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

Ethnic disparities in rapid tranquillisation use and explanations in adult mental health emergency settings? A systematic review

OBJECTIVE

Ethnicity is a frequently reported risk factor for rapid tranquillisation (RT) use in mental health. We aimed to investigate the association between ethnicity and RT use in adult mental health emergency settings and explore potential explanations for the relationship between ethnicity and RT use in these settings.

METHODS

Studies were included if they reported the association between ethnicity and RT use in adult mental health emergency settings. Searches were conducted across six databases and in grey sources and references until 15 April 2024. A narrative synthesis was performed and, in addition, a random-effects model was used for meta-analysis, with odds ratio as the measure. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the overall certainty of evidence. Potential explanations for RT use in relation to ethnicity were also synthesised narratively.

RESULTS

Five studies from Norway (n = 1), Spain (n = 1) and the United States (n = 3) were included (14,777 individuals). Multiple classifications of ethnicity were used, with White, non-Hispanic and native-born serving as the ethnic majority group compared to ethnic minority counterparts. Overall, ethnic minorities in adult mental health emergency settings were non-statistically more likely to receive RT than ethnic majority populations. The overall certainty of evidence was deemed as low according to GRADE.

CONCLUSION

While RT use was not statistically significantly higher among ethnic minorities overall, Black individuals, as a specific ethnic group, had significantly increased odds of experiencing RT compared to ethnic majority populations. Additional research is necessary to confirm these findings and better understand the reasons behind these disparities through valid explanations.

Experiences of New Zealand Māori Mothers' Engagement with Health and Social Services Post-COVID-19 2020 Lockdown

BACKGROUND

Despite universal provision of maternity care, Māori (Indigenous peoples of Aotearoa/New Zealand) experience significant maternal and infant health disparities compared to their dominant Pākehā (non-Māori) counterparts. This paper examined the lived realities of postnatal Māori māmā (mothers) engaging with health and social services. Enablers and barriers were identified to better understand what is required to strengthen health services' responsiveness to Māori māmā health needs and aspirations.

METHODS

Underpinned by Kaupapa Māori research principles, which are grounded in Māori cultural values, emphasising self-determination, and Māori aspirations, a small cohort of 17 expectant Māori māmā were recruited from a Māori childbirth education programme to participate in a three-phase study. Phase three, the focus of this paper, involved seven semi-structured, open-ended telephone interviews with Māori māmā. A thematic analysis, underpinned by a mana wahine (authority inherent in Māori women) theoretical perspective amplified these experiences.

RESULTS

Five themes were identified that encapsulated participants' engagement and interactions with health and social services. These themes were as follows: (1) right to enact tino rangatiratanga (autonomy) and self-achievement; (2) responsiveness of services; (3) service and system issues; (4) need for greater choice and opportunity; and (5) impact of COVID-19.

CONCLUSIONS

This study privileged the voices of Māori wāhine, highlighting their experiences with a complex and often unresponsive health system. Participants valued services that enabled them to exercise tino rangatiratanga. Echoing the experiences of other Indigenous Peoples, incorporating culturally relevant practices into perinatal health services is crucial for achieving health equity and addressing disparities.

A Bi-Cultural Multidisciplinary Approach to Achieving Excellence in Care for Indigenous Māori: Report From the Wānanga, Auckland, 2023

AIMS

To explore the alignment of nursing and healthcare practice illustrated in the Fundamentals of Care framework with Māori (Indigenous person of Aotearoa, New Zealand) worldviews using Indigenous methods.

DESIGN

Discursive report.

METHODS

In October 2023, around 50 healthcare professionals and Māori leaders from across Aotearoa, New Zealand, attended a wānanga, an Indigenous Māori approach for sharing knowledge and engaging in in-depth discussion and deliberation.

RESULTS

Attendees understood the origins of the Fundamentals of Care framework and how it translates to practice. The depth and breadth of meaning when referring to Māori values and practices adds a layer of complexity when attempting to align Māori worldviews with the Fundamentals of Care framework. A key outcome of the day was a call for tāngata Tiriti (people of the Treaty-non-Māori) to continue to work in partnership with tāngata whenua (people of the land-Māori) to explore how the Fundamentals of Care framework could be used with a mode of practice that emphasises Māori values and practices such as whakawhanaungatanga (establishing relationships) and manaakitanga (showing respect, generosity and care for others).

