Browsing by Author "Schill, Kaela"

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    Cultural safety strategies for rural Indigenous palliative care: a scoping review
    (2019-02-14) Schill, Kaela; Caxaj, Susana
    Abstract Background There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. Methods We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts. Results The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. Discussion Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. Conclusions Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.
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    “It's a whole package…all part of your body and mind, your soul”: Experiences and Knowledge of Mental Wellness Among Urban Indigenous Elders in the Southern Interior of British Columbia
    (2018-09-21) Schill, Kaela; Thurston, Wilfreda Enid; Oelke, Nelly Donszelmann; Page, Stacey A.; Kurtz, Donna L. M.
    Indigenous peoples in Canada experience higher rates of adverse health outcomes due to historical and contemporary colonialism. In conjunction with a Community Advisory Committee, this research project explored knowledge and experiences of mental wellness among urban Indigenous Elders in the Southern Interior of British Columbia. This project used a qualitative methodology, including traditional and modified sharing circles and individual interviews for data collection. The resulting transcripts were thematically analyzed. Internal validity was established using member checking. Five themes were identified, including: holistic wellness; poor mental wellness outcomes; determinants of mental wellness; the healing journey; and, services and supports. A self-reflection chapter provides insight on the project from the student’s perspective. The research findings are located within the existing academic literature, and the unique ways urban Indigenous Elders experience mental wellness are discussed. Implications of the findings are provided for healthcare systems, cultural safety, policy makers, inter-sectoral collaboration, and future research.