Evaluating awareness of Cultural Safety in the Australian midwifery workforce: A snapshot

Fleming, Tania; Creedy, Debra; West, Roianne

doi:10.1016/j.wombi.2018.11.001

Cited by 12 publications

(9 citation statements)

References 8 publications

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“…This capability was demonstrated in nine audit tools 6 8 13–16 18 20 21. Relationship building and effective communication with Aboriginal and Torres Strait Islander people and communities was a characteristic of eight of these audit tools 6 8 13 14 16 18 20 21.…”

Section: Resultsmentioning

confidence: 99%

“…Relationship building and effective communication with Aboriginal and Torres Strait Islander people and communities was a characteristic of eight of these audit tools 6 8 13 14 16 18 20 21. Eight tools included implementation of self-determination processes (eg, having Aboriginal and Torres Strait Islander people actively participate and lead planning, monitoring and evaluation of services) as an important feature 6 8 13–16 18 20…”

Section: Resultsmentioning

confidence: 99%

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Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

Muller,

Devine,

Geia

et al. 2024

BMJ Glob Health

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Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare practices, ensuring accountability and sustainability of changes, necessitates robust mechanisms for auditing and monitoring progress. This study examined existing cultural safety audit tools, and facilitators and barriers to implementation, in the context of providing culturally safe and responsive healthcare services with Aboriginal and Torres Strait Islander people. This will assist organisations, interested in developing tools, to assess culturally responsive practice. A scoping review was undertaken using Medline, Scopus, CINAHL, Informit and PsychInfo databases. Articles were included if they described an audit tool used for healthcare practices with Aboriginal and Torres Strait Islander people. Selected tools were evaluated based on alignment with the six capabilities of the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness in Action Framework. Implementation barriers and facilitators were identified. 15 papers were included. Audit tools varied in length, terminology, domains assessed and whether they had been validated or evaluated. Seven papers reported strong reliability and validity of the tools, and one reported tool evaluation. Implementation facilitators included: tool comprehensiveness and structure; effective communication; clear organisational responsibility for implementation; commitment to prioritising cultural competence; and established accountability mechanisms. Barriers included: the tool being time-consuming and inflexible; responsibility for implementation falling on a small team or single staff member; deprioritising tool use; and lack of accountability for implementation. Two of the six IAHA capabilities (respect for the centrality of cultures and inclusive engagement) were strongly reflected in the tools. The limited tool evaluation highlights the need for further research to determine implementation effectiveness and sustainability. Action-oriented tools, which comprehensively reflect all cultural responsiveness capabilities, are lacking and further research is needed to progress meaningful change within the healthcare system.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

Muller,

Devine,

Geia

et al. 2024

BMJ Glob Health

View full text Add to dashboard Cite

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“…Additionally, future studies could test assessment of cultural safety 74 and evaluation of cultural safety programs in LMICs. [75][76][77] This will add to calls for clear clinical de nitions of cultural safety so that interventions can be more culturally safe. 78 Utilizing these tools at every level of the health system will takes emphasis off patient, who, as nonexperts, cannot be expected to state their health needs thoroughly.…”

Section: Discussionmentioning

confidence: 99%

’God is the one who give child’: An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework

Egger,

Bitewulign,

Rodriguez

et al. 2024

Preprint

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Background: Postnatal care is recommended as a means of preventing maternal mortality during the postpartum period, but many women in low- and middle-income countries (LMICs) do not access care during this period. We set out to examine sociocultural preferences that have been portrayed as barriers to care. Methods: We performed an abductive analysis of 63 semi-structured interviews with women who had recently given birth in three regions of Ethiopia using the Health Equity Implementation Framework (HEIF) and an inductive-deductive codebook to understand why women in Ethiopia do not use recommended postnatal care. Results: We found that, in many cases, health providers do not consider women’s cultural safety a primary need, but rather as a barrier to care. However, women’s perceived refusal to participate in postnatal visits was, for many, an expression of agency and asserting their needs for cultural safety. Trial registration:n/a Conclusions: We propose adding cultural safety to HEIF as a process outcome, so that implementers consider cultural needs in a dynamic manner that does not ask patients to choose between meeting their cultural needs and receiving necessary health care during the postnatal period.

