The Status and Legitimacy of Aboriginals in Nursing - Assignment Example

Running Header: THE STATUS AND LEGITIMACY OF ABORIGINALS IN NURSING The Status and Legitimacy of Aboriginals in Nursing BY YOU YOUR SCHOOL INFO HERE DATE HERE ABSTRACT Canadian aboriginals face many discriminatory and stereotypical viewpoints from non-aboriginal members of society. Long-standing perspectives paint aboriginals as being dependent on drugs and being incompetent to be contributing members of society, thus having a dependency on welfare systems and federal government oversight. The researcher in this project has observed biased attitudes toward aboriginals in a real-world health setting which sparked an exploration of discrimination against aboriginals in this field. Research uncovered that the impact of coping with stereotypes and discrimination could lead to negative health consequences for this aboriginal population. Through investigation of three paradigms: empirical, interpretive and critical, the research uncovered that the dominant discourse is that such bias is not present in the health services sector and that perceptions of discrimination is a product of pre-existing lack of self-esteem and lack of resiliency as a result of cultural inadequacies prevalent in aboriginal cultures. It was discovered that power is maintained in the health sector while deliberate or unconscious marginalization against aborigines dominates the Canadian social and professional sentiment about aborigines. The study concludes that while the researcher has personally observed these biased attitudes, culpability for negative health outcomes on aborigines may be attributable to these populations themselves. The Status and Legitimacy of Aboriginals in Nursing Introduction Despite the fact that the Canadian health care system provides a legislative framework for ensuring equity of care provision for all members of Canadian society, discrimination seems to be still prevalent in the nursing profession. Bias can be oftentimes observable when providing care to aboriginal members of society, namely against those sharing ethnic characteristics of Indian, Métis and Inuit native peoples. Anti-aboriginal discrimination manifests itself through stereotyping, which stigmatizes these society members even in the health care environment. Long-standing stereotypes often portray aboriginals as being pervasive drug users, violent and incessantly unemployed (de Leeuw, Kobayashi & Cameron, 2011). The most prominent label marginalizing Canadian aboriginals is that they are highly dependent on welfare programs and incompetent to the degree that their affairs should be fully supervised by the Canadian federal government (Erickson, 2005). In the health care sector, Canadian aboriginals seek health services, though disproportionate in frequency to non-aboriginal patients. When providing nursing care to these individuals, debasing stereotypes about the legitimacy of aboriginals in Canadian society can manifest themselves in the discourse between professional staff in clinical environments, a phenomenon personally observed by the researcher. It is the moral and ethical responsibility of nursing professionals to provide equitable and unbiased health care to all members of Canadian society. Hence, understanding what underpins such negative discriminatory discourse against aboriginals is absolutely critical in improving health care quality for aboriginal people. The purpose of this research is to determine whether nursing professionals, by exhibiting discriminatory behaviours and attitudes toward aboriginals during the health service interventions, actually contribute to enhancing negative health outcomes for their aboriginal patients. This knowledge can assist in changing attitudes and posture of nursing professionals when compelled to provide services to aboriginals seeking health care. Because aboriginal discrimination maintains sociological and psychological implications, it was necessary to examine a diverse collection of literature in these domains to gain a robust foundation of understanding about what underpins such negative sentiment about aboriginal Canadians. Hence, the researcher procured scholarly journals containing empirical data about the impact of discrimination on aboriginal health status and socio-psychological literature which explained what factors fortify these long-standing, negative beliefs about aboriginals. It was determined that this approach to research procurement would provide a more balanced and realistic foundation of knowledge of why aboriginals might still be marginalized in society and in the health care system. This study required both qualitative and quantitative knowledge to establish a framework for what constituted this potential bias toward aboriginals in health services. A Discourse Analysis of Aboriginal Discrimination The empirical paradigm emphasizes confirmation or validation of a theory based on quantitative (statistical) data. The notion that aboriginal peoples are victimized by stereotypical attitudes, from a socio-psychological perspective, could undoubtedly be defended from an intuitive or interpretivistic perspective. However, the procurement of empirical data, gleaned from relevant sample populations of aboriginal peoples, can provide insight into the frequency and legitimacy of discrimination experienced by these peoples. A study recruiting over 1,000 First Nation aboriginal participants identified that 63 percent of respondents