Julian Grant

An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition.

Objective : This research explored how the concept of cultural competence was represented and expressed through health policies that were intended to improve the quality and efficacy of healthcare provided to families from culturally marginalised communities, particularly women and children with refugee backgrounds.

‘Culture it’s a big term isn’t it’? An analysis of child and family health nurses’ understandings of culture and intercultural communication

Abstract Understandings of culture and multiculture are broad and deeply embedded in every day talk and practices. In an increasingly globalised world, how we understand and work with these terms affects how parents and their families experience health care services and the support intended by health care professionals. This is particularly important for parents who are new to Australia. In this paper we report on findings from an ethnographic study undertaken across two community child and family health nursing sites in South Australia. Using examples, we explore how child and family health nurses appear to understand and use constructs of culture and multiculture during everyday, intercultural communication with parents who are new to Australia and Australian health services. By analysing these understandings through postcolonial and feminist theories we found pervading evidence that neo-colonial constructs of a white western monoculture shaped intercultural communication practice. We conclude by reflecting on how these constructs might be addressed to improve intercultural communication in child and family health settings.

Culture, communication and child health

Abstract Cultural beliefs and values implicitly and explicitly shape every aspect of the way we parent our children and how we communicate about parenting. To support parents appropriately in this new and challenging role, child health services for parents in Australia need to do more than acknowledge a diverse range of cultural practices. While many health professionals believe they act in culturally sensitive ways, we need to closely examine this belief, question the cultural assumptions implicit in the information we give, and assess the extent to which our interactions are culturally appropriate. In this paper, we present a critical review of the literature on health care provision for migrant women and families. We then suggest a need to re-examine the values, beliefs and attitudes within cultural frameworks that inform how child health professionals communicate. Specifically, communication between child health professionals and migrant parents requires further analysis. We suggest that professionals need to reflect on the cultural self rather than solely on the culture of others.

Educational preparation for maternal, child and family health nurses in Australia

AIM The study aims to map and critique the current postgraduate educational nursing programmes offered to nurses and midwives in maternal, child and family health in Australia. BACKGROUND Nursing specialties that focus on the early years of child health and development are based on international recognition of the developmental needs of the growing infant and of the social, health and economic consequences of failing to support families to raise their children in optimal environments. Little is known whether the educational programmes that prepare maternal, child and family health nurses (MCFHNs) for practice in Australia have kept up with new knowledge and understanding of the early years of life. METHODS A survey of all maternal, child and family health education programmes offered in Australia was undertaken. FINDINGS Marked variations in course titles, length, content, clinical exposure and award exist across the 12 institutions offering such programmes in Australia. Many institutions provide inadequate preparation in some of the core skills required of the workforce. CONCLUSION The establishment of minimum standards for the education of MCFHNs across Australia is required. This study also highlights the need for further research around the scope of practice of MCFHNs, and the role of midwives who are not nurses, in this specialty area.

Applying Ecological Modeling to Parenting for Australian Refugee Families

Children in families with parents from refugee backgrounds are often viewed as a vulnerable group with increased risks of developing physical or psychological problems. However, there is very little research regarding the strategies that parents might use to parent their children in a new country while they also manage the interrelated challenges of poverty, social isolation, maternal stress, and mental ill health that often go along with resettlement. We explore the application of ecological modeling, specifically at individual, institutional, and policy levels, within an Australian context to critique the factors that shape the development of parenting capacity within refugee families settling in a new Western country. Ecological modeling enables examination of how public policy at local state and national levels influences the individual and family directly and through the organizations that are given the task of implementing many of the policy recommendations. Recommendations for health practice and research are made.

Intercultural communication in child and family health: insights from postcolonial feminist scholarship and three-body analysis.

