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Parrella A, Zagler J, D'Antoine M, Brodie T, Smith K, Watts AM, Ieremia T, Aitken G, Brown A, Pearson O. Workforce training needs to address social and emotional wellbeing in home-based Aboriginal and Torres Strait Islander aged care. AUST HEALTH REV 2024; 48:283-290. [PMID: 38528716 DOI: 10.1071/ah23236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
Objective To explore the training needs of the home care workforce in supporting the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander peoples receiving aged care services through the Home Care Package (HCP) Program. Methods A mixed-methods design including (1) a focus group and interview with coordinators of HCP Program services for Aboriginal and Torres Strait Islander peoples across metropolitan and rural South Australia in April and June 2022, and (2) a desktop review of training, professional development opportunities and resources for existing and pre-entry workforce addressing the SEWB of Aboriginal and Torres Strait Islander peoples in aged care across the Vocational Education Training and higher education sectors in South Australia, the Australian Indigenous HealthInfoNet, the Department of Health and Aged Care website and aged care email alerts between December 2021 and September 2022. Results Five themes representing workforce training needs were identified: cultural safety, trauma-informed care, case management, compliance with funding rules and preferred formats for training. The desktop review identified a paucity of formal training, professional development and resources within the context of addressing the SEWB of Aboriginal and Torres Strait Islander peoples in aged care. Conclusions These findings suggest that ongoing practice-based professional development learning opportunities are needed within organisations to enhance peer-learning and support. These need to be available together with dedicated formal training programs and practical resources on meeting Aboriginal and Torres Strait Islander peoples' SEWB in aged care.
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Affiliation(s)
- Adriana Parrella
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Jonathon Zagler
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Matilda D'Antoine
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, WA, Australia
| | - Aunty Martha Watts
- South Australian Stolen Generations Aboriginal Corporation, Salisbury Downs, SA, Australia
| | | | - Graham Aitken
- Aboriginal Community Services, Mile End, SA, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; and Indigenous Genomics Group, Telethon Kids Institute, Perth, WA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
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Dawe R, Penashue J, Benuen MP, Qupee A, Pike A, van Soeren M, Sturge Sparkes C, Winsor M, Walsh KH, Hasan H, Pollock N. Patshitinikutau Natukunisha Tshishennuat Uitshuau (a place for Elders to spend their last days in life): a qualitative study about Innu perspectives on end-of-life care. BMC Palliat Care 2024; 23:121. [PMID: 38760796 PMCID: PMC11100191 DOI: 10.1186/s12904-024-01431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Indigenous palliative persons and their families often have different values, spiritual traditions, and practices from Western culture and Canadian health systems. Additionally, many healthcare policies and practices have been established without adequate consultation of the Indigenous populations they are meant to serve. This can result in barriers to Innu receiving culturally safe end-of-life care. Innu community leaders from Sheshatshiu, Labrador, have identified a need for further research in this area. The purpose of this study is to: (1) describe the cultural and spiritual practices related to death and dying of the Innu in Sheshatshiu; (2) identify aspects of current end-of-life care delivery that serve and/or fail to meet the cultural and spiritual needs of the Innu in Sheshatshiu; and (3) explore ways to integrate current end-of-life care delivery practices with Innu cultural and spiritual practices to achieve culturally safer care delivery for the Innu. METHODS This qualitative patient-oriented research study was co-led by Innu investigators and an Innu advisory committee to conduct semi-structured interviews of 5 healthcare providers and 6 decision-makers serving the community of Sheshatshiu and a focus group of 5 Innu Elders in Sheshatshiu. Data was analyzed thematically from verbatim transcripts. The codebook, preliminary themes, and final themes were all reviewed by Innu community members, and any further input from them was then incorporated. Quotations in this article are attributed to Innu Elders by name at the Elders' request. RESULTS The findings are described using eight themes, which describe the following: relationships and visitation support a "peaceful death"; traditional locations of death and dying; the important role of friends and community in providing care; flexibility and communication regarding cultural practices; adequate and appropriate supports and services; culturally-informed policies and leadership; and Innu care providers and patient navigators. CONCLUSIONS The Innu in Sheshatshiu have a rich culture that contributes to the health, care, and overall well-being of Innu people approaching end of life. Western medicine is often beneficial in the care that it provides; however, it becomes culturally unsafe when it fails to take Innu cultural and spiritual knowledge and traditions into account.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nathaniel Pollock
