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Wiapo C, Adams S, Komene E, Davis J, Clark T. An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand. J Clin Nurs 2024; 33:2936-2948. [PMID: 38716866 DOI: 10.1111/jocn.17205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 07/09/2024]
Abstract
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.
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Affiliation(s)
- Coral Wiapo
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Sue Adams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ebony Komene
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Josephine Davis
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Terryann Clark
- School of Nursing, University of Auckland, Auckland, New Zealand
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Nelson C, Mandrusiak A, Forbes R. Perceived preparedness and training needs of new graduate physiotherapists' working with First Nations Australians. Physiother Theory Pract 2024; 40:1537-1550. [PMID: 36809246 DOI: 10.1080/09593985.2023.2179382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION There is a considerable and ongoing health gap experienced by First Nations Australians. Physiotherapists play an integral role in the health care of this population; however, little is known about new graduate preparedness and training needs to work in a First Nations context. OBJECTIVE To explore the perceptions of new graduate physiotherapists regarding their preparedness and training needs for working with First Nation Australians. METHODS Qualitative telephone, semi-structured interviews of new graduate physiotherapists (n = 13) who have worked with First Nations Australians in the last two years. Inductive, reflexive thematic analysis was used. RESULTS Five themes were generated: 1) limitations of pre-professional training; 2) benefits of work integrated learning; 3) 'on the job' development; 4) intrapersonal factors and efforts; and 5) insights into improving training. CONCLUSION New graduate physiotherapists perceive that their preparedness to work in a First Nations health context is supported by practical and varied learning experiences. At the pre-professional level, new graduates benefit from work integrated learning and opportunities that evoke critical self-reflection. At the professional level, new graduates express a need for 'on the job' development, peer supervision, and tailored professional development, that focuses on the unique perspectives of the specific community in which they work.
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Affiliation(s)
- Curtley Nelson
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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Saunders P. Fulfilling cultural safety expectations in specialist medical education and training: considerations for colleges to advance recognition and quality. Med J Aust 2024; 221:8-12. [PMID: 38946654 DOI: 10.5694/mja2.52317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/18/2024] [Indexed: 07/02/2024]
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de Groot A, Brown B, Lindsay D, Gall A, Hewlett N, Hickman A, Garvey G. 'How Your Spirit Is Travelling'-Understanding First Nations Peoples' Experiences of Living Well with and after Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:798. [PMID: 38929044 PMCID: PMC11203506 DOI: 10.3390/ijerph21060798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
As the number of people living with cancer increases, it is important to understand how people can live well with and after cancer. First Nations people diagnosed with cancer in Australia experience survival disparities relating to health service accessibility and a lack of understanding of cultural needs and lived experiences. This study aimed to amplify the voices of First Nations individuals impacted by cancer and advance the development of a culturally informed care pathway. Indigenist research methodology guided the relational and transformative approach of this study. Participants included varied cancer experts, including First Nations people living well with and after cancer, health professionals, researchers, and policy makers. Data were collected through online Yarning circles and analysed according to an inductive thematic approach. The experience of First Nations people living well with and after cancer is inextricably connected with family. The overall themes encompass hope, family, and culture and the four priority areas included the following: strength-based understanding of cancer, cancer information, access to healthcare and support, and holistic cancer services. Respect for culture is interwoven throughout. Models of survivorship care need to integrate family-centred cancer care to holistically support First Nations people throughout and beyond their cancer journey.
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Affiliation(s)
- Anneliese de Groot
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- Australian Institute of Health Innovation, Macquarie University, Sydney 2113, Australia
| | - Bena Brown
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Brisbane 4077, Australia
| | - Daniel Lindsay
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Alana Gall
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
| | - Nicole Hewlett
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
| | - Amy Hickman
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Gail Garvey
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (B.B.); (D.L.); (A.G.); (N.H.); (A.H.); (G.G.)
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Hurley J, Longbottom P, Bennett B, Yoxall J, Hutchinson M, Foley KR, Happell B, Parkes J, Currey K. Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review. Aust J Rural Health 2024; 32:462-474. [PMID: 38572866 DOI: 10.1111/ajr.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. OBJECTIVE To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. DESIGN A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010-2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. FINDINGS Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. DISCUSSION The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. CONCLUSION A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.
