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Brown MEL, George RE. Supporting critically conscious integrated care: A toolbox for the health professions. CLINICAL TEACHER 2023:e13569. [PMID: 36883581 DOI: 10.1111/tct.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Riya E George
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London, UK
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Lyons R, Carroll C, Gallagher A, Merrick R, Tancredi H. Understanding the perspectives of children and young people with speech, language and communication needs: How qualitative research can inform practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:547-557. [PMID: 35188849 DOI: 10.1080/17549507.2022.2038669] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Much of the published research is "on" rather than "with" children and young people with speech, language and communication needs (SLCN). According to the UN Convention on the Rights of the Child (1989), children's views must be considered and taken into account in all matters affecting them. In this paper, we discuss ways in which innovative qualitative methods have been used to explore the views of children and young people with SLCN. We also discuss how we can apply concepts from qualitative research, in particular critical reflexivity, to shape our thinking, inform our practice, and lead to innovation in our work with children and young people with SLCN.
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Affiliation(s)
- Rena Lyons
- Discipline of Speech and Language Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, NUI Galway, Ireland
| | - Clare Carroll
- Discipline of Speech and Language Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, NUI Galway, Ireland
| | - Aoife Gallagher
- Discipline of Speech and Language Therapy, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Haley Tancredi
- School of Early Childhood and Inclusive Education within the Faculty of Education, Queensland University of Technology, Brisbane, Australia
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Hudson L, Engel-Hills P, Davidson F, Naidoo K. Radiography lecturers' understanding of a socially responsive curriculum. Radiography (Lond) 2022; 28:684-689. [PMID: 35724473 DOI: 10.1016/j.radi.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/03/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers' understanding of how students become socially responsive. The concept of 'critical consciousness' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context. METHOD A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis. RESULTS Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies. CONCLUSION Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice. IMPLICATIONS FOR PRACTICE Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice.
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Affiliation(s)
- L Hudson
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Office H041, Ground Floor, New Science Building, Bellville Campus, Robert Sobukwe Road, Bellville 7530, South Africa.
| | - P Engel-Hills
- Faculty of Health and Wellness Sciences & Professional Education Research Institute, Cape Peninsula University of Technology, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Cape Peninsula University of Technology, New Health Science Building, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
| | - K Naidoo
- Department of Medical Imaging and Therapeutic Sciences, Cape Peninsula University of Technology, New Health Science Building, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
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Kim JH, Lee J, Richardson TV, Lee DH, McMahon BT, Kim H, Sametz RR. Psychometric Validation of Adapted Inventory of Virtues and Strengths. REHABILITATION COUNSELING BULLETIN 2021. [DOI: 10.1177/0034355221993553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to validate the Adapted Inventory of Virtues and Strengths (AIVS). AIVS is a unique instrument that operationalizes virtues in terms of character traits that are specially designed for psychosocial adaptation and rehabilitation. Data were collected from 464 individuals with disabilities and analyzed via the combination of exploratory ( n = 256) and confirmatory analyses ( n = 208). Although the results suggest dropping some items, the original five-virtue structure was supported and confirmed via both analyses. The construct validity of AIVS was further analyzed via correlation analyses between AIVS and other measures including Values in Action Inventory of Strengths 72-Item, Satisfaction with Life Scale, Connor-Davison Resilience Scale, and General Self-Efficacy Scale. The results suggest that with continuing research to document reliability and validity, AIVS has potential in the context of rehabilitation research. Further discussion on psychometric information of AIVS and future implications were presented.
