1. What population groups do you primarily work with? Please describe your work setting a little.
I recently returned to work after a maternity leave with my second son, who was born on December 25, 2010. What a memorable Christmas that turned out to be! Not only did I re-enter the work force this January, but I took on 2 new positions, one with Northern Health Authority, working 2 days a week in the communities of Granisle and the Southside of Francois Lake. The other position is 2.5 days per week directly employed by the Lake Babine Nation (a modified version of my previous full-time job), serving their communities of Ft. Babine, Tachet, and Woyenne. The populations of the area are almost exclusively First Nations and Caucasian.
2. Culture is an overarching term that often describes communities that may share common race, beliefs or values. As a health care provider working with a culturally defined/diverse population, what are some key approaches you incorporate in your client encounters to bridge any gaps in communication?
Before entering the NP program, I worked for a First Nations transferred health organization as a Community Health Nurse serving some of the same communities as I work in now. The relationships that developed over the years with the people I was serving became deep and trusting and extended across extended families, but I always felt limited by my scope of practice. This was my reason for pursuing the NP role, I wanted to be able to provide Primary Health Care to First Nations people within their own communities.
In my practice, I always try to do the best that I can in the time that I have- If a family has squeezed in for a 15 minute rapid access visit, I will do whatever I can there, and then book follow ups for anything that I am not able to immediately address. Raising important topics, such as family planning and health maintenance issues at opportune times is key as well, as is providing care creatively, implementing home visits, developing partnerships with community agencies and cross referring in this way. These partnerships are imperative, for example, tracking patients who may be transient can be next to impossible without the inside knowledge of Band Office staff.
3. Culture may shape or influence one’s outlook on health and illness. Subsequently, priorities might be different between client and health provider. When such differences in perspective become apparent, how do you reconcile these differences?
A mentor-colleague of mine once told me that when she sees a patient, they have their priorities for the visit, and we have ours. I find that by addressing the patient’s priorities initially, trust is rapidly established. In my experience, in First Nations communities, once this has occurred with a few community champions, word spreads, and more will come. The most rewarding thing about my practice is that I am able to provide Primary Health Care for patients who really need it. There is so much strength and resilience within these communities, and celebrating successes is an important role for Health Care Professionals who work with them.
4. Do you have specific tools and resources you find useful, which you could recommend to your colleagues?
I rely heavily on my senior colleague, Celia Evanson, FNP in neighboring Fraser Lake. She has been gracious enough to make herself available by cell phone. I also link up with physician colleagues in the Fraser Lake clinic, network with the local physicians and other NPs within our Omenica Lakes group. As far as print resources, I use the SOGC guidelines for women’s health, the Provincial Guidelines, the Canadian Diabetes Guidelines and Up to Date. As for my learning about the traditional practices, I’ve read some books specific to the way of life of the First Nation people in our area, but I love to listen to stories of the elders, or just take some time to go to traditional activities, like the Salmon harvest, and learn from the people themselves.
Beth Berlin, Family Nurse Practitioner
Indigenous competence training: http://www.culturalcompetency.ca/home