CONCLUSION

Applying Indigenous methods to explore problems and co-create solutions offers the potential to advance health equity agendas. Wānanga, as a forum for engaging in the process of sharing, reflecting, discussing and learning, provides a mana-enhancing (strengths-based) space for tāngata whenua (people of the land-Māori) and tāngata Tiriti (people of the Treaty-non-Māori), to relate and collaborate. Additional wānanga are required to co-create a mode of practice that can be applied by all health professionals and that meets the needs of Māori.

IMPACT

This report addresses how the Fundamentals of Care framework can be scrutinised for its usefulness or adaptability to encompass Indigenous populations' culture and care needs. Critical points of difference between the Fundamentals of Care framework and Indigenous Māori worldviews exist and need further exploration. This report impacts the delivery of healthcare for Indigenous Māori and the provision of healthcare by all nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Bridging historical understanding with culturally safe nursing and midwifery care for indigenous people: a scoping review's telling gap in literature

AIM

The purpose of this paper is to explore the need for historically informed, culturally safe nursing and midwifery literature about Australian Indigenous people.

BACKGROUND

The cultural safety framework, developed by Irihapeti Ramsden, has long identified the importance of historical literacy in delivering culturally safe nursing and midwifery care. However, little evidence is available exploring the links between these domains. In the Australian setting, this is particularly relevant due to the health gap and, therefore, life differentials between Indigenous and non-Indigenous Australians and the potential of culturally safe nursing and midwifery care to contribute to rectifying this.

METHODS

A scoping literature review was conducted by searching four databases for both articles and grey literature that explored historically informed, culturally safe nursing and midwifery practice for Indigenous people internationally. This search spanned from 2003 onwards and required discussion of clinical practice by registered nurses or midwives. A discursive method was utilised to analyse the discourse surrounding these domains.

RESULTS

The review found only two texts that explored the connection between Indigenous peoples, history, cultural safety, nursing and midwifery in depth. This highlights a large literature gap internationally. Following this review, a discursive argument was created that highlights how a lack of culturally safe, historically informed care in Australia has resulted in unsafe and racist health experiences for Indigenous people.

CONCLUSIONS

Australian nurses, midwives, healthcare organisations and health academics are provided with recommendations on how they can create the mandated cultural safety through historically informed environments and care practices. These include but are not limited to, ongoing Indigenous-led professional development, appropriate remuneration for Indigenous knowledge holders, and professional development for all nursing and midwifery academics.

Supporting minority cultures during initial engagements with body donors in the dissecting room: A pilot study exploring perspectives of Pasifika medical students around culture and cultural safety

The first experience of medical students in the dissecting room (DR) is a challenging event. Few data exist around whether or how culturally appropriate support is required in the DR for students from ethnic minorities. This pilot study explored Pasifika (peoples with heritage from the Pacific Islands) students' first experience of the DR and exposure to body donors to explore cultural perspectives around this event. Participants were second year Pasifika medical students with no prior engagement with body donors. Following a first exposure to body donors, semi-structured face-to-face interviews were conducted. Questioning explored how Pasifika students experienced initial DR engagement in regard to Pasifika culture and cultural safety. Interviews were recorded, transcribed, and analyzed thematically. Eight Pasifika students were interviewed (ages 18-32 years, mean 21.3 years, five females); mean interview duration 24.5 min. Four themes were identified: cultural observations, student behaviors, cultural safety, and cultural comfort. Dominant messages included the cultural challenges presented by this event, conformity of cultural behavior, identification of cultural safety being appropriate, and illumination of potential cultural support strategies. Current mechanisms supporting cultural safety were identified as adequate, which juxtaposed against behavior where students could not act in a culturally authentic manner. Suggestions were made around improving cultural comfort, such as the presence of elders or Christian-focused elements such as prayer. Enhanced cultural support could increase cultural comfort for the initial DR and body donor experience of Pasifika students, which may facilitate increased cultural knowledge and promote cultural diversity within the medical student cohort.

