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Open Access The Influence of Geographical and Social Distance on Nursing Practice and Continuity of Care in a Remote First Nations Community L'influence de la distance géographique et sociale sur l'exercice des soins infirmiers et la continuité des soins dans une communauté autochtone éloignée

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Abstract:

The purpose of this article, which draws on the findings of a larger ethnographic study, is to explore the influences of geographical and social distancing on nursing practice and continuity of care in a remote First Nations community in Canada. Employing an ethnographic design, the authors use multiple data sources to ground the analysis in the unique context of health services in the selected community. The findings suggest that remote geographical location, the inequitable social conditions that shape the health and well-being of First Nations people, and nurses' level of preparedness to practise in this complex environment fostered patterns of social distancing in nurse-patient relationships. These patterns constrained nurses' ability to engage in practice that promotes continuity of care. In some cases, social distancing took the form of Othering practices and relational disengagement from patients. Changing the social determinants of Aboriginal people's health in remote communities is an important first step in supporting the changes in nurses' practice that are key to improving continuity of care and to effecting long-term, sustainable health improvements.

French
Le but de cet article est d'explorer, à partir des conclusions d'une étude ethnographique, l'influence de la distance géographique et sociale sur l'exercice des soins infirmiers et la continuité des soins dans une communauté autochtone éloignée du Canada. Les auteures ont eu recours à des sources de données multiples afin de situer leur analyse dans le cadre unique que constituent les services de santé au sein de la communauté à l'étude. Leurs conclusions révèlent que l'éloignement géographique, les conditions sociales inéquitables qui influent sur la santé et le bien-être de la population autochtone, de même que le degré de préparation des infirmières face aux exigences d'un environnement complexe, engendraient des modèles de distanciation sociale en matière de relation thérapeutique. Ces modèles restreignent la capacité des infirmières à adopter une approche qui favoriserait la continuité des soins. Dans certains cas, la distanciation sociale s'est traduite par des pratiques d'étiquetage de l'Autre et par un désengagement à l'égard des patients. Transformer les déterminants de la santé autochtone dans les communautés éloignées constitue un premier pas important vers l'adoption de pratiques infirmières susceptibles de favoriser la continuité des soins et d'engendrer des améliorations durables en matière de santé.

Keywords: ABORIGINAL PEOPLES; CONTINUITY OF CARE; FIRST NATIONS; NURSING PRACTICE; OTHERING PRACTICES; PATIENT-PROVIDER INTERACTIONS; PRIMARY HEALTH CARE NURSING; RELATIONAL DISENGAGEMENT; REMOTE COMMUNITIES

Document Type: Research Article

Publication date: 2007-09-01

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