Written by: Brian Cole

Wanda Phillips-Beck knew early on in life that she wanted to work in health care.

But it wasn’t until she completed her third year at the University of Manitoba that she decided to focus her attention on becoming a nurse. That was just about 30 years ago.

Since then, Phillips-Beck has worked tirelessly to improve care for Indigenous people, first as a frontline nurse working in remote communities, and then as a researcher and Seven Generations Scholar with First Nations Health and Social Secretariat of Manitoba. 

Along the way, the 54-year-old Anishinaabekwe woman from Hollow Water First Nations Territory has earned a Master’s of Science degree in qualitative research and is working to complete a PhD in population health research and quantitative methods from the University of Manitoba’s Department of Community Health Sciences. She has also spent the last six years studying Indigenous ways of doing research while working with the First Nations Health and Social Secretariat of Manitoba.

Now, Phillips-Beck will have an opportunity to build on her efforts to improve care for Indigenous people after being named Manitoba’s first Indigenous Research Chair in Nursing. It is the first time that someone working for a community-based Indigenous organization has received a research chair, which is normally given to scientists affiliated with academic institutions.

The five-year appointment, announced June 25, provides nearly $1 million to support research that will promote better health care through a project entitled Mentoring Nurse Leaders and Researchers in Indigenous Health Grounded in Culturally and Equity Informed Approaches to Research and Education. The initiative is supported by Research Manitoba ($258,500), the Canadian Institutes of Health Research (CIHR) ($699,500), and the Canadian Nurses Foundation (CNF) ($27,000).

Christina Weise, CEO of Research Manitoba, says the appointment of Phillips-Beck represents another step towards creating a better health-care system.

“We are excited to partner with CIHR and CNF so Ms. Phillips-Beck can advance the fields of Indigenous health and nursing and train Manitoba’s Indigenous nursing students,” said Weise. 

“As one of a handful of Indigenous Research Chairs in Nursing across Canada, Ms. Phillips-Beck’s work will advance culturally- and equity-informed approaches to mentor current and future nurse leaders and researchers to have a positive impact on the health of Indigenous peoples in Manitoba, First Nation communities, and the health-care system,” Weise says. 

Phillips-Beck recently took time to discuss her goals as Manitoba’s newest research chair. 

RT: You mention that you had wanted to work in health care but didn’t decide on nursing until your third year of university. What attracted you to nursing?

Phillips-Beck: I was initially encouraged by family and teachers to apply to medicine, but my heart was not in it. In my childhood, I spent a lot of time in hospitals and saw nurses interact with my mother. It was then that the seed was planted. Once I made the decision, I knew it was the right one and never looked back. 

RT: You spent much or your career as a nurse working in northern and remote First Nations communities. What was that experience like and how did it shape your view of health care?

Phillips-Beck: My earlier experiences working in northern and remote communities was extremely valuable in making me very aware of the gaps and challenges in a health-care system that didn’t treat our First Nations (FN) people equally. The quality of care we take for granted in urban and non-isolated communities often does not exist in many FN communities.

For example, did you know that pregnant women living in First Nations communities are often required to leave their homes in order to give birth? This means these women must leave behind their family support networks for weeks and even months. And when they give birth, there is no one there from their family to support them or share in what should be a joyful moment. Fortunately, this is starting to change. Researchers and advocacy groups have long maintained that pregnant women who must leave their home communities to give birth should be accompanied by a family member. Now, in certain communities in Manitoba, that is starting to happen. 

RT: Your bio notes that you are a Seven Generations Scholar. What does that mean?

Phillips-Beck: People ask me that a lot. My research has always been focused on the early origins of disease, which is basically the problems that can arise in pregnancy or early childhood that results in poor child outcomes. My interest is more of a prevention focus. One of the teachings that exists in First Nations culture is the concept of seven generations – that it will take seven generations for the health outcomes (of First Nations people) to turn around and improve, so having a focus on early childhood and pregnancy is, to me, really talking about those changes that will unfold beginning in pregnancy and early childhood over the course of seven generations. Diabetes is one example. Research focusing on improving breastfeeding initiation and duration for childbearing women will, in the long run, help prevent the development of diabetes for generations to come.

