This document provides an overview of a presentation on First Nations, Inuit and Métis (FNIM) cultures in Saskatchewan. The presentation discusses key concepts like the medicine wheel, cultural competence, reflective practice and land acknowledgments. It encourages learning about residential schools and their impact, as well as Treaty rights and Indigenous health services. Storytelling is used to illustrate concepts. The goal is to help attendees broaden their understanding of applying the Platinum Rule of treating others how they want to be treated when working with diverse clients.

1. FNIM cultures In Saskatchewan
Practical Nursing
November 28th 0815 - 1015
Greg Riehl RN BScN MA

2. Where am I?
I would like to acknowledgeTreaty 4
Who am I?
• I am a settler…
• FromTreaty 6
• And…
Why am I here?
• I ask myself this every
day, and I also ask
those who I am
working with from
time to time…

3. I come from a small town

4. What kind of learner are you?

5. Stories
• I will use some of my experiences working in health, in
the north, and as a nurse, often an outsider, working in
different situations.
• You are a part of the story.

6. Perspectives are very important
When a person looks out
at the world, he sees it
filtered through a screen of
his words, and this process
is as invisible to him as
water is to a fish.

7. Objectives
 To broaden the understanding of the Platinum Rule.
 To describe how to apply the Platinum Rule.
 Compare the Golden and Platinum Rules.
 To explore cultural aspects of nursing care.
 To identify the unique challenges faced by care providers
working with diverse clients.

8. We Don’t SeeThings AsThey Are,
We SeeThem As We Are Anaïs Nin
“It has been well said that we do not see things as they are, but as we are
ourselves. Every man looks through the eyes of his prejudices, of his preconceived
notions. Hence, it is the most difficult thing in the world to broaden a man so that
he will realize truth as other men see it.”

9. Invisible Backpack
“All of us carry an invisible ‘backpack’ of our culture,
experiences, beliefs, values and morals.Whenever we
encounter another person, our backpack is present with us
and influences how we interact with our patients and their
families”.
Scott Harrison
Invisible Knapsack Peggy McIntosh

10. What is Culture?
• Behaviour is what you do…
• Culture is how you do it…

11. What is Culture?
• More than just the 3 or 4 F’s?

12. Everything is about CULTURE
• Everybody knows about it
• Everybody does it
• Nobody talks about it
• Kathleen Bartholomew, RN, MN

13. Culture is a world view
• North American culture sees health as an individual problem,
but we live in dynamic, intercultural communities.
• Culture can be a barrier to caring for our clients.
• We learn about disease models of health
• We need to focus on wellness and resilience models of
health
• Health is multifaceted with issues related to mental, spiritual,
emotional, and physical health.

14. Cultural Competence is a part of the
Platinum Rule
• Cultural Awareness
• Cultural Sensitivity
• Cultural Knowledge
• Cultural Competence
• Cultural Humility
• Cultural Safety

15. Cultural Awareness
Is really concerned about acceptance

16. Cultural Sensitivity
Is about respecting differences and often uses neutral
language, and neutral communication

17. Cultural Sensitivity
Is about respecting differences and often uses neutral
language, and neutral communication

18. What happens if a bird poops on you?
• Bird poop brings good luck!There is a belief that if a bird
poops on you, your car or your property, you may receive
good luck and riches.The more birds involved, the richer
you'll be! So next time a bird poops on you, remember
that it's a good thing.

19. Cultural Knowledge
Familiarization with selected cultural characteristics, history, values,
belief systems, and
behaviours of the members of another ethic group

21. Cultural Competence
Is about understanding, knowledge skills and attitudes, working
effectively in cross cultural and intercultural situations, this is the
application of knowledge, creates the environment of cultural safety

22. Cultural Competence
Is about understanding, knowledge skills and attitudes, working
effectively in cross cultural and intercultural situations, this is the
application of knowledge, creates the environment of cultural safety

23. Cultural Competence in Health Care
1. Provide interpreter services
2. Recruit and retain diverse staff
3. Provide training to increase cultural awareness, knowledge, and skills
4. Coordinate with traditional healers
5. Use community health workers
6. Incorporate culture-specific attitudes and values into health promotion tools
7. Include family and community members in health care decision making
8. Locate clinics in geographic areas that are easily accessible for certain populations
9. Expand hours of operation
10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice
lines, medical billing, and other written materials

24. Cultural Competence in Health Care
• Awareness of the influences that sociocultural factors have on patients, clinicians, and the
clinical and care relationship.
• Acceptance of our responsibility to understand the cultural aspects of health and illness in
context
• Willingness to make clinical and care settings more accessible to patients
• Recognition of personal biases against and towards people of different cultures and
backgrounds
• Respect, tolerance, acceptance, and interest for cultural differences
• Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia,
and other kinds of biases and discrimination that occur in health care settings.

