Cooperative Process to Draw Up a Portrait of the Initial Training Path for Nurses in Quebec and Identify Possibilities in the Area of Cultural Safety Among First Nations and Inuit

Introduction: In recent years, several provincial and national reports have highlighted the need for more cultural safety education for health care professionals to ensure safe equitable care for Indigenous people. In the province of Quebec, the death of Joyce Echaquan has been a key lever for diverse health organizations and teaching institutions in order to take concrete actions against health inequities and systemic racism experienced by Indigenous people within the health care system. In response, the Order of Nurses of Quebec officially recognized the existence of systemic racism within the health care system and initiated actions to promote cultural safety and to engage against systemic racism within the nursing profession. Among the actions, the Order of Nurses of Quebec mandated a working group to address an advisory to evaluate if the entry-to-practice nursing education in Quebec was sufficient to provide culturally safe, relevant, and equitable care to Indigenous individuals. We are the authors who carried out the collaborative process leading to the advisory. From this collaborative process, we believe that our approach, our findings and our reflections are relevant to share with those who are involved in nursing education in Quebec and Canada. Objective: This discussion paper aim to describe the collaborative process leading to the advisory which was divided into four iterative stages: 1) a narrative literature review, 2) a short online survey, 3) discussions sessions, and 4) consultations. It also aims to discuss the main findings and reflections regarding the cultural safety competencies in initial nursing education in Quebec. Discussion and Reflections: We believe that our collaborative process was a strength of the main findings and reflections that are described in this discussion paper. The results of the survey showed that Indigenous cultural safety content and time allocation was insufficient and varied greatly between teaching institutions in Quebec. No institutions offered electives or specific courses on Indigenous cultural safety; however, cultural safety was addressed in a cross-cutting manner by the majority of institutions. As for the narrative literature review and the discussions sessions, numerous strategies are outlined to guide educators in further developing the Indigenous cultural safety content in their nursing programs. These strategies highlight the need to work with Indigenous communities to decolonize and indigenize the nursing profession and education and the need to focus on faculty development including, hiring Indigenous nurses. Conclusion: Within our collaborative process, we consider that we have succeeded in bridging together reflections to support teachers and professors in Quebec and Canada to develop and integrate Indigenous cultural safety content in nursing programs. We also agree that is necessary for all Canadian provinces to initiate a reflection about Indigenous cultural safety in entry-to-practice nursing programs in order to ensure culturally safe, relevant, and equitable care to Indigenous individuals.

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