Changing Conversations

Research driven by empathy and a desire for new perspectives

When Annette Schultz pursued her nursing diploma in Regina, she knew that she wanted to work with children when she graduated. Her interest stemmed in part from the fact that she grew up in a house with seven kids and was a full-time summer babysitter by the time she was 11.

That aside, she knew working on a hospital pediatric unit would be challenging at times, but also fun. “Every day I went to work, I played,” recalls Dr. Schultz. “When providing any kind of health care procedure to a child, stepping into their world of play supports them in dealing with the procedure.”

A start in pediatrics

A Master’s degree, a PhD, and a couple of decades later, Dr. Schultz is no longer a hands-on nurse working with children, but that same spirit of empathy and truly understanding the needs of patients drives her fascinating research. And much of that spirit is influenced by language – how we talk about health care issues and challenges.

“There was almost no investigation of cardiovascular disease from a critical social perspective.”

Different ways to look at health

Take her work on tobacco, for instance. It’s a topic she’s been looking at since working on her Master’s thesis in 1997.

“The language has been about getting people to quit; it was always about smoking cessation,” she says. But when she talked to nurses, she came to understand that having patients quit smoking while in hospital “was not a realistic goal.” Her research has shown there are benefits to framing the issue differently.

“Today the language I would use when admitting somebody (a smoker) to the hospital is that they are going to have withdrawal symptoms. That means they are going to have cravings, they are going to be irritable, they are going to be depressed. And whatever else their symptoms are, the bottom line is they’re likely to be difficult people to look after in a hospital,” explains Dr. Schultz. “I don’t know that makes it a good time for them to quit, but I do think that’s a really great time to provide them with the opportunity to find out that there are other ways to manage those symptoms, rather than just having another cigarette.”

In other words, says Dr. Schultz, her work points to new ways to deal with hospitalized smokers that helps them feel supported in managing their addiction – especially now that hospitals have clean air policies forbidding smoking on hospital grounds.

“It’s about treating tobacco dependency, which means understanding that it’s an addiction,” says Dr. Schultz. “It’s about helping people see that when they smoke a cigarette, what they’re really doing is managing symptoms of (nicotine) withdrawal and there’s a variety of other things that could be done instead of having a cigarette.”

By changing the conversation about tobacco, Dr. Schultz’s work could lead to a change of guidelines and practice.

Exploring tobacco use and HIV

Currently, Dr. Schultz is one year into a four-year research project on heart health among First Nations peoples. The project – called “Debwewin – The Sound of Our Hearts” – is funded by the Canadian Institutes of Health Research.

The study emerged from the ideas and observations of a Clinical Resource Nurse, a graduate student of Dr. Schultz who noticed that what she was reading in the medical literature didn’t match what was happening among the First Nations people she was treating.

The reality is that the rates of cardiovascular disease among First Nations were roughly the same as the general population until about the late 1970s, and since then there has been a growing divide with First Nation rates higher in comparison.

“I started reading the literature,” says Schultz. “It was intriguing to me because very quickly I noticed what’s written about First Nations peoples and heart health could be summarized in a paragraph or two as the focus was epidemiological and very biomedical.” The literature discusses statistics and rates, she says, and then very quickly points to individual risk factors and behaviours.

“There was almost no investigation of cardiovascular disease from a critical social perspective,” says Dr. Schultz. The grant was based on observing practice, reviewing the scientific literature, and, most important, holding many discussions with First Nations People including Elders over two years. All of these efforts affirmed the need for the study and influenced its design.

The heart is first, always

With “Debwewin – The Sound of Our Hearts,” Dr. Schultz and her colleagues will be looking at health services data starting in 2000 to gain a deeper understanding of heart health trends and issues among urban and rural members of the First Nations community. They will also be working with Elders from the community and have convened an Integrated Knowledge Translation Board to help mesh Euro-western medicine with Indigenous knowledge. In the end, evidence generated will help shed light on a fuller understanding of hearth health among First Nations populations in Manitoba.

For a second study, led by Lorena Fontaine (Cree/Anishinaabe) from the University of Winnipeg, Schultz, along with four other First Nations women researchers, recently received partial funding from the Canadian Institutes of Health Research. The team will collaborate with First Nations women on a digital story-telling initiative called Mite Achimowin (Heart Talk), capturing and understanding First Nations women’s expressions of heart health. The digital stories honour the oral history of Indigenous women’s knowledge, which is a novel space to open dialogue about heart health.

Both studies are grounded in the spirit of the Mi’kmaq Elder Albert Marshall’s concept of “two-eyed seeing” – the idea of seeing and exploring the world around you through traditional First Nations and Euro-western worldviews. This means respecting and valuing both worldviews, rather than choosing one over the other.

“What would make me very happy is to find a way to move the discourse beyond talking about individual risk factors and on to systemic and social factors that can positively influence the situation,” says Dr. Schultz. “With the right evidence, we can open up a different dialogue.”

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