Getting to the Heart of Cultural Safety in Unama’ki: Considering kesultulinej (Love)

De-Ann Sheppard Cape Breton University

Cite as: Sheppard, D. M. (2020). Getting to the Heart of Cultural Safety in Unama’ki: Considering kesultulinej (Love). Witness: The Canadian Journal of Critical Nursing Discourse, Vol 2 (1), 51-65 https://doi.org/ 10.25071/2291-5796.57

Abstract

Reflecting upon my early knowledge landscapes, situated within the unceded Mi’kmaq territory of Unama’ki (Cape Breton, Nova Scotia), living the Peace & Friendship Treaty and the teachings of Mi’kmaw Elders, I contemplate the essential relationship with land and language, specifically, kesultulinej (love as action) and etuaptmumk (two-eyed seeing) to Cultural Safety. I recognize my position, privilege, and Responsibility in teaching and learning about the contextual meanings of Cultural Safety, situated in specific Indigenous terrains and in relation with the land, across time, and relationships. Critical reflection on my story and experiences challenge me to consider why and how Maori nursing theorizations of Cultural Safety have been indoctrinated into the language of national nursing education by the Canadian Association of Schools of Nursing (CASN), Canadian Nurses Association (CNA) and most provincial nursing regulatory bodies; this is increasingly relevant as nursing education is progressively shaped by neoliberal and Indigenizing agendas. As I contemplate wrapping Cultural Safety with kesultulinej, I see the potential to decolonize nursing. Mi’kmaw teachings of etuaptmumk and kesultulinej call forth Responsibilities to act, and in doing so move us into a space of potential to resist the colonizing forces within nursing. In this moment I realize the interconnected meaning of being amidst these relationships that matter to me as a person and as a nurse; relationships that are marked by love, care and compassion.

Keywords: Cultural Safety, decolonizing nursing, Indigenous nursing, love as action, nursing education

Corresponding Author: De-Ann Sheppard, RN, NP, MScHQ, Cape Breton University. Email: [email protected] 51

Getting to the Heart of Cultural Safety in face, or the colonized systems, policies and Unama’ki: Considering kesultulinej (Love) regulations they must adhere to in practice?” I would later learn that he wasn’t asking my In one of my first conversations with thinking mind, rather engaging my whole Elder Albert Marshall he described knowledge being, awakening the curiosity of the learning as a living garden with a learning spirit.1 The spirit. I waited for his response. “Anyway…” way he described knowledge as being alive he says and eventually the conversation and having its own curious essence resonated circled back to love, care and compassion. with me. I have come to appreciate how Within this critical context I had not despite having heard Elders stories repeated considered the discourse of love as action. I numerous times, consistently something new had to catch a deep breath, taking a moment to emerges in my being, shifting my perspective integrate this new seed of knowledge, as they teach. Wise Knowledge Holders and pondering how it might grow. It took time for teachers plant seeds of knowledge, often me to learn to be patient and to sit with the without our conscious awareness, not knowing discomfort and confusion these conversations when or how the germination process will generated for me. I had to learn to trust in unfold. They have patience and trust that when processes that allowed knowledge to ready, the seed will grow into the persons germinate. Looking back, it is in these knowledge garden. Listening to him, I moments that I become closer to the heart of wondered what knowledge might be what matters. (Elder Albert Marshall, awakening inside me. Acquiring knowledge is Mi’kmaq, Eskasoni, these co-learning essential to my work as a nurse practitioner - conversations began in May of 2017 and I’ve always been interested in patients’ stories continue on Mi’kmaq Ancestral territory in of what mattered most to them in their healing person, over the phone and occasionally by e- journeys, and how they come to know the mail when he considers and gives feedback on experience of care. Elder Albert shared with my writing.) me some of his encounters with the healthcare system. While he might agree with me if I Turning to my Stories described his experiences as racist, he would not choose this language. We both recognized How do I decolonize my mind and these experiences as everyday occurrences for bring my whole being, allowing the learning Mi’kmaq in mainstream healthcare and spirit to lead, as I become closer to the heart of awareness of that reality is mutually troubling. what matters? Where do my story and lived I felt his frustration when he declared, “I experience fit? My experience of leaving home shouldn’t have to legislate love, legislate care (never to return) for education, working for 11 and compassion” (personal communication, years as a Registered Nurse, followed by 22 June 6, 2018). When he initially drew my years as a Nurse Practitioner in rural and attention to love, care and compassion, I remote Indigenous communities. The suffering didn’t really appreciate what he was telling associated with this disconnection and me and almost missed it. It is only now, that I dislocation and the innate longing to reclaim realize that in that moment he gave me much and reconnect with my kinship, stories and to think with. Our conversations deepened as teachings lies lurking in the backdrop. My 22- our relationship grew and he would often pose year healing journey of reclaiming my rhetorical questions to me. Questions such as: Indigeneity is part of my experience and how I “Why do you think L’nu nurses return to their continue to grapple with the tension of being a communities the first chance they get?”2 woman of Mi’kmaq and Irish descent. The Uncertain I would try to answer the question: collective Responsibility I now shoulder is “could it be the racism, or discrimination they unmistakable, as I bear the weight of

