The experiences of Aboriginal and Torres Strait Islander Bachelor of Midwifery students: An integrative literature review

Exploring first-year occupational therapy students' perspectives of an On-Country experience: A study from an Australian undergraduate program

INTRODUCTION

In Australia, poor health outcomes for Aboriginal and Torres Strait Islander peoples have been well-documented. This often results from colonising practices embedded in systemic, environmental, economic, and social factors leading to marginalisation. To address these injustices, directives to enshrine cultural safety in health-care education/training have been proposed to ensure the development of a culturally safe workforce. Several frameworks have been developed to support tertiary education providers to decolonise curricula. However, with little published about occupational therapy curricula, how and whether occupational therapy students and/or graduates are culturally safe is not known. The purpose of this study is to capture the experiences of students that attended an inaugural On-Country experience embedded within a first-year, undergraduate occupational therapy unit (subject).

METHODS

This qualitative study used a reflexive thematic analysis method to recruit undergraduate students enrolled in a first-year occupational therapy unit, which incorporated an immersive On-Country learning experience. Data were collected from students via online blog posts, which prompted participants to describe their observations and reflections pre and post the On-Country experience. Data were analysed using Braun and Clarke's six stage thematic analysis process to generate themes.

CONSUMER AND COMMUNITY INVOLVEMENT

This study was conducted and authored with input from two diverse Aboriginal and Torres Strait Islander people-the facilitator and a colleague of mixed heritage. The tailored On-Country experience was facilitated by the Wadawurrung Traditional Owners Corporation.

FINDINGS

Analysis of the responses revealed three overarching themes: (1) Creation of a learning experience; (2) an awareness of embarking on a journey to being culturally safe practitioners and recognition of an emerging occupational therapy lens; and (3) engagement and connection to clinical practice.

CONCLUSION

Students expressed enhanced awareness and reflexivity in that they examined themselves, their history and recognised the influential value this had on health and wellbeing. This awareness can be used as a tool/opportunity to inform curriculum design and promote development of professional identity.

PLAIN LANGUAGE SUMMARY

Aboriginal and Torres Strait Islander peoples often have worse health because the health-care system has treated them unfairly. To change this, we need a fair system and health workers who give safe and respectful care. Culturally safe care means health workers must think about what they know and how they act. Universities try to teach this, but there are problems. Some teachers and students feel unsure. There are not enough resources. Health courses mostly follow Western ideas. Strong leaders are needed to help change this. One way to improve learning is by, including Aboriginal and Torres Strait Islander knowledges. This study looked at what first-year occupational therapy students learned from an On-Country experience. Students shared their thoughts online. They said the experience helped them think in new ways and understand the struggles of Aboriginal and Torres Strait Islander peoples. They are not yet working as health professionals, but they know their role in making health-care fair and safe. Many said, they now see the world differently. But more learning and changes in universities are needed.

Midwifery students' perceptions and learning experiences during clinical practice: a qualitative systematic review

OBJECTIVES

This systematic review aimed to investigate, critically appraise, and synthesize qualitative evidence related to midwifery student perceptions and learning experiences during clinical practice.

INTRODUCTION

Midwifery students are expected to acquire strong competencies during pre-registration education. Clinical practice offers valuable opportunities for the students to develop essential practical capacities. Gaining insights into the perceptions and experiences of midwifery students in relation to their clinical practice is significant in devising effective strategies for clinical education. The literature shows a range of qualitative studies conducted to focus on these aspects. While a single study may not comprehensively capture all the experience. This review aggregated existing qualitative evidence to inform the development of more effective clinical education programs.

INCLUSION CRITERIA

This review included studies that explored midwifery students' perceptions and experiences in relation to their clinical practice in any practical settings. The review focused on qualitative data of various designs including, but not limited to, phenomenology, grounded theory, ethnography, action research, and mixed-method research.

METHODS

A 3-stage search was conducted to include published and unpublished articles. Databases searched included PsycINFO (EBSCOhost), ProQuest Dissertation and Theses, CINAHL Complete (EBSCOhost), Science Direct, Cochrane Library, Embase, PubMed, Web of Science, and gray literature. Papers published in English were considered. Data were extracted using a standardized tool. Data synthesis adhered to the meta-aggregative approach to categorize findings. The categories were synthesized into a set of findings to inform midwifery practical education.

RESULTS

This review encompassed 32 qualitative studies. A total of 212 findings were extracted and classified into 21 distinct categories, which then generated 3 synthesized findings related to midwifery students' adaption to clinical environment, clinical teaching and mentorship, and student learning and development. The overall study quality, assessed using ConQual, was rated as moderate, with moderate dependability and high credibility.

CONCLUSIONS

This review highlights a need for supporting midwifery students to access their practical learning experience in order to develop essential professional capabilities. Strategies may address key aspects with regards to building a positive clinical learning environment to support the students' adaption, identifying their specific learning needs, and applying effective mentoring strategies.

'Mob aren't staying when there's no support': Enablers and barriers of recruitment and retention of First Nations midwifery students - A qualitative study

BACKGROUND

Aboriginal and Torres Strait Islander (hereafter referred to as First Nations) childbearing women report negative experiences from a lack of culturally safe maternity care. Evidence supports improved health outcomes for First Nations women and infants when cared for by First Nations midwives. There are barriers to First Nations students accessing university, particularly nursing and midwifery students, with a lack of evidence exploring the experiences of First Nations midwifery students.