sustained measurable negative impact on self-esteem as a result of recurrent aboriginal stereotyping (First Nations Centre 2005). Sufficient self-esteem is considered a determinant of health and when an individual experiences repeated instances of racism and discrimination, poor health status is a common result (Smye, Rameka & Willis, 2006). As compared to the Canadian average, life expectancy for aboriginal people was 7.4 years less for males and 5.2 years less for females (Health Canada, 2000). Young (2003) asserts that off-reserve aboriginals maintain a higher frequency of smoking behaviours than other Canadian citizens, representing 62 percent of the aboriginal population (Young). Empirical data gleaned through research provides remarkable statistics on what might serve as a predictor of negative health status in aboriginal people. However, the literature does not make a direct connection between such behaviours as smoking as a means of coping with the psychological implications of confronting discrimination and racism. Discourse founding on empirical data seems to maintain an objective of presenting health-related statistics in an effort to confirm that aboriginal peoples, however this quantitative distinction is not addressed fully. In fact, Young (2003) iterates that there is a distinct discrepancy between statistical research and the fundamental health indicators of aboriginals after the researcher examined quantitative data from 254 studies on aboriginal people and aboriginal health status. Discourse, however, insinuates that discrimination against this marginalized group should be considered a predictor of poor health outcomes and health status for these peoples. A recent study utilising survey instruments targeting a sample of 488 aboriginals found a direct correlation between the experience of racism and symptomology associated with post-traumatic stress disorder (Currie, et al., 2013). This particular study utilising a quantitative methodology provided the first reliable discourse that made a direct and blatant association between poor health statuses of aboriginals as a result of recurring racial discrimination. The authors, supported by empirical data, insist that the study provides a relevant framework for policy development that can assist Aboriginal people to cope with negative health outcomes as a result of recurring racist situations (Currie, et al.). The general discourse from authors providing empirical data is that racism, stereotyping and discrimination is a competent predictor of negative health outcomes for aboriginal Canadians. It appears that the general intention of various researchers involved in empirical data collection are attempting to utilise quantitative data to support the general hypothesis that negative health status is a legitimate and statistically-measurable outcome of discrimination and stereotyping. It would appear, even though the quantitative correlation between negative aboriginal health status and experience of recurring discrimination is virtually nil, that researchers approach their empirical studies under the subjective pretence that such evidence will ultimately be uncovered through future quantitative investigation. In the research community, discourse alludes to researcher partiality in favour of aboriginal discrimination underpinning poor health status for these peoples. From a different perspective, the interpretive paradigm is descriptive and qualitative in nature, with data supportive of experiences or observations. Interpretive theory calls for more subjectivity in analysis of data achieved through research (e.g. interviews) and is founded on an interactional model of research. One study utilised interviews in order to understand how aboriginal women perceive the quality of health care services provided to them in clinical environments. Respondents indicated that the darker their skin, the more unpleasant the health care experience (Kurtz, Nyberg, Van Den Tillaart & Mills, 2008). One can consider the sentiment of a participant in the Kurtz, et al. (2008) study who was adamant that she did not drink when responding to her physician’s disbelieving inquiry about alcohol consumption: “I have not drank for many years. I’ve been sober for 15 years. [they will ask], ‘Are you sure? Are you sure you put your own pants on this morning?’ That’s what he said to me!” (Kurtz, et al., p.57). In this study, another aboriginal participant sought medical assistance for severe abdominal discomfort. Her physician, without conducting a competent medical exam, insisted that it was phantom pain, a form of post-traumatic stress stemming from childhood sexual abuse (Kurtz, et al.). Later diagnoses indicated that patient had life-threatening cancer of the uterus. Offered the participant, “I’m having a hard time with it. I’m really angry right now.” (Kurtz, et al., p.57). Dion Stout & Downey (2006) provide that aboriginal women have a much higher rate of mortality and suicide than other Canadian females. Discourse under the interpretive paradigm does not appear slanted or biased as if founded on preconceptions that aboriginal people will certainly experience discrimination in the health care industry. In fact, a rather matter-of-fact attitude founded on the sentiment by participants in the Kurtz, et al. (2008) study indicates that there is evidence of the perpetration of racism and discrimination against aboriginals in the Canadian health care sector. However, the authors indicate that it