Minore B, Jacklin K, Boone M, Cromarty H
Centre for Rural and Northern Health Research, Lakehead University Site, Thunder Bay, Ontario, Canada.
Educ Health (Abingdon). 2009 Aug;22(2):298. Epub 2009 Aug 26.
First Nation communities in Canada rely on a mix of non-indigenous professionals and large numbers of indigenous paraprofessionals to deliver healthcare. Formerly allowed to perform controlled acts in emergencies, the direct care role of paraprofessionals is now restricted because of concerns about liability and accountability. As such, they are limited to health promotion and prevention activities.
Focusing on the largest group of indigenous health workers, viz. Community Health Representatives (CHRs), for illustration purposes, this paper (1) examines the evolving role of First Nation health workers, and (2) discusses the proposed introduction of competency-based standards for their education, certification and regulation.
The paper is informed by findings from open ended, semi-structured and focus group interviews, as well as qualitative survey data, derived from seven studies done in Ontario, Canada.
Paraprofessionals face conflicting and sometimes unrealistic expectations. Past practices have accustomed community members to hands-on care; however, professionals will no longer delegate tasks requiring clinical skills to them. Moreover, First Nation leaders are concerned about liability for their paraprofessional employees' actions. The paper discusses issues related to paraprofessional competence, preparation for practice, and continuing health education. It then presents the National Indian and Inuit Community Health Representatives Organization's proposal to establish a scope of practice and set of competencies that can form the basis for national practice and training standards, accreditation and regulation.
In Canada or elsewhere, changing practice environments may require adjustments in the roles played by indigenous health workers. The case of First Nation Community Health Representatives illustrates a strategy for role transformation.
加拿大的原住民社区依靠非原住民专业人员和大量原住民辅助专业人员相结合来提供医疗保健服务。辅助专业人员以前在紧急情况下被允许实施受控行为，现在由于对责任和问责制的担忧，其直接护理角色受到限制。因此，他们仅限于健康促进和预防活动。
为便于说明，本文以最大的原住民卫生工作者群体，即社区健康代表（CHR）为例，（1）研究原住民卫生工作者不断演变的角色，（2）讨论为其教育、认证和监管引入基于能力的标准的提议。
本文依据开放式、半结构化访谈、焦点小组访谈的结果以及定性调查数据撰写，这些数据来自于在加拿大安大略省进行的七项研究。
辅助专业人员面临相互冲突且有时不切实际的期望。过去的做法使社区成员习惯了实际护理；然而，专业人员不再会将需要临床技能的任务委托给他们。此外，原住民领袖担心其辅助专业人员雇员行为的责任问题。本文讨论了与辅助专业人员能力、实践准备和持续健康教育相关的问题。然后介绍了全国印第安和因纽特社区健康代表组织关于确定实践范围和一套能力要求的提议，这些提议可作为国家实践和培训标准、认证及监管的基础。
在加拿大或其他地方，不断变化的实践环境可能需要调整原住民卫生工作者所扮演的角色。原住民社区健康代表的案例说明了一种角色转变策略。