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Affiliation(s)
- John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Paula Longbottom
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Bindi Bennett
- Federation University, Ballarat, Victoria, Australia
| | - Jacqui Yoxall
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kitty-Rose Foley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Jill Parkes
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kate Currey
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Cowley S, Baigrie K, Panaretto K, Trudgen K, Clements V, Whitehead O, Lacey R. Empowering our First Nations workforce: evaluation of a First Nations COVID-19 vaccination training program. Aust J Prim Health 2024; 30:NULL. [PMID: 38104344 DOI: 10.1071/py23027] [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: 02/24/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND A COVID-19 vaccination training program was designed for Aboriginal and Torres Strait Islander (First Nations) health workers and practitioners in Queensland to expand their scope of practice to include COVID-19 immunisation. In the setting of a global pandemic, the project aimed to improve vaccination levels and show how First Nations staff are central to community-led responses to effectively address their community's health needs. METHODS The program, consisting of an online module and face to face workshop, is described and then evaluated with the RE-AIM framework via mixed methods of participant training surveys and qualitative feedback. RESULTS The program reached 738 online and 329 workshop participants with the majority identifying as First Nations. The 52 workshops were attended by participants from 12 different hospital and health services in Queensland and 13 Aboriginal Community Controlled Health Organisations (ACCHOs). Feedback was positive, with participants rating the training highly. Of the First Nations Health Workers and Practitioners who responded to the workshop follow up survey, the majority (34/40) implemented their new skills in practice helping minimise the impact of COVID-19 outbreaks in their community. Most respondents (38/40) considered vaccination should be permanently in their scope of practice. CONCLUSIONS The successful implementation of the vaccination training project was an example of First Nations led health care. Improving scope of practice for First Nations health staff can improve not just career retention and progression but also the delivery of primary care to a community that continues to bear the inequity of poorer health outcomes.
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Affiliation(s)
- Sean Cowley
- Office of First Nations Health, Queensland Health, Brisbane, QLD 4000, Australia
| | - Karina Baigrie
- Office of First Nations Health, Queensland Health, Brisbane, QLD 4000, Australia; and Cunningham Centre, Darling Downs Health, Toowoomba, QLD 4350, Australia
| | - Katie Panaretto
- Office of First Nations Health, Queensland Health, Brisbane, QLD 4000, Australia; and Darling Downs Health, Toowoomba, QLD 4350, Australia
| | - Kelly Trudgen
- Office of First Nations Health, Queensland Health, Brisbane, QLD 4000, Australia
| | - Vanessa Clements
- Office of First Nations Health, Queensland Health, Brisbane, QLD 4000, Australia
| | - Oscar Whitehead
- Torres and Cape Hospital and Health Service, Cairns, QLD 4870, Australia
| | - Rica Lacey
- Darling Downs Health, Toowoomba, QLD 4350, Australia
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Brown JA, Harvey CL, Byrne AL, Hegney DG. Nurse and midwife navigator resilience, well-being, burnout, and turnover intent: A multi-methods study. Public Health Nurs 2024; 41:77-89. [PMID: 37787742 DOI: 10.1111/phn.13256] [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: 03/14/2023] [Revised: 09/04/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To explore levels of Navigator resilience, well-being, burnout, and turnover intent. DESIGN A longitudinal, multi-methods study concurrently collected quantitative and qualitative data over three years. METHODS A survey and Action Learning Groups. FINDINGS No statistically significant change in resilience, well-being, burnout, or turnover intent. Supports, self-care and leaving the position, were used to maintain well-being. CONCLUSIONS While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well-being. Recommendations for nurses working in Navigator, or similar community/public health roles include work-based programs targeting support, good leadership, governance systems including their impact on turnover intent. CLINICAL EVIDENCE Job turnover intent can be used as a mechanism to monitor resilience and well-being.
