Journal palliative and end of life care”

Journal Article Analysis
An analysis throughout the paper will include a journal article summary on end-of-life beliefs, traditions and perspectives from Aboriginal families and Elders in Saskatchewan, and the impact of a medical model procedural system on Aboriginal families. The critical analysis will assess points of view, evidence, strengths, weaknesses, and sociological perspective, while incorporating recommendations for improvement of experiences from Aboriginal Elders. The analysis will try to best explain the broader picture and understanding of the journal article and recommendations while linking the web article, “Enhancing Aboriginal palliative and end of life care” (In the Loop, 2018). A personal perspective on the information gathered from the journal article and web article will also be included.

Journal Article Summary
Within the presented journal article, Completing the Circle: Elders speak about end-of-life care with Aboriginal families in Canada, the question the authors and researchers pose to participants is, “What would you like non-Aboriginal health care providers to know when providing end-of-life care for Aboriginal families?” (Hampton, Baydala, Bourassa, McKay-McNabb, Placsko, Goodwill, McKenna, McNabb & Boekelder, 2010, p. 6). The researchers state the purpose is to document research results in a format, from where the oral traditions and experiences of Aboriginal people during end-of-life, are written within an academic form and context which will help make the research information accessible to healthcare providers for future knowledge and exploration (Hampton et al., 2010).

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The journal article describes how the research gathered builds upon results from a previous study where barriers and restrictions were highlighted regarding medical model policies and culturally appropriate end-of-life care experiences of Aboriginal people and their families – specifically within an Hospital/Acute care environment (Hampton et al., 2010). The journal article suggests there is little existing research, on the traditional beliefs and practices, to help guide healthcare providers end-of-life delivery for Aboriginal people and their families (Hampton et al., 2010). The researchers also mention end-of-life care must become a high priority in research, as Aboriginal populations are growing exponentially even though mortality rates are four to five times higher than those of non-Aboriginal populations (Hampton, et al., 2010).
Journal Article Critical Analysis
Point of View.

According to researchers there is a higher mortality rate among Aboriginal populations though the life expectancy of Aboriginal populations is increasing. The implication is Aboriginal people are increasingly aging and suffering longer due to chronic illnesses before the onset of death which then increases end-of-life care needs (Hampton, et al., 2010). From a macro level, in regards to historical trauma and lack of human rights of Aboriginal populations due to colonization, disenfranchisement, residential schools, sixties scoop and forced relocation, and at a individual and community level dealing with personal experiences of Hospitals and healthcare procedures, as well as from the types of deaths such as, accidents, suicides, and homicides, the rate of chronic illnesses is increasingly higher because of the direct impact from these historical experiences and trauma (Hampton et al., 2010).
The researchers suggest cultural protocols will help to protect Aboriginal individuals and communities at a time of crisis (Hampton et al., 2010). The journal article also implies if cultural traditions are not followed, social supports are limited which negatively impacts healing in times of grief and trauma and thereby communities will lose protective healing rituals to create the sense of healing (Hampton et al., 2010). The research indicates there is a fundamental aspect when preparing before end of life, such as the search for spiritual meaning, where existing guidelines in Hospitals in Saskatchewan are not suited for Aboriginal cultures (Hampton et al., 2010). The article mentions the time after the death is also very sacred as traditional practices will support the person who just passed and help for them “to take the next step in their journey in peace” (Hampton et al., 2010, p. 11).
Evidence.
The research was guided by two Elders and utilized qualitative data collection and analysis, with open-ended interviews (Novak & Campbell, 2006, p. 29). The data collected implemented purposive sampling procedures with the recruitment of five Elders from diverse First Nations in south Saskatchewan such as Cree, Saulteaux, Anishinabe, Metis, and Lakota/Dakota (Hampton et al., 2010; Novak & Campbell, 2006). The researchers defined elder as: “a person who has significant wisdom in areas of traditional Aboriginal knowledge, recognized by the community and nation as having the wisdom, and who has the capacity to transmit their knowledge to others” (Hampton et al., 2010, p. 8).