25. Cultural Humility
Focuses on self reflection and acknowledges power
differences, and privilege.

26. Cultural Safety
Stresses the importance of relationships and partnerships, power
shifts to the client, to decide what is safe and what is not

28. An environment that is safe for people; where there is no assault,
challenge or denial of their identity, of who they are and what they need.
It is about shared respect, shared meaning, shared knowledge and
experience, of learning, living and working together
with dignity and truly listening.
(Health Q. F., 2012)
Cultural Safety

29. • Cultural safety
stresses the
importance of
reflection &
acceptance of
differences.
• We should not treat
everyone the same.
• We do need to
recognize and
acknowledge our
blind spots.

30. Invisible Backpack

31. Invisible Backpack

34. "...if there was a subdivision and
a house was on fire. The fire
department wouldn't show up and
start putting water on all the
houses because all houses matter.
They would show up and they
would turn their water on the
house that was burning because
that's the house that needs the
help the most." (Lyrics from
Macklemore and Ryan Lewis’
"White Privilege II").
it’s like the analogy of going to a doctor
for a broken bone
“Aren’t all your bones important?
Shouldn’t we be as concerned about all the
other bones?”
Sure, but this is the one that needs fixing
right now

35. Physical Mental Emotional Spiritual
My perspective is that each
of these four parts can be
treated as its own body.
Each requires its own form
of sustenance and exercise
to be healthy

36. BALANCE
Wheel of Life

37. Seven Directions!
East
South
West
North
Life Above the Earth
Life Below the Earth
Life on the Earth (and within ourselves)

38. Direction and Hierarchy
• The more vertical a culture or an organization is in its
hierarchy, the more complicated communication
becomes.

39. Classroom Seating Position and College Grades
• Studies show that students who sit in the front and center
(middle) of the classroom tend to achieve higher average
exam scores.
• One study discovered a direct relationship between test
scores and seating distance from the front of class:
students in the front, middle, and back rows of class
scored 80%, 71.6%, and 68.1% respectively

40. Standards and Best Practices
• One of the problems with “best practices” are that they are
inflexible, especially for social sciences, and they may not
reflect the diversity of human worldviews or the underlying
differences between Indigenous worldviews.Typically, this
proposition creates oppression and discrimination.
• Indigenous wise practices vsWestern educational system best
practices

41. Good Hunters or BadTipi Builders

42. Bronze Silver Gold Platinum Rules
• Bronze
• Do unto others as they have done unto you
• Silver
• What you do not want done to yourself, do not do to others
• Gold
• Do unto others as you would have them do unto you.
• Platinum
• Do unto others as they want done unto them

43. Bronze silver gold platinum rules
The culture ofWestern medicine places diagnosis as a
central goal
Aboriginal medicine, see diagnosis as less central and pay
more attention to finding a safe environment in which the
patient may recover.
For conditions such as mental disorders, this latter
approach may prove more effective than struggling to
attach a label to the disorder.

44. Bronze rule
Do unto others as they have done unto you

45. Silver
What you do not want done to yourself, do not do
to others

46. Gold
Do unto others as you would have them do unto you.

47. Platinum
Do unto others as they want done unto them

48. THE PLATINUM RULE.
TREAT OTHERS
HOW THEY WANT TO BE TREATED

49. • 1. If, in the future you have a patient or a colleague who has been
affected by attendance in a residential school, how would you talk
about this with them? Is this part of the patient’s history that is
important for you to know? Why?
• 2.What might be some of the ramifications for your patients of
attending a residential school? Did attendance contribute to their
present illness? How might this affect their recovery?
• 3. How you think that nursing students would benefit from hearing
about the experiences of those people who attended a residential
school?
• 4. How do you think that learning about the work of theTruth and
ReconciliationCommission of Canada, and the recommendations for
health of indigenous people will affect your nursing practice in the
future?

50. Nursing Process and the Medicine
Wheel

52. MedicineWheel-TheWhole Person

53. Treaty Rights

54. MedicineWheel
 The Medicine Wheel shows the path out of conflict begins
at the center
 There is calm and power at the center - where honesty is
considered more important than loyalty.
•The goal is to restore balance.