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Affiliation(s)
- Janie A Brown
- Curtin University and Senior Research Fellow St John of God Midland Public and Private Hospitals, Perth, Australia
| | | | - Amy-Louise Byrne
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Townsville, Australia
| | - Desley G Hegney
- School of Nursing, University of Adelaide, Adelaide, Australia
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Brooks D, Johnston S, Parker C, Cox L, Brodie M, Radbourne C, MacAndrew M. Elements of Long-Term Care That Promote Quality of Life for Indigenous and First Nations Peoples: A Mixed Methods Systematic Review. THE GERONTOLOGIST 2024; 64:gnac153. [PMID: 36239454 PMCID: PMC10733124 DOI: 10.1093/geront/gnac153] [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: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Deborah Brooks
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sandra Johnston
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christina Parker
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Leonie Cox
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melissa Brodie
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Catherine Radbourne
- Library Services, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret MacAndrew
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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Parter C, Gwynn J, Wilson S, Skinner JC, Rix E, Hartz D. Putting Indigenous Cultures and Indigenous Knowledges Front and Centre to Clinical Practice: Katherine Hospital Case Example. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:3. [PMID: 38276792 PMCID: PMC10815878 DOI: 10.3390/ijerph21010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
The inclusion of Indigenous cultures, known as the cultural determinants of health, in healthcare policy and health professional education accreditation and registration requirements, is increasingly being recognised as imperative for improving the appalling health and well-being of Indigenous Australians. These inclusions are a strengths-based response to tackling the inequities in Indigenous Australians' health relative to the general population. However, conceptualising the cultural determinants of health in healthcare practice has its contextual challenges, and gaps in implementation evidence are apparent. In this paper, we provide a case example, namely the Katherine Hospital, of how healthcare services can implement the cultural determinants of health into clinical practice. However, to be effective, health professionals must concede that Australia's Indigenous peoples' knowledges involving cultural ways of being, knowing and doing must co-exist with western and biomedical knowledges of health practice. We use the Katherine Hospital ABC Radio National Background Briefing interview, which was mentioned by two research participants in a 2020 study, as an example of good practice that we can learn from. Additionally, the six Aboriginal and Torres Strait Islander Health actions contained in the 2nd Edition of the Australian National Safety and Quality Health Service Standards provide governance and accountability examples of how to enable Indigenous people's cultures and their knowledges in the provision of services. The role of non-Indigenous clinical allies and accomplices is imperative when embedding and enacting Indigenous Australians' cultures in service systems of health. When Indigenous Peoples access mainstream hospitals, deep self-reflection by allies and accomplices is necessary to enable safe, quality care, and treatment that is culturally safe and free from racism. Doing so can increase cultural responsiveness free of racism, thereby reducing the inherent power imbalances embedded within mainstream health services.
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Affiliation(s)
- Carmen Parter
- Djurali Centre for Aboriginal & Torres Strait Islander Education and Health Research, Heart Research Institute, Newtown, NSW 2042, Australia;
| | - Josephine Gwynn
- Charles Perkins Centre, Faculty of Health Sciences, University of Sydney, Sydney, NSW 2006, Australia;
| | - Shawn Wilson
- Department of Community, Culture and Global Studies, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - John C. Skinner
- Djurali Centre for Aboriginal & Torres Strait Islander Education and Health Research, Heart Research Institute, Newtown, NSW 2042, Australia;
| | - Elizabeth Rix
- Adelaide Nursing School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Donna Hartz
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