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Affiliation(s)
- Jeong Han Kim
- Texas Tech University Health Sciences Center, Lubbock, USA
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A critical‐cultural‐relational approach to rupture resolution: A case illustration with a cross‐racial dyad. J Clin Psychol 2020; 77:369-383. [DOI: 10.1002/jclp.23080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 01/09/2023]
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Wilson AM, Kelly J, Jones M, O’Donnell K, Wilson S, Tonkin E, Magarey A. Working together in Aboriginal health: a framework to guide health professional practice. BMC Health Serv Res 2020; 20:601. [PMID: 32611413 PMCID: PMC7329497 DOI: 10.1186/s12913-020-05462-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 06/24/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Working effectively with Aboriginal and Torres Strait Islander people is important for maximising the effectiveness of a health care interaction between and Aboriginal and Torres Strait Islander patients and a health professional. This paper presents a framework to guide health professional practice in Aboriginal and Torres Strait Islander health. METHODS This qualitative study was based in a social constructionist epistemology and was guided by a critical social research methodology. Two methods were employed: interviews with Aboriginal health workers and allied health professionals about their experiences of working together in Aboriginal health, and an auto-ethnography conducted by the researcher, a non-Aboriginal dietitian and researcher who worked closely with two Aboriginal communities while undertaking this research. RESULTS Interviews were conducted with 44 allied health professionals and Aboriginal health workers in 2010. Critical Social research, which involves the deconstruction and reconstruction of data, was used to analyse data and guided the evolution of themes. Strategies that were identified as important to guide practice when working respectfully in Aboriginal health included: Aboriginal and non-Aboriginal people working with Aboriginal health workers, using appropriate processes, demonstrating commitment to building relationships, relinquishing control, having an awareness of Aboriginal history, communication, commitment, flexibility, humility, honesty, and persistence. Reciprocity and reflection/reflexivity were found to be cornerstone strategies from which many other strategies naturally followed. Strategies were grouped into three categories: approach, skills and personal attributes which led to development of the Framework. CONCLUSIONS The approach, skills and personal attributes of health professionals are important when working in Aboriginal health. The strategies identified in each category provide a Framework for all health professionals to use when working with Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Annabelle M. Wilson
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Janet Kelly
- Adelaide Nursing School, Adelaide University, Adelaide, South Australia 5005 Australia
| | - Michelle Jones
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Kim O’Donnell
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Sandra Wilson
- Aboriginal Primary Health Care Unit, Murray Bridge, South Australia 5253
| | - Emma Tonkin
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Anthea Magarey
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
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Chan RCH, Mak WWS. Liberating and Empowering Effects of Critical Reflection on Collective Action in LGBT and Cisgender Heterosexual Individuals. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:63-77. [PMID: 31268185 DOI: 10.1002/ajcp.12350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Critical consciousness represents the transformation from a passive target of oppression to an active actor with an increased capacity to analyze and negotiate conditions of oppression. It is considered as an antidote for oppression that can liberate people from oppressive ideologies and empower them to resist social injustice. Building on the theory of critical consciousness and the Social Identity Model of Collective Action, this paper examined the liberating and empowering effects of critical reflection on collective action for minority rights. Results of a cross-sectional study in 1,050 LGBT individuals (Study 1) showed that critical reflection was associated with lower levels of internalized oppression and higher levels of collective efficacy, which in turn were associated with greater intentions to undertake collective action for LGBT rights. Findings from a prospective longitudinal study in 428 cisgender heterosexual individuals (Study 2) indicated that critical reflection was associated with lower levels of internalized domination and heightened levels of efficacious beliefs, which positively predicted actual participation in collective action at a subsequent wave. The findings supported the effects of critical reflection on collective action mobilization and offered leads for future research and praxis on how to orient different sectors of society to work toward social equity.
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Affiliation(s)
- Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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McKivett A, Paul D, Hudson N. Healing Conversations: Developing a Practical Framework for Clinical Communication Between Aboriginal Communities and Healthcare Practitioners. J Immigr Minor Health 2019; 21:596-605. [PMID: 30066058 DOI: 10.1007/s10903-018-0793-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner's own cultural identity and will be guided by collective Aboriginal worldviews in select Australian settings. Using a two-eyed seeing approach the framework will be developed and tested in health professional education. The aim of this research journey is to enable health practitioners to have more effective healthcare conversations with Aboriginal peoples, working toward more socially just and equitable healthcare interactions and outcomes.
