Chapter 2 – Inclusive Approaches to Health Assessment

Inclusive Health Assessments with Indigenous Clients

Case Application: Joyce Echaquan

Joyce Echaquan was a 37-year-old Indigenous woman who died in a Canadian hospital in September 2020. Before she died, she posted a Facebook Live video of a nurse and another healthcare worker demoralizing her with racist slurs, calling her stupid and saying, “she’d be better off dead” (CBC, 2021).

Take a moment to reflect on this. The healthcare workers did not interact with Joyce in a way that uplifted her humanity.

How might Joyce’s story have been different?

Here are a few strategies to consider when engaging in an inclusive assessment with Indigenous clients:

  1. Always try to understand the cultural experiences that affect their health. A nurse interacting with someone like Joyce should be aware that as an Indigenous woman, she may have experienced trauma from colonization, anti-Indigenous racism, and systemic oppression, all of which may have affected her health. The experiences of residential schools have inflicted trauma and abuse on Indigenous children and families, which have resulted in problems including addictions, violence, and suicide (Aguiar & Halseth, 2015; Bourassa et al., 2015). It is important to convey respect for Indigenous clients and their family and empathy for their positionality.
  2.  When working with Indigenous people, you should recognize their trauma experiences. Ensure your interactions do not aggravate oppression and health disparities within the healthcare system. Healthcare providers have historically contributed to inequities for Indigenous people, and anti-Indigenous racism persists today in healthcare systems, which has perpetuated systemic discrimination and barriers in healthcare for Indigenous people (Richmond & Cook, 2016). As a result, many Indigenous individuals are distrustful of Canadian institutions including hospitals. Use inclusive and anti-racist communication: language should put clients at ease and promote belonging. Joyce’s case illustrates how treatment by healthcare workers reinforced social oppression and trauma, and stripped Joyce of her dignity before her death.
  3. Try to uphold their self-determination. Consider how historical and current policies affect all aspects of health and acknowledge the inherent right to self-determination among all clients (Richmond & Cook, 2016). Even if you lack this kind of knowledge, you can engage in assessments that uphold self-determination. Resist controlling or paternalistic approaches to care and instead prioritize the client’s right to make decisions for themselves. In this context, this means that you need to engage in active learning about:
    • Systemic discrimination directed at Indigenous Peoples.
    • The privileging of Western forms of knowledge within healthcare.
    • Inter-generational trauma caused by historical events like residential schools.
  4. Reflect on your own bias and assumptions about Indigenous people. Reducing inequities in health care for Indigenous people requires being conscious of implicit biases that may affect your view of Indigenous people. Implicit bias toward Indigenous people has become normalized in the healthcare system, such that many are desensitized to it (Wylie & McConkey, 2019). Nurses must engage in critical self-reflection about how their own biases affect their professional practice and the health of their clients (Hughes et al., 2020). When applying an inclusive approach to health with an Indigenous client, you should share the space, listen, and attend to the needs expressed by the client. 


Aguiar, W., & Halseth, R. (2015). Aboriginal Peoples and historic trauma: The process of intergenerational transmission.

Bourassa, C., Blind, M., Dietrich, D., & Oleson, E. (2015). Understanding the intergenerational effects of colonization: Aboriginal women with neurological conditions—their reality and resilience. International Journal of Indigenous Health, 10(2), 3-20.

Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Cudjoe, J., Ford, A., Rushton, C., D’Aoust, R., & Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28–33.

Matheson, K., Foster, M. D., Bombay, A., McQuaid, R. J., & Anisman, H. (2019). Traumatic experiences, perceived discrimination, and psychological distress among members of various socially marginalized groups. Frontiers in Psychology10, 416.  

Wylie, L., & McConkey, S. (2019). Insiders’ insight: Discrimination against Indigenous Peoples through the eyes of health care professionals. Journal of Racial and Ethnic Health Disparities, 6(1), 37–45.

Richmond, C. A. M., & Cook, C. (2016). Creating conditions for Canadian Aboriginal health equity: The promise of healthy public policy. Public Health Reviews, 37(2), 1-16.



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