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Hosking K, De Santis T, Vintour-Cesar E, Wilson PM, Bunn L, Gurruwiwi GG, Wurrawilya S, Bukulatjpi SM, Nelson S, Ross C, Binks P, Schroder P, Davis JS, Taylor S, Connors C, Davies J. "The most culturally safe training I've ever had": the co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia. BMC Health Serv Res 2023; 23:935. [PMID: 37653370 PMCID: PMC10472722 DOI: 10.1186/s12913-023-09902-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The Aboriginal health workforce provide responsive, culturally safe health care. We aimed to co-design a culturally safe course with and for the Aboriginal health workforce. We describe the factors which led to the successful co-design, delivery, and evaluation of the "Managing hepatitis B" course for the Aboriginal health workforce. METHODS A Participatory Action Research approach was used, involving ongoing consultation to iteratively co-design and then develop course content, materials, and evaluation tools. An Aboriginal and Torres Strait Islander research and teaching team received education in chronic hepatitis B and teaching methodologies. Pilot courses were held, in remote communities of the Northern Territory, using two-way learning and teach-back methods to further develop the course and assess acceptability and learnings. Data collection involved focus group discussions, in-class observations, reflective analysis, and use of co-designed and assessed evaluation tools. RESULTS Twenty-six participants attended the pilot courses. Aboriginal and Torres Strait Islander facilitators delivered a high proportion of the course. Evaluations demonstrated high course acceptability, cultural safety, and learnings. Key elements contributing to success and acceptability were acknowledging, respecting, and integrating cultural differences into education, delivering messaging and key concepts through an Aboriginal and Torres Strait Islander lens, using culturally appropriate approaches to learning including storytelling and visual teaching methodologies. Evaluation of culturally safe frameworks and findings from the co-design process led to the creation of a conceptual framework, underpinned by meeting people's basic needs, and offering a safe and comfortable environment to enable productive learning with attention to the following: sustenance, financial security, cultural obligations, and gender and kinship relationships. CONCLUSIONS Co-designed education for the Aboriginal health workforce must embed principles of cultural safety and meaningful community consultation to enable an increase in knowledge and empowerment. The findings of this research can be used to guide the design of future health education for First Nations health professionals and to other non-dominant cultures. The course model has been successfully transferred to other health issues in the Northern Territory.
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Affiliation(s)
- Kelly Hosking
- Northern Territory Health, Darwin, NT, Australia.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | | | - Emily Vintour-Cesar
- Northern Territory Health, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Linda Bunn
- Northern Territory Health, Darwin, NT, Australia
| | - George Garambaka Gurruwiwi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Miwatj Aboriginal Health Corporation, Nhulunbuy, East Arnhem Land, Northern Territory, Australia
| | | | | | | | - Cheryl Ross
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Phoebe Schroder
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, NSW, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- John Hunter Hospital, Newcastle, NSW, Australia
| | - Sean Taylor
- Northern Territory Health, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Jane Davies
- Northern Territory Health, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Jennings W, Egert S, Fisher C, Renouf S, Bryce V, Grugan S, Wang W, Askew D. Better cardiac care - the patient experience - a qualitative study. Int J Equity Health 2023; 22:122. [PMID: 37380998 DOI: 10.1186/s12939-023-01931-5] [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: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND In 2015, a Brisbane tertiary hospital's cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients' voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members. METHODS This descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones' hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants' stories to be heard and understood from their perspectives. RESULTS Relationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys. CONCLUSIONS Empowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient's needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality.
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Affiliation(s)
- Warren Jennings
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, Inala, Qld, 4077, Australia.
- General Practice Clinical Unit, The University of Queensland, Women's Hospital, Level 8, Health Sciences Building, Royal Brisbane, Brisbane, Qld, 4029, Australia.