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Affiliation(s)
- Andrea McKivett
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
| | - David Paul
- School of Medicine Fremantle, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicky Hudson
- University of Adelaide, Adelaide, SA, Australia
- University of Newcastle, Newcastle, NSW, Australia
- University of Wollongong, Wollongong, NSW, Australia
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Travers JL, Teitelman AM, Jenkins KA, Castle NG. Exploring social-based discrimination among nursing home certified nursing assistants. Nurs Inq 2019; 27:e12315. [PMID: 31398775 DOI: 10.1111/nin.12315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social-based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory to explore the phenomenon of social-based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social-based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower-class workers and subsequently improving resident care delivery.
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Affiliation(s)
- Jasmine L Travers
- National Clinician Scholars Program, Yale University Schools of Medicine and Nursing, New Haven, CT, USA
| | - Anne M Teitelman
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kevin A Jenkins
- Perelman School of Medicine, University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA
| | - Nicholas G Castle
- Department of Health Policy, Management and Leadership, West Virginia University, Morgantown, WV, USA
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Haque A, Tubbs CY, Kahumoku-Fessler EP, Brown MD. Microaggressions and Islamophobia: Experiences of Muslims Across the United States and Clinical Implications. JOURNAL OF MARITAL AND FAMILY THERAPY 2019; 45:76-91. [PMID: 29855055 DOI: 10.1111/jmft.12339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This mixed methods exploratory study illustrates the influence of pervasive misconceptions about Islam on the experiences of 314 adult Muslims across the United States. Quantitative results suggest that Muslim stress levels are comparable to the stress levels of other marginalized groups in the United States. Qualitative analysis revealed four themes that highlight the challenges faced by Muslims as well as their resiliency in the face of microaggressions and marginalization. Family therapists may utilize these personal accounts to expand their understanding of Muslim experiences, and to reflect on their own implicit biases toward Muslims in order to reduce chances of premature termination. Clinical implications include using resiliency-based models and creating collaborative partnerships with community leaders when working with this religious minority group.
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Slack-Smith L, Hearn L, Scrine C, Durey A. Barriers and enablers for oral health care for people affected by mental health disorders. Aust Dent J 2017; 62:6-13. [PMID: 27164018 DOI: 10.1111/adj.12429] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies. RESULTS The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions. CONCLUSIONS Considerable investigation of barriers had not elucidated options to improve care or outcomes.
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Affiliation(s)
- L Slack-Smith
- School of Dentistry, University of Western Australia, Perth, Australia
| | - L Hearn
- School of Dentistry, University of Western Australia, Perth, Australia
| | - C Scrine
- School of Dentistry, University of Western Australia, Perth, Australia
| | - A Durey
- School of Dentistry, University of Western Australia, Perth, Australia
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Halman M, Baker L, Ng S. Using critical consciousness to inform health professions education : A literature review. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:12-20. [PMID: 28050879 PMCID: PMC5285284 DOI: 10.1007/s40037-016-0324-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To explore how, in health professions education (HPE), the concept of critical consciousness has been defined and discussed, and to consider and suggest how critical pedagogy could be applied in practice. This exploration responds to increasing calls in the literature for HPE to foster compassionate care and social consciousness through the social sciences and humanities. METHOD The authors searched Medline/PubMed, ERIC and Web of Science for articles focusing on critical consciousness and/or critical pedagogy involving health professions. A thematic analysis aimed to identify key themes of critical consciousness in HPE literature. RESULTS The authors included 30 papers in their review. Key themes related to defining and discussing core attributes of critical consciousness in HPE were: 1) appreciating context in education and practice; 2) illuminating power structures; 3) moving beyond 'procedural'; 4) enacting reflection; and 5) promoting equity and social justice. CONCLUSIONS Critical consciousness may inform an appropriate critical pedagogy for fostering compassionate, humanistic, socially conscious health professionals who act as agents of change. While the authors share critical teaching practices for educators, considerable care must be taken in efforts to use critical pedagogy within the current structures of HPE programmes. The authors suggest attending to the philosophical and theoretical origins of critical consciousness and those of the dominant models of contemporary HPE (e. g. competency-based approaches) in order to ensure the tenets of critical pedagogy can be enacted authentically.