must be the voices of aboriginal peoples to improve inequities, respect and communications quality when seeking health care services (Kurtz, et al.). The authors of this study seem to recognise that such discrimination and stereotyping is long-standing and engrained in the Canadian culture which requires efforts on behalf of the victimized, rather than suggesting a marked effort on behalf of nurses and physicians. Perhaps this is an interpretive supposition founded on subjective knowledge that the Canadian health care system masks these stereotypical attitudes and denial in this industry that such prejudices exist. The aforementioned supposition is founded on discourse from a qualitative study conducted by Neufeld (2014) designed to measure aboriginal patient and caregiver perspectives on health service quality. In reference to aboriginals, one prenatal caregiver stated: “It’s more trust of the system. They don’t want to be identified as people that have problems, right? I mean, you’re always stigmatized as people who have all these challenges” (Neufeld, p.440). Offered yet another physician in the study: “We tell them you have to watch your diet. You have to exercise. And then the women come back and their sugars are still high. I think they’re worried that we blame them for not caring enough about their pregnancy or baby.” (Neufeld, p.440). The general discourse in these qualitative studies is that aboriginal people, themselves, are blamed for any deterioration or lack of quality engagement in the health care sector. It would appear that while caregivers maintain that they uphold the most upright integrity when intervening with aboriginals, it is the patients themselves who enter these services interventions with a lack of trust in the professional competency of caregivers and maintain rather irrational emotions toward their health care professionals. Even a prenatal program administrator in the study speaks about how aboriginal women need a comforting and relaxed environment to discuss their pregnancy issues. However, the administrator iterates, “I think it’s just one of those things that could be done with ‘here’s the brochure.’” (Neufeld, p.441). Even the researcher herself, Neufeld, asserts that poor intervention quality is a result of a more bureaucratic health care environment that forbids providing more empathic, individualized attention to aboriginal women. Such discourse as emotionally difficult and lack of understanding when referring to aboriginal patients points toward that the real blame for poor health interventions are primarily a result of aboriginal irrationality and not a discriminatory health environment. The author even suggests that aboriginal patients are unwilling to accept personal responsibility for their health problems as it would seek to confirm perceived judgments of aboriginal inadequacy and incompetency as held by caregivers (Neufeld). Hence, the discourse in interpretive research seems to place culpability for poor health service quality directly on aboriginal patients. This paradigm dominates the discourse. As such, the discourse would seem to reject that health caregivers maintain discriminatory attitudes toward aboriginals and that any negative health outcomes are pre-existing in a population with previously-established trust issues, shame and general lack of social competency and not a product of discrimination in the health field. In the Neufeld (2008) study, the researcher had approached many health care agencies that refused participation in the study. Hence, this again might point toward a method of avoiding exposure of legitimate discriminatory sets of attitudes in health care services. From a third perspective, the critical paradigm is derived from analysis of possibility, essentially how a scenario could be against a certain normative ideology. To describe critical theory, Lemert (1989) suggests that if God had given Noah the option to consider critical epistemology, the pursuit of knowledge’s validity, it is likely everyone would have drowned. Hence, the critical paradigm is the exploration of rational assertions commenced by reason itself. Under the critical paradigm, analytical research seeking to refute or challenge aboriginal discrimination and its correlation to negative health outcomes is limited. However, discourse provided by Anderson & Ledogar (2008), who analyzed 15 different studies on aboriginal negative health implications, points toward support that it is the aboriginals, themselves, who are responsible for low self-esteem and emotional distresses. The most common finding in critical analysis of 15 health studies is that aboriginals would have more personal resiliency, increased self-esteem and reduced tobacco use if they worked toward finding pride in their heritage and sustained a culture that teaches how to buffer against discrimination and diversity (Anderson & Ledogar). This same sentiment is provided by Bryant-Davis (2007) who asserts that race-based trauma is a product of aboriginal culture and not prevalent in the health care sector. Discourse here seems to criticize the notion that discrimination and stereotyping in health services contributes to negative health outcomes for aborigines, rather that Canadian caregivers are instrumental in trying to combat it and educate others about the perils of race-based trauma. Exploring Power Relations Are researchers in the health care sector, then, to assume that discrimination against aborigines is fantasy and a