N2130 - Culture, Equity, Diversity & Inclusion, Indigenous Child Health (Lecture 4)

Why are thorough family assessments important in pediatric nursing?

They help nurses understand family dynamics, strengths, weaknesses, structures, functions, and processes, and anticipate how families may cope with a child’s illness.

What are the three social determinants of health emphasized in the lecture as affecting child health?

Culture, socioeconomic status, and social supports.

How can culture influence child health and illness?

It can shape views of sickness, when and how healthcare is sought, relationships with healthcare providers, and acceptance of treatments.

How can cultural awareness improve healthcare?

It can promote trust, improve care, increase acceptance of diagnoses, and improve adherence to treatment.

According to the lecture, which factor has the most adverse influence on health?

Socioeconomic status; poverty can make it difficult for families to obtain healthcare for themselves and their children.

What are examples of social supports for children and families?

Communities, schools, and peer groups.

How can social supports affect child health?

They can provide opportunities and support, or contribute to toxic stress.

What is cultural competence?

An approach that prompts reflection on social elements that perpetuate inequity or injustice, such as racism, ageism, and homophobia.

What is cultural safety?

The goal and outcome of practising in a culturally competent environment.

What is cultural humility?

A lifelong commitment and active process of learning with patients, communities, colleagues, and oneself.

How should nurses approach children and families when practising cultural humility?

With curiosity and a willingness to learn; develop awareness and knowledge of predominant groups in the work community.

How should nurses respond to traditional health practices that do not harm patients?

Respect them and keep communication open with the family.

Why can cultural health practices be challenging during assessment?

Practices or remedies may be misunderstood, misinterpreted, or mistakenly judged as child abuse by an uninformed practitioner.

What is equity?

An approach that ensures people have access to the same opportunities by identifying and eliminating barriers, while recognizing that people do not all start from the same place or history.

What is diversity?

The existence of differences within a setting.

What kinds of differences can diversity include?

Gender, race, ethnicity, disability, sexual orientation, Indigenous identity, age, class, family status, and socioeconomic class.

What does diversity recognize?

How people are both different and similar at individual and group levels.

What is inclusion?

An active, intentional, continuous process that addresses inequities in power and privilege so people with varied identities can fully participate in society.

What does an inclusive culture aim to make people feel?

Respected and valued as individuals and groups, by identifying and removing barriers.

What does inclusion require in a community?

A respectful, safe, diverse community with opportunities for everyone to participate.

What is privilege?

Unequal access to advantages that may relate to the body someone is born with, where they are born, or what they believe; these advantages can make life easier.

Why can privilege be difficult to recognize?

Its benefits may be invisible to the person who has them, and the topic can evoke shame or complicated feelings.

Why is reflecting on personal privilege important?

It is an important first step toward awareness and further action.

What is bias, as described in the lecture?

A lack of awareness of privilege and failure to acknowledge that others may not have the same opportunities.

What can unconscious bias arise from?

Beliefs deeply rooted in personal history and upbringing.

What is confirmation bias?

The tendency to interpret new evidence as confirmation of existing beliefs or theories.

How should nurses respond to the fact that everyone has different perspectives?

Maintain continuous awareness that another perspective is always possible.

What is intersectionality?

The way identities intersect to create overlapping and interdependent systems of discrimination or disadvantage.

Which identity markers may intersect?

Race, class, gender, sexual orientation, age, ethnicity, religion, disability, and others.

How is intersectionality connected to oppression?

Intersectionality helps explain how overlapping identities shape experiences of disadvantage; oppression enables unjust treatment or control of people.

What are examples of concerns or needs diverse pediatric patients and families may bring to healthcare?

Distrust of providers, fear of Western medicine, reliance on social networks, interest in complementary/alternative medicine or traditional remedies, disease stigma, parental self-blame, language or health-literacy barriers, and limited resources.

What practical barriers may prevent families from following healthcare recommendations?

Financial difficulties, family dynamics, resident status, cultural-community factors, transportation access, and limited access to safe spaces.

What are the four strategic priorities in the SickKids EDI strategy listed in the lecture?

Embed EDI in organizational structures, systems, and policies; build a workforce reflecting community diversity; integrate EDI into care, research, and education; create an inclusive child, youth, and family experience.

What is a safe space?

A place or environment where people can express themselves without fear of discrimination, harassment, or emotional or physical harm based on identity or ability.

Can a safe space be more than a physical room?

