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Objective: In the past few years, increasing numbers of Indigenous doula collectives have been forming across Canada. Indigenous doulas provide continuous, culturally appropriate support to Indigenous women during pregnancy, birth, and the post-partum period. This support is critical to counter systemic medical racism and socioeconomic barriers that Indigenous families disproportionately face. This paper analyzes interviews with members of five Indigenous doula collectives to demonstrate their shared challenges, strategies, and missions. Methods: Qualitative interviews were conducted with members of five Indigenous doula collectives across Canada in 2020. Interviews were transcribed and returned to participants for their approval. Approved transcripts were then coded by all members of the research team to ascertain the dominant themes emerging across the interviews. Results: Two prominent themes emerged in the interviews. The first theme is "Indigenous doulas responding to community needs." Participants indicated that responding to community needs involves harm reduction and trauma-informed care, supporting cultural aspects of birthing and family, and helping clients navigate socioeconomic barriers. The second theme is "Indigenous doulas building connections with mothers." Participants' comments on providing care to mothers emphasize the importance of advocacy in healthcare systems, boosting their clients' confidence and skills, and being the "right" doula for their clients. These two inter-related themes stem from Indigenous doulas' efforts to counter dynamics in healthcare and social services that can be harmful to Indigenous families, while also integrating cultural teachings and practices. Conclusion: This paper illustrates that Indigenous doula care responds to a wide range of issues that affect Indigenous women's experiences of pregnancy, birth, and the post-partum period. Through building strong, trusting, and non-judgemental connections with mothers and responding to community needs, Indigenous doulas play a critical role in countering medical racism in hospital settings and advancing the resurgence of Indigenous birthing sovereignty. [ABSTRACT FROM AUTHOR]

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Background: Indigenous palliative persons and their families often have different values, spiritual traditions, and practices from Western culture and Canadian health systems. Additionally, many healthcare policies and practices have been established without adequate consultation of the Indigenous populations they are meant to serve. This can result in barriers to Innu receiving culturally safe end-of-life care. Innu community leaders from Sheshatshiu, Labrador, have identified a need for further research in this area. The purpose of this study is to: (1) describe the cultural and spiritual practices related to death and dying of the Innu in Sheshatshiu; (2) identify aspects of current end-of-life care delivery that serve and/or fail to meet the cultural and spiritual needs of the Innu in Sheshatshiu; and (3) explore ways to integrate current end-of-life care delivery practices with Innu cultural and spiritual practices to achieve culturally safer care delivery for the Innu. Methods: This qualitative patient-oriented research study was co-led by Innu investigators and an Innu advisory committee to conduct semi-structured interviews of 5 healthcare providers and 6 decision-makers serving the community of Sheshatshiu and a focus group of 5 Innu Elders in Sheshatshiu. Data was analyzed thematically from verbatim transcripts. The codebook, preliminary themes, and final themes were all reviewed by Innu community members, and any further input from them was then incorporated. Quotations in this article are attributed to Innu Elders by name at the Elders' request. Results: The findings are described using eight themes, which describe the following: relationships and visitation support a "peaceful death"; traditional locations of death and dying; the important role of friends and community in providing care; flexibility and communication regarding cultural practices; adequate and appropriate supports and services; culturally-informed policies and leadership; and Innu care providers and patient navigators. Conclusions: The Innu in Sheshatshiu have a rich culture that contributes to the health, care, and overall well-being of Innu people approaching end of life. Western medicine is often beneficial in the care that it provides; however, it becomes culturally unsafe when it fails to take Innu cultural and spiritual knowledge and traditions into account. [ABSTRACT FROM AUTHOR]

This paper brings forth the voices of adult Aboriginal First Nations community members who gathered in focus groups to discuss the problem of youth suicide on their reserves. Our approach emphasizes multilevel (e.g., individual, family, and broader ecological systems) factors viewed by participants as relevant to youth suicide. Wheaton’s conceptualization of stressors and Evans-Campbell’s multilevel classification of the impacts of historical trauma are used as theoretical and analytic guides. Thematic analysis of qualitative data transcripts revealed a highly complex intersection of stressors, traumas, and social problems seen by community members as underlying mechanisms influencing heightened levels of Aboriginal youth suicidality. Our multilevel coding approach revealed that suicidal behaviors were described by community members largely as a problem with deep historical and contemporary structural roots, as opposed to being viewed as individualized pathology. [ABSTRACT FROM AUTHOR]

