To support Truth and Reconciliation and the wound, ostomy and continence health of Indigenous People, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched an Indigenous Sharing Circle in June 2018. The members were interprofessional healthcare providers working with Indigenous people in communities across Canada. The members made a commitment to improved patient care delivery with access to skin and wound education. The process involved examining unique Indigenous community perspectives in rural, remote, and urban areas.

The NSWOCC Indigenous Sharing Circle members work in the frontline with Indigenous, Metis, and Inuit people. They conducted a Strengths, Opportunities, Aspirations and Results (SOAR) analysis that identified the gaps in the system and where they could make a positive impact. Collectively the circle explored possible solutions to common health challenges faced by First Nations and
Indigenous Groups

One of the areas identified requiring a change in process and improvement, was inequitable skin and wound care education provided to healthcare professionals working in Indigenous Communities. To provide equitable and sustainable skin and wound education, it was essential that NSWOCC partner with another organization. This culturally sensitive, skin and wound education program needed to reach Indigenous communities across Canada. 

Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications including foot ulcers, lower extremity amputations, and peripheral arterial disease. WoundPedia led by Dr. Gary Sibbald, was identified as the right partner. Dr Sibbald and his partners had already successfully launched ECHO (Extension for Community Healthcare Outcomes) Ontario over the past 7 years. This program reached a wide variety of healthcare professionals across Ontario through a virtual platform. The education process focused on interprofessional collaboration, early screening for the high-risk diabetic foot and patient education with a strong focus on the lower limb. Using a hub and spoke model, there was an emphasis on educating healthcare professionals in practice. A key element was the development of interprofessional teams (doctor, nurse and allied health professionals) through the use of multimodal interactive didactic methods . Educational activities included case-based interactive learning and virtual skills training, leading to evidence-based care management with outcome evaluation. The Ontario ECHO Skin and Wound had already trained more than 600 healthcare professionals in 120 health care organisations and provided team consultations to more than 240 complex patients. More than 90 per cent of participants said the learning met their needs and 87 per cent changed their practice. The ECHO project focuses on treating patients in their communities, by ‘moving knowledge, not patients’.

NSWOCC linked with WoundPedia and their Ontario ECHO Skin and Wound experience with Queen’s University who provide accreditation and outcomes analysis. Indigenous Services Canada has supported initial funding and dissemination to create the Indigenous ECHO Canada Skin and Wound program. Eight education sessions will be provided virtually. The educational materials were reviewed by an Indigenous healthcare professional for cultural safety. A lower extremity “Tool Kit” was developed by Dr Sibbald and the ECHO Ontario team. This kit will support improved community lower limb management capacity. This will improve care and healthcare equity in rural and remote Indigenous communities. A launch meeting was held January 13, 2025 (119 participants) and the first Indigenous ECHO Canada Skin and Wound session will start February 10, 2025.

The NSWOCC Indigenous Sharing Circle will provide Nurses Specialized in Wound, Ostomy and Continence (NSWOC) mentors across Canada to support building the knowledge of healthcare professionals who take this education program. This will help to support the student’s success and sustainability of this education program. Healthcare professionals from Indigenous communities can access this program from their own community and have been registering for this educational skin and wound care program. An evaluation of outcomes will be conducted after the completion of the eighth session May 26, 2025.

The sessions will be broadcast Monday evenings twice monthly from 7 to 8:30 pm Eastern time from February through May. The 8 sessions will cover 4 wound topics: Wound Bed Preparation 2024 as a process for wholistic patient wound care, vascular assessment, Infection and Plantar pressure redistribution. An indigenous dermatologist from Saskatchewan, .Dr. Rachel Asiniwasis performed a dermatology needs assessment for the indigenous communities. The assessment identified general skin care along with atopic dermatitis, skin infections and bites, stings and infestations. 

Each 60-minute session will be accompanied by 30 minutes of skills with short assignments to practice the skills and complete the requirements for a toolkit. 

The vision for the development of the Indigenous ECHO Canada Skin and Wound Care will fuel equitable access to skin and wound care education. The development of this program will improve the healthcare of Indigenous people from coast to coast. Healthcare Professionals can enroll in the program by contacting Linda@WoundPedia.com. Further information can be obtained at office@nswoc.ca.

By Dr. R. Gary Sibbald and Catherine Harley
Dr. R Gary Sibbald is the lead of Project ECHO Ontario Skin and Wound. He is a dermatologist and internist with a special interest in wound care and education. He is a professor of medicine and public health at the University of Toronto. As a wound care educator, clinician and clinical researcher he is an international wound care key opinion leader.

Catherine Harley is Chief Executive Officer, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC).