scholarly journals From “stuck” to satisfied: Aboriginal people’s experience of culturally safe care with interpreters in a Northern Territory hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vicki Kerrigan ◽  
Stuart Yiwarr McGrath ◽  
Sandawana William Majoni ◽  
Michelle Walker ◽  
Mandy Ahmat ◽  
...  
Keyword(s):  
Narrative Analysis ◽  
Northern Territory ◽  
Cultural Safety ◽  
Sampled Data ◽  
Health Providers ◽  
Participatory Action ◽  
Discharge Rates ◽  
Field Notes ◽  
Ward Rounds ◽  
Safe Care

Abstract Background Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia’s Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019. Methods This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient’s language or English, researcher field notes from shadowing doctors, doctors’ reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted. Results The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling “stuck” and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates. Conclusions A culturally unsafe system which restricted people’s ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.

scholarly journals “The talking bit of medicine, that’s the most important bit”: doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Vicki Kerrigan ◽  
Stuart Yiwarr McGrath ◽  
Sandawana William Majoni ◽  
Michelle Walker ◽  
Mandy Ahmat ◽  
...  
Keyword(s):  
Scale Up ◽  
Aboriginal Peoples ◽  
Culturally Competent ◽  
Participatory Action ◽  
Work Routines ◽  
Hospital Systems ◽  
Interpreter Service ◽  
Field Notes ◽  
Ward Rounds ◽  
Inductive Thematic Analysis

Abstract Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.

Problems and Practice of Management on Menstruation by Adolescents Girls of Basic Schools of Chitwan, Nepal

2020 ◽  
Vol 8 ◽  
pp. 85-94
Author(s):  
Sudha Ghimire
Keyword(s):  
Current Practice ◽  
Quantitative Information ◽  
Community Schools ◽  
Mixed Method Research ◽  
Participatory Action ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Field Notes ◽  
Sanitary Pads

Managing menstruation in a hygienic way is a challenge in most of the low and middle-income countries (LMIC) including Nepal, where normal and natural physiological process of menstruation is considered as girls’ problem which is viewed as sinful, unholy and matter of shame. This paper explores the current practice and existing difficulties that adolescents girls encounter hygienic management of menstruation (MHM) especially during school days. The study was conducted on five purposively selected community schools of Chitwan district. The study adopted Participatory Action Research (PAR) as an approach, that is encapsulated with mixed method research design. For qualitative information observation, focus group discussions (FGD) and field notes were used, whereas for quantitative data self-administrative questionnaires were used. Quantitative information was collected from 205 girls students who were present at schools on the day of data collection. The finding shows that majority of the girls (93.7%) who encounter hygienic management of menstruation were of 10-14 years old age, whereas nearly one third of them were (29%) from grade eight. Similarly, among the total 205 girls, only 79 girls have already started their menstruation; among those who have started menstruation majority (78%) had heard about menstruation form their mothers. Likewise, 35% girls used homemade cotton pads and 40.5% of them changed pad three times a day. During FGD, adolescents girls shared that lack of water and soap in toilets, stress and lack of concentration during menstruation are the major difficulties which they encounter during days of menstruation. They suggested the concerned authorities to manage pad bank, make soap and water available, and develop skills for proper disposing of used sanitary pads for MHM at schools. 

scholarly journals Exploring the ‘active mechanisms’ for engaging rural-dwelling older men with dementia in a community technological initiative

2019 ◽  
Vol 40 (9) ◽  
pp. 1906-1938 ◽  
Author(s):  
Ben Hicks ◽  
Anthea Innes ◽  
Samuel R. Nyman
Keyword(s):  
Computer Game ◽  
Older Men ◽  
Community Dwelling ◽  
Microsoft Kinect ◽  
Participatory Action ◽  
Nintendo Wii ◽  
Traditional Health ◽  
People With Dementia ◽  
Health And Social Care ◽  
Field Notes

AbstractResearch has suggested ecopsychosocial initiatives can promote a sense of wellbeing and inclusion in people with dementia. However, few studies have elucidated the ‘active mechanisms’ whereby such initiatives can achieve these outcomes, so hindering their generalisability. This is particularly pertinent when seeking to support community-dwelling older men with dementia who are reluctant to engage with traditional health and social care initiatives. This paper reports on a study that drew from the principles of Participatory Action Research to explore the ‘active mechanisms’ of a technological initiative for older men (65+ years) with dementia in rural England. An individually tailored, male-only initiative, using off-the-shelf computer game technology (e.g. iPad, Nintendo Wii and Microsoft Kinect) was delivered over a nine-week period. Multiple qualitative methods were employed, including: focus groups, open interviews and extensive reflective field notes, to gather data from the perspective of 22 men, 15 care partners and five community volunteers. The data were analysed thematically and interpreted using a masculinity lens. Three mechanisms contributed to the initiative's success: the use of the technology, the male-only environment and the empowering approach adopted. The paper argues that initiatives aimed at community-dwelling older men with dementia would be advised to consider these gendered experiences and ensure participants can maximise their masculine capital when participating in them, by providing enabling activities, non-threatening environments and empowering approaches of delivery.