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, Canada
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3
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Thomas K, Dettwiller P, Gonzalez-Chica D. Who cares about Aboriginal Aged Care? Evidence of home care support needs and use in rural South Australia. Aust J Rural Health 2023. [PMID: 37154266 DOI: 10.1111/ajr.12992] [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: 04/22/2022] [Revised: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To assess awareness, needs and use of Australian Government-funded home aged care services among Aboriginal and Torres Strait Islander Peoples from rural and remote South Australia. DESIGN Mixed-method study. SETTING Four rural and remote communities with a higher proportion of Aboriginal populations (Ceduna, Port Augusta, Port Lincoln and Whyalla). PARTICIPANTS Fifty Aboriginal peoples aged 50-89 years (68% females) interviewed between August 2020 and October 2021. MAIN OUTCOME MEASURES Participant awareness, needs and unmet needs. RESULTS 88% of the participants indicated they needed home care support with daily activities (median number of needs = 3; interquartile range 2-6 needs), especially housework (86%) and transportation (59%). However, only 41% of those reporting current needs were receiving home care services. The most prevalent unmet needs were allied health (87%), housework (79%), help with meals/meals preparation (76%), shopping (73%) and personal care (73%). Overall, 62% of the participants were unaware of the Commonwealth Home Support Programme, and 54% were unaware of the Home Care Packages program. Qualitative data showed participants felt there is insufficient information and public consultation about these services for older Aboriginal adults. Regular communication in group activities was the preferable approach to becoming aware of these services rather than websites, posted materials or phone calls. CONCLUSION Further work is needed to increase home aged care service access for Aboriginal and Torres Strait Islander Peoples living in rural and remote settings. Promotion of these programmes through local group activities could facilitate access to these services and facilitate community engagement in decision-making.
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Affiliation(s)
- Kym Thomas
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Pascale Dettwiller
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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4
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Panozzo S, Bryan T, Mason T, Garvey G, Lethborg C, Boughey M, Philip JA. Bridging cultures in palliative care: A qualitative study of the care of Indigenous Australians with advanced illness. Palliat Med 2023; 37:498-507. [PMID: 36645146 DOI: 10.1177/02692163221137929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Lack of access, late engagement and limited referral for palliative care remain critical issues in supporting Indigenous Australians with life limiting illness. AIM To explore the experiences and perspectives of Indigenous and non-Indigenous health professionals regarding the provision of palliative care for Indigenous people with advanced disease. DESIGN Qualitative study involving semi-structured focus groups/interviews with analysis following an inductive thematic approach. SETTING/PARTICIPANTS A purposive sample (n = 54) of medical, nursing, allied health and Indigenous Hospital Liaison Officers engaged in caring for Indigenous patients at a metropolitan teaching hospital in Australia. RESULTS Four overarching themes were identified regarding provision of palliative care for Indigenous patients. These were (1) the intersection of cultures - Indigenous peoples, health and palliative care, (2) bridging the cultural divide: the integral role of Indigenous Hospital Liaison Officers, (3) health professionals devolve their responsibility to provide culturally appropriate care and (4) building towards a more holistic, culturally aware provision of palliative care. CONCLUSIONS For many Indigenous people, the health system may be experienced as inflexible, narrowly focused and even prejudiced and traumatising. For Indigenous patients at the end of life, these challenges are heightened. The Indigenous Hospital Liaison Officers, working at the intersections of these two cultures, are key to negotiating such challenges as they seek opportunities to facilitate communication and understanding between firmly held cultural needs.
