2020 is the Year of the Nurse and Mid-Wife. In celebration and recognition, we will feature stories all year long of community health nurses from across the province and the great work they do for BC First Nations people and communities.
April 16, 2020 is Advance Care Planning (ACP) Day. As an advocate for ACP and medical care planning, Nikki recognizes the importance of this day, especially in the face of a pandemic.
“This is my way of doing ACP right now. We've had to shift the conversation and it's difficult to do [that] over the phone because I cannot fully gauge emotions, which is essential," says Nikki. “In Líl̓wat, people often do not want to talk about illness and death – some see this as a 'jinx,' but I'm trying to shift that narrative and make it about building empowerment over your own well-being."
The process of building awareness and empowerment around ACP has been slow in Líl̓wat, but as the community prepares for COVID-19, interest is piqued. With all the changes that are happening, and the help of Nikki and her team prior to the pandemic and during, community members are understanding why this planning is important.
Advance Care Planning can be viewed as a living will – which is difficult for many people talk about – but it is really about trying to uphold a person's dignity and wishes as they experience illness or journey to the Spirit World. A clear ACP can save families from trauma and unnecessary grief.
Nikki is from Secwepemc First Nations in BC's Interior region and discovered her passion for community health and Advance Care Planning through a last minute turn of events in nursing school, which led her to a practicum at a Kamloops hospice. “Because I worked in a hospice I'm comfortable talking about death," shares Nikki. “I'm OK with having that rawness in conversation."
However, she recognizes the need to be mindful in communicating about ACP and the purpose of it. “I communicate through scenarios because I have a lot of experience with palliative clients. I try to highlight what this experience can look like and the purpose of it by saying, 'this is about you and your family,' says Nikki.
In First Nations communities there is a spiritual way of looking at ACP, and that varies from community to community and Nation to Nation, as many aspects of First Nations culture does. “We are mindful of that spirituality piece and ask permission before talking about this planning so we do not bring something up that could potentially ruin relationships," explains Nikki. This confidence in speaking about death and medical planning is complimented by the fact that Nikki moved to Líl̓wat when she was five years old and grew up in the community. Many community members know her, which creates an even more comfortable situation to discuss ACP.
A large part of these conversations is providing education. This component is especially true as the focus of ACP has shifted since COVID-19. Lions Gate Hospital in North Vancouver is the nearest hospital, and is an hour and a half away, so the planning conversations and questions become “do you want to be admitted to the hospital or do you want to manage your symptoms in community," and what those scenarios might look like.
In addition to these tough telephone conversations, Nikki goes above and beyond to make sure people in the community receive up-to-date information about COVID-19 in a good way, by posting as much information as possible to the bulletin board at the Líl̓wat Health and Healing Centre for those who do not have online access, and going around the community while practicing physical distancing to provide friendly, in-person updates to those who may be more transient. “You have to think outside the box in these situations, it's not fair for people to be left behind," maintains Nikki.
Thank you to Nikki Hunter and her team at Líl̓wat Health and Healing Centre for continuing to empower community members and their health journeys.