The guidance from the two Elders helped the Aboriginal and non-Aboriginal research assistants understand how to respectfully approach other Elders at powwows and were able to implement cultural protocols such as offering tobacco and cloth. Five Elders agreed to video interviews, three females and two males (Hampton et al., 2010). The purpose of the interviews was to expand on the research question, “What would you like non-Aboriginal health care providers to know when they are delivering end-of-life health care to Aboriginal people and families?” (Hampton et al., 2010, p. 8). The interviews were sixty minutes, no preparation was done prior to the interviews, and the assistants offered an honorarium at the end of the interviews (Hampton et al., 2010). The research was transcribed for analysis following OCAP principles (ownership, control, access, and possession) and the data collected was coded into six themes to help organize information such as: realization; gathering of community; care and comfort/transition; moments after death; grief, wake, funeral; and message to health care providers (Hampton et al., 2010). The researchers indicated the information recorded was able to highlight a narrative of the dying person’s journey. The narrative was called, “Completing the Circle: End-of-Life Care with Aboriginal Families” (Hampton et al., 2010, p. 9), and researchers made the video accessible to interested health care providers.
From the research, the article implies the completion of the circle is important in the aspect of Aboriginal culture as the belief from Elders is “death is a part of life and is apart of living” (Hampton et al., 2010, p. 9). Through the interviews Elders conveyed traditional cultural beliefs such as, “death is not the end but only a completion of the circle of life, as life will continue after death” (Hampton et al., 2010, p. 9). The research noted the Elders believe what people do here in this life affects the dead and what happens after death affects the living (Hampton et al., 2010). Elders indicated in the research when people surround the dying and families, they are giving their energy as support by praying and burning sweet grass and smudging, as these traditions are spiritually essential (Hampton et al., 2010).
The senses of the research indicated many Elders experienced racism and disrespect from a western medical model view on policies and procedures and from healthcare providers personal beliefs on how they feel and deal with Aboriginal cultural traditions (Hampton et al., 2010). The Elders state there are many misinterpretations such as Hospital policies and procedures only allowing limited number of people to visit a dying person, and at only specific times, as the reasoning given was to conserve the energy of the dying person (Hampton et al., 2010). The research article implies Aboriginal people want to surround the dying with as many family and friends as possible, to pass on good energy, to pray and smudge.
The journal article also mentions the belief of the Elders is the western model of healthcare and traditional Aboriginal cultural views can work in conjunction with one another (Hampton et al., 2010). Through the interviews, the Elders made suggestions for healthcare providers which included: understand, empathize, appreciate the care and traditions of Aboriginal cultures and understand how western institutional policies can interfere with Aboriginal traditions; provide family rooms where extended family and friends can connect, eat, cook, and support each other and the dying; allow for traditional spiritual practices such as smudging and preparation of the body after death while still in Hospital; to have cross-cultural education for healthcare providers and Aboriginal people which stems from the heart; to have healthcare providers knowledgeable on appropriate culture resources and to let Aboriginal families know of these resources (Hampton et al., 2010).
Weaknesses.
Some weaknesses to be considered is the information collected was a representative of only a small sample, within a small area of Saskatchewan, and the individual perspective and knowledge of the five Elders. The data does not necessarily representative other Aboriginal cultures and traditions across the province of Saskatchewan or Canada. During the analysis of data, the researchers made assumptions and judgement of what was important and what to include within the video, thereby creating bias within the research (Novak ; Campbell, 2006, p. 30). The collection of information was only offered to healthcare providers, not a required training within the healthcare system; the information then may or may not be accessed therefore there could be the assumption there will be no known documented knowledge gained by the research.

Strengths.

The research method was guided by research community action methodology, approved by the University ethics board, in partnership with the University and Hospital (Hampton et al., 2010). The Elders recruited were a representation of diverse Aboriginal people and their variations in their access to healthcare and different lifestyles. The Elders interviewed were considered traditional in knowledge by their community and nation and practice culturally traditional customs in a holistic and spiritual meaning (Hampton et al., 2010).
The research assistants respectfully followed culturally appropriate protocols which allowed for the Elders to open-up within the interviews. The data collected was transcribed for analysis, was member checked, and content was reviewed for approval by the Elders (Hampton, et al., 2010). There was continuous collaboration on all stages of data analysis and the evidence gathered supported the researchers question, “What would you like non-Aboriginal health care providers to know when providing end-of-life care for Aboriginal families?” (Hampton et al., 2010). From the evidence, the researchers were able to produce a video format for health care providers to access for future reference. The researchers also produced recommendations, from the Elders thematical results, to healthcare providers for consideration during end-of-life care within a Hospital/Acute-care settings (Hampton, et al., 2010).

Agree of Disagree
The journal article and web article were very interesting to me. I would say I agree with what the research data and researchers are saying. Within Canada, Indigenous populations have experienced tremendous traumatic events throughout history, from the onset of colonization, to the continuous and repeated racism still be experienced today. The history and truths about Indigenous populations had historically been ignored, covered up, falsified truths taught to the rest of Canadian populations as being one way, when the reality is the real truths are now being vocalized. The reality is historical trauma is still being experienced intergenerationally within Indigenous populations and communities. I feel healthcare providers need to be more culturally aware and allow for cultural and traditional customs when dealing with the end-of-care needs of Aboriginal family and friends. Through building respect and education in this aspect, then maybe more trust and relationship building can begin and help in the healing of historical traumas, thereby trying to limit the intergenerational traumas still being experienced.

