Horrill Tara C, Martin Donna E, Lavoie Josée G, Schultz Annette S H
Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada.
Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Nurs Inq. 2021 Jul;28(3):e12394. doi: 10.1111/nin.12394. Epub 2020 Dec 21.
Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma- and violence-informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity-oriented care for primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma- and violence-informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice.
健康公平是一个全球关注的问题。尽管健康公平远远超出了医疗保健的公平分配范畴，但公平获得医疗保健对于实现健康公平至关重要。在加拿大，原住民在健康和获得医疗保健方面存在不平等现象。文化安全以及基于创伤和暴力的护理已被提议作为改善医疗保健可及性的护理模式，但从业者缺乏关于如何实施这些模式的指导。在本文中，我们在现有的初级医疗保健环境中以公平为导向的护理框架基础上，提出策略来指导护士在个体层面将文化安全以及基于创伤和暴力的护理纳入护理实践。这一内容是纠正加拿大原住民获得护理不平等现象的一项策略。我们将获得医疗保健的障碍概念化为个人层面、人际层面和结构层面的障碍。然后，我们为护理行动定义了三个领域：进行反思、优先考虑人际关系以及考虑背景情况。我们已在加拿大原住民的背景下应用了这个扩展后的框架，以此来说明具体概念并聚焦我们的论点；然而，这个框架与其他面临边缘化状况且获得医疗保健不平等的群体相关，因此适用于护理实践的许多领域。
