There is no health without cultural safety: Why cultural safety matters.

Abstract Background Developing since colonisation, Australia’s healthcare system has dismissed an ongoing and successful First Nations health paradigm in place for 60,000 years. From Captain James Cook documenting ‘very old’ First Nations Peoples being ‘far more happier than we Europeans’ and Governor Arthur Phillip naming Manly in admiration of the physical health of Gadigal men of the Eora Nation, to anthropologist Daisy Bates’ observation of First Nations Peoples living ‘into their eighties’ and having a higher life expectancy than Europeans; our healthcare system’s shameful cultural safety deficit has allowed for an Aboriginal and Torres Strait Islander child born in Australia today to expect to live 9 years less than a non-Indigenous child. Disproportionately negative healthcare outcomes including early onset diabetes-related foot disease and high rates of lower limb amputation in Aboriginal and Torres Strait Islander Peoples contribute to this gross inequity. Main body In 2020, the Australian Health Practitioner Regulation Authority released the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025 - empowering all registered health practitioners within Australia to provide health care to Aboriginal and Torres Strait Islander Peoples that is inclusive, respectful and safe, as judged by the recipient of care. This recently released strategy is critically important to the podiatry profession in Australia. As clinicians, researchers and educators we have a collective responsibility to engage with this strategy of cultural safety. This commentary defines cultural safety for podiatry and outlines the components of the strategy in the context of our profession. Discussion considers the impact of the strategy on podiatry. It identifies mechanisms for podiatrists in all settings to facilitate safer practice, thereby advancing healthcare to produce more equitable outcomes. Conclusion Aboriginal and Torres Strait Islander Peoples access health services more frequently and have better health outcomes where provision of care is culturally safe. By engaging with the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy, all registered podiatrists in Australia can contribute to achieving equity in health outcomes for Aboriginal and Torres Strait Islander Peoples.

Download Full-text

Illuminating Indigenous health care provider stories through forum theater

AlterNative An International Journal of Indigenous Peoples ◽

10.1177/1177180121995801 ◽

2021 ◽

Vol 17 (1) ◽

pp. 61-70

Author(s):

Vanessa Van Bewer ◽

Roberta L Woodgate ◽

Donna Martin ◽

Frank Deer

Keyword(s):

Higher Education ◽

Health Care ◽

Health Care Professionals ◽

Indigenous Health ◽

Indigenous Education ◽

Cultural Safety ◽

Lateral Violence ◽

Indigenous Students ◽

Current Context ◽

Physical Spaces

Learning about the historical and current context of Indigenous peoples’ lives and building campus communities that value cultural safety remains at the heart of the Canadian educational agenda and have been enacted as priorities in the Manitoba Collaborative Indigenous Education Blueprint. A participatory approach informed by forum theater and Indigenous sharing circles involving collaboration between Indigenous and non-Indigenous health care professionals ( n = 8) was employed to explore the above priorities. Through the workshop activities, vignettes were created and performed to an audience of students and educators ( n = 7). The findings emerging from the workshop illuminated that Indigenous people in nursing and higher education face challenges with negotiating their identity, lateral violence and struggle to find safe spaces and people due to tokenism and a paucity of physical spaces dedicated to Indigenous students. This study contributed to provoking a greater understanding of Indigenous experiences in higher education and advancing reconciliation.

Download Full-text

An Environmental Scan of Indigenous Cultural Safety in Canadian Baccalaureate Nursing and Midwifery Programs

Canadian Journal of Nursing Research ◽

10.1177/08445621211016143 ◽

2021 ◽

pp. 084456212110161

Author(s):

Nicholas Metheny ◽

Claire Dion Fletcher

Keyword(s):

