Nursing and Nation Rebuilding: An Ethnography of Care in the Context of Indigenous Self-Determination

Culturally safe care is gaining traction in health policy, yet the health disparities faced by Indigenous populations persist. In addressing this discrepancy, this thesis addresses the different ways culturally safe care is defined, envisioned, and applied within health policy, Indigenous nursing practice, and within Nuu-chah-nulth communities. The research was conducted in partnership with the Nuu-chah-nulth Tribal Council (NTC) Nursing Services on the Canadian West Coast. This project involved two years of collaborative ethnographic field research based in Port Alberni, BC. My role at the NTC was both a student ethnographer and an embedded health systems researcher. Data was also collected from semi-structured narrative interviews with nurses, community members, and health leaders and participant observation of nursing visits, health-related workshops, and community events. Findings illustrate that Indigenous self-determination enables relational modes of care, which have increased access to health services by providing a site for individuals to overcome past trauma, as well as a platform for nation-rebuilding and collective healing. At the same time, a biopolitics imbued with colonial logics continues to justify the lack of health services available in Indigenous communities. Indigenous patients are subjected to racialized stereotypes which affect the quality of care they receive. These practices are perpetuated through the discourse that the health care system is experienced the same by all Canadians. I challenge this by demonstrating how Indigenous peoples are subjected to constructs of "deserving" and "undeserving" patients informed by a truth discourse which is enacted through clinical decision-making and specific biomedical care practices which normalize structural racism. By understanding care practices as the subject of multiple ontologies, the collective modes of care performed informally within Nuu-chah-nulth families or during social gatherings expand the kinds of care afforded in biomedical settings, by emphasizing an ontologically relational nature of being. Ultimately, Indigenous modes of care are both marginalized by and actively transforming biomedical standards of care in western Canada. This produces simultaneous, oppositional movements between enacting relational modes of care and the colonial legacy linked to systemic racism that oppresses Indigenous ways of knowing and excludes Indigenous peoples from the ostensibly universal public good of health care.