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Affiliation(s)
- Mark Halman
- Department of Psychiatry, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Lindsay Baker
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stella Ng
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Shin RQ, Smith LC, Welch JC, Ezeofor I. Is Allison More Likely Than Lakisha to Receive a Callback From Counseling Professionals? A Racism Audit Study. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000016668814] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Richard Q. Shin
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, USA
| | - Lance C. Smith
- Graduate Program in Counseling, University of Vermont, Burlington, VT, USA
| | - Jamie C. Welch
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, USA
| | - Ijeoma Ezeofor
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, USA
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Durey A, McAullay D, Gibson B, Slack-Smith L. Oral Health in Young Australian Aboriginal Children. JDR Clin Trans Res 2016; 2:38-47. [DOI: 10.1177/2380084416667244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite dedicated government funding, Aboriginal Australians, including children, experience more dental disease than other Australians, despite it being seen as mostly preventable. The ongoing legacy of colonization and discrimination against Aboriginal Australians persists, even in health services. Current neoliberal discourse often holds individuals responsible for the state of their health, rather than the structural factors beyond individual control. While presenting a balanced view of Aboriginal health is important and attests to Indigenous peoples’ resilience when faced with persistent adversity, calling to account those structural factors affecting the ability of Aboriginal people to make favorable oral health choices is also important. A decolonizing approach informed by Indigenous methodologies and whiteness studies guides this article to explore the perceptions and experiences of Aboriginal parents ( N = 52) of young children, mainly mothers, in Perth, Western Australia, as they relate to the oral health. Two researchers, 1 Aboriginal and 1 non-Aboriginal, conducted 9 focus group discussions with 51 Aboriginal participants, as well as 1 interview with the remaining individual, and independently analyzed responses to identify themes underpinning barriers and enablers to oral health. These were compared, discussed, and revised under key themes and interpreted for meanings attributed to participants’ perspectives. Findings indicated that oral health is important yet often compromised by structural factors, including policy and organizational practices that adversely preclude participants from making optimal oral health choices: limited education about prevention, prohibitive cost of services, intensive marketing of sugary products, and discrimination from health providers resulting in reluctance to attend services. Current government intentions center on Aboriginal–non-Aboriginal partnerships, access to flexible services, and health care that is free of racism and proactively seeks and welcomes Aboriginal people. The challenge is whether these good intentions are matched by policies and practices that translate into sustained improvements to oral health for Aboriginal Australians. Knowledge Transfer Statement: Slow progress in reducing persistent oral health disparities between Aboriginal and non-Aboriginal Australians calls for a new approach to this seemingly intractable problem. Findings from our qualitative research identified that structural factors—such as cost of services, little or no education on preventing oral disease, and discrimination by health providers—compromised Aboriginal people’s optimum oral health choices and access to services. The results from this study can be used to recommend changes to policies and practices that promote rather than undermine Aboriginal health and well-being and involve Aboriginal people in decisions about their health care.