It is critical that nurse education programs in Canada respond to the Truth and Reconciliation Commission's call to develop a course about the documented impacts of Indigenous-specific racism on the health outcomes of Indigenous people. Initiatives such as San'yas Anti-racism Indigenous Cultural Safety Education, courses on trauma-informed care, and required Indigenous health and history classes in nursing programs are providing a solid beginning. However, the effectiveness of this education requires interrogation. The assumption that education results in changes in nursing practice behavior or uptake of critical knowledge may not be completely accurate in complex environments. To this end, this mixed methods study aimed to explore nursing student experience with incorporating decolonizing and antiracist knowledge into nursing practice with Indigenous patients/clients. Fourth-year baccalaureate program nursing students at a Canadian university who had completed a core course on the impacts of colonization and Indigenous-specific racism on Indigenous health in Canada were surveyed regarding their experience of applying this knowledge during their clinical rotations. Sixteen participants responded to an anonymous online survey consisting of three short-answer open-ended questions and six Likert-style questions about their experiences. The emergent narrative themes and Likert-scale data indicate that although the students valued the information provided in the class, they continued to experience some uncertainty when caring for Indigenous clients. Prominent areas of uncertainty included applying knowledge to practice, student confidence in disrupting racist treatment of Indigenous patients by their healthcare colleagues, and knowing how to approach sensitive client situations to avoid re-traumatization. This article discusses these student responses and implications for nursing education and future research. [ABSTRACT FROM AUTHOR]

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. [ABSTRACT FROM AUTHOR]

Background: Outdoor education (OE) should be understood in place, time, and culture because it is not a universal teaching approach. We currently know little about what constitutes the "Canadian ways" of doing OE or what students gain from the experience. Purpose: Our goal was to (a) identify the underlying factors guiding OE programs in Canada and (b) describe the learning outcomes and psychosocial benefits of engaging in OE from the students' perspective. Methodology/Approach: We conducted a systematic review of qualitative studies that examined OE in Canada. We searched published studies from electronic databases (1980-2018). We used meta-ethnography to synthesize the findings. Findings/Conclusions: We reviewed 21 studies reporting on the experiences of 508 students. Using thematic analysis, we identified eight themes highlighting process, goals, and learning outcomes. We developed a model that describes the common teaching components, learning process, and short-term outcomes for OE in Canada. Implications: Our results represent the first study to synthesize OE published research in Canada, which help form a unified voice and a distinctive national identity for OE in Canada. Our results serve as a catalyst for educators to share ideas, practices, and learning goals. [ABSTRACT FROM AUTHOR]

Participation in sport and recreation may contribute to various holistic benefits among Indigenous youth in Canada. However, there is a need for a consolidated evidence base to support the development of sport and recreation opportunities that could facilitate such holistic benefits. The purpose of this research was to produce a meta-study of qualitative research examining sport and recreation experiences of Indigenous youth in Canada. Following record identification and screening, 20 articles were retained for analysis and synthesis. Strengths and weaknesses of included studies were identified through the meta-method and meta-theory analysis. The meta-data analysis revealed five themes that represent the sport and recreation experiences of Indigenous youth. Working collaboratively with community members, our final meta-synthesis situated these five themes within the integrated Indigenous ecological model. This review consolidates the qualitative evidence base, and provides direction for future research and practice. [ABSTRACT FROM AUTHOR]

Although commonly perceived as a typical family type in western society, the nuclear family structure may not resonate with other cultures, including Indigenous populations. This study explored the conceptualization of Indigenous families in Canada. 15 Indigenous and non-Indigenous people participated in semistructured interviews. Findings revealed that the perception of Indigenous family may be framed through a personal or institutional perspective. At the personal level, the perception of an Indigenous family was influenced by culture, specifically social ties, language, childrearing practices, and residential location. At the institutional level, the perception of an Indigenous family was defined through demographic or legal terms, and influenced by temporal change, though generally through a non-Indigenous lens. These findings suggest that current (standard) western definitions of the family may not accurately represent Indigenous families; cultural influences need to be taken into consideration. However, institutional definitions of family may serve specific purposes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this qualitative study was exploring what the roles and challenges of health care providers working within Northern Canadian Aboriginal communities are and what resources can help support or impede their efforts in working toward addressing health inequities within these communities. Design: The qualitative research conducted was influenced by a postcolonial epistemology. The works of theorists Fanon on colonization and racial construction, Kristeva on semiotics and abjection, and Foucault on power/knowledge, governmentality, and biopower were used in providing a theoretical framework. Methods: Critical discourse analysis of 25 semistructured interviews with health care providers was used to gain a better understanding of their roles and challenges while working within Northern Canadian Aboriginal communities. Findings: Within this research study, three significant findings emerged from the data. First, the Aboriginal person’s identity was constructed in relation to the health care provider’s role of delivering essential health services. Second, health care providers were not treating the “ill” patient, but rather treating the patient for being “ill.” Third, health care providers were treating the Aboriginal person for being “Aboriginal” by separating the patient from his or her identity. The treatment involved reforming the Aboriginal patient from the condition of being “Aboriginal.” [ABSTRACT FROM AUTHOR]