RT: As research chair in nursing, what are your goals?

Phillips-Beck: I really have two goals. One is to develop and mentor nursing leaders, and the second is to encourage more Indigenous students to become researchers in Indigenous health.  

RT: Why is it important to develop nursing leaders?

Phillips-Beck: Indigenous people in Canada continue to experience racism in many different ways, including stereotyping and structural racism. Given this, it seems clear that racism is a determinant of Indigenous peoples’ health, and contributes to the fact that Indigenous people have the highest burden of illness and widest gaps in terms of access to health care in Canada.

The nursing research chair is important because it opens the door to developing a group of young nurses who can take all of these issues into account when delivering care. Nurses are by far the largest group of health-care providers in Canada. They represent 75.5 per cent of all people working in Indigenous health. In rural and remote First Nation communities, they are often the first and last point of contact with the health-care system.

As a result, nurses and nursing leaders in Indigenous health have great potential to influence patient care, patient continuity, and health outcomes among Indigenous peoples. They also have the greatest potential to address problems associated with racism in health care, both on a personal and institutional level. 

RT: Do we also need more Indigenous health-care providers?

Phillips-Beck: Increasing the number of Indigenous health-care providers is only one part of the solution. The problem cannot be solved by simply recruiting more Indigenous people into nursing. It can only be solved by ensuring all nursing students are equipped to deliver culturally safe care and are aware of the structural inequalities that lead to poor health outcomes. We are really taking about improving the quality of care. Every provider has to do their part to advocate for system changes. 

RT: In addition to being a nurse, you are also a researcher in health policy. Why is it important to have more Indigenous health researchers?

Phillips-Beck: Indigenous researchers can add a different perspective in their work, particularly in regard to the role that Indigenous knowledge has, and can, contribute to the well-being of individuals, families and communities. This Indigenous world view is so important, if we are interacting with Indigenous people. We are better able to articulate their needs and to have a two-way dialogue. Indigenous researchers can, if provided with the appropriate mentorship, also do research differently that incorporates this Indigenous knowledge and science. For far too long  western researchers, with their Eurocentric views and values, have disregarded this knowledge and way of doing research which brought a great deal of harm to our people, in the guise of doing good research. 

RT: You mentioned structural racism. How does structural racism manifest itself in the health-care system?

Phillips-Beck: Structural racism a very elusive concept to describe. It can manifest itself in the health-care system in the form of unequal access to health care or in policies that are oppressive.

For example, we have 25 First Nations communities in Manitoba with nursing station models of care. And First Nations people have access to those services within their communities, but not at the same level as you would have in an urban setting. Those nursing stations are staffed by nurses who provide emergency and acute care treatment. Physicians come and go. So, there are issues of continuity of care, quality of care, and a general lack of access to the same amenities you and I are used to in the health-care system. 

There is structural racism in every conceivable system you can think of from the child welfare system to the justice system. Take, for example, that 80 to 90 per cent of the children in care in Manitoba are Indigenous children, and our jails are overpopulated and overly represented by Indigenous people. You really have to stop and think about who is making the decisions in the system. How are the laws and policies created? How are they set up? Do we have an equal representation of Indigenous people in positions where decisions are made? If we have Indigenous people in these positions, are they operating in systems that are structured in such a way that it is normal to base decisions on “the way things have always been” or on legitimate laws that discriminate?

The example I talked about earlier regarding removing women from their communities and away from the supports of family is one example. Has this policy been implemented to keep babies and moms safe during childbirth, or to protect health-care providers? Where is the evidence that it is unsafe to deliver closer to home? 

In any example, whether it is children at risk, poor health, incarcerations, are we addressing the root causes of what seems to be the problem or, are we using the system to avoid addressing them? These are important and difficult questions that we must bring out into the open. 

RT: These are complicated issues. How will you try to address them?

Phillips-Beck: My focus is on the education of nursing students and the development of nurse leaders through mentorship. The challenge with educating nurses today is providing them with information around racism and oppressive policies that have a huge impact on the well-being of Indigenous people.