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, Inala, Qld, 4077, Australia
| | - Celestine Fisher
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Sonia Renouf
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Vivian Bryce
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Sean Grugan
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - William Wang
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
- Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Deborah Askew
- General Practice Clinical Unit, The University of Queensland, Women's Hospital, Level 8, Health Sciences Building, Royal Brisbane, Brisbane, Qld, 4029, Australia
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Biles J, Deravin L, McMillan Am F, Anderson J, Sara G, Biles B, Biles B. Aboriginal and Torres Strait Islander nurses and midwives culturally safe mentoring programmes in Australia: A scoping review. Contemp Nurse 2023:1-11. [PMID: 36734665 DOI: 10.1080/10376178.2023.2175700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective/Aim: To examine the experiences of culturally safe mentoring programmes described by Aboriginal and Torres Strait Islander nurses and midwives in Australia.Design: A systematic scoping review.Data Sources: The following databases were accessed: CINAHL Plus with Full Text (EBSCO), EMCARE (Ovid), MEDLINE (Ovid), INFORMIT (Health Collection/Indigenous Collection) and SCOPUS. Support relating to key words and appropriate databases was provided by a university librarian.Review Methods: Search terms across databases were sourced from 1997-2021, identifying a total of 161 papers. Title/abstract searches were screened against the inclusion/exclusion criteria, resulting in 18 papers reaching full-text review. Of the 18 full-text papers reviewed, six were eligible for inclusion in the final review.Results/Findings: Culturally safe mentorship was a positive experience for Aboriginal and Torres Strait Islander nurses and midwives. Thematic discussion identified three key themes: Mentorship as a way forward, Culture in mentorship, and Cultural safety's role in mentorship.Discussion: Culturally safe mentoring has been a key recommendation in the nursing literature for over 20 years. There is limited knowledge on what constitutes an effective programme as mentoring programmes have not been empirically evaluated or reviewed.Conclusion: This review provides evidence that Cultural Safety and the exploration of culture impact culturally safe mentoring and can impact workforce cultural capability.Impact Statement: This review indicates that culturally safe mentoring has been a key recommendation in nursing literature for over 20 years. This review provides evidence that Cultural Safety and the exploration of culture impact culturally safe mentoring and can impact workforce cultural capability. However, there is limited knowledge of what constitutes an effective programme, as mentoring programmes have not been empirically evaluated or reviewed providing an opportunity for further research.Plain Language Summary: Little is known about Aboriginal and Torres Strait Islander nurses' and midwives' perspectives of culturally safe mentoring programmes in Australia. However, mentoring programme are seen as a key workforce retention strategy. This scoping review aims to explore and interpret Aboriginal and Torres Strait Islander nurses' and midwives' perspectives of culturally safe mentoring programmes in Australia. This review concludes that mentoring programmes require content in Cultural Safety and that programmes need to be empirically evaluated.
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Affiliation(s)
- Jessica Biles
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Albury, Australia
| | - Linda Deravin
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Albury, Australia
| | - Faye McMillan Am
- School of Public Health, University of Technology Sydney, Australia
| | - Judith Anderson
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Albury, Australia
| | | | - Brett Biles
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Brett Biles
- Charles Sturt University, School of Nursing, Paramedicine and Healthcare Sciences, Albury, NSW Australia
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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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14
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Sanjida S, Garvey G, Ward J, Bainbridge R, Shakeshaft A, Hadikusumo S, Nelson C, Thilakaratne P, Hou XY. Indigenous Australians' Experiences of Cancer Care: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416947. [PMID: 36554828 PMCID: PMC9779788 DOI: 10.3390/ijerph192416947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 05/31/2023]
Abstract
To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples' cancer care experiences in the Australian healthcare system from the patient's point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.
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Affiliation(s)
- Saira Sanjida
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Gail Garvey
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Anthony Shakeshaft
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Stephanie Hadikusumo
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
- Royal Brisbane and Women’s Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Carmel Nelson
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
| | - Prabasha Thilakaratne
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
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15
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Cunningham FC, Murphy MG, Ward G, Fagan R, Arley B, Hornby-Turner YC, d'Abbs PH. Impact of an Aboriginal and Torres Strait Islander brief intervention training program on health staff participants' own health behaviours: smoking, nutrition and physical activity. Health Promot J Austr 2022; 33 Suppl 1:235-245. [PMID: 35661321 DOI: 10.1002/hpja.628] [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: 02/02/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Abstract
ISSUE Little research has been conducted on the impact of Aboriginal and Torres Strait Islander brief intervention training programs on health staff participants' own health behaviours. Through the Queensland B.strong program (2017-2020), brief intervention training in smoking cessation, nutrition and physical activity was provided to the Aboriginal and Torres Strait Islander health workforce and other health and community professionals. This study examined the program's impact on participants' own health behaviours. METHODS Data were collected through four surveys (pre-and post-training workshop, and 3-month and 6-month follow-up) of the 1,131 participants in B.strong training workshops from June 2017 to August 2019. Surveys included items on participants' own health behaviours. Pre- and post-workshop surveys were paper-based, and follow-up surveys were completed online. For the analysis of data reported in this paper, paired-samples t-tests were used to assess changes between pre-workshop and 3-month follow-up. RESULTS Statistically significant improvements were found between pre-workshop and 3-month follow-up in the number of serves of vegetables or legumes/beans eaten per day, the number of serves of fruit eaten per day, and in time spent in physical activity. However, there was: no statistically significant change in smoking status, with baseline rates being relatively low; a statistically significant increase in consumption of sugary drinks, and of take-away foods; a non-significant increase in consumption of snack foods; and no significant change in sedentary behaviour of participants. CONCLUSION While some positive changes in participants' own health behaviours in nutrition and physical activity were associated with the B.strong program, there was no change in their smoking behaviour. SO WHAT This study found that some improvements in participants' own health behaviours were associated with the B.strong program. This research may inform future Indigenous brief intervention training programs and health services on how to promote healthy behaviours for health staff themselves.