Yes. It can be a dedicated physical space or the overarching principles guiding an organization.

What features should safe spaces in healthcare include?

Privacy, up-to-date records, preferred names and pronouns, protection from harassment and discrimination, appropriate washroom access, flexible dress codes, access to gender-segregated activities, and inclusive messaging.

What is the child’s right regarding private personal information?

Children and families have a right to privacy; children are not required to disclose everything to schools, employers, or healthcare providers.

When might personal information such as medical history, sexual orientation, or gender status be shared?

Only when there is a specific need-to-know reason, such as providing appropriate care or an accommodation; it should not be shared without consent.

Why should records be updated when a child legally changes their name or gender?

Accurate records help prevent mistakes in care and in how the child is served or addressed.

How should healthcare staff address a child’s preferred name and pronouns?

Use the name and pronouns the child identifies as comfortable and appropriate for their gender identity.

What does protection from harassment and discrimination mean in a safe space?

Children should not face unjust or unfair treatment based on gender, sexual orientation, or medical history.

What washroom access principle is described in the lecture?

Children should have safe restroom facilities and be able to use a washroom that best corresponds with their gender identity.

What is the purpose of flexible dress codes?

Children should not have to choose between male or female clothing; a good policy applies to all clothing for all bodies.

What does access to gender-segregated activities mean?

Children have the right to participate in activities that correspond with their gender identity.

What are examples of inclusive messaging in healthcare?

Welcoming signs and pamphlets, gender-neutral washroom signs, interpreters for patients whose first language is not English, and forms that include more than two genders.

What is gender-inclusive language?

Language that respects a person’s preferred terms or avoids favouring a particular sex.

What should a nurse do when they know a person’s preferred name or pronouns?

Use the terms the person has requested.

What should a nurse do if they do not know how someone wishes to be addressed and are uncomfortable asking?

Default to gender-neutral terms such as they/them.

What should a nurse do after making a mistake with someone’s name or pronouns?

Apologize, correct the mistake, and move on.

How does the lecture distinguish gender from sex?

Gender is broader than assigned sex at birth and includes a person’s sense of who they are; sex refers to biological features.

What biological features are included in sex?

Chromosomes, hormones, internal reproductive organs, and external sexual anatomy.

What does intersex mean?

Being born with or developing reproductive or sexual anatomy that does not fit typical definitions of female or male.

What example of an intersex variation is given in the lecture?

Androgen insensitivity syndrome (AIS), in which the body is resistant to certain sex hormones and may develop differently than expected for the person’s chromosomes.

Do all intersex people identify in the same way?

No. Some identify as intersex; others adopt a gender identity that best reflects their internal sense of self.

What is gender identity?

A person’s psychological sense of their gender, such as woman, man, both, in between, or something else.

At about what age are most children aware of their gender, according to the lecture?

By about age three, although it is okay to question gender identity as children grow older.

What factors may influence gender identity, according to the lecture?

Biological sex, hormones, and environment; identity may shift and evolve over time.

What is gender expression?

How a person presents themselves to the world.

What can influence gender expression?

Gender identity, sexuality, mood, and circumstances such as uniforms or costumes.

How might children express gender?

Through names, pronouns, clothing, voice, hairstyle, and how they act and interact.

What broad categories are commonly used to describe gender expression?

Masculine, feminine, and androgynous.

Can gender expression vary across settings or time?

Yes. It is flexible and may change depending on the day or setting.

What are gender norms?

Societal and cultural expectations for women and men, such as expectations about clothing.

Why should nurses avoid assuming there is one correct way to express gender?

Gender norms vary across cultures, generations, regions, communities, and peer groups, and are continually changing.

What is sexual orientation?

Who a person is attracted to sexually and/or romantically.

What does LGBTQ2S+ stand for in the lecture?

Lesbian, gay, bisexual, transgender, queer/questioning, Two-Spirit, and the plus indicates nobody is left out.

How can nurses address income and social-status inequities?

Ask about health insurance or coverage and work with families to choose medication options that fit their financial situation.

How can nurses address healthcare-access inequities?

Collaborate with interdisciplinary teams during discharge planning so families have needed resources and community supports.

How can nurses address inequities in physical environments?

Create safe spaces free from discrimination, harassment, and emotional or physical harm.

How can nurses address inequities related to gender and culture?

Create safe spaces, use gender-inclusive language, and build awareness of personal privilege, bias, and intersectionality.

How can nurses support social supports and coping skills?