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Affiliation(s)
- A. Durey
- School of Dentistry, University of Western Australia, Perth, Western Australia
| | - D. McAullay
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - B. Gibson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - L.M. Slack-Smith
- School of Dentistry, University of Western Australia, Perth, Western Australia
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Pergert P, Ekblad S, Enskär K, Björk O. Obstacles to Transcultural Caring Relationships: Experiences of Health Care Staff in Pediatric Oncology. J Pediatr Oncol Nurs 2016; 24:314-28. [DOI: 10.1177/1043454207308066] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This qualitative study explores the caring situation of families with an immigrant background within the context of pediatric oncology care from the perspective of health care staff. Five focus group interviews and 5 complementary individual interviews were conducted after purposive and theoretical sampling, respectively. Grounded theory methodology revealed that obstacles to transcultural caring relationships are a main concern of the health care staff. These obstacles are divided into 4 main categories: linguistic, cultural and religious, social, and organizational. When health care staff fail to recognize obstacles to transcultural caring relationships, the result is inequity in care of families with an immigrant background. Equity in care for all does not mean identical treatment but, rather, care adjusted to the needs of the individual family regardless of background.
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Affiliation(s)
- Pernilla Pergert
- Childhood Cancer Care Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital/Solna, Stockholm, Sweden. Stockholm, Sweden,
| | - Solvig Ekblad
- Department of Clinical Neuroscience, Psychiatry/HS, Karolinska Institutet, Stockholm, Sweden
| | - Karin Enskär
- Department of Nursing Science, School of Health Sciences, Jönköping University
| | - Olle Björk
- Swedish Children's Cancer Foundation (Barncancerfonden)
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Durey A, McAullay D, Gibson B, Slack-Smith L. Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia. Int J Equity Health 2016. [PMID: 26754073 DOI: 10.1186/s12939-12016-10299-12937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Improving oral health for Aboriginal Australians has been slow. Despite dental disease being largely preventable, Aboriginal Australians have worse periodontal disease, more decayed teeth and untreated dental caries than other Australians. Reasons for this are complex and risk factors include broader social and historic determinants such as marginalisation and discrimination that impact on Aboriginal people making optimum choices about oral health. This paper presents findings from a qualitative study conducted in the Perth metropolitan area investigating Aboriginal Health Workers' (AHWs) perceptions of barriers and enablers to oral health for Aboriginal people. METHODS Following extensive consultation with Aboriginal stakeholders, researchers conducted semi-structured interviews and focus groups across 13 sites to investigate AHWs' perceptions of barriers and enablers to oral health based on professional and personal experience. Responses from 35 AHWs were analysed independently by two researchers to identify themes that they compared, discussed, revised and organised under key themes. These were summarised and interrogated for similarities and differences with evidence in the literature. RESULTS Key findings indicated that broader structural and social factors informed oral health choices. Perceptions of barriers included cost of services and healthy diets on limited budgets, attending services for pain not prevention, insufficient education about oral health and preventing disease, public dental services not meeting demand, and blame and discrimination from some health providers. Suggested improvements included oral health education, delivering flexible services respectful of Aboriginal people, oral health services for 0-4 year olds and role modelling of oral health across generations. CONCLUSION Reviewing current models of oral health education and service delivery is needed to reduce oral health disparities between Aboriginal and non-Aboriginal Australians. Shifting the discourse from blaming Aboriginal people for their poor oral health to addressing structural factors impacting on optimum oral health choices is important. This includes Aboriginal and non-Aboriginal stakeholders working together to develop and implement policies and practices that are respectful, well-resourced and improve oral health outcomes.
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Affiliation(s)
- Angela Durey
- School of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, 6009, WA, Australia.
| | - Dan McAullay
- School of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, 6009, WA, Australia.
| | - Barry Gibson
- School of Clinical Dentistry, University of Sheffield, 31 Claremont Crescent,, Sheffield, S10 2TA, UK.
| | - Linda Slack-Smith
- School of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, 6009, WA, Australia.