1 Mi’kmaw Elder from Eskasoni First Nation University. From this point forward I will refer to renowned for his conceptualizations of him simply as Elder Albert. Etuaptmumk, two-eyed seeing and co-developer of 2 The term Mi’kmaq is used to refer to themselves, the Integrative Science Program and Cape Breton and loosely translates to people of the land.

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community expectations, intensified by the practitioner and faithfully grounded, what I radical hope of Elders to move the Indigenous now call etuaptmumk (two- eyed seeing), into health agenda forward, and to ultimately my being. Building on this foundation, I grew improve the health of L’nu in Unama’ki. How my primary care expertise and confidence over can I plant seeds of knowledge in ways to the following decade. As such, I felt foster and grow new knowledge gardens? competent when I assumed my role as the Gardens to which love, care and compassion Director of Patient Care in the remote First are central? Reflecting on this question I look Nation community of Attawapiskat, Ontario. back and recall my teachers of love. I am Yet, somewhere in the midst of Chief Theresa reminded of my early knowledge landscapes Spence’s protest for community resources, and and teachings of the importance of introducing subsequent hunger strike, the grassroots who I am, where I come from and where I am emergence of Idle no More, the protest that going on the path of life (Cajete, 1994). blocked the ice road to Victor mines, three states of emergency called in six months, and a (Re)membering Home tragic helicopter crash, I realized my My name is De-Ann Sheppard and I ineptitude. These dire experiences taught me am from Labrador. My father, Greg, is from how crucial culturally safe practices, which are St. George’s, Newfoundland and was raised in guided by love, care and compassion, are to a Mi’kmaw Catholic home, while my mother, the health and well-being of a community. Mary, is from Bell Island, Newfoundland and Humiliated and exhausted I retreated to was raised in an Irish Catholic home. The embark on a different learning and healing oldest daughter of four girls, I am a mother to journey. I hold deep gratitude for this two sons with big hearts. I am also a partner, experience of desperate powerlessness, it friend, grandmother, aunt, nurse practitioner, broke open my heart, as it awakened me to nurse educator, PhD student, peer mentor and knowledge and strength, I forgot I had. emerging scholar. My daily intention is to lead a life of gratitude, guided by my heart and that Revisiting Elder Albert’s Words all thoughts, acts and deeds are done with Mi’kmaw worldviews that understand integrity. In my heart I carry my teachings, love, care and compassion have called me to stories and wisdom. My true work is to be an return home to the Teachings of Elder active presence, share my gifts, and to Albert. As I revisit his words, I also begin to facilitate research and learning in a healing see the importance of place, the connections way, to create spaces where we feel inspired to lands generative nature and the language and to be brave while feeling safely held at the land speaks – love, care and compassion is same time. contextual and situated in particular places The Algonquins of Pikwàkanagàn welcomed and relationships. The Canadian Indigenous me into my first Nurse Practitioner position, a Nursing Association (CINA) describes rural satellite clinic of the Wabano Centre, Indigenous health nursing scholarship as “a situated in Golden Lake, ON. My instructions genuine search for a new way of nursing and were to establish a primary health care clinic, the challenges and benefits it presents for specifically with the intention of integrating clients and populations born of social, western medicine with traditional medicine. physical, economic, political, historical and This privileged me to work and study with cultural realities [Indigenous People] want to Mi’kmaw Elder and Medicine Woman, be faithfully reflected in nursing care” Sagaligesgw (Plant Woman), Jeorgina (ANAC, 2001, p.40). As I contemplate how LaRocque. I tear up when I recall my first this understanding shapes my nursing heart piercing encounter, she embraced me, practice, I begin to feel a shift in my wrapped in what I can only describe as an knowledge garden – in my turn towards unconditional loving presence that I had never practice, I turn towards love and care. Love felt before. This was my invitation to reclaim as both a concept and a practice has my stories, healing practices, ceremonies and previously been explored (McGregor, 2012; the power of recovering my identity. It Simpson, 2013; hooks, 2001). Indigenous profoundly shaped my worldview as a nurse theorizations of love describe a communal