scholarly journals Crossing Borders in Search of the Mother-Daughter Story: Interdependence across Time and Distance

2008 ◽  
Vol 89 (4) ◽  
pp. 631-639
Author(s):  
Ruth Ann Belknap
Keyword(s):  
United States ◽  
Data Collection ◽  
Narrative Analysis ◽  
The United States ◽  
Mothers And Daughters ◽  
Analysis Techniques ◽  
Mexican Culture ◽  
Mother Daughter Relationship ◽  
Field Notes ◽  
Distance Data

Although studies have identified the importance of the mother–daughter relationship and of familism in Mexican culture, there is little in the literature about the mother–daughter experience after daughters have migrated to the United States. This study explores relationships between three daughters in America and their mothers in Mexico, and describes ways in which interdependence between mothers and daughters can be maintained when they are separated by borders and distance. Data collection included prolonged engagement with participants, field notes, and tape-recorded interviews. Narrative analysis techniques were used. Findings suggest mother–daughter interdependence remains. Some aspects may change, but the mother–daughter connection continues to influence lives and provide emotional and, to a lesser extent, material support in their lives.

scholarly journals What was Research for the Peasants of Córdoba? Participation in the Early Years of Participatory Action Research

2021 ◽  
Vol 18 ◽  
Author(s):  
Joanne Rappaport
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Collaborative Research ◽  
National Association ◽  
Early Years ◽  
Participatory Action ◽  
Field Notes ◽  
The Caribbean

Abstract Reflections on participatory and collaborative research commonly neglect to pay attention to the fact that for community researchers, investigation into their own realities frequently takes forms very different from those of academic scholars. They may use methods that are more explicitly intuitive and may depart from approaches that involve the rigorous collection and systematization of data. This paper explores what research might have meant to the Caribbean peasants of the early 1970s with whom Colombian sociologist Orlando Fals Borda developed his approach to what is today called participatory action research. In particular, it focuses on the field notes of Alfonso Salgado Martínez, a leader of the National Association of Peasant Users-Sincelejo Line (ANUC, Asociación Nacional de Usuarios Campesinos-Línea Sincelejo), juxtaposing them to his published work, both read in comparison to Fals Borda's own notes and writings.

Monitoring and Evaluation

2021 ◽  
pp. 99-116
Keyword(s):  
Narrative Analysis ◽  
Social Transformation ◽  
Quantitative Methods ◽  
Monitoring And Evaluation ◽  
Analysis Tool ◽  
Participatory Action ◽  
Action Monitoring ◽  
Qualitative And Quantitative Methods ◽  
Development Goals ◽  
Social Change Organizations

This chapter focuses on how monitoring and evaluation plays a pivotal role in the design and execution of initiatives leading up to social transformation. The work evidences that measuring effectiveness is one of the biggest challenges that many social change organizations face; this chapter addresses this issue. It explores and suggests qualitative and quantitative methods to track progress and how to measure growth. Among these methods is a narrative analysis tool that the authors have developed to evidence the ways in which a person's story of self, or the story of a group, transforms overtime. The methods suggested here respond to both local needs and global measures of success, such as the United Nations' sustainable development goals. Conceptually, this section draws from the notions of participatory action monitoring and evaluation as discussed by Chevalier and Buckles, and of the power relations that mediate processes of evaluation discussed by Chapela and Jarillo.

scholarly journals ‘I always live in a quebrada [favela] and today I am here. So, you can be also here one day’: Exploring pre-service teachers’ perceptions of love for youth from socially vulnerable backgrounds

2020 ◽  
Vol 26 (4) ◽  
pp. 1006-1022 ◽  
Author(s):  
Carla Luguetti ◽  
Brent McDonald
Keyword(s):  
Data Analysis ◽  
Physical Education ◽  
Participatory Action Research ◽  
Sociocultural Context ◽  
Participatory Action ◽  
Teachers Perceptions ◽  
Embodied Experiences ◽  
Field Notes ◽  
Project Participants ◽  
Democratic Spaces

In recent years, socially critical scholars have argued that love, as a moral basis for socio-critical work, should not be colorblind or power blind and that marginalized populations may understand caring within their sociocultural context, creating spaces for youth and teachers to challenge the racism, sexism, class exploitation and linguicism imposed on their communities. While there is advocacy of love in education and physical education, there is little research that aims to explore how pre-service teachers’ (PSTs’) conceptions change across time. The aim of this study was to explore PSTs’ changing perceptions of love as they worked in an activist sport project with youth from socially vulnerable backgrounds. Participatory action research framed this four-semester research project. Participants included the lead researcher, four PSTs and 110 youth. Data collected included the following: (a) the lead researcher’s field notes; (b) collaborative PSTs’ group meetings; (c) PSTs’ generated artifacts; and (d) PSTs’ focus groups and interviews. Data analysis involved induction and constant comparison. The PSTs understood that love was represented by the following: (a) creating democratic spaces for students to care for each other and their community; (b) trusting and understanding the students, and dreaming possible futures with them; (c) being the best teacher in order to facilitate students’ learning; and (d) making sure all students are included. We concluded that the PSTs’ embodied experiences of oppression and the reflexive experience lived in the activist approach created a space for the PSTs to see themselves in the youth, reconnect with their own identity and develop empathy and love for the diverse youth.

