1. Objectifs

Intentions :
This study explores «how the process of childbirth evacuation is implicated in the quality of the medical encounter between Indigenous women and their southern, typically non-Indigenous health care providers. [The authors] document and analyze patient–provider interactions from the perspectives of medically high-risk Indigenous childbirth evacuees and their southern, non-native doctors and nurses (hereafter, health care providers).» (p. 1859)

2. Méthode

Échantillon/Matériau :
«The patient sample consists of 25 pregnant and postpartum First Nations and Inuit women who were medically evacuated or transferred from northern Quebec to Valley Hospital for pregnancy-related complications or child-birth. Valley Hospital is a tertiary care institution located in Metropolis, a city in southern Quebec. [The authors] also included a total sample of eight physicians and nurses who delivered care to Indigenous women in either the OB/GYN clinic or the antepartum/postpartum unit.» (p. 1861-1862)

Instruments :
Guide d’entretien semi-directif

Type de traitement des données :
Analyse de contenu

3. Résumé

«The medical encounter between Indigenous childbirth evacuees and their southern, non-Indigenous health care providers were affected by three factors: evacuation-related stress, hospital bureaucracy, and stereotypes. The combination of these factors created situations where misunderstandings and mistrust could occur. […] Childbirth evacuation was a stressful experience for Indigenous women, owing in part to their medically high-risk pregnancies. But the separation from their families, especially older children, was also a source of stress. Significant household management and childrearing challenges arise for women because they must coordinate with adult family members and friends to care for their older children while they are away.» (p. 1863) The results also highlight «the mechanisms whereby hospital bureaucracy compounds women’s distress by leaving them feeling dehumanized by the medical encounter. Specifically, short medical visits emerged as an important bureaucratic impediment to building effective communication and trusting patient–provider relationships. [Moreover, the authors] found that stereotypes of Indigenous patients and the ensuing misunderstandings and avoidance behaviors that occur further strains patient–provider interactions. Stereotypes of Indigenous patients as unresponsive due to their more reticent communication style can hinder the development of trusting relationships. The potential for harm lies in individual health care providers’ behavioral responses to the stereotypes.» (p. 1867)