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Rix E, Doran F, Wrigley B, Rotumah D. Decolonisation for health: A lifelong process of unlearning for Australian white nurse educators. Nurs Inq 2024; 31:e12616. [PMID: 38031248 DOI: 10.1111/nin.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Indigenous nurse scholars across nations colonised by Europeans articulate the need for accomplices (as opposed to mere performative allies) to work alongside them and support their ongoing struggle for health equity and respect and to prioritise and promote culturally safe healthcare. Although cultural safety is now being mandated in nursing codes of practice as a strategy to address racism in healthcare, it is important that white nurse educators have a comprehensive understanding about cultural safety and the pedagogical skills needed to teach it to undergraduate nurses. We open this article with stories of our journeys as two white nurses in becoming accomplices and working alongside Indigenous Peoples, as patients and colleagues. Our lived experience of the inertia of healthcare and education organisations to address systemic and institutional resistance to the practice of cultural safety underpins the intention of this article. We understand that delivering this challenging and complex topic effectively and respectfully is best achieved when Indigenous and white educators work together at the cultural interface. Doing so requires commitment from white nurses and power holders within universities and healthcare institutions. A decolonising approach to nurse education at individual and institutional levels is fundamental to support and grow the work that needs to be done to reduce health inequity and increase cultural safety. White nurse accomplices can play an important role in teaching future nurses the importance of critical reflection and aiming to reduce power imbalances and racism within healthcare environments. Reducing power imbalances in healthcare environments and decolonising nursing practice is the strength of a cultural safety framework.
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Affiliation(s)
- Elizabeth Rix
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Frances Doran
- School of Nursing, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Beth Wrigley
- School of Nursing, Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Darlene Rotumah
- Gnibi College of Indigenous Australians, SCU, Bilinga, Queensland, Australia
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Anstice NS, Alam K, Armitage JA, Biles B, Black JM, Boon MY, Carlson T, Chinnery HR, Collins AV, Cochrane A, Duthie D, Hopkins S, Fitzpatrick G, Keay L, Watene R, Yashadhana A, Bentley SA. Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand. Clin Exp Optom 2023; 106:110-118. [PMID: 36336833 DOI: 10.1080/08164622.2022.2136514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.
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Affiliation(s)
- Nicola S Anstice
- Optometry and Vision Science, Flinders University, Adelaide, Australia
| | - Khyber Alam
- Division of Optometry, University of Western Australia, Perth, Australia
| | - James A Armitage
- School of Medicine (Optometry), Deakin University, Geelong, Australia
| | - Brett Biles
- Office of Medical Education, University of New South Wales, Sydney, Australia
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Aotearoa New Zealand
| | - Mei Ying Boon
- Optometry and Vision Science, University of Canberra, Bruce, Australia
| | - Teah Carlson
- College of Health, Massey University, Aotearoa, New Zealand
| | - Holly R Chinnery
- Department of Optometry and Vision Science, The University of Melbourne, Melbourne, Australia
| | - Andrew V Collins
- School of Optometry and Vision Science, The University of Auckland, Aotearoa New Zealand
| | - Anthea Cochrane
- Department of Optometry and Vision Science, The University of Melbourne, Melbourne, Australia
| | - Debbie Duthie
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shelley Hopkins
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Australia
| | - Gary Fitzpatrick
- Division of Optometry, University of Western Australia, Perth, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Renata Watene
- School of Optometry and Vision Science, The University of Auckland, Aotearoa New Zealand
| | - Aryati Yashadhana
- Office of Medical Education, University of New South Wales, Sydney, Australia
| | - Sharon A Bentley
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Australia
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Clifford S, Smith-Vaughan H, Brown L, Walters N, Hoosan W, Boyd N. Incorporating local health education priorities in HealthLAB: Learnings from very remote Australia. Health Promot J Austr 2023; 34:13-16. [PMID: 35879266 DOI: 10.1002/hpja.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/14/2022] [Accepted: 06/27/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED It is well-established that health education and promotion programs work best when they have been tailored to meet local contextual needs. In this brief report we describe a health education program and how it identified and incorporated local priorities into its delivery in two remote Aboriginal communities in the "Top End" of the Northern Territory. METHODS During the first visit to each community team members met with local stakeholders and ran an inaugural HealthLAB session. Fieldnotes were taken during or directly after each interaction. At the end of each day team members debriefed regarding their fieldnotes. After both trips had been completed, priority areas were extracted from fieldnotes and synthesised. RESULTS Although some health priorities were congruent across all groups, Community Members and Childcare staff tended to identify practical solutions while School and Clinic staff were focused on the clinical outcome. Community Members were particularly focused on the wider social and systemic factors impacting health. CONCLUSION In response to the need for practical support, HealthLAB modified their health education packages to upskill mothers and sports coaches to provide brief health education sessions to local children and young people. SO WHAT?: It is recognised that many health promotion programs focus on individual behaviours without creating supportive environments. While it was out of scope for HealthLAB to address physical environmental factors, by building local capacity and knowledge to deliver health education, the program can contribute to a healthier and supportive social environment.
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Affiliation(s)
- Sarah Clifford
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Louise Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Northern Territory Department of Health, Darwin, Australia
| | - Niamah Walters
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Whitney Hoosan
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nicole Boyd
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Saunders P, Doyle K. Gambling Interventions in Indigenous Communities, from Theory to Practice: A Rapid Qualitative Review of the Literature. J Gambl Stud 2021; 37:947-982. [PMID: 33751361 DOI: 10.1007/s10899-021-10019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/24/2022]
Abstract
Indigenous populations globally experience problem gambling at higher rates than mainstream communities, often leading to adverse outcomes in social, cultural, and health domains (The term 'indigenous' within this paper refers to all first nations people from the specified countries. When capitalised, this refers to Australian Indigenous people specifically.). Problem gambling in indigenous communities has been linked to relative poverty and social disadvantage. The sweeping impacts of problem gambling for indigenous communities are holistic in nature and are felt throughout many aspects of the community, including the local economy, education, employment, and cultural kinship obligations. The social links inherent in many gambling activities in addition to the motivations of players and complex socio-cultural milieu can make it very difficult to renounce the practice. This paper aims to evaluate the indigenous gambling literature to discern appropriate and effective principles to guide intervention development in the context of problem gambling pertaining to the Australian Indigenous population. A rapid review will be undertaken to gather, analyse, and interpret appropriate theoretical and empirical literature relating to gambling interventions for indigenous populations. Papers from Canada, Australia, New Zealand, and U.S.A (CANZUS) will be considered in the review and thematic analysis will be undertaken to ascertain a broad understanding of effective and appropriate problem gambling intervention principles applicable to these population groups. Despite the relative dearth of empirical evidence within this field, approaches to problem gambling intervention within indigenous populations must be culturally-centred and underpinned by a public health framework that considers the broad socio-politico-cultural context of the whole community. The importance of community-control, collaboration, community capacity building, workforce competence, a holistic approach, and gambling regulation cannot be overstated. The available literature focusses on an alternative approach to addressing problem gambling in indigenous communities, with much of the findings highlighting key indigenist principles within a context-based method of engagement and intervention, including addressing the social, political, and cultural determinants of problem gambling at a community-level.
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Affiliation(s)
- Paul Saunders
- Indigenous Health, School of Medicine, Western Sydney University, Narellan Rd, Campbelltown, NSW, Australia.
| | - Kerrie Doyle
- Indigenous Health, School of Medicine, Western Sydney University, Narellan Rd, Campbelltown, NSW, Australia
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