Tammy Bruno, RN, BN, MN student
I am a home care nurse manager from the Samson Cree Nation, located in Maskwacis Alberta (pronounced Musk-wah-chees), on Treaty 6 territory. I am a single mother of three boys and I have returned to graduate school to complete the Nurse Practitioner Family and All Ages program. I hope with this education that I can support changes in policy around public health services, including palliative care and mental health. My story that I want to share about the tea dance is inspiring of what can be achieved when nurses care for dying people and their families.
The significance of the tea dance is that it is a way for the Maskwacis Cree to honor and celebrate the people who have left this world, and it is done on the day the person has passed. Tea is a sacred gift that we offer in this ceremony, as well as berries and a special rice soup. Many people come to gather and remember the person who passed with drumming and songs.
Last year, I was asked on the Thanksgiving long weekend to care for a lady who had chosen to discontinue dialysis. She was given one to two weeks of life to live after she stopped the procedure. She understood this and wanted to be at home to pass. I was asked by the family to come and sit with them. They felt it would make the process easier as none of them had any medical knowledge or background in caring for a palliative person. This sweet lady came home and the family was all present. She was able to communicate the first night and two days later she passed.
All the while, I was able to reassure the family of the changes she was going through; the slowed breathing, no communication, some twitching, and yes she moaned some, indicating possible pain or wanting to speak. The local ambulance was consulted and they came to administer morphine for comfort. The family was there the whole time; all disputes were put aside. They told stories and once in a while this sweet lady smiled.
When she passed, I did what nurses do – cleaned the body, dressed the body, and waited for the funeral director to arrive to pick up the body. I missed Thanksgiving with my family and children last year, but I felt it was an important mission, supporting the family.
A year passed. This Thanksgiving, I was asked to attend a tea dance ceremony to mark the first anniversary of her death. I accepted but did not expect the surprise that awaited me there. After the feast was served, the drumming occurred and songs were sung. The lady’s family stood to thank everyone for attending. They had a special thanks for me. They offered me a ribbon skirt and beaded earrings as a token of their appreciation. I cried. Normally, I’m a tough lady, but I cried because, sometimes, nursing can be a thankless job. I had no idea that what I did last year would result in my receiving my first ribbon skirt.
You see, the ribbon skirt is not a fashion trend, it is not Calvin Klein or any designer brand. It is simple fabric, with ribbons of colors and patterns. The significance is to restore a Cree woman’s power, for her empowerment and with this also a way of taking back the cultural knowledge that was once taken away from us.
I didn’t know that what I did was so worthy of this beautiful ribbon skirt. I didn’t realize serving this family with palliative care in the home meant so much.
This reflection was written with the encouragement and assistance of Donna Wilson, RN, PhD, Nursing Professor, University of Alberta. Donna recently found only 44% of deaths in Canada take place in hospital now, making it much more likely that nurses will be involved in home deaths and nursing home deaths. Her study used complete Canadian hospital data (excluding Quebec as Quebec does not provide their provincial healthcare data to CIHI for comparative analyses). A report of this study can be found at Wilson, D. M., Shen, Y., & Birch, S. (2017). New evidence on end-of-life hospital utilization for enhanced health policy and services planning. Journal of Palliative Medicine, 20(7), 752-758. doi:10.1089/jpm.2016.0490