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loving responsibility, interdependence, and that you can build from, is the spiritual- interconnectedness. “As Native scholars, emotional-physical-mental link to the whose teachings include love, our writing cultural-social-economic-political aspects of and our work is influenced by the love of our society” (personal communication, May 6th, people and all of creation. This love will 2019). My understanding of his teachings is always be there” (Whiteduck, Algonquin, that we achieve love when the intersections of 2013, p.89). It is essential as you read that all society domains are in balance. Love as you understand the nature of the colonized action therefore requires a much broader political correctness of the term Indigenous worldview of a person’s physical, mental, Peoples: a problematic categorization of our emotional, and spiritual health. I return to First Peoples of North America and their Elder Albert’s question. Were L’nu nurses descendants, consisting of Indians (First relieved to leave behind the institutional Nations), Métis, and Inuit. Careful attention violence and return to their communities? is required when using this terminology as it Reconnecting to land and language, where risks assimilation and erasure of the plurality they are safe to be themselves, free to embody and diversity of cultures of First Peoples. kesultulinej? Was this true for all nurses? Leanne Betasamosake Simpson, Anishinaabe, (2013) describes her search to Turning towards etuaptmumk decolonize love: “[t]he kind of love I was (two-eyed seeing) interested in, could liberate [us] from that horrible legacy of colonial violence. I am Thinking back to my time in speaking about decolonial love […] is it Attawapiskat, remembering the over- possible to love one’s broken-by-the- whelming sense of futility, I return to my coloniality-of-power self in another broken- conversations with Elder Albert. I lean into a by-the-coloniality-of-power person?” (p. i). relational space of possibility Elder Albert My mentor and Mi’kmaw Elder Stephen calls etuaptmumk (two eyed seeing) to become Augustine describe kesultulinej (love), as a closer to the heart of what matters. verb in the Mi’kmaw context, as action and Etuaptmumk, like all Mi’kmaw language, not to be confused with the English word arises from the land and our relationship to all love. “In Mi’kmaw language, the word is not creation. There is an embedded assumption self-serving; it is more a that values the ability to simultaneously access collective/communal love that includes multiple perspectives. When considering a respect, dignity, and pride for the whole way forward, Elder Albert describes bringing community and seven generations ahead” together his Mi’kmaw worldview and inviting (personal communication, May 23, 2019). in the Eurocentric scientific worldview, I hold a deep respect and looking for strengths and potential synergy for Responsibility to the stories and teachings I action. Sometimes he muses that ‘its common have received. The reciprocal nature of these sense really’. It is in those moments that my teachings come out of relationships and have being feels the uncertainty, and I return to my contextual meaning unique to those story and I am able to see how this Indigenous relationships. Much of what I know, I cannot relational interconnected epistemology is share without this connection. As I think and counterintuitive and challenging for colonized write about kesultulinej, I asked Maliseet minds, including my own. I am learning the Elder Ken Paul, a Knowledge Keeper of the nuances and complexity of this concept and Teachings of love, if I could share these with continue to deepen my understandings of this others. He felt I should hold back most of Knowledge and always defer to my Elder for what I had come to learn from him, as he was Teachings. It is with Elder Albert’s permission not there to ensure that others, like readers of that I am ready to carry the Responsibilities of this paper would be ready. I might confuse sharing my experiences of my decolonial you, in my attempt to write about love, care untangling etuaptmumk moments. Elder Albert and compassion. Yet, while cautioning me, Elder Ken Paul at the same time, encouraged me to say, “the most important steppingstones