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Durey A, McAullay D, Gibson B, Slack-Smith L. Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia. Int J Equity Health 2016; 15:4. [PMID: 26754073 PMCID: PMC4709938 DOI: 10.1186/s12939-016-0299-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022] Open
Abstract
Background Improving oral health for Aboriginal Australians has been slow. Despite dental disease being largely preventable, Aboriginal Australians have worse periodontal disease, more decayed teeth and untreated dental caries than other Australians. Reasons for this are complex and risk factors include broader social and historic determinants such as marginalisation and discrimination that impact on Aboriginal people making optimum choices about oral health. This paper presents findings from a qualitative study conducted in the Perth metropolitan area investigating Aboriginal Health Workers’ (AHWs) perceptions of barriers and enablers to oral health for Aboriginal people. Methods Following extensive consultation with Aboriginal stakeholders, researchers conducted semi-structured interviews and focus groups across 13 sites to investigate AHWs’ perceptions of barriers and enablers to oral health based on professional and personal experience. Responses from 35 AHWs were analysed independently by two researchers to identify themes that they compared, discussed, revised and organised under key themes. These were summarised and interrogated for similarities and differences with evidence in the literature. Results Key findings indicated that broader structural and social factors informed oral health choices. Perceptions of barriers included cost of services and healthy diets on limited budgets, attending services for pain not prevention, insufficient education about oral health and preventing disease, public dental services not meeting demand, and blame and discrimination from some health providers. Suggested improvements included oral health education, delivering flexible services respectful of Aboriginal people, oral health services for 0–4 year olds and role modelling of oral health across generations. Conclusion Reviewing current models of oral health education and service delivery is needed to reduce oral health disparities between Aboriginal and non-Aboriginal Australians. Shifting the discourse from blaming Aboriginal people for their poor oral health to addressing structural factors impacting on optimum oral health choices is important. This includes Aboriginal and non-Aboriginal stakeholders working together to develop and implement policies and practices that are respectful, well-resourced and improve oral health outcomes.
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Affiliation(s)
- Angela Durey
- School of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, 6009, WA, Australia.
| | - Dan McAullay
- School of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, 6009, WA, Australia.
| | - Barry Gibson
- School of Clinical Dentistry, University of Sheffield, 31 Claremont Crescent,, Sheffield, S10 2TA, UK.
| | - Linda Slack-Smith
- School of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, 6009, WA, Australia.
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Williams JM, McMahon HG, Goodman RD. Eco-Webbing: A Teaching Strategy to Facilitate Critical Consciousness and Agency. COUNSELOR EDUCATION AND SUPERVISION 2015. [DOI: 10.1002/ceas.12006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - H. George McMahon
- Counseling and Human Development; George Mason University
- Now at Counselor Education and Supervision; University of Georgia
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19
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Durey A, Wynaden D, O'Kane M. Improving forensic mental health care to Indigenous Australians: theorizing the intercultural space. J Psychiatr Ment Health Nurs 2014; 21:296-302. [PMID: 23981233 DOI: 10.1111/jpm.12105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/29/2022]
Abstract
This paper uses the 'intercultural space' as an educational strategy to prepare nurses to work respectfully with Indigenous patients in a forensic mental health context; offers an educational approach that introduces nurses to Indigenous knowledge, beliefs and values, examines power relations in colonized countries between the dominant white cultural group and the Indigenous population and encourages nurses to critically reflect on their health care practice; and explores the intercultural space as a shared space between cultures fostering open and robust inquiry where neither culture dominates and new positions, representations and understandings can emerge. Given the disproportionately high number of Indigenous people imprisoned in colonized countries, this paper responds to research from Western Australia on the need to prepare forensic mental health nurses to deliver care to Indigenous patients with mental health disorders. The paper highlights the nexus between theory, research and education that can inform the design and implementation of programmes to help nurses navigate the complex, layered and contested 'intercultural space' and deliver culturally safe care to Indigenous patients. Nurses are encouraged to critically reflect on how beliefs and values underpinning their cultural positioning impact on health care to Indigenous patients. The paper draws on intercultural theory to offer a pedagogical framework that acknowledges the negative impacts of colonization on Indigenous health and well-being, repositions and revalues Indigenous cultures and knowledges and fosters open and robust inquiry. This approach is seen as a step towards working more effectively in the intercultural space where ultimately binary oppositions that privilege one culture over another and inhibit robust inquiry are avoided, paving the way for new, more inclusive positions, representations and understandings to emerge. While the intercultural space can be a place of struggle, tension and ambiguity, it also offers deep potential for change.