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Affiliation(s)
- Stacey Panozzo
- Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Tamsin Bryan
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Gail Garvey
- Inclusive Health, St Vincent's Health Australia, Brisbane, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Carrie Lethborg
- Department of Social Work, St Vincent's Hospital Melbourne, Melbourne, Australia.,Centre for Rural Health, University of Tasmania, Tasmania, Australia
| | - Mark Boughey
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jennifer A Philip
- Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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5
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Chakanyuka C, Bacsu JDR, DesRoches A, Dame J, Carrier L, Symenuk P, O'Connell ME, Crowshoe L, Walker J, Bourque Bearskin L. Indigenous-specific cultural safety within health and dementia care: A scoping review of reviews. Soc Sci Med 2021; 293:114658. [PMID: 34942579 DOI: 10.1016/j.socscimed.2021.114658] [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: 08/24/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
Globally, health inequities experienced by Indigenous communities are often described and documented in terms of deficits and disease. However, health disparities are complex and involve numerous underlying issues beyond the social determinants of health. Indigenous Peoples face unique barriers to accessing culturally safe and equitable healthcare, including racism, systemic injustice, and a historical legacy of colonialism. There is a paucity of knowledge on Indigenous-specific cultural safety interventions to support health and dementia care. The objective of this scoping review of reviews was to appraise the existing literature to identify key elements, conceptualizations, and interventions of cultural safety to improve health services and dementia care for Indigenous Peoples. Guided by Indigenous principles of relationality, we conducted a scoping review of reviews published between January 2010 to December 2020. We searched CINAHL, PubMed, Scopus, Web of Science, and Google Scholar. Given the limited literature focusing specifically on Indigenous people with dementia, our inclusion criteria focused broadly on Indigenous cultural safety in healthcare. A collaborative and relational rights-based approach co-led by Indigenous cisgender, Two-Spirit, and non-Indigenous cisgender health care providers was used to re-center Indigenous ways of knowing. A total of seventeen articles met our inclusion criteria. Our review identified a range of cultural safety themes from education initiatives to collaborative partnerships with Indigenous communities. Themes emerged at three levels: person-centered/individual level, health practitioner/student level, and healthcare organizational level. Few reviews described specific interventions, implementation strategies, evaluation methods, or the concept of sex and gender to improve cultural safety in healthcare delivery. Findings from this review can help to inform future research, inspire innovative collaborative methodologies, and enhance cultural safety interventions. In moving forward, there is an urgent need for anti-racism education, self-determination, and authentic partnerships to achieve Indigenous-specific cultural safety inclusive of sex and gender considerations in health and dementia care.
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Affiliation(s)
- Christina Chakanyuka
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8V 2Y2, Canada.
| | - Juanita-Dawne R Bacsu
- Department of Psychology, Rural Dementia Action Research (RaDAR) Team, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, SK, S7N 4N3, Canada.
| | - Andrea DesRoches
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Jessy Dame
- Independent Researcher/Community Partner, Vancouver, BC, Canada.
| | - Leah Carrier
- School of Nursing, Dalhousie University, Halifax, NS, B3H 3J5, Canada.
| | - Paisly Symenuk
- Independent Researcher/Community Partner, Edmonton, AB, Canada.
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Lynden Crowshoe
- Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary Alberta, T2N 1N4, Canada.
| | - Jennifer Walker
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, P3E 2C6, Canada.
| | - Lisa Bourque Bearskin
- School of Nursing, Thompson Rivers University, 840 College Way, 272A, Kamloops, V2C 0C8, British Columbia, Canada.