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Affiliation(s)
- Frances C Cunningham
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| | - Majella G Murphy
- Molly Wardaguga Research Centre, Charles Darwin University, Level 11, East Tower, 410 Ann St., Brisbane City Qld, Australia
| | - Grace Ward
- Diabetes Australia Queensland, 29 Finchley St., Milton Qld 4064, Australia
| | - Royden Fagan
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| | - Brian Arley
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| | - Yvonne C Hornby-Turner
- College of Medicine and Dentistry, James Cook University, Cairns Qld Australia, Room 003A, E Block, Health and Sciences Building, Nguma-Bada Campus, James Cook University, McGregor Rd., Smithfield Qld, Australia
| | - Peter H d'Abbs
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
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16
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Knibbs V, Manley S. Being away from home for cancer treatment: a qualitative study of patient experience and supportive care needs during radiation therapy. J Med Radiat Sci 2022; 69:336-347. [PMID: 35373930 PMCID: PMC9442298 DOI: 10.1002/jmrs.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/12/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Supportive care needs (SCN) refer to support required by patients and their families to better cope with cancer. Many rural radiation therapy (RT) patients stay away from home for significant periods, which can lead to the negative effects of both social isolation and cultural disparity. They may demonstrate complex SCN. This study aimed to explore experiences of being away from home by considering patient perspectives of their own SCN. The objectives were to provide a deeper understanding of how these patients think and feel and present a foundation of patient-centred insights for further research. METHODS Thirteen patients participated in semi-structured interviews; all stayed away from home for RT at the North Coast Cancer Institute for >3 days a week for >3 weeks. The data were subject to interpretive phenomenological analysis: a thorough process of understanding and analysis that is accompanied by reflection to improve researcher transparency. RESULTS Two themes influenced patient experiences of their care: values and identity, and expectations. Patients discussed the value they place on rural life, community connections and health care and referred to information for managing expectations. SCN discussed fell into practical, physical and psycho-social needs. CONCLUSIONS Experiences of culturally appropriate patient-centred supportive care improve control and confidence. Patient well-being is influenced by compassionate, caring and respectful connections with others. Several practical ways of managing expectations and promoting the psycho-social well-being of patients are discussed, for example, tailored packing lists and easy access to green spaces. Future research can be shaped by lived experiences.
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Affiliation(s)
- Vanessa Knibbs
- North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Stephen Manley
- North Coast Cancer Institute, Lismore, New South Wales, Australia
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17
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Taylor EV, Lyford M, Parsons L, Holloway M, Gough K, Sabesan S, Thompson SC. Putting Policy into Practice: How Three Cancer Services Perform against Indigenous Health and Cancer Frameworks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020633. [PMID: 35055464 PMCID: PMC8775789 DOI: 10.3390/ijerph19020633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
Abstract
Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.
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Affiliation(s)
- Emma V. Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
- Correspondence: ; Tel.: +61-8-9956-0232
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
| | - Lorraine Parsons
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sabe Sabesan
- Department of Medical Oncology, Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD 4814, Australia;
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia; (M.L.); (L.P.); (M.H.); (S.C.T.)
