Clinical encounters in Canada's northern territories: implications for nurse practitioners working with aboriginal women to promote sexual health

In Canada's northern territories, nurse practitioners (NPs) play a significant role in the delivery of health care and are often the first and only point of contact as primary health care providers for Aboriginal women. As such, NPs are uniquely situated to work with Aboriginal women in northern communities to address the greater health inequities, incidences of communicable and chronic disease in ways that account for locally specific historical, geographic, economic, social, and cultural contexts. However, it is increasingly evident that clinical encounters between NPs and Aboriginal women in the north are not resulting in improved sexual health outcomes. The intent of this review was to explore the factors influencing why sexual health outcomes for Aboriginal women are not improving. A review of Nursing and Aboriginal peoples' health literature revealed that, while broader colonial contexts inform Aboriginal women's health, there are concrete structural and interpersonal factors that most directly impact clinical encounters. These include how health services are delivered to Aboriginal peoples in Canada, the health policies that govern the delivery of health care to Aboriginal women, and NP clinical practice issues in the north. These factors come together to inform how relationships between NPs and Aboriginal women can and does evolve in clinical settings. What is evident from this review is the importance of NPs becoming aware of the historical complexities and post colonial processes that impact Aboriginal women's health. This awareness will allow NPs to work collaboratively with Aboriginal women to address those mechanisms of delivery, policies, and cultural attitudes that can act as barriers for accessing health care. It is through working collaboratively with Aboriginal women to improve clinical encounters that changes in sexual health outcomes will occur. --P. iii.