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What can archivists learn from person-centred nursing care? A conversation between a nurse and an archivist

22 Nov 2022 8:00 AM | Anonymous member

By Catherine Barnwell & Jacinthe Pepin

As guest editors of the special issue of Archivaria on person-centred archival theory and praxis, we, Jennifer Douglas, Jessica Lapp and Mya Balin, are pleased to share a series of blog posts that reflect on the nature and enactment of person-centred approaches to archival materials and work. These blog posts complement the articles in the special issue, presenting a variety of perspectives on how centring the person in archival processes happens and why it matters. We're grateful to the authors for sharing their research and experiences!

Catherine: When I attended the Association of Canadian Archivists [ACA] Conference for the first time in 2021, I had been working in the field for about a year and a half. I participated in a panel session focused on “Acknowledging Emotions in Archival Education,” led by Elizabeth Bassett, Ted Lee, Christina Mantey, and Jennifer Douglas. Though I was still unfamiliar with much of archival theory, acknowledging the emotional aspect of archival work seemed like a novel approach that helped me make sense of some of the realities I experienced (and still experience) in my daily work on the reference desk.

It seemed that there were parallels to be drawn between this perspective of archival work and the health field, but more specifically with nursing practice and theory. The concept of care is primordial to the discipline of nursing – and has been used in recent years by some thinkers to describe the affective relationships that are at the heart of archival work (Caswell & Cifor, 2016). This led me to ask what archivists could learn from research in nursing regarding person-centred care. Consulting existing frameworks for person-centred care from the field of nursing, and opening a dialogue with our colleagues in that discipline, could be the firsts steps in identifying the building blocks of a person-centred framework for archivists.

First, Jacinthe, can you tell me a bit about yourself and your field of research?  

Jacinthe: Early in my academic career, I was asked to reflect and write on the nature of nursing. With colleagues, we gathered responses given by nurse scholars and theorists in both French and English. A recurrent answer to the question was that nursing is both an art and a science, a relational and scientific practice, and that “le soin” [care] is the main focus of the nursing discipline together with the person and family’s health experiences (Pepin et al., 2017). Person-centred care/nursing and family-centred care/nursing are among the well-known frameworks guiding the clinical nursing practice.

C: How would you define care in the field of nursing? And what is person-centred care?

J: Many definitions of care can be found in the nursing literature but invariably, the patients and families and their health are at the centre of what we mean by care: listening to patients describing their specific health situations and contexts, evaluating patients’ health and their health projects or suggested treatments with them in relation with their values, beliefs, and habits, and joining reflection and knowledge to action in life transitions and life-threatening situations. McCormack and McCance (2006) were among the first authors to propose a person-centred nursing framework, whose processes include “engagement, sharing decision-making, having sympathetic presence, providing for physical needs, and working with the patients’ beliefs and values” (p. 476). What the authors call the care environment includes power-sharing and the potential for innovation and risk-taking.

Further, in their Clinical Best Practice Guidelines, the Registered Nurses’ Association of Ontario [RNAO] (2015) raised the ethical perspective where health-care providers demonstrate “person-centred-care attitudes and behaviours that are respectful of the whole person and their preferences, are culturally sensitive, and involve the sharing of power within a therapeutic alliance to improve clinical outcomes and satisfaction” (p. 7). With events such as the death of the Atikamekw woman Joyce Echaquan in a health care milieu in Quebec, cultural safety and cultural humility are now at the forefront of what we mean by patient- and family-centred care. How do you envision the place that care occupies in the field of archives?

C: It strikes me that these definitions, though they emerge from an entirely different field of research and practice, resonate with the Reconciliation Framework for Canadian archives in response to the Calls to Action of the Truth and Reconciliation Commission [TRC] (The Steering Committee on Canada’s Archives, 2022). Among the strategies proposed for improving professional archival practice, the framework includes “providing First Nations-, Inuit-, and Métis-led cultural competency training” for archival staff (p. 35) and ensuring that reference archivists are trained to provide trauma-informed services to researchers consulting “emotionally distressing archival material” (p. 38).

