Creating a safe space for First Nations youth to share their pain

Abstract

Introduction:Indigenous children and youth may be quiet about the way they express their pain and hurt which is in contrast to how health professionals are trained to assess it.Objectives:The aim was to understand how youth from 4 First Nation communities express pain using narratives and art-based methods to inform culturally appropriate assessment and treatment.Methods:This qualitative investigation used a community-based participatory action methodology to recruit 42 youth between 8 and 17 years of age to share their perspectives of pain using ethnographic techniques including a Talking Circle followed by a painting workshop. Physical pain perspectives were prominent in circle conversations, but emotional pain, overlapping with physical, mental, and spiritual pain perspectives, was more evident through paintings. Art themes include causes of pain and coping strategies, providing a view into the pain and hurt youth may experience. Youth were more comfortable expressing emotional and mental pain through their artwork, not sharing verbally in conversation.Results:Circle sessions and artwork data were themed using the Indigenous Medicine Wheel. Content of the circle conversations centered on physical pain, whereas paintings depicted mainly emotional pain (eg, crying or loneliness; 74% n = 31) with some overlap with physical pain (eg, injuries; 54%), mental pain (eg, coping strategies; 31%), and spiritual pain (eg, cultural symbols; 30%). Common threads included hiding pain, resilience, tribal consciousness, persistent pain, and loneliness.Conclusion:Once a safe space was created for First Nation youth, they provided a complex, culturally based understanding of the pain and coping experience from both an individual and community perspective. These engaging, culturally sensitive research methods provide direction for health providers regarding the importance of creating a safe space for young people to share their perspectives.

Humanizing Indigenous Peoples’ engagement in health care

“…6 Elder Marshall collaborated on the Aboriginal Children's Hurt and Healing Initiative study, in an attempt to invoke 2 sets of lenses or perspectives within a sharedlearning process, to improve patient engagement. In this study, 7 Indigenous and non-Indigenous clinicians amassed knowledge and experiences based on their interactions with Indigenous patients, and then offering recommendations to humanize Indigenous Peoples' health care engagement.…”

“…Indigenous people often seek primary care as outpatients, but it is also where Indigenous people feel most vulnerable, owing to racism and fear of stigmatization for seeking pain care. 7 The acronym FIRST means an approach that comprises Family (recognizing the extended family of a patient), Information (communication that is respectful), Relationship (building positive relationships), Safe Space (understanding cultural safety) and Treatment (providing options for treatment, both traditional medicine and standard clinical treatment). 2 Combining Indigenous knowledge (community-based experiences and practices) with Western (clinical) knowledge produced the "FIRST" approach.…”

“…Two-Eyed Seeing guides us toward a relational way of being, 5 listening and learning from what children say about their health, for example. 7 It is critical that clinicians comprehend the complexity of how Indigenous children may share their pain or hurt through stories, which may require additional time while encouraging positive relationship growth.…”

“…10 Currently, within Canadian health care, Indigenous people may feel stigmatized because of deficit-based discourses in relation to Indigenous health inequalities. 7…”

Results of a culturally relevant, physical activity-based wellness program for urban Indigenous women in Alberta, Canada

“…In Indigenous 'circle methodology', researchers are given permission to share what is discussed in the group (Lavallée, 2007;Restoule, 2006). Future program evaluations could consider incorporating more Indigenous Research Methods, including circle methodology or medicine wheel framework methodology, to enhance how women experience the WW program and how healthy change can be influenced (Latimer et al, 2018;Rothe, Ozegovic, & Carroll, 2009). One of the greatest challenges is capturing the lived experience of Indigenous women, recognizing that the journey toward good health can be particularly challenging and circuitous for those who have experienced--and continue to experience--the effects of intergenerational trauma and colonialism.…”