Roianne West

Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: What is getting in the way?

Abstract The provision of a well trained and culturally safe health workforce is critical to the alleviation of health inequities for Australian Indigenous peoples. Educating and graduating signifi cant numbers of Indigenous registered nurses is one way the ‘Close the Gap’ initiative succeeds. Indigenous nurses bring a set of unique skills, knowledge and understanding to health service delivery. Their contribution has the potential to enhance future outcomes for Indigenous people by improving access to health services, ensure services are culturally appropriate and respectful, and assist non-Indigenous nurses to deliver culturally appropriate care. This paper discusses the background to the current numbers of Indigenous undergraduate nursing students enrolled in and completing tertiary nursing courses, with a focus on Queensland nursing programs. A range of identifi ed barriers impede Indigenous nursing students’ successful completion of their studies. We propose recommendations for education, cresearch and employment to help overcome these problems, and ensure greater Indigenous participation in the nursing workforce.

Through a Critical Lens: Indigenist Research and the Dadirri Method

Indigenous scholars have addressed the problematic nature of research by adopting methodologies that fit well with their communities and that relate effectively and culturally with how knowledge is shared to give indigenous people a voice. In this article we discuss Dadirri, an indigenous research method and way of life, as a vital research framework, connecting it to other relevant political and critical methodologies such as Freire’s transformative education process and Habermas’ theory of communicative action. In doing so, we illustrate how this methodology provides a significant framework for indigenous researchers undertaking liberatory studies that promote change.

Integrated systematic review on educational strategies that promote academic success and resilience in undergraduate indigenous students

BACKGROUND Despite numerous recommendations by governments, researchers, and education policymakers the recruitment, retention and success of undergraduate indigenous students in higher education is not commensurate of the wider student population. There is minimal evidence of valuing indigenous worldviews and perspectives in curricula, and effectiveness of educational strategies to strengthen indigenous student success rates in completing undergraduate studies. OBJECTIVES To conduct an integrative systematic review of educational strategies to promote academic success and resilience in undergraduate indigenous students. METHODS Major databases of Scopus, ProQuest, Informit and Web of Science were searched. Inclusion criteria were peer reviewed research articles from scholarly journals that referenced indigenous, aboriginal, First Nation or Māori students in undergraduate programs in higher education. The search was limited to English language and studies conducted from 1995 to 2014. RESULTS The search yielded 156 research papers which reduced to 16 papers that met the inclusion criteria. The included papers were critiqued from a standpoint theory approach that reflects feminism, cultural respect, and humanism. Much of the literature describes issues, and provides qualitative analyses of experiences, but empirical evaluations of interventions are rare. CONCLUSIONS There was a gap in current research evaluating strategies to improve indigenous student success and resilience. Key strategies for indigenous student success are multi-faceted, layered support, underpinned by the principles of respect, relationships, and responsibility. Implications for nursing and midwifery education, research and health care practice are outlined.

Indigenous Australians' participation in pre-registration tertiary nursing courses: A mixed methods study

Abstract Indigenous nurses have the potential to improve access to health services for Indigenous people by ensuring that services are culturally safe and respectful of Indigenous peoples’ needs. Therefore, developing a well-educated Indigenous nursing workforce is one way to improve the poor health outcomes of Indigenous Australians. A mixed methods study was undertaken to determine the current rates of enrollment, progression and completion of Indigenous nursing students in Australia and to explore student and staff perceptions of barriers to completion and strategies for success. The results indicate that the national average completion rates are 36.3% for Indigenous nursing students and 64.6% for non-Indigenous nursing students – an average difference of 28.3%. Indigenous nursing students and academics identified barriers to completion, which were similar to those identified in previous research. Success strategies, however, revealed the importance of individual student characteristics; academics’ knowledge, awareness, and understanding; relationships, connections, and partnerships; institutional structures, systems, and processes; and, family and community knowledge, awareness, and understanding. This paper offers an overview of the integration and interpretation process that makes up the final phase of a mixed methods study.

Tjirtamai - 'To Care For': a nursing education model designed to increase the number of Aboriginal nurses in a rural and remote Queensland community

Abstract In 2009, a nursing education model was locally designed and delivered to support the interest of a group of Aboriginal community members living in a rural and remote town in Queensland, specifically to prepare for entry into further nursing education. Named ‘Tjirtamai’ by the traditional owners of the area, the program was offered in recognition of the challenges faced by Aboriginal people when they enter nursing education courses and as a way to increase the local number of Aboriginal nurses. This program, while funded by the Government, had unprecedented support and involvement from both the local Aboriginal and wider community. The model offered multiple exit points, assistance with financial and other known challenges for Aboriginal and Torres Strait Islander students, and included contextualised literacy and numeracy. Of the 38 Aboriginal students who enrolled in the course, 26 students completed. Of those students, 18 have since enrolled in a bachelor degree in nursing while another 4 enrolled in a diploma of nursing. This paper provides an overview of the course and its outcomes.

