance or hamper ANS' experiences. When conceptualizing the study, I corresponded with several Aboriginal nurses to acquire their opinions about the necessity to explore ANS' experiences. One Aboriginal nurse exclaimed that if an Aboriginal person conducted the research, the Aboriginal individual would experience a "backlash" when findings were reported. In fact, she perceived that an Aboriginal individual would be punished for "stating the truth." Because of this powerful statement, I was motivated to conduct a critical ethnography about ANS' experiences as my doctoral thesis. Further discussions about my standpoint as a non-Aboriginal person conducting research with Aboriginal peoples will be presented in Chapters Three and Four. 1.3 The need for a critical ethnography "Interpretivist movements in anthropology and sociology have recently merged with neo-Marxist and feminist theory to produce a unique genre of research in the field of education known as 'critical ethnography'" (Anderson, 1989, p. 249). According to Carspecken (1996), critical ethnography can be applied to studies about human life and experience as it provides researchers with principles for conducting valid inquires into any area of human experience. The aim of critical ethnography "is to theorize social structural constraints and human agency, as well as the interrelationship between structure and agency in order to consider paths towards empowerment of the researched" (Gordon, Holland & Lahelma, 2001, p. 193). Using critical ethnography as a method of inquiry, I remained sensitive to the dialectical relationship between the social structural constraints on the ANS as well as their personal agency. 8 In critical ethnography, studies of schools are combined with critical insights into how broader structures are mediated and produce change (Gordon, Holland & Lahelma, 2001). I used interviews, field notes, and textual analysis to explore ANS' everyday experience within the local setting of the participating schools of nursing and then examined how the ANS' everyday lives were shaped by the broader historical, social, cultural, political, and ideological context. The study relied primarily upon specific tenets from several theoretical and methodological perspectives. I used tenets grasped from Aboriginal epistemologies,9 L. Smith's decolonizing methodologies for Indigenous peoples1 0 (1999), Ramsden's concept of cultural safety11 (1993, 2002), and the social organization of knowledge12 developed by Dorothy Smith (1986,1987). Using these chosen tenets within my theoretical lens, "reality" was conceptualized as the everyday world, which is subjective, co-constructed, and highly influenced by its context (D. Smith, 1987). My theoretical lens provided a backdrop for me to critically examine ANS' experiences, social relations, 9 Epistemology refers to a branch of philosophy that inquires into the nature and possibility of knowledge (Mautner, 1996). Aboriginal epistemologies are distinct and deal with each Tribe's scope and limits of human knowledge, how it is acquired and possessed. However, commonalities exist and I relied on the unique commonalities within Aboriginal epistemology. 1 0 Linda Tuhiwai Smith (1999) articulated a research agenda for Indigenous peoples by Indigenous peoples. "Methodology is important because it frames the questions being asked, determines the set of instruments and methods to be employed and shapes the analysis" (L. Smith, 1999, p. 143). In particular, I found decolonizing methodologies for research and Indigenous peoples helpful in shaping my analysis. 1 1 Irihapeti Ramsden (1993), the architect of cultural safety, contended that all nursing interactions were bicultural. Cultural safety required that nurses examine their own cultural realities, attitudes and behaviors and the impact that has on others. In contrast, cultural risk in nursing described a process in which people from one culture were demeaned, diminished and/or disempowered by the actions and the delivery systems of people from another culture (Ramsden, 1993). 1 2 Dorothy Smith (1986, 1987), a Canadian sociologist, introduced a mode of inquiry referred to as institutional ethnography, to describe an "empirical investigation of linkages among local settings of everyday life, organizations, and translocal processes of administration and governance" (DeVault & McCoy, 2001, p. 751). Students of D. Smith described this theoretical perspective as the social organization of knowledge (Campbell & Manicom, 1995). 9 and the schools' textually mediated discourses1 3. Campbell and Gregor (2002) explained that social organization of knowledge "is the interplay of social relations, of people's ordinary activities being concerted and coordinated purposefully, that constitutes 'social organization'" (p. 27). 1 4 A critical ethnography examining the local, translocal, and extra local aspects that shape and influence the everyday experiences of ANS was urgently required. Key stakeholders such as ANS, nurse educators, nursing education administrators, health services employers and Aboriginal leaders will benefit by learning more about factors that negatively and positively influence recruitment and retention from within the school of nursing and beyond. Key stakeholders require more information about factors that shape ANS' experiences to facilitate a positive transformation in the everyday experiences, in which Aboriginal peoples learn how to become a nurse. 1.4 Organization of the thesis In Chapter One, I provide the background to the study, introduce the research topic and specify the research questions. The remainder of the dissertation will unfold to illustrate how dominant ideologies and nursing discourse influence the everyday experience of ANS and their social relations within Canadian schools of nursing. 1 3 In this study, texts are broadly defined and encompass an array of documents such as the school's mission statement, policies and procedures, nursing course descriptions, nursing course syllabus, nursing textbooks, media reports, clinical evaluation forms, websites, etc (D. Smith, 1999). Discourse refers to the "talk" as well as the texts of the institution. The "talk" includes professional nursing jargon and the language used by various social groups within the school of nursing (Campbell, 1998; Cummins, 1995; Hagey & Mackay, 2000). 1 4 Campbell and Gregor (2002) identified key concepts and assumptions that support D. Smith's research method. In D. Smith's social ontology, the social arises out of people's activities and through the ongoing and purposeful coordinating of those activities (i.e. concerting). "Analytically fundamental to this approach is an ontology that views the social as the concerting of people's activities" (DeVault & McCoy, 2001, p. 752). Concerting is synonymous with organizing or shaping people's activities in local settings (DeVault & McCoy, 2001). 10 In Chapter Two, I provide a review of the existing knowledge about ANS and nursing education. I begin by addressing the historical context of Aboriginal peoples in education with a synopsis of the history of Aboriginal peoples in Canadian nursing education. I examine how practices from the past continue to shape the educational experience of ANS. This examination provides the foundation to build a current examination of the everyday/every night world of ANS. Chapter Three outlines the theoretical and methodological perspectives guiding this dissertation. Positioned within a static body of nursing scholarship, I explain the theoretical and methodological perspectives that influenced the way that I explored ANS' everyday experiences. In Chapter Four, I describe the method of inquiry - a critical ethnography guided by tenets from four theoretical and methodological perspectives: Aboriginal epistemologies, decolonizing methodologies for research and Indigenous peoples, cultural safety, and the social organization of knowledge. I tell the story of how this research study unfolded. Chapters Five to Eight represent the empirical findings of this research. In Chapter Five, I focus on the everyday experience of ANS from the standpoint of ANS. In Chapter Six, I address the perspectives of nursing faculty in regard to factors shaping ANS' experiences. I identify social relations and explicate tensions between social groups within the schools of nursing in Chapter Five and Six. In Chapter Seven, I delineate the perspectives of key informants who were identified as individuals knowledgeable about contextual factors influencing ANS' educational experiences. In Chapter Eight, I describe the ways in which various hidden or embedded messages 11 within nursing discourse shape the experiences of ANS and their relations with other social groups. In Chapter Nine, I discuss the findings in light of the theoretical and methodological perspectives that guided the work and the existing knowledge of ANS' experiences. In this process, I identify new knowledge and develop recommendations to facilitate an important yet complicated process that I refer to as decolonizing nursing education. Bold initiatives within the local, translocal, and extra local contexts will positively influence the everyday world of ANS and Non-Aboriginal nursing students, as well as the future health care of Aboriginal peoples in Canada. 1.5 Chapter summary In this chapter, I provide the background to a critical ethnographic study of ANS' experiences in Canadian schools of nursing. By providing my purposes for conducting the study, I introduced the research topics: (a) ANS' experiences in Canadian schools of nursing, (b) intergroup relations from the standpoint of ANS, and (c) the context and nursing discourse that shapes nursing education of Aboriginal peoples. I conclude the chapter with an overview of the content of the dissertation. According to Schmitt (2002), it is time to revalue nursing education research as various questions have been raised about the adequacy of present day nursing curricula and pedagogy. In light of difficulties in recruitment and retention of ANS, Canadian schools of nursing need new educational assumptions, innovative educational models, and the research capability to demonstrate which models are most efficient and effective for graduating more ANS. 12 2 R E V I E W O F E X I S T I N G K N O W L E D G E On one hand there is very little research and educational literature on racism and Aboriginal people, yet on the other hand, the literature is filled with references to the effects of racism on Aboriginal people in educational institutions. This is a paradox, one that must be understood within larger social and political, national and academic commitments and traditions (St. Denis & Hampton, 2002, p. 4-5). 2.1 Introduction The main purpose of this chapter is to provide a critical analysis of existing knowledge of ANS' experiences in Canadian schools of nursing. "A review of relevant literature is the basis for analysis and critique of what is already known about events of the kind that the researcher is exploring" (Campbell & Gregor, 2002, p. 50). It was necessary to unravel the existing knowledge about the educational experiences of ANS and decipher how it was socially constructed. Firstly, I review the history of education of Canada's Aboriginal peoples. Guided by the tenets in Aboriginal epistemology, decolonizing research and Indigenous peoples, and cultural safety, I provide a brief overview of important historical events that greatly influence the educational experiences of Aboriginal peoples today. The history of Aboriginal education in Canada is presented using four overlapping phases: (1) traditional education prior to European contact, (2) colonial domination and segregation, (3) assimilation and acculturation, and (4) self-determination. Secondly, I include a synopsis of the history of Aboriginal peoples in Canadian nursing education. Traditionally, nursing students were young, white, working or middle class women. Towards the latter portion of the twentieth century, Aboriginal peoples entered into the nursing profession. The review of the history of Aboriginal peoples in nursing education and practice revealed several concerns about ANS' experiences from the standpoint of Aboriginal nurses. Aboriginal nurses voiced their concerns about their experiences as nursing students: the trauma of leaving their home communities, being 13 scrutinized as "elitists" by community members, and struggling with inner conflicts due to different values, beliefs, and communication practices inherent in becoming a nurse. Thirdly, I incorporated a tenet within Dorothy Smith's social organization of knowledge that guided me to critically review located literature in the post-secondary education of Aboriginal peoples, including nursing education. I synthesized and analyzed located literature in regards to what was present and what was absent (Marker, 1997). As suggested by Campbell & Gregor (2002), I did not cede authority to the literature as in conventional research studies. By reviewing existing knowledge about ANS' everyday life, I analyzed how the literature was socially constructed and organized. The analysis of existing knowledge of ANS' experiences facilitated the focus and direction of the research (Paterson, Osborne, & Gregory, 2004). The literature review helped me reflect on different ways of knowing about ANS' everyday experiences as well as affirmed that this doctoral thesis will add greatly to existing knowledge about ANS' everyday world (Campbell & Gregor, 2002). Although there was extensive literature on Aboriginal issues, it was often difficult to locate. Information about Aboriginal peoples' experiences in postsecondary educational institutions was scattered throughout the biomedical and social science literature. Using Aboriginal, First Nations, Indian, Indigenous, Metis, Native, Native Alaskans, Native Americans and education as key subject terms, I conducted searches in the computerized library databases of the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Educational Resources Information Centre (ERIC), Medline, and a web-based search through Google Scholar at the University of British Columbia library. I experienced great difficulty unearthing existing knowledge about the everyday experiences of Aboriginal peoples in postsecondary education. I often located research literature by reviewing reference lists and proceeding to acquire those 14 additional sources. When other researchers were informed about my research interest, they kindly shared their work with me (Health Canada, 2002; Marker, 1998, 2005; Walsch, 1995, Yurkovich, 1997). Browsing through libraries and bookstores, I located other literature about Aboriginal peoples' and Indigenous peoples' experiences in education. Due to my standpoint as a middle-aged, middle class, white, female nurse educator with experience educating ANS, I worked closely with a research assistant15 and the Advisory Council1 6 who have Aboriginal ancestry. By collaborating with Aboriginal peoples who experienced nursing education, I focused on the standpoint of the ANS, 'unknown' aspects of ANS' everyday world, social relations in schools of nursing, and the social organization of knowledge (Campbell & Gregor, 2002). "The quality of research in First Nations education is not improved simply by having Aboriginal people doing the writing. It is improved by a more detailed analysis that includes the perspectives and location of both Natives and non-Natives" (Marker, 2001, p. 31). 2.2 Historical overviews I begin this chapter with two brief historical overviews. In the first overview, I present a brief history of the education of Aboriginal peoples in Canada. In the second one, I address the history of Aboriginal peoples in Canadian nursing. As the historical context of Aboriginal education influences ANS experiences today, it was prudent for me to become knowledgeable about the events as well as how these events continue to shape the current experiences of Aboriginal peoples in postsecondary institutions. Ms. Ardelle Kipling, RN, BN, was hired as the research assistant for this project. Ms. Kipling recruited and conducted interviews with 29 ANS and participated in analysis of several transcripts and field notes. 1 6 Advisory Council was comprised of five Aboriginal nurses who donated their time and expertise by reviewing issues regarding method of inquiry and preliminary findings. 15 2.2.1 Brief history of Aboriginal education I divided this overview into four overlapping phases or eras: (1) traditional education - prior to European contact, (2) colonial domination and segregation, (3) assimilation and acculturation, and (4) self-determination (Kirkness, 1999). Following this section, I provide a review of the history of educating Aboriginal peoples in nursing. To the American Indian, history is better explained as the importance of "experience." People recall an experience in greater detail because of the emotions involved, vivid colors, familiar sounds described, and the people and/or beings involved. When retold, the experience comes alive again recreating the experience by evoking the emotions of the listeners, transcending past-present- future (Fixico, 2003, p. 22). Traditional education: Prior to European contact Prior to European contact, Aboriginal peoples implemented a form of education within their communities. Aboriginal peoples conducted and highly valued education in a manner that the community was the classroom, community members were the teachers, and each adult was responsible to ensure that every child learned how to live a fruitful life (Kirkness, 1999). "Education was not separated institutionally" from other aspects of Aboriginal peoples' lives" (Wotherspoon & Satzewich, 2000, p. 116). Oral tradition was and remains the conduit for sharing knowledge within the Aboriginal community (Fixico, 2003). Central to each lesson was a belief in the existence of the Great Spirit, the totality of being, as well as the importance of relationships with the community, its members, and nature (Cajete, 1994; Kirkness, 1999). Traditional forms of education embodied a quest for self, individual and community survival, and wholeness in the context of the community and the land (Cajete, 1994, 2004). 16 The community became paramount by virtue of its role as repository and incubator of total tribal knowledge in the form of custom and culture. Each part of the community became an integral part of the whole flowing movement and was modeled on the inward wholeness and harmony (Ermine, 1995, p. 105). Colonial domination and segregation The question of what actually constituted contact is an important one to clarify. Even though the year 1492 A.D. has become a powerful metaphor for European contact in the Americas, direct and regular contact between ethnically diverse groups of Europeans and Aboriginal peoples began at different times in different geographical locations. In Western Canada, contact generally began in the late eighteenth and early nineteenth centuries (Waldram, Herring, & Young, 1995). "Colonization refers to a process in which imperial powers established European sovereignty over the various areas of Canada" (Fleras & Elliott, 1999, p. 179). Generally, colonization entailed subjugation of a people who lived in a territory colonized by Europeans. Colonization, particularly, involved a process whereby: (a) Indigenous lands were confiscated, (b) the British legal system was imposed, (c) existing political structures were amalgamated, and (d) Indigenous peoples were assimilated into the dominant Eurocentric culture (Fleras & Elliott, 1999). Some Aboriginal peoples signed treaties with the Crown or Canadian government and these individuals were referred to as "treaty Indians." Treaties covered most of Western Canada and Northern Ontario (excluding most of British Columbia) and served to remove Aboriginal peoples' entitlement to the land. The Dominion of Canada became the colonizing arm of Great Britain, assuming the rights and responsibilities of the Crown in the Constitution Act of 1867. The Dominion of Canada imposed British rule through occupation, negotiated treaties, and 17 the threat of force. The 1867 Constitution Act enshrined federal responsibility for Aboriginal peoples by governing Aboriginal lands and affairs. "Canadian federalism tended to dismiss any thought of aboriginal peoples as political communities, preferring, instead, to see them as wards of the state with limited civil rights but fully entitled to federal custodial care" (Fleras & Elliott, 1999, p. 180). Sir John A. Macdonald espoused a "no more Indians" national policy (Fleras & Elliott, 1999). The Indian Act, first passed in 1876, was designed to facilitate the administration of programs to the Indians, as well as the assimilation of Indians into mainstream society (Waldram, Herring, & Young, 1997). "The imposition of the Indian Act bestowed sweeping state powers to invade and regulate the minutest aspect of reserve life, even to the point of curbing constitutional and citizenship rights" (Fleras & Elliott, 1999, p. 180). The Indian Act of 1876 served to: • define who came under its provision (status or non-status Indians, treaty versus non-treaty), • designate what each status Indian was entitled to receive from government obligations, • delineate how the local communities were to be governed - by elected Band Councils in contrast to traditional leadership, • govern how reserve lands and resources were utilized, as well as, • curtail economic opportunities in that Aboriginal peoples could not possess direct title to land or private property (Fleras & Elliott, 1999). With European contact came the missionaries who initiated day or mission schools for the purpose of "civilizing" Aboriginal peoples (Kirkness, 1999). "Policies evolved from mission schools to industrial schools and then to what were called residential schools in Canada..." (Marker, 2005, p. 91). Aboriginal leaders placed much 18 faith in the missionaries who ran the first residential schools; Aboriginal leaders believed that the Crown and the church would provide for their welfare. Several centuries later, 130 Indian Residential Schools were established to conduct an extreme and tragic deculturation process (Barman, Hebert, & McCaskill, 1987; Kirkness, 1999; Ryan, 1992). Deculturation is a useful and meaningful concept when analyzing and describing the role of education in the spread of European culture through Canada (Ryan, 1992). "Residential schools left a potent legacy of language and culture loss, sexual abuse, disruption of parenting knowledge, and erosion of youth" (Marker, 2005, p. 90). Although many treaties guaranteed educational assistance, education was a pawn to extend white domination over the colonies that Europeans claimed for themselves while treaty promises never materialized (James, 1992; Ryan, 1992). Indian Residential Schools were located mainly in Western Canada (Indian Residential School Survivor Society, 2004). In 1907, the Canadian press acknowledged that the mortality rate in residential schools was higher than 50% due to illness, physical violence, attempts to escape, or suicide with minimal reaction by the public (Annett, 2001). Despite knowledge of high mortality rates, the Federal Government of Canada amended the Indian Act in 1920 making it mandatory for Aboriginal children to attend residential schools. Aboriginal children relocated to schools hundreds to thousands of miles away from their homes. Government policy stated that the schools could not educate Aboriginal children "above the possibilities of their station." Formal schooling consisted primarily of training Aboriginal peoples for subordinate roles that served the dominant culture and engendered "in these people an allegiance to a particular and very different political, economic, and moral way of life" (Ryan, 1992, p. 92). Thus, the curriculum included moral training through physical labor, academic instruction to a Grade 3 level, and 19 industrial training for subordinate positions (Indian Residential School Survivor Society, 2004). Although the 1928 publication of the Miriam Report further exposed deplorable conditions in Residential schools, this format for educating Canada's Aboriginal children continued until the 1970s when the National Indian Brotherhood lobbied for Aboriginal control of their own education. Unfortunately, the last Indian Residential School, located in Saskatchewan, did not close its doors until 1996 (Government of Canada, 2003). While the residential schools in Canada aimed to assimilate Aboriginal people by eradicating their language and culture, "the public histories of struggle for Aboriginal self-determination was apparent and 'education' was identified as both an assimilative force to be resisted and as an indigenous force to be reclaimed" (Marker, 2005, p. 93). "The federal government has continually said that education is a privilege, not a right" (Henderson, 1995, p. 245). The government's position on Aboriginal education stems from British law and its premise that education is a product of the family's socioeconomic status, parental goals for the child, and the individual's cognitive talent; this position juxtaposed Aboriginal peoples' belief that education was a right for all (Henderson, 1995). Assimilation The third phase or era in the history of Aboriginal education was referred to as assimilation and continued acculturation. To accommodate the closure of residential schools, a number of federally run Indian Day Schools were established in Aboriginal communities (Kirkness, 1999). Concomitantly, there was a policy of integration in which Aboriginal children were assimilated through education into the dominant Euro- Canadian culture (Huff, 1997; Kirkness, 1999). The approach to Aboriginal education was notably paternalistic, coercive, racist, discriminatory, and assimilative (Burns, 1998; 20 Marker, 2005). Only a decade ago, Hampton (1995) described the status of education as "now as in the past hundred years, Indian education means the education of Indians by non-Indians using non-Indian methods" (p. 6). While historical studies of Aboriginal education focused primarily on residential schooling, Marker (2005) argued for more research on the recent past, specifically at sites where secondary schools served as dress rehearsals for the inequalities and scripted adult roles that Aboriginal and non-Aboriginal adolescents would soon occupy. Using historical research, Marker (2005) explored Lummi adolescents' experiences 30 years ago and found that these Aboriginal teens were struggling to attain their identity and young adulthood under conditions whereby white teachers and students were "intent on maintaining both economic and cultural privilege" (p. 107). In comparison to the Lummi case in the Coast Salish community of the United States, Furniss (1999) described recent cross-cultural tensions in a Western Canadian high school: These different perspectives on racism were clearly evident in a 1992 assessment of the needs of Aboriginal students in the Cariboo-Chilcotin School District. An educational consultant surveyed Aboriginal students, their families, district educational staff, principals, teachers, and counselors. Students and their families reported that racial discrimination - ranging in expression from direct racial taunts to more subtle forms of being excluded or being expected to be low achievers - was among the most important problems that Aboriginal students faced. In contrast, few of the teachers, and none of the administrators, identified racial discrimination as an issue facing Aboriginal students (p. 125-6 as cited in Marker, 2005). Similar to Non-Aboriginal peoples, many Aboriginal peoples believe that postsecondary education has the capacity to equip them with the knowledge and skills 21 required to get along in today's world. Ironically enough, formal education, conducted as it is within a Euro-Western tradition that controls the conditions of learning, may also require substantial adjustment on the part of Aboriginal students, an adjustment that may have a decisive impact on their ability to be successful in these programs even if programs propose to cater to Aboriginal peoples (Ryan, 1995). According to Health Canada (2002), only three percent of Aboriginal peoples completed a university degree as compared to 13% of the overall Canadian population. In contrast to Euro-Canadian university students, Aboriginal students rarely come from affluent families that may provide financial support for their post-secondary education. Student loans may be out of the question in that Aboriginal students' debt load may be too high by the time they complete their nursing degree and secure a paying job. Public education has hidden or dismissed the legacy of having confiscated Indian lands and the subsequent colonization of Aboriginal peoples (Huff, 1997). Textbooks buried the stark reality that the wealth of Canada was derived from Indian lands and labor (Huff, 1997). Huff (1997) noted that public education has paid "lip service" to accepting culturally diverse ideas of Aboriginal peoples, who justifiably resisted being tossed into a "racial food processor." The average Canadian was found to be divorced from the historic past and conflicts which were rooted in the past. "It serves no purpose to wax nostalgic about the successes education enjoyed transforming European immigrants into the middle and upper classes, because that model lacks one variable, race" (Huff, 1997, p. 159). Euro-Canadian teachers and administrators under-estimated the resilience of Aboriginal peoples. Aboriginal peoples' thinking could not be totally altered to Euro- Canadian ways (Fixico, 2003). Aboriginal peoples were now equipped with dual 22 perspectives, from their tribal view and from the dominant "western" scientific viewpoint (Fixico, 2003). Self-determination Within the history of Aboriginal education in Canada is the fourth and final phase referred to as self-determination. Recently, the necessity of self-determination surfaced as some Canadians began to identify the importance in Aboriginal peoples having ultimate control over their own education. I explain how recent historical events led towards Aboriginal self-determination. The National Indian Brotherhood prepared a report in 1971 about the educational concerns of Aboriginal peoples (Barman, Hebert, & McCaskill, 1987). The report indicated that church and state failed to provide an effective educational program for Aboriginal peoples as promised in many treaties. In 1973, the Minister of Indian Affairs provided official departmental recognition to the policy of Indian Control of Indian Education, based on two principles: (a) parental responsibility, and (b) local control (Kirkness, 1999). Implementation of the policy resulted in a range of educational programs from small to large additions of Aboriginal peoples' content and pedagogy in the curricula (Barman, Hebert, & McCaskill, 1987). Three main areas of concern emerged following the implementation of this policy: administration, funding, and legislation (Haig-Brown, 1995; Kirkness, 1999). Unfortunately, Aboriginal adolescents continued to exit from high schools at the rate of 70% (Downey, 2004; Health Canada, 2002). By not obtaining a high school diploma, many Aboriginal adolescents were destined to enter a vicious cycle of poverty and unemployment (Health Canada, 2002). Deprez and Lithman (1973) argued that the success of any educational effort depended on the overall employment opportunities at 23 the level of the home Aboriginal community and beyond. If there is no hope for a better life through gainful employment, why remain in a Euro-Canadian secondary school system? Marker (2001) examined how economic pressures and political forces constrained Aboriginal educational self-determination. Local cultural responsiveness to celebrating and promoting language and identity was resisted by white institutional hegemony as funding and accreditation continued to be ultimately administered by government or government agencies. The National Aboriginal Health Organization, with an objective to increase the participation of Aboriginal peoples in health careers, promoted the incorporation of both traditional knowledge and western-based perspectives in elementary through high school curricula to improve the educational standards and experiences of Aboriginal children and adolescents (Downey, 2004). By integrating Aboriginal languages in schools, students' attendance improved with an increase in students' self-esteem, academic achievement, and graduation rate (Downey, 2004). In terms of self-determination of 'higher learning,' Marker (2004a) identified considerations that were structural and conceptual challenges for collaborating with Aboriginal peoples about their postsecondary educational experiences. In undergraduate and graduate studies, Aboriginal peoples experienced a cultural clash around the themes of research, methodology, theory, and community. This cultural clash occurred at the deepest levels of ontological and epistemological assumptions. "Interrupting the lemming-like journey of Western technocratic knowledge could become the most powerful and enduring legacy yet of First Nations education" (Marker, 2004a, p. 187). By maintaining a strong Eurocentric perspective in higher education, Marker (2004b) identified that today's society continued to be complacent in facilitating colonial dominance. 