Introduction: Aboriginal children in Canada are at a higher risk for overweight and obesity than other Canadian children. In Northern and remote areas, this has been linked to a lack of affordable nutritious food. However, the majority of Aboriginal children live in urban areas where food choices are more plentiful. This study aimed to explore the experiences of food insecurity among Métis and First Nations parents living in urban areas, including the predictors and perceived connections between food insecurity and obesity among Aboriginal children. Methods: Factors influencing children's diets, families' experiences with food insecurity, and coping strategies were explored using focus group discussions with 32 parents and caregivers of Métis and off-reserve First Nations children from Midland-Penetanguishene and London, Ontario. Four focus groups were conducted and transcribed verbatim between July 2011 and March 2013. A thematic analysis was conducted using NVivo software, and second coders ensured reliability of the results. Results: Caregivers identified low income as an underlying cause of food insecurity within their communities and as contributing to poor nutrition among their children. Families reported a reliance on energy-dense, nutrient-poor foods, as these tended to be more affordable and lasted longer than more nutritious, fresh food options. A lack of transportation also compromised families' ability to purchase healthful food. Aboriginal caregivers also mentioned a lack of access to traditional foods. Coping strategies such as food banks and community programming were not always seen as effective. In fact, some were reported as potentially exacerbating the problem of overweight and obesity among First Nations and Métis children. Conclusion: Food insecurity manifested itself in different ways, and coping strategies were often insufficient for addressing the lack of fruit and vegetable consumption in Aboriginal children's diets. Results suggest that obesity prevention strategies should take a family-targeted approach that considers the unique barriers facing urban Aboriginal populations. This study also reinforces the importance of low income as an important risk factor for obesity among Aboriginal peoples. [ABSTRACT FROM AUTHOR]

ABSTRACT The purpose of the study was to describe ways that successful culture-based Aboriginal preventive family service agencies offer employment and education opportunities for staff. Staff in three inner-city, culture-based Aboriginal family agencies were asked about their employment and educational opportunities. Forty-four individuals were asked the question: 'what employment and education opportunities have you had while in this job?' A total of 81 unique responses were received. Participants grouped the responses into eight themes including: planning for services, promotion within the agency, specific skill development, enhanced self-confidence, cultural awareness, teaching others, workshops as well as certified training. Differences between the experiences of study participants and the existing literature indicate that practices within culture-based Aboriginal family agencies are distinct in relation to funding, staff mobility, strengths-base, practical training and cultural knowledge, and that these should be understood and recognized formally in funding decisions and in future research. [ABSTRACT FROM AUTHOR]

There is a dearth of knowledge about the social determinants of substance use among young pregnant-involved Indigenous women in Canada from their perspectives. As part of life history interviews, 17 young pregnant-involved Indigenous women with experiences with substances completed a participant-generated mapping activity CIRCLES (Charting Intersectional Relationships in the Context of Life Experiences with Substances). As women created their maps, they discussed how different social determinants impacted their experiences with pregnancy and substance use. The social determinants identified and used by women to explain determinants of their substance use were grouped into 10 themes: traumatic life histories; socioeconomic status; culture, identity and spirituality; shame and guilt; mental wellness; family connections; romantic and platonic relationships; strength and hope; mothering; and the intersections of determinants. We conclude that understanding the context and social determinants of substance use from a woman-informed perspective is paramount to informing effective and appropriate programs to support young Indigenous women who use substances. [ABSTRACT FROM AUTHOR]