Cultural Safety

In Aotearoa New Zealand there is limited research exploring the tensions for Indigenous Māori nurses when integrating cultural priorities into clinical practice. This study explores how Māori nurses navigate delivering culturally responsive care to iwi, hapū, and Māori whānau across different healthcare settings. A qualitative Indigenous narrative inquiry was used to obtain data. Semi-structured interviews were conducted with 12 Māori registered nurses and nurse practitioners. The thematic analysis was both inductive and deductive. The narratives provide insight into the nurses’ holistic Indigenous world view by contextualising their professional practice experiences. Four main themes were derived from data: te tuakiri Māori - cultural identity; kawenga taumaha - bearing the burden; te kaikiritanga - racism; and tauutuutu - reciprocity. Māori practitioners routinely experienced compromises within biomedically oriented healthcare services. Practitioners witnessed discriminatory pract...

Background Cultural safety requires healthcare professionals and organisations to improve healthcare, facilitate patient access to healthcare, and achieve equity within the workforce. Methods This ethnomethodological study, which consisted of two phases, explored the concept of cultural safety from the perspective of Advanced Practice Nurses. Semi-structured interviews and the nominal group technique were used to prioritise challenges related to cultural safety, identify barriers to clinical practise and assess educational needs. The data collected was subjected to thematic analysis. Results Nurses working in Austria, Germany and Switzerland were recruited (N = 29). Accordingly, the phenomenon of cultural safety in health care is not generally known and there is little prior knowledge about it. The most frequently discussed themes were communication difficulties, lack of knowledge, the treatment of people with insufficient language skills and expectations of treatment goals and outc...

Background: Indigenous women in the southern Mexican state of Guerrero face poor maternal health outcomes. Living as they do at the very periphery of the Western health system, they often receive low-quality care from health services that lack human and financial resources. Traditional health systems remain active in indigenous communities where traditional midwives accompany women through motherhood. Several interventions have explored training birth attendants in Western birthing skills, but little research has focussed on supporting traditional midwives by recognising their knowledge. This trial supports traditional midwifery in four indigenous groups and measures its impact on maternal health outcomes. Methods: The study includes four indigenous populations in the State of Guerrero (Nahua, Na savi/Mixteco, Me'phaa/Tlapaneco and Nancue ñomndaa/Amuzgo), covering approximately 8000 households. A parallel-group cluster-randomised controlled trial will compare communities receiving usual care with communities where traditional midwives received support in addition to the usual care. The intervention was defined in collaboration with participants in a 2012 pilot study. Supported midwives will receive a small stipend, a scholarship to train one apprentice, and support from an intercultural broker to deal with Western health personnel; additionally, the health staff in the intervention municipalities will participate in workshops to improve understanding and attitudes towards authentic traditional midwives. A baseline and a final survey will measure changes in birth and pregnancy complications (primary outcomes), and changes in gender violence, access to healthcare, and engagement with traditional cultural activities (secondary outcomes). The project has ethical approval from the participating communities and the Universidad Autónoma de Guerrero. Discussion: Indigenous women at the periphery of Western health services do not benefit fully from the attenuated services which erode their own healthcare traditions. Western health service providers in indigenous communities often ignore traditional knowledge and resources, inadvertently or in ignorance, disrespecting indigenous cultures. Improved understanding between midwives and the official healthcare system can contribute to more appropriate referral of high-risk cases, improving the use of scarce resources while lowering costs of healthcare for indigenous families.

Journalism has both contributed to shaping and been shaped by colonialism and has reproduced the status quo at the expense of those on the margins. Considering this reality, this study explores how journalism education and practice can be unlearned through a decolonising, Indigenous standpoint. It does this through an Indigenous co-led approach that brings together journalism students, journalism academics, and working journalists with family connections to, or extensive experience working with, 10 distinct Indigenous people groups. The participants provided provocations to journalists interested in unlearning the standard way that journalism is learned and practised.

This study investigates the lived experience of Aboriginal Australians presenting to practitioners in SouthEast Australia. It was informed by an Indigenous Research Paradigm which privileges Indigenous worldviews (Wilson, 2001) and engages with Aboriginal resistance to racist oppression (Rigney, 1999). Moreover, the paradigm acknowledges the impact of the colonisation processes and the privileging of Aboriginal voices to understand our shared assumptions about social reality.