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18
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Currie GM. Yindyamarra Winhanganha: a Conduit to Indigenous Cultural Proficiency. J Nucl Med Technol 2021; 50:66-72. [PMID: 34330810 DOI: 10.2967/jnmt.121.262436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
The first nation peoples in the USA, Canada, Australia and around the world are substantially disadvantaged by colonialization including health inequity. For nuclear medicine, cultural competence of staff and cultural proficiency of the institution, are important minimum expectations. This can be achieved through a scaffold of Indigenous cultural training and immersion programs that allow the nuclear medicine department to be a culturally safe environment for Indigenous patients. This requires careful planning and inclusivity of Indigenous people as the key stakeholders but, done appropriately, can positively drive the Indigenous equity pipeline. Central to this is an understanding of Indigenous ways of learning and the nexus of these ways of learning and learning taxonomies. There remain substantial gaps between the most culturally insightful and the least insightful (individuals and institutions) that could be addressed, in part, by rich immersive professional development activities in nuclear medicine targeting cultural proficiency and creating culturally safe clinical environments. The opportunity lies before us to provide leadership in nation building and in living respectfully while creating a world worth living in; yindyamarra winhanganha.
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Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. From "stuck" to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital. BMC Health Serv Res 2021; 21:548. [PMID: 34088326 PMCID: PMC8178868 DOI: 10.1186/s12913-021-06564-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019. METHODS This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient's language or English, researcher field notes from shadowing doctors, doctors' reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted. RESULTS The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling "stuck" and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates. CONCLUSIONS A culturally unsafe system which restricted people's ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
- Royal Darwin Hospital, Darwin, Northern Territory 0811 Australia
- Flinders University, Northern Territory Medical Program, Darwin, Northern Australia 0815 Australia
| | - Michelle Walker
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, Northern Territory 0801 Australia
| | - Mandy Ahmat
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, Northern Territory 0801 Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
- Royal Darwin Hospital, Darwin, Northern Territory 0811 Australia
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20
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Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. "The support has been brilliant": experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC Health Serv Res 2021; 21:493. [PMID: 34030670 PMCID: PMC8142293 DOI: 10.1186/s12913-021-06535-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Improving health outcomes for Indigenous people by providing person-centred, culturally safe care is a crucial challenge for the health sector, both in Australia and internationally. Many cancer providers and support services are committed to providing high quality care, yet struggle with providing accessible, culturally safe cancer care to Indigenous Australians. Two Australian cancer services, one urban and one regional, were identified as particularly focused on providing culturally safe cancer care for Indigenous cancer patients and their families. The article explores the experiences of Indigenous cancer patients and their families within the cancer services and ascertains how their experiences of care matches with the cancer services’ strategies to improve care. Methods Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience. Results Eight Indigenous people affected by cancer and 23 hospital staff (Indigenous and non-Indigenous) were interviewed. Three experiences were shared by the majority of Indigenous cancer patients and family members interviewed in this study: a positive experience while receiving treatment at the cancer service; a challenging time between receiving diagnosis and reaching the cancer centre; and the importance of family support, while acknowledging the burden on family and carers. Conclusions This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06535-9.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia.
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Lorraine Parsons
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Toni Mason
- Aboriginal Health Unit, Mission, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
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21
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Carlisle K, Matthews Quandamooka V, Redman-MacLaren M, Vine K, Turner Anmatyerre/Jaru NN, Felton-Busch Yangkaal/Gangalidda C, Taylor J, Thompson S, Whaleboat Meriam Le D, Larkins S. A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services. BMC Health Serv Res 2021; 21:431. [PMID: 33957914 PMCID: PMC8101223 DOI: 10.1186/s12913-021-06383-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. Methods A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. Results A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce). Conclusions These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06383-7.
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Affiliation(s)
- Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia. .,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.
| | | | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Nguma-bada Campus, QLD, Australia
| | - Kristina Vine
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | | | - Catrina Felton-Busch Yangkaal/Gangalidda
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Murtupuni Centre for Rural & Remote Health, James Cook University, Mt Isa, QLD, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | - Sandra Thompson
- Western Australia Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Donald Whaleboat Meriam Le
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
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