Clarifying Cultural Safety: its focus and intent in an Australian context

Indigenous students' experiences of being taught indigenous health

BACKGROUND

Increasing the numbers of Indigenous health professionals is an international priority to enhance health outcomes for Indigenous communities. It is also incumbent on academics to ensure all graduates are culturally safe to work with Indigenous Peoples, and that accredited health degrees contain appropriate Indigenous content, improving the cultural competence of the registered health workforce. However, little current research investigates Indigenous tertiary students' experiences of learning about Indigenous health.

AIM

To explore Indigenous students' experiences of being taught Indigenous health.

DESIGN

This study employed an online survey (16 % response rate) developed to evaluate student's beliefs, attitudes and learning experiences following operationalisation of a university Indigenous Graduate Attribute. An Aboriginal researcher also conducted Yarning Circles with Indigenous students as a culturally appropriate means to deepen insight into their experiences of studying Indigenous health topics alongside non-Indigenous peers.

SETTING

A large urban Australian university.

PARTICIPANTS

Twelve Indigenous students from four health disciplines completed the anonymous survey. Five Indigenous midwifery students participated in a Yarning Circle.

METHODS

Survey data were analysed descriptively using SPSS version 27. Qualitative data from Yarning Circle transcripts were analysed thematically from an inductive Indigenous standpoint.

RESULTS

Results from the survey demonstrated unanimous agreement that all health students should learn about Indigenous Peoples' health and cultures. However, most participants agreed that there needed to be more content on Indigenous knowledges, derived from Indigenous authors, researchers, and community presenters. The Yarning Circle yielded rich discussion of students' experiences, explored across three key themes and associated sub-themes. Themes were: When your culture is content; Being an Indigenous student; and Sources of strength and support as Indigenous students.

CONCLUSIONS

Findings indicate the importance of framing Indigenous content, incorporating Indigenous knowledge into curricula, ensuring Cultural Safety in classrooms with both Indigenous and non-Indigenous students, and supporting Indigenous students to excel.

Decolonizing nursing for health equity: A scoping review

BACKGROUND

The recent push to "decolonize nursing" has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword.

PURPOSE

This article clarifies "decolonizing nursing" by addressing the following questions: (a) How has "decolonizing nursing" been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity?

METHODS

We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included.

DISCUSSION

"Decolonization" has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes.

CONCLUSION

Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism's historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand

AIM

To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.

DESIGN

An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens.

METHODS

Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles.

DATA SOURCES

Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023.

RESULTS

Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing.

CONCLUSION

Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism.

REPORTING METHOD

This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPLICATIONS FOR THE PROFESSION

Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care.

IMPACT

This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

Elements of Long-Term Care That Promote Quality of Life for Indigenous and First Nations Peoples: A Mixed Methods Systematic Review

BACKGROUND AND OBJECTIVES

Little is known about elements of long-term care (LTC) that promote quality of life (QoL) for older Indigenous and First Nations peoples. This systematic review aimed to extend understanding of those deemed most important.

RESEARCH DESIGN AND METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic database and hand-searching were used to find published and unpublished qualitative studies and textual reports. A convergent integrated approach was used to synthesize data, according to the Joanna Briggs Institute methodology for mixed methods systematic reviews.

RESULTS

Included papers (11 qualitative; seven reports) explored views and experiences of Indigenous residents, families, and LTC staff from North America (8), South Africa (1), Norway (1), New Zealand (1), and Australia (7). Elements of care included: (a) codesigning and collaborating with Indigenous and First Nations communities and organizations to promote culturally safe care; (b) embedding trauma-informed care policies and practices, and staff training to deliver culturally safe services; (c) being respectful of individual needs, and upholding cultural, spiritual and religious beliefs, traditional activities and practices; (d) promoting connection to culture and sense of belonging through sustained connection with family, kin, and Indigenous and First Nations communities.

DISCUSSION AND IMPLICATIONS

This review identifies elements or models of care that promote QoL for Indigenous and First Nations peoples in LTC. While included papers were mostly from the United States and Australia, the congruence of elements promoting QoL was evident across all population groups. Findings may be used to inform standards specific to the care of Indigenous and First Nations peoples.

'Only for the white'. A qualitative exploration of the lived experiences of Black, Asian and Minority Ethnic midwifery students

BACKGROUND

An ethnically diverse workforce has been identified as a key component of safe, compassionate maternity care, and yet midwifery remains a predominantly White profession across the Global North. Understanding the experiences of Black, Asian and Minority Ethnic midwifery students is key to addressing this disparity.

