Leadership enhancing culturally safe models of care in a Western Australian Aboriginal community context: A qualitative investigation

BackgroundModels of care for community health nursing need to address social determinants of health for families, requiring community health nurse leaders to encourage all nurses to facilitate culturally safe models of care, particularly for vulnerable and underserved populations. Many challenges impact on provision of support for a range of population groups, with increasing attention focusing on how community health nurses lead equitable health activities for Aboriginal Australian families.AimThe aims of this study were to investigate the suitability, feasibility and acceptability of parent support, informing a culturally safe model for a peer-led support program for Aboriginal families.MethodsParticipatory action research enabled Aboriginal peer support workers and parents, community agencies and a child health researcher to collaboratively review cultural safety, suitability, and progress of the program. Qualitative data were analysed through thematic analysis.FindingsThe Australian Health Practitioner Regulatory Agency's cultural safety framework guided four themes: Acknowledgement of colonisation, racism, and social determinants of health; recognition of influences of personal racism and power differentials; recognising importance of partnership approaches to care and collaboration with individuals and families to ensure appropriate and acceptable care; and promotion of safe working environments.DiscussionCommunity-based initiatives informed by Aboriginal perspectives are needed to support Aboriginal families. Participatory action research enables community health nurse leaders to engage with Aboriginal participants, facilitating co-design of culturally safe models of care.ConclusionReflections on culturally safe strategies enabled development of peer-led support for Aboriginal families, focusing on self-determination, empowerment, and equity. Acceptability of the strategies has contributed to an emerging culturally safe model of care. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.     

Evolving beyond antiracism: Reflections on the experience of developing a cultural safety curriculum in a tertiary education setting

There is an inextricable link between cultural and clinical safety. In Australia high-profile Aboriginal deaths in custody, publicised institutional racism in health services and the international Black Lives Matter movement have cemented momentum to ensure culturally safe care. However, racism within health professionals and health professional students remains a barrier to increasing the number of Aboriginal and Torres Strait Islander Health professionals. The Australian Health Practitioner Regulation Agency's Aboriginal and Torres Strait Islander Health Strategy's objective to ‘eliminate racism from the health system’, and the recent adoption of the Aboriginal and Torres Strait Islander peoples led cultural safety definition, has instigated systems level reflections on decolonising practice. This article explores cultural safety as the conceptual antithesis to racism, examining its origins, and contemporary evolution led by Aboriginal and Torres Strait Islander peoples in Australia, including its development in curriculum innovation. The application of cultural safety is explored using in-depth reflection, and the crucial development of integrating critical consciousness theory, as a precursor to culturally safe practice, is discussed. Novel approaches to university curriculum development are needed to facilitate culturally safe and decolonised learning and working environments, including the key considerations of non-Indigenous allyship and collaborative curriculum innovations and initiatives.     

Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians

Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model.     

The Yapunyah project: embedding Aboriginal and Torres Strait Islander perspectives in the nursing curriculum

The Yapunyah Project is an initiative of the Faculty of Health at Queensland University of Technology. It was instigated to further improve the development of cultural competence in health graduates with respect to Aboriginal and Torres Strait Islander perspectives. The project was informed by the cultural competence in healthcare delivery models of Campinha-Bacote (1998a) and Cross, Bazron, Dennis and Isaacs (1989) and by the cultural safety reforms to nursing curricula in New Zealand. The Yapunyah Project involved extensive consultation and collaboration with Indigenous staff and health experts in the local Aboriginal and Torres Strait Islander community. A core curriculum, and associated graduate transcultural competencies, were informed by these discussions and earlier reforms in health curricula by the Committee of Deans of Australian Medical Schools and the Royal Australian College of General Practitioners. Although the overall project involved four separate schools within the faculty, this paper details the experience of embedding Indigenous perspectives within the undergraduate nursing curriculum. The experience has been a challenging and positive one, and the reforms have been supported by a sustainable framework. This paper outlines how one university faculty is endeavouring to educationally prepare nursing students to practice with evidence-based transcultural nursing knowledge based on culture care values, beliefs, and traditional lifeways of Indigenous people of Australia. As such, the project aims to contribute to the improvement and promotion of the health and well-being of Indigenous Australians in culturally and ethnohistorically meaningful ways.     

