Employee perceptions of race and racism in an Australian hospital

BACKGROUND

Racism contributes to health inequities faced by people of colour and marginalised groups. Despite widespread recognition of the impacts of racism, mitigating strategies and legislation have been largely unsuccessful. Research into racism in healthcare has mostly examined personal experiences of healthcare workers and patients, assuming that the definitions of racism and race are similarly understood by all. However, ethnicity and race are often conflated, and racism seen as primarily interpersonal and ahistorical.

PURPOSE

This paper explores hospital employee understandings of racism, its impacts and how to reduce it.

METHODS

Forty-nine staff within one Australian hospital participated in individual qualitative interviews regarding the definition, impact, and ways of reducing racism. Interviews were analysed with a reflexive thematic analytic approach using a Postcolonial framework.

RESULTS

Participants described racism as being experienced by marginalised groups of people in Australia. They identified that racism has detrimental effects on health and wellbeing. Not all were clear regarding what constituted racism: it was not described as an ideology created to justify colonial distribution of power and resources. Some thought that racism was individual prejudice while others noted it was also structural in nature. Participants commonly defined race as involving physical or cultural differences, suggesting that discredited historical and colonial concepts of race continue in Australian society. While many felt that education was the best way to reduce racism and its impacts, some participants noted that being educated did not necessarily change racist behaviour.

CONCLUSIONS

The lack of accurate understanding of the concept of race and racism likely contributes to the relatively poor effect of current strategies to combat racism. As an initial part of deeper systemic anti-racist reform, this research supports calls for anti-racist education to clarify the definition of racism as an ideology.

Identifying and dismantling racism in Australian perinatal settings: Reframing the narrative from a risk lens to intentionally prioritise connectedness and strengths in providing care to First Nations families

INTRODUCTION

The perinatal period is a time when provision of responsive care offers a life course opportunity for positive change to improve health outcomes for mothers, infants and families. Australian perinatal systems carry the legacy of settler-colonialism, manifesting in racist events and interactions that First Nations parents encounter daily.

OBJECTIVE

The dominance of a western risk lens, and conscious and unconscious bias in the child protection workforce, sustains disproportionately high numbers of First Nations infants being removed from their parents' care. Cascading medical interventions compound existing stressors and magnify health inequities for First Nations women.

DESIGN

Critical discourse was informed by Indigenous ways of knowing, being and doing via targeted dialogue with a group of First Nations and non-Indigenous experts in Australian perinatal care who are co-authors on this paper. Dynamic discussion evolved from a series of yarning circles, supplemented by written exchanges and individual yarns as themes were consolidated.

RESULTS

First Nations maternity services prioritise self-determination, partnership, strengths and communication and have demonstrated positive outcomes with, and high satisfaction from First Nations women. Mainstream perinatal settings could be significantly enhanced by embracing similar principles and models of care.

CONCLUSIONS AND RELEVANCE

The Australian Anti-racism in Perinatal Practice (AAPP) Alliance calls for urgent transformations to Australian perinatal models of care whereby non-Indigenous health policy makers, managers and clinicians take a proactive role in identifying and redressing ethnocentrism, judgemental and culturally blind practices, reframing the risk narrative, embedding strength-based approaches and intentionally prioritising engagement and connectedness within service delivery.

Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia

BACKGROUND

Refugee and migrant women are at higher risk of childbirth complications and generally poorer pregnancy outcomes. They also report lower satisfaction with pregnancy care because of language barriers, perceived negative attitudes among service providers, and a lack of understanding of refugee and migrant women's needs. This study juxtaposes health policy expectations in New South Wales (NSW), Australia on pregnancy and maternity care and cultural responsiveness and the experiences of maternal healthcare providers in their day-to-day work with refugee and migrant women from non-English speaking backgrounds.

METHODS

This study used a qualitative framework method to allow for a comparison of providers' experiences with the policy expectations. Sixteen maternal health service providers who work with refugee and migrant women were recruited from two local health districts in New South Wales, Australia and interviewed (November 2019 to August 2020) about their experiences and the challenges they faced. In addition, a systematic search was conducted for policy documents related to the provision of maternal health care to refugee and migrant women on a state and federal level and five policies were included in the analysis.