This article has been written to challenge the seemingly unquestioning acceptance of changing roles in New Zealand nursing. It is evident in nursing history that a number of issues, such as community versus hospital services and generalist versus specialist practice, tend to resurface in a cyclic manner. Characteristics that are currently associated with 'advanced' nursing roles can be recognised when the origins and development of nursing in New Zealand are traced. This gives rise to speculation that changes to nursing scope of practice are not so much revolutionary as evolutionary, and can perhaps be viewed as a reclaiming rather than a redefining of nursing roles.

Objective Health practitioners’ Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. This research assessed all Codes for cultural safety specific content. Methods Following the release of the Australian Health Practitioner Regulation Agency’s (Ahpra) Health and Cultural Safety strategy 2020–25, the 16 Ahpra registered health practitioner Board Codes of Conduct and professional Codes of Ethics were analysed by comparing content to Ahpra’s new cultural safety objectives. Two Codes of Conduct, Nursing and Midwifery, met these objectives. The Aboriginal and Torres Strait Islander Health Practitioners Code ...

Background Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teachi...

OBJECTIVE To present a clinical framework for addressing critical social elements for Indigenous patients with type 2 diabetes. SOURCES OF INFORMATION The Educating for Equity (E4E) Care Framework was developed through a rigorous analysis of qualitative research that included the perspectives of Indigenous patients (n = 32), physicians (n = 28), and Indigenous health curriculum developers (n = 5) across Canada. A national advisory group of Indigenous health experts, educators, leaders, physicians, and community members provided feedback on integrating analysis from primary research into recommendations for physicians. Systematic literature reviews were conducted and a nominal group technique process helped forge research team consensus around the framework's themes and recommendations. MAIN MESSAGE For Indigenous patients with type 2 diabetes, social factors arising from the legacy of colonization are often barriers to improved diabetes outcomes, while culture is often not recog...

Objective: Explore the healthcare needs of Sudanese refugee women settling in Australia. Background: Refugees from Sudan are the fastest growing community in Australia. Nurses who care for people from the Sudan will be required to be familiar with the needs of this emerging community and offer culturally competent and safe care. Methods: Integrative review of the literature. Results: Sudan is one of the countries in Africa where the practice of female genital mutilation (FGM), cutting or circumcision is considered a social norm. This is a deeply rooted traditional cultural practice that is still prevalent in many developing countries. Healthcare professionals in Australia are ill equipped to care for women and children who have undergone this procedure. This paper explores the Sudanese refugee community in Shepparton, Victoria to explore the nursing considerations caring for women affected by FGM within the Australian health care context. Conclusions: There is a need for more education in undergraduate, postgraduate and continuing professional education on the healthcare needs of women who have undergone female genital mutilation in order to provide appropriate care and support for these women.

Background: Despite the rise in numbers of incarceration women, disparities between health care services and access exist. The health needs of incarcerated women is complex and influenced by multiple social determinants of health.Purpose: Explore the healthcare issues of incarcerated women within Australian Prisons.Methods: Integrative review of the literature.Results: Incarcerated women represent a small proportion of the prison population within Australia, however, health outcomes are significantly impacted. Socioeconomic status, abuse (physical, emotional, sexual), previous incarceration, generational factors are some of the factors impeding the health of incarcerated women. Mental health, chronic disease conditions, maternal and child factors are significant health concerns of this vulnerable population. There is a disparity in health access and programs to improve their health outcomes. This paper explores the challenges impacting the health of incarcerated women.Conclusions: S...

Objective: Explore the healthcare needs of Sudanese refugee women settling in Australia.Background: Refugees from Sudan are the fastest growing community in Australia. Nurses who care for people from the Sudan will be required to be familiar with the needs of this emerging community and offer culturally competent and safe care.Methods: Integrative review of the literature.Results: Sudan is one of the countries in Africa where the practice of female genital mutilation (FGM), cutting or circumcision is considered a social norm. This is a deeply rooted traditional cultural practice that is still prevalent in many developing countries. Healthcare professionals in Australia are ill equipped to care for women and children who have undergone this procedure. This paper explores the Sudanese refugee community in Shepparton, Victoria to explore the nursing considerations caring for women affected by FGM within the Australian health care context.Conclusions: There is a need for more education ...

