42 Educating Health Care Providers in the Yukon

Introduction: Educating Health Care Providers in the Yukon

The Yukon is a sparsely populated region of 38,455 people in Canada’s northwest (Yukon Bureau of Statistics, 2017). It is home to fourteen First Nations, eleven of which have comprehensive land claims and self-government agreements (Council of Yukon First Nations, n.d.). Yukon College is the sole post-secondary institution in the territory, and one in three (30%) students self-identify as First Nations (Yukon College, 2016). At the official opening of the college in 1988, Mrs. Angela Sidney, a highly respected Yukon Elder and honored guest, sang an ancient Tlingit song to convey her feelings about what Yukon College could mean for young people in the future. According to Sidney (2015), “The reason I sang this song is because that Yukon College is going to be like the Sun for those students. Instead of going to Vancouver, or Victoria, they’re going to be able to stay here and go to school here. We’re not going to lose our kids anymore. It’s just going to be like the Sun for them!” Yukon College’s mandate, articulated in the Yukon College Act, is to “provide educational programs, services, and activities to meet the needs of people in the Yukon” (Yukon College Act, 2002, p. 1).  The College prioritizes capacity building, support for economic development, and relationship building, particularly in meeting First Nations’ interests (Yukon College, 2016). The College has provided health care-related programming since its inception and is committed to the idea of offering Northerners the opportunity to live, learn, and work in place. This chapter provides a historical snapshot of Yukon College health-related programming and a glimpse of an educational future where programming responds to the changing needs of the Yukon, First Nations, and the wider northern community.

History of Yukon Health Care Provider Education

            A variety of health care related programs and courses have been delivered by Yukon College over its fifty-five-year history. Specifically, Longstanding Certified Nursing Assistant, Practical Nurse, Nursing Home Attendant/Home Support Worker (NHA/HSW), and Health Care Assistant programs have been offered, alongside a range of short-term programs, professional development opportunities, and continuing education courses for local health care providers.

Certified Nursing Assistants/Licensed Practical Nurses

From 1963 to 1995, a 10-month Certified Nursing Assistant (CNA) program was delivered twice a year in the Yukon with approximately 271 graduates in total. In 2000 and 2003, a Practical Nurse Access certificate was offered, modeled after a British Columbia program that used the NHA/HSW program as an entry requirement. Fifteen students graduated from this program (K. Diamond, personal communication, May 10, 2018). By 2005, CNA certificate programming in Canada evolved to Practical Nurse (PN) diploma programming, in part due to the fact that Registered Nurse (RN) entry to practice became a degree rather than a diploma. PN diploma programs reflected an expanding PN scope of practice and helped LPNs establish a distinct professional identity (Pringle, Green & Johnson, 2004). The Yukon followed suit with the delivery of the first two-year PN diploma at Yukon College in 2008. The PN curriculum was brokered through Bow Valley College in Calgary, Alberta. To date, five cohorts totaling more than 60 students have graduated, and a move to annual intakes is anticipated in 2019 (S. Starks, personal communication, May 15, 2018).

Health Care Aides/Assistants

A Nursing Home Attendant/Home Support Worker program, based on an Okanagan College curriculum, was initiated in 1996. In 2002, federal funding supported the development of a Home and Community Care Program, which included courses from the NHA/HSW program and was delivered in rural Yukon communities. The NHA/HSW program ran until 2009 when the College adopted the British Columbia licensed curriculum for the Health Care Assistant (HCA) program, which continues today. More than 85 students completed the NHA/HSW program and 76 students have graduated from the HCA program to date (K. Diamond, personal communication, May 10, 2018).

Registered Nurses

Although there has been interest in RN education in Yukon since the early 1980s, a 2001 feasibility study recommended that Yukon College offer PN education rather than develop a RN diploma or degree and encouraged the delivery of arts and science courses that would allow students to complete part of their RN education in Yukon before transferring out (Hanson & Associates/Malloch Graham & Associates Management Consultants, 2001). Interestingly, Camosun College in Victoria now offers a Whitehorse Field School opportunity for first- and second-year nursing students, making Yukon a destination for RN students from other jurisdictions (Camosun College, 2018).

Other Health Care Programming

A Community Health Representative (CHR) program was designed in 1986 and delivered twice between 1988 and 1993. At the request of the Yukon Government, the NHA/HSW program was suspended in 1998, so faculty and community stakeholders could develop a Northern Addictions Worker certificate for frontline addictions workers, which was ultimately not delivered (K. Diamond, personal communication, May 10, 2018).

Continuing Education for Health Care Providers

Yukon College has also supported a number of the continuing education and upgrading needs of CNAs, LPNs, and RNs, including refresher courses, medication administration, pharmacology, and health assessment. Eight students completed an RN refresher program and 14 completed a CNA refresher program between 1981-1996 (K. Diamond, personal communication, May 10, 2018). The College has further assisted with clinical practice placement for students taking RN programs elsewhere and supported Yukon RNs pursuing their nursing degrees through the University of Victoria and other distance courses and programs.

Towards Indigenizing Programs

Yukon College’s diverse health programming provides Yukoners the opportunity to access quality education, leading to meaningful employment here in the territory. In 1973, the Council for Yukon Indians stated that “the whole Yukon is our school. In the past we learned from our surroundings” (The Council for Yukon Indians, 1973, p. 21). Through its various decolonization, indigenization and reconciliation initiatives, Yukon College is striving to embed this perspective in its institutional life and educational programs. Where we learn matters, but so too does what and how we learn.