24 2.2.2 History of Aboriginal Peoples in Canadian nursing In this overview, I continue to tell the story of the historical context shaping Aboriginal peoples' experiences in nursing education. Traditionally, North American schools of nursing recruited and attracted female, white, middle-class students (Brink, 1990; Dickerson & Neary, 1999; Furuta & Lipson, 1990). In 1982, there were approximately 200 Aboriginal health care professionals in Canada (Aboriginal Nurses Association of Canada, 2004a; Thomlinson, 1992). By 1992, there were approximately 350 Aboriginal nurses, accounting for less than 1% of Canadian nurses, which was similar to American nursing demographics (Buerhaus & Auerbach, 1999). In the United States and Canada, Indigenous peoples were the least represented of all minority groups, including men, in schools of nursing (Buerhaus & Auerbach, 1999; Canadian Nurses Association and Canadian Association of Schools of Nursing, 2004; Crow, 1993; Dickerson, Neary, & Hyche-Johnson, 2000; Martin, 1997; Plumbo, 1995; Thomlinson, 1992). The history of Aboriginal nurses in Canada has been mired with political and financial struggles. In 1975, several Aboriginal nurses came together with a common concern to improve the health of Aboriginal peoples and formed the Registered Nurses of Canadian Indian Ancestry. The organization was renamed the Indian and Inuit Nurses of Canada and today is known as the Aboriginal Nurses Association of Canada (ANAC). In the early years of its formation, ANAC experienced political and financial struggles, but the organization was successful in meeting its objectives to improve the health of Aboriginal peoples and recruit more Aboriginal peoples into health professions. ANAC members believed in the principle of Aboriginal control of Aboriginal 25 organizations and resisted using federal and provincial nursing associations as an avenue to voice their concerns about Aboriginal health issues (ANAC, 2004a, 2004b). To celebrate its efforts and stimulate recruitment of Aboriginal peoples into nursing, the ANAC published profiles of its members (1995). "These nurses shared their individual histories, career goals, and a vision of improved health for Aboriginal people" (Martin, 1997, p. 22). I identified some concerns about the educational experiences of ANS from these and other anecdotal reports by Canada's Aboriginal nurses: (a) the trauma of leaving home communities to acquire a nursing education, (b) being scrutinized as "elitists" by community members because of an educational experience "outside" of the reservation, and (c) inner conflicts due to different values, beliefs, and communication practices (ANAC, 1995; Crow, 1993; Goodwill, 1992; Hart, 2002; Martin, 1997; Thompson, 1993). I attended a recent symposium about Aboriginal nursing education held by the Aboriginal Nurses Association of Canada (ANAC) in Ottawa, Canada (2005). Participants included nursing administrators, educators, Aboriginal nurses, and ANS. Some participants expressed concern that nurse educators and administrators sustain acculturation of ANS in their nursing programs by forcing them to conform to the dominant group's beliefs, values, and communication styles. Participants at the symposium perceived that nursing curricula was based upon the health care needs of Euro-Canadians, while nursing pedagogy was primarily focused on the learning styles of Euro-Canadians. Strategies were discussed to improve recruitment and retention of Aboriginal peoples in nursing. The first strategy involved funding a position within the ANAC, whereby the incumbent would lobby the federal government to provide financial support to all ANS. This strategy was recommended by Health Canada (2002) in that the key 26 concern of ANS was inadequate funding. The second strategy was to lobby the Canadian Association of Schools of Nursing (CASN) to adopt accreditation protocols, whereby schools must include mandatory courses about Aboriginal culture and Aboriginal health beliefs and issues. "Curriculum that promotes and includes Aboriginal cultures to reflect the diversity across the country is critical" (ANAC, 2005, p. 4). CASN, in turn, would collaborate with professional nursing associations and the National Aboriginal Health Organization to establish criteria to evaluate culturally safe nursing practice of all graduates. Cultural safety17 was deemed crucial to delivery of professional nursing care to Aboriginal peoples (Browne, Fiske, & Thomas, 2000; Coup, 1994; Dowd & Eckerman, 1992; Joho & Ormsby, 2000; Kavanaugh, Absalom, Beil & Schliessmann, 1999; Keitner, 1999; Pinikahana, Manias, & Happell, 2003; Polaschek, 1998; Smye & Browne, 2002; Weaver, 1999). Given the backdrop of the history of Aboriginal education in Canada and the history of Aboriginal peoples in Canadian nursing, I reflected upon how the historical context influenced ANS' experiences. The first historical phase of traditional education is important in that ANS may or may not be aware of Aboriginal health beliefs, communication styles, and traditional healing methods. Since Aboriginal health care issues are paramount in Canada, a culturally sensitive approach to information about traditional health beliefs, communication styles, and healing methods would be beneficial to all nursing students. Furthermore, an understanding of the influence of colonization and neo-colonialism on the overall health status of Aboriginal peoples in Canada and the student-teacher relationship would enhance nursing practice and learning environments. By placing Aboriginal health and learning in its historical 1 7 According to Polaschek (1998), culturally safe nursing practice involves actions and behaviors that recognize, respect and nurture the unique cultural identity of minority patients and safety meets their needs, expectations and rights. 27 context, nurse educators and students would incorporate more sensitive ways of promoting health and learning. The fourth historical phase of self-determination promoted the vision that Aboriginal nurses would have ultimate control over their organizations. This vision may prove to influence the development and implementation of curriculum and educational policies that enhance recruitment and retention of Aboriginal peoples in schools of nursing. Nurse educators would benefit by collaborating with Aboriginal nurses in developing curriculum content and teaching strategies that promote inclusiveness. 2.3 The social construction of existing knowledge In this section, I provide a review of the existing knowledge of ANS' experiences. I reviewed existing literature to grasp a sense of the social construction of ANS' experiences and factors that influenced those experiences. Ten descriptive studies were located that examined the educational experiences of ANS in undergraduate and graduate nursing programs in North America (Care, 2003; Dickerson, Neary, & Hyche- Johnson, 2000; Health Canada, 2002; Kulig, 1987; McLeland, 2005; Ryan, 1992, 1995; Usher, Lindsay, Miller & Miller, 2005; Walsch, 1995; Weaver, 2001; Yurkovich, 1997). While most of the studies used qualitative research methods, Kulig (1987) and Weaver (2001) explored ANS' experiences using survey methods. Two other studies explored the essence of practicing nursing as an Aboriginal person (Plumbo, 1995; Struthers & Littlejohn, 1999). Along with these 12 studies of ANS' experiences and Aboriginal nursing, I reviewed literature about postsecondary education of Aboriginal peoples. In the following sections, I offer a synthesis of existing knowledge of the ANS' experiences. I describe barriers that contributed to a negative educational experience under the theme 28 called "Struggles" as it reflected a life cycle event from Aboriginal epistemology. I refer to all factors that contributed to a positive educational experience under "Survival." In the process of critically analyzing existing knowledge of Aboriginal peoples' experiences in postsecondary institutions, I was also looking for what was missing (Campbell & Gregor, 2002; Marker, 1997). In the section entitled, "What was missing?" I discuss how intergroup relations and racism may influence ANS' experiences. Although intergroup relations and institutional racism were indentified in the literature about postsecondary education, these important influences were rarely identified in the nursing literature (Huff, 1997; Jackson, Smith & Hill, 2003; Law, Phillips & Turney, 2004; Makinauk, 2003; Marker, 2000; Penketh, 2000). 2.3.1 Struggles A resounding theme in the literature from adult education is that Aboriginal peoples experience many struggles in their attempts to attain post-secondary education (Archibald & Urion, 1995; Arvizu, 1995; Crow, 1993; Hoover & Jacobs, 1992; Hornett, 1989; Huff, 1997; Huffman, 1991; Jackson, Smith & Hill, 2003; James, 1992; Kirkness & Barnhardt, 1991; Kleinfeld, Cooper & Kyle, 1987; Lin, Lacounte, & Eder, 1988; Long & Nelson, 1999; Makinauk, 2003; Marker, 1997; More, 1987; Perry, 2002; Reyhner, 1992; Rhodes, 1998; Ryan, 1995; Sawyer, 1990; St. Denis & Hampton, 2002; Tate & Schwarz, 1993; Tierney, 1992). Inter-related struggles identified in the literature were: (a) inadequate high school preparation, (b) lack of support services, (c) rigid institutional policies and procedures, (d) ethnocentrism, and finally, (e) inadequate funding. Inadequate primary and secondary education Four North American studies identified that Aboriginal peoples from reserves faced difficulties from the very beginning of their postsecondary education because their 29 high school preparation provided them with substandard English, mathematical, and scientific backgrounds (Health Canada, 2002; Deprez & Lithman, 1973; Walsch, 1995; Yurkovich, 1997). Although Indigenous nursing students in Australia indicated that they also struggled with inadequate educational preparation, the rationale for this issue was not clarified (Usher, Lindsay, Miller, & Miller, 2005). Aboriginal peoples who received their secondary education in Aboriginal communities were inadequately prepared academically for post-secondary education (Health Canada, 2002). Grade equivalency was identified to be widely variable. According to one participant, "38% of First Nations students are completing high school, 8.2% have the required courses for university in British Columbia" (Health Canada, 2002, p. 77). Frequently, federally-funded high schools were not meeting the same educational standards as provincial schools. This actuality was a crucial factor that was repeatedly brought forward to the researchers (Health Canada, 2002). Because the high school educational standards and resources for many northern communities were lower than their urban counterparts, Aboriginal peoples were often required to attend a "bridging" program (Faculty of Nursing, University of Manitoba, 2000; Health Canada, 2002; James, 1992; Walsch, 1995). Health Canada (2002) recommended that the federal, provincial, and territorial education departments in partnership with Aboriginal communities make tutors readily available to Aboriginal high school students, especially for English, math, and science. Other studies indicated that recruitment, retention, and graduation of Aboriginal high school students were enhanced when Aboriginal cultural content was integrated into the Euro-Canadian educational system (Downey, 2004; Marker, 1997). Success of secondary and postsecondary education depended upon the overall employment context for Aboriginal peoples, which remained bleak in many Aboriginal communities 30 (Deprez & Lithman, 1973). However, many Aboriginal peoples were aware of the current nursing shortage and the related nursing positions available in Aboriginal and Non-Aboriginal communities. In Yurkovich's study (1997), 17 out of 18 ANS indicated that their high school experience was predominantly comprised of the Euro-American culture (Yurkovich, 1997). One participant voiced her anger in response to discriminatory practices and attitudes of a high school advisor. In this example, I depict how racism over-shadowed inadequate high school preparation. This ANS stated, My friends had taken algebra and chemistry, and he wouldn't let me take those classes and I asked him why....He said because I was Indian and our stats show that by the time you are 17 or 18 you will be pregnant and drop out of school. So we don't spend our precious resources on people who will drop out (Yurkovich, 1997, p. 97). Lack of support services Canadian schools of nursing participated in a survey to determine what progress had occurred with respect to recruitment and retention of ANS (Health Canada, 2002). An improvement was identified in that general Aboriginal student support services existed in almost 91% of participating institutions (universities, affiliated colleges); whereas, general access programs were limited in that they were occurring in only 37% of these facilities (Kleinfeld, Cooper & Kyle, 1987; Weaver, 2001). General access programs were available to Aboriginal and non-Aboriginal students who had been "disadvantaged" academically, socially, economically, and politically (Health Canada, 2002). General access programs provided these students with academic supports such as tutors and personal supports such as councilors. Unfortunately, some universities and colleges reported that general access students rarely enroll in nursing programs (Health Canada, 2002). With inadequate high school preparation, it was important for postsecondary institutions to support general access programs in that transition years 31 were required to prepare Aboriginal students for mainstream university or college admission. Specific access programs in schools of nursing were severely lacking (Health Canada, 2002). Only two jurisdictions offered specific access programs in schools of nursing: Saskatchewan and Manitoba - two provinces with the highest percentage of Aboriginal peoples in their population, given that the overall Aboriginal population has grown to be approximately 13.6%. Nursing access programs offered support to ANS throughout the duration of their preparatory year and the nursing program. Jurisdictions with nursing access programs had more ANS than those schools of nursing where no such program existed. "It is worth noting that it is the colleges that have taken a leadership role in preparing Aboriginal people for university-level nursing studies in Canada" (Health Canada, 2002, p. 60). Seventy percent of Canadian Association of Schools of Nursing (CASN) members did not designate any specific seats in their schools of nursing for Aboriginal peoples. Only nine schools of nursing set aside one to five seats for Aboriginal peoples (Health Canada, 2002). Two schools of nursing admitted all Aboriginal students who successfully completed a bridging program (Health Canada, 2002). Although some schools of nursing claimed to recognize the Aboriginal perspective, institutional actions and behaviors were incongruent with this claim (Health Canada, 2002). ANS noted that Aboriginal approaches and perspectives always required justification. Institutional racism was noted to over-shadow lack of support services for Aboriginal peoples in post-secondary education (Huff, 1997; Jackson, Smith & Hill, 2003; Marker, 2004b). Once Aboriginal students were accepted into a nursing program, they often needed to relocate and rearrange housing, childcare, access to public transportation 32 within the constraints of their limited budget (Health Canada, 2002; Ryan, 1995). Problems associated with housing, family, finances, and racism generated considerable additional struggles for these students, which in turn, affected their ability to progress through their nursing program. Ryan (1995) described the experiences of ANS as they adapted to life in an urban setting: Finding a suitable house or apartment was complicated by discriminating landlords. "Many Native students have faced situations where they are told on the phone that accommodation is available, only to be informed when they show up in person that it has already been claimed (Ryan, 1995, p. 215- 216). Adapting to life in an urban setting dominated by Euro-Canadians involved new experiences of discrimination (Ryan, 1995). Approximately 80% of ANS identified themselves as parents (Health Canada, 2002). Childcare issues interfered with ANS' ability to fully participate and meet some practical obligations of being a student nurse (Health Canada, 2002). "Family concerns retain a high priority for students throughout their tenure" (Ryan, 1995, p. 217). Many children of the ANS grew up in a milieu where rules and conventions are substantially different from those they encounter in an urban setting. Confronting racism is the most unsettling obstacle for the children and their parents (Jackson, Smith & Hill, 2003; Ryan, 1995). In lieu of Health Canada's finding that there were only 23 Aboriginal nursing faculty members in Canada, several ANS identified the need for Aboriginal tutors and student advisors within the schools of nursing (2002). Participants suggested that nursing faculties should establish good working relationships with Aboriginal student services and ANS to meet the needs of ANS (Dickerson, Neary & Hyche-Johnson, 2000; Jackson, Smith & Hill, 2003). 33 Rigid institutional policies and procedures Many researchers identified rigid institutional policies and procedures as a contributing factor in the experience of a hostile postsecondary environment for Aboriginal students (Dickerson, Neary, & Hyche-Johnson, 2000; Health Canada, 2002; Huff, 1997; Huffman, 1991; Kirkness & Barnhardt, 1991; Marker, 2004a; Tierney, 1992; Walsch, 1995; Womack, 1997; Yurkovich, 1997). Rigid institutional policies and procedures were strongly associated with ethnocentrism (please see page 36) as revealed in entrance requirements, failure to grant leaves of absence for family/community losses, and strict time frames for completion of postsecondary programs. ANS' narratives revealed their perceptions of a rigid academic environment with a set of specific standards, in which there was only one way to learn. ANS believed that their learning environment had a strong traditional approach, which required a sequence of learning tasks in a specific manner (Dickerson, Neary & Hyche- Johnson, 2000). Blame was conveyed to Aboriginal students through rigid institutional policies and procedures (granting or not granting a leave of absence, length of time for program) that discounted students' values of family and community. Defining the problem in terms of poor retention, low achievement, and high attrition placed the onus of adjustment on Aboriginal students. Kirkness and Barnhardt (1991) advocated changing the language to facilitating easy access, leaves of absences, and returning access to place the onus of adjustment on the institution. However, they questioned if those who were in a position to make a difference in the education of Aboriginal peoples "will seize the opportunity and overcome institutional inertia" (Kirkness & Barnhardt, 1991, p. 14). By using an Aboriginal perspective and applying respect, relevance, reciprocity, and 34 responsibility to postsecondary institutions and higher education, Kirkness and Barnhardt (1991) identified that the institution and the entire community would benefit. Ethnocentrism I use the phrase, ethnocentrism, to refer to the conscious and subconscious viewpoint that one's way to "see" the world, science, knowledge, and education is superior to others' viewpoints. I found that the literature indicated there was "only one way" of thinking, communicating, learning, acting, and being a nurse. This ethnocentric perspective existed in nursing education at multiple levels. "Native American students described an Anglo-centric focus in the classroom that reflected a Western medicine model and differed from their traditional model. Students were sensitive to this difference and viewed it personally" (Dickerson, Neary & Hyche-Johnson, 2000, p. 192). Ryan (1992) identified that the dominant Eurocentric perspective was reflected in nursing ideology and practices of Non-Aboriginal nursing students, nurse educators, health care practitioners, as well as educational and hospital administrators and their institutions. Ethnocentric viewpoints and behaviors affected intergroup relations: student-student, student-patient, student-nurse, and student-teacher. Representations and enactments of ethnocentric perspectives occurred in the nursing curriculum, schools' policies and procedures, policies within the professional nursing associations and unions, as well as the images and behaviors present in society (Dickerson & Neary, 1999; Dickerson, Neary, & Hyche-Johnson, 2000; Hagey & MacKay, 2000; Health Canada, 2002; McLeland, 2005; Paterson, Osborne, & Gregory, 2004; Ryan, 1992; Weaver, 2001). Eurocentric ideology perpetuated the dismissal of the importance of Aboriginal cultures' values, ways of interpersonal communication, strategies for gathering information, and the manner in which many people solve problems (Adams, 1992; 35 Dickerson, Neary, & Hyche-Johnson, 2000; Jackson, Smith & Hill, 2003; Ryan, 1992). ANS perceived that the academic environment was rigid with only one way to learn, one way to think, and one way to behave like a nurse (Dickerson, Neary, & Hyche-Johnson, 2000; Health Canada, 2002; Paterson, Osborne, & Gregory, 2004; Ryan, 1992). A Euro-Canadian perspective within schools of nursing forced ANS to conform to dominant group's communication practices. According to several ANS, they tended to be more reflective in their listening in classrooms, whereas nursing faculty expected them to demonstrate more assertiveness and "perky" participation (Health Canada, 2002; Jackson, Hill & Smith, 2003). "The teachers think there is something wrong with a Native student because they do not talk, or they do not communicate [in ways that teachers expect]" (Ryan, 1992, p. 98). ANS perceived nursing faculty as strict evaluators who concentrated solely on the ANS attaining "white" standards of nursing practice regardless of individual cultural differences. ANS perceived that feedback from faculty was consistently negative, judgmental, and disrespectful (Dickerson, Neary, & Hyche-Johnson, 2000). Several sources critiqued conventional culturalist18 approaches to address the issue of race, ethnicity, and health in nursing education (Culley, 1996, 1997; Paterson, Osborne & Gregory, 2004; Tullman, 1992). "Within the professional discourse of nursing, the issue of 'race' and health is dominated by the discourse of 'culture', 'cultural sensitivity' and 'cultural awareness'" (Culley, 1997, p. 30). By solely adopting a cultural awareness approach to Aboriginal peoples, the significance of the historical, sociopolitical and structural aspects of society was denied. Complex social phenomena 1 8 Cultural pluralism and essentialism are two aspects of culturalist approaches. By focusing on culture, the significance of the political and structural aspects of society and power relationships between health care providers and patients are ignored and culture, itself, becomes problematic. Health differences tend to be related to cultural differences and/or deficits. With an essentialist concept of culture, the Aboriginal culture is viewed as an absolute and fixed category (Culley, 1997). 