Machine Learning Model Reveals Determinators for Admission to Acute Mental Health Wards From Emergency Department Presentations

This research addresses the critical issue of identifying factors contributing to admissions to acute mental health (MH) wards for individuals presenting to the emergency department (ED) with MH concerns as their primary issue, notably suicidality. This study aims to leverage machine learning (ML) models to assess the likelihood of admission to acute MH wards for this vulnerable population. Data collection for this study used existing ED data from 1 January 2016 to 31 December 2021. Data selection was based on specific criteria related to the presenting problem. Analysis was conducted using Python and the Interpretable Machine Learning (InterpretML) machine learning library. InterpretML calculates overall importance based on the mean absolute score, which was used to measure the impact of each feature on admission. A person's 'Age' and 'Triage category' are ranked significantly higher than 'Facility identifier', 'Presenting problem' and 'Active Client'. The contribution of other presentation features on admission shows a minimal effect. Aligning the models closely with service delivery will help services understand their service users and provide insight into financial and clinical variations. Suicidal ideation negatively correlates to admission yet represents the largest number of presentations. The nurse's role at triage is a critical factor in assessing the needs of the presenting individual. The gap that emerges in this context is significant; MH triage requires a complex understanding of MH and presents a significant challenge in the ED. Further research is required to explore the role that ML can provide in assisting clinicians in assessment.

Disproportionate mental health presentations to emergency departments in a coastal regional community in Australia of first nation people

Emergency department (ED) presentations for mental health (MH) help-seeking have been rising rapidly in recent years. This research aims to identify the service usage demographic for people seeking MH care in the ED, specifically in this case, to understand the usage by First Nation people. This retrospective cohort study examined the sociodemographic and presentation characteristics of individuals seeking MH care in two EDs between 2016 and 2021. Data were collected using existing records and analysed using descriptive univariate analysis with statistical significance between the two sites determined using chi-squared test, p < 0.05. The overall data presented in this analysis show an overall ED mental health presentation rate of 12.02% for those who identified as 'Aboriginal but not Torres Strait Islander origin', 0.36% as 'Both Aboriginal and Torres Strait Islander' and 0.27% as 'Torres Strait Islander' totalling 12.63%. This is an overrepresentation compared to the regional population of 4.9%. One site recorded 14.1% of ED presentations that identified as Aboriginal and/or Torres Strait Islander, over double the site's demographic of 6.3%. Given the disproportionately high representation of First Nation people in MH-related ED presentations, further research is required to prioritise a First Nation research perspective that draws on First Nation research methods, such as yarning and storytelling to understand the unique cultural needs and challenges experienced by First Nation people accessing MH care via ED. Understanding the demographic is but one step in supporting the Cultural Safety needs of First Nation people. Additionally, research should be designed, governed and led by First Nation researchers.

Culturally safe healthcare: changing the lens from provider control to patient agency

BACKGROUND AND GOAL

Marginalized patients often feel unwelcome in healthcare. The concept of culturally safe healthcare (CSH) represents an important paradigm shift from provider control to patients who feel safe voicing health concerns and believe that they are heard by providers. This study has five goals: review works describing CSH, identify CSH themes, describe provider behaviors associated with CSH, describe interventions, and discuss how health communication can advance CSH.

METHODS

A scoping review was conducted for articles published between 2019 and 2023 following modified PRISMA guidelines. Online databases included Pubmed (Medline), CINAHL, Web of Science, Google Scholar, and Redalyc. Thematic analysis was also conducted.

RESULTS

Twenty-one articles meeting inclusion criteria were identified and analyzed. Of these, five explained features of CSH, four were empirical studies, seven were content analyses, and five were interventions. Five themes were identified including (1) how patients perceive CSH, (2) sociocultural determinants of health inequity, (3) mistrust of care providers, (4) issues with the biomedical model of healthcare, and (5) the importance of provider-patient allyship. Care provider communication behaviors fostering CSH were discussed. Three CSH interventions were highlighted. Finally, there was a discussion for how health communication scholars can contribute to CSH.

CONCLUSIONS

CSH offers a paradigm shift from provider control to marginalized patients' experience of patient-provider communication. Recommendations for how health communication scholars can contribute to the implementation of CSH included developing guiding theories and measurement, evaluation of CSH outcomes, and conducting focus groups with patients to assess the meaning of cultural safety.

