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Palliative care of First Nations people

A qualitative study of bereaved family members

Barb Linkewich, RN IBCLC CHPCN(C) and Helen Cromarty, RN
Ms Linkewich is Vice President of Health Services and Ms Cromarty is Executive Director of Aboriginal Services at Meno Ya Win Health Centre in Sioux Lookout

Natalie St Pierre-Hansen
Research intern at the Northern Ontario School of Medicine.

Irwin Antone, MD CCFP and Chris Gilles, MD CCFP
Assistant professors in the Division of Clinical Sciences at the Northern Ontario School of Medicine

Correspondence: Dr Len Kelly, Northern Ontario School of Medicine, Box 489, Sioux Lookout, ON P8T 1A8; e-maillkelly{at}mcmaster.ca

OBJECTIVE To understand cross-cultural hospital-based end-of-life care from the perspective of bereaved First Nations family members.

DESIGN Phenomenologic approach using qualitative in-depth interviews.

SETTING A rural town in northern Ontario with a catchment of 23 000 Ojibway and Cree aboriginal patients.

PARTICIPANTS Ten recently bereaved aboriginal family members.

METHODS Semi-structured interviews were conducted, audiotaped, and transcribed. Data were analyzed using crystallization and immersion techniques. Triangulation and member-checking methods were used to ensure trustworthiness.

MAIN FINDINGS First Nations family members described palliative care as a community and extended family experience. They expressed the need for rooms and services that reflect this, including space to accommodate a larger number of visitors than is usual in Western society. Informants described the importance of communication strategies that involve respectful directness. They acknowledged that all hospital employees had roles in the care of their loved ones. Participants generally described their relatives’ relationships with nurses and the care the nurses provided as positive experiences.

CONCLUSION Cross-cultural care at the time of death is always challenging. Service delivery and communication strategies must meet cultural and family needs. Respect, communication, appropriate environments, and caregiving were important to participants for culturally appropriate palliative care.

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