36 such as Aboriginal health and nursing were deconstructed to grossly over-generalized stereotypes as viewed by the dominant Euro-Canadian group. A culturalist approach in nursing education tended to perpetuate denial of the power relations between Aboriginal peoples and the dominant Euro-Canadian culture and the power relations inherent between student and teacher, patient and health care provider. Within nursing education, there was an over-emphasis on culture and language rather than equal opportunities and anti-racism. Although cultural awareness education for nursing students was important since aspects of culture had bearings on health beliefs, behaviors, and utilization of services, it was noted as vital that nursing education about race, ethnicity, and health was conducted in a critical way that promoted the interest of minority groups such as Aboriginal peoples (Paterson, Gregory & Osborne, 2004). I found that Aboriginal students were identified as "other than white" and from the standpoint of ANS, feelings of alienation were described (Dickerson, Neary, & Hyche- Johnson, 2000). Within the historical context, a hierarchy of white Euro-Canadians, white immigrants, immigrants of color, gay and lesbian students, I identified Aboriginal peoples as being positioned at the lowest status of "other than white" (as noted by Lithman in 1973). "Whiteness, which includes 'acting white', is required for full assimilation into the nursing establishment on the part of students, faculty and clinical nurses regardless of color" (Puzan, 2003, p. 195). Being a "visible" Aboriginal person placed ANS in a more precarious position than a lighter skinned "non-visible" Aboriginal person (St. Denis & Hampton, 2002). Aboriginal students were examined for their "different" learning styles (Crow, 1993; James, 1992; More, 1987; Reyhner, 1992; Rhodes, 1998), "different" worldviews (Crow, 1993; Dickerson & Neary, 1999; Plumbo, 1995), and resulting value conflicts 37 within a postsecondary environment (Dickerson & Neary, 1999; Dickerson, Neary, & Hyche-Johnson, 2000; Health Canada, 2002; Kavanagh, Absalom, Beil, & Schliessmann, 1999; Lin, Lacounte, & Eder, 1988; Walsch, 1995; Weaver, 2001; Yurkovich, 1997). By placing the onus of adjustment on the student for being other than white or different from the dominant group, a hostile learning environment ensued (Canales, 2000; Health Canada, 2002; Kirkness & Barnhardt, 1991; Ryan, 1992; Walsch, 1995; Womack, 1997; Yurkovich, 1997). Jackson, Smith and Hill (2003) noted that American Indian postsecondary students described a non-linear path in their journey to acquire a college degree. The students valued the cyclic rather than Euro- Canadian linear progressions and they valued the present more than the Euro- Canadian focus on the future. In 1976, Ryan described a process in which researchers and theorists examined society's problems and then attributed the problems to the affected individuals (as cited in Jackson, 1993). This process was referred to as victim blaming and with an element of cynicism, Ryan listed these steps: First, identify a social problem. Second, study those affected by the problem and discover in what ways they are different from the rest of us as a consequence of deprivation and injustice. Third, define the difference as a cause of the social problem itself. Invent a humanitarian action program to correct the differences. To blame the victim is to conduct and interpret research that shows how "these people" think in different values, seek different goals, and learn different truths (Ryan, 1976, p. 215 as cited in Jackson, 1993, p. 373). Traditionally, the problem of recruitment and retention of Aboriginal peoples in postsecondary education involved a similar process by blaming students. Educators used these terms to describe ANS' performances: low achievement, high attrition, poor 38 retention, and weak persistence (Kulig & Thorpe, 1996). This language placed the onus of adjustment on ANS students and strengthened the discursive power of the educational institution in that the school was viewed as superior and virtuous (Cannella & Reif, 1994; Cummins, 1995; Funkhouser & Moser, 1990; Huff, 1997; Kirkness & Barnhardt, 1991; Ladson-Billings, 1995; Phillips, 2000; Ryan, 1992; Womack, 1997). Despite the growing Aboriginal population in Canada and their health care needs, nursing curricula strongly reflected a biomedical view of health, illness, and health care that excluded information about Aboriginal health (Campbell & Jackson, 1992; Crow, 1993; Culley, 1996, 1997; Health Canada, 2002; Jackson, 1993; Puzan, 2003; Roberson & Kelley, 1996; Ryan, 1992; Weaver, 2001; Yoder, 1996; Yurkovich, 1997). Weaver (2001) found that 40 ANS and Aboriginal nurses indicated that 35% of their nursing programs lacked content on Native America health issues. "Consequently, students and teachers are socialized to accept and validate particular discourses, ontologies, and epistemologies without capacity or motivation to challenge their legitimacy" (Puzan, 2003, p. 196). This finding was congruent with results of a survey of family medicine programs in Canada (Redwood-Campbell, MacDonald, & Moore, 1999). All Canadian family medicine program directors were surveyed with a 100% response rate. Findings indicated that no programs had formal objectives regarding Aboriginal health issues. Many Canadian family medicine programs provided "some exposure to aboriginal health issues, but most need more expertise and direction on these issues" (Redwood-Campbell, MacDonald, & Moore, 1999, p. 325). Inadequate funding In 1977, the Department of Indian and Northern Development (DIAND) implemented the Post Secondary Education Assistance Program (PSEAP), designed to assist registered Indian and Inuit peoples to acquire postsecondary education (Health 39 Canada, 2002). High school graduates were invited to apply to the PSEAP and the DIAND initially administered the program. At first, students were accountable to pay their academic expenses from the fund with the expectation that a basic level of academic achievement was maintained (Health Canada, 2002). In 1989, the DIAND implemented a revised postsecondary support program (Health Canada, 2002). New funding criteria along with a maximum allowance and duration were established. Restrictions were placed on student eligibility, while daycare and rental subsidies were removed. Types of assistance for full-time students were altered to include: (a) tuition assistance (registration, tuition fees, supplies and textbooks), (b) travel costs for one return visit for the student and their dependents to their community per semester, and (c) living expenses with maximum monthly allowances for students and their dependents (Health Canada, 2002). "Although DIAND has continually increased its level of funding for education, it remains at a 2% growth rate" (Health Canada, 2002, p. 159) with the level of funding remaining the same since 1989. Post-secondary education funding to all Aboriginal communities has not reflected the costs of inflation and the increasing number of Aboriginal peoples who wished to pursue postsecondary education. Although the DIAND allocated $228 million for postsecondary education in 2000-2001, an estimated number of 8,475 Aboriginal peoples were unable to access postsecondary funding (Health Canada, 2002). The federal government continued to control postsecondary funds for First Nations and Inuit students with ultimate authority. Some First Nations communities administered the funds, while Indian and Northern Affairs Canada (INAC) directly controlled postsecondary funds in other First Nations communities. First Nations students must apply to their local Band for sponsorship. INAC's criteria for funding include: (a) demonstrated academic ability, (b) letter of acceptance from an accredited 40 school, (c) enrollment in at least 60% course load, (d) proof of no other funding sources, and (e) submission of transcripts on a regular basis. Current federal funding covers less than half the costs an ANS will incur in an academic year (Health Canada, 2002). Although financial "problems are a major barrier to success for many minority students," (Campbell & Davis, 1996, p. 299), the inadequate funding for Aboriginal peoples' postsecondary education has been mired with a long history of institutional racism (Archibald & Urion, 1995; Assembly of Manitoba Chiefs, 1999; Health Canada, 2002; James, 1992; Kirkness, 1999; Walsch, 1995; Yurkovich, 1997). Inadequate funding was the second most frequently cited barrier faced by Aboriginal students and the key concern for ANS (Archibald & Urion, 1995; Health Canada, 2002; Walsch, 1995). Makilauk (2003) identified that insufficient and unstable Band sponsorships contributed to Aboriginal postsecondary students being able to meet basic health, food, and housing needs. "Due to insufficient funds, students reported eating less expensive foods that were often poor quality, excluded healthy essentials such as fruits and vegetables, and included excessive amounts of pasta" (Makilauk, 2003, p. 98). These Aboriginal students experienced the consequences of a poor diet - health problems. Health Canada (2002) conducted the most thorough examination of available funding to ANS where most ANS lived below the poverty level with dependents. Funding was highly complicated, non-standardized, and grossly inadequate and it came from a variety of bureaucratic sources that were inconsistent across provinces, territories, and institutions. Funding sources included: the First Nations and Inuit Health Branch (FNIB), the DIAND, local Bands, or student loans. For example, all Aboriginal and non-Aboriginal nursing students attending nursing education programs in Canada's territories were entirely supported by the federal government (Bainbridge, 2004). Of 41 particular note was the finding that Metis nursing students were the most marginalized group (financially), as their Aboriginal ancestry was not included in the DIAND criteria for funding. Scholarships were only available to Metis students during the last 15 months of their nursing program (Health Canada, 2002). In the following section referred to as "survival," I describe the existing knowledge about ANS' ability to cope and succeed despite their struggles. 2.3.2 Survival Weaver (2001) found that 24% of the ANS identified no struggles in their nursing educational program. Many ANS who identified no struggles pursued their nursing education within an Aboriginal context such as in a tribal college with a large group of ANS and Aboriginal faculty members. Other ANS who identified no struggles claimed that they led their entire lives immersed in the dominant culture (Weaver, 2001). In terms of recruitment, what factors motivate Aboriginal peoples to enter into nursing education? In terms of retention, what strategies enhance ANS' success in schools of nursing? Several studies identified why Aboriginal peoples chose nursing as a profession. ANS were motivated to enter nursing education because they wanted to help their peoples (Health Canada, 2002; Walsch, 1995; Yurkovich, 1997)). All located studies identified ANS' strategies to survive and succeed in a hostile learning environment (Care, 2003; Dickerson, Neary, & Hyche-Johnson, 2000; Health Canada, 2002; Kulig, 1987; Ryan, 1992; Walsch, 1995; Weaver, 2001; Yurkovich, 1997). I refer to the existing knowledge about ANS' personal and interpersonal strengths as "survival," which consisted of several factors that enhanced ANS' success in the school of nursing: (a) previous life experience, (b) perseverance, (c) interpersonal support, (d) playing the game, and (e) desire to make life better for Aboriginal peoples. I describe each factor that contributed to ANS' ability to endure their nursing programs. 42 Previous life experience Walsch (1995) identified that previous life or work experience was a contributing factor in the success of ANS, despite a lack of formal academic preparation. Usually, ANS with broad life or work experience in non-academic settings developed skills that compensated for lack of formal education. A description of these skills was lacking. Several studies indicated that some ANS had previous work experience in positions such as hospital volunteers, hospital unit clerks, and emergency medical technicians within the health care system, which motivated these individuals into entering nursing as a profession. These ANS learned that they enjoyed working with people, yet their subordinate positions limited their acquisition of an appropriate knowledge base and ability to provide proper care to Aboriginal peoples and communities (Health Canada, 2002; Walsch, 1995; Yurkovich, 1997). Previous life or work experience was a positive contributing factor assisting many Non-Aboriginal and Aboriginal postsecondary students through their programs. However, most researchers failed to recognize that ANS required specific previous life experience in terms of practicing the nuances of assessing and coping with individual, group, and institutional racism. Previous life experience negotiating the nuances of individual, group, and institutional racism may better equip Aboriginal students to establish effective coping mechanisms in their postsecondary education (Jackson, Smith & Hill, 2003). Perseverance Griffiths and Tagliareni (1999) found that minority nursing students participating in their qualitative sample ranked themselves and their drive to succeed as the number one factor contributing to success in their programs. These participants revealed an intense inner drive, unwavering personal commitment and strong self-awareness. 43 Successful ANS had a strong personal desire and an ability to persist through their programs in order to graduate (Dickerson, Neary, & Hyche-Johnson, 2000; Health Canada, 2002; Jackson, Smith & Hill; 2003; Kulig, 1987; Yurkovich, 1997). ANS identified within themselves their strengths to persist and represent the Aboriginal culture "as fighters" that additionally, created a sense of pride in meeting the challenge (Dickerson, Neary, & Hyche-Johnson, 2000). Interpersonal support Weaver (2001) found that those ANS who acquired support often located it through formal and informal student groups. Family and peer support were significant indicators of success (Health Canada, 2002; Jackson, Smith & Hill, 2003; Kulig, 1987; Weaver, 2001; Yurkovich, 1997). The literature failed to acknowledge how ANS utilized formal and informal interpersonal support to succeed in their programs. Did peer and family support simply allow ANS to focus on studying or was it used to assist ANS in their ability to cope with their experiences of passive and active forms of racism? Playing the game As in the case of most postsecondary students, ANS learned how to "play the student nurse game" to overcome hindrances in their educational experiences (Dickerson, Neary, & Hyche-Johnson, 2000; Ryan, 1992). However, "playing the game" was compounded by recurring experiences of being forced to conform to Euro- Canadian viewpoints, communication styles, and behaviors (Jackson, Smith & Hill, 2003). By changing their communication practices to being assertive and conforming to "look people in the eye," ANS acknowledged that they used reflexivity and decided to play the game and conform to faculty expectations rather than receive a failing grade (Dickerson, Neary & Hyche-Johnson, 2000). 44 Several ANS used isolation from other student groups to create and maintain a focus for success. Some ANS "bottled-up" feelings for the purpose of maintaining the status quo and conforming to the written or unwritten rules of the school. They coped with the dominant group's culture determining what could be given up or retained for the duration of their nursing education and future practice (Yurkovich, 1997). Desire to make life better In lieu of the historical context of Aboriginal peoples in Canada, ANS had a strong desire to make life better for themselves, their families, and communities. In Yurkovich's study (1997), 14 of the 18 participants repeatedly expressed a need to provide a better life for their children. Despite thoughts of exiting the nursing program, one ANS persisted with her studies because of a personal goal to provide a hopeful future for her children (Health Canada, 2002). Nine of the 16 ANS in Health Canada's study (2002) indicated their desire to provide care for Aboriginal people and half of the ANS wanted to work as a nurse in an Aboriginal community. These ANS wanted to "give back" to their communities upon completion of their nursing degree. ANS also wished to provide an improvement in the quality of health care to Aboriginal peoples living in northern communities. Some ANS voiced a desire to promote further opportunities for Aboriginal peoples. 2.3.3 What was missing? In my review of the located literature, I noted a lack of information and research related to problematic intergroup relations and racism's influences on ANS experiences. Research about teaching strategies to promote inclusiveness and anti-racism and different learning styles of ANS was also missing in the nursing literature. Although problematic intergroup relations and racism were virtually ignored in the nursing literature specific to ANS' experiences, I explain how problematic intergroup 45 relations and racism influenced other Aboriginal students' postsecondary educational experiences. "The fact that racism, discrimination and prejudice in nursing are not well- publicized may contribute to a general complacency and a belief that they simply do not exist" (Health Canada, 2002, p. 87). Intergroup relations Berkowitz and Barrington (1998) described multicultural education in terms of intergroup relations and identified that terms such as dominant and minority groups are relational. There is a paucity of research that examined linkages between the experiences of ANS in educational settings and the politics of intergroup relations between Non-Aboriginal and Aboriginal peoples in Canada. In relation to the literature appraisal, I identified how the ideology of a culturalist approach dominated intergroup relations between nursing faculty and ANS. Many researchers and scholars identified the importance of a positive student- teacher relationship, whereby teachers facilitate the empowerment of culturally diverse students (Calliste, 1996; Cannella & Reif, 1994; Crow, 1993; Cummins, 1995; Furuta & Lipson, 1990; Health Canada, 2002; Jackson, Smith & Hill, 2003; Ladson-Billings, 1995; Nairn, Hardy, Parumal, & Williams, 2004; Paterson, Osborne & Gregory, 2004; Rather, 1994). This finding was congruent with studies about ANS' experiences (Dickerson, Neary, & Hyche-Johnson, 2000; Health Canada, 2002; Ryan, 1992). "Native American students came to the program with expectations of a milieu where supportive learning occurs in a nurturing and culturally sensitive environment" (Dickerson, Neary, & Hyche- Johnson, 2000, p. 192). As these ANS became more experienced in their graduate nursing program, they sensed that faculty was more focused on competency-based objectives than the promotion of student-focused teaching (Dickerson, Neary, & Hyche- Johnson, 2000). Unfortunately, several ANS exited their nursing programs, citing 46 "personal reasons"; however, further investigation established that ANS, who were progressing well in their studies, decided to leave the school because their relationship with nursing faculty was constrained (Health Canada, 2002). Dickerson and Neary (1999) noted that participating faculty members held preconceptions of the ANS upon entry into the advanced nurse practitioner program. These preconceived notions affected the teaching/learning environment. Rather than conduct a thorough assessment of each individual student, participating faculty members formulated preconceived assumptions such as all ANS would demonstrate a passive style of communication. This finding was congruent with previous research in multicultural education that found that teachers' expectations of students' performances profoundly affected students' outcomes including motivation (Ladson-Billings, 1994). Native American students' narratives were often focused on faculty-student relationships as important to their experiences, whether as a support or barrier to their success. Factors influencing the faculty-student relationships included student expectations of a nurturing relationship, the reality of the competitive environment, views of faculty feedback as negative criticism, feelings of powerlessness, reticence to seek help because of perceived negative consequences, and perceptions of faculty views (Dickerson, Neary, & Hyche-Johnson, 2000). Placing issues of respect, relevance, reciprocity, and responsibility in the foreground of discussions about First Nations participation in higher education means that many mainstream students and faculty will have to change the way they relate to Indigenous students. Aboriginal students frequently face a hostile environment in classes since, for them, social and political issues merge with their own identity struggles. Present discussions about First Nations are often contentious because of 47 unresolved treaties, land claims, and a neoconservative attack on Aboriginal sovereignty (Marker, 2004a, p. 174). Racism "The common dictionary definition of racism as discrimination against people because of race and the belief that one race is superior hides the central and most destructive element of racism" (St. Denis & Hampton, 2002, p. 11). St. Denis and Hampton (2002) advocated a definition of racism that specifically acknowledged unequal power relations and the history of the relationship between the groups. In lieu of the relevant implications that racism might have on recruitment and retention of Aboriginal peoples within schools of nursing, I rarely found research specifically interested in its examination (Huff, 1997; Lin, LaCounte & Eder, 1988). Six studies indicated that Aboriginal people experienced racism within postsecondary institutions (Archibald & Urion, 1995; Huff, 1997; Huffman, 1991; Jackson, Smith & Hill, 2003; Lin, LaCounte, & Eder, 1988; Makinauk, 2003) while others in the field of Aboriginal education address the issue (Hornett, 1989; Marker, 1997, 2000, 2004b, 2005; St. Denis & Hampton, 2002). Jackson, Smith and Hill (2003) acknowledged their surprise that American Indian postsecondary students experienced rampant racism in passive and active forms during their tenure and related their naivete to their own privileged culture. Lack of scholarly attention or complicity to racism in the "academy" must be understood in its long and established national and academic traditions and commitments (Health Canada, 2002; Marker, 2004b; St. Denis & Hampton, 2002; Tullman, 1992). Individual, group, and institutional denial of racism was rampant, yet Canadians continued to choose to condone racism through taken-for-granted societal practices (Ng, 1996 as cited in St. Denis & Hampton, 2002). 48 Hagey and MacKay (2000) conducted discourse analysis to address the nursing curriculum in regards to antiracism. These researchers found a denial of racism in the nursing profession, despite publicized grievances, law suits, and rallies organized by various professional support groups. Such denial is reflected in a curriculum that doesn't support either theory about racialist phenomena or the open discussion of issues that may come up clinically and has no commitment to ensuring that all graduates have some understanding of these phenomena (Hagey & MacKay, 2000, p. 55). Essentialist categorizations such as white and other than white were hidden in the perpetuation of inequality. Several theorists and researchers noted that essentialist categorizations needed to be named, reflected upon and bracketed in nursing education's new agenda (Culley, 1997; Hagey & MacKay, 2000; Paterson, Osborne & Gregory, 2004). "The goal of making racism and its effects see-able is to further equity in health professions, in health and in society" (Hagey & MacKay, 2000, p. 55). Aboriginal peoples' postsecondary learning environment was compromised of inter-related struggles that were over-shadowed by problematic intergroup relations and passive and active forms of racism. Passive racism was experienced by Aboriginal peoples as either being ignored or being singled out (Jackson, Smith, & Hill, 2003). Students viewed their experiences with passive forms of racism as an inherent aspect of their experience that they were required to manage (Jackson, Smith & Hill, 2003). Active racism was typically experienced in discussions about historical or cultural issues. Inclusive and anti-racist teaching strategies Research in nursing education was lacking in regards to development, implementation, and evaluation of inclusive and anti-racist teaching policies and 49 strategies. In an appraisal of multicultural and anti-racist teaching in nursing education, several nurse educators claimed that multicultural teaching was necessary to promote an understanding of the different ways that people experience health and illness (Culley, 1996, 1997; Nairn, Hardy, Parumal, & Williams, 2004). The inclusion of social scientific concepts and analyses into the nurse education curriculum provides an opportunity to discuss the more complex ways in which social relations and social structures impact upon minorities:..More importantly perhaps, nurses and nurse educators need to contextualize the health of minority ethnic groups, exploring the dynamics of discriminatory practices which structure many aspects of everyday life (Culley, 1996, p. 569). Despite recommendations that nurse educators might include a broader social context in studying minority health issues, racism was not necessarily directly examined by this approach. Paterson, Osborne and Gregory (2004) identified that nursing students quickly learned that both nurse educators and staff nurses supported the notion of cultural diversity in principle but their practices often revealed a lesser allegiance. Multicultural teaching strategies needed to be integrated with anti-racist teaching strategies to promote inclusiveness in learning and culturally safe nurse-client interactions (Back, 2004; Browne, Johnson, Bottorff, Grewal, & Hilton, 2002; Culley, 1996, 1997; Nairn et al, 2004; Sharma, 2004). Further research is warranted to study the effectiveness of these integrated teaching strategies on helping all nursing students become more open to diverse world views. I located one study that specifically examined anti-racism and racism within nursing discourse. Hagey and MacKay (2000) reported findings from a Canadian research initiative that integrated anti-racism in an undergraduate nursing curriculum. 50 They found that essentialist discourse in nursing curricula perpetuated racism and prevented the ideal of equity. In terms of education of Aboriginal peoples, A decolonizing pedagogical praxis challenges not only the forms, content, and intent of other pedagogies and their historical antecedents, but also requires a reconceptualization of the social organization of learning in schooling institutions and fundamentally in classrooms. Such a reconceptualization calls for a transformation in the social and intellectual relationships among participants both in schools and in particular communities where schools reside (Tejeda, Espinoza & Gutierrez, 2003, p. 35). 2.4 Chapter summary The Canadian historical context of Aboriginal peoples and education provided a backdrop to studying ANS' experiences in schools of nursing. The influences of colonial dominance continue today as many Aboriginal peoples struggle to pursue a postsecondary education. By providing a historical overview of Aboriginal peoples in Canadian nursing, I gained insight into the context that might shape ANS' experiences today. A review of the literature revealed that Aboriginal peoples experienced many barriers in acquiring postsecondary education. Researchers identified several struggles: (a) inadequate high school preparation, (b) lack of support services, (c) rigid institutional policies and procedures, (d) ethnocentrism, (e) and inadequate funding. What was blatantly missing in the nursing literature was how problematic intergroup relations and racism influenced ANS' experiences and what teaching strategies would facilitate inclusiveness and learning. No specific educational research was located that examined how inclusive and anti-racist teaching shaped ANS' experiences. 50 They found that essentialist discourse in nursing curricula perpetuated racism and prevented the ideal of equity. In terms of education of Aboriginal peoples, A decolonizing pedagogical praxis challenges not only the forms, content, and intent of other pedagogies and their historical antecedents, but also requires a reconceptualization of the social organization of learning in schooling institutions and fundamentally in classrooms. Such a reconceptualization calls for a transformation in the social and intellectual relationships among participants both in schools and in particular communities where schools reside (Tejeda, Espinoza & Gutierrez, 2003, p. 35). 2.4 Chapter Summary The Canadian historical context of Aboriginal peoples and education provided a backdrop to studying ANS' experiences in schools of nursing. The influences of colonial dominance continue today as many Aboriginal peoples struggle to pursue a postsecondary education. By providing a historical overview of Aboriginal peoples in Canadian nursing, I gained insight into the context that might shape ANS' experiences today. A review of the literature revealed that Aboriginal peoples experienced many barriers in acquiring postsecondary education. Researchers identified several struggles: (a) inadequate high school preparation, (b) lack of support services, (c) rigid institutional policies and procedures, (d) ethnocentrism, (e) and inadequate funding. What was blatantly missing in the nursing literature was how problematic intergroup relations and racism influenced ANS' experiences and what teaching strategies would facilitate inclusiveness and learning. No specific educational research was located that examined how inclusive and anti-racist teaching shaped ANS' experiences. 51 A study that examined ANS experiences was greatly needed to unearth how hidden and embedded messages in nursing discourse shaped ANS' experiences. New knowledge about local, translocal, and extra local factors shaping ANS' experiences was urgently required. An exploration of ANS' experiences and how the experiences are shaped can identify factors that enhance or hamper the educational experience. New knowledge can be translated into effective policies and initiatives that enhance ANS' educational experiences thus improving recruitment and retention. Student- teacher relationships, intergroup relations, nursing discourse, and other contextual aspects shaping the construction of Aboriginal peoples' experiences in predominantly white schools of nursing need further examination. Clearly, with a limited number of ANS to fill vacant nursing positions in Aboriginal communities - a study was required to examine the experiences of ANS in Canadian schools of nursing. Nurse educators and educational administrators required information about: • similarities/differences in experiences of ANS who originated from an urban versus a northern community, • how ANS' experiences were determined, • social relations generating the experience of ANS, and • ways in which the sociocultural, political, historical, and ideological construction of nursing education shapes ANS' experiences. 52 3 T H E O R E T I C A L A N D M E T H O D O L O G I C A L P E R S P E C T I V E S The word itself, 'research', is probably one of the dirtiest words in the indigenous world's vocabulary. When mentioned in many indigenous contexts, it stirs up silence, it conjures up bad memories, it raises a smile that is knowing and distrustful. It is so powerful that indigenous people even write poetry about research. The ways in which scientific research is implicated in the worst excesses of colonialism remains a powerful remembered history for many of the worlds' colonized peoples. It is a history that still offends the deepest sense of our humanity (L. Smith, 1999, p. 1). 3.1 Introduction In previous chapters, I explained the background to the study and offered a summary of existing knowledge of ANS' experiences in schools of nursing. The chosen theoretical and methodological perspectives guided the ways I viewed ANS1 experiences, negotiated access to participants, identified what constitutes data, collected and analyzed the data, and used the research findings. In this chapter, I describe the theoretical perspectives and research methodologies 19that guided the critical ethnography. I chose specific tenets from various theoretical perspectives and methodologies to broaden the existing knowledge about the everyday world of ANS in that the study would start with the standpoint of ANS, capture the context and discourse that shape ANS' everyday world, and end with the experience of ANS (Campbell, 1998). Limitations of applying these theoretical and methodological perspectives lie in the risk that I was predisposed to focus on some aspects of the data while ignoring others (Kirkham, 2000; Lather, 1991). To guard against this risk, my goal was to use these perspectives to guide aspects of the critical ethnography in a manner that prevented the theory from becoming the driving force. As stated by Lather (1991), 1 9 1 use the term, methodologies, to refer to the philosophical, theoretical, and practical basis of conducting research. Research method describes how the researcher implements the study. 