‘She knows how we feel’: Australian Aboriginal and Torres Strait Islander childbearing women's experience of Continuity of Care with an Australian Aboriginal and Torres Strait Islander midwifery student

BACKGROUND Marked differences exist between the maternal and neonatal outcomes of Australian Aboriginal and Torres Strait Islander women and their babies compared with the outcomes for other Australian women and their babies. Australian government policies underline the need to increase the number of practising Aboriginal and Torres Strait Islander midwives and nurses as a strategy for delivering culturally appropriate healthcare to improve health outcomes for Aboriginal and Torres Strait Islander families. Additional challenges are experienced by Aboriginal and/or Torres Strait Islander midwifery students providing Continuity of Care (COC) to Australian Aboriginal and/or Torres Strait Islander childbearing women. One such example is the challenge presented due to the close connections and relationships that exist within some Aboriginal and/or Torres Strait Islander cultures in terms of the maintenance of a professional relationship, in particular, the maintenance of professional boundaries. Whilst there is a growing body of evidence on the benefits to women of continuity of midwifery care models, little is known about the experiences of Aboriginal and Torres Strait Islander women who receive COC from Aboriginal and Torres Strait Islander midwifery students. AIM To explore the experiences of Australian Aboriginal and Torres Strait Islander childbearing women who participated in a Continuity of Care journey with an Aboriginal and/or Torres Strait Islander Bachelor of Midwifery student. METHODS Exploratory, descriptive study using semi-structured interviews informed by an Indigenous Research Methodology. FINDINGS Thematic analysis identified four major themes: (i) communicating our way, (ii) the role of relationships, (iii) support and assistance and (iv) challenges of the system. The findings illustrated the benefits Aboriginal women experience as a result of having Aboriginal and/or Torres Strait Islander midwifery students provide Continuity of Care. CONCLUSION Increasing the number of Australian Aboriginal and/or Torres Strait Islander midwives is essential to improving health outcomes for Australian Aboriginal and Torres Strait Islander childbearing women and their families. Caseload midwifery models with Aboriginal and Torres Strait Islander midwives across Australia are needed. Health services, in partnership with Universities and Aboriginal and Torres Strait Islander communities, have a vital role to play in the development and expansion of these models.

Cultural safety continuing professional development for midwifery academics: An integrative literature review

BACKGROUND Awareness of cultural safety by midwifery academics is integral to the provision of a safe learning and teaching environments, use of effective pedagogies, and academic success of Indigenous midwifery students. However, little is known about the scope and efficacy of continuing professional development activities that aim to develop awareness of cultural safety by midwifery academics. AIMS To conduct an integrative review of the literature with respect to the scope and efficacy of professional development interventions that aim to increase awareness of cultural safety by midwifery academics. METHODS An integrative review of peer-reviewed literature from 2005 -2017 was undertaken. Documents were assessed using the Critical Appraisals Skills Program (CASP) guidelines. Concepts were mapped thematically. RESULTS Results are reported and discussed using key themes identified in the analysis. Five broad themes emerged from the analysis of studies. The themes were named: Cultural Terms, Knowledge of Culture, Cultural Education, Cultural Aspirations and Culture in Curricula. CONCLUSIONS Midwifery academics requireprofessional development to raise their awareness of cultural safety in order to adopt effective learning and teaching practices. There is currently no agreed best practice framework to support awareness of cultural safety for midwifery academics. The philosophy of midwifery practice has many synergies with the principles of cultural safety. Cultural safety needs to be embedded into professional development plans for midwifery academics.

Addressing perinatal mental health issues for Aboriginal and Torres Strait Island parents and their families: Working towards better maternity outcomes

The disparities between birth outcomes for Aboriginal and Torres Strait Island mothers compared with the wider Australian population have far reaching sequelae that most mainstream Australian health services are not able to address (FergusonHill, 2010; Makregiorgos, Joubert, & Epstein, 2013; Milgrom et al., 2008). Families have always been, and, still are the functional unit and foundational living environment for Aboriginal and Torres Strait Island people along with their childrearing practices (Geia, Hayes, & Usher, 2011). Pregnancy and birth are major life changing events for the expectant parents and the family. Perinatal mental health morbidity is a significant public health issue that not only directly affects the mother and baby, it also negatively impacts on the rest of the family members as well as the wider Aboriginal and Torres Strait Island community (Austin, Reilly, Milgrom, & Barnett, 2010; Yelland, Sutherland, Wiebe, & Brown, 2009). Women tend to position their relationships with others as central to their sense of self and wellbeing (Kayser & Sormanti, 2002), and appraise themselves based upon their ability to nurture others. Therefore if mothering is disrupted there can be significant consequences for how a woman perceives herself (Power, 2012). Disruption makes it difficult to fulfil cultural ideals and ideologies which may have serious and long-term repercussions for women, their children and their families (Becker, 1997; Jackson, 2000; Power, 2012; Vallido, Wilkes, Carter, & Jackson, 2010). Nationally acclaimed beyondblue (2008) acknowledge the possible sequelae from perinatal mental health morbidity recognising that; ... vulnerability to psychological distress and disorder is accentuated in the perinatal period not only for the mother, EDITORIAL Addressing perinatal mental health issues for Aboriginal and Torres Strait Island parents and their families: Working towards better maternity outcomes

