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Build foundational knowledge of Indigenous health in a Canadian and North American context — essential for culturally safe nursing practice. Covers historical context, Truth and Reconciliation, Indigenous wellness frameworks, Two-Eyed Seeing, and culturally safe clinical practice.
Understanding how history created present-day health disparities
Historical Trauma and Healthcare
Indigenous Peoples in Canada (First Nations, Métis, and Inuit) and in the United States (American Indian, Alaska Native, and Native Hawaiian) experience significant and documented health disparities rooted in colonization, forced assimilation, and the ongoing legacy of policies designed to eliminate Indigenous cultures and languages. The Indian Residential School system in Canada operated from the 1870s to 1996 — forcibly removing children from their families, prohibiting Indigenous languages and cultural practices, and exposing children to widespread physical, emotional, and sexual abuse. The intergenerational trauma of this system continues to manifest in higher rates of substance use, mental illness, suicide, chronic disease, and healthcare avoidance among Indigenous communities. Healthcare providers who do not understand this history cannot provide culturally safe care.
Key Policies That Shaped Indigenous Health in Canada
Indian Act (1876, still in effect)
Federal legislation that controlled nearly every aspect of Indigenous life — land, governance, education, cultural practice. Indian Status defined eligibility for services.
Residential Schools (1870s–1996)
Forced removal of children, prohibition of language and culture, documented mass abuse. Final school closed 1996.
Sixties Scoop (1960s–1980s)
Mass removal of Indigenous children from their families into predominantly non-Indigenous foster and adoptive homes, severing cultural ties.
Forced Sterilization
Documented coercive sterilization of Indigenous women in Canada, continuing into the 2000s (SOGC Report, 2020). Joyce's Principle arose partly from this context.
Health Disparities Linked to Colonization
The most clinically important reason for nurses to understand the history of residential schools is:
TRC Calls to Action and Joyce's Principle
Truth and Reconciliation Commission (TRC) — Healthcare Calls to Action
The TRC (2015) issued 94 Calls to Action. The healthcare-specific calls include:
Joyce's Principle
Joyce Echaquan, an Atikamekw woman, died in a Quebec hospital in September 2020 after livestreaming racist and dehumanizing comments made by healthcare staff while she was in distress. Her death and the inquiry that followed led to Joyce's Principle — a commitment that every Indigenous person must have equitable access to all social and health services, without discrimination, and the right to enjoy the highest attainable standard of physical, mental, emotional, and spiritual health. This principle is now embedded in discussions of anti-racism in Canadian healthcare education.
TRC Call to Action #24 specifically calls on:
Holistic frameworks for health beyond the biomedical model
Two-Eyed Seeing — Etuaptmumk
Etuaptmumk — Two-Eyed Seeing — is a concept developed by Mi'kmaw Elder Albert Marshall that proposes learning to see from one eye with the strength of Indigenous knowledge, and from the other eye with the strength of Western knowledge. Neither perspective is subordinated to the other; both are held simultaneously. In healthcare, Two-Eyed Seeing means integrating evidence-based clinical practice with Indigenous healing frameworks, understanding that both can be valid and complementary. It requires curiosity, humility, and genuine openness on the part of the healthcare provider.
The Medicine Wheel (used by many Plains and Woodland nations, though frameworks vary by culture) represents wellness as the balance of four interconnected dimensions: physical, mental, emotional, and spiritual. Health is understood as harmony among all four — not just physical absence of disease. Implications for nursing care: assessing only physical symptoms misses the Indigenous concept of health. Ask about the other dimensions. Avoid imposing the biomedical framework as the only valid model.
For many Indigenous nations, connection to land, territory, and traditional practices is a primary determinant of health — not merely a cultural preference. Land dispossession through colonization directly caused health crises. Land-based healing (traditional food, ceremonies, territorial connection) is now recognized in clinical literature as evidence-based for Indigenous wellbeing.
In many Indigenous communities, healing is communal rather than individual. Elders hold specialized knowledge and serve as healers, counselors, and cultural bridges. Community support networks are protective against adverse health outcomes. Healthcare that isolates Indigenous patients from family and community may inadvertently undermine healing. Ask: 'Is there family or community you would like to have present?'
Biomedical model: individual body as the unit of care, disease as mechanistic malfunction, treatment as intervention. Indigenous wellness models: relational and spiritual dimensions are central; community and land are part of the 'patient'; healing addresses root causes including historical trauma. Tension: not incompatible — Two-Eyed Seeing holds both. Practical implication: ask about traditional healing practices, offer to involve them where clinically safe, and treat them with respect.
Moving from cultural competence to cultural safety
Cultural Safety vs Cultural Competence — A Critical Distinction
Cultural Competence
Learning about another culture to provide better care. Risk: can lead to stereotyping — assuming all members of a group share the same practices. Focuses on the nurse gaining knowledge about 'other' cultures.
Cultural Safety
Power-aware approach that requires the healthcare provider to examine their own cultural assumptions, biases, and how power dynamics affect the care relationship. The patient defines whether the interaction felt safe — not the provider. Includes anti-racist practice.
Cultural safety was developed by Māori nurses in New Zealand (Irihapeti Ramsden) and is now embedded in nursing regulation in Canada, New Zealand, and Australia as the standard for Indigenous healthcare.
Practical Principles for Culturally Safe Care
components.interactiveLearning.terms
components.interactiveLearning.definitions
Cultural safety, as defined in nursing practice, is best characterized as:
