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First Nations women and health care services : the sociopolitical context of encounters with nurses Browne, Annette Jo

Abstract

Health care provided to Canadian Aboriginal peoples continues to unfold against a backdrop of colonial relations. This study explored the sociopolitical and historical context of encounters between nurses and First Nations women. Using an ethnographic design and Dorothy Smith's standpoint perspective as the method of inquiry, interactions between nurses and First Nations women were observed in a northern hospital setting. Subsequently, indepth interviews were conducted with First Nations women, nurses, and three other health professionals (N= 35). Incorporating aspects of postcolonial and feminist theories, this study illustrates how dominant ideologies and professional discourses intersect to organize the knowledge and attitudes that nurses bring to their practice. Three related frames of reference were examined: (a) theories of culture, (b) liberal notions of egalitarianism, and (c) popularized images and discourses of Aboriginality. In the absence of competing frames of reference, embedded assumptions about Aboriginal peoples, culture and "difference" influence the relational aspects of nurses' work with First Nations women. Using vignettes from the data, I explain how women's social positioning, material circumstances, past experiences and pragmatism shape their patterns of relating with nurses, their efforts to "get along with all the nurses," and their perceptions of nurses as "all good." Turning their analytical gaze inward, women focused on how they were perceived by health professionals, and how they could best position themselves. To unpack the layers of subtext embedded in women's accounts, critical consideration is given to mediating life circumstances and to particular methodological issues. The study concludes by analyzing strategies for challenging taken-for-granted assumptions and discourses that inadvertently perpetuate colonial relations in health care. The concept of cultural safety, positioned within postcolonial perspectives, is discussed as a means of fostering critical consciousness. By directing nurses to examine historically mediated relations of power, long-standing patterns of paternalism/maternalism, and assumptions about 'race', culture and class relations, cultural safety has the potential to shift nurses' knowledge and attitudes. Locating heath care interactions within these wider historical and sociopolitical contexts can help nurses to more fully contribute to social justice in the realm of Aboriginal health.

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