There is no health without Cultural Safety: why Cultural Safety matters.

Background: Nurses and midwives predominately work in western-centric health care settings, which may not align with Indigenous perspectives of health and wellbeing. Nurses and midwives will also view care through their own cultural lens. Culturally inappropriate health care can reduce access and engagement in services and contribute to reduced health outcomes for Indigenous peoples. Australian codes of conduct for nurses and midwives now advocate for care that is holistic, free of bias and racism, challenges beliefs based on assumption, and is culturally safe for Indigenous peoples. However, there are varying understandings of cultural care, what it looks like, and how to best achieve it.Aim: To highlight the importance of cultural safety in health care and discuss the integration into nursing and midwifery practice.Design: Discussion paper.Discussion: Cultural safety has emerged in Australia as the framework to improve the access and quality of health care for Indigenous people and to improve disparities in health care outcomes. However, the application of these principles for nurses and midwives has not been widely explored. Misconceptions around the concept remain despite the inclusion in national standards and practice frameworks.Conclusion: Evaluation and research that contributes to evidence-based knowledge specifically on the integration of cultural safety in nursing and midwifery practice is required.Impact Statement: This paper provides an overview of the importance of cultural safety in nursing and midwifery practice. Although cultural safety is now embedded in professional codes and standards, there is limited evidence of how this is translated to clinical care. Research and evaluation are needed to evaluate the application of cultural safety principles by nurses and midwives.

Improving forensic mental health care to Indigenous Australians: theorizing the intercultural space.

This paper uses the 'intercultural space' as an educational strategy to prepare nurses to work respectfully with Indigenous patients in a forensic mental health context; offers an educational approach that introduces nurses to Indigenous knowledge, beliefs and values, examines power relations in colonized countries between the dominant white cultural group and the Indigenous population and encourages nurses to critically reflect on their health care practice; and explores the intercultural space as a shared space between cultures fostering open and robust inquiry where neither culture dominates and new positions, representations and understandings can emerge. Given the disproportionately high number of Indigenous people imprisoned in colonized countries, this paper responds to research from Western Australia on the need to prepare forensic mental health nurses to deliver care to Indigenous patients with mental health disorders. The paper highlights the nexus between theory, research and education that can inform the design and implementation of programmes to help nurses navigate the complex, layered and contested 'intercultural space' and deliver culturally safe care to Indigenous patients. Nurses are encouraged to critically reflect on how beliefs and values underpinning their cultural positioning impact on health care to Indigenous patients. The paper draws on intercultural theory to offer a pedagogical framework that acknowledges the negative impacts of colonization on Indigenous health and well-being, repositions and revalues Indigenous cultures and knowledges and fosters open and robust inquiry. This approach is seen as a step towards working more effectively in the intercultural space where ultimately binary oppositions that privilege one culture over another and inhibit robust inquiry are avoided, paving the way for new, more inclusive positions, representations and understandings to emerge. While the intercultural space can be a place of struggle, tension and ambiguity, it also offers deep potential for change.

The power of vivid experience in hand hygiene compliance.

In recent years, explicit behavioural theories have been used in some research into hand hygiene behaviour. One of the most prominent of these has been the theory of planned behaviour (TPB). In this qualitative study aimed at increasing understanding of infection prevention practice in the acute care setting, TPB was identified as a suitable framework for the emergence of new insights that have the potential to improve the power of existing education and training. The theory emerging from the research was based on a finding that individual experience is of greater import than formal education in explaining hand hygiene behaviour. This indicated that exposure to vivid vicarious experience is a potential means to improving the power of existing training methods and increasing the propensity for instilling sustainable adequate hand hygiene habits.

Best practice in psychogeriatric care.

This paper presents a best practice model for psychogeriatric care. Best practice is becoming one of the most common expressions used in the area of health care, and is often referred to in government reports and documents. The definition of 'best practice', however, is still evolving. What then, is best practice? And how can the principles of best practice be applied and integrated into the clinical speciality of psychogeriatrics? The article emphasizes the importance of evidence-based interventions and the need to focus on the pragmatic aspects of providing best practice in the clinical area of psychogeriatrics; that is, what works best in practice? The position taken by the authors of this paper is that the conceptualization of a best practice model in psychogeriatrics is necessary in order to describe and explain the different components involved in the service provided. This conceptualization also communicates and articulates the role of the major stakeholders, and the key players in the achievement of best practice. A psychogeriatric service may become more coherent, more goal-orientated and more efficient if a model is utilized. This paper outlines a proposed model of best practice in psychogeriatrics, and discusses the potential implications for achieving desirable clinical outcomes.

Ethics in qualitative research.

PURPOSE: To critically examine ethical issues in qualitative research. ORGANIZING CONSTRUCT: The ethical principles of autonomy, beneficence, and justice are guides for researchers to address initial and ongoing tensions between the needs and goals of the research and the rights of participants. METHODS: Research literature, ethics literature, and researcher experiences. CONCLUSIONS: Ethical principles can be used to guide the research in addressing the initial and ongoing issues arising from qualitative research in order to meet the goals of the research as well as to maintain the rights of the research participants.