Urinary incontinence – meeting a transcultural challenge in Sydney, Australia

The universal phenomenon of immigration is a continuous reality in many developed countries. As a consequence, nurses and other health professionals are expected to recognize, understand, take action and interact favourably with people from diverse cultural backgrounds . Nurses need to become culturally competent and develop their knowledge, skills, behaviours and values in transcultural nursing in order to deliver optimum care to the multiethnic cultures accessing health care. However, the combination of a paucity of systematic research and the lack of formal education programmes has resulted in poor development in this area. Many concepts relevant to cross‐culture are poorly understood, valued and studied. The first author describes how she established a urology/continence nurse‐led clinic for local non‐English speaking Chinese residents in South East Sydney. The authors give recommendations for nurses who wish to establish similar clinics to provide culture‐specific urological and continence care required for multiethnic populations.     

Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young Aboriginal women in Adelaide

Young Aboriginal women are consistently identified as having poorer health outcomes and access to sexual health services than non-Indigenous Australians. Yet the literature is particularly silent on what sexual health nurses need to know and do in order to work well with young urban Aboriginal women. This paper reports on a qualitative pilot study undertaken by a non-Indigenous nurse in Adelaide. The participatory action research methods used in this study were sensitive to the history of problems associated with research in Aboriginal communities. A reference group of Elder Aboriginal women and Aboriginal health workers guided all aspects of the study. A partnership approach between the researcher and the Reference Group ensured that the methods, analysis, and final report were culturally safe. Three groups participated in this study: Elders and Aboriginal health workers; young Aboriginal women, and sexual health nurses. All participants acknowledged the importance of nurses being clinically competent. However, the overarching finding was a lack of a clear model of cultural care to guide health service delivery. Three interrelated themes emerged from the data to support this contention. These were: the structural and personal importance of establishing and maintaining trustworthy relationships between nurses, Aboriginal health workers and Elders; the recognition that Aboriginal culture does exist, and is important in urban areas; and the importance of gender considerations to understanding urban women's health business. A partnership approach was recommended as a way to use these findings to develop a transparent cultural model of care. Further research is currently being undertaken to progress this agenda.     

Culture, communication and child health

Cultural beliefs and values implicitly and explicitly shape every aspect of the way we parent our children and how we communicate about parenting. To appropriately support parents in this new and challenging role, child health services for parents in Australia need to do more than acknowledge a diverse range of cultural practices. While many health professionals believe they act in culturally sensitive ways, we need to closely examine this belief, question the cultural assumptions implicit in the information we give, and assess the extent to which our interactions are culturally appropriate. In this paper, we present a critical review of the literature on health care provision for migrant women and families. We then suggest a need to re-examine the values, beliefs and attitudes within cultural frameworks that inform how child health professionals communicate. Specifically, communication between child health professionals and migrant parents requires further analysis. We suggest that professionals need to reflect on the cultural self rather than solely on the culture of others.     

Encounters with difference: Mental health nurses and Indigenous Australian users of mental health services

This article presents findings from the multi‐sited ethnography of mental health nursing practice as it relates to the care of Indigenous users of public mental health services in Australia. It provides an analysis of mental health nurses beliefs and ideas about Aboriginal and Torres Strait Islander people encountered over the course of this research. The Indigenous service user was positioned as Other to the non‐Indigenous mental health nurse, and to non‐Indigenous service users. Cultural difference and the legacy of colonization, including its impact on the health of Aboriginal and Torres Strait Islander peoples, contributed to these beliefs of alterity. Despite emphasizing the differences with Aboriginal and Torres Strait Islander people in mental health services, nurses did not clearly relate this to Indigenous ways of understanding ill health. While cultural differences were recognized, what they meant for the nurses or their nursing practice was interpreted in different ways. In these circumstances, approaches towards care for Aboriginal and Torres Strait Islander people varied between nurses.     