When I think of the place that care occupies in archival work, I think first and foremost of my interactions with researchers in my role as a reference archivist at The Archive of the Jesuits in Canada. Of course, care is not limited to the relationship between archivist and researcher: it extends to all types of interpersonal relationships that form the fabric of our work. As Marika Cifor and Michelle Caswell (2016) write, archivists have “affective responsibilities” towards creators and donors of archival material, users of archival material, the people who are documented within the records, as well as broader communities (p. 24-25). For example, at The Archive of the Jesuits, I work with many researchers looking for genealogical information. Notably, The Archive holds material that speaks to encounters between Jesuits and various Indigenous communities across North America since the 17th century, including materials regarding the residential school operated by the Jesuits in Ontario. Ensuring that these archival documents are made accessible to Indigenous researchers and communities, and ensuring that researchers feel safe and welcomed in the reading room, is a priority.

Are culturally competent care and person-centred care currently being integrated into nursing curricula? If so, how are they being taught?

J: In nursing, actions are gradually being implemented throughout Canada to meet health-related recommendations of the TRC: 22 (integration of Indigenous healing practices into nursing care), 23 (recruitment and inclusion of Indigenous professionals and cultural safety education for all health professionals) and 24 (requirement for all to learn about Aboriginal health issues, including the history and legacy of residential schools, and the United Nations Declaration on the Rights of Indigenous Peoples). At the last national day for Truth and Reconciliation, the Faculty of Nursing at Université de Montréal, together with the Centre intégré universitaire de santé et de services sociaux [CIUSSS] Centre-Sud-de-Montréal, held a Cercle de parole with Indigenous and non-Indigenous participants to share health experiences in the hope of regaining trust; this was an event open to our students and to all nurses and health professionals. Our planning committee included Indigenous and non-Indigenous members of the Faculty and the CIUSSS. Only through collaboration and power-sharing can we create authentic learning activities.

In proposing a person-centred care framework for nursing as well as for archives, one key concept would be cultural safety, which includes cultural humility.

C: It’s interesting that the Cercle de parole event brought together students, academic researchers, and nurses who practise in different clinical environments.

In addition to my position at The Archive of the Jesuits, I worked as a research assistant under the supervision of Anne Klein at Université Laval in 2021-2022. This project, focusing on the archives of the Québécoise playwright Pol Pelletier, entailed taking stock of her documents and compiling an inventory, with a view to assembling her fonds and preparing it for donation. Since I was unfamiliar with the history of theatre in Quebec, we decided to survey the documents together so I could better understand their context and meaning. Our method of working evolved as Pol began to understand the how and why of archival practice, and as I began to understand her artistic career and the makeup of her archive. Some days we had the stamina to go through many files; other days, one of us would be tired, or had something else on our mind. Some files also touched upon heavier topics that demanded more mental and emotional energy. The nature of this project required that I be attuned to Pol and to her needs and wants. This experience speaks to Caswell and Cifor’s (2016) proposition to rethink the archivist’s role as that of a caregiver.

J: It seems that the relationship you are developing with Pol is one of true presence, of journeying with her as you go through her files: it reflects engagement from both of you towards the same goal. McCormack and McCance (2006) wrote that engagement is a marker of the quality of the nurse-patient relationship and is one of the patient-centred care processes. Nurses often find it hard to not be able to spend as much time with their patients and families as they see would be required. It could even lead nurses to lose some of the meaning they find in their work, since care is so ingrained in nursing.

C: Engagement could be a second building block for a framework of person-centred archival practice. This would inevitably look different in different working contexts. In the case of the project with Pol Pelletier, we had no hard deadlines. Building upon the work of Christian Hottin (2003), who considers that the acquisition process can be viewed as the establishment of an interpersonal relationship, we were able to first spend time getting to know each other, which then facilitated the process of working through her archives together. However, I am conscious that archivists working within institutional settings would have to balance engagement with donors or researchers with the myriad of other tasks they have to accomplish within their work hours.