53 Data must be allowed to generate propositions in a dialectical manner that permits use of a priori theoretical frameworks, but which keeps a particular framework from becoming the container into which the data must be poured. The search is for theory which grows out of context-embedded data, not in a way that automatically rejects a priori theory, but in a way that keeps preconceptions from distorting the logic of evidence (p. 62). For the purposes of a critical ethnography that examined the everyday world of ANS in Canadian schools of nursing, it was logical to rely on selected tenets from Aboriginal epistemology, Linda Smith's decolonizing methodologies for research and Indigenous peoples (1999), Ramsden's concept of cultural safety (2002), and the social organization of knowledge developed by Dorothy Smith (1986, 1987). Although some theoretical and methodological perspectives were introduced in Chapter One, further clarification is warranted. While Indigenous peoples conceptualized and developed Aboriginal epistemology, decolonizing methodologies, and cultural safety, the social organization of knowledge was rooted in a feminist critique of mainstream sociology and 'western' science. As experienced by McCleland (2005) in her study of 10 Indigenous nursing students in New Zealand, melding Indigenous viewpoints with feminist theory was somewhat problematic. I dealt with tensions between the theoretical and methodological perspectives by choosing particular tenets from the Indigenous and feminist viewpoints to formulate a theoretical lens to guide the study. Rather than view these tensions as binary or polar opposites, I chose to use different tenets from these theoretical and methodological perspectives to add depth and scope to the study. 54 For example, in Aboriginal epistemology the oral tradition is the primary route of knowledge translation and acquisition in Indigenous cultures (Battiste, 2002). In contrast, D. Smith's social organization of knowledge posits that texts and discourse mediate the social. In other words, written words govern how people perform their daily activities and work. In this study, I utilized both perspectives in that ANS were asked to tell a story about their experiences in the schools of nursing reflecting somewhat on the oral tradition of knowledge translation in Aboriginal epistemology. I also examined how nursing discourse shaped those experiences reflecting on D. Smith's social organization of knowledge. Please see the table on the following page that depicts tenets I selected from each theoretical and methodological perspective. 55 Table 1 Commonalities and Unique Features of Theoretical and Methodological Perspectives Aboriginal Decolonizing Cultural Safety Social Epistemology Methodologies Organization of Knowledge Origin •Indigenous * Indigenous * Health care, * Feminist Peoples' Peoples' Research, & critique of Traditional Research Education for sociology and Education Indigenous & "western Non- science" Indigenous peoples Collaborators Indigenous - Indigenous & Indigenous & - Social Peoples Non-Indigenous Non- activists Peoples Indigenous - Nurses - Nurses Peoples - Educators - Educators (Nurses, health - Social - Researchers care providers, Workers researchers) Researcher- Full Full Partnership •Acknowledges •Sharing Participant Partnership historical information for Relationship context and purpose of power relations consciousness- in raising relationships; * Reciprocity Knowledge Oral Tradition Oral Tradition Oral Tradition * Interviews Translation * Empirical * Empirical * Empirical * Reflexive and observations observations observations fieldwork Transference Revelations Revelations Revelations * Textual analysis How Explains * Illuminates •Historical •Provided a theoretical relationship historical and context & starting and perspective b/w material sociopolitical power relation ending point for contributes to world, context inherent in all research - knowledge land/nature, personal standpoint of development and internal relationships; ANS & research self * Illuminates •Explicates *Broad importance of how texts interpretive reflection and organize lens reflexivity, people's positionality activities Note. * Tenets used in this study 56 In the following section, I explain Aboriginal epistemology, L. Smith's decolonizing methodologies for research and Indigenous peoples, and cultural safety followed by my interpretation of D. Smith's social organization of knowledge. I describe how chosen tenets created theoretical and methodological perspectives to study ANS' experiences and the context that shapes those experiences. All theoretical and methodological perspectives embrace the importance of historical influences on current experiences of individuals and the notion of embodied knowledge that reflected the fluidity of tenets guiding the study. 3.2 Aboriginal epistemology As described in Chapter Two, Aboriginal education, epistemologies and knowledges have been under attack for many years. Aboriginal knowledges are unique to given individuals, families, localities, bands, tribes, and societies (Sefa Dei, Hall, Rosenberg, 2000). Canada's Aboriginal peoples have diverse histories and identities, ranging from hunters and gatherers of the Eastern woodlands, to agriculturalists of the Great Lake region, to game hunters of the prairies, to ocean-travelers of the Pacific coast, to the Inuit of the far North and then the Metis, who emerged historically from interactions between European and Aboriginal peoples (Castellano, 2000). Given this diversity among Aboriginal peoples, an all-encompassing Aboriginal epistemology is not possible (Battiste, 2002). Aboriginal epistemology does not apply to all Aboriginal peoples; rather, my description of Aboriginal epistemology is based upon information gathered from several sources. I describe chosen tenets from Aboriginal epistemology. 57 Although there is a paucity of writings about Aboriginal epistemology in the Canadian context, there is a measure of consensus on its characteristics and method of transmission. In Eurocentric thought, epistemology is defined as the theory of knowledge and pedagogy involving the processes by which children come to learn or know. The Aboriginal people of Canada have their own epistemology and pedagogy. Aboriginal epistemology is found in theories, philosophies, histories, ceremonies, and stories as ways of knowing. Aboriginal pedagogy is found in talking or sharing circles and dialogues, participant observations, experiential learning, modeling, meditation, prayer, ceremonies or story telling as ways of knowing and learning (Battiste, 2002, p. 18). Aboriginal knowledge is personal, oral, experiential, and holistic. Knowledge is conveyed in oral narratives - sometimes using metaphors (Battiste, 2002; Castellano, 2000). A value shared by many Aboriginal peoples is that their stories, language, customs, songs, dances and epistemology must be preserved because they sustain the life of the individual, family, and communities (Cajete, 1994). The knowledge valued in aboriginal societies derives from multiple sources, including traditional teachings, empirical observations, and revelation. These categories overlap and interact with one another, but they are useful for examining the contours of aboriginal knowledge (Castellano, 2000, p. 23). In most Aboriginal societies, Elders were honored as wise and assigned the responsibility of teaching children. Traditional teachings were passed down from generation to generation and tell of the creation of the world. Traditional teachings were 58 shared by storytelling and the stories record genealogies and ancestral rights to land. This notion of being connected to the land is integral to Aboriginal epistemology. Empirical knowledge is created from observations of many people over extended time. This knowledge represents "a convergence of perspectives from different vantage points, accumulated over time" (Castellano, 2000, p. 24). I used this tenet to guide the research method in that the research assistant and I made observations in the field and documented our observations in field notes. I also interviewed many people - ANS, Aboriginal nurses, faculty, student support services personnel, and employers - to gather their perspectives of the factors that shaped ANS' experiences. Similar to the theoretical and methodological perspectives of L. Smith and D. Smith, a key principle of Aboriginal learning is a preference for experiential knowledge (Battiste, 2002). Aboriginal epistemology relies on knowledge that is personal or experiential in nature or in other words, embodied knowledge (Battiste, 2002). In the following quote, the connectedness to the land is linked with inner revelations. Those who seek to understand the reality of existence and harmony with the environment by turning inward have a different, incorporeal knowledge paradigm that might be termed Aboriginal epistemology...This inner space is that universe of being within each person that is synonymous with the soul, the spirit, the self, or the being (Ermine, 1995, p. 102-3). Aboriginal knowledges reflect people's experience and relationships that address lived, material, and cosmological concerns (Mclsaac, 2000). In the production of these forms of knowledge, traditional values, interests and objectives articulate relationships between land/nature, spirit world, and humans. "The history of indigenous peoples has 59 shown that to sever these relationships is tantamount to genocide" (Mclsaac, 2000, p. 100). Similar to perspectives of L. Smith, Ramsden, and D. Smith, Aboriginal epistemology relies on the importance of the historical, sociopolitical, and cultural contexts. Hence, I incorporated the historical context of Aboriginal people and education into my theoretical lens. Aboriginal peoples believe that all existence is connected and that the whole context is fundamental to understanding the meaning of many mysteries of the universe (Ermine, 1995). A distinctive feature of Aboriginal epistemology is its environmental foundation and strong link to the land (Battiste, 2002; Cajete, 1994). This foundation connects an individual, family, or Tribe to their place in the world and establishes their relationship to their land and In turn, the earth in their hearts and minds. The environmental foundation reflects a deeper understanding of the importance of the natural environment as the essential reality or "place of being." Based on the environmental foundation, a mutual relationship or reciprocity was established and perpetuated between people and their environment. The importance of connecting with their "place" is not a romantic notion out of step with current times; it is rather the quintessential ecological mandate (Cajete, 1994). Nature is a sacred reality for Aboriginal peoples. Relationships to the environment formed the basis for Aboriginal expression of traditional education. A direct and abiding understanding of nature's cycles - life, death, struggle, and survival - was integral to the survival of Aboriginal peoples. Aboriginal peoples perceived multiple realities in Nature - that experienced by the five senses was simply one of many realities. Other characteristics of Aboriginal epistemology include: 60 • Teaching and learning radiate in concentric rings of process and relationship (Fixico, 2003), • Recognition of personal agency (Fixico, 2003; Cajete, 1994), • Use of stories as expressed through experience, myth, parables and various forms of metaphor (Battiste, 2002), • Integration of individuality with communal needs (Mclsaac, 2000), • Learning occurs not only in the mind but also in the body and spirit (Ermine, 1995; Mclsaac, 2000). In Chapter Four, I explain how Aboriginal epistemology provided a broad interpretive lens in the analysis of data. Within the broader interpretive lens of Aboriginal epistemology, I proceed to discuss how tenets within L. Smith's decolonizing methodologies further guided the study in terms of relationships between the researcher and the researched. 3.3 Decolonizing methodologies for research & Indigenous peoples Linda Tuhiwai Smith (1999), an Indigenous woman from Aoteaoroa/New Zealand2 0 developed a research agenda or set of approaches situated within decolonizing politics of the Indigenous peoples' movement21. For many Indigenous peoples of Aoteaoroa/New Zealand, the term 'research' was inextricably linked to European imperialism and colonialism. Decolonization was defined by L. Smith as a 2 0 The Maori name Aotearoa refers to the nation-state of the country known in today's world as New Zealand. By signifying Aotearoa/New Zealand, I acknowledge the historical context of colonialism situated in this geographical area. 2 1 1 would like to thank Dr. Michael Marker for his advice to review Linda Tuhiwai Smith's work prior to conducting the research. 61 process that engaged with imperialism and colonialism at multiple levels. When describing European imperialism, the term described one or more of these: 1. Economic expansion, 2. Subjugation of 'others' such as Indigenous peoples, 3. An idea or spirit with different forms of realization stemming from the Enlightenment period, and/or 4. A discursive field of knowledge (L. Smith, 1999). According to L. Smith (1999), "colonialism became imperialism's outpost, the fort and the port of imperial outreach....Research within late-modern and late-colonial continues relentlessly and brings with it a new wave or exploration, discovery, exploitation and appropriation" (p. 23-24). Decolonizing methodologies expanded the notion of personal agency by focusing on the goal of self-determination of Indigenous peoples. Self-determination was more than a political goal; rather, self-determination became a goal of social justice expressed through and across a wide range of psychological, social, cultural, and economic levels (L. Smith, 1999). Decolonizing methodologies involved transformation, decolonization, healing and mobilization of Indigenous peoples. Although L. Smith (1999) represented the four states of Indigenous peoples and communities as: (1) survival, (2) recovery, (3) development and (4) self-determination, she stipulated that these conditions were not sequential but fluctuated back and forth. L. Smith's guidelines aimed at respect and protection of the rights, interests, and sensitivities of the researched. These guidelines ensured that research and Indigenous 62 peoples was more respectful, ethical, empathetic and useful. Researcher responsibilities included: • Aroha ki te tangata (a respect for people). • Kanohi kitea (the seen face, that is present yourself to people face to face). • Titiro, whakarongo ... koreto (look, listen ...speak). • Manaaki ki te tangata (share and host people, be generous). • Kia tupato (be cautious). • Kaua e takahia te mana o te tangata (do not trample over the mana of people). • Kaua e mahaki (don't flaunt your knowledge) (L. Smith, 1999, p. 120). From the perspectives of Indigenous peoples, ethical codes of conduct served partly the same purpose as the protocols that governed their relationships with other people and with the environment and land with 'respect' as a key value (L. Smith, 1999). Specific research methods stemming from decolonizing methodologies are articulated in the following chapter. Tenets from L. Smith's decolonizing methodologies for research and Indigenous peoples provided me with key values to conduct the research and analyze the data. In the following section, I proceed to explain how tenets from cultural safety were used to promote reflection and reflexivity in the study in that cultural safety ensured that I acknowledge the presence of power relations and the influences of positionality. 63 3.4 Cultural safety Cultural safety, sometimes referred to as Kawa Whakaruruhau in the Indigenous22 context of Aotearoa/New Zealand, is defined as: The effective nursing or midwifery practice of a person or family from another culture, and is determined by that person or family. Culture includes, but is not restricted to age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief and disability (Nursing Council of New Zealand, 2002, p. 7 as cited in Richardson, 2004, p. 35). During the 1980s in Aotearoa/New Zealand, several Indigenous nursing students identified deleterious effects of the Eurocentric nursing education system on Indigenous nursing students as well as the negative effects of an ethnocentric health care system on the overall health of the Indigenous population (Coup, 1996). Historically, colonizing processes within health care and nursing education disregarded the illness and health beliefs of the Indigenous peoples and privileged those of the dominant 'white' culture in the construction of Aotearora/New Zealand's health care system (Smye & Browne, 2002). In 1990, Irihapeti Ramsden, an Indigenous nursing student and the principal architect of cultural safety, articulated the need for nurses to provide culturally safe care to Indigenous peoples of Aotearoa/New Zealand in recognition of the historical practices within a health care system that failed to recognize Indigenous peoples as a distinct population group (Coup, 1996; Kearns & Dyck, 1996; Ramsden, 2002). Ramsden built 2 2 1 use the term, Indigenous, rather than Maori based upon Linda Tuhiwai Smith's observation that Maori is a label that defines the colonial relationship between the Maori and the Pakeha, the non-Indigenous settlers (1999). 64 her ideas about cultural safety using the work of Paolo Friere, recognizing the potential for educators to perpetuate oppression (Kearns & Dyck, 1996). "The concept of cultural safety provides for the formal recognition of power relations within health care (and particularly nursing) interactions" (Richardson, 2004, p. 35). The main objective of cultural safety was to prevent actions that prompted its inception: disenfranchisement of Indigenous peoples and lack of understanding about the Indigenous models of health and illness (Dyck & Kearns, 1995). Ramsden (1993, 1995, 2000, 2002) worked with Indigenous leaders to develop a model for a negotiated and equal partnership between Indigenous nursing students and nurse educators in Aotearoa/New Zealand's nursing education system. Also in consultation with Indigenous peoples, Ramsden conceptualized a model to address the issue of cultural safety when practicing nursing in a bicultural context, which became integral to the nursing curricula (Browne, 2003; Kearns & Dyck, 1996; Ramsden, 2002). "Cultural safety is, therefore, not about 'cultural practises'; rather, it involves the recognition of the social, economic and political position of certain groups within society, such as the Maori people in New Zealand or aboriginal people in Canada" (Smye & Browne, 2002, p. 46). Starting in 1991, the Nursing Council in New Zealand established a requirement that 20% of the national examination for nursing registration should focus on cultural safety. In other words, nursing graduates were required to demonstrate that they were not only safe academically, clinically, and legally, but that they were also culturally safe in their interactions with Indigenous peoples (Dyck & Kearns, 1995; Ramsden & Page, 1993). According to Kearns and Dyck, 65 The objectives of the Nursing Council guidelines clearly indicate that what is required of students is more than passing familiarity with customs or 'differences.' Rather nurses and midwives are to examine their own cultural realities and the attitudes they bring to their practices; they must be open-minded and flexible in their attitudes toward people from differing cultures to whom they offer and deliver service; and they need to be cognizant of the location of health problems within historical and social processes (1996, p. 372). Nurses, who use cultural safety as a standard of practice, recognize that there is more diversity among Indigenous groups. As well, these nurses acknowledge the position of certain groups such as Indigenous groups within a particular society. "It is how this group is perceived and treated that is relevant rather than the different things its members think or do" (Polaschek, 1998, p. 452). As a researcher, I acknowledged that Aboriginal nursing students would have an array of experiences in their home communities and in the schools of nursing. I ensured that I was aware of the position of Aboriginal groups within Canada by gaining knowledge of the history of Aboriginal peoples and education and by following the media (radio, television, newspapers) with its discourse about Indian-white relations. Nurses, who use cultural safety as a concept, recognize that no health care interaction including interactions between nursing students and nurse educators is ever simply objective. Nurses recognize that they always operate from their own cultural beliefs and mores that influence how they interact with Indigenous clients and/or Indigenous nursing students. "If mitigation of cultural risk is important in health practice it can also be argued that it is an important, indeed, a necessary, requirement of the 66 research enterprise" (Lynam & Young, 2000), p. 8). As a researcher, using cultural safety as a concept, I recognized that no interaction between participants and me was ever simply objective. I recognized that I operated from my own Euro-Canadian cultural beliefs and mores that influenced my interactions with participants. Cultural safety was a key theoretical and methodological perspective in that it facilitated a more reflexive, critical understanding of this research (Richardson, 2004). Nurses' attitudes and values inevitably evolved from their social and political contexts. As such, nurses' attitudes and values are somewhat reflective of the wider community (Richardson, 2004). By incorporating tenets of cultural safety into my theoretical and methodological perspectives, the research assistant and I were constantly poised to be reflexive in regards to our positionality and standpoint. The research assistant was an urban Aboriginal with an undergraduate nursing degree. Her ancestors were from a northern First Nations community and she shared this information about her origins with participants. As a middle-aged, middle class, white researcher, I utilized the relational tenet of cultural safety to challenge my openness to others' viewpoints and my sensitivity to others' standpoints. In addition to being viewed as a process, cultural safety has been regarded as an interpretive lens (Anderson, Perry, Blue, Browne, Henderson, Basu Khan, Reimer Kirkham, Lynam, Semeniuk, & Smye, 2003; Browne, 2003; Richardson, 2004; Smye and Browne, 2002). Cultural safety prompted nurses to ask themselves a series of questions to unmask the ways in which policies, research, education and practices may perpetuate neocolonial approaches to the health care and education of Indigenous peoples. Although cultural safety is applicable to health care services, education, 67 research, and policy across diverse cultural groups, Smye and Browne (2002) believed that cultural safety was particularly useful when examining Aboriginal health. As cultural safety initially was poised to address and promote inequities in the nursing education of Indigenous students, I view cultural safety as being particularly applicable to nursing education involving Canada's Aboriginal peoples, given the historical context of Aboriginal health and education. Using this tenet of cultural safety, questions were facilitated to unmask the ways in which the school's policies were developed and sustained. To be compatible with principles of cultural safety a number of points needed consideration. These points included: the nature of the research question and knowledge it produced, the relationship between the researcher and the 'researched', how culture was viewed and its influences appraised. The research question must be designed to produce knowledge that will be of use to the population of concern" (Lynam & Young, 2000, p. 8). For the purposes of this study, I used tenets of cultural safety to guide specific research strategies. Cultural safety ensured that I engaged in praxis2 3 while conducting the study. These strategies will be discussed in depth in Chapter Four. I proceed to explain how tenets from D. Smith's social organization of knowledge were used to provide a starting and ending point for the research. 3.5 The social organization of knowledge Dorothy Smith initially developed a feminist sociology from the standpoint of women as a critique of mainstream North American sociology (Campbell & Manicom, 2 3 "The advent of the concept of 'praxis' within nursing signified that nursing scholarship had taken a turn beyond preparation of scientists, theoreticians, and practitioners, toward preparation of those who are capable of handling the implications of their ideas within each of these realms" (Thorne, 1997, p. xi). 68 1995). "Established sociology has objectified a consciousness of society and social relations that "knows" them from the standpoint of their ruling and from the standpoint of men who do that ruling" (D. Smith, 1987, p. 2). Smith's sociology for women endured a wider application in that it served to guide research studies of other groups of marginalized people and their social processes, not solely women (DeVault & McCoy, 2001; D. Smith, 1987). This theoretical and methodological perspective evolved over time and its nomenclature changed to the social organization of knowledge (Campbell & Manicom, 1995). Many researchers relied upon the social organization of knowledge in studies about various social processes such as sexuality (Khayatt, 1995; Kinsman, 1995, 2002), health care including nursing practice (Browne, 2003; Campbell, 2000; Kirkham, 2000; Rankin, 2002; Townsend, 1996), education including nursing education (Campbell, 1995; Jackson, 1995; Paterson, Osborne, & Gregory, 2004), other social services (DeMontigny, 1995, 2002; O'Neill, 1998, 2002; Pence, 2002), and political and social activism (G. Smith, 1995). Dorothy Smith conceptualized "reality" as the everyday world, which was subjective, co-constructed, and influenced by its historical and sociopolitical context (1986, 1987). The aim of the social organization of knowledge was to examine the problematic defined as: properties of the social organization of the everyday world in contemporary society, which is only partially discoverable within its scope and the scope of the individual's daily activities. Its local organization is determined by the social relations of an immensely complex division of labour knitting local lives and local 69 settings to national and international social, economic, and political processes (D. Smith, 1986, p. 6-7). The social organization of knowledge involved an ontology that viewed "the social" as the way to shape or rule people's work or activities (DeVault & McCoy, 2001). Other social theorists also adopted this ontology - phenomenology, symbolic interaction, and ethnomethodology (DeVault & McCoy, 2001). Smith expands this through the concept of social relations, which ...refers to the coordinating of people's activities on a large scale, as this occurs in and across multiple sites, involving the activities of people who are not known to each other and who do not meet face-to-face (DeVault & McCoy, 2001, p. 752). "The fulcrum of the social organization of knowledge is the standpoint of the subject, preserving the presence of subjects as knowers and as actors" (D. Smith, 1987, p. 105). Using this tenet from the social organization of knowledge, I was provided with a starting point for the research - exploring the experiences of ANS from the standpoint of the ANS. I needed to acquire rich data from ANS about their educational experiences. Because the social organization of knowledge provided a theorized basis for critically examining textually mediated discourses, researchers then explored how ideas and social forms of consciousness might originate outside of participants' experience. D. Smith (1987) viewed that how people think about and express themselves arises out of their everyday social relations. Ideas and images produced by the dominant social group penetrate the social consciousness of a society and may effectively silence expression of the actual reality that people experience. This ideology offers an analysis 70 that shows how a contradiction can arise between the world as it is known directly in experience and as it is shared with others. The ideas and images fabricated externally to the everyday world may dictate a means to think and envision it (D. Smith, 1987). Using this tenet from the social organization of knowledge, I proceeded to examine how nursing discourse shaped the everyday experiences of ANS. It is necessary to briefly clarify key concepts within Dorothy Smith's social organization of knowledge. In this section, I provide definitions to important terms that interplay throughout this theoretical and methodological perspective. 3.5.1 Social organization Similar to tenets within Aboriginal epistemology that views the world as a social world (Cajete, 1994), D. Smith articulated that the only way a person can be in the world is as a social being. The "social arises in people's activities and through the ongoing and purposeful concerting and coordinating of those activities" (Campbell & Gregor, 2002, p. 27). The depiction of social life is that it is well organized. People's decisions and actions are somehow coordinated with outside events and this "concert" stems from social relations. "It is the interplay of social relations, of people's ordinary activities being concerted and coordinated purposefully, that constitutes 'social organization'" (Campbell & Gregor, 2002, p. 27). 3.5.2 Social relations Social relations are not simply relationships between people such as relationships between students and teachers. Social relations are actual practices and actions through which people's lives are socially organized. "Different individuals, different individual courses of action, enter into relations through which they are 71 organized vis-a-vis one another" (D. Smith, 1999, p. 150). Social relations are courses of action that take place across different social settings. People participate in social relations, often without knowing that they are, as they act with competence and knowledge to concert and coordinate their own actions with particular standards, expectations, or rules. "Smith saw the benefits of being able to make visible as social relations the complex practices that coordinate people's actions across separations of time and space, often without their conscious knowledge" (Campbell & Gregor, 2002, p. 31). 