Is it Aboriginal friendly? Searching for ways of working in research and practice that support Aboriginal women

This article describes my journey as a nurse as I search for better ways to work with urban Aboriginal women. Learning as I build and maintain trusting relationships with Elders, Aboriginal health professionals and communities has been an important first step. Incorporating reflective practice, participatory action research and ethical guidelines has further assisted me to work in more culturally safe and respectful ways. While there has been increasing recognition of access and equity issues in Australia's current neo-colonial period, actual improvements have been very slow to emerge. Meanwhile many Aboriginal people continue to experience poor levels of health. My hope is that this article can contribute to the growing body of knowledge that recognises the impact of past and present colonisation practices and shifts health care towards collaborative healing and well being models that are more supportive of Aboriginal people and their needs. The emphasis on Aboriginal women's health rather than mixed gender health care comes from my experiences in sexual health, where many Australian Aboriginal women prefer to access 'women only' services.     

Cultural aspects of communication in cancer care

Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and practices of communication of the truth and of decision-making styles throughout the world. Cultural competence always presupposes oncology professionals’ awareness of their own cultural beliefs and values. To be able to communicate with cancer patients in culturally sensitive ways, oncologists should have knowledge of the concept of culture in its complexity and of the risks of racism, classism, sexism, ageism, and stereotyping that must be avoided in clinical practice. Oncologists should develop a sense of appreciation for differences in health care values, based on the recognition that no culture can claim hegemony over others and that cultures are evolving under their reciprocal influence on each other. Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care.     

Time to listen: Chronic disease yarning with Aboriginal and Torres Strait Islander peoples living in remote Australia

BackgroundChronic disease affects Aboriginal and Torres Strait Islander peoples at a disproportionately higher level and at younger ages, particularly for those living in remote locations, than for the overall Australian population.AimTo examine the perceptions and experiences of Aboriginal and Torres Strait Islander adults residing in remote North West Queensland regarding chronic disease education, and how they self-manage their health.MethodsSemi-structured open ended ‘yarning’ interviews were conducted between March and May 2017 with Aboriginal and Torres Strait Islander adults (n = 20) with a medical diagnosis of a chronic disease/s. Interviews focussed on their views and experiences in receiving information regarding their chronic disease/s, self-management education, and how they engaged with healthcare professionals. Data were subjected to thematic analysis.FindingsThree themes emerged: 1) It’s going to happen, 2) Communication as a Barrier and Facilitator, and 3) Recognising the Past and Looking Forward. Chronic disease was described as inevitable, and that communication between patient and healthcare professionals was compromised due to the constant use of medical terminology by healthcare professionals. Yarning as a strategy for patient education was suggested as a way to strengthen the relationship with healthcare professionals and to assist with chronic disease self-management abilities.DiscussionFor Aboriginal and Torres Strait Islander Australians, communication, particularly whilst delivering healthcare is an important factor in providing effective support to improve health outcomes.ConclusionTo help improve health literacy and to build trusting relationships, healthcare professionals should adopt culturally appropriate and effective communication rather than simply relying on individuals’ functional health literacy skills.     

Closing the Gap: cultural safety in Indigenous health education

The challenge for the future is to embrace a new partnership aimed at closing the gap between Indigenous and non-Indigenous Australians on life expectancy, educational achievement and employment opportunities. Significant improvements in contemporary Indigenous health care can be achieved through culturally safe health education programs for Indigenous students. However, while participation rates of Australian Indigenous students in the higher education sector are increasing, attrition rates are markedly higher than those of the general student population. This paper focuses on a unique degree program that is offered exclusively to Indigenous students in the field of mental health in the School of Nursing, Midwifery and Indigenous Health, Charles Sturt University. This qualitative exploratory study aimed to identify strategies that were especially helpful in sustaining students in the program and to identify and address barriers to the retention of students, to empower students to better prepare for the university environment and to inform academics within the course about areas that could be improved to provide a more culturally safe learning environment. The first stage of the study utilised focus group interviews with 36 Indigenous students across all three years of the program. The findings of the study addressing the issues of culturally appropriate pedagogy, curricula and cultural safety in the mental health degree program are discussed.     