Creating connections: Enhancing Indigenous education through collaboration

It was heartening that the call for papers for this special edition attracted so many quality papers focused on education. Not only is this focus from the health delivery level it is now espoused at Australian Federal and State Governments, the need for Indigenous people to access quality education as intrinsic to improving Indigenous health at every level is paramount. This includes educating and empowering Aboriginal and Torres Strait Islander peoples in addition to educating non-Indigenous people about Indigenous culture and history. The commitment to producing culturally competent health professionals was reflected in the papers by Virdun, Gray, Sherwood, Power, Phillips, Parker, and Jackson (2013), Jackson, Power, Sherwood, and Geia (2013) and Thackrah and Thompson (2013). Virdun et al. (2013) reported on an alliance formed between Indigenous and non-Indigenous academics to create safe collaboration spaces that facilitated the sensitive design of health care curricula. These academics have made producing culturally competent health professionals a faculty priority, through the introduction of an Indigenous graduate attribute. The commitment to producing culturally competent health professionals is reflected in the way this graduate attribute sits at a course rather than a subject level. This means that every health course must address the Indigenous graduate attribute and it is not relegated to a single core Indigenous health subject. Continuing with the theme of Indigenous and non-Indigenous academic collaboration, Jackson, Power, Sherwood, and Geia (2013) provided evidence that an intensive workshop facilitated by a EDITORIAL Creating connections: Enhancing Indigenous education through collaborationIt was heartening that the call for papers for this special edition attracted so many quality papers focused on education. Not only is this focus from the health delivery level it is now espoused at Australian Federal and State Governments, the need for Indigenous people to access quality education as intrinsic to improving Indigenous health at every level is paramount. This includes educating and empowering Aboriginal and Torres Strait Islander peoples in addition to educating non-Indigenous people about Indigenous culture and history.The commitment to producing culturally com- petent health professionals was reflected in the papers by Virdun, Gray, Sherwood, Power, Phillips, Parker, and Jackson (2013), Jackson, Power, Sherwood, and Geia (2013) and Thackrah and Thompson (2013). Virdun et al. (2013) reported on an alliance formed between Indigenous and non-Indigenous academics to create safe collabo- ration spaces that facilitated the sensitive design of health care curricula. These academics have made producing culturally competent health profession- als a faculty priority, through the introduction of an Indigenous graduate attribute. The commit- ment to producing culturally competent health professionals is reflected in the way this graduate attribute sits at a course rather than a subject level. This means that every health course must address the Indigenous graduate attribute and it is not rel- egated to a single core Indigenous health subject.Continuing with the theme of Indigenous and non-Indigenous academic collaboration, Jackson, Power, Sherwood, and Geia (2013) provided evi- dence that an intensive workshop facilitated by a team of Indigenous academics had the power to transform the perceptions about Indigenous people, held by a large Masters level postgraduate class. The evidence drawn from both solicited and un-solicited feedback from students reveals the power of personal stories and the value of engaging students emotion- ally as well as intellectually with Indigenous content.The success of Jackson et al.s (2013) use of trans- formational learning and Indigenous team teach- ing is remarkable when you compare it to findings by Thackrah and Thompson (2013). Observing an undergraduate midwifery class engage with Indigenous content, taught by a non-Indigenous academic, Thackrah and Thompson (2013) reported this style of content delivery failed to address issues of racism in the class. Validating the approach taken by Virdun et al. (2013) these authors also concluded that Indigenous health should be threaded through- out curricula rather than siloed to a single subject.It is widely acknowledged that increasing par- ticipation of Indigenous people in the health dis- ciplines is crucial to improving Indigenous health. In response to a limited increase in the numbers of enrollments and completions of a pre-r egistration Bachelor of Nursing course by Indigenous students, West, Usher, Foster, Buettner, and Stewart (2013) compared completion rates of non-Indigenous and Indigenous students and explored barriers and enablers to successful graduation. Enablers to suc- cessful graduation included individual student characteristics, Indigenous academic leadership, understanding of inequity from non-Indigenous aca- demics, and sustainable relationships that spanned family and community and university and industry. Indigenous Education Support Units were found to be intrinsic to success as they provided a network of Indigenous people and links to community.Furthermore, in response to low completion rates of a nursing degree by Indigenous students, Felton- Busch et al. (2013) reported on a research team comprised of local and Indigenous members, using mentoring circles to enhance self reflection, time management, and communication. …