Seeking paths to culturally competent health care: lessons from two Saskatchewan Aboriginal communities.

The Southern Saskatchewan/Urban Aboriginal Health Coalition is an interdisciplinary, intersectoral team of researchers and communities dedicated to exploring culturally respectful care in Aboriginal communities. Through a community-based research approach, the communities and the Coalition used sharing circles to determine the key elements that 2 Saskatchewan Aboriginal communities see as requisite for culturally competent care. Through triangulation and thematic analysis, 9 initial themes and 4 broad thematic groupings were derived.The lessons from this study could inform further research with these communities and other culturally diverse groups with respect to cultural competency in terms of both health-care providers and health services.     

Critical cultural perspectives and health care involving Aboriginal peoples

Despite a growing body of critical scholarship in nursing, the concept of culture continues to be applied in ways that diminish the significance of power relations and structural constraints on health and health care. In this paper, we take a critical look at how assumptions and ideas underpinning conceptualizations of culture and cultural sensitivity can influence nurses' perceptions of Aboriginal peoples and Aboriginal health. Drawing on examples from our research, we examine how popularized assumptions about culture can shape nurses' views of Aboriginal patients. These assumptions and perceptions require closer scrutiny because of their potential to influence nurses' practice with Aboriginal patients. Our specific aims are to: (a) consider some of the limitations of cultural sensitivity in relation to health care involving Aboriginal peoples; (b) explore how ideas about culture have the potential to become problematic in nursing practice with Aboriginal peoples; and (c) explore the relevance of a 'critical cultural approach' in extending our understanding of culture in relation to Aboriginal peoples' health. We discuss a critical cultural perspective as one way of broadening nurses' understandings about the complexities of culture and the many facets of culture that require critical consideration. In relation to Aboriginal health, this will require nurses to develop greater critical awareness of culture as a relational process, and as necessarily influenced by issues of racism, colonialism, historical circumstances, and the current political climate in which we live.     

Applying interdisciplinary theory in the care of Aboriginal women's mental health

This paper describes theories from various disciplines that are useful in conceptualizing and reflecting on the mental health of Aboriginal women. Critical social theory (sociology), Parse's human becoming theory (nursing) and ecological systems theory (developmental psychology) are considered valuable theories that aid in nursing praxis. These papers discuss how these different theoretical approaches are beneficial for achieving different goals and therefore provide important foundational underpinnings to challenging traditional assumptions that effect human behaviour and practice.     

Improving forensic mental health care for Aboriginal Australians: Challenges and opportunities

Mental illnesses constitute a major burden of disease in Aboriginal Australians and Torres Strait Islanders (hereafter Aboriginal Australians), who are also overrepresented in the prison system. A legacy of colonization compounds such prevalence, and is further exacerbated by the persistence of racial discrimination and insensitivity across many sectors, including health. This research completed in a Western Australian forensic mental health setting identifies non‐Aboriginal health professionals' support needs to deliver high‐quality, culturally‐safe care to Aboriginal patients. Data were collected from health professionals using an online survey and 10 semistructured interviews. Survey and interview results found that ongoing education was needed for staff to provide culturally‐safe care, where Aboriginal knowledge, beliefs, and values were respected. The findings also support previous research linking Aboriginal health providers to improved health outcomes for Aboriginal patients. In a colonized country, such as Australia, education programmes that critically reflect on power relations privileging white Anglo‐Australian cultural dominance and subjugating Aboriginal knowledge, beliefs, and values are important to identify factors promoting or compromising the care of Aboriginal patients and developing a deeper understanding of ‘cultural safety’ and its clinical application. Organizational commitment is needed to translate the findings to support non‐Aboriginal health professionals deliver high‐quality care to Aboriginal patients that is respectful of cultural differences.     

What nurses should know when working in Aboriginal communities

Nurses working in aboriginal communities need to understand the history, socio-political climate and culture within the specific community. In addition to placing a high priority on this learning, nurses should also understand the concept of respect in aboriginal terms and apply respect in all their dealings in the community Self-awareness of their own beliefs and assumptions is critical if nurses are to have an effective relationship with the community. The author, an aboriginal person who grew up in a non-aboriginal home, illustrates these concepts with anecdotes from her own experiences when she returned to her Dene community.     

The diabetes health care of Aboriginal people in South Australia (Part 2)

Although type 2 diabetes is a recognised health priority in South Australia, Aboriginal people with diabetes do not utilise the mainstream diabetes health services on a regular basis for health care. This means that Aboriginal clients have the potential to develop diabetes-related problems and, furthermore, are not in a position to make informed decisions about health care issues. This lack of client empowerment is contrary to the goals of contemporary diabetes health care and, as a result, Aboriginal clients suffer the consequences of ineffective management with a compromised lifestyle. To identify how this situation might be improved, a qualitative study funded by Diabetes Australia was undertaken in South Australia. The overall goal was, firstly, to identify the reasons why Aboriginal people with diabetes do not attend mainstream health agencies on a regular basis and secondly, if possible, to improve attendance. Thus, Aboriginal health professionals (n = 43) were recruited from the 8 statistical divisions of South Australia and interviewed about Aboriginal diabetes health care issues. In Part 1 of this series, the research findings indicated the beliefs and attitudes held by clients about diabetes, their lack of knowledge about management issues, their responses to diabetes, the effects of diabetes on their lifestyle and the strategies that diabetes health professionals used to help their clients deal with diabetes health issues. In Part 2 the research findings indicated the importance of the Aboriginal health worker to the successful diabetes management of Aboriginal clients, the constraints that affect the delivery of diabetes health care and the recommendations made by health professionals to improve the standard of diabetes health services.     

The diabetes health care of Aboriginal people in South Australia (Part 1)

Although type 2 diabetes is a recognised health priority in South Australia, Aboriginal people with diabetes do not utilise the mainstream diabetes health services on a regular basis for health care. This means that Aboriginal clients have the potential to develop diabetes-related problems and, furthermore, are not in a position to make informed decisions about health care issues. This lack of client empowerment is contrary to the goals of contemporary diabetes health care and, as a result, Aboriginal clients suffer the consequences of ineffective management with a compromised lifestyle. To identify how this situation might be improved, a qualitative study funded by Diabetes Australia was undertaken in South Australia. The overall goal was, firstly, to identify the reasons why Aboriginal people with diabetes do not attend mainstream health agencies on a regular basis and secondly, if possible, to improve attendance. Thus, Aboriginal health professionals (n = 43) were recruited from the 8 statistical divisions of South Australia and interviewed about Aboriginal diabetes health care issues. In Part 1 of this series, the research findings indicated the beliefs and attitudes held by clients about diabetes, their lack of knowledge about management issues, their responses to diabetes, the effects of diabetes on their lifestyle and the strategies that diabetes health professionals used to help their clients deal with diabetes health issues. In Part 2 the research findings indicated the importance of the Aboriginal health worker to the successful diabetes management of Aboriginal clients, the constraints that affect the delivery of diabetes health care and the recommendations made by health professionals to improve the standard of diabetes health services.     

Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition

The work of Aboriginal health workers (AHWs) in the primary care setting is discussed, emphasising that partnership with non-Indigenous health providers such as nurses and general practitioners brings complementary skills together to improve the health care available to Aboriginal clients, and to decrease the cultural and communication barriers to delivering such health care.The diverse skills and responsibilities of AHWs, which include clinical, health promotion, education and leadership roles, are illustrated.The current focus on increasing AHW educational opportunities, and the need to recognise AHWs as core health professionals and equal members of the health care team is presented. The increasing recognition of the role of AHWs in providing cultural mentorship for non-Indigenous colleagues is discussed.