Cultural attitudes and beliefs about pain.

Patients and health professionals bring their own cultural attitudes to the communication and interpretation of the patient's pain experience. In this interaction, it is the health professional's knowledge and attitudes that dominate the response to the patient's experience of pain. In Saudi Arabia, a multicultural foreign and local health care team is challenged to understand the cultural beliefs and attitudes toward pain of both patients and team members. To increase cultural understanding and knowledge, a collaborative inquiry project using a culturally diverse group was conducted to learn about cultural attitudes and beliefs on the causes, treatment, and experience of pain. This article presents the knowledge gained from the collaborative inquiry journey of action and reflection.     

Laissez les bon temps rouler (let the good times roll): can embedded Cajun cultural health beliefs be changed through traditional health education?

An exploration to identify the impact of traditional health education on embedded cultural beliefs of the Cajun population in Cameron Parish Louisiana was performed. The largest parish in the state also has a much higher incidence of coronary heart disease (CHD) than the national average. Ten residents in western Cameron Parish of Cajun heritage were interviewed to obtain views of health as it relates to their culture and CHD. In general, although the participants had acquired knowledge pertaining to the cause of CHD, they valued their culturally prepared foods and way of life above their health. As a unique and isolated group, they continue to have many beliefs and health practices different than the mainstream. The challenge for health care professionals is to use innovative social and health education that will break through cultural barriers to promote health prevention.     

Cultural considerations in interprofessional education and practice

Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cultural awareness and support culturally sensitive care. Many of the issues raised are generic and likely to occur whenever patients' health practices and beliefs differ from conventional Western care. The main theme that emerged with respect to the practice environment was the use of a participatory action approach to foster collaboration with patients, traditional healers and the community. Successful collaboration is likely to result in a blend of ideas and perspectives from traditional health practices and conventional Western health care. With respect to education, programs need to focus on providing opportunities both in the classroom and in the clinical arena for students to work in interprofessional teams. These teams should not only comprise partners from medicine, nursing, physical therapy and other health professions but also include aboriginal paraprofessionals. Pedagogical initiatives also need to incorporate case-based formats and interactive sessions with patients and families. The principles underlying this approach: openness, mutual respect, inclusiveness, responsiveness and understanding one's roles should be fundamental to the delivery of culturally competent health care to all ethnic communities.     

Culturally competent nursing care during the perinatal period

Effective nursing interventions require culturally competent nursing practice. Nurses can develop the skill sets needed to provide culturally competent care. These skills derive from nursing principles and practice that support respect for individual dignity and self-determination. Sweeping changes in health care delivery have shortened the length of client exposure to nursing care, especially in perinatal nursing. Moreover, changes in the United States population challenge the nurse's ability to respond appropriately to the expectations, values, and beliefs of many diverse cultural groups. Nursing theoretical frameworks provide a basis for cultural competence in practice.     

Two Aboriginal registered nurses show us why black nurses caring for black patients is good medicine

In Queensland, Aboriginal nurses are limited in number in comparison to the mainstream nursing workforce. More Aboriginal registered nurses are needed to cater for Aboriginal patients in our Australian healthcare system in view of today's burgeoning Indigenous health crisis. It is a foregone conclusion that Aboriginal nurses are the most suitable nurses to provide optimal cross cultural care for Aboriginal patients, due to having similar cultural backgrounds. The following paper will show how two Aboriginal registered nurses are optimistic about the possibilities of expanding the ranks of Aboriginal registered nurses through role modelling, and are channelling their research to achieve this with the aim of promoting better health outcomes for their people. A qualitative research approach has been used to examine the subjective human experience of the participants. Three dominant themes emerged from the research and will be expanded upon within the body of this paper to support the authors' thesis that Aboriginal nurses are a valuable commodity to address the Aboriginal health crisis.     

Online resources for culturally and linguistically appropriate services in home healthcare and hospice, part 2: resources for Asian patients

Home care and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient's health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of Asian-born patients and appropriate patient education materials in the many languages spoken by this population. The resources have been made available free on the Web by healthcare professionals and government agencies from around the world.