A Woman with Medicine

In my previous paper, my personal definition of nursing was the Cree word maskihkewiskwew, “a woman with medicine”. This paper will expand my conceptualization of this phrase and how it sums my personal nursing philosophy. I will explain my definition of the word “medicine” and introduce the community in which I learned Indigenous ways of knowing. I will demonstrate how concepts of Belonging and the Seven Grandfather Teachings have come to undergird my philosophy of nursing. I will discuss how I perceive a Christ-following worldview and Chinn & Kramer’s patterns of nursing knowing (2018) to fit alongside the Grandfather Teachings. Finally, I will explain why the integration of Indigenous knowledges with nursing knowledges is important to my future areas of nursing practice. I believe this journey is continued through deliberate un-silencing and prioritizing of Indigenous knowledges
in nursing discourse, and their consolidation with our more conventional knowledges.

Medicine and Community

There are many different understandings of the word “medicine.” Referencing my previous paper, my personal definition of “medicine” is “the integration of multiple ways of knowing so that persons are honoured, uplifted, and healed”. My approach to healing and medicine is informed by my participation in Indigenous Pathways (IP), a North American and global community of Indigenous people who “seek to bring a message of health and well-being
to the wider Indigenous community” (IP, 2020). Through participation in this community and particularly through serving in their yearly week-long summer camps for Indigenous youth, I was introduced to a concept of medicine as all things that uplift and heal in the physical, mental, emotional, and spiritual aspects of human living. When seen this way, many more things than Western biomedical treatments are also medicine: traditional teachings, art, laughter—even body language might be a form of medicine.

In staff training for IP summer camp and in listening to Elders teach Story to the youth and staff, I learned about Belonging from Martin Brokenleg et al.’s Circle of Courage (Government of Manitoba, 2007) and about the Seven Grandfather Teachings. The primary Elders who taught and teach in our community are Elder Harold Roscher, Dr. Terry LeBlanc, and Elder Nora Yellowknee. We were encouraged implicitly to live out these teachings while
working with Indigenous youth throughout the weeks of camp. I experienced how life-giving, community-building, and profoundly healing these virtues can be. I realized that these teachings are medicine for all human beings, and that I should extend their application into my nursing practice. In the rest of the paper I will introduce each Grandfather Teaching with the phrase “I heard the Elders say…” to connect back to the community from which I learned them.

Belonging

Belonging in the Circle of Courage is described as “treating others as kin” which “draw[s] all into relationships of respect” (Government of Manitoba, 2007). Indigenous belonging is significant to my personal knowing. Chinn and Kramer (2018) describe personal knowing as “a process of Self-knowing that is conscious; it is developed deliberately to know fully who you are and to understand your actions and relationships” (p. 117). In a past paper I wrote that I was offered deep belonging from Indigenous blood family and non-blood family, and that I want my patients to experience this same kind of deep belonging (Friesen, 2019). This is a similar concept to Maori nurse scholar Irihapeti Ramsden’s emphasis on “the importance of establishing the ‘trust moment’ between the nurse and the patient” (Ramsden, 2002, p. 105). Whether it is described as “belonging” or as “trust”, the heart of the matter is that the patient needs to feel that they belong in the place of care, and that the people who care for them will treat them as if they belong there. I as the nurse am responsible for finding an individualized way for each patient to feel belonging.

Love

I heard the Elders say that Love is carried by the Eagle, a symbol of purity who flies highest and therefore closest to Creator. My understanding of love is also informed by the traditions of following Creator Sets Free (Jesus) that I resonate with most strongly. In the First Nations Version Bible, Creator Sets Free speaks to his followers: “In the same way the Father loves me, I have loved you…To walk the road with me, you must love each other in the same
way I have loved you” (John 15: 9&12 FNV). As a nurse who follows Creator Sets Free, I seek to treat all human beings with love because of the belief that all human beings are loved deeply by the Creator Himself. I believe this is the Christian understanding of the value of all human life. Early Anabaptist theology also emphasized love: Another foundation stone was the insistence on the practice of true brotherhood and love among the members of the church…Hans Leopold, a Swiss Brethren martyr of 1528, said of the Brethren: ‘If they know of any one who is in need, whether or not he is a member of their church, they believe it their duty, out of love to God, to render him help and aid.’
(Bender, 1942, p. 38) This quotation is from a book that my grandfather Alvin Friesen studied when he was in high
school; his name in teenage writing is on the cover page. Such a calling, rooted in Love and carried by my ancestors, compels me to render that same “help and aid” to my patients and their families when I nurse.