Background Urban Indigenous populations in Canada are steadily growing and represent diverse and culturally vibrant communities. Disparities between Indigenous and non-Indigenous peoples' experiences of the social determinants of health are a growing concern. Under the guidance of the West End Aboriginal Advisory Council (WEAAC), Parkdale Queen West Community Health Centre (PQWCHC) launched the Niiwin Wendaanimak Four Winds Wellness Program that seeks to enhance health and community services for homeless and at-risk Indigenous populations in Toronto. Objectives A process evaluation was carried out to (1) assess the collaborative service delivery model; (2) identify service gaps and issues for homeless and at-risk Indigenous populations; and (3) develop recommendations for how non-Indigenous organizations can provide culturally responsive services for Indigenous populations. Methods In consultation with the WEAAC, a thematic analysis of qualitative data collected from 2 focus groups with community members who access the Niiwin Wendaanimak program and 17 key informant interviews with staff and peers was conducted. Results The Niiwin Wendaanimak program bridges teachings of inclusivity and the practice of harm reduction to create a nonjudgemental space where community members' dignity and autonomy is respected. Strengths of the program include Indigenous leadership and access to activities that promote wellness and community building. Conclusions As a non-Indigenous service provider, PQWCHC is meeting the needs of homeless and at-risk Indigenous populations in Toronto. Program strengths, system gaps, and challenges including policy recommendations were identified. Résumé Contexte Les populations autochtones du Canada sont en croissance constante et constituent des communautés diversifiées et culturellement dynamiques. Les disparités entre l'expérience des déterminants sociaux de la santé chez les Autochtones et les non-Autochtones inquiètent de plus en plus. Sous l'impulsion du conseil consultatif autochtone West End Aboriginal Advisory Council (WEAAC), le centre de santé communautaire Parkdale Queen West (PQWCHC) a lancé un programme de mieux-être, Niiwin Wendaanimak Four Winds, en vue d'améliorer les services de santé et les services collectifs offerts aux populations autochtones sans abri et vulnérables de Toronto. Objectifs Une évaluation des processus a été menée pour: 1) analyser le modèle concerté de prestation de services; 2) repérer les lacunes et les problèmes de l'offre de services touchant les populations autochtones sans abri et vulnérables; et 3) formuler des recommandations pour que des organismes non autochtones puissent offrir des services adaptés à la réalité culturelle des populations autochtones. Méthode En consultation avec le WEAAC, une analyse thématique des données qualitatives recueillies à la faveur de 2 groupes de discussion avec des membres de la communauté inscrits au programme Niiwin Wendaanimak et de 17 entretiens avec des informateurs (employés et pairs) a été menée.

Research on cultural identity clearly indicates that a healthy cultural identity is associated with positive outcomes including increased self-esteem, increased academic achievements, and higher reports of satisfying family interactions. This retrospective study explored the perceptions of culture, identity, and resilience among Aboriginal former Crown Wards of the Ontario government. Each participant in this research study reflected on the influence of their experiences of intergenerational trauma and being a Crown Ward in the development of their cultural identities. Overall findings indicate the importance of spirituality, culture, having purpose and meaning in life and acceptance of multiple identities, as they are critical elements of resiliency processes for former Aboriginal Crown

Culturally safe health practitioners are essential for effective service provision to culturally diverse populations, including Indigenous Australians. Therefore, cultural safety education during training as a health care professional is an essential component in helping improve the health of Indigenous Australians. This study examined whether the implementation of an Indigenous cultural safety education workshop increased self-rated cultural safety knowledge and attitudes of allied health students. The study employed a quantitative before-and-after design using pre- and post-surveys to determine the level of attitudinal change in students who attended a day long workshop. The study sample consisted of 1st year (n = 347) and 4th year (n = 149) allied health students at a regional Australian university over the years 2007–2011. Whilst the results of this current study are varied in terms of achieving positive change across all of the taught items of knowledge and attitude, they provi...