OBJECTIVE

To capture the university and placement experiences of Black, Asian and Minority Ethnic midwifery students in a culturally White environment.

METHODS

A qualitative approach underpinned by a feminist, inductive, interpretivist paradigm informed a study undertaken with student midwives studying at three separate universities in South East England. Five virtual focus groups and two semi-structured interviews were conducted with thirteen current student midwives and one preceptee (recently graduated) midwife self-identifying as Black, Asian or Minority Ethnic. Analysis was inductive, data-driven and thematic. Standards for Reporting Qualitative Research recommendations have been used to formulate this report.

FINDINGS

Although some participants reported positive experiences and felt well-supported, an overarching narrative emerged of midwifery as an exclusive and White profession. Institutionalised Whiteness was experienced in university, in placement and within individual student cohorts. Four themes were identified: 'being an outsider', 'prejudice, discrimination and racism', 'nowhere to turn' and 'positive forces'.

CONCLUSIONS

Racist and discriminatory beliefs and practices in some midwifery education and placement settings negatively impact student experience and are likely to result in poorer care being provided to Global Ethnic Majority women and families. An unwillingness among some White educators and students to recognise the presence and impact of inequitable and racist environments, and a lack of clear, acceptable, and effective pathways for students to use to raise and discuss concerns, makes it difficult to challenge and change this injustice.

Determining a common understanding of interprofessional competencies for pre-registration health professionals in Aotearoa New Zealand: A Delphi study

There is growing awareness that factors such as the growing incidence of co-morbidity and increasing complexity of patient health needs cannot be addressed by health professionals practicing in isolation. Given this, there is an increasing emphasis on preparing students in health-related programs for effective interprofessional practice. Less clear, however, are the specific skills and clinical or learning opportunities necessary for students to develop effectiveness in interprofessional practice. These factors drove a team associated with a tertiary health education provider in Hamilton, New Zealand to transform traditional clinical student experiences in the form of an interprofessional student-assisted clinic. The clinic was intended, in part, to provide students with opportunities to learn and experience interprofessionalism in practice but was hampered by limited information available regarding the specific skill requirements necessary for students in New Zealand to learn in this context. In this Delphi study, we synthesize national expert opinion on student competency indicators necessary for effective interprofessional practice. The resultant set of indicators is presented and opportunities for application and further research discussed. The paper offers guidance to others seeking to innovate health curricula, develop novel service-oriented learning experiences for students, and foster interprofessional practice competence in the future health workforce.

Occupational therapists' practice with complex trauma: A profile

INTRODUCTION

Many children in Aotearoa (New Zealand) and Australia experience complex trauma and its developmental impacts. Internationally, occupational therapists work with complex trauma and use sensory-based, integrative, and functional approaches. The practices of occupational therapists in Aotearoa and Australia with children experiencing complex trauma have not previously been described.

METHODS

This article reports the quantitative results of a mixed-methods study which profiled occupational therapists' practice in Aotearoa and Australia with children aged 0 to 12 years old who experienced complex trauma. Twenty-five participants completed the survey. The average age of participants was 43 years (SD = 10.65), all were female (n = 25), and most identified as New Zealand European (n = 11) or Australian European (n = 9). A survey was distributed via Occupational Therapy New Zealand - Whakaora Ngangahau Aotearoa and Occupational Therapy Australia.

RESULTS

The majority of participants had a bachelor's degree (64%) and worked in community settings (76%). Fourteen participants (56%) used sensory approaches. The most common assessments used were those of sensory processing (n = 12, 48%) and observation (n = 12, 48%). The Sensory Profile was the most popular standardised assessment (n = 8, 32%). The most common interventions used with children experiencing complex trauma were sensory (n = 13, 52%) and play based (n = 13, 52%). Most participants reported not adapting their practices for Māori or Aboriginal children. Most participants felt somewhat prepared (n = 15) for working with complex trauma, with most reporting a lack of experience in this area (n = 10). Supervision was suggested by 92% (n = 23) of the participants.

CONCLUSION

Sensory-based practices were most common among occupational therapists in Aotearoa and Australia who worked with children experiencing complex trauma. The participants suggested supervision, social support, and practical training when working with complex trauma. Advocacy and research are required within this subspecialty, and further professional engagement in the application of culturally safe practice.