RESULTS

Framework analysis revealed structural barriers to culturally responsive service provision and the differential impacts of implementation gaps that impede appropriate care resulting in moral distress. Rather than being the programmatic outcome of well-resourced policies, the enactment of cultural responsiveness in the settings studied relied primarily on the intuitions and personal responses of individual service providers such as nurses and social workers.

CONCLUSION

Authentic culturally responsive care requires healthcare organisations to do more than provide staff training. To better promote service user and staff satisfaction and wellbeing, organisations need to embed structures to respond to the needs of refugee and migrant communities in the maternal health sector and beyond.

A call for culture-centred care: exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia

BACKGROUND

Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants' second birthday. It explores health workers' perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health.

METHODS

Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed.

RESULTS

Three key themes emerged: the system takes priority, culture is not central in approaches to care, and 'we've got to be allowed to do it in a different way'.

CONCLUSIONS

This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants' first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.

Attending to our conceptualisations of race and racism in the pursuit of antiracism: A critical interpretative synthesis of the nursing literature

Race and racism are matters of urgent concern for the international nursing community. Recent global events have presented the discipline with an opportunity to generate and sustain long overdue discussions. However, with this opportunity comes a need to consciously attend to what we mean by race and racism, especially in the context of the nursing literature. Indeed, the development of antiracism depends on how we conceptualise race and racism; it is these conceptualisations that actively shape the scope and priorities of antiracist organising and action. The aim of this critical interpretative synthesis (CIS) is to examine conceptualisations of race and racism in the nursing literature by drawing on contemporary race scholarship. The synthesis of diverse literature is enabled through the explorative and expansive process of the CIS method. This review generates three synthesising arguments-a problem 'of' not 'for'; conceptual inconsistencies and drift; and reliance on the lens of experience-that both critique and contribute to the nursing literature. In the pursuit of antiracism, this article urges us to pay close attention to our conceptualisations of race and racism by illuminating the pitfalls that occur when our conceptualisations are inconsistent, contradictory, or simply neglected.

Are Australian Universities Perpetuating the Teaching of Racism in Their Undergraduate Nurses in Discrete Aboriginal and Torres Strait Islander Courses? A Critical Race Document Analysis Protocol

Systemic racism has a profound negative impact on the health outcomes of Australia’s First Nations peoples, hereafter referred to as Aboriginal and Torres Strait Islander peoples, where racism and white privilege have largely become normalised and socially facilitated. A national framework is being mobilised within the tertiary-level nursing curriculum to equip future health professionals with cultural capabilities to ensure culturally safe, equitable health care for Aboriginal and Torres Strait Islander peoples. In 2019, nurses comprised more than half of all registered health professionals in Australia, and current national standards for nursing state that Australian universities should be graduating registered nurses capable of delivering care that is received as culturally safe. It is therefore critical to evaluate where learning objectives within nursing curricula may lead to the reinforcement and teaching of racist ideologies to nursing students. This protocol outlines a framework and methodology that will inform a critical race document analysis to evaluate how learning objectives assert the social construction of “race” as a tool of oppressive segregation. The document analysis will include each discrete Aboriginal and Torres Strait Islander health course within all undergraduate nursing programs at Australian universities. The approach outlined within this protocol is developed according to an Indigenous research paradigm and Colonial Critical Race Theory as both the framework and methodology. The purpose of the framework is a means for improving health professional curriculum by reducing racism as highlighted in nation-wide strategies for curriculum reform.

Racism in healthcare: a scoping review

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.

'It's a cultural thing': excuses used by health professionals on providing inclusive care

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.

Compelling Voices of Diversity, Equity, and Inclusion in Prelicensure Nursing Students: Application of the Cultural Humility Framework

BACKGROUND

Diversity, equity, and inclusion are increasingly recognized as core values for guiding nursing education, practice, and research. The conceptual framework of cultural humility has been adapted in a variety of health care settings, fostering a culture of diversity, equity, and inclusion through openness, supportive interaction, self-awareness, self-reflection, and critique.