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Parrella A, Pearson O, Davy C, Barrie H, Mott K, Morey K, D'Angelo S, Sambo R, Aitken R, Franks C, Canuto K, Brown A, Braunack-Mayer A. Understanding culturally safe aged care from the perspectives of older Aboriginal Australians in rural and remote communities. Health Promot J Austr 2021; 33:566-575. [PMID: 34529305 DOI: 10.1002/hpja.541] [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: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Aboriginal and Torres Strait Islander peoples face challenges in accessing aged care and are less likely to use some services than their non-Indigenous counterparts. Culturally safe care is increasingly recognised as an enabler to improve access and quality of care. This study explored older Aboriginal peoples' perceptions and experience of culturally safe aged care. METHODS We conducted semi-structured interviews with sixty-three older Aboriginal people, purposively sampled from three rural and remote geographic locations in South Australia, between April and October 2018, with participants who were both receiving and not receiving aged care services. We asked participants how organisations do or could meet their aged care needs. We analysed interview data inductively into themes. These themes were incorporated into six principles of culturally safe aged care which were subsequently endorsed by participants and study stakeholders. RESULTS Participants described culturally safe aged care services as those which facilitated or maintained connection to participants' culture, traditional lands and community. Five themes were identified: maintaining cultural identity, culturally informed service delivery, culturally competent workforce, culturally supportive environments and partnerships and collaboration within the aged care service system. CONCLUSION Addressing cultural safety in aged care will require organisations to adapt their policies, service delivery, environments and work practices to meet the needs of older Aboriginal peoples. SO WHAT? Identifying culturally safe aged care from the perspectives of older Aboriginal and Torres Strait Islander peoples provides timely insight to how services may be better designed and implemented to promote quality of life.
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Affiliation(s)
- Adriana Parrella
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carol Davy
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Helen Barrie
- The Australian Alliance for Social Enterprise, UniSA Business, University of South Australia, Adelaide, South Australia, Australia
| | - Kathy Mott
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Shane D'Angelo
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Roxanne Sambo
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Richard Aitken
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Christine Franks
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kootsy Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Annette Braunack-Mayer
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Social Sciences, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.,Faculty of Health and Medical Sciences, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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7
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Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliat Care 2019; 18:21. [PMID: 30764810 PMCID: PMC6376644 DOI: 10.1186/s12904-019-0404-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. Methods We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts. Results The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. Discussion Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. Conclusions Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.
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Affiliation(s)
- Kaela Schill
- Cumming School of Medicine, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Susana Caxaj
- School of Nursing, Faculty of Health and Social Development, Okanagan Campus, University of British Columbia, Kelowna, British Columbia, Canada
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Arkles R, Jankelson C, Radford K, Jackson Pulver L. Family caregiving for older Aboriginal people in urban Australia: Disclosing worlds of meaning in the dementia experience. DEMENTIA 2018; 19:397-415. [PMID: 29877735 DOI: 10.1177/1471301218776761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia in Australia’s Aboriginal and Torres Strait Islander population is an area of significant health and community concern. In this article, we use a hermeneutic mode of interpretation to deepen understanding of experience and meaning in dementia for family carers of older Aboriginal people in urban Australia. Specifically, we draw from the hermeneutic concept of “world disclosure” to illuminate the dementia experience in three ways: through an artwork of the brain and dementia; through concrete description of the lived relation of caregiving; and through an epochal perspective on the significance of contemporary caregiving in dementia. Using narrative and visual knowledge, this three-fold approach brings to the forefront the importance of ontological and existential meanings which resonate for Aboriginal families in the dementia caregiving experience.
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Affiliation(s)
- Rachelle Arkles
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Claire Jankelson
- Macquarie Graduate School of Management, Macquarie University, Sydney, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Jackson Pulver
- Public Health Epidemiologist, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliat Care 2018; 17:72. [PMID: 29739457 PMCID: PMC5938813 DOI: 10.1186/s12904-018-0325-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. Electronic supplementary material The online version of this article (10.1186/s12904-018-0325-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shaouli Shahid
- Centre for Aboriginal Studies (CAS), Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.