Baccalaureate Nursing ◽

Ways Of Knowing ◽

Truth And Reconciliation Commission ◽

Cultural Safety ◽

Indigenous Students ◽

Safe Spaces ◽

Environmental Scan ◽

Truth And Reconciliation ◽

Substantial Progress ◽

Cultural Competency Education

Background The Truth and Reconciliation Commission (TRC) TRC has called to increase the number of Indigenous practitioners and include cultural competency education in their curricula. However, it remains unknown how nursing and midwifery programs are progressing towards these goals. Purpose To examine the extent to which baccalaureate nursing and midwifery programs are creating culturally safe spaces for Indigenous students, responding to TRC-recommended curricular changes, and including Indigenous content. Methods A digital environmental scan of accredited baccalaureate nursing and midwifery programs in Canada was conducted. Analysis was conducted using descriptive statistics. Results Of the 107 programs, less than one-fifth (n = 19, 17.8%) met all three cultural safety criteria. More than half (n = 59, 55.1%) included culturally safe spaces for Indigenous students, 20 (18.7%) satisfied TRC call #24 to require Indigenous-relevant coursework, and one-third (n = 36, 33.6%) were seen as infusing their curricula with Indigenous-related content. Conclusions This represents the first attempt to systematically catalog nursing and midwifery programs’ response to the TRC Calls to Action. Most schools have not made substantial progress towards cultural safety. Nursing and midwifery programs should commit to expanding their cultural safety programming to incorporate multiple ways of knowing and being in their curricula.

Download Full-text

Cultural safety for First Nations people in aged care

Contemporary Nurse ◽

10.1080/10376178.2021.1962378 ◽

2021 ◽

pp. 1-7

Author(s):

Linda Michelle Deravin ◽

Judith Anderson ◽

Nicole Mahara

Keyword(s):

First Nations ◽

Aged Care ◽

Cultural Safety ◽

Nations People ◽

First Nations People

Download Full-text

Indigenous mothers’ experiences of power and control in child welfare: Families being heard

Journal of Social Work ◽

10.1177/14680173211009187 ◽

2021 ◽

pp. 146801732110091

Author(s):

Suzanne C Robertson ◽

Carey Sinclair ◽

Andrew R Hatala

Keyword(s):

Family Relationships ◽

Daily Practice ◽

Cultural Safety ◽

Indigenous Research ◽

Children And Families ◽

Child And Family Services ◽

Power And Control ◽

Indigenous Children ◽

Welfare Families ◽

And Control

Summary There are upward of 11,000 Indigenous children and families in the Manitoba Child and Family Services (CFSs). Many factors coalesce as contributors to these high rates of care, including oppressive histories of Canadian settler colonialism, governmental policies and the Indian Residential Schools, and mass apprehensions of Indigenous children through “the 60’s scoop.” Although a process of “Devolution” began in Manitoba in 1999 to address Indigenous overrepresentation and improve cultural safety for children and families, the voices of women whose children are in care often remain silenced and marginal. Findings Utilizing an Indigenous Research lens, this qualitative study explored the stories and experiences of 12 Indigenous mothers involved with Manitoba CFS. The mothers’ stories revealed dynamics of power and control outlined in five core themes: (1) Being “set up to fail”; (2) Confronting “normalcy” and navigating case plans; (3) Dealing with tactics of intimidation; (4) Experiencing judgment and being labelled; and (5) Emotional politics. The mothers’ stories suggest that the CFS system continues to reflect colonial structures of oppression and that the “Devolution” did not fully have the intended impact on daily practice. Applications The womens' shared experiences highlight several areas for change, such as: enhanced family supports and worker relationships; utilization of capacity building frameworks; better institutional collaborations; increased efforts to maintain family relationships and units; and greater access to and quality of Indigenous cultural supports for mothers and children, including ceremony, healing, and access to Elders. Suggestions for more efficient and family-centered service provision are also offered.