PROBLEM

Nurse educators have the opportunity, but may find it challenging, to teach students about the changing landscape of health care and the populations we serve.

APPROACH

This article describes the integration of the cultural humility framework into nursing curricula to teach principles of diversity, equity, and inclusivity. We provide a practical example of a diversity panel, with student and panelist reflections, exploring the intersectionality of experiences in health care and integration of personal accounts and perspectives.

CONCLUSION

Dialogue about diversity, equity, and inclusion is essential for preparing future nurses to deliver culturally competent care and promote health equity.

'It looks like a breadbox': a pilot study investigating implementation of the Pepi-Pod® program with Aboriginal families in metropolitan South Australia

AIMS

To collaboratively explore the cultural acceptance of the Pepi-Pod® program as an alternate safe sleep space and to explore the process of implementing the Pepi-Pod® program in a mainstream health service for Aboriginal families living in urban South Australia.

BACKGROUND

Aboriginal and Torres Strait Islander infants continue to die from sudden infant death syndrome (SIDS) and sudden unexpected death in infancy (SUDI) at rates three to four times greater than other infants born in Australia despite Council of Australian Governments commitment to halve the gap in the Indigenous infant mortality rate by 2018. The Pepi-Pod® program is evidenced in New Zealand and Queensland to provide a culturally appropriate safe sleep alternative that contributes to the reduction of SIDS and SUDI. We have no evidence of acceptability or feasibility when offered through mainstream services in metropolitan South Australia.

METHODS

With a focus on decolonizing the research process through a two-way process for mutual learning between Aboriginal and non-Aboriginal team members and community, a novel qualitative design was employed including photo elicited yarning sessions (n = 7), focus groups (n = 2), and field notes (n = 15).

RESULTS

Four themes emerged: 'you don't have to worry'; 'a way of sharing knowledge'; 'it looks like a bread box?' and 'need for consistent safe sleep messages'. The findings suggest that participants believe the Pepi-Pod® program may enrich Aboriginal families' lives evoking feelings of comfort and safety; however, the design could be improved to make them more culturally appropriate. There was confusion around safe sleep processes and education with a call for streamlining safe sleep messaging.

Demystifying, recognising and combating racism during the pandemic

The increased reports of escalation of social inequalities, xenophobic and racist ideologies during the COVID-19 pandemic presents a growing concern. Nurses are not immune to xenophobia and racism, both as perpetrators and as victims. Although COVID-19 brings a new wave of xenophobia and racism, healthcare organisations have been tackling discriminatory and racist practices for decades. However, racist practice quite often goes undetected or unchallenged due to its associated sensitivity and a lack of understanding of its complexity. There is a need for a more open and non-judgemental discourse around interpretations of racism and its predisposing factors as a means of combating the growing reports. This discussion paper proposes a practice-orientated conceptualisation of racism and outlines some particular and sustainable areas for consideration for nurses to use in their daily practice. Developing self-awareness and nurturing the courage, confidence and commitment to challenge self and others is critical for transforming ethnocentric and racist ideologies.

Exploring the role-based challenges of providing culturally inclusive health care for maternal and child health nurses: Qualitative findings

Aims

To explore how maternal and child health nurses (MCHNs) working in a specific regionally located service perceive and experience delivering health care to a diverse population.

Design

Qualitative exploratory study.

Methods

Qualitative interviews were conducted with MCHNs (N = 6) working in a particular regionally located service. Data were selectively coded, categorized and interpreted through a process of argument writing influenced by poststructuralist thought and Foucauldian conceptualizations of power.

Results

The data analysed were interpreted into the following categories: (a) system-level expectations of the maternal and child health role; (b) what these system-level expectations mean for the role and practice of MCHNs; and (c) what MCHNs themselves report prioritizing in their work. The analysis suggests that a substantial hindrance to the development and support of culturally safe, inclusive and quality maternal and child health care lies in the very ways contemporary health institutions seek to discipline the routine practices of MCHNs.