55. Physical Mental Emotional Spiritual
My perspective is that each
of these four parts can be
treated as its own body.
Each requires its own form
of sustenance and exercise
to be healthy

56. MedicineWheel

57. MedicineWheel
http://walkashamanspath.com/

58. MedicineWheel
http://walkashamanspath.com/

59. EAST

60. SOUTH

61. WEST

62. NORTH

63. Healing Paths

64. The Circle
•The Circle lies at the centre of
First Nation's spirituality.

65. Imbalance Creates Illness
Holistic approach to address issues and factors
that impact illness targeting not just the disease,
but also the social determinants of health and
economic circumstances.
It is recognized that the whole family (broadly
defined) is as impacted by disease and needs
healing just as the individual who is ‘sick’ requires
care, treatment and support.

66. Restoring Balance
• Individualistic versus collective cultures
• Collective cultures, like First Nations, have been
impacted by colonialism, residential schools,
changing gender roles, capitalism, and a foreign
justice system, to name a few.
• The loss of culture, language, traditions, and
ceremonies has resulted in an imbalance to
traditional ways of living.
• The resulting loss of balance and harmony has
resulted in pain: Mental, Spiritual, Emotional and
Physical.

67. Cycle of Pain &Trauma & Harm
TREATMENT
THERAPY
JUSTICE
STI’s
HIV
HCV
PRISON
ADDICTION
RISKY
BEHAVIOUR
METHODS
TO
DECREASE
OR
HIDE PAIN
PAIN
TRAUMA
-Introduction of Stigma and
Discrimination
-Loss of Balance
-Goal is to restore balance
-The path out of conflict begins at the
center
-There is calm and power at the center
-Honesty not loyalty with all
interactions
-Medicine wheel

68. Law
Justice
Access to
Care
Treatment
&
Support
Harm
Reduction
Prevention
Pain SYSTEMS
ORGANIZATIONS
REFLECTION
ASSESSMENT
WISDOM
CLARITY
OF
PURPOSE
COMMUNITY
PEOPLE
How can you incorporate
the medicine wheel into
your practice?

69. Star Blanket - Symbol

70. Self Awareness Through
Reflective Practice
• What is self awareness?

71. Where to Start?
• "Reflection is an important human activity in which
people recapture their experience, think about it, mull it
over and evaluate it. It is this working with experience
that is important in learning."
• The meaningful education of children has an underlying
purpose: to transfer knowledge for the preservation of
one’s culture and society.
• http://www.learnalberta.ca/content/aswt/#/home

72. Reflection Leads to Awareness
• Reflection is more than review.
• Reflection can help with
ambiguity, stress, change, gaps,
and duplication.
• We need time to reflect and time
to come together.
• Acceptance versus understanding.

73. Tacit Knowledge
• Knowledge that is ‘unspoken’ or ‘tacit’.
• Many expert nurses are unable to verbalize the
knowledge that they demonstrate on a daily basis.

74. Reflective Practice
“Reflective practice is
an approach that
enables professionals
to understand how
they use their
knowledge in
practical situations
and how they
combine action and
learning in a more
effective way”
Massachusetts Institute of
Technology, Open Courseware

75. How do we Perform Reflective
Practice?
• Reflection stimulates personal and
professional growth.
• Integrate theory and practice
• Supports new ways of doing things
• At a group level you will find your
personal strengths and your weaknesses.
• Your colleagues will keep you on track.
• You need to commit to ‘doing’
something.
• Reflection involves learning from
experience.
• In nursing, there is a risk of focusing on
standards of care and losing sight of
unique client needs.
• Reflective practice supports
individualizing client care by evaluating
(reflecting on action) outcomes.

76. Do you have, or are you caring for
any Indigenous patients today, or in
the past?
• How do you know?
• Why is it important to know?
• What percentage of the population is Indigenous in
Saskatchewan? In Canada? In the hospital?

77. Do you know if there are any
Indigenous Health
Services/Supports in your clinical
area?
• Have you been there?
• What services are offered?
• Would you be comfortable talking about Native Health
Services with a patient, or family?
• What other services are available in the city, region,
treaty area, province

78. Land Acknowledgment
• Regina is onTreaty 4 territory, traditional homeland of
the Cree, Dene, Lakota, Nakota, Dakota, Salteaux and the
Métis Nation. We give thanks to these groups for being
stewards of this land for generations and we
acknowledge this land as providing for other Indigenous
groups that moved through here as well. We give thanks
to them all and are humbled by the opportunity to live,
grow, play, and work here.We affirm our commitment to
recognizing the historical and ongoing harms and to
honoring the spirit of peace and friendship.