The cultural safety of research reports on primary healthcare use by Indigenous Peoples: a systematic review

INTRODUCTION

Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories.

METHODS

Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool.

RESULTS

We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access.

CONCLUSION

Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs.

Understanding the needs and preferences for cancer care among First Nations people: An integrative review

AIM

This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people.

DESIGN

Integrative review.

DATA SOURCES

An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted.

RESULTS

Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs.

CONCLUSION

Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs.

PATIENT OR PUBLIC CONTRIBUTION

Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work.

IMPLICATIONS FOR NURSING PRACTICE

Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

Objectives

Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic.

Methods

Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020-August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months.

Results

Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33-16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33-11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43-15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06-6.94) had higher odds of experiencing recent difficulty accessing routine healthcare.

Discussion

Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.

Healthcare professionals' cultural safety practices for indigenous peoples in the acute care setting - a scoping review

BACKGROUND

For Indigenous Peoples the disparities in health status are largely associated with the direct social determinants of invasion and colonisation, marginalisation, intergenerational traumas, and lack of conscious government policy to address these ongoing effects. There is currently limited evidence in the literature on what Cultural Safety practices mean in acute care settings.

OBJECTIVE

We aimed to understand the extent and type of evidence in relation to current knowledge and evidence regarding Cultural Safety practices for Indigenous Peoples in acute care settings.

DESIGN

This is a scoping review.

METHODS

We searched six databases in consultation with a librarian experienced in health research.

RESULTS

A total of 16 papers were included in the scoping review. Four main barriers to Cultural Safety in practice were identified; Among the included studies, only one quality improvement study reported an intervention, which improved culturally safe care.

CONCLUSION

The four barriers identified each have a variable impact on Indigenous Peoples' health outcomes and are dependent upon the circumstances and experiences of both Indigenous Peoples and healthcare professionals.

Integration of traditional therapies for first nations people within western healthcare: an integrative review

AIMS

To conduct an integrative literature review to reveal any evidence supportive of the integration of traditional therapies for First Nations peoples in Australia within a western healthcare model, and to identify which, if any, of these therapies have been linked to better health outcomes and culturally safe and appropriate care for First Nations peoples. If so, are there indications by First Nations peoples in Australia that these have been effective in providing culturally safe care or the decolonisation of western healthcare practices.

DESIGN

Integrative literature review of peer-reviewed literature.

DATA SOURCES

Online databases searched included CINAHL, Medline, Scopus, ScienceDirect InformitHealth, and ProQuest.

REVIEW METHODS

Databases were searched for papers with full text available and published in English with no date parameter set. The PRISMA guidelines were used during the literature review and the literature was critiqued using the Critical Appraisal Skills tool.

RESULTS

Seven articles met the inclusion criteria and were included in the review. Four articles selected were qualitative, two used a mixed method design, and one used a quantitative method. Six themes arose: (i) bush medicine, (ii) traditional healers, (iii) traditional healing practices, (iv) bush tucker, (v) spiritual healing, and (vi) therapies that connected to cultures such as yarning and storytelling.

CONCLUSION

There is limited literature discussing the use of traditional therapies in Western healthcare settings. A need exists to include traditional therapies within a Western healthcare system. Creating a culturally safer and appropriate healthcare experience for First Nations people in Australia and will contribute to advancement in the decolonisation of current healthcare models.

Promoting mental health recovery by design: Physical, procedural, and relational security in the context of the mental health built environment