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reminds me regularly that there is always Indigenous life” (p.127), to describe how another way.3 innocently Indigenous racism is embedded and This space has been theorized by normalized in everyday contemporary other Indigenous scholars as “ethical space” Canadian reality. Brian Sinclair’s Anishinaabe (Ermine, Cree, 2007), cultural interface presence remained invisible for 36 hours, as he (Nakata, Torres Strait Islander 2006 & 2007) died in plain sight in the emergency room and cultural hybridity (Chulach & Gagnon, waiting area of the Winnipeg Health Sciences 2016). While conceptually different, there is Centre (McCallum & Perry, 2018, p.127). agreement that this is a powerful space that Despite repeated concerns voiced by patients values the importance of multiple and families, security, housekeeping, nurses, perspectives and requires respectful and a nursing student, all failed in their duty to navigation. Considering the fluidity and the care for Brian Sinclair as he sat dying in his veil-like thinness of this relational space as I wheelchair. Biased assumptions that normalize sit in the unceded territory of Unama’ki (Cape Indigenous Peoples as intoxicated, homeless, Breton), the place of fog and first light, I am and needing to sleep it off in the department, reminded of the Teachings of the sunrise, and allowed moral actors to perform everyday how that space, thinner than a strand of hair, racist behaviour (Browne, 2017 & Allan & holds so much potential. Cultural hybridity Smylie, 2015). How did we get here? What acknowledges this is a challenging place to are we prepared to do to make this stop? What be, the site of the active construction of if they had understood zahgidiwin professional identity and agency, and a (Anishinaabe word for love) as action that counter strategy to colonial authority calls forth Responsibilities? (Chulach & Gagnon, 2016). Moreover, this is the space of potential where one feels either Cultural Safety the invisibleness and erased self-presence or As I think about what could have been the reclamation of identity and agency. The otherwise, I think about how Cultural Safety, latter is where love, care, and compassion raised hope to disrupt the status quo and the matter most. Given that love is seen as action, language to articulate the inherent danger and it requires a relational space – love, if political nature of the change required to understood as action calls forth response and provide safe spaces of care for and with Responsibilities. This relational space holds Indigenous Peoples. Maori Scholar, Irhapeti great potential for Indigenous nurses to work Ramsden (2002), answered the call of her within multiple worldviews, their ability to People and wrote prolifically about this hold the paradox of the colonial shame and nursing concept, Cultural Safety. Accepting Indigenous Pride, with kesultulinej as the Responsibility to commit to what communities balancing medicine. Coming full circle, over asked for, to protect Maori nurses in their and over, I return to kesultulinej. places of education and practice, she ensured that the community retained the power to My Disruption define and evaluate Cultural Safety (Ramsden, McCallum and Perry’s (2019) 2002). Yet, in Canada, theorizations of Structures of Indifference: An Indigenous Life Cultural Safety have not created the urgency and Death in a Canadian City, painstakingly or activated the anticipated social justice force our attention to the detailed account of response from nursing (Browne, 2017 & Allan the last 36 hours of an Indigenous man’s life in & Smylie, 2015). I often wonder if this lack of a Canadian institution of care. The authors response signals a lack of love and incorporate Razack’s terminology of “casual understanding? Is this how nurses live their inhumanity” and “deep disregard for Responsibility? Experienced transformative

3 This Responsibility is understood by Indigenous Indigenous Knowledge. Etuapmumk has been scholars. The decision to write instantaneously transplanted into health research. If our readers are places you at a delicate crossroad of tension not ready to consider relationality, to suspend for a holding the possibility to be either the colonizer, moment the certainty their knowledge is complete, the colonized or both. Cash Richard Ahenakew, then these seeds of knowledge may end up Cree, (2017) uses the metaphor of grafting genetically modified and patented.