product of aboriginal patients’ inherent mistrust and lack of resiliency? Discourse from professionals in this sector (and interpretive researchers) paints the portrait of health care professionals as being empathetic educators aware of perceived aboriginal (pre-existing) deficiencies that complicate health care relationships between patient and their respective nurses and physicians. Additionally, these professionals maintain a legitimized power in the health care relationship in an environment where aboriginal patients are wholly reliant on the professional capacities to provide effective and respectful treatment and care. As shown in Nuefeld (2014), professionals assert that environmental bureaucracy forbids more emotionally-based interventions with a here’s the brochure methodology of care-giving as an appropriate and viable model. Hence, professionals in the health care field seem to recognize the many challenges faced by aboriginal patients, but segregate taking responsibility for contributing to further negative health outcomes. Whether realized or not, it would seem that health care professionals continue to marginalize aboriginal patients by continuously pointing out that they are a troubled and disadvantaged population, but insulate themselves from admitting that stereotypes guide health services decision-making and attitude. In the discourse, the views and voices of non-patient aboriginals are not heard, either to defend their social and cultural (perceived) deficiencies or lend support that negative health outcomes of aborigines might be a product of long-standing, non-supportive heritage rather than a product of nurse and physician stereotypes impacting health service quality and engagement. If society and health professionals are to assume the blame should be placed on aborigine patients, then critical discourse challenging this perspective should be uncovered through studies spotlighting the dynamics of social relationships in the aboriginal cultures. Conclusion and Discussion of Cultural Factors The articles analyzed in this research endeavour shape the culture of the health care environment as being officious and not conducive to developing intimate and benevolent relationships between professionals and patient. This ideology seems to underpin why certain aboriginal patients may perceive judgment or inconsiderate behaviours about their heritage and culture when, in fact, it is the product of health care culture in Canada today. The majority of literature also seems to identify that culpability for lack of resilience, thus leading to negative health outcomes for aborigines, is a direct result of socio-cultural inadequacies and wariness toward others that manifests itself in a type of paranoia against health professionals in which blame toward nurses and physicians for negative health consequences is unfounded or even irrational. This research project explored three paradigms to uncover potential aboriginal stereotyping and discrimination in the health field, sparked by personal researcher perceptions of this bias in a professional environment. However, discourse in empirical, interpretive and critical paradigms seems to refute that health caregivers contribute to negative health outcomes as a result of maintaining stereotypical discriminations and that the real problem is deeply embedded within the aboriginal communities where the patients originate from. References Anderson, N. & Ledogar, R.J. (2008). The CIET Aboriginal Youth Resilience Studies: 14 Years of Capacity Building and Methods Development in Canada, Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 6, pp.65-87. Bryant-Davis, T. (2007). Healing requires Recognition: The Case for Race-Based Traumatic Stress, The Counseling Psychologist, 35, pp.135-143. Currie, C.L., Wild, T.C., Schopflocher, D.P., Laing, L., Veugelers, P. & Parlee, B. (2013). Racial Discrimination, Post Traumatic Stress, and Gambling Problems among Urban Aboriginal Adults in Canada, Journal of Gambling Studies, 29(3), pp393-415. de Leeuw, S., Kobayashi, A. & Cameron, E. (2011). Difference, in V.J. Del Casino, M.E. Thomas, P. Cloke and R. Panelli (eds.), A Companion to Social Geography. Oxford: Wiley-Blackwell, pp.17-37. Dion Stout, M. & Downey, B. (2006). Nursing, Indigenous Peoples and Cultural Safety: So What? Now What?, Contemporary Nurse, 22(2), pp.327-332. Erickson, L. (2005). Constructed and Contested Truths: Aboriginal Suicide, Law and Colonialism in the Canadian West, The Canadian Historical Review, 86(4), pp.595-618. First Nations Centre. (2005). First Nations: Regional Longitudinal Health Survey. Ottawa: First Nations Centre. Health Canada. (2000). A Statistical Profile on the Health of First Nations in Canada: Highlights of First Nations Health Statistics. Retrieved February 10, 2015 from http://www.hc-sc.gc.ca/fnihspni/pubs/gen/stats_profile_e.html Kurtz, D.L.M, Nyberg, J.C., Van Den Tillaart, S. & Mills, B. (2008). Silencing of Voice: An Act of Structural Violence – Urban Aboriginal Women speak out about their Experiences with Health Care, Journal of Aboriginal Health (January), pp.53-63. Lemert, J.B. (1989). Criticizing the Media: Empirical Approaches. London: Sage. Smye, V., Rameka, M. & Willis, E. (2006). Indigenous Health Care: Advances in Nursing Practice, Contemporary Nurse, 22(2), pp.142-154. Young, T.K. (2003). Review of Research on Aboriginal Populations in Canada: Relevance to their Health Needs, British Medical Journal, 327(7412), pp.419-422. Read More