The need for effective medication management strategies is well documented in the literature in the context of such a high burden of disease amongst Aboriginal people. Since both the clinical and social needs of the patient is an important stage in working towards better adherence to prescribed treatment, Aboriginal Health Practitioners (AHPs) and other health professionals have a significant role to help Aboriginal people manage their medications appropriately. 1,2 AHPs have a multi-faced role within the Aboriginal community. They are invaluable liaisons between Aboriginal people and health care professionals. Their familiarity with the

ObjectiveThe aim of this study is to examine the challenges faced by the Aboriginal Health Practitioners in the community assisting their clients to manage medicines.DesignQualitative, in depth interviews with eight Aboriginal Health Practitioners employed at various Aboriginal Community Controlled Health services in Victoria were undertaken.SettingRural Aboriginal Community Controlled Health Service.ParticipantsAboriginal Health Practitioners who are registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia as an Aboriginal Health Practitioner and who have experience in the planning, provision, management and evaluation of health services within their scope of practice.ResultsThis study revealed multiples challenges faced by Aboriginal Health Practitioners assisting clients with medication management. These were mainly divided into the attitudes and the culture of the workplace and barriers with medications use faced by the clients. The following ...

Secular recovery coaching offers a non-religious, evidence-based approach to help individuals overcome addiction, achieve personal growth, and maintain long-term wellness. Unlike traditional recovery programs that may involve spiritual or faith-based elements, secular recovery coaching focuses on personal empowerment, practical strategies, and behavioral change. It emphasizes meeting individuals where they are, regardless of their beliefs, and offers tools that align with science, psychology, and self-actualization.

Potential for Change: At the Intersection of Philanthropy and the Landscape of First Nations Specialist Domestic and Family Violence Service Providers – is an initiative and investment of the Paul Ramsay Foundation.

In 2023, the Paul Ramsay Foundation, in partnership with the Australian Communities Foundation, awarded $13.6 million to 58 applicants under a Specialist Domestic and Family Violence Programs National Open Grant Round for organisations with a primary focus on victim survivor cohorts, children and young people, and perpetrators and users of violence.

Of these, 27 applicants were ‘First Nations led specialist domestic and family violence service providers’ from across Australia.

We, ResearchCrowd – an independent, Supply Nation certified Indigenous research agency – were invited by the Paul Ramsay Foundation to act as ‘a learning partner’ to the 27 First Nations led specialist domestic and family violence service providers.

We feel honoured to have been invited to partner with the Paul Ramsay Foundation and the 27 First Nations led specialist domestic and family violence service providers – all of whom are community-controlled organisations. We share in common a vision for a world in which all
people are enabled and empowered to live their best lives.

Learning together, we applied our cultural lens to address two key areas of inquiry:
• What is the landscape of the specialist domestic and family violence sector?
• What are the possible systemic moves that need to happen?

Guided by the principles of cultural safety and self-determination, this report presents the results of the research that we conducted from 1 June 2023 to 30 June 2024.

We present the research report under eight main headings: Big Picture, Statement of Requirement, Finding Our Way, Designing the Research, A View of the Landscape, Structural Conditions, Relational Conditions and Transformative Conditions.

We deliver a logical flow of information that reflects the structure of the overall report and the ordering of our ideas – setting out how we went from one point to the next as we moved across the landscape, taking the reader on a learning journey with us.

The main body of the report provides a comprehensive view into the complexities that challenge the domestic and family violence landscape. We explore the historic, political, social and cultural waters that give meaning to the landscape. We draw on the Water of Systems Change (Kania, Kramer & Senge, 2018) to explore structural, relational and transformative conditions that shape and make the landscape. We map points of view, values and mindsets; of people, place and protocols; of policy, power and practices; and whole organisations and institutions.

