Using Two Eyed Seeing to Explore Practice Level Perspectives and Experiences of Collaboration across Diverse Health Services with Cancer Control as an Exemplar
Whiting, Cheryl Frances 1956-
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ABSTRACT Background: Health inequalities have resulted in higher chronic disease rates in Indigenous populations and access to culturally appropriate services has been an ongoing effort of the health system in addressing these needs (Reading & Wien, 2013). Throughout the cancer control continuum, the importance of collaborative partnerships with Indigenous populations has been recognized in Saskatchewan and Canada to improve health outcomes (Canadian Partnership Against Cancer [CPAC], 2011). Culturally competent wholistic care requires effective interprofessional collaboration (Lomax & White, 2015) when bridging the traditional Indigenous and mainstream health services. Some health practitioners have experienced difficulty when collaborating across the two services. Although there has been considerable research on collaboration, its definition, enablers and barriers, the concept remains misunderstood (Bedwell et al., 2012) with limited information of how these partnerships could be more effective from the perceptions of the traditional Indigenous health services (Taylor & Thompson, 2011). For this study, cancer services was used as an example of a healthcare setting through which a better understanding of collaboration when working with Indigenous populations could help to strengthen these partnerships and improve health outcomes. Study Purpose: To explore the perspectives and experiences of collaboration of select Saskatchewan health professionals practicing across the traditional Indigenous and mainstream health/cancer services, to further understand the concept of collaboration from their perspectives. Methodology: Using interpretive description and purposive sampling (Thorne, 2008), this qualitative study explored collaboration through observation and individual interviews to elicit the considerations of professionals working across these two services. Overlapping of perspectives or two-eyed seeing (Iwama, Marshall, Marshall, Bartlett, 2009) provided insight of both services to help understand collaboration. Individual transcripts were coded, combined and organized to reflect thematic similarities. Results/Conclusions: Study participants described collaboration as challenging and difficult to achieve, requiring considerable time and effort for improving health outcomes for Indigenous clients and communities. The idea of collaboration, between these services, was more common than actual collaboration and not always a system priority. Findings supported a need for a shared definition of collaboration that was guided by the virtues of Indigenous and values of mainstream health services, with more inclusive language and valuing of Indigenous cultures and client and community voices, wholistic approaches, and sustainable outcomes. For participants, collaboration was considered an ongoing commitment similar to offering sacred tobacco. The themes constructed that participants described as enablers of collaboration recognized the importance of embedding virtues/values; valuing difference; building and maintaining relationships; supportive environments, wholistic approaches; having the right people at the table; and making a change for impactful outcomes. These results demonstrate the significance of systemic and organizational support for effective interprofessional collaborative, culturally competent, wholistic service approaches when working across diverse services. The experiences shared by study participants have shown that certain individual behaviors and system supports help to improve relationships thereby enabling effective collaboration. Given the significance of collaboration for effective health outcomes, a more focused provincial effort toward the development and further integration of collaborative practice in Saskatchewan would be beneficial. The findings from this study have provided only a glimpse of the enablers and challenges of collaboration when working together with the traditional Indigenous and mainstream health and cancer services. A comprehensive list of all the enablers of collaboration could be useful at the practice level. For study participants, two-eyed seeing has provided the ability to see the tremendous value and strengths of both worlds and how these diverse services complement each other. These kinds of professionals have become a gateway between these two worlds thereby making accessible the best support available from both services to meet the diverse needs of clients and communities (Hatcher et al.; Iwama et al., 2009).
DegreeMaster of Nursing (M.N.)
CommitteeJansen, Lynn; Butler, Lorna; Dietrich Leurer, Marie; Bassendowski, Sandra; Hoffman, Carolyn
Copyright DateOctober 2016
diverse health care systems
healthcare delivery integrated
delivery of healthcare
Indigenous health services
medicine Native Americans
Indigenous health services
mainstream health services
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