Moving Systems to Cultural Safety

All Indigenous peoples across the globe have experienced multiple historical colonial aggression and assaults. In Canada and the USA for example, education was used as a tool of oppression for Indigenous peoples through residential school. Child welfare, health and health care, and forced land relocation are also sites of intensive and invasive harms. Health services continue to be a site of systemic and personal oppression for Indigenous peoples across Canada and the world (Reading 2013). For many years, Indigenous peoples have faced discrimination and racism when accessing biomedical health care. Implementation of colonization in Canada, Australia, New Zealand, and elsewhere, have been well documented to adversely influence aspects of health in many Indigenous communities worldwide and linked to high rates of mental health, education, and employment challenges (see Loppie & Wein, 2009; Mowbray, 2007; Paradies, Harris, & Anderson, 2008); these traumas are rooted attempts in cultural extermination and deep-set pains in regard to identity and well-being (Stout & Downey, 2006; Thurston & Mashford-Pringle, 2015).

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Culturally safe health care practice for Indigenous Peoples in Australia: A systematic meta-ethnographic review

Journal of Health Services Research & Policy ◽

10.1177/13558196211041835 ◽

2021 ◽

pp. 135581962110418

Author(s):

Stephanie De Zilva ◽

Troy Walker ◽

Claire Palermo ◽

Julie Brimblecombe

Keyword(s):

Health Care ◽

Indigenous Peoples ◽

Health Care Services ◽

Torres Strait Islander ◽

Indigenous Health ◽

Cultural Knowledge ◽

Cultural Safety ◽

Care Practice ◽

Health Care Practice ◽

Torres Strait

Objectives Culturally safe health care services contribute to improved health outcomes for Aboriginal and Torres Strait Islander Peoples in Australia. Yet there has been no comprehensive systematic review of the literature on what constitutes culturally safe health care practice. This gap in knowledge contributes to ongoing challenges providing culturally safe health services and policy. This review explores culturally safe health care practice from the perspective of Indigenous Peoples as recipients of health care in Western high-income countries, with a specific focus on Australian Aboriginal and Torres Strait Islander Peoples. Methods A systematic meta-ethnographic review of peer-reviewed literature was undertaken across five databases: Ovid MEDLINE, Scopus, PsychINFO, CINAHL Plus and Informit. Eligible studies included Aboriginal and Torres Strait Islander Peoples receiving health care in Australia, had a focus on exploring health care experiences, and a qualitative component to study design. Two authors independently determined study eligibility (5554 articles screened). Study characteristics and results were extracted and quality appraisal was conducted. Data synthesis was conducted using meta-ethnography methodology, contextualised by health care setting. Results Thirty-four eligible studies were identified. Elements of culturally safe health care identified were inter-related and included personable two-way communication, a well-resourced Indigenous health workforce, trusting relationships and supportive health care systems that are responsive to Indigenous Peoples’ cultural knowledge, beliefs and values. Conclusions These elements can form the basis of interventions and strategies to promote culturally safe health care practice and systems in Australia. Future cultural safety interventions need to be rigorously evaluated to explore their impact on Indigenous Peoples’ satisfaction with health care and improvements in health care outcomes.

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Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzv010 ◽

2015 ◽

Vol 27 (2) ◽

pp. 89-98 ◽

Cited By ~ 44

Author(s):

Anton Clifford ◽

Janya McCalman ◽

Roxanne Bainbridge ◽

Komla Tsey

Keyword(s):

Systematic Review ◽

Health Care ◽

New Zealand ◽

Cultural Competency ◽

Indigenous Peoples ◽

The Usa

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Indigenous access barriers to health care services in London, Ontario

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v86i2.1407 ◽

2017 ◽

Vol 86 (2) ◽

pp. 6-9 ◽

Cited By ~ 2

Author(s):

Stephanie McConkey

Keyword(s):

Health Care ◽

Health Services ◽

Indigenous Peoples ◽

Health Care Services ◽

Service Providers ◽

Cultural Safety ◽

Cultural Barriers ◽

Access Barriers ◽

Care Services ◽

Pain Medications

Introduction: Indigenous peoples in Canada suffer higher rates of health inequalities and encounter a number of health services access barriers when compared to their non-Indigenous counterparts. Indigenous peoples experience social and economic challenges, cultural barriers, and discrimination when accessing mainstream health services. Methods: In London, Ontario, 21 interviews and 2 focus groups (n = 25) with service providers were completed, each session spanning approximately 1 to 1.5 hours. Interviews were voice recorded and transcribed verbatim. Themes were identified using NVIVO 10 software. Findings: Approximately 2 to 5% of clients are Indigenous in hospital-based services. There are a number of social factors that influence whether Indigenous peoples access health services. Indigenous peoples do not have access to adequate pain medications because physicians are reluctant to provide Indigenous patients with pain medications due to common perceptions of addiction. Indigenous peoples also have barriers accessing a family physician because physicians are reluctant to take on new patients with complex health needs. Conclusion: Systemic discrimination is still alive in the health care system; therefore, there is a need for cultural safety training among physicians to increase awareness of access barriersand challenges that many Indigenous patients face when seeking health care.

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Child welfare systems and migrant families in Estonia, Norway, Spain, the Netherlands and the USA

PsycEXTRA Dataset ◽

10.1037/e578482014-058 ◽

2013 ◽

Author(s):

Katrin Kriz

Keyword(s):

Child Welfare ◽

The Netherlands ◽

Migrant Families ◽

Welfare Systems ◽

The Usa ◽

Child Welfare Systems

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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.

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Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2474 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 704-704

Author(s):

Yuchi Young ◽

Barbara Resnick

Keyword(s):

Older Adults ◽

Health Care ◽

Health Systems ◽

Long Term Care ◽

The United States ◽

World Population ◽

Term Care ◽

The Usa ◽

Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

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Postcolonial theory and Canada’s health care professions: bridging the gap

Medicine Health Care and Philosophy ◽

10.1007/s11019-021-10019-2 ◽

2021 ◽

Author(s):

Stephen Wilmot

Keyword(s):

Health Care ◽

Indigenous People ◽

Indigenous Peoples ◽

Postcolonial Theory ◽

Professional Knowledge ◽

Healthcare Personnel ◽

Positive Outcomes ◽

Training Context ◽

Explanatory Framework ◽

Health Care Professions

AbstractIn recent years there have been several calls in professional and academic journals for healthcare personnel in Canada to raise the profile of postcolonial theory as a theoretical and explanatory framework for their practice with Indigenous people. In this paper I explore some of the challenges that are likely to confront those healthcare personnel in engaging with postcolonial theory in a training context. I consider these challenges in relation to three areas of conflict. First I consider conflicts around paradigms of knowledge, wherein postcolonial theory operates from a different base from most professional knowledge in health care. Second I consider conflicts of ideology, wherein postcolonial theory is largely at odds with Canada’s political and popular cultures. And finally I consider issues around the question of Canada’s legitimacy, which postcolonial theory puts in doubt. I suggest ways in which these conflicts might be addressed and managed in the training context, and also identify potential positive outcomes that would be enabling for healthcare personnel, and might also contribute to an improvement in Canada’s relationship with its indigenous peoples.

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