3.5.3 Ruling relations "Ruling relations" denotes more than an imposition of rules. In comparison with L. Smith's decolonizing methodologies for research and Indigenous peoples and cultural safety in their acknowledgement of power relations and positionality, "ruling" reflects the socially-organized exercise of power that shapes people's activities. In her depiction of ruling relations, D. Smith (1987) relied upon the premise that people actually know how to work alongside particular standards, expectations, rules and act accordingly. According to D. Smith, ruling relations are text-based (1999). "Ruling takes place when the interests of those who rule dominate the actions of those in local settings" (Campbell & Gregor, 2002, p. 36). 3.5.4 Texts According to D. Smith (1999), printed and electronic texts are essential to the social organization of knowledge. With the proliferation of texts of all kinds, text-based communication interplays within social relations. People, particularly in occupations in the human services such as nursing and nursing education, conduct their daily 72 activities, work, and studies by following texts, forms, and reports. Texts are important tools and "taken for-granted-instruments for the work" (Campbell & Gregor, 2002, p. 33). D. Smith poses to understand how texts are components within social relations. Texts are viewed as "being like speakers in a conversation; that is, though deprived of the possibility of hearing and responding to us, as nonetheless present and active in 'speaking' to us as our reading activates them" (D. Smith, 1999, p. 135). In contemporary societies such as the Canadian society, texts are commonly involved in the translocal and extralocal processes of administration and governance that constitute ruling relations (D. Smith, 1999). 3.5.5 Experience Similar to Aboriginal epistemology and L. Smith's decolonizing methodologies for research and Indigenous peoples, experience has both conceptual and methodological centrality. Experience "is the ground zero of the analysis. The analysis begins in the participants' experience and returns to it, having explicated how the experience came to happen as it did" (Campbell, 1998, p. 56). "The conceptual importance of experience lies within the ability to provide people with a "real-life context" to reflect upon one's activities and their effects on other peoples' lives" (Campbell & Manicom, 1995, p. 7). Campbell and Gregor (2002) referred to embodied knowing as a crucial theoretical point in the social organization of knowledge. Human beings know through having a body and having a consciousness (D. Smith, 1990). The methodological importance of experience is that it provided me as the researcher with a standpoint, a place to start and end the inquiry, to demonstrate its purpose. "Beginning in experience helps the researcher identify 'whose side she is on,' 73 while constructing an account that can be trusted" (Campbell & Manicom, 1995, p. 7). Participants are viewed as the "knowers" and the research assistant and I chose to think of the ANS as the experts in knowing their experience. This approach kept the ANS at the centre of the analysis. By maintaining a standpoint in the ANS's everyday world, I analyzed how the ANS' world was socially organized. By working closely with the research assistant and the Advisory Council, I focused on the standpoint of the ANS. I then proceeded to examine the "discourse as the organizer of experience while maintaining one's analytic interest in the subject, the knower" (Campbell & Gregor, 2002, p. 40). I explored how nursing discourse shaped the ANS' experience. 3.6 Chapter summary In this chapter, I explained chosen tenets from Aboriginal epistemology, L. Smith's decolonizing methodologies of research with Indigenous peoples, Ramsden's cultural safety, and D. Smith's social organization of knowledge that influenced the ways that I studied ANS' everyday experience and the ways in which the social, historical, ideological, and political construction of nursing education shaped ANS' experiences. These theoretical and methodological perspectives provided me with a panoramic lens to view social structures and power issues within schools of nursing. Social structures and ruling relations required examinations within their social, historical, ideological, and political contexts. These theoretical and methodological perspectives provided a broadened scope and increased depth to guide me in the examination of how the historical, sociopolitical, cultural, and ideological context shaped ANS' experiences in a predominantly Euro- 74 Canadian educational setting (Townsend, 1996). D. Smith's social organization of knowledge provided a starting point for the research - the experience of the ANS. In Chapter Four, I outline the research strategies and explain how the theoretical and methodological frameworks were used to guide my approach. By engaging critically with the theoretical and methodological perspectives and being conscientious of reflection and reflexivity specified by cultural safety, I promoted a study whereby the theory grows out of the context-embedded data - not data being categorized by theory. 75 4 M E T H O D O F I N Q U I R Y There is no "one way" to conduct an IE [institutional ethnography] investigation; rather, there is an analytic project that can be realized in diverse ways. IE investigations are rarely planned out fully in advance. Instead, the process of inquiry is rather like grabbing a ball of string, finding a thread, and then pulling it out; that is why it is difficult to specify in advance exactly what the research will consist of. IE researchers know what they want to explain, but only step by step can they discover whom they need to interview or what texts or discourses they need to examine (DeVault & McCoy, 2001, p. 755). 4.1 Introduction Given the background to this study, current knowledge about ANS' experiences, and the theoretical and methodological perspectives guiding this study, it was logical for me to choose a critical ethnography as a method of inquiry. I delineate how I incorporated specific aspects of Aboriginal epistemology, decolonizing methodologies for research and Indigenous peoples, cultural safety, and the social organization of knowledge into the method of inquiry. In this chapter, I describe the research design and its implementation to study the experience of ANS and the context that shaped it. I follow with a discussion of how scientific and ethical quality was established. Finally, I conclude the chapter with a brief summary of the method of inquiry. In choosing the design, I asked myself these questions: (1) How does the design connect to the theoretical and methodological perspectives - how do the empirical materials inform and interact with the paradigm? (224) Who or what will be studied? (3) What strategies can best address the research questions? (4) What strategies of inquiry will be used? in addition (5) What methods will be used for collecting and analyzing I use the word, paradigm, to designate worldview. A paradigm consists of several elements: epistemology, ontology, methodology, and axiology. Guba and Lincoln (1994) delineated the major paradigms and perspectives as positivism, postpositivism, constructivism, and critical theory (where I locate feminisms). 76 empirical materials? (Denzin & Lincoln, 1998). In the following section about the method of inquiry, I address the answers to these aforementioned questions. 4.2 Critical ethnography/Institutional ethnography In 1986, Dorothy Smith proposed a research strategy for studying the social organization of knowledge, aiming to explicate the actual social processes and practices that organize people's everyday/everynight lives (D. Smith, 1986). In her research strategy, researchers understand that everyday life is "constituted by people whose activities are coordinated in specific ways" (Campbell & Gregor, 2002, p. 69). For that reason, data that captured rich details and the contextual aspects of ANS' experiences was necessary for the study. Data included interviews and fieldwork about (a) the everyday lives of ANS from the standpoint of ANS, (b) faculty's experiences teaching ANS, (c) the context shaping ANS' experiences, along with (b) a collection of texts, such as the schools' policies and procedures, nursing textbooks and course syllabus, websites among others to map how the everyday world of ANS was organized by people in an extralocal setting (Campbell & Gregor, 2002). Institutional ethnographers explore a particular problematic in explicating what is happening in a local setting, as people know and live it there. The notion of explication is important - it is the analytic core of the research process in institutional ethnography. We say that researchers begin in the everyday world, collect data about it, and proceed to explicate a problematic by going beyond what can be known in any local setting. There are really two levels of data and data collection involved in explication. Data collection has to expand beyond what people in the local setting know and do...To understand the workings of any 77 setting involves learning how people, seemingly positioned outside the setting, are nevertheless active inside it (Campbell & Gregor, 2002, p. 59-60). For various personal and professional reasons, the study actually evolved over time. I began conducting the research in 2002-3. After many hours of fieldwork and difficulty recruiting ANS, I took a leave of absence from the doctoral program to grieve a significant loss in my family. During this time away from the doctoral dissertation, I reflected upon the fieldwork and developed revisions to the research design. I re- entered the doctoral program in 2004-5 and resumed the fieldwork in the same research settings with revisions to recruitment and design. Reflexivity and discussions with members of the Advisory Council and my thesis committee were crucial in that these dialogues helped me to process the need to hire a research assistant (RA) using these criteria: (a) Aboriginal ancestry; (b) experience as a student nurse, (c) good listening skills, and (d) experience in health related research. In July, 2004, I hired Ms. Ardelle Kipling, RN, BN, to work with me to recruit ANS, conduct interviews with ANS, conduct fieldwork in the schools of nursing, analyze several transcripts of interviews with ANS, and co-present findings of the research via paper presentations and publications. I acquainted the RA with the study by providing her with a copy of my application for ethical approval. I provided the RA with the interview guide. We met to discuss interviewing techniques and revised the interview guide to emulate the RA's voice, not mine. The theoretical and methodological perspectives guided the interview process in that I wanted to gather data experientially, in context, and in relationships characterized by empathy and egalitarianism (Heyl, 2001). 78 Incorporating aspects from decolonizing methodologies and cultural safety, the RA and I worked as a team in informal and formal meetings with ANS and faculty in the research settings and with Aboriginal nurses in the wider nursing community. We held informal meetings with the president of the Aboriginal Nurses Association of Canada to discuss the experiences of ANS and our plan to disseminate the study's findings. A nursing faculty member contacted me about a symposium about Aboriginal Nursing Education chaired by the ANAC in Ottawa, Ontario, Canada and invited me to attend based on a suggestion by an administrator. At the symposium, I networked with Aboriginal nurses and other educators who recognized the influences of colonialism and internal neo-colonialism on nursing education of Aboriginal peoples in Canada. Another strategy to connect with ANS and establish the notions of trust and respect included holding one-hour informal information sessions at the research sites about the study. The other purpose of these sessions was to recruit potential participating ANS. I held formal meetings with the RA and chief administrators of the schools of nursing to establish rapport and ensure administrative support for access to the institutions (Campbell & Gregor, 2002). In the following sections, I describe the implementation of studying the local setting of the two schools of nursing as well as the translocal and extralocal influences using specific aspects from the theoretical and methodological perspectives categorized by important components of qualitative methods: • Sampling including settings and sources of information such as individuals and texts, • Relationship between the researcher and those studied, 79 • Data collection, and • Data analysis. 4.2.1 Sampling Sampling includes what times, settings, or individuals are selected to observe or interview, and what other sources of data are utilized. "Purposeful/theoretical sampling attempts to select research participants according to criteria determined by the research purpose but also guided by the unfolding theorizing" (Tuckett, 2004, p. 53). Within my explanation of sampling, I describe these important components: (a) research settings, (b) gaining and sustaining access to the settings, and (c) description of the sample. Research settings I used purposeful/theoretical sampling in that I deliberately selected two Canadian schools of nursing25 as the research sites based upon criteria. I sought schools of nursing that were actively recruiting Aboriginal peoples into their programs. It would have been illogical to conduct the study in a school of nursing that lacked ANS. At one school of nursing, approximately 2% of the student body identified themselves as being Aboriginal, while at the second school, 11% of the student population was comprised of Aboriginal students. Travel costs and ethical considerations influenced my choice of settings. For example, it would be cost prohibitive to travel 2000 miles away to conduct the research in Halifax, Nova Scotia. I also limited the research settings to the classroom and laboratory settings within the schools because the inclusion of clinical practice sites Schools of nursing located within universities are referred to as either faculties or schools depending upon specific criteria. Schools of nursing located within colleges are known as schools. To protect the identity of participants, I refer to the research sites as schools of nursing. 80 would require acquisition of informed consents from patients, family members, nurses, and other health care professionals and that process would have been overly daunting. My standpoint provided me with insight into the diversity of Canada's Aboriginal population, Aboriginal health and education issues, and the current shortage of nurses in Aboriginal communities. You begin your research training from your own place with particular background experiences and expectations...Rather than treating a knower's location as a problem of bias, we believe it reveals something about whose interests are served. And that is an issue of power (Campbell & Gregor, 2002, p. 14-15). I was aware of the invisibility of Aboriginal issues within the media and urban culture. My past experience as a nurse educator provided me with some knowledge of the scope of the curricula and pedagogy offered to ANS. As explained in Chapter One, my experience led me to question how ANS' experiences were organized - by whom and by what. One school of nursing was located in a modern sterile building with a spacious lobby. Classrooms, practice laboratories and faculty offices were typically located within this one building. The other school of nursing was situated in an older cramped building that emulated a high school environment with some faculty offices and practice laboratories located in other areas of the campus. Aboriginal Student Resources were located at both educational institutions; these resources were located within walking distance from the schools of nursing. During 2002-3, fieldwork at the first school of nursing was comprised of 150 hours in classrooms and laboratory practice sessions with participating ANS and faculty. 81 The numbers of students attending each classroom or laboratory session varied from five to a 150 students. During 2004-5, the RA and I conducted another 50 hours of fieldwork at both research sites. During 2002-3, I conducted one interview outdoors on a park bench and another one in a coffee shop because I lacked an on-site interview room. In 2004-5, the RA and I negotiated access to interview rooms at both sites. Gaining & sustaining access Gaining and sustaining access to the research setting and participants was a crucial component in this study. I discuss gaining and sustaining access to the research setting in terms of gaining and sustaining access to the: (a) advisory council, (b) setting, (c) ANS, (d) nursing faculty, and (e) key informants. Advisory council Because of my standpoint as a Non-Aboriginal nurse with experience as a nurse educator, the chair of my thesis committee and I decided that it would be highly beneficial for me to recruit several Aboriginal nurses for advisement. The advisory council was comprised of five Aboriginal nurses who volunteered to participate. The purpose of the advisory council was to provide me with expertise about ANS' experiences and advice if I came upon issues in conducting research with Aboriginal peoples. Prior to recruiting ANS, faculty, and key informants, I approached an executive member of the Aboriginal Nurses Association of Canada to contact Aboriginal nurses of that person's choice to ask them if they would be available and interested in providing me with advice about conducting the study. The executive member contacted several Aboriginal nurses (I was unaware of the names of the individuals at that time) who 82 agreed to become members of the advisory council. One Aboriginal nurse was referred to me by a member of my thesis committee. I identified another Aboriginal nurse during an annual meeting for the Aboriginal Nurses Association of Canada. From these sources, I successfully recruited five Aboriginal nurses to assume the roles of advisory council members. I consulted the advisory council several times during data collection and analysis. The advisory council provided me with insight into problems with recruitment. I also shared preliminary findings with the advisory council members to see if the findings resonated with their experiences as student nurses in Canada. Two advisory council members also volunteered to participate in a one-hour audio-taped interview with me to share their experiences as ANS. These nurses' stories provided me with a historical perspective about ANS' experiences in Canadian schools of nursing as their experiences occurred up to 20 years ago. Upon completion of the thesis, advisory council members will receive a "thank you" card for their time and effort in offering me their insights into ANS' experiences and conducting research with ANS. I will include a copy of the executive summary of the study. Research setting With 30 years experience in nursing, I was familiar with some health care and educational administrators and nursing faculty. This prior contact eased the negotiation of my entry into both research settings. "There are people to meet and talk to about the research plan. There are formal relations to be negotiated consisting of issues of access - permissions, approvals, ethical reviews, and organizational and individual 83 consents" (Campbell & Gregor, 2002, p. 61). I sent chief educational administrators26 at two Canadian schools of nursing a letter to inform them of the proposed research study and to ask them for permission to conduct the study at their particular school of nursing. Chief administrators responded with a letter informing me that upon ethical approval, they would provide me with permission to access the schools of nursing. Ethical approval was acquired from Research Ethics Boards at the University of British Columbia and the two research sites. Upon acquisition of ethical approval, I contacted the chief administrator at the school of nursing that I will refer to as research site #1 and I met with the administrator to provide more information about the study. At this time, I decided to focus recruitment and data collection at site #1 due to a pervasive feeling of being overwhelmed by the process of recruitment and data collection at more than one research site. Prior to revisions to the research design in 2004-5, I held informal and formal meetings with chief administrators to inform them of the upcoming "restart" to my doctoral dissertation. One administrator suggested that I contact a health care administrator about recruitment strategies in that a health care agency had recently recruited several ANS to a meeting at the school of nursing. I contacted the administrator at the health care agency, who provided me with several useful suggestions based on their recruitment efforts. The chief administrators offered other suggestions that supported other strategies including: (a) hiring an Aboriginal research 2 6 In Canada, chief administrators of faculties of nursing are known as deans and chief administrators of schools of nursing are referred to as directors. To protect the identities of participants, I will simply designate chief administrators to describe people deemed to be leaders and primary decision-makers within the designated institutions. 84 assistant (RA), and (b) providing ANS students with an honorarium for participating in the interview process. I submitted applications for ethical approval of necessary revisions to the research design and requests for time extensions due to my leave of absence from the doctoral program. Concomitantly, I sent letters to the chief educational administrators requesting their continued support for the research (see Appendix A). Upon acquisition of ethical approval, I contacted chief administrators from the research sites and arranged a meeting to: reintroduce myself and the research topic, introduce the RA, discuss recruitment strategies and request resources such as an interview room. Chief administrators were informed that data collection was completed. Upon completion of the thesis, I will provide chief administrators with an executive summary of the study focusing on findings arid recommendations. At each research site, the RA and I will facilitate a seminar to share findings with the nursing faculty and devise innovative and collaborative teaching strategies and recommendations for policy development. Aboriginal nursing students Since the study focused on the experiences of ANS, I relied on the underlying tenets from D. Smith's social organization of knowledge and its related method of inquiry, institutional ethnography (IE), to frame the sampling strategies. To recruit ANS in 2002-3, a staff member of the schools posted advertisements for participants on bulletin boards located in various hallways of the building. I sent e-mail letters to course leaders, asking them to provide me with permission to visit their classrooms and spend five to ten minutes introducing myself, the study, and requesting that students who 85 identify themselves as being of First Nations ancestry27 volunteer to participate. At this time, I did not provide participating ANS with an honorarium. To recruit ANS in 2004-5, the RA and I used letters, posters, informal information sessions, and classroom visits by the RA (as per nursing faculty members' choice - see Appendix B for e-mail to faculty). Staff members from the schools posted advertisements for participants on bulletin boards, beside elevators, and outside faculty members' offices at the beginning of the fall session in 2004. These posters (see Appendix C) served to: 1. Invite ANS to attend a one-hour informal information session with refreshments offered, 2. Invite ANS to participate in a one hour audio-taped interview, 3. Provide information that ANS who participated in the interview would receive a $30.00 honorarium , and 4. Provide the RA's contact telephone number and e-mail address. I provided both sites with form letters written and signed by the RA, inviting ANS to participate (see Appendix D). The letters reiterated information from the posters and added information about the purpose, benefits, and risk of participating in the study. Chief administrators or designates were asked to X-press Post these letters to students who had identified themselves to the postsecondary institutions as having Aboriginal28 ancestry. 2 7 This nomenclature proved to be problematic in that students perceived that the study's inclusion criterion was only students who identified themselves as Status Indians or Treaty Indians. 2 8 In an interview with a key stakeholder, I acquired information about post-secondary educational institutions and their record keeping. In 2003, post-secondary educational institutions in this province began to keep records about the numbers of students who were Aboriginal. Upon registration, students were asked to self identify. It is recognized that many Aboriginal students will not self identify based upon past and present negative experiences if they are labeled as being Aboriginal. Although these records 86 Staff members at the first school of nursing informed me that it was difficult for them to access the list of Aboriginal nursing students' names and mailing addresses, so they elected to provide these letters to a student counselor who distributed them to ANS. I was becoming aware of the fact that "organizations typically exercise caution about disclosing organizational information" (Campbell & Gregor, 2002, p. 63), especially when the information was sensitive and private in nature, although I had constructed an ethically approved process whereby I was unaware of students' names and addresses. Twelve ANS received the letter via hand delivery from an Aboriginal student services support person. Following proof, in the form of a facsimiled copy, that I acquired ethical approval from school #2, a designated faculty member mailed the letters via Xpress Post to ANS from the educational facility's list of self-identified ANS. As well, nursing faculty chose to introduce and discuss the posters in their classes. "Besides convincing organizational leaders to cooperate with the research, researchers must interest ordinary members in acting as informants" (Campbell & Gregor, 2002, p. 64). The RA and I held a 60-minute informal information session for ANS in rooms at both research sites. Given our knowledge of the limited financial resources available to ANS and following L. Smith's recommendation to be generous (1999), we provided more than ample refreshments for interested ANS. The RA and I encouraged ANS to take refreshments home to their families that were gratefully accepted. Information sessions to students were informal. To begin the information sessions, I briefly introduced myself and provided information about the background and are an inaccurate reflection of the actual number of Aboriginal peoples enrolled in post-secondary education, a list of Aboriginal students exists. 87 nature of the study. I explained why I was interested in learning about ANS' experience. The RA then introduced herself by including information about her ancestral roots and the northern Aboriginal "places" or communities where her family originated. The RA then provided information about the interview process and discussed how we would protect students' identities. Interested students were asked to leave their names and telephone numbers with the RA. A total of 24 ANS attended the information sessions. Attendees were encouraged to "spread the word" that we wanted to hear the stories from all ANS. The RA then contacted ANS who left their names and numbers with her at the information session. The RA also contacted ANS who e-mailed or telephoned her indicating interest in the study or interest in participating because of the letter, poster, or word of mouth. Access to participating ANS was sustained through mutual respect during the interview process. Reciprocity was attained as ANS were provided with an honorarium for their time. As well, the RA informed students that they would be provided with a summary of the study's findings upon completion of the thesis. Prior to submitting the first paper presentation, the RA and I decided that we needed further permission from the ANS to use specific quotes. The RA telephoned the corresponding participants and asked for permission to use their quotes. The RA explained the context in which their quote would be used to illustrate points. Each student permitted us to use their quote and informed the RA that they wanted others to learn about their experiences. Upon completion of the thesis, the RA and I will provide ANS with a letter thanking participants with an enclosed summary of the study's findings. 