Indigenous Peoples and The Canadian Healthcare System: Wound Care Resources
The development of a website to provide a culturally safe method to communicate wound, ostomy and continence information and resources.
Despite Canada’s commitment to primary health care and principles of social justice, health inequities remain a pressing national concern for Indigenous peoples. In Canada, healthcare for Indigenous peoples, which include First Nations, Inuit and Métis, is shared by the federal, provincial and territorial levels of government. With a complex mix of policies, legislation and relationships, the Canadian healthcare system includes Indigenous peoples in the per capita allocations of funding from the federal transfer and are entitled to access insured provincial and territorial health services as residents of a province or territory. Indigenous Services Canada funds or directly provides services for First Nations and Inuit that supplement those provided by provinces and territories, including primary health care, health promotion and supplementary health benefits.1
Indigenous Services Canada also funds or directly provides certain health care services to First Nations communities and funds the provision of certain community health programs for Inuit peoples. This is in addition to federal funding provided to territorial governments. Indigenous Services Canada similarly funds non-insured health care benefits to eligible First Nations and recognized Inuit regardless of where they live in Canada.
A coordinated approach to address the health needs of First Nations, Inuit and Métis, and health care delivery among all levels of government remains an ongoing challenge. The inequities in access to healthcare and social determinants of health experienced by Indigenous peoples in Canada are known and documented, however, this relevant information and evidence has not been translated into improved health.2 The root causes of inequitable access to healthcare for Indigenous peoples are complex and need further assessment within the social, historical, and political context in order to develop solutions.
In June 2018, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched the Indigenous Wound, Ostomy and Continence Health Core Program to address the inequity of healthcare delivery. There was a commitment to gain a better understanding of the gaps in patient care delivery of wound, ostomy, and continence, looking at the unique perspectives in First Nations communities including rural, remote, and urban areas. Healthcare delivery solutions that were equitable to non-indigenous communities and supported cultural safety were at the forefront of the thinking.
One gap that was identified by this Core Program was the lack of a consistent process to deliver culturally safe information on the topic of wound, ostomy and continence to First Nations medical practitioners, nurses, family caregivers and patients. In January 2022, this Core Program put together a project team, that in addition to Catherine Harley, NSWOCC Chief Executive Officer, and Troy Curtis, NSWOCC Director of Operations, was made up of representatives who work in the frontline with Indigenous, Metis, and Inuit people. This project team met to set objectives to develop a national communication tool in the form of a website which would be an online informational and educational resource hub. The goal of this website was to enhance accessibility to information and ultimately improve healthcare for Indigenous peoples. To achieve this goal, the objectives were to create a website that would:
• Act as a single directory whereby hyperlinks to culturally safe Indigenous healthcare information and educational resources for patients, Nurses Specialized in Wound, Ostomy and Continence (NSWOCs), and other healthcare professionals could be found;
• Display hyperlinks to Indigenous Wound, Ostomy and Continence health resources broken down by Province/Territory to help patients, NSWOCs, Skin Wellness Associate Nurses (SWANs) and other healthcare professionals disseminate pertinent information that exists elsewhere online for the respective region they live and work in;
• Share news related to Indigenous Wound, Ostomy and Continence health;
• Welcome visitor-submitted suggestions for new links to resources to be added to the website;
• Support website visitors getting in contact with an NSWOC closest to their area using the NSWOCC “Find an NSWOC” tool;
• Provide information in multiple mediums including video, blog, external hyperlinks, and images;
• Establish a common language by providing a glossary defining key ostomy-related terms adapted from the 2022 NSWOCC Ostomy Patient Teaching Guides for Ileostomy, Ileal Conduit, and Colostomy as well as establishing a glossary of terms, in the future, for wound care and
continence.
The NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program project team met several times over the following seven months to refine the design, content, and navigation of the website. The group collectively came up with the name of the “Sharing Circle” for this website in order to support that healthcare for Indigenous peoples must be shared by everyone. Sharing circles provide opportunities for each voice to be heard, respected, and valued. They are a traditional practice in some Indigenous communities in North America and are designed to ensure everyone has an equal opportunity to share their opinions and ideas.
On August 10, 2022, the NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program launched this new “Sharing Circle” website, helping patients, Nurses Specialized in Wound, Ostomy and Continence (NSWOCs), Skin Wellness Associate Nurses (SWANs) and other healthcare professionals access a directory of resources, education, training, and support related to Indigenous Wound, Ostomy and Continence Health. The “Sharing Circle” website was implemented through electronic communications, a social media campaign, posting on the NSWOCC website and the websites of aligned organizations and through personal emails to colleagues.
The Sharing Circle can be accessed online at www.sharingcircle.online. In 2024 it continues to be updated as the NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program receives more feedback and resources to add to the site. The use of this website is evaluated monthly through the use of the website analytics.
We hope that by developing and launching the “Sharing Circle” website that we have provided an open, respectful way of obtaining wound, ostomy and continence information and resources for healthcare providers and First Nations people in a culturally safe manner. By having access to this website, we strive to support better access to patient care in a more timely manner. This is one step towards supporting equitable healthcare for
Indigenous peoples.
By Catherine Harley and Troy Curtis
Catherine Harley, eMBA, RN, IIWCC is CEO, Nurses Specialized in Wound, Ostomy and Continence Canada, Ottawa, Ontario, Canada. Troy Curtis, BHum, is Director of Operations, Nurses Specialized in Wound, Ostomy and Continence Canada, Ottawa, Ontario, Canada.