Respect

I heard the Elders say that Respect is carried by the Bison, who lays down his life and everything he has for the good of the people. The Elders say this is an example of doing right by others. To do right is also considered in ethical knowing, which explores how a nurse determines what s(he) ought to do and how to behave morally in each nursing situation (Chinn & Kramer, 2018). To behave ethically involves respect for the dignity of humanity and the use of my skills to honourably serve my patients (Chinn & Kramer, 2018; Benner, 1991). I was surprised to find that ethical knowing was not as frequently expressed in my practice as I had expected, considering my interest in marginalized populations and patient rights. However, I think that may simply be due to the framework I use for similar ideas. My respect for human dignity is grounded in the Love that I discussed above. My motivation for treating patients well comes from my Christ-following worldview and from the principles of Love and Respect, and this does lead me to pursue ethical behaviour. Like the Bison, I need to lay down my gifts and strengths as a nurse for the good of patients and their families.

Humility

I heard the Elders say that Humility is carried by the Wolf, who always submits to the will and needs of the pack over what the individual might want. Florence Nightingale herself understood humility as essential for nursing and wrote: I do say that these women had the true nurse-calling—the good of their sick first, and second only the consideration what it was their “place” to do—and that women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them. (Nightingale, 1898, p. 25). This fundamental sense of humility reminds me not to hold myself or behave as superior to my patients or any other member of the health care team. It is also an important virtue in intercultural settings where I might be tempted to assume that my approach or my knowledge is better than another’s. In a contemporary context, McGibbon et al. (2014) use a postcolonial framework to discuss the need for humility as we un-learn our own biases and accept that we will make mistakes while working through the process of decolonization. Without humility, I would not seek to know what I do not know.

Truth

I heard the Elders say that Truth is carried by the Turtle, who listens to all stories, preserving knowledge and carrying it on her back through the eons. My discussion of Truth includes empiric knowing, the pattern of knowing grounded in realist philosophy as a search for objective and quantifiable truth, described by Carper as necessary for the science of nursing (Chinn & Kramer, 2018; Hirani et al., 2018; Carper, 1978). The Elders say the Turtle’s task is to bear witness to the natural laws of the world that always hold true. This carries some resonance with empirical science’s role of the “observer” and the quest of the scientist to discover the cosmos’ inalienable laws of math and physics (Britannica, 2018). Both the Turtle and the scientist pursue what is immutable about reality. Empiric is the pattern of knowing I emphasize the least in my practice; I tend toward intuitive and emotive approaches to nursing as evident in
my last paper. However, empiric knowing is still crucial for the maintenance of evidence-based practice that supports high quality care (Hirani et al., 2018; Thorne & Sawatzky, 2014). Hirani et al. (2018) discuss alternatively the paradigm of relativism, a different way to view truth in which reality is subjective and depends on individual human experience. The authors stress the importance of this approach for tailoring nursing care to the unique situations,
experiences, and values of each patient. As I consider this for my own nursing practice, it reminds me to listen attentively and carefully like the Turtle to the stories each patient tells me. As a nurse I need to advocate for the patient’s truth to always remain central to their plan of care.

Wisdom

I heard the Elders say that Wisdom is carried by the Beaver, who applies his teeth and skills to the building of good things for his family. I have chosen the framework of Wisdom to explore one of my most frequently used patterns of knowing, aesthetic knowing. Chinn and Kramer (2018) describe aesthetic knowing as not merely having knowledge, but finding the exact time, place and way to creatively use what the nurse perceives and feels to transform a nursing event into one of deep human meaning and beauty. These scholars articulate that aesthetic knowing involves instinctually taking in information about the patient and knowing how to apply it through relationship with the patient, to create that meaningful experience. This was strongly seen in my practice example by the ways I chose to connect the patient with his family amidst a pandemic through window visiting and the speaker setting on his phone. It was also evident in my instinctual assessment of the family processes involved in his goal of care decision, and the ways that I chose to help maintain the family’s natural processes as they achieved informed decision-making. Before taking this course, I assumed that my most common pattern of knowing would be emancipatory, because I value improving health care for marginalized populations. I did not realize that who I am personally as someone who makes and enjoys art is such a large part of my nursing. I know now that at home I create forms of tactile art, and at work I create artful moments of nursing. This course has helped me evolve my conception of my own nursing into one that is supported and strengthened by my personal artistic and aesthetic strengths. This class has challenged me to stay open to new understandings of nursing practice. It has helped me understand myself better and more clearly articulate what I bring to my nursing practice. Art is my set of Beaver’s teeth, gifted to me by Creator, and an element of my best nursing practice. It is my tool to build good and beautiful things for my patients and my communities.