Concerns about intercultural communication practices in child and family health were raised during a South Australian ethnographic study. The family partnership model was observed as a universal pedagogic tool introduced into the host organisation in 2003. It has a role in shaping and reshaping cultural production within child health practice. In this study, we draw on insights from postcolonial feminist scholarship together with three-body analysis to critique the theoretical canons of care that inform intercultural communication in the child and family health setting. We contend that although the family partnership model may be very useful, its intended universal application is problematic in the context of multiculture. Issues of race, gender and class were seemingly unattended when using a communication approach based in historical scientific rationalism. Liberal interpretations of discourses of equity and empathy arising out of contemporary models of communication were often adopted by child and family health nurses and protected them from seeing the inherent binaries that constrain practice. Insights from postcolonial feminist thinking enabled us to recognise the problems of applying theory to practice in a linear fashion. We demonstrate the use of three-body analysis as a deconstruction strategy to refigure how theory might be understood and worked with in the multiculture that is Australia.

Understanding burn injuries in Aboriginal and Torres Strait Islander children: Protocol for a prospective cohort study

Introduction Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. Methods and analysis All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. Ethics and dissemination The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals.

BEING A PARENT ON DIALYSIS: A LITERATURE REVIEW

SUMMARY Aim: This literature review explored the extant literature to further our understanding of the experience of being a parent on dialysis. Methods: Keywords used to search the literature were haemodialysis, hemodialysis, chronic kidney disease, end stage renal disease, parent and experience. Databases searched included CINAHL, Medline, Wiley/Blackwell, EBSCOHost, Web of Science, Pubmed and ProQuest. Years included were 1999–2009. Seventeen primary research articles (sixteen qualitative, one mixed methods) met the search criteria with only one on parents undergoing dialysis. Findings: The experience of the parent on dialysis has rarely been explored in the literature. Related research has indicated important themes including: restricted lives; relationships; adjustment; consequences and future outlook. Conclusions: More should be known about challenges that face parents who receive dialysis. This review established an urgent need for further research to determine the experiences and needs of this population to provide empirical, person-centred nursing care.AIM This literature review explored the extant literature to further our understanding of the experience of being a parent on dialysis. METHODS Keywords used to search the literature were haemodialysis, hemodialysis, chronic kidney disease, end stage renal disease, parent and experience. Databases searched included CINAHL, Medline, Wiley/Blackwell, EBSCOHost, Web of Science, Pubmed and ProQuest. Years included were 1999-2009. Seventeen primary research articles (sixteen qualitative, one mixed methods) met the search criteria with only one on parents undergoing dialysis. FINDINGS The experience of the parent on dialysis has rarely been explored in the literature. Related research has indicated important themes including: restricted lives; relationships; adjustment; consequences and future outlook. CONCLUSIONS More should be known about challenges that face parents who receive dialysis. This review established an urgent need for further research to determine the experiences and needs of this population to provide empirical, person-centred nursing care.

Video: A Decolonising Strategy for Intercultural Communication in Child and Family Health within Ethnographic Research

Abstract The subject of this paper is the use of video as a decolonising tool in ethnographic research into intercultural communication in child and family health settings. Women and children who are migrants or new arrivals to Australia continue to experience health inequities. Communication is at the heart of these problems. In the practice setting, communication is inherently difficult to critique, particularly when working with vulnerable families. We describe how video was used by the first-named author in her doctoral research exploring intercultural communication between child health nurses and mothers who were migrants or new arrivals to South Australia. In particular, we describe how the use of video becomes a decolonising strategy when the focus of critique is placed on the health professional, rather than on a parent from a potentially vulnerable group. Video enables the researcher to bridge the gap between what health professionals say they do, and what they actually do in their practice.

Exploring mothers’ perspectives of an intensive home visiting program in Australia: A qualitative study

Abstract Intensive nurse home visiting programs are an early childhood, population based intervention that target vulnerable families. Programs are dependent on the relationship between home visitor and mother to bring about change. Few studies have focused on investigating parents’ perspectives of these programs using qualitative methods and none in the Australian context. The aim of this qualitative study was to explore and describe mothers’ perspectives of an intensive nurse home visiting program in South Australia. Eight in-depth interviews were conducted with mothers receiving the program. The findings indicated the role of a trusting relationship between nurse and participant as well as shared decision making was central to program engagement and led to participant perceptions of increasing control over their role as parents. However, a clear distinction was made by the mothers: that they engaged in a relationship, not a program.