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Affiliation(s)
- A Durey
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
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20
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Browne T, Pitner R, Freedman DA. When identifying health disparities as a problem is a problem: pedagogical strategies for examining racialized contexts. J Prev Interv Community 2014; 41:220-30. [PMID: 24010559 DOI: 10.1080/10852352.2013.818481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The current study presents a critical discussion on community responses to health disparity research and the need for utilizing pedagogical strategies to prepare students to understand and address health disparities in racialized contexts. Qualitative research methods were used to examine community responses to media stories on two health disparity research projects, and four themes emerged: naming health disparities is a tool for dividing, structural racism does not exist, naming of health disparities is a political act, and health disparities exist because of individual-level deficiencies. The implications for teaching students about racial health disparities are presented and discussed.
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Affiliation(s)
- Teri Browne
- a College of Social Work , University of South Carolina , Columbia , South Carolina , USA
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21
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Vallianatou C, Koliri ME. The economic crisis and its implications on same-culture identities and the therapeutic relationship. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2013. [DOI: 10.1080/13642537.2013.855249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Scott A. An exploration of the experience of Christian counsellors in their work with both Christian and non-Christian clients, with particular reference to aspects of cultural transition. COUNSELLING & PSYCHOTHERAPY RESEARCH 2013. [DOI: 10.1080/14733145.2012.761257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Windsor LC, Dunlap E, Armour M. Surviving oppression under the rock: the intersection of New York's drug, welfare, and educational polices in the lived experiences of low-income African Americans. J Ethn Subst Abuse 2012; 11:339-61. [PMID: 23216440 DOI: 10.1080/15332640.2012.735176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Drawing on standpoint and intersectionality theories, this study explores the degree to which interactions among New York State's Rockefeller Drug Laws and educational and welfare policies have contributed to the maintenance of a culture of surveillance in which the lives of impoverished African Americans are overseen and influenced by oppressive policies and governmental institutions. Qualitative secondary analysis of longitudinal ethnographic data was conducted. Findings demonstrate multiple disadvantages that impoverished African American families struggling with substance use or sale experience. These disadvantages accumulated intergenerationally, in a snowball effect, making it difficult for participants to maintain stable lives. Findings explored the tension between participants' lived experiences and the multiple ways they either assimilated or resisted their oppression. New sensitive policies informed by standpoint, intersectionality, and Afrocentric perspectives must be developed to increase the availability of meaningful employment and strengthening impoverished African American communities.
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Torres-Harding SR, Siers B, Olson BD. Development and psychometric evaluation of the Social Justice Scale (SJS). AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2012; 50:77-88. [PMID: 22080396 DOI: 10.1007/s10464-011-9478-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The study describes the development of the Social Justice Scale (SJS). Practitioners, educators, students, and other members of the community differ on their attitudes and values regarding social justice. It is important to assess, not only individuals' attitudes and values around social values, but also other constructs that might be related to social justice behaviors. The implication of Ajzen in Organizational Behavior and Human Decision Processes 50:179-211, (1991) theory of planned behavior suggests that attitudes, perceived behavioral control, and social norms predict intentions, which then lead to behaviors. A scale was designed to measure social justice-related values, attitudes, perceived behavioral control, subjective norms, and intentions based on a four-factor conception of Ajzen's theory. Confirmatory factor analysis and analyses for reliability and validity were used to test the properties of the scale.
