OBJECTIVE: The aim of this study was to explore how nurses and midwives (trained at Flinders University in Adelaide) from rural, remote and urban locations view the impact of cultural safety training on their practice and the extent to which they incorporated cultural safety principles into their practice. DESIGN: qualitative research study. SETTING: rural, remote and urban locations across Australia. PARTICIPANTS: Nurses and midwives who had undertaken cultural safety training at Flinders University as part of their undergraduate degree. METHODS: Participants were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Transcripts were coded independently by members of the research team. MAIN OUTCOME MEASURES: The use of cultural safety principles in participants' practice, and the extent to which they were applied, was determined. Barriers and enablers to enacting cultural safety in the workplace were also identified. RESULTS: 10 individuals participated in an interview (7 nurses and 3 midwives). The Modified Monash Model was used to classify participant location with the following observed: MM1, six; MM2, two; MM5, one; MM6, one. 3 participants were from the Northern Territory and 7 from South Australia. Participants were at varying stages in their journey of cultural safety, ranging from early stages to those able to embody the Cultural Safety Principles and negotiate barriers to provide culturally safe care. Educational strategies for participants to progress their cultural safety journey were also identified. CONCLUSION: The extent to which cultural safety principles are applied in practice is diverse amongst the nurses and midwives that participated in this study, demonstrating that cultural safety is a journey and ongoing support is needed.
Ryder C, Mackean T, Ullah S, et al. Development and validation of a questionnaire to measure attitude change in health professionals after completion of an Aboriginal Health and Cultural Safety Training Programme. Aust J Indig Educ. 2019;48(1):24-38.
NAHS Working Party. National Aboriginal Health Strategy Working Party. A national Aboriginal Health Strategy; 1989.
Eckermann A, Dowd T, Chong E, Nixon L, Gray R, Johnson S. Binan Goonj: Bridging Cultures in Aboriginal Health. Sydney, NSW: Churchill Livingstone; 2006.
Boddington P, Raisanen U. Theoretical and practical issues in the definition of health: insights from Aboriginal Australia. J Med Philos. 2009;34:49-67.
Behrendt L. Achieving Social Justice: Indigenous Rights and Australia's Future. Sydney, NSW: Federation Press; 2003.
Mackean T. A healed and healthy country: understanding healing for Indigenous Australians. Med J Aust. 2009;190(10):522-523.
Purdie N, Dudgeon P, Walker R. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 1st edn Canberra: Ageing Australian Government of Department of Health and Ageing; 2010.
The Royal Australian and New Zealand College of Psychiatrists. Psychiatrists TRAaNZCo. The Dance of Life Melbourne The Royal Australian and New Zealand College of Psychiatrists. https://www.ranzcp.org/practice-education/indigenous-mental-health/aboriginal-torres-strait-islander-mentalhealth/the-dance-of-life. Accessed February 26, 2019.
Milroy H, Dudgeon P, Walker R. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Canberra, ACT: Commonwealth of Australia; 2014:419-435.
Belfrage M. Why, "culturally safe" health care? Med J Aust. 2007;186:537-538.
Brascoup�� S, Waters C. Cultural safety: exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. J Aborig Health. 2009;5:6-41.
Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health. 2019;18(1):174.
Gladman J, Ryder C, Walters LK. Measuring organisational-level Aboriginal cultural climate to tailor cultural safety strategies. Rural Remote Health. 2015;15(4):3050.
Durie M. An Indigenous model of health promotion. Health Promot J Austr. 2004;15:181-185.
Hayman N, White N, Spurling G. Improving Indigenous patients' access to mainstream health services: the Inala experience. Med J Aust. 2009;190(10):604-606.
Health Workforce Australia. Australia's Health Workforce Series- Aboriginal and Torres Strait Islander Health Workers/Practitioners in Focus. In: Health Do, editor. Canberra, ACT; 2014.
