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2 DIVERSITY IN CANADA

• 22% of Canadians are visible minorities

• Most new immigrants arrive from Asia, then Africa, then Europe
(Statistics Canada 2016)
CH. 4
• Approx. 15000 2SLGBTQ+ older adults in Ottawa (Ottawa Senior Pride
ADDRESSING DIVERSITY IN OLDER Network. 2017)

ADULTS • Disability – 1 in 5 Canadians over age 15 has a disability (Stats Can, 2020)

Image credit: https://www.ic.gc.ca/eic/site/icgc.nsf/eng/07706.html

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3 DIVERSITY IN NURSING 4 WHAT IS CULTURE?

• Increasing diversity particularly with nurses and unregulated care providers • CNA (2018):
in long term care, home care • “a specific individual’s beliefs, values, norms and lifeways that can be shared,
• Increasing diversity in nursing providing opportunities for multi-culturalism learned, transmitted…. That influences their thinking, decisions, behaviors”
• “complex and shifting”
• Challenges • “influenced by history, experience, social, and political contexts”
• Health promotion programs “westernized” • “not limited to race or ethnicity”
• Creates communication barriers • Ex. Disability culture, sexual orientation culture, religious culture, work
• Use of interpreters – not just translation place culture

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5 CULTURAL COMPETENCY & SAFETY- WHY ARE 6 CULTURAL SAFETY CONTINUUM

THEY IMPORTANT?
What is at stake for the patient?
 improved health outcomes
 reduced inequities
 individualized care that meets unique needs
What is expected of ALL nurses?
 holistic, patient-centred care provision
 non-judgmental care
 continuous self reflection and learning about others

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7 CULTURAL AWARENESS & SENSITIVITY 8 CULTURAL COMPETENCE

Cultural awareness: • knowledge, self-awareness, attitudes, and skill development nurses need to facilitate
respectful and meaningful nurse-client relationships (CNA, 2018)
“beginning acknowledgement that there are differences between people” (St. Denis, 2017)
Is an ongoing process of continuously learning and adapting
Cultural sensitivity:
• “becoming” NOT “being” culturally competent (Cai, 2016, p. 270)
““understanding that there is a difference, and also that these differences may be Self-awareness exercise:
important.” (St. Denis, 2017)
 Box 2-1- how do you rate yourself
What are examples of required:
 knowledge, attitudes, skills?

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9 CULTURAL HUMILITY 10 CULTURAL SAFETY

• “… a process of self-reflection to understand personal and systemic biases and to
develop and maintain respectful processes and relationships based on mutual trust.
Cultural humility involves humbly acknowledging oneself as a learner when it comes to
understanding another’s experience.” (FNHA, 2022)
• “process and an outcome with the goal of greater equity and power
balance” (CNA, 2018, p. 4)
• “and creating an environment free of racism and discrimination where
people feel safe to receive care” (FNHA, 2016)

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12 CULTURAL SAFETY CON’T 12 CULTURAL PERSPECTIVES ON WELLNESS

• How do we support culturally safe practice? • What does it mean to be healthy?

• Establishing trust
• We have our own bias and perceptions about what is right and
• Collaboration with patients
• Patient-centred care
wrong – we can be judgmental when considering other’s world
• Patients feel HEARD and AUTONOMOUS to make decisions view
• Inclusion of patient values/beliefs/practices/language • What does it mean to be ‘other’?
• Interpreters, cultural healers/leaders included

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13 HEALTH BELIEFS 14 HEALTH INEQUITIES

• Western or biomedical system • Health inequities:

• Disease caused by germs, abnormalities, pure science base preventable and unjust differences in health outcomes.

• Personalistic or magicoreligious system  difference in rates of disease, incidence, prevalence, morbidity,

• Supernatural influences “out of our hands” mortality or life expectancy b/t one population or another
• Greater health inequities among racial, ethnic, gendered, disabled
• Naturalistic or holistic health
minorities
• Eastern medicine – harmony and balance

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15 FACTORS ASSOCIATED WITH HEALTH 16

INEQUITIES IN CANADA REDUCING HEALTH INEQUITIES
• Barrier identification
FACTORS VULNERABLE POPULATIONS
• Low socioeconomic status • Indigenous Peoples • Cultural competency
• Low education level • New Canadians
• Persons with disabilities • Culturally safe care
• Housing insecurity
• Female gender • Homeless

• Rural/remote residence • People with stigmatizing conditions

• Older adults
• Disadvantaged circumstances
• Individuals with poor literacy skills

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17 INDIGENOUS OLDER ADULTS 18 INDIGENOUS OLDER ADULTS

• Individual strengths:
• Unique cultural/spiritual/health views and rebuilding language and traditions- 600+ groups in
Canada  honour of elders, spiritual leaders, traditional healers, unique language and practices
• Histories of trauma • Vulnerabilities:
 cultural genocide
 poverty, shelter, sanitation and water, food insecurity
 residential schools
 violence
 60s scoop and current day CAS involvement
 higher rates of: mental illness, suicide, substance use disorders, HIV
 historical and intergenerational trauma
NSG approach to care:
 discrimination within health care system
 Cultural safety- first steps – RESPECT, GENIUNE INTEREST, PATIENT CENTRED CARE

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19 OLDER ADULTS WITH DEVELOPMENTAL 20 OLDER ADULTS WITH DEVELOPMENTAL

DISABILITIES DISABILITIES
• History of trauma in health care: • Health inequities

 institutionalization (ended in Ontario in 2009)  poor access to health promotion/disease prevention education materials

 forced sterilization (Evans, 1980)– assumed asexual, unfit to parent  missed screening for diseases
 5X more likely to have a mental illness than non-disabled

Uneducated health care providers!! (Lewis et al., 2017)  Dx overshadowing because of disability & age attribution
 discrimination/stigma (Don, 2019)
 4 X higher incidence of violent victimization than persons without IDD (Stats Can, 2018)

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21 SUMMARY

• Diversity and disparity require our attention and action

• Diversity and inclusion matter: Advocacy
• Reduce disparities by identifying barriers and practicing with cultural competence
• Don’t make assumptions
• Future generations will likely be more confident about sexual needs, sexual orientation
• Be willing to engage in discussion
• Examine your own stereotypes/biases
• Do not infantilize
• Do not impose your own beliefs on others

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