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educators who draw from anti-racist pedagogy even when we are uncomfortable and even describe ideologies of multiculturalism, afraid? How do we become willing to lean into meritocracy and innocence that are embedded what matters most? If we become kesultulinej in the consciousness of Canadians, yet we can work backwards to answer these evidenced in their classroom note experiences questions and live our communal of significant resistance to change (Schick & Responsibility in ways that create and ensure St. Denis, 2005; Ward, Branch & Fridkin, Indigenous futurities. 2016). How has Cultural Safety education in Respect for the lifelong Responsibility nursing classrooms addressed this resistance? and commitment of Maori nursing scholar Dr. Feminist Minnie Bruce Pratt (1983) asks: Irihapeti Ramsden to Cultural Safety, and Why and when does a person willingly recognition of this gift to nursing, must be undertake change, especially if one is reciprocated with our continuance. Ramsden’s materially and ideologically safe and (2002) doctoral dissertation chronicles two comfortable? What does one stand to decades of the New Zealand nursing gain from questioning one’s cherished collaborative journey and growing Cultural beliefs and changing fundamental Safety consciousness. Sharing both public and ways of thinking? (p. 16) personal narratives, she modeled a steadfast kesultulinej (love as action) as her Indigenous As a nurse motivated by love, I can no theory, methodology and framework. This was longer turn away from the questions asked by specifically achieved by grounding Cultural Pratt nor from experiences like those of Brian Safety in reciprocal relationship with the land, Sinclair. Pratt’s questions have not only language and the Treaty of Aotearoa and Te challenged me to look at who I am and the Waipounamu. Appreciating the power and assumptions I hold/have held, but have perceived threat of Cultural Safety to disrupt challenged researchers across disciplines, colonizing forces, Ramsden’s community was social psychologists and critical post-colonial fearful for its future in nursing. Is this fated feminist theorists, to ask ourselves difficult forecast being realized in the Canadian questions. Faced with these challenges healthcare landscape? Ramsden’s (2002) use holding, multiple perspectives, it is clear that of Reflective Topical Autobiography to there is not a single strategy to awaken critically (re)tell her story of reclaiming her peoples’ sense of Responsibility and gifts as a transformative healer and educator, kesultulinej. Building on the 1845 social using self-research as a vehicle to lead us to analysis of Engels, Chernomis and Hudson new consciousness and insights, while (2010) describe policies that intentionally fail consistently challenging the inherent to provide access to basic human needs such as indifference, dismissive ignorance and food, clean drinking water, or healthcare while arrogance housed in the convenience of simultaneously removing hope, dignity, and a colonialism, provides both inspiration and a shared common purpose create inequality map. Radical hope to change Indigenous equivocal to social murder. This analysis also futurities is inspired by the following poem “A demonstrates the roots of some of the Ritual to Read to Each Other”: conceptualizations of the lower class and Darwinist thinking to be rid of “the Indian If you don't know the kind of person I am problem” (Government of Canada, 1969). Is and I don't know the kind of person you are the experience of inequity of Canada’s a pattern that others made may prevail in the Indigenous Peoples, not only a failure to love world and care, but also intentional social murder? and following the wrong god home we may Why is there no sense of urgency or action to miss our star. attend to the body of Brian Sinclair, in For there is many a small betrayal in the mind, moments where his Indigenous presence a shrug that lets the fragile sequence break simultaneously occupies the spaces nurses sending with shouts the horrible errors of work? Are we asking too much? How do we childhood mobilize love and care? How do we compel a storming out to play through the broken dike. readiness to respond differently, take risks