In this article, we discuss the construct of cultural safety in relation to the ethics, politics, and practice of implementation research in Indigenous communities. We convened a 3-day workshop, bringing together 23 Indigenous and non-Indigenous collaborators from First Nation communities and universities across Canada to reflect on experiences with implementing an Indigenous youth and family mental health promotion program in First Nation communities. Participants identified three dimensions central to achieving culturally safe space in implementation research: (1) interpersonal dynamics of collaboration between Indigenous and non-Indigenous partners; (2) structural and temporal arrangements necessary for collaborative work; and (3) the systematic recognition and incorporation of Indigenous cultural knowledge, values, and practices. Within implementation research, attention to cultural safety can mitigate the epistemic injustice that arises from research frameworks and methodologies that exclude Indigenous perspectives and values. Cultural safety can increase the likelihood that the research process itself contributes to mental health promotion.

Background In Canada, disparities between Indigenous and non-Indigenous Peoples continue to exist in health and education because of the past and current harms of racism and colonization. One step towards closing health gaps is clinicians who can provide health and social care services that are free of racism and mistrust. Indigenous health providers are in the best position to provide this culturally relevant and safe care to their own communities. Therefore, more Indigenous students graduating from health professional programs are required to meet these needs. Indigenous identity support can be a facilitator for Indigenous student academic success but developing one's Indigenous identity can be challenging in post-secondary education environments. We explored how Indigenous rehabilitation students expressed, and wanted to be supported in their identity and academic success. Methods Using a narrative inquiry approach, we conducted interviews with seven students from the occupational, physical, and respiratory therapy programs of a Canadian university. Students were asked to tell their story of learning about, applying to, and being in their rehabilitation program and how their Indigenous identity impacted these experiences. Data analysis was conducted by Indigenous and non-Indigenous team members, analyzing the stories on interaction of the participant with (1) themselves and others, (2) time, and (3) situation or place. Results The researchers developed seven mini-stories, one for each participant, to illustrate the variation between participant experiences in the development of their Indigenous and professional identity, before and during their rehabilitation program. The students appreciated the opportunities afforded to them by being admitted to their programs in a Indigenous Peoples category, including identity affirmation. However, for most students, being in this category came with feared and/or experienced stigma. The work to develop a health professional identity brought even more complexity to the already complex work of developing and maintaining an Indigenous identity in the colonized university environment. Conclusion This study highlights the complexity of developing a rehabilitation professional identity as an Indigenous student. The participant stories call for universities to transform into an environment where Indigenous students can be fully accepted for their unique gifts and the identities given to them at birth.

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 challe...

The 9IATC saw an appetite amongst delegates for attention to be paid to social justice issues that exist in the International Adventure Therapy community. These include increasing diversity in the community and confronting practice-based issues that exist in some practice settings. One such issue was raised through social media, and the resultant 'heat' led the conference organizing committee to set up a facilitated session. An adapted Fishbowl facilitation approach was used to enable what was termed a 'courageous conversation' between key stakeholders, with delegates observing. Themes were identified that related to the topic under discussion (involuntary transportation of clients) and the method it was raised (social media). This facilitated session was one of a few planned responses to community-based issues that emerged at the conference, and illustrates a growing preparedness of the International Adventure Therapy community to address issues within the community and to promote ethical and just practices internationally. This paper does not intend to cover the full content of the Fishbowl, rather provide an overview to discuss the usefulness and practicality of the methods used and share resultant recommendations to the International Adventure Therapy Committee.

Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A nonsymptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in-and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy. Access to Mental Health Services Among Inuit in Quebec 1077-7229/20/Ó 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. This is an open access 1 First authorship shared. 2 First authorship shared.

Purpose. Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia. Data sources. CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest. Study selection. The review focuses on the conceptual and empirical literature on indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction. Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations. Results of data synthesis. Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect. Conclusion. This review shows that the evidence for the effectiveness of indigenous cultural training programmes in Australia is poor. Critiques of cultural training from indigenous and non-indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for indigenous Australians.

