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Taplin JG, Bill L, Blanchard IE, Barnabe CM, Holroyd BR, Healy B, McLane P. Exploring paramedic care for First Nations in Alberta: a qualitative study. CMAJ Open 2023; 11:E1135-E1147. [PMID: 38086557 PMCID: PMC10721334 DOI: 10.9778/cmajo.20230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prior work has shown that a greater proportion of First Nations patients than non-First Nations patients arrive by ambulance to emergency departments in Alberta. The objective of this study was to understand First Nations perspectives on transitions in care involving paramedics, and paramedic perspectives on serving First Nations communities. METHODS Participants for this participatory qualitative study were selected by means of purposive sampling through author networks, established relationships and knowledge of the Alberta paramedicine system. First Nations research team members engaged First Nations community organizations to identify and invite First Nations participants. Four sharing circles were held virtually in July 2021 via Zoom by the Alberta First Nations Information Governance Centre. We analyzed the data from the sharing circles using a Western thematic approach. The data were reviewed by Indigenous researchers. RESULTS Forty-four participants attended the 4 sharing circles (8-14 participants per circle), which ranged from 68 to 88 minutes long. We identified 3 major themes: racism, system barriers and solutions. First Nations participants described being stereotyped as misusing paramedic systems and substance using, which led to racial discrimination by paramedics and emergency department staff. Discrimination and lack of options to return home after care sometimes led First Nations patients to avoid paramedic care, and lack of alternative care options drove patients to access paramedic care. First Nations providers described facing racism from colleagues and completing additional work to act as cultural mentors to non-First Nations providers. Paramedics expressed moral distress when called on to handle issues outside their scope of practice and when they observed discrimination that interfered with patient care. Proposed solutions included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models. INTERPRETATION First Nations people face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities, and First Nations should lead in the design of and priority setting for paramedic services in their communities.
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Affiliation(s)
- John G Taplin
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Lea Bill
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Ian E Blanchard
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Cheryl M Barnabe
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Brian R Holroyd
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Patrick McLane
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta.
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Mollons MO, Penner KE, Elsom AL, Cameron EE, Hunter S, Woods L, Tomfohr-Madsen LM, Nijdam-Jones A, Roos LE. COVID-19 and indigenous youth wellbeing: A review. Curr Opin Psychol 2023; 53:101659. [PMID: 37597427 DOI: 10.1016/j.copsyc.2023.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/21/2023]
Abstract
Indigenous youth in Canada and the United States of America (USA) have been disproportionately affected by the COVID-19 pandemic due to the compounding of increased illness risk and legacies of colonization. This article reports the findings of a Cochrane rapid review of 23 studies that examined mental wellbeing outcomes for Indigenous youth from March 2020 to April 2023 in Canada and the USA. Reported pandemic-related mental wellbeing impacts included changes in alcohol and substance use, anxiety, depression, sleep, and suicidality. Protective factors emerged including cultural and community connection. Results suggest that mental wellbeing worsened for many Indigenous youth during COVID-19. Clinical implications are discussed alongside guidance for service provision improvements to support Indigenous youth wellbeing, from a lens of self-determination.
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Affiliation(s)
- Meghan O Mollons
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada.
| | - Kailey E Penner
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada
| | - Anthony L Elsom
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada
| | - Emily E Cameron
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada
| | - Sandra Hunter
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada
| | | | - Lianne M Tomfohr-Madsen
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, V6T 1Z4, Colombia
| | - Alicia Nijdam-Jones
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W2, Canada.
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