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And as elephants parade holding each implementation without contextual elephant's tail, incorporation of Indigenous worldviews, but if one wanders the circus won't find the honoring relationship to land and park, incorporation of treaties? What has been lost I call it cruel and maybe the root of all cruelty in translation? What has been silenced? to know what occurs but not recognize the Despite clear conceptual delineation, Cultural fact. Safety continues to be utilized interchangeably with cultural competence. Indigenous And so I appeal to a voice, to something Knowledges are located in specific places, shadowy, contexts, and across time. It is here that love, a remote important region in all who talk: care and compassion become secondary and though we could fool each other, we should are devalued. It is here that we silence the consider— voices of Elders and communities. In this lest the parade of our mutual life get lost in the silence, the travesty of Cultural Safety being dark. described as “a strategy in high‐income English‐speaking countries in response to For it is important that awake people be evidence of health disparities, structural awake, inequalities, and poorer quality health care and or a breaking line may discourage them back outcomes [in minority groups…], a paucity of to sleep; evidence to […specific] outcomes” harms my the signals we give — yes or no, or maybe — resolve (Horvat, Horey, Romios, & Kis‐Rigo, should be clear: the darkness around us is 2014, p. 7). It is in this darkness I extend deep. myself care and compassion and I remain (Stafford, 1998, p. 76) awake. The challenges faced by Canadian As I sit in Wabanaki (the people of the institutions responsible for credentialing dawn), the place of first light, living the Treaty nurses in the context of neoliberal knowledge of Peace and Friendship, I consider Ramsden’s production are exacerbated by the TRCs gift of Cultural Safety and what she has (2015) Calls to Action, and more specifically awakened in my being. In this moment, I open to number 24: my heart and allow myself to welcome her We call upon medical and nursing schools learning spirit into mine and I feel less alone. in Canada to require all students to take a She has awakened a deeper knowing of course dealing with [Indigenous] health kesultulinej and etuaptmumk, along with a issues, including the history and legacy of curiosity of how the seed of Cultural Safety residential schools, the United Nations might emerge if grown here in this land. Declaration on the Rights of Indigenous How do we remain awake and accountable Peoples, Treaties and Aboriginal rights, and to ground Ramsden’s gift to nursing in the Indigenous teachings and practices. This Canadian nursing colonialscape? “The merit will require skills-based training in and [significance] of Cultural Safety is well- intercultural competency, conflict reso- established and its [necessary] role in the lution, human rights and anti-racism (p. 3). delivery of healthcare increasingly accepted” (Guerra & Kurtz, 2017, p. 140). While These calls have startled the nursing consideration of Cultural Safety in Canadian consciousness creating a new appetite for all nursing literature has significantly increased things Indigenous and a continuum of with the Calls to Action of the Truth and responses across schools of nursing in Canada. Reconciliation Commission (2015), the The spectrum of these Indigenization simultaneous pressure on Canadian academies responses is described by Gaudry & Lorenz, to Indigenize curriculum has resulted in (2018) as a minimum Indigenous inclusion (I predominantly Indigenous inclusion policy would argue exclusion) moving progressively rather than treaty-based decolonizing action towards reconciliation and decolonial (Gaudry & Lorenz, 2018). What are the Indigenization. Their research demonstrated ramifications of such rapid and broad consistent themes from Indigenous scholars in