There is an inextricable link between cultural and clinical safety. In Australia highprofile 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 Nursing Inquiry.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health We acknowledge the distinct culture and history of Australia's First Peoples, their sovereignty over land and sea and their pursuit of self-determination in accordance with the United Nations Declaration on the Rights of Indigenous Peoples. We also acknowledge the distinct culture of Australia's South Sea Islander Peoples and their intergenerational connection with Australia's First Peoples. Acknowledgement of Indigenous Nursing and Midwifery Elder Aunty Dulcie Flower AM We acknowledge the supporting authorship, and the cultural and professional Eldership of Aunty Dulcie Flower AM, a Miri woman of the Meriam Nation, Torres Strait Islands, Registered Nurse and Midwife. Aunty Dulcie led the way for Indigenous nursing and midwifery as the first Indigenous nurse and midwife to open the doors of the new Redfern Aboriginal Medical Service 49 years ago, practicing her profession in the Redfern community. Aunty Dulcie extended her care of Australia's First Peoples through her remarkable service to the community in the 1967 Referendum Campaign. Appointed to the Member of the Order of Australia (AM) in 2019 for her service to the community, Aunty Dulcie is an Indigenous nursing and midwifery pioneer, a giant on whose shoulders we stand on today with gratitude. Terminology In this paper, the term Australia's First Peoples, Indigenous, and specific cultural 'country' affiliation respectfully and congruently affirm Aboriginal and Torres Strait Islander Peoples and their ways of 'knowing, being and doing'.

There is a global shortage of nurses, leading many countries to recruit internationally qualified nurses (IQNs) to fill the gap. However, IQNs encounter challenges in integrating into their new professional environment, particularly in their interactions with locally qualified nurses (LQNs). Intraprofessional cultural competence (IPCC), defined as 'a set of congruent behaviours and attitudes that enable professionals to work respectfully and effectively in cross-cultural situations', may be a strategy to address these challenges. Content analysis was used to examine nursing regulatory documents (Standards for Practice [Standards] and Codes of Conduct [Codes]) from the United Kingdom, New Zealand and Australia. Data were extracted and organised based on four key themes relevant to IPCC. The analysis revealed a focus on 'Mutual collaboration and professional relationships' in six regulatory documents, with explicit commitments to preventing racism and discrimination in the Australian and NZ Codes. However, issues such as racism, discrimination, bullying and harassment faced by IQNs are not comprehensively addressed, as the documents mainly prioritize culturally appropriate patient interactions over relationships between colleagues. Using regulatory documents to address IPCC may influence positive change such as improving communication, and preventing racism, bullying, discrimination and harassment within nursing.

ObjectiveCultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care.Design and settingInterviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens.ParticipantsSaturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants).ResultsThree domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and cont...

The magnificent voices of Indigenous women who want to restore, preserve and extend the beauty of Indigenous culture must be relocated and honoured as the last best hope of escaping the tragic impacts of colonization. This paper started as an exploration of New Zealand Indigenous scholar Irihapeti Ramsden’s extraordinary efforts to imbed Cultural Safety as a foundation for nursing training and unity of purpose for all community helpers to alter the trajectory of colonization and its tragic impacts on Indigenous peoples. It morphed into a celebration of the powerful ‘reflective topical auto-biographies’ or meta-narratives of adaptability and resilience all Indigenous people need to share as we recover and heal from intergenerational traumas inflicted in the name of civilization and racial supremacy. Transformative change starts with self discovery as Irihapeti Ramsden taught her student nurses. Women and children are the most poignant victims of that foolish colonial project and thei...

In Canada, cultural safety (CS) is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples’ encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how CS for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted, and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, although l...

Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health and wellbeing. Are definitions of cultural safety, in themselves, culturally safe? A purposive search of diverse sources in Australian identified 42 definitions of cultural safety. Structuration theory informed the analytical framework and was applied through an Indigenist methodology. Ten themes emerged from this analysis, indicating that cultural risk is embedded in cultural safety definitions that diminish (meddlesome modifications and discombobulating discourse), demean (developmentally dubious and validation vacillations), and disempower (professional prose, redundant reflexivity, and scholarly shenanigans) the cultural identity (problematic provenance and ostracised ontology) of First Nations Australians. We offer four guidelines for future definitional construction processes, and methodology and taxonomy for building consensus based of definitions of cultural safety. Using this appr...