I am a product of western-based model of health care. Over the years, I have also developed a deep understanding of all the underlying issues that impact health. I didn’t have that when I graduated from nursing school. So, why does it take 15 or 20 years to have this understanding when it should be integrated into our training, not just for student nurses who happen to be First Nations/Metis or Inuit, but for everyone?

RT: Can you give me some examples of what should be included in the nursing curriculum?

Phillips-Beck: There are a number of changes that could be made.

Let’s look at a simple example like health policy. A nurse may take a course on health policy, but it may not include the fact that in Canada there is a dual system, one for First Nations people and one for everyone else. So you include that content: how are the systems different? How is care delivered differently to First Nation individuals living on reserves?

Cancer care is a good example of how care differs. You may want to include content on how First Nations people have different and inequitable access to cancer care. Nurses should be aware of how they must travel or be away from their family for long periods of time to access care; how being away from home impacts their emotional health? It is not possible to have access to good cancer care in every community – that is not realistic. But having this awareness of how differently First Nation and Indigenous people are impacted by the health-care system should be a core component of health care education. 

RT: How will pointing out these differences lead to better care?

Phillips-Beck: The goal is that when nurses graduate, they should do so with a very broad understanding of how First Nations people are impacted in every aspect of their lives. By educating (nursing students) about all these different impacts, you develop a sense of empathy, you develop a greater sense of ‘Maybe it is not the fault of the individual why they are not healthy. Maybe there are some structural issues at play here,’ rather than blame the individual for the obesity that has led to the diabetes and so on and so forth.

If all the underlying issues that affect the health of an individual are integrated through the curriculum, then, at the end of their education, nurses will have a better understanding of macro-level issues that impact people’s health.

RT: Are universities working to address the problems you have highlighted?

Phillips-Beck: Yes. There is a lot of work being done to address these issues now. The University of Manitoba’s College of Nursing’s strategic plan contains a pillar that talks about honouring and integrating Indigenous world views, ways of knowing, and knowledge and practices about health and healing to promote cultural safety. That’s a step in the right direction. The challenge is how do you actually make this happen?

That’s where my research comes in. My research is looking at cultural safety in an integrated model where you have Indigenous world views, ways of knowing, knowledge and practices that are informing the education. My research will look at where this has been done successfully and identify the core components of what should be included in a comprehensive curriculum. 

RT: Can you elaborate a bit more on cultural safety and why it is important?

Phillips-Beck: Cultural safety is really about understanding that Indigenous patients may have a world view and values that differ from a nurse who is caring for that person. For student nurses, that really starts with understanding their own biases and recognizing the trans-generational effects of colonization and the impact it has had on the heath and health experiences of Indigenous people. It is about helping nursing students to reflect on their values and views and the impact it has on the attitude they project and the care they give. It is not something you teach once. Having a reflective practice is and should be carried through your entire career. 

RT: The nursing research chair has five-year term. How do you see that playing out?

Phillips-Beck: The first year will be spent doing an assessment and scan of what has been done in regard to culturally informed approaches to nursing education and what is still needed. That includes working with First Nations, Metis and Inuit partners (and the College of Nursing) to identify the core components that need to be included within this augmented training.

Year two, I will probably be doing more hands-on mentoring and training of students, based on what we have learned. I’m hoping that at the end of year three, we will be placing students within First Nations communities or organizations and then supporting these placements with additional readings and support so they start to develop while they are still practising their skills. 

At the end, we hope to graduate in five years a number of students – at least 15 students – who have gone through the placement and have a more comprehensive understanding of Indigenous health and health care.

This is my initial plan, but I am working with a number of key partners, including an advisory circle of experts and knowledge keepers to finalize it, so it could evolve in the future. 

RT: Trying to effect change on this scale seems like a daunting mission.

Phillips-Beck: It can be overwhelming, but we are not starting from scratch. We have some committed leaders with the College of Nursing. We have experience and some solid content that has been used in the Max Rady College of Medicine. And I think that, coupled with the College of Nursing’s strategic plan to incorporate more Indigenous content, means we are off to a really good start.