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the academy voicing their concerns of commodifying and marketing professions to balancing the potential for self-determination creating requirements to standardize and sovereignty of Indigenous nation’s evaluation and legitimize nursing knowledge resources with the real threat that superficial (Foth & Holmes, 2016). This initially resulted policies without changes in governance and in failure rates of up to 30% (specifically balancing of power could further strengthen impacting diverse student populations, colonialism. Moreover, participants in Gaudry Indigenous and Francophone students), & Lorenz’s (2018) study emphasised that delaying graduate nurses’ entry into practice, Indigenous bodies in academic institutions and critique from then CASN president with inclusive Indigenization policies felt Kristen Woodend (2016). Although there is unsafe in these hostile spaces and the invisible denial, curriculum has adjusted to teach to the messaging that their full Indigenous presence, test. NCLEX scores now significantly including epistemological and ontological influence how individual nursing programs are assumptions, are best left at the door. evaluated while nursing students contribute to The narrative of Canada’s universal a multi-million-dollar industry. This is only healthcare system as struggling to meet the one example but teaching students to conform demand for healthcare dominates many to systems that oppress and dehumanize conversations and often further marginalizes patients without the skills of critiquing their the voices of those who require more from the everyday realities leads to “disempowerment, system. The turbulent context of neoliberal disillusion and disengagement of nurses” education policy in Canada and the erosion of (Goodman, 2014, p.1055). It is here that we the preparation of nursing graduates must not must place and accept responsibility for the be ignored in this conversation – the focus death of Brian Sinclair and the absence of becomes one that recognizes outcomes, and kesultulinej. dismisses processes (Goodman, 2014). This Accountable nursing education, shift creates unique challenges for nurse models Ramsden’s teaching philosophy and educators to understand and teach Cultural embraces transformative nurse educators as Safety (Doran, Wrigley & Lewis, 2019). This transformative healers. This requires a difficulty is accentuated at a time where commitment to weave decolonized spaces into universities are being encouraged to the everyday places throughout the curriculum. expediently produce practice ready nurses, Decolonized nursing education, informed by with incentives to offer advanced entry and anti-racist and transformative pedagogy, compressed nursing programs. It is in these unpacks the invisible skill set required for moments where I wonder: Where are the Cultural Safety and provides students with the spaces and places for nurses to learn about skills to challenge the status quo, raising kesultulinej and about etuaptmumk, concepts critical awareness of bias, and the cultural central to furthering our understanding of what courage to step into spaces that include Culturally Safe practices look like at the Indigenous presence. Brian Sinclair is seen. As bedside, in the home or in the community? I struggle to find ways forward and to make When we incorporate Cultural Safety into sense of the inequities I have seen in practice standards, what do we really mean? Attawapiskat, I am reminded of Elder Albert’s How does nursing as a profession understand teachings, as well as Ramsden’s work on this Indigenous theorization to both educate Cultural Safety. Ramsden’s concerns about and evaluate nurses to provide Culturally Safe nurses being seen as doers not thinkers remain care? a challenge. How do we, as nurses, remain In 2015, asserting improved patient awake, re-engage and gain the critical thinking safety, nursing regulators across the country and political skills necessary to articulate what (excluding Quebec and New Brunswick) made we do and demonstrate that our knowledge changes to Canada’s nursing entrance matters? requirements from a Canadian to an American exam: NCLEX-RN. Not only did this result in the absence of Cultural Safety indicators but further supports the neoliberal policy of

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Considering Kesultuline (love as action) those who are, including the nursing profession (McCallum, 2014). Illuminating Indigenous nurses embody the tension Indigenous nursing perspectives focuses our of living at the intersection of nursing in a attention, creates a space of potential and colonized healthcare system as a site of opportunity for the exploration of the complex resistance and social change, balanced with the role that nurses play in the individual and awareness of the everyday colonizing forces of collective health of their communities. It is the profession to assimilate. The ability to precisely the ability Indigenous nurses have of navigate multiple perspectives simultaneously leaving parts of themselves at the door as they is where Indigenous nursing knowledge and enter educational and practice setting, ways of knowing will allow for the creation of respecting multiple perspectives and the a contextualized, treaty informed, decolonized unconscious competence they demonstrate as nursing curriculum. The strengths, they do this that models etuaptmumk. The achievements and unique contributions of ability to navigate knowledge systems that are Indigenous nurses are often underappreciated epistemologically incommensurable holds the or misunderstood by those who are not directly key. This struggle with incongruence is involved in healthcare and sometimes even by illustrated by artist Nicole Hawkins (2018):

Figure 1. ‘Self-Preservation’ by Nicole Hawkins (2018) with permission.

The profession of nursing, despite the steps of listening, knowing, being being recognized as a colonizing force, is and doing are followed. (p. 36) embraced by Indigenous nurses as a site of resistance as they shoulder the Responsibility Creating contexts, times, and places to of decolonizing healthcare. Moreover, listen and appreciate the complex Canadian Indigenous Nurses Association past sociopolitical contexts and colonized President Lisa Bourque Bearskin (2016) adds structures Indigenous nurses negotiate will the following in context of reconciliation, allow for imagining what action will be The wisdom of […] Indigenous nurses required to support nursing practice that teaches us that all Canadians - and recipients of care decide is Culturally Safe. It every nurse - can engage in will create maps for navigating worlds with relationships at the personal, loving perceptions, so we can authentically professional and political level that are and honestly travel to the heart of what authentic, reciprocal and meaningful if matters. I understand that the personal is political and to enter this conversation at this