This paper describes the processes and challenges presented when Pākehā lecturers supervised a research project undertaken by Māori and Pacific nursing students in a New Zealand Bachelor of Nursing programme. It reflects on the reality of translating institutional policies from paper to practice and is situated in the framework of the Treaty of Waitangi and cultural safety. Cultural safety is a nursing concept that focuses on power in health-care relationships. People involved in the project experienced degrees of vulnerability in different cultural contexts, in terms of cultural identity, personal, professional and cultural values and beliefs, nursing and psychology knowledge and academic and institutional policies and practices. Culture is used in a broad sense and not confined to ethnicity. Various issues encountered during the project are identified, and examples of difficult experiences discussed. The paper concludes that working across broad cultural borders requires working w...

Background: Quality and safety in Australian healthcare is inequitably distributed, highlighted by gaps in the provision of quality care for Aboriginal and Torres Strait Islander children. Burns have potential for long-term adverse outcomes, and quality care, including culturally safe care, is critical to recovery. This study aimed to develop and apply an Aboriginal Patient Journey Mapping (APJM) tool to investigate the quality of healthcare systems for burn care with Aboriginal and Torres Strait Islander children. Study design: Interface research methodology, using biomedical and cultural evidence, informed the modification of an existing APJM tool. The tool was then applied to the journey of one family accessing a paediatric tertiary burn care site. Data were collected through yarning with the family, case note review and clinician interviews. Data were analysed using Emden's core story and thematic analysis methods. Reflexivity informed consideration of the implications of the APJM tool, including its effectiveness and efficiency in eliciting information about quality and cultural safety. Results: Through application of a modified APJM tool, gaps in quality care for Aboriginal and Torres Strait Islander children and families were identified at the individual, service and system levels. Engagement in innovative methodology incorporating more than biomedical standards of care, uncovered critical information about the experiences of culturally safe care in complex patient journeys. Conclusion: Based on our application of the tool, APJM can identify and evaluate specific aspects of culturally safe care as experienced by Aboriginal and Torres Strait Islander peoples and be used for quality improvement.

Cultural safety has been a developing movement within the nursing profession in Australia over the past decade, led by the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. This thesis explores this progress towards cultural safety; with a focus upon the Schools of Nursing in Australia. The philosophical and educational shifts from cultural awareness and competence, towards cultural safety are required within these very Schools that prepare nurses for their profession and its practice. This thesis utilises a descriptive survey method, derived from the Aboriginal and Torres Strait Islander Health Framework, to gather information about the Schools of Nursing and their commitment and readiness towards cultural safety. This research is undertaken within a Decolonisation theoretical framework, turning the 'gaze' upon those who hold the dominant cultural position. The findings demonstrate significant progress towards cultural safety strategies and actions. Weaknesses in progress are identified in areas of organisational resources, in the recognition of the knowledge and needs of Aboriginal and Torres Strait Islander staff and students, and in the ongoing project of decolonising curriculum and faculty. Recommendations are presented to support the continuing pathways towards cultural safety within the nursing profession. Cultural safety-in its philosophy and practice-requires continuing shifts in each nurse, in their relationships and practice, and in the nursing education that powerfully shapes the health care of Aboriginal and Torres Strait Islander peoples. Dedication This thesis is dedicated to my mother, Veronika Petric, uz ljubav i šalicu čaja (with love and a cup of tea).. Culturally appropriate terminology: In this research study, different terminology is used to refer to Aboriginal and Torres Strait Islander peoples. It is recognised that the term 'Indigenous Australians' is not always agreed with, and that language/cultural names are often the preferred identification. Generic terminology has been used in this document, with no intention of disrespect, and with recognition of the sensitivities surrounding language use.