88 Nursing faculty To recruit faculty in 2002-3, I presented a 20-minute overview of the research proposal to nursing faculty. An e-mail letter was sent to all nursing faculty, inviting them to attend. A total of twelve faculty members participated in my presentation. In 2004-5, I invited faculty to participate by sending them a letter via e-mail forwarded to them by the chief administrator (see Appendix B). Based on preliminary findings from 2002-3, I was interested in recruiting student advisors and clinical teachers about their experiences with ANS, so I especially targeted this group by a specific letter in their mailbox (see Appendix E). Upon completion of the thesis, the RA and I will offer a seminar to nursing faculty at the two research sites to present the study's findings and facilitate collaboration in devising recommendations to promote more inclusive teaching strategies. Participating faculty will be provided with a summary of the study's findings. Key informants I employed a purposive/theoretical sampling strategy in the recruitment of key informants to fully elaborate and validate theoretically derived variations discerned in the data (Campbell & Gregor, 2002; Sandelowski, 1995). Through participating ANS and faculty members' stories and descriptions, I began to identify some of the "translocal relations, discourses, and institutional work processes that are shaping the informants' everyday work" (DeVault & McCoy, 2001, p. 755). I was interested in moving beyond the interchanges of the local schools of nursing to track the macroinstitutional policies and practices that organized the research setting (DeVault & McCoy, 2001; Paterson, Osborne & Gregory, 2004). As one of the concluding 89 questions in the semi-structured interview guide was "if you were conducting this study, whom would you approach for information about the social factors that influence the experiences of Aboriginal nursing students?" (see Appendix F), I relied upon my insights and these referrals to identify individuals deemed knowledgeable about the context shaping ANS' experiences. "Interviewees will be chosen as the research progresses, and as the researchers learn more and more about the topic. She will see what she needs to know and will find out who would know it" (Campbell & Gregor, 2002, p. 77). I sent a letter via Canada Post or e-mail, inviting key informants to participate in a one hour audio-taped interview (see Appendix F). Ten individuals identified as possible key informants did not respond to my letter inviting them to participate. In 2004, I placed an advertisement in a quarterly nursing journal entitled, Aboriginal Nurse, distributed by the Aboriginal Nurses Association of Canada to approximately 350 of its members. The advertisement asked interested Aboriginal nurses to contact me if they were willing to share their stories about their educational experiences. No honorarium was offered. One nurse contacted me after seeing the advertisement, but we were unable to schedule an interview at that time. At the beginning of each interview with ANS, faculty, and key informants, participants were notified that a summary of the study's findings would be sent to them, if they chose to provide an e-mail address or mailing address. During the interviews with ANS, the RA brought and shared information about funding sources for ANS to the interview as per L. Smith's research agenda (1999). The interviews were semi- structured (see Appendix G for interview guides) and participants were encouraged to "take the RA wherever they wanted to go." As recommended by DeVault (1990), 90 "researchers need to interview in ways that allow the exploration of incompletely articulated aspects of women's experiences" (p. 100). To ground the interviewing in accounts of the ANS' everyday experiences, we needed to carefully listen to find dues to ANS' social relations in the interviewee's "talk" (DeVault, 1990). Talk about the work undertaken in a setting offers clues to how social relations that operate across boundaries organize it...Embedded in informants' talk about their work, generously defined, is their tacit knowledge of how to do it, how to concert their own pieces of the work with the work of others and how to work with the texts that coordinate action" (Campbell & Gregor, 2002, p. 79). At the completion of the interview, the RA provided ANS with a "thank you" card signed by the RA and me, along with the enclosed honorarium in cash. Findings of the study will be shared with ANS in the form of a summary mailed via Canada Post or electronically. When the RA and I began to experience hearing similar stories and redundancy about the social organization of nursing knowledge and the social relations that organized ANS' everyday lives, we discussed the stories and our analysis of transcripts. Upon saturation of the data and consultation with the thesis committee, we halted recruitment or sampling (Tuckett, 2004). I notified chief administrators of the schools that we had acquired an adequate sample size, recruitment strategies were successful, and data collection was completed, and thanked them for their support. Description of the sample The sample was comprised of 31 ANS, 5 Aboriginal nurses, 24 nursing faculty members, 16 key informants, and 135 texts. My description of the purposive/theoretical 91 sample includes an overview of participating ANS and Aboriginal nurses, nursing faculty, key informants, and texts. I explain how I shifted the investigation from studying the experiences of ANS from the standpoint of ANS to an examination of the translocal and extra local settings to analyze how ANS' experiences were socially organized. Eventually, however, the researcher will usually need to shift the investigation to begin examining those institutional processes that he or she has discovered to be shaping the experience but that are not wholly known to the original informants. Thus a second stage of research commonly follows that usually involves a shift in research site, although not in standpoint. Often, this shift carries the investigation into organizational and professional work sites...the researcher may use text and discourse analysis to examine the textual forms and practices of knowledge that organize those work processes. But interviews continue to play an important role here as well, whether as the primary form of investigation or as a way of filling in the gaps of what the researcher can learn through observation and document analysis (DeVault & McCoy, 2001, p. 756). Sampling numbers or the "n" reflects the summation of the number of interviews, participant observations, journal entries, and texts from the schools of nursing and professional nursing associations (Sandelowski, 1995). The total number of participants was 76. Thirty-one interviews were conducted with ANS. Five interviews were conducted with Aboriginal nurses to gather historical information about the experiences of ANS. I interviewed 24 nursing faculty members to grasp an understanding of the translocal and 16 key informants to gather their perspectives of the broader social context shaping ANS' experiences (extralocal). 92 I conducted 150 hours of fieldwork in one school of nursing in 2002-3. The RA conducted 39 hours of field work at two schools of nursing, while I conducted an additional 11 hours of fieldwork in both research settings in 2004. The total number of fieldwork hours was 200. Fieldwork included our observations of meetings with administrators and staff from both sites during access negotiations. In 2002-3,1 documented field notes of my experience in classrooms and laboratory practice sessions as I "shadowed" two ANS as they attended lectures and laboratory practice sessions. I observed six participating nursing faculty members as they taught ANS and other students in the classroom and lab. Fieldwork also included the RA's and my observations of the setting prior to, during, and after each interview with participating ANS and faculty. Overview of Aboriginal students and nurses In discussions with my committee during the proposal phase, I hoped to recruit at least 30 ANS based upon an ethnographic study of ANS, in which Ryan (1992) examined the local setting of a Western Canadian school of nursing. Sandelowski (1995) explained that inadequate sample sizes could hamper the credibility of qualitative research findings. As cited in Sandelowski (1995), Morse recommended that some ethnographic studies directed towards examining experiences should include 30 to 50 interviews and/or observations (1994). Of course, I was deeply concerned in 2002-3 when only two ANS were recruited. Adequacy of sample size in qualitative research is relative, a matter of judging a sample neither small nor large per se, but rather too small or too large for the 93 intended purposes of sampling and for the intended research product (Sandelowski, 1995, p. 179). In 2004, the RA recruited and conducted 29 interviews with ANS in a 6-week time frame, making the total number of participating ANS to be 31. Additionally, I conducted interviews with five Aboriginal nurses (two of these participants were also members of the advisory council). I contacted these individuals and they agreed to volunteer and tell me about their educational experiences in Canadian schools of nursing. This data helped me further examine the historical context that shaped the everyday world of ANS in that these nurses acquired their nursing education several years ago to 20 years ago. Their stories were rich in data as these individuals had time to reflect upon their past experiences as ANS. Because we advertised for ANS and nursing faculty to participate in the study, we could not select participants other than stipulating that participants were included if they were ANS enrolled in the participating schools. These participants volunteered to tell their stories about their experiences in the schools of nursing. This type of sampling technique is known as secondary selection (Morse, 1998). Maximum variety sampling, however, was eventually accomplished in that the sample of ANS became heterogeneous and included these demographic variables: (a) gender - male and female, (b) community of origin - urban or rural (northern), (c) status - First Nation or Metis, (d) age range - young adult to middle-aged, (e) relationship status - single, partnered, (f) number of dependents - zero to eight, (g) year in nursing program - one to four, (h) admission procedure - nursing access program versus typical "mainstream" admission, (i) funding - Band funded, Canada Student Loan, or other sources. These 94 kinds of demographic variations were exactly what we hoped to acquire in the sample of ANS. "The researcher's purpose in an IE investigation is not to generalize about the group of people interviewed, but to find and describe social processes that have generalizing effect" (DeVault & McCoy, 2001, p. 753). I need to clarify that we were not aiming for categorical descriptions, but for various ANS' experiences in our analyses that mapped how the ANS' everyday life was drawn into a common set of organizational processes. I conceived this kind of selection in terms of diversity of ANS' experience rather than categorically (DeVault & McCoy, 2001). For example, I was able to gather a diversity of ANS' experiences in that 9 ANS grew up in large cities while 27 ANS relocated to an urban centre from northern Aboriginal communities to acquire their nursing education. This diversity in the ANS' past experience aided my data analysis in that I was able to map how the diversity of experience was still drawn into a common set of coordinating and organizing processes in the institution. Thus interviewees located somewhat differently are understood to be subject, in various ways, to discursive and organizational processes that shape their activities. These institutional processes may produce similarities of experience, or they may organize various settings to sustain broader inequalities (DeVault & McCoy, 2001, p. 753). While 21 ANS entered into nursing education via an available access program, 15 ANS entered the school of nursing as "mainstream" students so I was able to compare availability of resources to these diverse groups with inequalities of services available to the "mainstream" students. Please see the Table 2 on page 99 with my description of the sample. 95 Table 2 Profile of participants Description (Benderi Descent Admission Funding' Origin Relationship Number of $ource! ^Status Dependents ANS* n=31 Aboriginal Nurses n=5 Male=2 Female=34 FN** = 28 Metis = 8 Access*** = 21 Regular = 15 Band+ = 28 Student Loans = 4 Other=4 Urban = 9 Rural or northern = 27 Single++=15 Partnered = 21 0 = 12 1-3 = 18 4 - 8 = 6 Faculty n=24 Male=1 Female=23 0 Key Informants n=16 Male=3 Female=13 FN=4 Metis=1 Note. Total number of participants - 76. * A N S were recruited from 2 Canadian schools of nursing and represent various years in undergraduate nursing programs. 2 students recently exited the nursing program. ** FN designates that participants identified themselves as having First Nations ancestry. "First Nations" has gained wide acceptance in Canada since the early 1980s, promoted from within the Indigenous community as a substitute for band in referring to any Aboriginal group formally recognized by the government. While it includes Status, Non-Status, Treaty, Non-Treaty Indians, it specifically does not include people that identify themselves as having Inuit or Metis ancestry. Whereas, M designates Metis which is a term used to describe descendants of Indigenous peoples and French settlers or fur traders. *** Access programs were established to assist academically, economically, and socially disadvantaged residents to facilitate their pursuit and acquisition of a postsecondary education. Access programs provide a preparatory year, tutoring, bursaries, and personal counseling. + Successful First Nations applicants acquire sponsorship from their Band to cover tuition, some books, and a negligible living allowance. ++ 2 5 % of participating A N S identified themselves as single with dependents. 96 Nursing faculty In 2002-3, 15 faculty members participated in the study. I conducted one-hour semi-structured audio taped interviews with nursing faculty who volunteered to participate. In 2004-5, another 9 faculty members volunteered to participate. Of these, three teachers participated in a focus group (by their choice), which was moderated by me. The purposive/theoretical sample of nursing faculty was 24. Most nurse educators were female, white and middle-aged. One faculty member was male. Numbers of years experience in nursing education varied from 1 - 2 5 years, but the majority had over 10 years experience. Most faculty members were involved in classroom or laboratory sessions, while four faculty members assumed the roles of clinical teachers. Although I had specifically recruited student advisors and clinical teachers, only two student advisors and four clinical teachers volunteered to participate. During the latter portion of data collection, interviews with educational administrators were conducted (DeVault & McCoy, 2001). To protect the identities of educational administrators, I categorized them as nursing faculty. I focused my questions on trying to uncover the social and textual organization of the school's position about recruiting and retaining ANS (DeVault & McCoy, 2001). Key informants Key informants were recruited based upon perceptions of their knowledge about the broader context shaping ANS' experiences. The total number of key informants was 16. I conducted face-to-face interviews with all key informants in their offices. Two participants requested to be interviewed together. Interviewing is: 97 driven by faithfulness to the actual work processes that connect individuals and activities in the various parts of an institutional complex. Rigor comes not from technique - such as sampling or thematic analysis - but from the corrigibility of the developing map of social relations (DeVault & McCoy, 2001, p. 764-5. Texts The majority of texts referred to by ANS and Aboriginal nurses were performance improvement plans (PIPs), clinical evaluation forms, and course syllabi. To discern how nursing knowledge was socially organized, I randomly purchased a nursing textbook and course syllabus from one nursing course in each year. Nursing faculty members also talked about PIPs, clinical evaluation forms, and course syllabuses. Several nursing faculty members provided me with a blank copy of a PIP. Key informants talked about admission policies and procedures for ANS and access students. I gathered these texts about the admission policies from the appropriate departments at the postsecondary institutions. Texts appear in people's talk because they are an integral part of what people do and know. The texts that researchers see being used by informants during field observations are often central to everything that happens. Therefore to understand the setting and explicate the problematic arising in it, texts are a very useful ethnographic data source (Campbell & Gregor, 2002, p. 79), I also collected mission statements and reviewed websites from the schools of nursing, access programs, major employers of Aboriginal nurses, and the provincial nursing association to analyze mission statements, policies and procedures. The total number of texts collected was 135. 98 A common aspect of IE research at this second stage involves the researcher's investigating institutional work processes by following a chain of action, typically organized around and through a set of documents, because it is texts that co- ordinate people's activity across time and place within institutional relations (DeVault & McCoy, 2001, p. 756). 4.2.2 Relationship between researcher and researched An important component of qualitative methods is the relationship between the researcher and those studied. Due to the nature of the study, I tried to establish rapport with ANS, Aboriginal nurses and key informants. "Your relationships with the people in your study can be complex and changeable, and these relationships will necessarily affect you as the 'research instrument,' as well as have implications for other components of your research design" (Maxwell, 1998, p. 86). Reflexivity was often used to reflect the unavoidable mutual influence of the research participants and the researcher on each other (Maxwell, 1998). Throughout the study, I reflected on my role in the relations of the ruling and documented these reflections in a detailed journal via field notes (Smith, 1987). Important concerns were the power of the researcher in relation to the researched and existing power relations in the research setting, and how research knowledge was going to be used (Campbell & Gregor, 2002). "For institutional ethnographers, the conceptualization of power as ruling is decisive for how the inquiry is taken up" (Campbell & Gregor, 2002, p. 67). Using the social organization of knowledge as a theoretical lens, I was required to assume the standpoint of the researched - the ANS, share findings, and work with 99 ANS and/or Aboriginal nurses to enhance the educational experiences of Aboriginal people in nursing. The RA and I debriefed on a biweekly basis to discuss situations and circumstances in which it was easy or difficult for us to assume the standpoint of ANS. A notion of strong reflexivity would require that the objects of inquiry be conceptualized as gazing back in all their cultural particularities and that the researcher, through theory and methods, stand behind them, gazing back at his own socially situated research project in all its cultural particularity and its relationships to other projects of his culture—many of which (policy development in international relations, for example, or industrial expansion) can be seen only from locations far away from the scientist's actual daily work (Harding, 1991, p. 163). Anderson (1991) noted that empowerment began within the actual research encounter. For example, when interested ANS were contacted to arrange an interview date and time, they were requested to choose a convenient interview date and time and during informal information sessions, ANS were provided with information about the Aboriginal Nurses Association of Canada, which articulated sources of bursaries and student loans. My power as the researcher was complicated by the fact that I was a Non- Aboriginal researcher and former nurse educator studying ANS' experiences (Alcoff, 1991; Ramsden, 2002; L. Smith, 1999). To advise me on how to redeem a more-equal relationship with participants, I consulted the RA and the five Aboriginal nurses that were members of the advisory council. The advisory council members initially reviewed a summary of the findings of the first few transcripts and took part in one teleconference 100 where I pondered the ANS' reticence to participate in the study. I provided up-dates to the advisory council members about the research process on a biannual basis. The RA and I sent an initial draft of a paper to advisory council members for their perusal. I informally met with several advisory council members. Although I conducted 150 hours of fieldwork over two sessions at one school of nursing (site #1), I was only able to recruit two ANS into the study during 2002-3. During the fieldwork, one ANS was slightly uncomfortable with my presence in the laboratory practice sessions until I contributed to learning by being a "mock patient." In the subsequent interview, this ANS said that the reciprocity of the relationship was an important feature that facilitated a comfort level between us. During fieldwork with another ANS, the student began to question the actual purpose of the fieldwork when I loaned her and other students reference material for an assignment. The ANS did not understand that I was attempting to use reciprocity in the research relationships; rather, she questioned if I was aligning myself with Non-Aboriginal students. In the interview process with ANS in 2002-3,1 brought cups of coffee for the interviewees. I tried to emulate that I was a researcher and a person who believed that ANS were the experts about their experience. Based upon excerpts of these first two transcripts, field notes, and the fact that I had limited success in the recruitment of participants, I deduced that ANS were reticent to share their experiences with a Non- Aboriginal, white, middle-aged doctoral student and former nurse educator (Martin, 2002). In the field, I noted that ANS were more comfortable approaching the RA with questions about the study and in discussing their experiences as student nurses. For 101 example, in one informal information session held for recruitment, as soon as the RA introduced herself and mentioned the communities where her family originated, several ANS became engaged in conversations with the RA about the First Nations communities and mutual acquaintances. In another information session, ANS approached the RA with their questions about anonymity and then the RA brought the question forward to me. I provided the RA with the answer and the RA approached the ANS with the answer. By using reflection in my journal, I deduced that these interactions illustrated that the students had a connectedness with the RA, while ANS experienced less comfort interacting with me. Tenets of cultural safety encouraged me to reflect upon my positionality as a white, middle-aged, doctoral nursing candidate in that my standpoint influenced ANS' discomfort in approaching me with valid concerns and questions. By collaborating with an Aboriginal nurse as the RA for the remainder of the study, I used reflexivity and discussions with the RA to provide me with further insight into the importance of historical factors coming into play when ANS interacted with a Non-Aboriginal, middle-aged woman who previously was a nurse educator. Because of the primacy of historical features in Aboriginal epistemology, ANS were more comfortable sharing their concerns and questions with an Aboriginal nurse than a Non-Aboriginal doctoral nursing student. Recruitment of faculty and key informants was somewhat more successful. I typically arranged with interested faculty and key informants that I would conduct the interview in their offices at a mutually convenient date and time. Frequently, I would prearrange to bring the faculty member or key informant a cup of coffee or tea of their choice. Faculty members and key informants were more apt to be comfortable with me 102 if they were familiar with me or due to commonalities of our experience. Because I had previous experience as a faculty member and was a doctoral nursing student, I detected minimal power differentials between faculty members and myself. However, I noted particular power relations during an interview with a senior faculty member, who insinuated that I was only conducting research about ANS' experiences because there was funding available for such studies rather than me having a keen personal interest in the topic. Similar to other critical ethnographers' experiences (Campbell & Gregor, 2002), I observed some skepticism on the part of some participants as to what the purpose of the study entailed and what the findings might unearth about their organizations. I approached twenty-six individuals that were identified as potential key informants for the study. Of these twenty-six individuals, ten avoided responding to my invitation to participate and 16 agreed to volunteer to participate. Faculty and key informants were interested in receiving a copy of the summary of the study's findings, upon completion of the study. One key informant with Aboriginal ancestry expressed that nursing faculty might be more receptive to hearing about their institution from the RA and me because we were perceived as nurse researchers (insiders - not outsiders). "The recognition that there is a problem in speaking for others has arisen from two sources" (Alcoff, 1991, p. 6). The first source stems from my social location as a white, middle-aged, upper-middle class woman with my family of origin being working class. I disclosed to all participants that I was a doctoral nursing student and former nurse educator. My social location has an epistemologically significant influence, which 103 can authorize or disclaim ANS' voices. To strengthen my ability to authorize ANS' voices, I worked diligently to establish a sense of teamwork with the ANS, RA, committee members, advisory council members, and executive members of the Aboriginal Nurses Association of Canada as per L. Smith's research agenda (1999). "The second source involves a recognition that, not only is location epistemologically salient, but certain privileged locations are discursively dangerous" (Alcoff, 1991, p. 7). In light of the fact that the practice of privileged persons speaking on behalf of disenfranchised people actually resulted in increasing oppression in some instances, the RA and I were particularly diligent in protecting the identities of all participants and the participating schools of nursing. I focused on addressing hegemony29 in schools of nursing. When presenting findings, my social location will be acknowledged along with its discursive context (Alcoff, 1991). By presenting the analysis of the data and the "mapping" of social relations, a scientifically sound study will be upheld. 4.2.3 Data collection "Possibly nothing is more important to data collection than a good grasp of what institutional ethnography can do and how it does it" (Campbell & Gregor, 2002, p. 59). During the proposal stage of the study, I worked with my committee and the advisory council to establish what would constitute data. Institutional ethnography relies on interviews, participant observations, and documents as data (Campbell, 1998). During 2 9 The word, hegemony, was derived from the Greek term egemonia or emenon, meaning leader, ruler of political predominance. Hegemony refers to the psychocultural aspects of control, and the role of cultural institutions within this control. This control is achieved through the social and cultural realms where it is more effectively invisible, more pervasive. Hegemony 'saturates' even what we think of as 'common sense' as it becomes part of our lived system of meanings and values. the initial interviews with ANS, intersubjective constructions of knowledge of the everyday world of ANS began. Data sources included: 1. one-hour audio taped semi-structured interviews with ANS and Aboriginal nurses with the resultant transcripts, 2. one-hour audio taped semi-structured interviews with faculty and their transcripts, 3. one-hour audio taped semi-structured interviews with key informants, 4. field notes that included participant observations with ANS, other nursing students, and faculty in classrooms and laboratory practice sessions, accounts of informal "talking" with ANS, other nursing students, and faculty and our reflections and reflexivity as recorded in a journal format, and 5. texts such as nursing textbooks, course syllabi or course outlines, application forms, websites from the schools and professional nursing associations. I describe each of the particular sources of data in the following subsections. According to Campbell and Gregor (2002), The techniques employed in doing interviews and observations in institutional ethnography are the practices of field methods that any ethnographer would use. Perhaps the key point about using field methods in institutional ethnography is figuring out what, out of all the possibilities, is useful to observe or otherwise pay attention to and record (p. 71). Interviews with Aboriginal nursing students and nurses "The first step in the process of institutional ethnography is an examination of the experiences of members of the group from whose standpoint the inquiry is being 105 conducted, in relation to the institution understudy" (O'Neill, 1998, p. 132-133). The RA and I conducted formal and informal interviews as well as participant observations to examine the ways in which the ANS describe and enact their experiences in the everyday world. "Norms" and "things taken for granted" were identified and explored in detail. At one end of the continuum are planned interviews, where the researcher makes an appointment with someone for the purpose of doing a research interview. Then there is the kind of "talking with people" that occurs during field observation, when the researcher is watching someone do his work and asks him to explain what he is doing, why he did what he just did, what he has to think about to do the work, where this particular document goes, and so one. "Informal," on-the-spot interviews can be combined with later "formal" or planned interviews, in which the researcher brings to the longer interview a set of questions or topics based on the earlier observation-and-talk (DeVault & McCoy, 2001, p. 756-757). Because we were aiming for a picture that displays the social activity sustaining a particular institutional nexus or arena, this analytic goal gave rise to several distinctive ways to conduct interviews (DeVault & McCoy, 2001). The RA and I developed a semi- structured interview guide that was used to seek ANS' descriptions of how the work of an ANS is socially organized. The RA and I recognized the importance of reflexivity and were apt to share insights and information with participants during the course of the interview. For example, the RA provided ANS with information about funding sources. 