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moment it is important to mindfully consider knowledge garden, as teacher. Ramsden the colonized, gendered, and racialized spaces models love and courage in her lifelong my Indigenous body occupies. My commitment to act in relationship, as she positionality as a nurse practitioner, professor, makes visible her nuanced understanding of and researcher, as a heterosexual female Cultural Safety. As I witness and learn from conforming to a hegemonic gender binary, and her story, I know my story matters and has phenotypically I pass for white, all hold something to teach. I have a Responsibility to potential for disruption of power perceptions. I love also who I am. Leanne Betasamosake am originally from Newfoundland and Simpson’s, (2013) poetry reminds me of how Labrador, and while welcomed as one of their important this is: own I consistently and specifically locate For everyone of your questions there myself as a guest in Unama’ki. Positioning is a story hidden in the skin of the myself from this place of dislocation and forest, use them as flint, fodder, love disconnection also serves as a reminder that I songs, medicine, you are from a place am not a fluent Mi’kmaw speaker. of unflinching power, the holder of our Simultaneously, as an Indigenous nurse I am stories, the one who speaks up called by our Elders to engage with the The chance for spoken up words learning spirit in ways that can grow drowned in ambush knowledge gardens within myself, my You are not a vessel for white settler communities, and those with whom I engage shame, with on a daily basis. Even if I am the housing that failed you (p. 132) Answering the Call It’s mid-afternoon on November 15th, Sharing my story feels dangerous and 2019. I can no longer procrastinate. I am being necessary. It feels both like the right thing to called to commit to writing about what matters do while simultaneously breaking the code of to me. I am terrified and yet I am compelled to silence. Holding these opposing ideas with write as there is a dissonance growing inside kesultinej as they enter into our consciousness, of me; a feeling of dis/ease. Indigenous our conversations, using etuaptmumk to feminist scholar Dian Million (2009) respectfully hold these ideas without challenges me to consider my feelings as dismissing the most inconvenient ones, we theory “[My feelings] are [my] frames and no make ourselves resilient and strong. In that two of us can ‘see’ them distinctly the same light, I share the link to my video story of my way […] thus our feelings […] are important journey home as kesultultinij (Sheppard, projections about what is happening in our 2019): lives. They are also culturally mediated https://vimeopro.com/user20653208/cbu knowledges, never solely individual” (p. 61). As I write this paper, I am humbled by the steadfast determination and commitment of the Returning to home growing number of Indigenous nurses and I take a deep breath as I am being scholars and the current ground-breaking called back to the land in Unama’ki. “The land scholarship happening around the globe and knows you even when you are lost” their resolve to resist/persist forevermore. (Kimmerer, 2013); it is the land, the sea that Ramsden’s (2002) scholarship beckons us to know me, invite me repeatedly to be found be brave and speak up. Theorizing a again and again. Amswekewe (How it framework for nursing grounded in was/How it is/How it will always be) makes it kesultulinej, means centering Indigenous possible for me to return. I am called to Knowledges in all that I do. Ramsden reconnect with the land and language of established Indigenous nursing scholarship in Mi’kma’ki. The welcoming spirit, love and a new paradigm as she recognized that genuine friendliness of the Mi’kmaw transformative change started with her. Using communities inspire me and feed my mind, reflective topical autoethnography, she body and spirit. A community of engaged, acknowledges her personal story, her creative and enthusiastic Mi’kmaw nurses

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exemplify kesultulinej in the communities they compassion, is a way to live and breathe my serve. As our relationships grow, I look Responsibilities and the possibilities nursing forward to supporting their research visions, holds if we listen closely, if we notice Brian inviting their expertise into our classrooms and Sinclair, if we stay in conversations with learning how to become closer to what matters people who matter deeply. I do this for my most. My grandmother Rose spent Sunday family. M’sit No’kmaq, All my Relations. afternoons admiring pictures of her grandchildren and great grandchildren, Acknowledgment marveling “Isn’t a human being’s capacity to Ethical citation of the all the visible love amazing, just when you thought your and invisible kinship relationships that have heart couldn’t stretch any further, you discover shaped my worldview and stretched my heart it can”. I do this to strengthen our capacity for is always my intention, as an imperfect human. kesultulinej. The healing, decolonizing, The safe space and mentorship provided by Dr reconciling and liberating nature of this work Vera Caine made this writing process a radical starts with me and my kinship relationships. act of love. Deep gratitude to all who help us Coming home to a place of love, care and believe our stories matter.

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