scholarly journals Pedagogical Laboratories: A Case Study of Transformative Sustainability Education in an Ecovillage Context

2019 ◽  
Vol 11 (14) ◽  
pp. 3880 ◽  
Author(s):  
Jason Papenfuss ◽  
Eileen Merritt
Keyword(s):  
Narrative Analysis ◽  
Design Education ◽  
Sustainability Education ◽  
Sustainable Living ◽  
Descriptive Case Study ◽  
Global North ◽  
Field Notes ◽  
The Individual ◽  
Cautionary Tales

Students, practitioners, and scholars of sustainability education are increasingly calling for divergent curricula and novel pedagogical approaches that cultivate transformation and emancipation at both the individual and institutional levels. For decades, ecovillages around the globe have provided alternatives for sustainable living and many have also developed alternative educational approaches. For this reason, ecovillages can be important learning laboratories for experimenting with sustainability education curricula and pedagogies, allowing scholars to learn across disciplinary, cultural, and worldview boundaries. In the present study, we conducted a descriptive case study of Findhorn Foundation College’s 5-week Ecovillage Design Education course. By applying a narrative analysis of archives, field notes, surveys, and interviews, we arrived at 17 different categorical elements across six major themes. Using the field data, we linked these categorical elements to three consistent pedagogical elements: ritual pedagogies, pedagogies of story, and collaborative pedagogies. We conclude by highlighting several inductive themes present in participant data that indicated potential hindrances, constraints, and cautionary tales regarding implementation of these pedagogies in higher education contexts situated in the Global North.

Self-discharge by adult Aboriginal patients at Alice Springs Hospital, Central Australia: insights from a prospective cohort study

2013 ◽  
Vol 37 (2) ◽  
pp. 239 ◽  
Author(s):  
Lloyd J. Einsiedel ◽  
Eileen van Iersel ◽  
Robert Macnamara ◽  
Tim Spelman ◽  
Malcolm Heffernan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Past History ◽  
Cultural Safety ◽  
Patient Factors ◽  
Discharge Rates ◽  
Central Australia

Objective. To determine rates and risk factors for self-discharge by Aboriginal medical inpatients at Alice Springs Hospital. Methods. Prospective cohort study. Interviews were conducted in primary language by Aboriginal Liaison Officers, from July 2006 to August 2007. Topics included understanding of diagnosis, satisfaction with services and perceptions of staff and environment. Risk factors for self-discharge were then determined prospectively. Results. During the study period 202 (14.7%) of 1380 patients admitted to general medical units at Alice Springs Hospital, were interviewed. Self-discharge rates for all admissions were significantly lower during the study period than they had been previously (pre-study, mean 22.9 ± standard error 0.3%; study, 17.0 ± 0.2%) (P < 0.001). Most interviewees (73.4%) did not know their reason for admission (73.4%) or estimated length of stay (82.3%). Forty interviewees (19.8%) self-discharged. Mean monthly self-discharge rates differed between the three medical units (Unit A, 13.9 ± 0.3%; Unit B, 17.3 ± 1.37%; Unit C, 20.0 ± 0.4%) (P = 0.005). Multivariable predictors of self-discharge included male sex (hazard ratio (HR) 2.4; 95% confidence interval (CI) 1.1, 5.2), a past history of self-discharge (HR 3.2; 95%CI 1.5, 6), planned transfer to a tertiary referral centre (HR 3.8; 95%CI 1.3–7.4) and a desire to drink alcohol (HR 4.5; 95%CI 1.8–10.2). Conclusions. Physician, institutional and patient factors all contribute to self-discharge. Improving cultural safety may be the key to lowering self-discharge rates. What is known about the topic? Rates of self-discharge by Aboriginal adults in Central Australia are the highest reported worldwide. Previous studies have been retrospective and focussed on patient demographics without addressing the environmental and cultural contexts in which self-discharge occurs. What does this paper add? In this acute care setting, we found a pervasive failure to communicate effectively with Aboriginal patients. Consequently, most patients were unaware of their diagnosis or length of stay. Self-discharge was a common practice; nearly half of all previously admitted patients had self-discharged in the past. We demonstrate that physician, hospital and patient factors all contribute to this practice. Prospectively determined risk factors included the treating medical team, the need for transfer outside Central Australia, and patient factors such as male gender and alcohol dependence. Self-discharge rates fell significantly with Aboriginal Liaison involvement. What are the implications for practitioners? Cross-cultural communication skills must be markedly improved among medical staff caring for this marginalised population. Critical to reducing rates of self-discharge are improvements in institutional cultural safety by involving Aboriginal Liaison Officers and family members. However, persistently high self-discharge rates suggest a need to redirect medical services to a more culturally appropriate community-based model of care.

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