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“…2,13,14 In a recent survey of Australian midwives, Fleming et al (p. 555) noted 'over 70% of participants agreed that racism existed in their workplace and that not all staff were respectful to First Peoples midwifery students and staff '. 15 Best 16 further notes that improvements in First Peoples health are strongly linked to increased numbers of Indigenous people working in health service delivery, hence, this under-representation is particularly concerning as it links First Peoples poor health outcomes to employment outcomes. Perhaps most distressing is the loss of First People's knowledge and wisdom to a system that acutely needs these critical insights for the benefit of all.…”

Section: Introductionmentioning

confidence: 99%

Achieving cultural safety for Australia’s First Peoples: a review of the Australian Health Practitioner Regulation Agency-registered health practitioners’ Codes of Conduct and Codes of Ethics

Milligan¹,

West²,

Saunders³

et al. 2021

Aust. Health Rev.

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Objective Health practitioners’ Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. This research assessed all Codes for cultural safety specific content. MethodsFollowing the release of the Australian Health Practitioner Regulation Agency’s (Ahpra) Health and Cultural Safety strategy 2020–25, the 16 Ahpra registered health practitioner Board Codes of Conduct and professional Codes of Ethics were analysed by comparing content to Ahpra’s new cultural safety objectives. Two Codes of Conduct, Nursing and Midwifery, met these objectives. The Aboriginal and Torres Strait Islander Health Practitioners Code partially met these objectives. ResultsMost Codes of Conduct (14 of 16) conflated Aboriginal and Torres Strait Islander peoples with culturally and linguistically diverse (CALD) communities undermining the sovereignty of Australia’s First Peoples. Eleven professions had a Code of Ethics, including the Physiotherapy Code of Conduct, which outlined the values and ethical principles of practice commonly associated with a Code of Ethics. Of the 11 professions with a Code of Ethics, two (Pharmacy and Psychology) articulated specific ethical responsibilities to First Peoples. Physiotherapy separately outlined cultural safety obligations through their reconciliation action plan (RAP), meeting all Ahpra cultural safety objectives. The remaining eight advocated respect of culture generally rather than respect for Aboriginal and Torres Strait Islander cultures specifically. ConclusionsThe review identified multiple areas to improve the codes for cultural safety content for registered health professions, providing a roadmap for action to strengthen individual and systems practice while setting a clear regulatory standard to ensure culturally safe practice becomes the new norm. It recommends the systematic updating of all professional health practitioner Board Codes of Conduct and professional Codes of Ethics based on the objectives outlined in Ahpra’s Cultural Safety Strategy. What is known about the topic?Systemic racism and culturally unsafe work environments contribute to poor health outcomes for Aboriginal and Torres Strait Islander peoples. They also contribute to the under-representation of Aboriginal and Torres Strait Islander peoples in the health workforce, denying the system, and the people who use and work in it, much needed Indigenous knowledge. Creating a culturally safe healthcare system requires all health practitioners to reflect on their own cultural background, to gain appreciation of the positive and negative impacts of individually held cultural assumptions on the delivery of healthcare services. Competence in cultural safety as a required standard of practice is therefore essential if broad, sustainable and systemic cultural change across the health professions and ultimately across Australia’s healthcare system is to be achieved. Given that Codes of Conduct and Codes of Ethics are integral in setting the practical and moral standards of the professions, their contents with respect to cultural competence are of great importance. What does this paper add?A review of this type has not been undertaken previously. Following the establishment of the Ahpra Aboriginal and Torres Strait Islander Health Strategy Group, release of Ahpra’s 2018 Statement of intent, and the 2019 Aboriginal and Torres Strait Islander Health and Cultural Safety strategic plan and Reconciliation Action Plan, we analysed the content of each of the 16 registered health professions Codes of Conduct and Code of Ethics looking for content and guidance in accordance with the new national cultural safety definition. Several opportunities to improve the Codes of Conduct and Codes of Ethics were identified to realise the vision set out in the statement of intent including through the application of the National Law. This analysis provides a baseline for future improvements and confirms that although some current health practitioner Codes of Conduct and Codes of Ethics have begun the journey of recognising the importance of cultural safety in ensuring good health outcomes for Australia’s Indigenous peoples, there is broad scope for change. What are the implications for practitioners?The gaps identified in this analysis provide a roadmap for improvement and inclusion of Aboriginal and Torres Strait Islander Health and cultural safety as a required standard in Codes of Conduct and Codes of Ethics for all registered health practitioners. Although it is recognised that Codes alone may not change hearts and minds, codifying the clinical competency of cultural safety provides a portal, and a requirement, for each individual practitioner to engage meaningfully and take responsibility to improve practice individually and organisationally.

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Evaluating awareness of Cultural Safety in the Australian midwifery workforce: A snapshot

Cited by 12 publications

References 8 publications

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

’God is the one who give child’: An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework

Achieving cultural safety for Australia’s First Peoples: a review of the Australian Health Practitioner Regulation Agency-registered health practitioners’ Codes of Conduct and Codes of Ethics

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