'Contradictions in having care providers with a South Sami background who speak South Sami': older South Sami People in Sweden's expectations of home nursing care

"All I expect is that they accept that I am a Sami" an analysis of experiences of healthcare encounters and expectations for future care services among older South Sami in Norway

The aim of this study first aims to forward our empirical knowledge of how older Sami experience healthcare encounters in Norway and what they expect in terms of future care services, and second, to forward our understanding of how more culturally safe services could be offered to the Sami population, 30 years after they were officially recognised as an Indigenous People. A qualitative interpretative and constructivist research design was used. 12 older South Sami were interviewed about their experiences with healthcare encounters, and their expectations for future care services. The results showed that the participants sometimes felt deprioritised and misunderstood by healthcare professionals. Moreover, they sometimes experienced that healthcare professionals had little or no knowledge about Sami history, culture and cosmology. They worried that they would not be accepted for being Sami if one day they would have to move into a nursing home. To conclude, the participants of this study are situated in a colonising context characterised by personal and collective experiences of accumulated discrimination that have taken place over many generations. The concepts of health equity and accumulated discrimination provide useful insights in the further development of culturally safe services for Indigenous Peoples in Norway and beyond.

Values and preferences for future end-of-life care among the indigenous Sámi

INTODUCTION

Research with Indigenous peoples internationally indicates the importance of socio-cultural contexts for end-of-life (EoL) preferences. However, knowledge about values and preferences for future EoL care among the Indigenous Sámi is limited.

AIM

We investigated if and how a Swedish adaptation of the English-language GoWish cards, DöBra cards, supports reflection and discussion of values and preferences for future EoL care among the Sámi.

METHODS

This qualitative study is based on interviews with 31 self-defined Sámi adults who used DöBra cards at four events targeting the Sámi population, between August 2019 and February 2020. Using directed content analysis, we examined aspects of interviews addressing Sámi-specific and Sámi-relevant motivations for choices. Data about individuals' card rankings were collated and compiled on group level to examine variation in card choices.

FINDINGS

All 37 pre-formulated card statements were ranked as a top 10 priority by at least one person. The cards most frequently ranked in the top 10 were a wild card used to formulate an individual preference and thus not representing the same statement, and the pre-formulated card 'to have those I am close to around me'. Reactions to interviews varied, with some participants commenting on the taboo-laden nature of discussing EoL issues, although many commented positively about EoL conversations in general, and the benefit of using the DöBra cards in particular. We categorised reasoning about Sámi-specific and Sámi-relevant values and preferences under the themes: Attributes of contemporary Sámi culture, Spirituality, Setting for death, Maintaining identity, Preferences related to death, Dying and EoL care and After death.

CONCLUSIONS

The DöBra cards were found to be easy-to-use, understandable and a flexible tool for initiating and supporting conversations about EoL values and preferences. The open formulations of cards, with wild cards, enable discussions about individual values and preferences, with potential to reflect life as a Sámi in Sweden.

Being connected to nature, reindeer, and family: findings from a photovoice study on well-being among older South Sámi people

In this paper, we examine the perceptions of well-being among older South Sámi people with various experiences from reindeer herding by use of a method called photovoice. Eleven participants, including six men and five women aged 67–84 years, agreed to take photos of situations, things, or persons that made them feel a sense of well-being. When the researcher collected the photos, the participants were invited to tell their stories related to each photo. In the thematic analysis of the photos, three main themes emerged: a) well-being through connection to nature, b) well-being through connection to the reindeer, and c) well-being through connection to the family. In conclusion, we argue that if healthcare professionals are to enhance the well-being of care receivers – in this case older people with South Sami background from reindeer-herding families – they must consider the care receiver’s life story and what constitutes well-being for the individual person.

A Salutogenic Perspective on End-of-Life Care among the Indigenous Sámi of Northern Fennoscandia

There is limited empirical data about both health and end-of-life (EoL) issues among the Indigenous Sámi of Fennoscandia. We therefore aimed to investigate experiences of EoL care and support among the Sámi, both from the Sámi community itself as well as from more formalized health and social care services in Sweden. Our primary data source is from focus group discussions (FGDs) held at a Sámi event in 2017 with 24 people, complemented with analysis of previously collected data from 15 individual interviews with both Sámi and non-Sámi informants familiar with dying, death and bereavement among Sámi; "go-along" discussions with 12 Sámi, and individual interviews with 31 Sámi about advance care planning. After initial framework analysis, we applied a salutogenic model for interpretation, focusing on a sense of community coherence. We found a range of generalized resistance resources in relation to the Sámi community, which appeared to support EoL care situations, i.e., Social Organization; Familiarity with EoL Care, Collective Cultural Heritage; Expressions of Spirituality; Support from Majority Care Systems; and Brokerage. These positive features appear to support key components of a sense of community coherence, i.e., comprehensibility, meaningfulness and manageability. We also found relatively few, but notable deficits that may diminish the sense of community coherence, i.e., lack of communication in one's own language; orientation, familiarity and/or agreement in contacts with formal health and social care systems; and/or support from extended family. The results suggest that there is a robust basis among Sámi for well-functioning EoL care; a challenge is in developing supportive interactions with the majority health and social care systems that support and complement these structures, for partnership in developing care that is meaningful, comprehensible and manageable even in potentially difficult EoL situations.