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25
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Durey A, Thompson SC. Reducing the health disparities of Indigenous Australians: time to change focus. BMC Health Serv Res 2012; 12:151. [PMID: 22682494 PMCID: PMC3431273 DOI: 10.1186/1472-6963-12-151] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 06/10/2012] [Indexed: 11/12/2022] Open
Abstract
Background Indigenous peoples have worse health than non-Indigenous, are over-represented amongst the poor and disadvantaged, have lower life expectancies, and success in improving disparities is limited. To address this, research usually focuses on disadvantaged and marginalised groups, offering only partial understanding of influences underpinning slow progress. Critical analysis is also required of those with the power to perpetuate or improve health inequities. In this paper, using Australia as a case example, we explore the effects of ‘White’, Anglo-Australian cultural dominance in health service delivery to Indigenous Australians. We address the issue using race as an organising principle, underpinned by relations of power. Methods Interviews with non-Indigenous medical practitioners in Western Australia with extensive experience in Indigenous health encouraged reflection and articulation of their insights into factors promoting or impeding quality health care to Indigenous Australians. Interviews were audio-taped and transcribed. An inductive, exploratory analysis identified key themes that were reviewed and interrogated in light of existing literature on health care to Indigenous people, race and disadvantage. The researchers’ past experience, knowledge and understanding of health care and Indigenous health assisted with data interpretation. Informal discussions were also held with colleagues working professionally in Indigenous policy, practice and community settings. Results Racism emerged as a key issue, leading us to more deeply interrogate the role ‘Whiteness’ plays in Indigenous health care. While Whiteness can refer to skin colour, it also represents a racialized social structure where Indigenous knowledge, beliefs and values are subjugated to the dominant western biomedical model in policy and practice. Racism towards Indigenous patients in health services was institutional and interpersonal. Internalised racism was manifest when Indigenous patients incorporated racist attitudes and beliefs into their lived experience, lowering expectations and their sense of self-worth. Conclusions Current health policies and practices favour standardised care where the voice of those who are marginalised is often absent. Examining the effectiveness of such models in reducing health disparities requires health providers to critically reflect on whether policies and practices promote or compromise Indigenous health and wellbeing - an important step in changing the discourse that places Indigenous people at the centre of the problem.
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Affiliation(s)
- Angela Durey
- Curtin Health Innovation Research Unit, Curtin University, Perth, 6845, Western Australia.
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Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Intern Med J 2012; 42:17-22. [PMID: 22032537 DOI: 10.1111/j.1445-5994.2011.02628.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Improvements in Aboriginal health have been slow. Research demonstrates ongoing discrimination towards Aboriginal Australians based on race, including in health services, leads to poor health outcomes. Using an eclectic methodology based on observations and discussions with health practitioners experienced in working with Aboriginal patients, this paper identifies how cross-cultural misunderstandings undermine the quality of care to Aboriginal patients in hospital and offers suggestions for improving practice. It also explores the concept of institutional racism and challenges doctors to reflect on their role in perpetuating power imbalances. We argue that physicians and healthcare providers need to do more than just deliver evidence-based interventions, by critically reflecting on their own attitudes to and practices with Aboriginal Australians and work collectively to effect systemic change which creates a more inclusive and safe environment for all people accessing healthcare.
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Affiliation(s)
- A Durey
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
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27
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Collins S, Arthur N, Wong-Wylie G. Enhancing Reflective Practice in Multicultural Counseling Through Cultural Auditing. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2010.tb00031.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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28
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Durey A, Wynaden D, Thompson SC, Davidson PM, Bessarab D, Katzenellenbogen JM. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq 2011; 19:144-52. [PMID: 22530862 DOI: 10.1111/j.1440-1800.2011.00546.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model.
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Affiliation(s)
- Angela Durey
- School of Nursing and Midwifery Curtin Health Innovation and Research Institute, Curtin University, Perth, Australia.
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Chao MM, Okazaki S, Hong YY. The Quest for Multicultural Competence: Challenges and Lessons Learned from Clinical and Organizational Research. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2011. [DOI: 10.1111/j.1751-9004.2011.00350.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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