106 The RA and I adopted Holstein and Gubrium's conceptualization of active interviewing (2003). We thought of the interviews as semi-structured interpersonal interactions that would develop a broader image of reality as an ongoing, interpretive learning process for both the interviewee and the interviewer. We regarded participants as 'knowers' and experts in their everyday experience. We asked ANS to describe their everyday lives and tell us what happens. "The subject/knower of inquiry is not a transcendent subject but is situated in the actualities of her own living, in relations with others (Smith, 1992, p. 92). In keeping with the social organization of knowledge framework, we asked participants to work with us to decipher how ANS' experiences happened. The interviews were scheduled at a mutually convenient date and time in an available interview room at the participating research sites. The RA would contact the ANS the day before the interview to remind them of the scheduled appointment and reschedule if necessary. Prior to the interview, the RA reviewed the informed consent with the ANS (see Appendix H for all informed consents) and provided the ANS with a signed copy. The RA turned the audiotape recorder on and began by stating that she had some questions to guide the interview, but the ANS could "take her wherever they wanted to go." Interviews lasted between 30 and 60 minutes. At the conclusion of the interview, the RA asked ANS if they had anything else to say. Once the ANS acknowledged that there was nothing further to share, the RA turned the tape recorder off. The RA handed the ANS an envelope that contained a "thank you" card signed by the RA and me with the enclosed honorarium. 107 Several times, ANS talked more about their everyday lives once the tape recorder was turned off. The RA documented her observations about the interview and the nature of these informal "talks" in field notes, protecting the identity of the ANS by altering identifiable features in their stories. "Most IE interviewers tape conversations with informants, both as an aid in making notes and to preserve details whose relevance may not be immediately obvious" (DeVault & McCoy, 2001, p. 758). The audiotapes of interviews with ANS, Aboriginal nurses, faculty, and key informants were sent to a transcriptionist to be transcribed. The transcriptionist e-mailed the first draft of the transcript of an interview with an ANS to the RA. The RA reviewed the transcript and removed any identifying features such as names of individuals, locations, and the school of nursing. The RA altered other identifying features, but kept the essence of the experience intact. For example, if the ANS initially described inadequate health care provision to an aunt with diabetes, the RA altered the story to inadequate health care provision to a cousin with cardiovascular disease3 0. The RA sent the revised transcript back to the transcriptionist, who forwarded the text to me. Transcripts were labeled as Student #1,2,3, etc. I reviewed the initial transcripts of interviews that I conducted with Aboriginal nurses, faculty, and key informants and removed identifying features. Aboriginal nurses' transcripts were labeled Aboriginal Nurse #1-5. Faculty member's transcripts were labeled Faculty #1,2,3, etc. Key informants' transcripts were labeled Key #1,2,3, etc. 3 0 Thesis committee members and I acknowledged that such changes might prove to be problematic as they could alter interpretations of the data: However, these changes were given careful consideration and agreed upon by the committee as a way of protecting participants' identities. 108 For two reasons, I reformatted the document into a text file and incorporated the text file into a qualitative research software program called N6 Student, the latest version of Non-numerical Unstructured Data Indexing Searching and Theorizing (NUD*IST). Firstly, the data was monumental and I wanted to keep it well organized. Secondly, I used the software program to organize data analysis, which I will discuss shortly. Interviews with faculty members With a theoretical lens that ANS' everyday world is influenced by people in translocal and extralocal settings, I examined faculty's experience teaching ANS through participant observation and interviews. My standpoint and previous experience as a nurse educator helped me to discern that nursing faculty were frontline professionals that were especially important because they "make the linkages between clients and ruling discourses, 'working up' the messiness of an everyday circumstance so that it fits the categories and protocols of a professional regime" (DeVault & McCoy, 2001, p. 760). Interviewing nurse educators presented a distinctive challenge in that faculty members were trained to use concepts and categories that I wanted to "unpack." Because nursing educators were accustomed to speaking from within a ruling discourse, I maneuvered my questions to encourage faculty to talk about what actually happens rather than talking about teaching jargon and rhetoric. "Professional training in particular teaches people how to recycle the actualities of their experience into the forms in which it is recognizable within institutional discourse" (D. Smith, 1986, p. 8). People who work in a large organization or large profession such as nursing, for instance, will be members of a discourse that has a shared language, beliefs and 109 values, and ways of working (Campbell & Gregor, 2002). Because of my previous experience as a nurse educator, I was privy to some aspects of the shared language, but genuinely required further explanations about some phrases or acronyms. For example, several faculty members and students referred to "PIPs," which was unfamiliar to the RA and me, so we asked participants to further explain the terminology. We deciphered that PIPs were documents known as performance improvement plans or contracts between the students and the teachers. I scheduled and conducted one-hour audio taped interviews with faculty who volunteered to participate at a mutually convenient date and time. Interviews generally took place in the faculty member's office. Sometimes, faculty members chose to sit behind their desk while other faculty members moved their chair to come and sit closer to me. One faculty member wanted me to conduct the interview in a coffee shop close to the school. The focus group interview with three faculty members occurred in a staff lounge as per their choice. Three faculty members negotiated to be interviewed at their homes. Following a review of the consent form, I provided each faculty member with a copy of the signed form. When the faculty member agreed, I turned the tape recorder on. I used a semi-structured interview guide (see Appendix I) and began the interview by stating that I had questions to guide the interview process, but the interviewee could lead me wherever they wanted to go. Prior to the conclusion of the interview, I asked nursing faculty if they had anything else that they wanted to tell me. When nursing faculty indicated, I turned the tape recorder off. 110 Interviews with key informants An examination of broader social context shaping ANS' experience was conducted by interviewing individuals that I refer to as key informants. "Talk about the work undertaken in a setting offers clues to how social relations that operate across boundaries organize it" (Campbell & Gregor, 2002, p. 79). An important feature of the inquiry was to see how ideas and social forms of consciousness might originate outside of ANS' experience. As suggested by DeVault and McCoy (2001), I usually used interviews with ANS and faculty as sources of information or pointers towards potential key informants. I sent a letter to the key informant and invited them to participate in a one-hour audio taped interview. Depending on the geographical location of the key informant, I conducted one- hour audio taped telephone or in-person interviews. In-person interviews were usually conducted in the individual's office or a conference room in their workplace. Field notes "When institutional ethnographers conduct observations, besides making note of what is happening, they listen for the sort of informants' talk that contains and expresses their expertise of living their lives" (Campbell & Gregor, 2002, p. 69). I needed to observe the actual ongoing practices of actual individuals (Smith, 1992). In 2002-3 I conducted 150 hours fieldwork with 2 participating ANS in various classrooms and laboratory practice sessions, provided I had permission from the corresponding nursing faculty member. Going into the schools of nursing to conduct participant observations was an open-ended undertaking, because the RA and I had to remain I l l open to see what was happening. I used Wolcott's suggestions to enhance our participant observations (2001). These strategies were: • I told the ANS and nursing faculty that I was observing the learning environment in that I wanted to understand the experiences of ANS from the standpoint of ANS, • We reviewed constantly what we were looking for and listening to - stories about the everyday lives of ANS, • We capitalized on "bursts" of vignettes or conversational exchanges that captured the essence of ANS' work, • We assessed and evaluated what we were doing during the fieldwork, what we were observing, and what we were documenting, and • We knew that we needed information about the actualities of the ANS' experience and wanted to learn how they were socially organized. As soon as possible following the fieldwork, the RA and I recorded personal accounts of the participant observations in field notes, which became a rich resource as I learned how to see, hear about, and otherwise understand what ANS do in the course of their everyday lives (Campbell & Gregor, 2002). In 2004-5, the RA conducted 30 hours of fieldwork with the 29 participating ANS in the schools of nursing. The RA recorded field notes about her visits to the schools and included reflections of how she understood the work of ANS. As Wilson (1987) explained, there are many different types of field notes: observational notes, methodological notes, and personal notes. I used Wilson's format in a previous ethnographic study and was comfortable with this way of documenting the fieldwork, so 112 I adapted this format for this critical ethnography. The RA and I reviewed field notes in our biweekly meetings, making a practice of including date, time, and place along with personal reflections. We removed identifiable features and revised the field notes accordingly. I converted the field notes from documents to text files and incorporated them into the software program for analysis. Texts "A prominent aspect of institutional ethnography is the recognition that text- based forms of knowledge and discursive practices are central to large-scale organization and relations of ruling in contemporary society" (DeVault & McCoy, 2001, p. 765). The textual mediation of social relations and forms of organization has the "miraculous effect of creating a joint between the local and particular (on one hand) and the generalizing and generalized organization of the relations of ruling (on the other), making the latter investigatable in a new way" (D. Smith, 1992, p. 93). In this study, texts mean documents or representations that have a relatively fixed and replicable character, such as textbooks, student application forms, paper documents such as performance improvement plans, course syllabi, nursing textbooks, nursing standards, school's policies and procedures, nursing profession's policies and procedures and various websites and computer files. Because texts can be stored, transferred, copied, produced in bulk, and distributed widely, these texts are allowed to be activated by users at various times and locales (DeVault & McCoy, 2001; D. Smith, 1992). As data collection and analysis was occurring simultaneously, I became more adept at asking faculty and key informants to talk in detail about a text or those aspects of a textual process that the interviewee knew. To find out how ANS' everyday lives 113 were organized, I located texts and text-based knowledge forms in the schools' and nursing profession's operation. I collected the texts and website addresses and reviewed them. The data collection process required that I tracked back and forth or followed clues forward from the local setting and the data that was collected there. Data collection required connections between the data and the social organization of knowledge. "Bringing data together with theory happens explicitly in the process of analysis" (Campbell & Gregor, 2002, p. 81). 4.2.4 Data analysis The fourth component of qualitative research is data analysis. "A successful analysis supersedes any one account and even supersedes the totality of what informants know and can tell" (Campbell & Gregor, 2002, p. 85). As IE is fundamentally an analytic project, analysis on the part of the researcher needed to begin at the proposal stage and continued throughout data collection and the analysis phase of the project. However, the stages of analysis do not occur chronologically - I moved back and forth between data collection, reading, thinking, analyzing, discussing, and writing. I used this question as a guide while reading transcripts, field notes, and texts: "What does the data tell me about how these schools function to influence the everyday lives of ANS?" A distinct feature about this research method is that it explicates the experience; it is not a simple description of the experiences of ANS. My analysis used what participants know and what they were observed doing. My analysis focused on identifying captions in the transcripts, field notes, and texts for the purpose of identifying, mapping, and describing the social relations that extend beyond the 114 boundaries of the participants' experience. Data analysis was driven by this study's purpose, which was to explore the 'concerting' of ANS' everyday lives and the social relations that generated the varieties of lived experiences of the ANS (Campbell & Gregor, 2002; D. Smith, 1999). Like some critical ethnographers, I utilized qualitative data analysis software called QSR N6 Student, the latest version of NUD*IST line of software designed with student needs in mind. N6 Student offered me relatively inexpensive features to import text data with flexible document management systems. I used the software to: group chunks of transcript, sometimes pages in length by theme or topic...This kind of computer-aided sorting works at a fairly primary level and offers researchers a manageable way to work with large numbers of interviews; it still leaves the analytic work to be done, as always, through writing, thinking, and discussion with collaborators and colleagues (DeVault & McCoy, 2001, p. 768-9). I grouped the analysis rather simply, sticking closely to conversation topics about ANS' everyday lives and references to institutional sites and processes. Similar to Townsend's approach in her study of occupational therapists in mental health services (1996), I followed three analytic processes. Firstly, I used reflection and collaborated with the RA and the thesis committee to work from the standpoint of the ANS in undertaking the task of describing the everyday world of ANS. I read and reread the ANS' (n=31) and Aboriginal nurses' (n=5) transcripts - one by one and then in groups. Using an approach described by Browne (2003), entire transcripts and corresponding field notes were read and reread to identify similar, converging or contradictory patterns of ANS' experiences, key concepts about the work of ANS, clues 115 to ruling relations, and linkages to the social organization of nursing knowledge. I asked the RA to choose specific transcripts to review separately and then together. We compared, contrasted, and discussed our analysis. The same transcripts were then forwarded to Dr. Joan Anderson, Chair of the Thesis Committee, to separately review. On several occasions, the RA and I met with Dr. Anderson in-person to compare, contrast, and discuss our findings. Secondly, I explored and explicated the actualities of the experience, rather than those of a generalizing science (Seibold, 2000). The second analytic process involved searching the data to link, map, or trace the social processes that connected the everyday world of ANS with the work of the nursing faculty. I read and reread each transcript and their corresponding field notes and then progressed to read and reread groups of transcripts to delineate similar, converging, or different patterns of nurse educators' experience teaching ANS. With the assistance of the RA, I was able to stay focused on the standpoint of the ANS, rather than assume the standpoint of faculty. Through a back-and-forth method of exploration, I examined the data to trace connections between ANS' everyday life and the associated texts or other social processes that governed the students' lives. I used strategies suggested by Campbell and Gregor (2002) in that I talked with the RA and the chair about findings from the data. Being an extrovert, I found it helpful to talk about the pieces of the puzzle and then put them together. I progressed from there to access extended social relations occurring inside and then outside of the school of nursing. When interpreting the data, I explored and explicated linkages that were the actualities of people's lives. The data guided the 116 interpretation, not a priori theory (Campbell & Gregor, 2002). I examined the "ideological character" of the educational process occurring within these schools of nursing. I examined all transcripts, field notes, and texts for conceptualizations and categories emulating Aboriginal peoples, ANS, student nurses, nursing faculty, knowledge, nursing education, and nursing practice. I re-read and examined all transcripts, field notes, and texts for traces of information that revealed how ANS' everyday lives were co-coordinated and regulated through textual facts (DeVault & McCoy, 2001). My task was to: search out, come to understand and describe the connections among these sites of experience and social organization...Being able to count on using social relations to discover the concerting of action across time and space is what makes the inquiry methodical...The question to be explored is "What are the social relations coordinating those experiences?" (Campbell, 1998, p. 62) Data analysis occurred by and through writing and rewriting. Writing and rewriting the findings of the study began to make something out of the data, and helped move me through analysis. Writing altered the data from a massive collection of documents to "analytic writing." Writing and rewriting the findings into stories began the process of making use of the data as evidence. The data held my writing to the accounts of the ANS (Campbell & Gregor, 2002). Campbell and Gregor (2002) noted that writing the analysis is a challenging process in that researchers might have difficulty translating their understanding of the social relations in a setting into a written argument supported by the data. 117 I shared preliminary findings with the RA, thesis chair and committee, and the Advisory Council. By sharing preliminary findings, I was able to step back and see where my analysis and argument was strong and places where I needed to strengthen the linkages (Campbell & Gregor, 2002; Martin, 2002; Martin & Kipling, 2005). Findings explicated the experience of ANS and revealed what is happening relevant to the standpoint of ANS. By focusing on social relations and the institutional processes organizing them, this form of analysis identified the actual workings of the schools of nursing. Ensuring scientific quality Researchers using quantitative methods generally attempt to design controls that address both anticipated and unanticipated threats to validity. Qualitative researchers, on the other hand, rarely have the benefit of formal comparisons, sampling strategies, or statistical manipulations that 'control for' the effect of particular variables, and must try to rule out most validity threats after the research has begun, using evidence collected during the research itself to make these 'alternative hypothesis' implausible (Maxwell, 1998, p. 91). Making meaning of the data that stands up to relevant scientific tests is the purpose of any scholarly analysis. I established the validity, warrantability, or truth-value of my analysis within the tenets of the theoretical and methodological perspectives. Supported by Aboriginal epistemology and conventional ethnography, triangulation provides evidence to specific findings, while the ethnographer attempts to explicate how the local settings (including 118 local understandings and explanations) come about. By using the data to map the social relations, I relied on the possibility that truth can be told in the following very ordinary sense: that when people disagree about statements made about the world, accuracy or truth is not decided on the basis of 'authority' or on the shared beliefs of a community but by referring back, in principle at least, to an original state of affairs, extraneous to the accounts they have given. In a sense, it wants an account of knowledge that takes for granted that people's experiences are various and can be coordinated, and that a social theory of knowledge grasps it as a definitive mode of coordinating people's activities (D. Smith, 1999, p. 97). Providing an account that explicates the social relations of schools of nursing is what this analysis achieved (Campbell & Gregor, 2002). I chose criteria of validity that best suited the theoretical and methodological perspectives and the method of inquiry (Heron, 1988; Sandelowski, 1986). Using aspects of Lather's (1991) reconceptualization of validity for research committed to just social order, I discuss these aspects of rigor: triangulation, construct, face, and catalytic validity (1991). Triangulation Similar to the importance of gathering information from multiple sources in Aboriginal epistemology, Lather (1991) expanded the notion of triangulation from meaning multiple measures to include multiple data sources, methods, and theoretical schemes. Multiple data sources was achieved in that the sample included a diverse account of ANS' experiences, faculty members, key informants, the RA's and my field 119 notes, websites and texts. Multiple methods of data collection were implemented: interviews, participant observations in the fieldwork, acquisition of nursing texts and school documents. Multiple theoretical schemes were used to guide the study. Construct validity "Determining that constructs are actually occurring rather than mere inventions of the researcher's perspective requires a self-critical attitude toward how one's own preconceptions affect the research" (Lather, 1991, p. 67). Relying on a tenet from cultural safety about the importance of reflexivity and acknowledgement of location and positionality, a systematized reflexivity, which demonstrates how a priori theory was changed by the logic of the data, was essential in establishing construct validity (Lather, 1991). I identified "priori" theories in the literature review. I described how I formulated my initial premonitions about the everyday world of ANS in field notes. I collected data that was rich in detail and complete enough that it provided a full and revealing picture of what is going on. Interviews were transcribed verbatim. I revisited the data to test developing theories, rather than simply using the data as a source to support beginning ideas of how ANS' lives were organized. By mapping how ruling relations influenced ANS' everyday lives, construct validity was attained. Face validity Face validity is complex and intricately related to construct validity (Lather, 1991). Research with face validity offers the reader an "oh, yes, that's happened to me" sense of recognition when findings are presented (Lather, 1991). Face validity was operationalized primarily by sharing preliminary findings and through consultations with the RA, thesis committee members, and the advisory council (Lather, 1991). An initial 120 draft of a paper about the study's findings was provided to advisory council members for review. These Aboriginal nurses reviewed the paper and acknowledged that our findings resonated with their own experiences as student nurses up to 20 years ago. Catalytic validity "Catalytic validity represents the degree to which the research process re-orients, focuses and energizes participants toward knowing reality in order to transform it, a process Freire (1973) terms conscientization" (Lather, 1991, p. 68). The RA and I engaged in conversations and written communications with ANS, faculty, and Aboriginal nurses to provide our interpretation of the social relations in Western Canadian schools of nursing. Being guided by L. Smith's decolonizing methodologies for research and Indigenous peoples, I was committed to collaborating with ANS, Aboriginal nurses, and members of the Aboriginal Nurses Association of Canada as ANS and Aboriginal nurses may choose to incorporate this information to gain a broader contextual understanding of the social relations that organize their everyday lives, and ultimately self-determination. The RA and I engaged in a reciprocal dialogue during interviews and attempted reciprocity during participant observations. 4.3 Ethical considerations "Ethics pertains to doing good and avoiding harm" (Orb, Eisenhauer, Wynaden, 2001, p. 93). I was required to balance the principles of research with the well-being of ANS. As addressed by L. Smith (1999), violation of human rights in the name of scientific research has been among the darkest events in the colonial and neo-colonial history of Aboriginal peoples. 121 Just knowing that someone measured our 'faculties' by filling the skulls of our ancestors with millet seeds and compared the amount of millet seed to the capacity for mental thought offends our sense of who and what we are. It galls us that Western researchers and intellectuals can assume to know all that it is possible to know of us, on the basis of their brief encounters with some of us. It appalls us that the West can desire, extract and claim ownership of ways of our knowing, our imagery, the things we create and produce, and then simultaneously reject the people who created and developed those ideas and seek to deny them further opportunities to be creators of their own culture and own nations (L. Smith, 1999, p. 1). When preparing the research proposal and application for ethical approval, I considered the potential ethical issues that could arise such as informed consent, confidentiality, data generation and analysis, researcher/participant relationships and reporting of findings. Although I acquired ethical approval for this study from Ethical Review Boards at the University of British Columbia and the two research sites, it was problematic for me to recruit ANS into the study in 2002-3. "The desire to participate in a research study depends upon a participants' willingness to share his or her experience" (Orb et al, 2001, p. 93). Due to a possible lack of trust, ANS were not willing to share their experiences with me. "A balanced research relationship will encourage disclosure, trust, and awareness of potential ethical issues" (Orb, Eisenhauer, & Wynaden, 2001, p. 94). By incorporating the aid of an Aboriginal nurse as a RA, a more balanced research relationship was attained. The RA and I worked diligently at protecting the identities of 122 participants by altering details of their stories to capture the essence but protect the student from being identified. I was obliged to consider possible outcomes of an interview and weigh benefits and potential harm. It came to my attention, that several participating ANS and Aboriginal nurses could possibly be survivors of Residential Schools. I anticipated that interviewing survivors of Residential Schools might trigger painful memories causing distress, so I incorporated a section in the consent form that I specifically directed to survivors. I wanted to provide survivors and the interviewer with a "heads up" that the participant might become distressed during the interview. In this case, the RA and I decided that we would stop the tape recorder, provide the participant with time, a glass of water, and a tissue. We would then seek ongoing consent from the participant and let them choose whether or not they wanted to continue with the interview. "Stopping the interview and searching for possible solutions for the participants' distress indicates that researchers are aware of the vulnerability of participants and their rights" (Orb et al, 2001, p. 94). I interviewed two participants who were survivors of Residential Schools. One participant had a positive experience in a Residential School, while the other participant told me that her experience was horrific. This participant said that she was distressed and saddened by her memories, but she wanted to continue with the interview because she thought the study was important. Informed consent provided participants with their right to autonomy - the right to be informed about the purpose, nature, risks, benefits of the study, the right to freely decide about their participation, and the right to withdraw without penalty. 