| | - Emma V Taylor
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Shelley Cheetham
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - John A Woods
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Australia.,Institute for Health Research, Notre Dame University, Fremantle, WA, 6160, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
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10
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Caxaj CS, Schill K, Janke R. Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e329-e336. [PMID: 28703394 DOI: 10.1111/hsc.12469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
We carried out a scoping review to identify key priorities and challenges relevant to rural Indigenous palliative care stated in existing literature. Our scoping review activities followed Arskey and O'Malley's principles for conducting a scoping review. We included peer-reviewed literature from MEDLINE, CINAHL and EMBASE that included a discussion of Indigenous populations, palliative care, and rural settings, and did not use date limits. The literature search was conducted in April 2016, and the retrieved literature was screened for relevance and appropriateness April 2016-March of 2017. In addition to the academic literature, a scan of the grey literature was conducted in March 2017. The retrieved grey literature was screened for relevance and reviewed by a team from a provincial health authority serving Indigenous peoples to ensure relevance in a rural BC setting. Once reviewed for relevance and appropriateness, we added four reports to supplement our analysis. Ultimately, 44 peer-reviewed articles and 4 pieces of grey literature met our inclusion criteria and were included in the review. Our analysis revealed several challenges and priorities relevant to rural Indigenous palliative care. Key challenges included: (i) environmental and contextual issues; (ii) institutional barriers; and (iii) interpersonal dynamics challenging client/clinician interactions. Priorities included: (i) family connections throughout the dying process; (ii) building local capacity for palliative care to provide more relevant and culturally appropriate care; and (iii) flexibility and multi-sectoral partnerships to address the complexity of day-to-day needs for patients/families. These findings point to several areas for change and action that can improve the relevance, access and comprehensiveness of palliative care programming for rural Indigenous communities in Canada and elsewhere. Taking into account of the diversity and unique strengths of each Indigenous community will be vital in developing sustainable and meaningful change.
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Affiliation(s)
- C Susana Caxaj
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Kaela Schill
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Graduate Studies, Community Health Sciences, The University of Calgary, Calgary, Alberta, Canada
| | - Robert Janke
- Library, The University of British Columbia, Kelowna, British Columbia, Canada
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Kinchin I, Mccalman J, Bainbridge R, Tsey K, Lui FW. Does Indigenous health research have impact? A systematic review of reviews. Int J Equity Health 2017; 16:52. [PMID: 28327137 PMCID: PMC5361858 DOI: 10.1186/s12939-017-0548-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander Australians (hereafter respectfully Indigenous Australians) claim that they have been over-researched without corresponding research benefit. This claim raises two questions. The first, which has been covered to some extent in the literature, is about what type(s) of research are likely to achieve benefits for Indigenous people. The second is how researchers report the impact of their research for Indigenous people. This systematic review of Indigenous health reviews addresses the second enquiry. Methods Fourteen electronic databases were systematically searched for Indigenous health reviews which met eligibility criteria. Two reviewers assessed their characteristics and methodological rigour using an a priori protocol. Three research hypotheses were stated and tested: (1) reviews address Indigenous health priority needs; (2) reviews adopt best practice guidelines on research conduct and reporting in respect to methodological transparency and rigour, as well as acceptability and appropriateness of research implementation to Indigenous people; and (3) reviews explicitly report the incremental impacts of the included studies and translation of research. We argue that if review authors explicitly address each of these three hypotheses, then the impact of research for Indigenous peoples’ health would be explicated. Results Seventy-six reviews were included; comprising 55 journal articles and 21 Australian Government commissioned evidence review reports. While reviews are gaining prominence and recognition in Indigenous health research and increasing in number, breadth and complexity, there is little reporting of the impact of health research for Indigenous people. This finding raises questions about the relevance of these reviews for Indigenous people, their impact on policy and practice and how reviews have been commissioned, reported and evaluated. Conclusions The findings of our study serve two main purposes. First, we have identified knowledge and methodological gaps in documenting Indigenous health research impact that can be addressed by researchers and policy makers. Second, the findings provide the justification for developing a framework allowing researchers and funding bodies to structure future Indigenous health research to improve the reporting and assessment of impact over time. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0548-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina Kinchin
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia. .,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia.
| | - Janya Mccalman
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Roxanne Bainbridge
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Komla Tsey
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Felecia Watkin Lui
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
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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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