The Need For Palliative Care Services For First Nations People
‘When a man moves away from his familiar environment, his heart becomes hard’. The first nation people are more connected with mother earth so they enjoy the sounds and sights of environment. In Ontario, more than 220, 00 people consider themselves as first nations. There are 133 first nation communities across Ontario and each nation is unique in their beliefs, language and histories. Less than half of these communities are small and living in rural areas, where individual experience deep connection to their mother earth. In a mean time, about 65% of First Nations peoples live in large urban regions where they experience a vibrant and modern cultural perspective of dining, arts and events. The need for palliative care services for First Nations people is increasing drastically due to increased aging population and the high incidence of chronic and terminal disease amongst this population.
Health and wellness of first nation people is mainly centred on a holistic model of health, but this is always unnoticed in the prevention and treatment of chronic conditions and in the promotion of health and wellness. The fundamental focus of first nations healing and wellness is through the balance and inter-relationships of the physical, mental, emotional, and spiritual aspects of a being. People give more importance to traditional treatment over western medicine. Traditional healing is the use of health practices, beliefs, knowledge and approaches for healing and wellness while using ceremonies, plant, mineral medicines, energetic therapies and physical techniques. Each family person tries to finds out the needs of person with illness and it is family’s responsibility to satisfy their needs and walk with them in their every steps. In addition, traditional foods are more important and it gives them more emotional comfort. For example, the first nation people consider salmon as traditional food. Doctor advised one to restrict salmon due to some medical reasons and the community think it cause more emotional discomfort and pain to the client. So when providing cares to fist nation people, the nurse should understand about their culture to provide cultural sensitive care. In the expectations of care for the First Nations, there are 2 main areas to emphasize, the prevention of illness and the promotion of the health needs of population as a whole. In the prevention of illness, the level of knowledge about the basic life necessities needed to be assessed and education must be given to them in regarding of hygienic life practices, betterment in the life style scenarios as well as follow up to the medical regimens during illness. Care should be social determinants like socioeconomic status, children and youth, physical environment, culture and language. Nurses have the responsibility to know about the traditional peculiarities of people to provide cultural sensitive care and educational guidance.
Family members of the client does not like to say the word ‘end of life’ because they think it is only ending physical body but spirit remain alive. Elders are the main decision maker for medical problems, as they are highly respected people in first nation communities. The people always accept advice from doctors because of their respect to elders and healers. Terminally ill patient’s family members do not want their loved ones to know about the seriousness of their medical condition, because they believe that positive thinking is very essential to promote health. They think that discussing about terminal illnesses or death can cause the patient to die more quickly. So some first nation community patients might accept uncertainty in prognosis or disease progression more easily than others. Family or friends often take care of their loved ones instead of involving external agencies due to various reasons like geographic remoteness, financial constraints and the personal importance of family. Most of the first nation patients want to die at their home because of their attachment to their family. In remote communities, the first nation people more commonly interacts with nurses, social workers, and alternative health care providers than family doctors due to transportation problems. Furthermore, if patients are incapable of making their final wishes and a substitute decision maker has not been appointed, health care providers might have to determine which family member acts as decision maker. Terminally ill patients like to stay with family members and it is very important for them to say goodbye to loved ones before they pass away.
The funeral customs are different for each tribe of first nations, including the use of native languages, symbols, ceremonial objects and practice. People consider their natural world as sacred place because of religious activities attached to it. The family directly involved in the preparation of the body, and some traditions have believe that the body not be left alone until burial and the body should be buried within 24 hours of death. Family members make all the arrangements like transporting the body, and utilize green burial techniques. Family members involved in wash and dress the body, and place it in a shroud or wooden casket. The body may be honoured for two to four days before burial and they don’t prefer embalming. Every family and tribe has their own traditional way like prayers, songs, smudging, and items that may be buried with the deceased. A medicine man may perform a ceremony in the tribe’s native language. Many tribes restrict what bereaved relatives can eat and what kind of activities they can engage in after the death of a loved one.
The palliative care services for first nations people is increasing due to an increasing aging population and the high incidence of chronic and terminal disease amongst this population. In order to meet the needs of person and family, a comprehensive palliative approach is adopted for all stages of frailty and chronic illness. It improves the person’s autonomy and right to be actively involved in his or her own care. It makes hospice palliative care as a distinct service offered to dying persons to enhance their quality of life throughout the course of their illness or the process of aging. Many first nations’ people always want to die in the communities where they have lived all of their lives and they have less accessible to formalized palliative care programs if living in remote areas. It is very important to ensure equitable access to health services for all Canadians to provide most efficient and effective care to first nation people.
Conclusion
The unspoken beliefs of First nation community about end-of-life issues are typically unexplored by physicians so the discussions can involve interpreters, family, and other key community members. In palliative care situations, Family members are not the best choice as interpreters. The interaction between individuality of patient, community and family concerns presents challenges for caregivers. Generalities might be useful to inform physicians of the potential scope of individual variation in end-of-life discussions, but each patient and family needs to be addressed individually.
References
- Kelly, L., Linkewich, B., Cromarty, H., St Pierre-Hansen, N., Antone, I., & Giles, C. (2009, April). Palliative care of First Nations people: A qualitative study of bereaved family members. Retrieved from https://www. ncbi. nlm. nih. gov/pmc/articles/PMC2669014/
- Kelly, L., & Minty, A. (2007, September). End-of-life issues for aboriginal patients: A literature review. Retrieved from https://www. ncbi. nlm. nih. gov/pmc/articles/PMC2234625/
- Native American Funeral Traditions. (n. d. ). Retrieved from https://agoodgoodbye. com/religious-traditions/native-american-funeral-traditions/
- Traditional Healing //. (n. d. ). Retrieved from http://www. fnha. ca/what-we-do/traditional-healing