Sociological Theory and Perspective
The journal article view on end-of-life care delivery of Aboriginal people and their cultural traditions could be seen through a symbolic interaction theory and perspective (Novak ; Campbell, 2006). According to the book ‘Aging and Society: A Canadian Perspective’ (Novak ; Campbell, 2006), symbolic interaction is considered a micro level view, as people give meaning to objects and events through their everyday interactions based on what they know or have learned to be true and have meaning (p. 22). Through a symbolic interaction perspective, based on the Aboriginal cultures, the journal article’s research tries to answer the research question, “What would you like non-Aboriginal healthcare providers to know when providing end-of-life care for Aboriginal families?” (Novak & Campbell, 2006). The research implies there is a higher need to have culturally appropriate end-of-life care delivery given to Aboriginal people and their families because of historical colonization and the meaning Aboriginal cultures have attached to these past experiences (Hampton et al., 2010; Novak & Campbell, 2006). As well, because of individual and cultural experience surrounding the types of traumatic deaths indicated in the research article, the search for spiritual meaning during preparation before death is critical in the healing of grief and trauma, for Aboriginal people to die ‘healed’ in the process of dying (Hampton, et al., 2010).

From the web article, “Enhancing Aboriginal palliative and end-of-life care”, the information gathered and documented is geared towards staff within the British Columbia health authority, called Interior Health (In the Loop, 2018). The web article builds upon the journal articles’ analysis and echoes the need for culturally appropriate end-of-life care and highlights the steps needed and already taken by BC Interior Health (In the Loop, 2018). The web article focus is on education for healthcare providers to provide culturally safe and respectful spaces, when providing care for Aboriginal families during end-of-care needs (In the Loop, 2018).

The journal article mentions there is recent theoretical work published regarding death and dying which indicates “cultural beliefs and practices are particularly influential at the end of life” (Hampton, et al., 2010, p. 7). According to the web article, information recently gathered within the BC health region indicates there have been requests by Aboriginal Elders to be respected and heard when asking for cultural and spiritual aspects during end-of-life care (In the Loop, 2018). Though the web article is from BC Health Authority, the article indicates BC health region is listening and providing appropriate education and provides current links for healthcare providers and others to access. The current links on the web article connect to Aboriginal individuals personally sharing experiences on video (In the Loop, 2018). From the BC health region, the implementations they have done and are continuing to do, is a model from which other provincial health regions could learn and grow from when supporting Aboriginal populations during end-of-life care needs. With the continuation of intergenerational trauma, culturally appropriate treatment of Aboriginal populations should be a high priority, to help Aboriginal populations make sense and be active within creating their social world, which could help to lessen the negative impact of colonization and intergenerational trauma (Novak ; Campbell, 2006; Hampton, 2010).

Conclusion
Throughout the paper, a journal article summary on end-of-life traditions for Aboriginal families and Elders in Saskatchewan, discussed how current procedures within the medical model system can have a negative impact on the person dying and others within the Aboriginal family system. The critical analysis assessed points of view, evidence, strengths and weaknesses of the research which drew connections to a sociological perspective – symbolic interaction theory. The analysis also highlighted recommendations from Elders for healthcare providers during end-of-life care of loved ones. The Elders also indicated their responsibility to work in conjunction with healthcare providers while providing a better understanding of values and beliefs when incorporating Aboriginal end-of-life cultural and spiritual traditions. The journal article analysis was also able to link and connect, within a broader aspect regarding the impacts of colonization and intergenerational trauma, and the reasoning surrounding the need for better understanding of Aboriginal end-of-life cultural traditions. From the analysis, research also provided recommendations from Aboriginal Elders personal perspective while incorporating and linking the web article, “Enhancing Aboriginal palliative and end of life care” (In the Loop, 2018), and the aspects already being implemented within the BC health region.

References
Hampton, M., Baydala, A., Bourassa, C., McKay-McNabb, K., Placsko, C. ; Goodwill, K.

(2010). Completing the circle: Elders speak about end-of-life care with Aboriginal families in Canada. Journal of Palliative Care, 26(1), 6-14. Retrieved from http://aboriginalendoflifecare.com/papers/elders_speak.pdf
In the Loop: News and Events for IH Staff (April 26, 2018). Enhancing Aboriginal palliative
and end-of-life care. Retrieved from https://ihintheloop.ca/enhancing-aboriginal-palliative-and-end-of-life-care/
Novak, M. W. ; Campbell, L. D. (2006). Aging in society: A Canadian perspective. Toronto:
Thomson/Nelson

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