Nursing Council of New Zealand. Kawa Whakaruruhau: Guidelines for Nursing and Midwifery education. Wellington: Nursing Council of New Zealand; 1992.
Bourke L, Sheridan C, Russell U, Jones G, DeWitt D, Liaw S-T. Developing a conceptual understanding of rural health practice. Aust J Rural Health. 2004;12(5):181-186.
Cunningham J, Cass A, Arnold P. Bridging the treatment gap for Indigenous Australians. Med J Aust. 2005;182(10):505-506.
Australian Nursing and Midwifery Accreditation Council. Standards and Criteria for Accreditation; 2014. http://www.anmac.org.au/accreditation-standards. Accessed October 7, 2014.
Westwood B, Westwood G. Aboriginal cultural awareness training: policy v. accountability - failure in reality. Aust Health Review. 2010;34:423-429.
Franks T. Aboriginal Cultural Awareness Training Evaluation. Lismore: Northern NSW Local Health District. 2013.
Durie M. Indigenous knowledge within a global knowledge system. Higher Education Policy. 2005;18:301-302.
Wilson A. Addressing uncomfortable issues: reflexivity as a tool for culturally safe practice in Aboriginal and Torres Strait islander health. Aust J Indig Educ. 2014;43(2):218-230.
Commonwealth of Australia. Modified Monash Model. Canberra: Department of Health; 2019.
Stedman A, Thomas Y. Reflecting on our effectiveness: Occupational therapy interventions with Indigenous clients. Aust Occup Ther J. 2011;58(1):43-49.
McDermott D. Can we educate out of racism? Med J Aust. 2012;197(1):15.
Wilson AM, Kelly J, Magarey A, Jones M, Mackean T. Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity. Int J Equity Health. 2016;15(1):187.
Downing R, Kowal E, Paradies Y. Indigenous cultural training for health workers in Australia. Int J Qual Health Care. 2011;23(3):247-257.
Fraser S, Grant J, Mackean T, et al. What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children. Burns. 2020;46(2):430-440.
Taylor K, Guerin P. Health Care and Indigenous Australians: Cultural Safety in practice. Melbourne, Vic.: Palgrave Macmillan; 2010.
Nguyen H. Patient centred care: cultural safety in indigenous health. Aust Fam Physician. 2008;37(12):990.
Mackean T, Fisher M, Friel S, Baum F. A framework to assess cultural safety in Australian public policy. Health Promot Int. 2019;35(2):340-351.
Bennett B, Zubrzycki J, Bacon V. What do we know? the experiences of social workers working alongside Aboriginal people. Aust Soc Work. 2011;64(1):20-37.
Fraser S, Grant J, Mackean T, et al. Burn injury models of care: a review of quality and cultural safety for care of Indigenous children. Burns. 2018;44(3):665-677.
Lloyd J, Wise M, Weeramanthri T. Changing shape: workforce and the implementation of Aboriginal health policy. Aust Health Rev. 2008;32(1):174-185.
Panaretto K, Coutts J, Leon D, Hayman N. Evaluating performance of and organisational capacity to deliver brief interventions in Aboriginal and Torres Strait Islander medical service. Aust N Z J Public Health. 2010;34(1):38-44.
Durey A, Wynaden D, Thompson S, Davidson P, Bessarab D, Katzenellenbogen J. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq. 2012;19(2):144-152.
Fredericks B. Which way? Educating for nursing Aboriginal and Torres Strait Islander peoples. Contemp Nurse. 2006;23(1):87-99.
Stratta EC, Riding DM, Baker P. Ethical erosion in newly qualified doctors: perceptions of empathy decline. Int J Med Educ. 2016;7:286-292.
Grants
/Flinders University Faculty of Health Sciences
MeSH Term
Cultural Competency
Culturally Competent Care
Health Services, Indigenous
Humans
Northern Territory
Qualitative Research
South Australia
Australian Aboriginal and Torres Strait Islander Peoples