Can a white nurse get it? 'Reflexive practice' and the non-Indigenous clinician/researcher working with Aboriginal people (original) (raw)
Related papers
International Journal for Equity in Health, 2014
Aboriginal and Torres Strait Islanders persistently experience a significantly lower standard of health in comparison to non-Indigenous Australians. The factors contributing to this disparity are complex and entrenched in a history of social inequality, disempowerment, poverty, dispossession and discrimination. Aboriginal medical services (AMS) provide a culturally appropriate alternative to mainstream medical services as a means to address this health disparity and also advocate for Indigenous rights and empowerment. This study provides a vignette of lay perspectives of Aboriginal and Torres Strait Islanders accessing community and government controlled AMS in Brisbane, Queensland with the intention of identifying self-perceived health determinants to inform the post-2015 international development goals.
Reducing the health disparities of Indigenous Australians: time to change focus
BMC Health Services Research, 2012
Background: Indigenous peoples have worse health than non-Indigenous, are over-represented amongst the poor and disadvantaged, have lower life expectancies, and success in improving disparities is limited. To address this, research usually focuses on disadvantaged and marginalised groups, offering only partial understanding of influences underpinning slow progress. Critical analysis is also required of those with the power to perpetuate or improve health inequities. In this paper, using Australia as a case example, we explore the effects of 'White', Anglo-Australian cultural dominance in health service delivery to Indigenous Australians. We address the issue using race as an organising principle, underpinned by relations of power. Methods: Interviews with non-Indigenous medical practitioners in Western Australia with extensive experience in Indigenous health encouraged reflection and articulation of their insights into factors promoting or impeding quality health care to Indigenous Australians. Interviews were audio-taped and transcribed. An inductive, exploratory analysis identified key themes that were reviewed and interrogated in light of existing literature on health care to Indigenous people, race and disadvantage. The researchers' past experience, knowledge and understanding of health care and Indigenous health assisted with data interpretation. Informal discussions were also held with colleagues working professionally in Indigenous policy, practice and community settings. Results: Racism emerged as a key issue, leading us to more deeply interrogate the role 'Whiteness' plays in Indigenous health care. While Whiteness can refer to skin colour, it also represents a racialized social structure where Indigenous knowledge, beliefs and values are subjugated to the dominant western biomedical model in policy and practice. Racism towards Indigenous patients in health services was institutional and interpersonal. Internalised racism was manifest when Indigenous patients incorporated racist attitudes and beliefs into their lived experience, lowering expectations and their sense of self-worth. Conclusions: Current health policies and practices favour standardised care where the voice of those who are marginalised is often absent. Examining the effectiveness of such models in reducing health disparities requires health providers to critically reflect on whether policies and practices promote or compromise Indigenous health and wellbeing -an important step in changing the discourse that places Indigenous people at the centre of the problem.
BMC Medical Education, 2016
Background: Unconscious bias and negative attitudes towards minority groups have detrimental effects on the way health care is, or is not, provided to these groups. Recognition of racist attitudes and behaviours as well as understanding clients' experiences of health and health care are pivotal to developing better health care strategies to positively impact on the quality and safety of care provided to Indigenous people. Indigenous research demands inclusive research processes and the use of culturally appropriate methodologies. This paper presents a methodological account of collecting narratives which accurately and respectfully reflect Aboriginal Australians' experiences with health care in Western Australia. The purpose of these narratives is to provide health students and professionals with an opportunity to 'walk-in the shoes' of Aboriginal people where face-to-face interaction is not feasible. Methods: With the incorporation of Indigenous peoples' voices being an important link in cultural safety, the project was led by an Indigenous Reference group, who encouraged active participation of Aboriginal people in all areas of the project. Using a phenomenological approach and guided by the Indigenous Reference group, yarning data collection was implemented to collect stories focusing on Aboriginal people's experiences with health care services. An open-access, on-line website was established to host education resources developed from these "yarns". Results: Yarning provided a rich source of information on personal experiences and encouraged the story provider to recognise their facilitative role in the research process. While the methodology used in this project was lengthy and labour-intensive it afforded a respectful manner for story collection and highlighted several innate flaws when Western methods are applied to an Indigenous context. Conclusion: Engagement of an Indigenous Reference Group was pivotal to designing an appropriate methodology that incorporated the voices of Aboriginal people in a multimedia resource of Aboriginal narratives. However further research is warranted to understand how the resources are being used and integrated into curricula, and their impact on students and health care outcomes.
Understanding Inequalities in Access to Health Care Services for Aboriginal People
Advances in Nursing Science, 2014
We present findings from an Access Research Initiative to reduce health disparities and promote equitable access with Aboriginal peoples in Canada. We employed Indigenous, interpretive, and participatory research methodologies in partnership with Aboriginal people. Participants reported stories of bullying, fear, intimidation, and lack of cultural understanding. This research reveals the urgent need to enhance the delivery of culturally appropriate practices in emergency. As nurses, if we wish to affect equity of access, then attention is required to structural injustices that act as barriers to access such as addressing the stigma, stereotyping, and discrimination experienced by Aboriginal people in this study.
Finding ways together: Researching with Aboriginal women in a mental health setting
Collegian, 2019
Introduction: This paper describes the collaborative development of a method and process for transcultural qualitative enquiry, undertaken as the second phase of a mixed methods PhD research project. Aim: To develop an ethical, sensitive and culturally secure research method and process with which to explore the experiences of Aboriginal women in an acute mental health inpatient unit, a potentially vulnerable research population. To invite Aboriginal women to share their stories and their experiences as current inpatients, or as carers, visitors and health service providers. Method: A local Aboriginal Reference Group (ARG) was constituted and collaborated with the first author in developing working strategies and tools. Members of the ARG guided all aspects of the research process, acted as primary agents for information-giving, informed consent and interview processes, and were co-authors of relevant publications. Results: The method described here fostered trust and cultural respect, and embedded informed consent as an ongoing process. Eleven Aboriginal women inpatients undertook a single semi-structured interview prior to discharge from the inpatient unit. Five ARG members also gave interviews, adding insights from their 'insider-outsider' perspectives. A rich dataset of personal experience was made available for analysis. Conclusions: The process devised for this study integrated principles of cultural respect and collaboration with an ongoing process of informed consent. By integrating these principles into research initiatives and evidence-based practice, and by ensuring familiarity with local Aboriginal and Torres Strait Island cultures, non-Aboriginal mental health nurses can enhance transcultural mental health service delivery in an acute setting.
Social Science & Medicine, 2005
Public health practitioners in Australian indigenous health work in a complex political environment. Public health training is limited in providing them with conceptual tools needed to unpack the postcolonial nexus of 'fourth-world' health. A workshop was designed by the authors to facilitate critical reflection on how the concepts of race and culture are used in constructions of indigenous ill-health. It was attended by researchers, students, clinicians and bureaucrats working in public health in northern Australia.
Ethnicity & Health, 2014
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International journal for equity in health, 2016
Aboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface. Thirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data. Interviews revealed two main typ...