79. Land Acknowledgment
• Today, many Post Secondary Educational institutions
have protocols and requires that we also acknowledge
the original inhabitants of this land and their descendants
who have lived here for millennia and whose way of life
has changed significantly over this time. We are reminded
that we are part of a long line of human and non-human
inhabitants of this land.
• Saskatchewan Polytechnic acknowledges that we work as
visitors on the traditional territory of the Indigenous and
Métis peoples of Saskatchewan.We recognize that all of
Saskatchewan Polytechnic campuses sit on traditional,
Indigenous lands inTreaty 4 and 6 territories.

80. Nipin and the Rocks
• Mosom reached inside the pouch and pulled out the most
eye-catching rock of all.This rock shone as bright as the
sun, and was filled with the deepest blue of the sky. Nipin,
filled with shock, stood quickly and shrieked “This can’t
be!” Looking upon Nipin with the gentlest nature Mosom
replied, “But it is my boy.” After several moments passed,
Mosom spoke, “These rocks are gifts from the universe,
and only when they are in their rightful spot do they
reveal their power. Do not be fooled, these are not my
rocks, but all of ours. I am only the story teller, the stones
tell me the stories that I then relate to you.”

82. Lateral Kindness
• Please be kind to each other
• Respectful and responsible relationships, there are no
apps for that.
• Be Grateful
• Be Great!

83. & DonT be arfaid to
kame mit sakes
Ask questions, listen,
and then ask more
questions.

84. Discussion, questions,
comments!!!
Thank you for your participation

85. Contact information
Greg Riehl RN BScN MA
greg.riehl@saskpolytech.ca
gregriehl@sasktel.net
@griehl

86. I try to be skeptical (question things) and not cynical (dismiss ideas &
find fault with them)

87. Contact information
Greg Riehl RN BScN MA
Aboriginal Nursing StudentAdvisor
Aboriginal Nursing StudentAchievement
Program
Saskatchewan Polytechnic
Regina Campus
Email: greg.riehl@saskpolytech.ca

88. Statement of Commitment to Co-workers
As your co-worker with a shared goal of providing excellent service to people
and families, I commit the following:
I will accept responsibility for establishing and maintaining healthy
interpersonal relationships with you and every member of this staff.
I will talk to you promptly if I am having a problem with you. The only
time I will discuss it with another person is when I need advice or help
in deciding how to communicate with you appropriately.
I will establish & maintain a relationship of functional trust with you and
every member of this staff. My relationships with each of you
will be equally respectful, regardless of job titles or levels of educational preparation.
I will not engage in the '3B's (bickering, back-biting and bitching) &
will ask you not to as well.
I will not complain about another team member & ask you not to as well.
If I hear you doing so, I will ask you to talk to that person.
I will accept you as you are today, forgiving past problems,
& ask you to do the same with me.
I will be committed to finding solutions to problems rather than
complaining about them or blaming someone, & ask you to do the same.
I will affirm your contribution to quality service.
I will remember that neither of us is perfect, & that human errors
are opportunities not for shame or guilt, but for forgiveness and growth.
(Adapted from Marie Manthey, President of Creative Nursing Management in Caroline Flint's Midwifery Teams and Caseloads 1993; p. 138)

89. WhereYou Sit In Class And What It Says About
Your Personality
• 8) In the back row.“I really don’t want to be here, so I’m
going to sit in the very back where I can fall asleep, or surf
Facebook without anyone looking over my shoulder at
the screen.”
• 7) In the front row.“I want the professor to see my face
everyday and know who I am. That way, he’s more likely
to bump up my grade when I need an extra half point. At
least, that’s what the article in Seventeen Magazine told
me.”

90. WhereYou Sit In Class And What It Says About
Your Personality
• 6) Close to an aisle.“I don’t care if people have to shuffle
over my knees just to get in and out, I just want a quick
exit when this class is over.”
• 5) Right in the middle.“I’m most comfortable when I’m
surrounded by people. Also, if this lecture hall is anything
like a movie theater, I’ll have the best view in the house.”

91. WhereYou Sit In Class And What It Says About
Your Personality
• 4) Uncomfortably close to someone else. “I choose this
desk right next to you, even when there’s two dozen
other desks available just because I like to assert my
dominance this way. Also, you smell nice.”
• 3)Taking up two or more desks. “I need room for my
laptop, my gigantic bag, my books, my purse, and my
coat. And damn anyone who thinks I don’t deserve the
extra space.”

92. WhereYou Sit In Class And What It Says About
Your Personality
• 2) In a different classroom. “I read the schedule wrong.”
• 1) In your bedroom. “I don’t feel like going to class
today.”