Another interesting aspect of the project surrounding Pol Pelletier’s archives has been the possibility of integrating Pol’s own ideas about her archives into my way of working. When I began to compile the inventory, the archival decisions I made were not based on institutional policies, but rather were rooted in my conversations with Pol and reflected the particularities of this work environment. Together, we brainstormed what the “final product” of this project would look like: for instance, where she would like her archives to be kept and what type of researchers would use them – historians, but also artists and the general public. We have not yet arrived at the final stages of transferring the fonds to a repository, but these discussions between Pol and myself have been vital to the development of the project and of my own archival practice.

J: Interesting. In her Strengths-based approach to nursing and health care, in which person-centredness is a pillar, Gottlieb (2013) insists on collaborative partnership where knowledge and decision-making are shared. It requires that partners set goals jointly and work together to determine a course of action that is right for the patient or family. Sharing decision-making almost inevitably leads to patients’ and families’ satisfaction with care, involvement with their own care, feeling of well-being, and feeling culturally secure, all of which are person-centred outcomes (McCormack and McCance, 2006). Equally important is the context in which the nursing practice takes place; a care environment that supports person-centred practice is one that allows for risk-taking and innovation together with patients and families. We mentioned earlier that cultural safety is essential to person-centred nursing as well as archival practice. I would add that by learning cultural safety with Indigenous communities, we are also enriching the person-centred practices that we adopt with all people and with other diverse communities.

C: In addition to cultural safety and engagement, sharing decision-making to work towards person-centred outcomes is a third building block that archivists could borrow from nursing frameworks.

In the ACA 2021 panel session mentioned earlier, one of the key points that emerged was that archivists sometimes feel unprepared to deal with difficult or emotionally charged situations. This aspect of archival work, as Jennifer Douglas and her research team highlighted, is not necessarily approached in archival education, though there are now concerted efforts to integrate trauma-informed practice, for example, into archival work (The Steering Committee on Canada’s Archives, 2022; Wright & Laurent, 2021). As culturally competent care and person-centred care have been integrated into nursing education, the concepts of person-centred archival practice that we have begun to draft here could become part of a more holistic and humanistic archival science curriculum. 

Thank you for sharing your theoretical knowledge of person-centred care frameworks, Jacinthe. It seems we have only begun to touch upon the possibilities for dialogue between our two fields of research and practice. As you said earlier about nursing, archival practice is not a “hard science”: it is a relational practice that is inevitably shaped by the people who create, use, and are documented within records, and the relationships among them.

References

Caswell, M. & Cifor, M. (2016). From Human Rights to Feminist Ethics: Radical Empathy in the Archives. Archivaria, 81, 23-43.

Gottlieb, L. N. (2013). Strengths-Based Nursing care: Health and healing for person and family. Springer Publishing.

Hottin, C. (2003). Collecte d’archives, histoire de soi et construction de l’identité : autour de deux fonds d’archives de femmes. Histoire et Sociétés, 6, 99-109.

McCormack, B. & McCance, T.V. (2006). Development of a framework for person-centred nursing.

Journal of Advanced Nursing, 56(5), 472–479.

Pepin, J., Ducharme, F., Kérouac, S. (2017). La pensée infirmière (4e édition). Chenelière éducation.

Registered Nurses’ Association of Ontario. (2015). Person- and Family-Centred Care. Toronto, ON: Registered Nurses’ Association of Ontario. 

The Steering Committee on Canada’s Archives. (2022). Reconciliation Framework: The Response to the Truth and Reconciliation Commission Taskforce. https://archives2026.files.wordpress.com/2022/02/reconciliationframeworkreport_en.pdf 

Wright, K. & Laurent, N. (2021). Safety, Collaboration, and Empowerment: Trauma-Informed Archival Practice. Archivaria, 91, 38-73.

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Catherine Barnwell is an archivist at The Archive of the Jesuits in Canada. She has also worked as a research assistant with professor Anne Klein at Université Laval, focusing on acquisition and donor-archivist relations through a case study of the archives of Québécoise playwright Pol Pelletier.

Jacinthe Pepin is a professor at Université de Montréal’s Faculty of Nursing who was until recently the scientific leader of an interdisciplinary research team funded by the Fonds de recherche du Québec, Société et culture (FRQSC, 2013-2025) that focused on health care professionals’ learning. She also happens to be Catherine’s mother.


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