The rates of mental health hospitalisations in Australia are rising. This paper presents the findings of a study undertaken in a regional mental health unit. The aim of the study was to obtain user perspectives to inform the redesign of the unit, which provides inpatient mental health services to rural and regional adults. A qualitative descriptive study with data collected via focus groups and in-depth interviews was undertaken with 38 participants, including current inpatients, carers and 27 staff members of a single regional inpatient mental health unit. The 25-bed mental health inpatient unit accommodates adults from 18+ years of age. The mental health unit sits within a referral hospital precinct and is associated with community-based mental health services within a large regional and rural Australian public health service. The analysis of interviews and focus groups with patients, carers and mental health professionals revealed three major themes congruent with the literature These were: Firstly, Theme 1: Rooms should be designed to promote physical security. Next, Theme 2: Purposeful planning to support interactions between users and systems will promote relational security. And finally, Theme 3: Optimizing service integrity should promote procedural security. Based on the themes arising from the study, a list of recommendations was produced to inform the design of a new build for a regional mental health unit. In particular, all users of the space should expect that the built environment will promote their physical security and psychological safety and accommodate a wide range of diversity and acuity. The aesthetics should align with the promotion of recovery in the context of person-centred and trauma-informed models of care. Designers should plan to alleviate boredom and accommodate meaningful wayfinding. Mental health nurses should have spaces that support their work without compromising their relational security with consumers. Building designers should optimize therapeutic environments to facilitate dignified intensive and stabilizing treatments and eliminate vicarious stigma associated with caring for people with mental illness. This study provides valuable insights from a community of users who have experienced receiving and delivering mental health care within a regional and rural mental health unit.

How is cultural safety understood and translated into midwifery practice? A scoping review and thematic analysis

AIM

To identify and understand the scope of the literature published since January 2008 that explored Australian midwives understanding of cultural safety and how this is translated into their practice when caring for First Nations women and families.

BACKGROUND

Recognition and understanding of First Nations peoples history and culture and the impact this has on the health and wellbeing of women and their families is essential if the midwife is to promote culturally safe and respectful maternity care. The role and responsibilities of the midwife in ensuring that their practice is culturally safe are now reflected in the Australian professional midwifery codes and standards. Whilst midwifery academics' awareness of cultural safety and how it is taught within midwifery education programs have previously been explored, at present, little is known about midwives' understanding of cultural safety, and how this translates into their clinical practice.

METHODS

A Scoping Review was undertaken following Arksey and O'Malley's five step process. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses - Scoping Review extension checklist. Twelve studies met the criteria for inclusion. Thematic analysis was used to analyse the data and organise the results.

RESULTS

Thematic analysis, guided by two predetermined review questions led to the identification of six overarching themes: 'Awareness of deficiencies', 'The importance of meeting women's diverse needs', 'Understanding relationships as a foundation for culturally safe care', 'Working in partnership with others', 'Providing individualised care' and 'Fostering effective relationships and communication'. One sub-theme of the first theme was identified, this was named 'Seeking an understanding of culture'.

CONCLUSION

Australian midwives' level of understanding of cultural safety and how it is translated into their midwifery practice when caring for First Nations women and their families differ widely. Midwives across Australia require increased and equitable access to appropriate opportunities to improve their knowledge and understanding of cultural safety. Whilst theoretical learning on cultural safety has a place in all midwives annual mandatory training requirements, this should ideally be supplemented, where possible, with opportunities for immersive practice in communities. Immersion was considered the optimal way to gain rich knowledge and understanding to strengthen culturally safe midwifery practice. Continuity models of midwifery care which incorporate the principles of cultural safety should be consistently implemented across Australia. These models enable midwives, women, families, communities, and Aboriginal Support Workers to work in collaboration towards achieving optimal outcomes for mothers and babies.

STUDY REGISTRATION

N/A.

Occupational therapists' practice with complex trauma: A profile

INTRODUCTION

Many children in Aotearoa (New Zealand) and Australia experience complex trauma and its developmental impacts. Internationally, occupational therapists work with complex trauma and use sensory-based, integrative, and functional approaches. The practices of occupational therapists in Aotearoa and Australia with children experiencing complex trauma have not previously been described.

METHODS

This article reports the quantitative results of a mixed-methods study which profiled occupational therapists' practice in Aotearoa and Australia with children aged 0 to 12 years old who experienced complex trauma. Twenty-five participants completed the survey. The average age of participants was 43 years (SD = 10.65), all were female (n = 25), and most identified as New Zealand European (n = 11) or Australian European (n = 9). A survey was distributed via Occupational Therapy New Zealand - Whakaora Ngangahau Aotearoa and Occupational Therapy Australia.

