Volume 12 | No. 3 | May / Jun 2024 query_builder 3 minutes

Case study: upholding Indigenous cultural safety in practice

Inquiry Committee case study


Providing culturally safe care to Indigenous patients is an expected competency of all registrants. Cases continue to emerge, showing that stereotypes rooted in colonization resulting in harm, neglect, misdiagnosis and even death of Indigenous persons persist.

A panel of the Inquiry Committee recently concluded a case where a registrant did not fully meet the expectations in the Indigenous Cultural Safety, Cultural Humility, and Anti-racism practice standard. 

Case study

An Indigenous woman with suicidal ideation was taken by ambulance to the emergency room of a rural hospital late at night. The patient was alone, displayed signs of mild alcohol intoxication and had a history of previous suicide attempts. The patient denied consuming any other substances or having an imminent plan of suicide.

Following the assessment, the registrant determined the patient was well enough to be discharged but offered her the option of spending the night at the hospital. The patient felt safe and decided to leave the hospital, walking two kilometers home as no taxis were available. While the care team did have a list of her emergency contacts, no one was contacted to provide the patient with a safe ride home. 

In the complaint filed with the College, the patient stated that she felt something was “off” in the conversation during the assessment. She felt that staff were condescending and disregarded her concerns. 

The registrant responded that the care provided was considerate and thorough, that they took time to listen to the patient’s stress and events that led her to the situation, and offered support for her to consider after discharge from the hospital. 

Case resolution

Following an investigation, the panel of the Inquiry Committee concluded the case with recommendations related to several aspects of the registrant’s involvement. 

First, the committee felt that the registrant did not follow up on how the patient would be getting home, as there were no documented efforts by any staff to contact family or other supports to assist her. While the patient’s autonomy was respected, as she chose to leave hospital, more efforts should have been made to ensure she got home safely. As per the Indigenous Cultural Safety, Cultural Humility, and Anti-racism practice standard, registrants must recognize the disproportionate impact of trauma on Indigenous women and girls. There was a potential risk to the patient walking alone in the middle of the night. It is important that cultural safety is at the forefront of all aspects of the patient’s care, including discharge planning. 

This case also illustrates the importance of thoughtful and culturally safe communication strategies to try to bridge the gap when a clinical encounter is being hampered by the patient’s and registrant’s differing perspectives. Registrants are reminded that “cultural humility” refers to one’s need to acknowledge that while they may be generally well-equipped to practise in a culturally safe manner, at times they will fall short despite their best intentions. 

Without clear documentation, it is challenging to know what care or offerings of support were provided, including, in this case, what efforts were made to ensure a safe transition from hospital to home. Documenting steps taken to provide culturally safe care makes it clear to others exactly what was done so care is more continuous. 

College resources 

Providing culturally safe care is a College requirement. The Indigenous Cultural Safety, Cultural Humility and Anti-Racism practice standard sets out clear expectations for registrants and can be used as a tool for ensuring a culturally safe medical practice. 

In addition to the standard, the College has a list of learning resources, from papers to full courses, which can aid registrants in their journey towards culturally safety.