Download Full-text

The dangers of libraries and archives for Indigenous Australian workers: Investigating the question of Indigenous cultural safety

IFLA Journal ◽

10.1177/0340035220987574 ◽

2021 ◽

pp. 034003522098757

Author(s):

Kirsten Thorpe

Keyword(s):

Cultural Safety ◽

Self Determination ◽

Front Line ◽

Truth Telling ◽

Indigenous Australian ◽

Doctoral Research ◽

The Voice

Libraries and archives are troubling spaces for Indigenous Australian people as they are sites of renewal and truth-telling as well as sites of deep tension. The topic of people’s cultural safety in libraries and archives is one that is being commonly discussed. However, limited research has been undertaken on the topic to reveal the issues and concerns of people who work on the front line in these institutions. This article discusses the dangers of libraries and archives for Indigenous Australian workers by introducing doctoral research on the topic of Indigenous archiving and cultural safety: Examining the role of decolonisation and self-determination in libraries and archives. The aim of the article is to bring greater visibility to the voice and experiences of Indigenous Australian people who are working to facilitate access to collections in libraries and archives.

Download Full-text

Selecting contextually appropriate performance indicators in a circumpolar context: a modified Delphi approach

BMC Health Services Research ◽

10.1186/s12913-021-06485-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rebecca Rich ◽

Thomsen D’Hont ◽

Kellie E. Murphy ◽

Jeremy Veillard ◽

Susan Chatwood

Keyword(s):

Child Health ◽

Performance Measurement ◽

Performance Indicators ◽

Maternity Care ◽

Cultural Safety ◽

Determinants Of Health ◽

Maternal Child Health ◽

Modified Delphi ◽

Delphi Approach ◽

Maternal Child

Abstract Background Meaningful performance measurement requires indicators to be scientifically robust and strategically focused. For many circumpolar states, indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations. The aim of this project was to identify contextually appropriate performance indicators for maternity care in circumpolar regions. Methods Fourteen maternity care and health systems experts participated in a modified Delphi consensus process. The list of proposed indicators was derived from a previously published scoping review. Fourteen participants rated each proposed indicator according to importance, circumpolar relevance, validity, and reliability and suggested additional indicators for consideration. Results Consensus was achieved after two rounds, as measured by a Cronbach’s alpha of 0.87. Eleven indicators, many of which represented physical health outcomes, were ranked highly on all four criteria. Twenty-nine additional indicators, largely focused on social determinants of health, health care responsiveness, and accessibility, were identified for further research. Travel for care, cultural safety and upstream structural determinants of health were identified as important themes. Conclusions This study identified the important gaps between current performance measurement strategies and the context and values that permeate maternal-child health in circumpolar regions. The indicators identified in this study provide an important foundation for ongoing work. We recommend that future work encompass an appreciation for the intersectoral nature of social, structural, and colonial determinants of maternal-child health in circumpolar regions.

Download Full-text

Factors supporting retention of health and wellbeing staff in Aboriginal health services: a strength-based case study

Human Resources for Health ◽

10.1186/s12960-021-00557-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Sara Deroy ◽

Heike Schütze

Keyword(s):

Health Service ◽

Health Services ◽

Aboriginal Health ◽

Social Accountability ◽

Cultural Safety ◽

Staff Retention ◽

Professional Advancement ◽

Aboriginal Community ◽

Health And Wellbeing

Abstract Background Aboriginal Community Controlled Health Services are fundamental to improving the health and welfare of Aboriginal peoples. A key element that contributes to the effectiveness of these services are Aboriginal health and wellbeing staff. However, Aboriginal health and wellbeing staff often suffer high rates of stress and burnout. Current literature focuses on proposed strategies to increase staff retention in Aboriginal Health Services, yet, there is limited information available showcasing what has actually worked. Method This was an intrinsic strengths-based case study of one regional Aboriginal Community Controlled Health Service. Semi-structured research yarning interviews were conducted with past and present staff employed in health and wellbeing roles to highlight the factors that staff felt contributed to their retention. Results Ten interviews were conducted between February and April 2018. Six key themes emerged: social accountability, teamwork and collaboration, cultural safety, supervision, professional advancement, and recognition. We add to the literature by identifying the importance of bi-directional communication, and showing that social accountability, teamwork and collaboration, cultural safety, supervision, professional advancement, and recognition continue to be important factors that contribute to health and wellbeing staff retention in Aboriginal Health Services. Conclusion This exemplar Aboriginal Health Service may provide insights into future strategies to improve staff retention in other health services.

Download Full-text