RESULTS

The majority of participants had a bachelor's degree (64%) and worked in community settings (76%). Fourteen participants (56%) used sensory approaches. The most common assessments used were those of sensory processing (n = 12, 48%) and observation (n = 12, 48%). The Sensory Profile was the most popular standardised assessment (n = 8, 32%). The most common interventions used with children experiencing complex trauma were sensory (n = 13, 52%) and play based (n = 13, 52%). Most participants reported not adapting their practices for Māori or Aboriginal children. Most participants felt somewhat prepared (n = 15) for working with complex trauma, with most reporting a lack of experience in this area (n = 10). Supervision was suggested by 92% (n = 23) of the participants.

CONCLUSION

Sensory-based practices were most common among occupational therapists in Aotearoa and Australia who worked with children experiencing complex trauma. The participants suggested supervision, social support, and practical training when working with complex trauma. Advocacy and research are required within this subspecialty, and further professional engagement in the application of culturally safe practice.

Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature

Cultural safety is increasingly being taught in tertiary programmes of study for health professionals. Reflexivity is a key skill required to engage in culturally safe practice, however, there is currently limited literature examining how reflexivity is taught or assessed within cultural safety curricula. A systematic review of the literature up until November 2021 was conducted, examining educational interventions which aimed to produce culturally safe learners. Studies were limited to those with a focus on Indigenous health and delivered in Australia, Aotearoa New Zealand, Canada, and the United States. A total of 46 documents describing 43 different educational interventions were identified. We found that definitions and conceptualisations of reflexivity varied considerably, resulting in a lack of conceptual clarity. Reflexive catalysts were the primary pedagogical approaches used, where objects, people, or Indigenous pedagogies provided a counterpoint to learners’ knowledges and experiences. Information regarding assessment methods was limited but indicates that the focus of existing programmes has been on changes in learner knowledge and attitudes rather than the ability to engage in reflexivity. The results demonstrate a need for greater conceptual clarity regarding reflexivity as it relates to cultural safety, and to develop methods of assessment that focus on process rather than outcomes.

The Bunya Project: Protocol to develop culturally informed curriculum (Preprint)

BACKGROUND

Indigenous peoples live across all continents, representing approximately 90 nations and cultures and 476 million people. There have long been clear statements about the rights of Indigenous peoples to self-determine services, policies, and resource allocations that affect our lives, particularly via the United Nations Declaration on the Rights of Indigenous Peoples. An area for urgent improvement is curricula that train the predominantly non-Indigenous health workforce about their responsibilities and that offer practical strategies to use when engaging with Indigenous peoples and issues.

OBJECTIVE

The Bunya Project is designed to advance Indigenous community-led teaching and evaluation of the embeddedness of strategies to achieve an Indigenous Graduate Attribute in Australia. The project centers the relationships with Aboriginal community services to lead education design relating to Indigenous peoples. The project aims to articulate community recommendations for university education in allied health in the usable format of digital stories to create culturally informed andragogy, curriculum, and assessment measures for use in teaching. It also aims to understand the impact of this work on student attitudes and knowledge about Indigenous peoples' allied health needs.

METHODS

Multilayered project governance was established, along with a 2-stage process using mixed methods participatory action research and critical reflection, using the reflective cycle by Gibbs. The first stage, preparing the soil, used community engagement, drew on lived experience, encouraged critical self-reflection, embodied reciprocity, and demanded working collectively. The second stage, planting the seed, requires more critical self-reflection, the development of community data through interviews and focus group discussions, the development of resources with an academic working group and community participants, the implementation of those resources with student feedback, the analysis of the feedback from students and community members, and reflection.

RESULTS

The protocol for the first stage, preparing the soil, is complete. The results of the first stage are the relationships built and the trust earned and gained, and it has resulted in the development of the planting the seed protocol. As of February 2023, we have recruited 24 participants. We will analyze data shortly and expect to publish the results in 2024.

CONCLUSIONS

The readiness of non-Indigenous staff to engage with Indigenous communities has not been ascertained by Universities Australia, nor can it be assured. Staff preparation and skills to support the curriculum, create a safe learning environment, and develop teaching and learning strategies to guide academics to recognize that how students learn is as important as the content students learn. This learning has broad implications and benefits for staff and students within their professional practice and for lifelong learning.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39864.