123 Research strategies in sampling techniques and data collection also have ethical considerations. I wanted to maintain the principle of beneficence as I was aware of potential consequences of revealing the identities of participating ANS, Aboriginal nurses, nursing faculty, schools of nursing, and key informants. Orl et al (2001) recommended the use of pseudonyms. I used Student #1,2,3, etc. and Faculty #1,2,3, etc. to identify the transcripts. The RA was the only member of the research team to have ANS' names, phone numbers, and mailing addresses. The RA reviewed transcripts and field notes, removing names and altered identifiable features. I reviewed the faculty and key informants' transcripts and my field notes and removed names and altered identifiable features. Some committee members knew the names of the participating schools of nursing because they were required to sign the ethical review board applications. When reporting findings, the RA and I will refer to the research setting as two Canadian schools of nursing. One of the most crucial and distinctive features of the ethical principle of justice is avoiding exploitation and abuse of research participants (Orb et al, 2001). As a white middle-aged female researcher and a doctoral nursing student, I struggled with the notion of speaking on behalf of ANS (Alcoff, 1991; Andersen, 1993; Arvizu, 1995; DeVault, 1995). I conducted some soul-searching in regards to the following questions: What is the "true" purpose of this study? Am I exploiting ANS to acquire a doctoral degree? By speaking about the experiences of ANS, will I be exposing them to further subordination? At this time, I concluded that a critical ethnography was required to begin to understand the social organization of nursing knowledge and the ruling relations that influence ANS' experiences in Western Canadian schools of nursing. I 124 shared my intentions about this study with the president and executive members of the Aboriginal Nurses Association of Canada. I conveyed to others that I am not the expert on ANS' experiences; ANS and Aboriginal nurses are the experts with first hand experience in Western Canadian schools of nursing. By assuming the standpoint of ANS throughout the study and attending to the voices of the ANS, I explored and explicated the everyday lives of Aboriginal peoples in nursing schools, maintaining ethical quality. 4.4 Chapter summary In this chapter, I explained that critical ethnography was the most appropriate method of inquiry to address the question: What are the social relations coordinating ANS' experiences? I used multiple sources of data: 31 transcripts about ANS' everyday lives, 5 transcripts about ANS' educational experience several years to decades ago, 24 transcripts from members of the nursing faculty, and 16 transcripts from key informants, field notes from 200 hours of fieldwork, and 135 texts. I incorporated aspects of Aboriginal epistemology, decolonizing methodologies for Indigenous peoples, cultural safety, and the social organization of knowledge into the research process. Using a computer software program to help organize the data, I used a three phase technique to analyze the texts (transcripts, field notes, and nursing texts, forms, documents), whereby ANS' experiences were explored, linkages with faculty's experiences were identified, and then ideologies were delineated. In the data analysis process, I focused on mapping how the everyday lives of ANS were coordinated and organized via texts originating from outside and inside the school of nursing. I explained how I maintained scientific and ethical quality throughout the project. 125 5 B E C O M I N G A N U R S E : T H E S T A N D P O I N T O F A B O R I G I N A L N U R S I N G S T U D E N T S Student #31: They should open up a nursing school for Aboriginals so it would make life that much easier (29). 5.1 Introduction In the remaining chapters, I present the empirical findings of the research. Beginning with the standpoint of ANS, this chapter focuses on some of the experiences of ANS in two Canadian schools of nursing. Experience is the starting point to unearth how people's lives are socially organized (Campbell, 1998; D. Smith, 1987). In Chapter Six, I present ANS experiences from the standpoint of nursing faculty. In Chapter Seven, I provide a synopsis of the broader social context shaping ANS' experiences from the perspectives of individuals identified as key informants. In Chapter Eight, I map how the experiences of ANS are coordinated and organized by discourse within and outside of the schools of nursing. In Chapter Nine, I discuss the findings in relation to the theoretical and methodological perspectives guiding the study. I analyzed transcripts from interviews with 31 ANS and 5 Aboriginal nurses along with our reflexive and descriptive field notes to describe: (a) the everyday/everynight experiences of ANS (the local) and (b) explicate perceived tensions between ANS and other social groups within the schools of nursing (the translocal). When I present the findings, I am not inferring that all ANS have similar experiences in all schools of nursing. The data was analyzed to explore diverse experiences of the varied standpoints of ANS in two Canadian schools of nursing. More to the point, the study was conducted to identify and describe social processes that had a generalizing effect- social processes associated with difficulty in recruiting and retaining Aboriginal peoples in nursing education. 126 The theoretical and methodological perspectives guiding the study also provided a template for my presentation of the findings. Relying on Aboriginal epistemology, I present the pathways ANS traveled to become a nurse. The beginning of the journey often occurred in the form of a young child's dream to become a nurse. As the child matured into a young adult, alternative pathways postponed the realization of the dream to become a nurse. Alternative pathways usually included becoming a parent and/or following a different or related career path. Guided by L. Smith's decolonizing methodologies for research and Indigenous peoples (1999) and cultural safety (Ramsden, 2002) as an analytical lens, I was awestruck with participants' determination, resilience, and personal agency interwoven into various scenarios whereby these Aboriginal peoples overcame huge obstacles and accessed opportunities to ensure that their dream of becoming a nurse became a reality. Using D. Smith's social organization of knowledge (1987), I proceed with the actual experiences of the ANS in two Canadian schools of nursing. Findings presented in this chapter address this research question, "What are some of the everyday/every night experiences of ANS in Western Canadian schools of nursing?" I provide examples from transcripts and field notes that illustrate experiences of ANS and how ANS perceive tensions from other social groups. To protect the identity of the two male ANS, I altered their comments to reflect the standpoint of a woman3 1. Identifiable features of certain stories were slightly altered to further protect the identities of participating ANS. 3 1 Although the committee and I acknowledged that gender shaped ANS' perceptions and experiences, we decided that protecting the identity of the two male ANS was the key priority. 127 I organized this chapter to reflect the long and arduous journeys that ANS experienced to become a nurse. The journey is divided into two phases: (a) the journey to the school of nursing, and (b) the journey through the school of nursing. 5.2 Becoming a nurse: A long and arduous journey Many ANS shared stories about their personal journeys to become a nurse. Using major themes, categories, and codes delineated from the data, I describe how participants became interested in becoming a nurse and then I relay the actualities of ANS' experiences of learning to become a nurse. During this interview, the ANS shared the notion that all ANS required a longer period of time to complete the nursing program. Ardelle: What factors have influenced your inability to participate in learning how to become a nurse? Student #23: For me, it's the long road to stay that focused (p. 19)...I haven't met anybody [any ANS] yet who has done it [the nursing program] in the 4 years, though. It's always been longer (p. 25). 5.2.1 Journey to the school of nursing I now describe the empirical findings that reflect the ANS' journey to the school of nursing, including excerpts from transcripts and field notes that illustrate how these Aboriginal people became interested in becoming a nurse. Beginning with a childhood dream and hopes of making future life better for themselves, their children, and their peoples led ANS down the path toward a school of nursing. A dream to become a nurse The journey to the school of nursing often began in early childhood with a dream of becoming a nurse. Many ANS explained that in their memory, they had always dreamt of becoming a nurse. Student #30: I have always wanted to be a nurse. I don't know how, but I remember in Grade 2 when I wanted to be a nurse (p. 1). 128 For several ANS, the idea of becoming a nurse was not brought to the forefront of their minds as self-doubt was experienced about their cognitive abilities to learn nursing. Student #6: I knew in the back of my mind I always wanted to be a nurse, but I thought I wasn't smart enough (p. 2). In contrast to always wanting to be a nurse, one participant was keenly aware of others' expectations that she would grow up and provide health care to Aboriginal peoples in some capacity. This participant pursued nursing education for the purpose of acquiring the necessary licensure to provide health care to Aboriginal peoples. Aboriginal Nurse #4: Well, I have always been in medicine. I was identified early in life as a medicine woman, and was expected to perform that function in society...So it was always an expectation of my community that I would be in medicine and it was just a matter of getting the right papers so I could practice... It was an expectation; it was my name from the time that I could remember, the nurse, not the nurse but the medicine woman or medicine girl (P-4). The dream to become a nurse was sometimes followed by observations of nurses or family members who worked in health care positions. Some ANS explained that nurses in their community were positive role models that encouraged Aboriginal youth to plan for their futures. Aboriginal nurses were proof that being a nurse was achievable. As many First Nations communities suffered from rampant rates of unemployment (as high as 80%), Aboriginal nurses explained to youth in the community that gainful employment was highly probable. Student #25: That was a long time ago. Probably when I was in my elementary years, I just, I was just fascinated by the way the nurses were working with young people and Elders (p. 1). As health care consumers, several ANS interacted with nurses. These positive experiences with nurses stimulated the idea to become a nurse. 129 Student #7: My father was sick and died of cancer and I had interacted with the nurses on the palliative ward and I found them to be very nice and knowledgeable and it just made me feel like I wanted to become like a person to help other people out (p. 1). In contrast, some participants had negative experiences in health care facilities. These ANS became interested in becoming nurses because they were determined that as nurses, they would deliver more appropriate and sensitive care. Student #11:1 think the thing that really influenced me most to be a nurse was just when I take my child to the hospital. It's not that me or my child have experienced bad behaviors from nurses. But just hearing nurses talk about other patients and then treating other patients this way. Well, if you are like that, why are you in this profession? You should be enjoying your job. You are supposed to be helping these people, nurturing these people - physically, mentally, emotionally. And you are like it's just become a job to them. It's not. They are forgetting the emotional aspect of it and not really helping these people (p. 12). Making a better future Future employment as a registered nurse would facilitate the provision of a more economically stable situation for these women and their families. The stigma of living as welfare recipients was painful and degrading. These women wanted to be able to provide a better future for themselves, their children, and their communities. Becoming a nurse would allow these women to engage in a fulfilling and meaningful career coupled with the financial benefits. The economical bleakness in First Nations communities was discussed with the realization that a nursing position in a First Nations community would be a viable option to make a better future for themselves, their children, and their peoples. Making a better future for families was a major motivator in ANS' perseverance to succeed in the nursing program. Aboriginal Nurse #3: So I'm telling you like I said to myself, I am going to be a nurse if it kills me. That's the drive I had and I remember I am going to get off of this welfare business and I am not going to be on welfare because I hate it. It is degrading. I am going to be a nurse. And I am going to do it if it kills me and I did. I was really happy after I graduated and I got a job and I was making money and I was off social assistance completely and supporting my family (p.8). 130 Student #19: After living up north in an isolated community for so long it seemed like there was nothing I could do like get a job. I could have just stayed and sat on welfare the whole time but because [the northern nurse] said that to me [you can go to school and help us and be a nurse here] that's when I thought you know, ya I could, and I could help them and it's not that hard (p. 1). The future prospect of being financially independent provided ANS with the hope that they would have the ability to provide more nutritious food, clothing, housing and recreational activities for their children. Dependents and partners supported the notion that becoming a nurse would make life better for all members of the family. Student #10: ...They [nurses at the nursing station] said it was nursing and then all these things they said, "You will never run out of food. You will have toys. You will have like..." (p.4). Student #18: They are proud of me, they are, they are, and I told them like I get them motivated, kids if you want to spend your vacation in Florida, then get those dishes done...Okay mommy, and they get the dishes done, ...maybe I could take them to Disney World some day (p. 20). Several participants identified that they only enrolled in nursing to ensure that they received Band sponsorship while they were waiting to access other forms of postsecondary education in other fields. An ANS decided to apply to the school of nursing when she heard that entrance requirement for Grade 12 mathematics had been lowered in nursing, capitalizing on an opportunity. Student #26: I took a health education program which was to enable us to learn about health profession courses, but my main interest was pharmacy and going into research after pharmacy but and then nursing happened so I took the nursing course because a lot of the courses were the same as the entry courses for pharmacy, so I have been on a 3 - 4 year waiting list and this is my second year on the waiting list (p. 1). Student #22: In deciding what career I should go into I overheard a student at X adult education program that they lowered the math pre-req for nursing, so I thought well, that's within my grasp. I may as well check it out (p. 1). These participants chose nursing for two important reasons. Firstly, they were provided with (albeit minimal) funding for immediate survival. Secondly, they viewed 131 their stint in nursing education as a temporary route to other fields that would ultimately serve to provide a better future for themselves, their families, and their peoples. Alternate pathways Many of the ANS were mothers, who decided to enter into a nursing education program after having their children to make life better. Being more mature and having diverse life experiences motivated ANS to pursue their dream of becoming a nurse. Student #5:1 have always wanted to be a nurse, right from when I was a little girl and just life circumstances - I wasn't able to. I have three children (p. 1)...So my goal was after my youngest got into school full-time, that I would go into nursing (P-2). Life circumstances and experiences promoted self-actualization and thus, ANS were more confident that their dream to become a nurse was achievable. Some ANS entered their nursing education after working at "dead end" jobs or having to experience the degradation of relying on social assistance. Self-confidence gained through life and work experience facilitated the process of applying and entering into a nursing education program. Successes elsewhere provided ANS with the self-confidence that they indeed had the capabilities to succeed in a school of nursing. Student #6: So then I took a first aid course and I was basically the only one who volunteered as a first aid provider for many years and it was a community of about 500 people so I thought after ten years, "I really, I am smart. I like this. It's time for a change...Maybe I should be getting paid" (p.2). Substandard education on reserves Twenty-seven of the 36 ANS and Aboriginal nurses (75% of the participants) identified that they grew up living in an Aboriginal community or reserve. These ANS were plagued with a huge obstacle, substandard primary and secondary education. Children's education in primary and secondary schools on reserves was perceived to be substandard to schools elsewhere. A Grade 12 education on a reserve was equated 132 with a Grade 8 education in an urban centre. The inequity between reserve and off reserve education was a taken-for-granted actuality. Aboriginal Nurse #3: And right away I felt, the word I would use is that I felt intimidated, maybe because these girls were all young and they were smart and right out of school, and they were getting good marks right from the start, you know, and my marks were just passable, I found some of these courses difficult because I had been out of school a long time and when you grow up on a reserve you don't get the education that other people get when they live in the city. Where their education is top notch, that's what I call it. When you are on a reserve, you don't get, your education is not as advanced, I think as others. So anyways, I struggled along with everybody else just getting passing grades and mind you on the physical part of the nursing, I was terrific... But you also need the theory part to pass and to become a good nurse you have to know a lot (p.2)... I took a short upgrading course, just to upgrade my skills because I have grade 12 and a lot of this I forgot, so it was great that I did that. I took some English and I took mathematics that helped. But yes I agree with that, the education on the reserve is the poorest (p.5). Even by successfully completing a Grade 12 education, several ANS from First Nations communities described how they observed other Aboriginal students' failure at postsecondary education. Their predecessors' experiences influenced these ANS' decisions to stay in their home communities to complete a "transition" year to up-grade prior to pursuing a nursing education. Student #10: I need to be here in the city with all the, resources, the extra stuff that they may know that I may not know...Well, I do know for sure that in the city you get a lot better education, which is why probably you had to do the prep here because we don't have the chemistry. We don't have the biology offered in high school, so where at the challenges?...It seems that everyone is more advanced in education that they have had the opportunity to already challenge themselves in high school. So here it's kind of like, well it's going to be kind of the same thing. But for me, it's a big leap. Work harder, that much harder. I know you have been working hard but...So when I ask people sometimes you know you ask people or a person a question and they say, "You don't know that! You should know that (p.7)." Another participant described how being educated on a reserve and having English as a second language negatively influenced her self-confidence in pursuing a nursing education. Other ANS and Aboriginal nurses inspired her. Student #20: So I applied for [the access program] and I got accepted through the school but I couldn't get into nursing yet. They were eventually you will get 133 accepted, but I just took [access program]. I wanted to be prepared. Because I thought I wasn't ready. I wanted to upgrade - more math and science (p. 1)....! kind of was overwhelmed with all the courses. I was thinking coming from a reserve - I was kind of doubting myself. I grew up on a reserve and I really doubt myself because English is my second language and it was kind of, I was kind of overwhelmed by that and I started seeing other students, Aboriginal students, meeting Aboriginal nurses and I was kind of inspired by that too (p.2). Several participants did not have a grade 12 education. As mature students, the access program facilitated their abilities to upgrade their knowledge requirements and related skills to pursue a nursing education. Lacking a complete secondary education created self-doubt. Field Note (7/10/04): She had a Grade 10 education and up-graded. She found school very hard. That is a common reoccurring theme - the limited education that they begin their programs with correlates with their confidence level being low. She made the comment that no Aboriginal person has completed this program in four years. We talked about Aboriginal parents long ago and how their expectations weren't that you graduate and seek a profession. But rather that you help the family live. She said her dad worked to feed, shelter, and clothe her family and when she was old enough to help, "I quit school and helped him on the farm." Transition and/or Access Programs Many ANS traveled alternate pathways and were hard pressed to believe that their dream could come true because of substandard education in First Nations communities. Because many Aboriginal peoples lacked prerequisites to enter into postsecondary institutions, these participants capitalized on available opportunities to prepare for postsecondary education in the form of available programs in First Nations communities and/or access programs at postsecondary institutions. Transition and/or access programs provided ANS with prerequisites to enter into their nursing programs. Several participants were categorized as "mainstream" students as they did not enter into the nursing education program via a transition and/or access program. "Mainstream" ANS experienced more difficulty finding academic, personal, and financial resources. These ANS seemed to fall between the cracks in that resources available to 134 ANS in access programs were unavailable to them. "Mainstream" ANS had to actively seek other campus resources such as financial support, tutorials and personal counseling. Ardelle: Can you tell me how you are funded to study nursing? Student #21: Through the employment training services. So they have paid 75% of my tuition and books for the first year and then I am receiving employment insurance. So far [it's enough to live on] so I know it's going to get tight because I had saved a lot of money before I moved [to the city] so I think by Thanksgiving, it's going to be getting tight because I am getting $600 every two weeks from employment insurance and my rent is $900 a month (p. 4). Ardelle: What factors have influenced your inability in learning how to become a nurse? Student #21: Stress and money and parenting. That's probably it. Ardelle: Do you have support at home with your children? Student #21: It's just me and them [my children] here but my grandpa lives in the city and an aunt. The rest of my family is up north. There is the phone so we are phoning home quite a bit. Childcare's been good. I was able to get my children into the daycare that's on campus and it is subsidized through there so...I don't know if I'd be able to handle them being across the city in a daycare while I'm at school...Our bus comes by at seven. We are up at 5:30 or 6...Throw them in daycare, run to my classes and then... (p. 5-6). Participants also identified that personnel within the Access Programs were important resources to them in their journey through the school of nursing. ANS' experiences in Access Programs will be further discussed on page 143. 5.2.2 Journey through the school of nursing The journey through the school of nursing was lengthy with many recurring obstacles along the way. For many ANS, upgrading their education was required to ensure they acquired necessary prerequisites to a postsecondary education. Thus, a four year nursing program actually became a minimum of five years for many ANS. Student #12: Two years ago, it was kind of funny because I was in the [preparatory courses] and it was like, "Oh, I am a nursing student." [Someone asked], "What year are you in?" [I answered], "Well, I am not in a year yet, next year I will be in year one. I am in year one of a five year program." That's what I tell people all the time. They are like you are in the four year program? "No, I am in the five." [They asked], "What's the five year program?" (p.27). 135 I organized ANS' descriptions of their experience under headings that reflect the trajectory of their tenure as student nurses: (1) culture shock, (2) informal and formal supports (3) intersectionality of gender, race, culture and economic status, and finally (4) the journey's end. "Culture shock" denoted the initial experience of entering nursing education at an urban campus. By using informal and formal resources and upon readjustment to the urban lifestyle and large campus, ANS experienced a relatively smooth ride through first and second year nursing. Informal and formal supports were necessary features to ensure a completed journey. ANS' personal agency was a crucial component in ensuring completion of the journey. Sharing experiences with other ANS enhanced student's abilities to cope with various challenges. Academic support was greatly appreciated. ANS felt connected and supported when nurse educators demonstrated an understanding of Aboriginal culture and life on a reserve. I used the phrase, intersectionality of gender, race, culture and economic status to capture the essence that aspects of ANS' experiences were directly or indirectly associated with the collision of being Aboriginal women juggling multiple roles and childcare in poverty. This intersectionality or collision created double, triple, and quadruple jeopardy for ANS. I identified that personal issues, lack of social support, lack of available childcare, ethnocentrism, racism, conflicts with teachers and the major obstacle - inadequate funding were associated with intersectionality of gender, race, culture and economic status. These issues were greatly shaped by the historical and sociopolitical context. Finally, I present the ANS' descriptions of the journey's end as ANS exited the schools of nursing in one of several ways. 136 Culture shock "Culture shock" best described how ANS' experienced relocating to an urban centre and beginning their nursing education at an urban campus - through an unknown, new, and fast-paced world. ANS described their initial feelings of being intimidated and overwhelmed in a city and in the postsecondary institutions. Adjustment to urban lifestyle Many participants were required to relocate to an urban centre to acquire a nursing education. These ANS spoke about their experience of culture shock as they tried to acquire housing, childcare, and transportation to and from school in an urban centre away from their extended families and friends. These ANS were required to readjust their lifestyles to accommodate the proximity of many busy people and use public transportation to travel to the postsecondary institution and clinical placements. Student #11: From high school I was a keener so it was easy at the academic point but transferring from rural area to urban area was very, very tough for me like I wasn't, I was not used to it at all. It took me a long time to adjust. Like I was stressed. I was, I guess, cranky and stuff like that just because I don't like city life even now. It's just I can't stand it. It's too stressing, too much. It's convenient but it's very, very stressing because you have so much more that you have to pay for financially and it's hard (p. 2). The next excerpt depicted the complexity of the entire family adjusting to anew world with limited resources and loneliness in a society laden with negative stereotypical images of Aboriginal peoples. Student #27: It's really tough. Especially when you have little ones you know. It's not only a transition for myself personally, but my family as well, like we struggled to find a place to stay and a place to call home. Like stability was a problem. And especially my children - they are still, like we have been here for about two months and they are still you know adjusting to the city life compared to at home where they can go out and run around and you know everybody watches everybody's kids and it's just...and the neighbors cause a lot of problems, too so (p. 3) we speak, I am looking for childcare for my children because my husband needs to find a job, right? So we are looking on finding daycare... Yes, I am just terrified to leave [children in the care of strangers]. I am actually thinking of begging somebody at home to come stay with me for awhile, 137 but I don't know if they will cause it's a big difference (pp. 1 0 - 11)... I think there is a lot of stereotypes in the city... Especially where as I explained to you, I wasn't even in my townhouse for a week and a social worker is knocking on my door, you know, like what is that? Like there is, my mother is phoning me and saying, "OH F them and don't worry, my daughter. You know there is a bunch of A holes that live around there." And she was furious...I have dealt with racism you know, I have been called primitive and savage but never have my kids been used against me was tough, you know. I felt terrified. I was mad...It was like if you talked to anybody at home, they would say, "Well, she never goes anywhere. She is home with her kids all the time." You know cause that's true. I never leave my kids since my son was a baby because I breastfed him so I never left him and just for that happening here, I wanted to run home (pp. 25-26). Adjustment to urban campus ANS described their initial experiences within the school of nursing as being overwhelmed and intimidated by the numbers of students unknown to them, the speed and amount of information provided to them, and the challenge of communicating in English as a second language. Campus size and the lack of Aboriginal peoples in the overall student population were identified as intimidating factors. Student #27: Oh, the classrooms - they are so huge. The first couple of weeks here I was so overwhelmed and nervous because of the people - there were so many and so little space. It's like you are invading my aura in a way (p. 7)...I was just sitting there and hiding and like I have never had so many people sit