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First Nations members’ emergency department experiences in Alberta: a qualitative study

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Objectives

In Alberta, First Nations members visit Emergency Departments (EDs) at almost double the rate of non-First Nations persons. Previous publications demonstrate differences in ED experience for First Nations members, compared to the general population. The Alberta First Nations Information Governance Centre (AFNIGC), First Nations organizations, Universities, and Alberta Health Services conducted this research to better understand First Nations members’ ED experiences and expectations.

Methods

This was a participatory research project. Elders selected topics of focus through discussion with the research team, and approved our method of data collection. Sharing circles were held in February 2018 with Elders, First Nations patients, healthcare providers and health administrators from across Alberta. We analyzed data using the Western approach of thematic analysis, with review by two Indigenous team members. AFNIGC is custodian of the research data on behalf of Alberta First Nations, and approves publication of this work.

Results

Forty-six persons participated in four sharing circles lasting between one and a half and three hours. Findings included First Nations patients’ understandings of ED work, limited access to primary care services driving ED use, expectations of different treatment in ED based on race, experiences of racism, concerns about interactions with Children’s Services, healthcare avoidance, and avoiding specific hospitals. Equity approaches were identified as key to improving First Nations patients’ ED experiences.

Conclusions

Bringing First Nations perspectives to Western understandings of ED care is an important step toward identifying required improvements in the health system for better patient experiences and outcomes.

Résumé

Objectifs

Les membres des Premières Nations en Alberta consultent un médecin au service des urgences (SU) presque deux fois plus souvent que les non-membres des Premières Nations. Par ailleurs, d’après des publications antérieures, l’expérience des membres des Premières Nations au SU est différente de celle de la population en général. L’Alberta First Nations Information Governance Centre (AFNIGC), des organisations des Premières Nations, des universités et les Alberta Health Services ont donc joint leurs efforts pour entreprendre une recherche afin de mieux comprendre l’expérience des membres des Premières Nations au SU ainsi que leurs appréhensions.

Méthodes

Il s’agit d’un projet de recherche participatif. Des aînés ont choisi les sujets de discussion après échange de points de vue avec l’équipe de recherche, et ont approuvé la méthode de collecte de données. Des cercles d’échange d’opinions ont été organisés en février 2018 avec des aînés, des patients des Premières Nations, des fournisseurs de soins et des gestionnaires de services de santé de partout en Alberta. Nous avons analysé les données en utilisant l'approche occidentale de l'analyse thématique, avec examen par deux membres de l'équipe autochtone. L’AFNIGC s’est fait le consignataire des données de recherche au nom des Premières Nations de l’Alberta et a approuvé la publication du travail de recherche.

Résultats

Quarante-six personnes ont participé à quatre cercles d’échange de points de vue, dont la durée a varié d’une heure et demie à trois heures. Les résultats incluent la compréhension du travail des urgences par les patients des Premières nations, l'accès limité aux services de soins primaires qui conduit à l'utilisation des urgences, les attentes d'un traitement différent aux urgences en fonction de la race, les expériences de racisme, les préoccupations concernant les interactions avec les Services pour Enfants, l'évitement des soins de santé et le fait d'éviter certains hôpitaux. Les approches axées sur l’équité ont été jugées essentielles à l’amélioration des expériences des patients des Premières Nations aux urgences.

Conclusion

Intégrer les perspectives des Premières Nations à la compréhension occidentale des soins à l'urgence est une étape importante vers l'identification des améliorations requises dans le système de santé pour de meilleures expériences et de meilleurs résultats pour les patients.

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Acknowledgements

We would like to acknowledge support in planning and conducting the meetings at which data were collected by Eunice Louis (Maskwacis Health Services), Toni Goodeagle (Siksika Health Services), Danika Littlechild (Maskwacis Health Services), Bonita Saddleback (formerly Maskwacis Health Services), Darcy Jagodzinsky (formerly Organization of Treaty 8 First Nations of Alberta), Kris Janvier (Organization of Treaty 8 First Nations of Alberta), Anne Bird (Yellowhead Tribal Council), Bonnie Healy (Blackfoot Confederacy), Chyloe Healy (formerly Alberta First Nations Information Governance Centre), Andy Alook (Bigstone Health), Brian Holroyd (University of Alberta and Alberta Health Services), Nicole Eshkakogan (formerly Alberta Health Services), Val Austen-Wiebe (Alberta Health Services), Kienan Williams (Alberta Health Services), Scott Fielding (formerly Alberta Health Services), as well as Elders Patsy Tina Jacobs (Stoney Nakoda Tsuut’ina Tribal Council), Dustin Twin (Organization of Treaty 8 First Nations of Alberta), and Leonard Bastien (AFNIGC).

Funding

Funding was provided by a peer-reviewed Campus Alberta Health Outcomes and Public Health Meeting Grant, and by larger contributions from Maskwacis Health Services, AFNIGC and Alberta Health Services (Strategic Clinical Networks). The funders had no role in directing research methods or reviewing results. AFNIGC has ensured compliance with the First Nations principles of Ownership, Control, Access to and Possession (OCAP®) of research data, and provides the disclaimer.

Author information

Authors and Affiliations

  1. Emergency Strategic Clinical Network, Alberta Health Services, 2-033 10030 107 Street, Edmonton, AB, T5J 3E4, Canada

    Patrick McLane

  2. Department of Emergency Medicine, University of Alberta, Edmonton, Canada

    Patrick McLane

  3. Alberta First Nations Information Governance Centre, Calgary, Canada

    Lea Bill

  4. Cumming School of Medicine, University of Calgary, Calgary, Canada

    Cheryl Barnabe

Authors
  1. Patrick McLane
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  2. Lea Bill
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  3. Cheryl Barnabe
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Corresponding author

Correspondence to Patrick McLane.

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Disclaimer

Parts of this publication are based on data and information from the Engaging First Nations Knowledge Holders, Health Care Providers and Technicians on First Nations Members Emergency Department Experiences and Concerns Project. The analyses, conclusions, opinions and statements expressed herein, however, do not necessarily reflect the views of the Alberta First Nations Information Governance Centre (AFNIGC) and are solely those of the author(s). Statistics reproduced from this document must be accompanied by a citation of this document, including a reference to the page on which the statistic in question appears.

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McLane, P., Bill, L. & Barnabe, C. First Nations members’ emergency department experiences in Alberta: a qualitative study. Can J Emerg Med 23, 63–74 (2021). https://doi.org/10.1007/s43678-020-00009-3

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