Cultural safety has been a developing movement within the nursing profession in Australia over the past decade, led by the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. This thesis explores this progress towards cultural safety; with a focus upon the Schools of Nursing in Australia. The philosophical and educational shifts from cultural awareness and competence, towards cultural safety are required within these very Schools that prepare nurses for their profession and its practice. This thesis utilises a descriptive survey method, derived from the Aboriginal and Torres Strait Islander Health Framework, to gather information about the Schools of Nursing and their commitment and readiness towards cultural safety. This research is undertaken within a Decolonisation theoretical framework, turning the 'gaze' upon those who hold the dominant cultural position. The findings demonstrate significant progress towards cultural safety strategies and actions. Weaknesses in progress are identified in areas of organisational resources, in the recognition of the knowledge and needs of Aboriginal and Torres Strait Islander staff and students, and in the ongoing project of decolonising curriculum and faculty. Recommendations are presented to support the continuing pathways towards cultural safety within the nursing profession. Cultural safety-in its philosophy and practice-requires continuing shifts in each nurse, in their relationships and practice, and in the nursing education that powerfully shapes the health care of Aboriginal and Torres Strait Islander peoples. Dedication This thesis is dedicated to my mother, Veronika Petric, uz ljubav i šalicu čaja (with love and a cup of tea).. Culturally appropriate terminology: In this research study, different terminology is used to refer to Aboriginal and Torres Strait Islander peoples. It is recognised that the term 'Indigenous Australians' is not always agreed with, and that language/cultural names are often the preferred identification. Generic terminology has been used in this document, with no intention of disrespect, and with recognition of the sensitivities surrounding language use.

This paper was submitted to help initiate a discussion and reflective thought on how committed we are to accessibility.
In this case the issues are discussed in relation to a desire for restrictions by Māori and other indigenous peoples.
How different from our ideals is the reality and practice of our profession especially when it involves indigenous knowledge?
This paper is relevant as it aims to help the members of our profession to take that “one small step” towards a realisation that Māori and other indigenous peoples’ ideas of knowledge and its guardianship are not dissimilar to our own library practices. It is hoped that the reader will make a “giant leap” to a better understanding of the importance for consultation with Māori and indigenous peoples when embarking on projects which give unrestricted access to their knowledge.

The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students' written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and determine how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students' understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care.

The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced “Dahl-beer-weer gum-um-be-goo” in the Gumbaynggirr language means ‘safe children’) model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety ...

(1946-2003) was a Māori nurse, educationalist, philosopher, and writer, who leaves an enduring legacy for the development of Kawa Whakaruruhau (cultural safety) both in Aotearoa New Zealand and globally. "The way in which people measure and define their humanity" (Ramsden, 1990a, p. 35)-is the central tenet of this article. "Moving on" was a speech given by Dr Irihapeti Ramsden to Diploma of Nursing graduands at Nelson Polytechnic on 17th November 1989. Ramsden brought together an appreciation of Florence Nightingale's achievements and legacy and our ongoing obligation to provide health services that are respectful and responsive to the humanity of the people needing those services. Of Nightingale, she said, "[i]t would seem appropriate to remember the woman who set up the British model of nursing which still underpins nursing in this country to some extent. We owe respect to Florence Nightingale" (p. 34). The paper offered a revision of Nightingale's historical 'noblesse oblige' nursing ideology, where privileged people provided care to 'others' irrespective of nationality, culture, creed, colour, age, sex, political, religious belief or social status. To facilitate a reduction in health inequities and improve Article 2 / Tuhinga 2

Cultural safety is a strengths-based construct which aims to subvert unequal power relations, honor diverse ways of knowing in community-specific contexts, and acknowledge community as arbiter of 'how' safety is actualized. Published literature documents the benefits of culturally safe healthcare yet pays scant attention to culturally safe research praxis. Our team of practitionerresearchers sought to uncover meanings of cultural safety in community-based health research with Hawaiian Homestead residents. Focus groups were conducted in three communities. Emic descriptions of cultural safety and non-resident researchers were elicited. Content analysis revealed trust (hilina'i) as the overarching theme fundamental to cultural safety. Cultural safety was demonstrated by practices that accommodate and engage community in their shared sense of place, history, ways of knowing, and capacity-building. Such practices likely mitigate perceptions of cultural imposition and promote relevant interventions developed with communities. Implications are enunciated in HILINA'I, a mnemonic for advancing knowledge decolonization and health equity. BACKGROUND SIGNIFICANCE CULTURAL SAFETY AND RESEARCH PRAXIS Cultural safety or kawa whakaruruhau in the Maori language is a construct borne from the experiences of Indigenous nurses who witnessed their non-Maori colleagues attribute poor