Yukon College’s goals of indigenizing the institution and acting on the Truth and Reconciliation Commission’s (TRC) calls to action are evident in its work to date. Some milestones include: becoming a charter signatory of the national Indigenous Education Protocol (Yukon College, 2016); developing Yukon First Nations core competency requirements for faculty, staff, and students; working internally with First Nations Initiatives to develop new Indigenous curriculum and reviewing existing curriculum for Indigenous content; developing a First Nations research protocol; and initiating a First Nation Elders-on-campus program. Program-level instructors aspire to indigenize their courses in meaningful ways. College health programs pay special attention to the TRC’s Calls to Action on education and health. The TRC highlights that reconciliation requires an “awareness of the past, acknowledgement of the harm that has been inflicted, atonement for the causes, and action to change behavior” (TRC, 2015, p. 6).

Since 2012, the HCA and PN programs have offered an eight-hour workshop on Residential Schools and Caregiving for their students and faculty that is delivered by First Nations Initiatives (FNI) staff. This workshop includes: a history of settlement in Canada/Yukon and its impact on First Nations; current legislation affecting First Nations people and communities in Yukon; a history of residential schools in Canada and Yukon; and the impact of intergenerational trauma on survivors and descendants and appropriate nursing care for those affected. Additionally, FNI staff deliver a further half-day workshop to address competencies related to heritage and culture, governance, contemporary issues, and First Nations world views and history.

Moreover, collaborative learning opportunities reinforce these competencies. Students work with First Nations liaison workers during a portion of their clinical experience, and staff from the First Nations Health Program at Whitehorse General Hospital share knowledge of traditional foods in class. Students learn that colonialism, as de Leeuw, Lindsay and Greenwood (2015) and McGibbon, Mulaudzi, Didham, Barton and Sochan (2014) assert, is a significant determinant of health – one that has yet to be fully accounted for – and that decolonization is iterative rather than an outcome. Elders are invited into classrooms to speak with students on several topics. One example is an HCA program initiative that includes Elders facilitating a learning activity in a palliative care course. Elders share their knowledge and beliefs related to end of life. Students learn about Indigenous ways of knowing and are invited to experience ceremony from a worldview that may be different from their own. This leads to an appreciation of multiple perspectives and “two-eyed seeing”, highlighting the importance of alternative ways of knowing and encouraging students to “constantly question and reflect on the partiality of [their] perspective” (Martin, 2012, p. 31). Anonson et al. (2014) explore the impact of Elders in the post-secondary classroom, noting that the “learning spirit” (p. 3) was traditionally developed through story-telling and ceremonies led by Elders. The presence of Elders in the classroom strengthens the learner’s ability to understand how content is both relevant and connected (Anonson et al., 2014). Faculty and students learn to value Indigenous pedagogy. HCA students report that this learning touches them deeply and allows them to honor their thoughts and feelings about the role of ceremony at end of life. By extension, they recognize the importance of attending to the spiritual needs of those in their care. Holistic learning experiences benefit all students, and Elders in the post-secondary classroom embody this approach (Anonson et al., 2014).

Future Directions

An exciting future includes Yukon College’s transition to Yukon University and community interest in rural health program delivery. A priority for the new Associate Vice President Indigenous Engagement and Reconciliation role is the indigenization of Yukon College/University. Health program instructors will engage in teaching and learning that incorporates Indigenous perspectives, aims to decolonize, and supports reconciliation. Indigenous scholars suggest reconsidering the primacy of western ways of knowing and integrating instructional methods embedded in an Aboriginal pedagogy including: talking and sharing circles; participant observations; experiential learning; modeling; meditation; prayer; ceremonies; and story-telling – informing health program teaching strategies (Battiste, 2002; Pete, Schneider & O’Reilly, 2013). Students will learn to be health care providers at home in the Yukon and grow through authentic learning experiences grounded in cultural safety and humility. In turn, they will develop excellence in supporting the health needs of the individuals, families, and communities they care for.

References

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Battiste, M. (2002). Indigenous knowledge and pedagogy in First Nations education. A literature review with recommendations. Ottawa, Ontario: Indian and Northern Affairs Canada (INAC). Retrieved from http://www.usask.ca/education/documents/profiles/battiste/ikp_e.pdf

Camosun College. (2018). Whitehorse Field School. Retrieved from http://camosun.ca/learn/programs/nursing/what-youll-learn/yukon-field-school.html.

Council of Yukon First Nations. (n.d.). First nations’ final agreements. Retrieved from https://cyfn.ca/.

de Leeuw, S., Lindsay, N.L. & Greenwood, M. (2015). Rethinking determinants of Indigenous peoples’ health in Canada. In M. Greenwood, S. de Leeuw, N. Lindsay & C. Reading (Eds.), Determinants of Indigenous Peoples’ health in Canada. Beyond the social. Toronto, Ontario: Canadian Scholars’ Press.

Hanson & Associates/Malloch Graham & Associates Management Consultants. (2001). Nursing human resources demand and options for supply: phase two: nursing program feasibility study. Whitehorse, YT: Yukon College.

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McGibbon, E., Mulaudzi, F.M., Didham, P., Barton, S. & Sochan, A. (2014). Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative. Nursing Inquiry, 21(3). Retrieved from https://repository.up.ac.za/dspace/bitstream/handle/2263/49265/McGibbon_Toward_2014.pdf?sequence=1

Pete, S., Schneider, B. & O’Reilly, K. (2013). Decolonizing our practice – indigenizing our teaching. First Nations Perspectives, 5(1). 99-115. Retrieved from http://www.mfnerc.org/wp-content/uploads/2013/04/Section6_Decolonizing-Our-Practice-Indigenizing-Our-Teaching.pdf

Pringle, D., Green, L. & Johnson, S. (2004). Nursing education in Canada: historical review and current capacity. Ottawa, Ontario: The Nursing Sector Study Corporation. Retrieved from https://www.nurseone.ca/~/media/nurseone/page-content/pdf-en/nursing_education_canada_e.pdf?la=en

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