Cross-cultural communication and health care practice.

This article describes concepts such as culture, cross-culture and the effect of culture in the communication process between clients and health professionals from culturally and linguistically diverse backgrounds in order to promote holistic health care. The paper outlines a case study that can be used to both support and improve cultural competence.

The use of seclusion in the year 2000: what has changed?

This study was undertaken to examine the perceptions of nurses working in three psychiatric settings regarding the effect and use of seclusion. It also aimed to identify current practices at these sites in the metropolitan area of Western Australia. A total of 78 nurses specialising in mental health care participated in the study by completing the 'Attitude towards seclusion survey'. The findings of this study indicate that nurses perceive seclusion as an accepted patient management strategy. The results also showed that the decision to seclude the patient was made by a senior mental health practitioner and that one hour was the average time a patient spent in seclusion. It is important to ensure that punishment, paternalistic attitudes or punitive actions are not part of clinical judgment regarding the use of seclusion. The study has provided evidence of nurses' perceptions concerning seclusion and the results highlight the need for staff to continue to explore and evaluate issues that lead to seclusion in order to facilitate the use of other management strategies that encourage a less restrictive environment.

A practice-research model for collaborative partnership.

The ability to integrate education, practice and research initiatives is well documented and the nursing literature presents several collaborative models that have emerged between educational institutions and service agencies to achieve this aim. However, a collaborative partnership agreement does more than integrate these initiatives; it is a vehicle by which the theory-clinical practice gap is bridged and best practice outcomes are achieved. This paper outlines an innovative collaborative partnership agreement between Fremantle Hospital and Health Service and Curtin University of Technology in Perth, Western Australia. The partnership engages academics in the clinical setting in two formalised collaborative appointments. This partnership not only enhances communication between educational and health services, but fosters the development of nursing research and knowledge. The process of the collaborative partnership agreement involved the development of a Practice-Research Model (PRM) of collaboration. This model encourages a close working relationship between registered nurses and academics, and has also facilitated strong links at the health service with the Nursing Research and Evaluation Unit, medical staff and other allied health professionals. Links have also been established with other health services and agencies in the metropolitan area. The key concepts exemplified in the application of the model include practice-driven research development, collegial partnership, collaborative ownership and best practice. Many specific outcomes have been achieved through implementation of the model, but overall the partnership between registered nurses and academics in the pursuit of research to support clinical practice has been the highlight. This has resulted in changes and innovations in current nursing practice and, importantly, dissemination of best practice outcomes.

Types of patients in a psychiatric intensive care unit.

OBJECTIVE: This paper reports the findings of a descriptive study of a patient population over a three-month period on an eight bed psychiatric intensive care unit (PICU) in Western Australia. The report provides a quantitative insight into the profile of patients in PICUs. It provides information on patients' diagnoses, presenting signs, symptoms and/or behaviours, legal codes assigned to patients, treatment interventions and management. METHOD: Data were collected prospectively from August to October 1999. A total of 122 patients were admitted to the PICU during the review period. Data were entered into an Access program then exported to SPSS (Version 9 for Windows) for analysis and frequency distributions were obtained. RESULTS: The results confirmed that the majority of patients admitted to the PICU were assessed as a high level of risk or needed containment. This finding is in line with the admission criteria developed by staff working in the PICU. It also supports the view that staff working in these units require expertise and confidence to communicate with and manage potentially aggressive and highly aroused patients. CONCLUSION: This study demonstrates the importance of ongoing evaluations of patient populations in promoting best practice initiatives in psychiatric care.

Are universities preparing nurses to meet the challenges posed by the Australian mental health care system?

The preparedness of comprehensive nurses to work with the mentally ill is of concern to many mental health professionals. Discussion as to whether current undergraduate nursing programs in Australia prepare a graduate to work as a beginning practitioner in the mental health area has been the centre of debate for most of the 1990s. This, along with the apparent lack of interest and motivation of these nurses to work in the mental health area following graduation, remains a major problem for mental health care providers. With one in five Australians now experiencing the burden of a major mental illness, the preparation of a nurse who is competent to work with the mentally ill would appear to be a priority. The purpose of the present study was to determine third year undergraduate nursing students' perceived level of preparedness to work with mentally ill clients. The results suggested significant differences in students' perceived level of confidence, knowledge and skills prior to and following theoretical and clinical exposure to the mental health area. Pre-testing of students before entering their third year indicated that the philosophy of comprehensive nursing: integration, although aspired to in principle, does not appear to occur in reality.

Staff confidence in dealing with aggressive patients: a benchmarking exercise.

Interacting with potentially aggressive patients is a common occurrence for nurses working in psychiatric intensive care units. Although the literature highlights the need to educate staff in the prevention and management of aggression, often little, or no, training is provided by employers. This article describes a benchmarking exercise conducted in psychiatric intensive care units at two Western Australian hospitals to assess staff confidence in coping with patient aggression. Results demonstrated that staff in the hospital where regular training was undertaken were significantly more confident in dealing with aggression. Following the completion of a safe physical restraint module at the other hospital staff reported a significant increase in their level of confidence that either matched or bettered the results of their benchmark colleagues.