Janet Kelly

Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young Aboriginal women in Adelaide

Young Aboriginal women are consistently identified as having poorer health outcomes and access to sexual health services than non-Indigenous Australians. Yet the literature is particularly silent on what sexual health nurses need to know and do in order to work well with young urban Aboriginal women. This paper reports on a qualitative pilot study undertaken by a non-Indigenous nurse in Adelaide. The participatory action research methods used in this study were sensitive to the history of problems associated with research in Aboriginal communities. A reference group of Elder Aboriginal women and Aboriginal health workers guided all aspects of the study. A partnership approach between the researcher and the Reference Group ensured that the methods, analysis, and final report were culturally safe. Three groups participated in this study: Elders and Aboriginal health workers; young Aboriginal women, and sexual health nurses. All participants acknowledged the importance of nurses being clinically competent. However, the overarching finding was a lack of a clear model of cultural care to guide health service delivery. Three interrelated themes emerged from the data to support this contention. These were: the structural and personal importance of establishing and maintaining trustworthy relationships between nurses, Aboriginal health workers and Elders; the recognition that Aboriginal culture does exist, and is important in urban areas; and the importance of gender considerations to understanding urban womens health business. A partnership approach was recommended as a way to use these findings to develop a transparent cultural model of care. Further research is currently being undertaken to progress this agenda.

Is it Aboriginal friendly? Searching for ways of working in research and practice that support Aboriginal women.

Abstract This article describes my journey as a nurse as I search for better ways to work with urban Aboriginal women. Learning as I build and maintain trusting relationships with Elders, Aboriginal health professionals and communities has been an important first step. Incorporating reflective practice, participatory action research and ethical guidelines has further assisted me to work in more culturally safe and respectful ways. While there has been increasing recognition of access and equity issues in Australia’s current neo-colonial period, actual improvements have been very slow to emerge. Meanwhile many Aboriginal people continue to experience poor levels of health. My hope is that this article can contribute to the growing body of knowledge that recognises the impact of past and present colonisation practices and shifts health care towards collaborative healing and well being models that are more supportive of Aboriginal people and their needs. The emphasis on Aboriginal women’s health rather than mixed gender health care comes from my experiences in sexual health, where many Australian Aboriginal women prefer to access ‘women only’ services.

Travelling to the city for hospital care: access factors in country Aboriginal patient journeys

OBJECTIVE This study described the challenges for rural and remote Aboriginal people requiring transport to city hospitals for tertiary care. DESIGN Semi-structured qualitative interviews. SETTING South Australian rural and remote health services and tertiary hospitals. PARTICIPANTS Twenty-eight urban health professionals from six hospitals and 32 health professionals from four rural and remote regions were interviewed. Twelve patients, three carers, four people responding as patient and carers, and one patient and carer couple were also interviewed, with eight elder women meeting as a focus group. MAIN OUTCOME MEASURES The study identified specific structural barriers in urban health services or policy that prevented rural and remote Indigenous patients from receiving optimum care. RESULTS Problems accessing transport were identified as the most significant factor affecting access to care by the majority of patients and staff. They reported that travel to an urban hospital was costly, and coordination of travel with care was poor. A further problem was travelling while unwell. CONCLUSIONS Travelling to a city hospital is a significant barrier for rural and remote Indigenous patients. Arranging and supporting travel is a time-consuming work that is not recognised by the health care system.

Ethics overload: impact of excessive ethical review on comorbidity research

Miriam Posselt, Cherrie Galletly, Charlotte de Crespigny, Imelda Cairney, John Moss, Dennis Liu, Hepsibah Francis, Janet Kelly, Nicholas Procter and Andris Banders

Disparities in acute in-hospital cardiovascular care for Aboriginal and non-Aboriginal South Australians.

Objectives: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non‐Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences.

Decolonizing Sexual Health Nursing With Aboriginal Women

Nurses striving to provide quality health care for and with Indigenous individuals and communities in Australia face particular challenges. Past and present discriminatory or non-responsive health-care practices and policies have caused many Aboriginal women and their families to mistrust health-care professionals and practices. It is vital that nurses develop culturally safe and respectful ways of working in partnership with Aboriginal colleagues and clients. The author discusses how nurses in both Canada and Australia have drawn on critical and postcolonial feminist theories, Indigenous epistemologies and methodologies, and models of cultural safety to develop a more responsive, decolonizing approach to health care and training. Two practice examples from the Australian context highlight both the challenges and the benefits of incorporating decolonizing approaches into practice. The similarities in and differences between situations reveal a clear need for responsive and flexible decolonizing approaches.

Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care.

This paper describes the rationale and process for developing a set of Aboriginal patient journey mapping tools with Aboriginal patients, health professionals, support workers, educators and researchers in the Managing Two Worlds Together project between 2008 and 2015. Aboriginal patients and their families from rural and remote areas, and healthcare providers in urban, rural and remote settings, shared their perceptions of the barriers and enablers to quality care in interviews and focus groups, and individual patient journey case studies were documented. Data were thematically analysed. In the absence of suitable existing tools, a new analytical framework and mapping approach was developed. The utility of the tools in other settings was then tested with health professionals, and the tools were further modified for use in quality improvement in health and education settings in South Australia and the Northern Territory. A central set of patient journey mapping tools with flexible adaptations, a workbook, and five sets of case studies describing how staff adapted and used the tools at different sites are available for wider use.

11 From research evidence to ‘evidence by proxy’? organisational enactment of evidence-based healthcare in four high-income countries

Objectives It is usually taken for granted that ‘the best available evidence’ is represented by the findings of rigorous scientific research which, in turn, directly inform the development of recommendations for practice in the form of clinical guidelines. We challenge this assumption and examine the role played in the enactment of evidence-based healthcare by other forms of codified knowledge, i.e. knowledge that is formal, systematic and expressible in language or numbers, making it easy to store, transfer and utilise across space. The study addresses the following research questions: What forms of codified knowledge are seen as credible evidence by practitioners? What are the relationships between these forms of knowledge in the enactment of evidence–based practice within healthcare organisations? What is the impact of these forms of knowledge on evidence–based practice? How do the composition and impact of codified knowledge vary across different high–income countries? Method This exploratory study emerged from a broader research programme examining leadership and facilitation in the implementation of evidence-based nursing across the UK, Australia, Canada and Sweden. Within each country, up to two organisations were selected based on the following criteria: self-declared adherence to the implementation of evidence-based nursing; adequate organisational performance; and broad access to several levels within the organisational hierarchy granted to the researchers. 55 research participants were recruited to represent different levels of the hierarchy, roles and sectors. Semi-structured interviews served as the main method of data collection. Data analysis was organised in two stages. The first stage, focusing on the construction of country-specific narratives, combined the codes derived from the interview guide with descriptive codes that emerged inductively. The second stage utilised the deductive coding framework informed by the literature and applied across all four datasets. Matrix analysis was deployed to facilitate cross-case analysis. Results We argue that research evidence and its direct derivatives, such as clinical guidelines, are NOT the dominant forms of codified knowledge deployed in the organisational enactment of evidence-based healthcare. We describe the chain of codified knowledge which reflects the institutionalisation of evidence-based healthcare as organisational ‘business as usual’. This chain is dominated by performance standards, policies and procedures, and locally collected (improvement and audit) data, i.e. various forms of ‘evidence by proxy’ which are, at best, informed by research partly or indirectly but are nevertheless perceived as credible evidence. Our cross-country analysis highlights the influence of macro-level ideological, historical and technological factors on the composition and circulation of codified knowledge. Prioritisation of ‘evidence’ by proxy’ and marginalisation of clinical guidelines are likely to be more prominent in those countries, whose healthcare sectors have historically been more engaged with the New Public Management logics of standardisation and performance measurement. Conclusions Our analysis reveals dual effects of this codification dynamic on evidence-based healthcare. On the one hand, the legitimisation and mobilisation of contextual and local knowledge counterbalance ‘dogmatic authoritarianism’ apparent in the more restrictive interpretations of ‘evidence’ and potentially enable bottom-up knowledge flows. On the other hand, this is achieved through a significant dilution of the initial paradigm, excessive formalisation, and detachment of frontline staff from the fundamental competencies and knowledge base of evidence-based decision-making, whereby direct use of research evidence and clinical guidelines is becoming a prerogative of experts, represented by professional elites and designated facilitators.

In-hospital communication experiences of Aboriginal and Torres Strait Islander people: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this systematic review is to identify and synthesize available qualitative evidence to understand the in-hospital communication experiences of Aboriginal and Torres Strait Islander adults, their family members and hospital staff, and the factors that impact on these experiences.Specifically, the review questions are as follows.

Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity

BackgroundAboriginal 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.MethodsThirty-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.ResultsInterviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual).ConclusionsA health professional’s practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.