Ensure children and families know about and can access community supports and education.

What are nursing strategies for promoting EDI in child and family health?

Recognize microaggressions, educate oneself, act as a role model and mentor, reflect on privilege and bias, collaborate to improve organizational EDI training, and dedicate resources to safe spaces.

What is a microaggression?

A statement or small action made in response to a stereotype about a particular group.

What historical and policy factors are linked in the lecture to Indigenous child health inequities in Canada?

Colonial policies, including the Indian Act, which contributed to inadequate healthcare access and poor health outcomes.

What health issues are reported at higher rates among Indigenous children in the lecture?

Injury, accidental death, SIDS, respiratory tract infections, obesity, dental problems, asthma, and other chronic conditions.

How did dispossession of land and traditional economies affect Indigenous Peoples?

It reduced access to traditional foods that had sustained communities and compromised health.

How did colonial government controls affect Indigenous communities?

They delegitimized traditional Indigenous systems and infrastructure and placed control over communities in non-Indigenous hands.

What were impacts of relocation to inadequate housing?

Housing was often poorly constructed, unsuitable for the environment, and did not accommodate extended family groups.

How did gender bias in the Indian Act affect Indigenous women?

It devalued women, denied legal rights, and reduced access to services for themselves and their children.

What were conditions and impacts associated with residential schools described in the lecture?

Indigenous children were forcibly placed in schools with insufficient heat, tuberculosis risk, malnutrition, cold, loneliness, illness, homesickness, and medical experimentation.

What population trends are described for Indigenous Peoples in Canada?

They are the youngest and fastest-growing segment of Canada’s population.

What family and care-system patterns affecting Indigenous children are described?

Indigenous children are more likely to live in single-parent-headed families or be in foster care, and their families tend to be larger than non-Indigenous Canadian families.

Why is growing up in an Indigenous home and community important for Indigenous children?

It helps maintain cultural connection, build pride in identity, and support family and community well-being.

What role do relationships, family, and Elders play in Indigenous child well-being?

Relationships and family provide strength and support; Elders and experienced family members pass on traditional knowledge and life skills that build resilience.

What limitation exists in data about Indigenous young children?

Comprehensive data are lacking for many health and well-being indicators.

What health indicators are described as poorer for Indigenous children?

Nutrition, breastfeeding, obesity, chronic disease, food security, oral health, otitis media, respiratory health, maternal health, and birth outcomes.

What are Indigenous-specific determinants of health beyond general SDOH?

Colonialism, language, culture, connection to land, self-determination, and structural/systemic factors such as policy, legislation, and agreements.

How does the lecture define Indigenous cultural safety?

Care informed by Indigenous Peoples’ history and the values surrounding traditional health practices.

What is decolonization?

Divesting colonial power from all aspects of society.

What is colonialism?

The policy or practice of acquiring full or partial political control over another country, occupying it with settlers, and exploiting it economically.

How does the lecture describe achieving decolonization?

Deconstruct colonial influences on knowledge and education, eliminate gendered hierarchies, recognize and respect each Indigenous nation’s sovereignty, and decentre settler narratives about Indigenous Peoples.

What is Indigenization?

Recognizing the importance of First Nations, Inuit, and Métis worldviews, knowledge, and perspectives and bringing Indigenous Ways of Knowing and Being to the forefront of society.

What holistic model of health is described in Indigenous worldviews?

A model seeking balance among mind, body, heart, and spirit in relation to community and environment.

Is there one homogeneous Indigenous worldview?

No. Each Indigenous nation or community has its own worldview.

Who was Jordan River Anderson?

A child from Norway House Cree Nation in Manitoba, born in 1999 with multiple disabilities who spent his life in hospital because governments could not agree on payment for his move to a specialized home.

Why did Jordan Anderson remain in hospital?

At age two, doctors recommended a specialized home, but federal and provincial governments could not determine who should pay; he remained in hospital until his death at age five.

What is the purpose of Jordan’s Principle?

To eliminate health inequalities and service gaps for First Nations children, including children who are Two-Spirit, LGBTQIA+, or have disabilities, as described in the lecture.

When did the House of Commons pass Jordan’s Principle?

In 2007, in memory of Jordan River Anderson.

How does the lecture characterize Jordan’s Principle legally?

As a legal requirement, not a policy or program.

What does Jordan’s Principle require for First Nations children?

They should receive needed products, services, and supports when needed, without payment disputes interfering with their care.