Honesty

I heard the Elders say that Honesty is carried by the Saabe, an ancient being who walked the earth reminding us to live with integrity. Here I will revisit the pattern of personal knowing that I introduced in my discussion of Belonging. Personal knowing is connected to this sense of Honesty because it is defined by being our authentic selves with our patients (Chinn & Kramer, 2018). It involves critically reflecting on who one is and how one’s self and actions impact
others as we interact in relationship, and maintaining “congruence between one’s actions and values” (p. 124). Much of who I am personally comes from situatedness within my three ethnic heritages of Euro-Settler, second-generation immigrant Chinese, and Indigenous Pasifika diaspora. Add to that my involvement in Indigenous communities of North America, and my life expression has become a combination of the West and the East, the European and the Indigenous. I must learn to reconcile different ways of thinking and being, epistemologies and ontologies within my own body and within my own mind. I must also navigate a constant sea of different worldviews and perspectives in my relationships with others. Through NURS 510, I came to realize that I cannot separate this complex multiplicity in my personal life from my nursing practice; this is the Self that I bring to my nursing. This is also the Self that I brought to this paper, because I am writing to you, reader, like I live my life, a little messily but in an honest seeking to reconcile Indigenous and all patterns of knowing towards each other so that they can coexist in friendship.

Courage

I heard the Elders say that Courage is carried by the Bear, who is gentle until she needs to be fierce, for the defense of her family in a time of danger. This is where I will explore emancipatory knowing: the use of the skills and power nurses possess to address injustices that our patients face (Chinn & Kramer, 2018). In my personal and nursing life, I have borne witness like that Turtle to many heartbreaking structural and individual injustices done against Indigenous patients. It has made me angry and determined to do something productive in response, like the Bear. Chinn and Kramer state that “the dimensions of emancipatory knowing include “critical questions” and “creative processes of critiquing and imagining” (p. 81). The first critical question I asked in Indigenous health was “why are Indigenous patients so commonly misunderstood and mistreated?” as exemplified by my nursing practice experience. As I explored the deeper roots of this question, I then asked “why aren’t Indigenous knowledges accepted in academia and bedside nursing?” If nurses understood more about Indigenous ways of knowing and the effects of colonization, they would likely be more sensitive to patients’ needs and nurse them more safely (McGibbon et al., 2014). This paper itself is one creative process of Chinn and Kramer’s “critiquing and imagining”; I deliberately centred Indigenous knowing in
my discussion of nursing, where I believe it fully belongs. It is my personal step towards conscientização, my learning to act against oppression (Friere, 1970). In my MSN studies, I hope to learn from scholars and Elders who have walked the road before me, to better understand the body of nursing research and praxis in Indigenous health. What research gaps need to be filled? And most importantly, how do we help Indigenous people redefine health care and wellness for themselves? I purpose to join the circle of people working to decolonize nursing. The more research and praxis I can participate in that restores good relationships with Indigenous people and health, the more justice and healing can be found for the harms in our health care system.

Conclusion

This course has taught me the importance of astutely balancing different knowledges to create the best nursing care for my patients and their families. Ignoring or silencing any of Indigenous, personal, ethical, empiric, aesthetic, or emancipatory patterns of knowing leads to care that is unable to fully meet diverse patient needs. What the Eagle, Bison, Wolf, Turtle, Beaver, Saabe, and Bear have to teach us leads to healing in many different ways which are not
incompatible with Western nursing. In the midst of profound human difference, we are not as diametrically opposed as we think. By bringing these different knowledges together and seeking to live them with integrity, I hope to be a maskihkewiskwew, a woman with medicine.

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References

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Bender, H. (1942). Mennonites and their heritage, number 1: Mennonite origins in Europe. The Mennonite Central Committee.
Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in nursing science, 1: 13-24. ISSN: 0161-9268
Chinn, P. & Kramer, M. (2018). Knowledge development in nursing: Theory and process. Elsevier Inc. Encyclopedia Britannica. (2018). Scientific theory. In Britannica.com. www.britannica.com/science/scientific-theory
Friere, P. (1970). Pedagogy of the oppressed. Seabury Press.
Friesen, M. (2019). Redeeming displacement: cultural safety in nursing as a Christ-motivated ministry of decolonization. Journal of NAIITS: An Indigenous Learning Community, 17, 28-49. Journal Table of Contents (naiits.com)
Government of Manitoba. (2007). Circle of Courage. www.edu.gov.mb.ca/k12/cur/cardev/gr9_found/courage_poster.pdf
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McGibbon et al. (2014). Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative. Nursing Inquiry, 21(3), 179-191. https://doi.org/10.1111/nin.12042
Nightingale, F. (1898). Notes on Nursing. www.fulltextarchive.com/pdfs/Notes-on-Nursing.pdf
Ramsden, I. (2002). Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. https://croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf
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Author’s note: Verbal permission was received from Elder Nora Yellowknee to use the Cree
word maskihkewiskwew as my definition of nursing and use it in writing.