Indigenous Health & Reconciliation in Healthcare
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.
Historical Context: Colonization and Health
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
Historical Context — Self-Check
1/1The most clinically important reason for nurses to understand the history of residential schools is:
Truth and Reconciliation in Healthcare
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.
Truth and Reconciliation — Self-Check
1/1TRC Call to Action #24 specifically calls on:
Indigenous Concepts of Wellness and Two-Eyed Seeing
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.
Indigenous Wellness Frameworks
Culturally Safe Practice with Indigenous Patients
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
- Reflect on your own assumptions, biases, and cultural position before assuming anything about the patient.
- Ask rather than assume: 'Are there any healing practices important to you that you would like us to incorporate?'
- Recognize that some Indigenous patients may be reluctant to disclose cultural practices for fear of judgment — create safety first.
- Address institutional racism when you see it — bystander silence is complicity.
- Understand that historical trauma may present as reluctance to engage with healthcare — do not label this as 'non-compliance.'
- Use person-first, self-identified terminology: ask how the person identifies (First Nations, Métis, Inuit, Indigenous, Native, etc.).
Match the Indigenous Health Concept to Its Meaning
Terms
Definitions
Indigenous Health — Comprehensive Quiz
1/3Cultural safety, as defined in nursing practice, is best characterized as:
Pre-nursing comprehensive review
1/20Which organelle contains its own DNA and is inherited exclusively from the mother?