Perspectives on Indigenous cultural competency and safety in Canadian hospital emergency departments: A scoping review [2019]

• There are multiple perspectives on how to create culturally safe EDs for Indigenous patients.

• Key facilitators include relationship building and ED-specific cultural competency training.

• Key barriers include ED capacity limitations and racism/discrimination.

• ED cultural safety initiatives should be built upon post-colonial understanding.

Emergency departments are primary health care entry points for Indigenous persons in Canada. They are also among the settings where Indigenous patients report access barriers and discriminatory treatment. Cultural competency and cultural safety have been proposed as approaches to improving emergency care.

To identify and elaborate upon barriers and facilitators of cultural competency and safety in Canadian Emergency Departments.

We conducted a scoping review to search published and grey literature to identify and extract data on definitions, measures, facilitators and barriers of cultural competency and safety.

Six articles met inclusion criteria. Studies presented perspectives from patients, care providers, health care organizations, and Indigenous knowledge holders. Key themes emerged across studies and stakeholders. These include: Interpersonal relationships between patients and care providers; cultural competency training; Emergency Department capacity; and racism and discrimination.

We recommend that Emergency Department cultural competency and safety initiatives i) be built upon post-colonial understanding and partnerships with local Indigenous communities ii) provide practitioners with competencies in relationship-building and self-awareness iii) orient ED resources and services to meet the needs of patients with limited access to non-emergency healthcare and iv) aim to prevent discrimination.

Kelsey Berg, Patrick McLane, Nicole Eshkakogan, Jennifer Mantha, Tracy Lee, Chelsea Crowshoe, Ann Phillips
International Emergency Nursing, Volume 43, March 2019