AIM

This study aims to understand the impact of the current strategies to improve recruitment and retention of First Nations midwifery students and identify further innovations.

METHODS

A semi-structured yarning circle was held with six Bachelor of Midwifery students at a university in Queensland, Australia.

FINDINGS

Three key categories emerged: student recruitment, student retention and student success. Enablers included culturally appropriate recruitment, partnerships with other First Nations peoples, incorporating First Nations ways of Knowing, Being, and Doing, culturally safe support, placements and mentorship, and identification and representation. Barriers included financial impacts, experiences of racism and lack of Cultural Safety and humility.

DISCUSSION

Overall, students felt the university provided a culturally safe environment and implemented strategies that supported students' recruitment, retention and success in the degree. They suggested improvements to current strategies and new ideas for implementation.

CONCLUSION

Strategies to improve recruitment and retention of First Nations midwifery students are imperative to close the gap in educational attainment and improve health outcomes for First Nations peoples. These strategies need to be multi-layered, culturally appropriate and implement a whole of university approach.

Indigenous students' experiences of being taught indigenous health

BACKGROUND

Increasing the numbers of Indigenous health professionals is an international priority to enhance health outcomes for Indigenous communities. It is also incumbent on academics to ensure all graduates are culturally safe to work with Indigenous Peoples, and that accredited health degrees contain appropriate Indigenous content, improving the cultural competence of the registered health workforce. However, little current research investigates Indigenous tertiary students' experiences of learning about Indigenous health.

AIM

To explore Indigenous students' experiences of being taught Indigenous health.

DESIGN

This study employed an online survey (16 % response rate) developed to evaluate student's beliefs, attitudes and learning experiences following operationalisation of a university Indigenous Graduate Attribute. An Aboriginal researcher also conducted Yarning Circles with Indigenous students as a culturally appropriate means to deepen insight into their experiences of studying Indigenous health topics alongside non-Indigenous peers.

SETTING

A large urban Australian university.

PARTICIPANTS

Twelve Indigenous students from four health disciplines completed the anonymous survey. Five Indigenous midwifery students participated in a Yarning Circle.

METHODS

Survey data were analysed descriptively using SPSS version 27. Qualitative data from Yarning Circle transcripts were analysed thematically from an inductive Indigenous standpoint.

RESULTS

Results from the survey demonstrated unanimous agreement that all health students should learn about Indigenous Peoples' health and cultures. However, most participants agreed that there needed to be more content on Indigenous knowledges, derived from Indigenous authors, researchers, and community presenters. The Yarning Circle yielded rich discussion of students' experiences, explored across three key themes and associated sub-themes. Themes were: When your culture is content; Being an Indigenous student; and Sources of strength and support as Indigenous students.

CONCLUSIONS

Findings indicate the importance of framing Indigenous content, incorporating Indigenous knowledge into curricula, ensuring Cultural Safety in classrooms with both Indigenous and non-Indigenous students, and supporting Indigenous students to excel.

Decolonizing nursing for health equity: A scoping review

BACKGROUND

The recent push to "decolonize nursing" has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword.

PURPOSE

This article clarifies "decolonizing nursing" by addressing the following questions: (a) How has "decolonizing nursing" been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity?

METHODS

We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included.

DISCUSSION

"Decolonization" has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes.

CONCLUSION

Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism's historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

Self-determination in programmes of perinatal health for Aboriginal Communities: A systematic review

OBJECTIVE

The importance of self-determination in restoring the wellbeing of Australian First Nations peoples is becoming understood. For thousands of years, Aboriginal women gave birth on Country and Grandmothers' Lore and Women's Business facilitated the survival of the oldest living civilisations on earth. Following colonisation, however, Aboriginal and Torres Strait Islander practices of maternal and perinatal care were actively dismantled, and self-determination by Aboriginal people was destroyed. This had significant implications for the wellbeing of Aboriginal and Torres Strait Islander people and their Cultures and practices.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-based systematic review of research about programmes of birthing and perinatal health care for Australian Aboriginal and Torres Strait Islander women and their children was undertaken. The review's primary aim was to assess the Cultural context of programme development and delivery, its secondary aim was to assess the Cultural appropriateness of programme components. Electronic databases SCOPUS, PsycINFO, Medline, and CINAHL were searched for peer-reviewed studies published in English in Australia between 2000 and 2023.

RESULTS

Twenty-eight publications met inclusion criteria. Included studies were assessed for their methodological characteristics, birthing-support characteristics, perinatal care and continuity of care characteristics. Overall, programmes were limited in meeting the Cultural needs of women, children, and individual Communities. The role of Aboriginal Communities in identifying, delivering, and reviewing programmes was also limited.

CONCLUSIONS

Findings articulate the importance of self-determination in maintaining strong Indigenous Cultures and informing the Culturally appropriate development and delivery of Culturally safe programmes of perinatal care for Aboriginal women, children, and Communities.

IMPLICATIONS FOR PUBLIC HEALTH

Programmes and services for use by Aboriginal and Torres Strait Islander people must involve Aboriginal and Torres Strait Islander people and their Communities in processes of programme planning, delivery, and review. The evaluation of a programme or service as "Culturally safe" represents a determination that is most appropriately made by service users based on their experience of that programme or service.

Aboriginal women's experiences of strengths and challenges of antenatal care in the Kimberley: A qualitative study

BACKGROUND

High-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women's experiences of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care.

METHODS

Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015-2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed.

FINDINGS

Most women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles.

CONCLUSIONS

The experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.