Embedding cultural safety into nursing practice is integral to the health and well-being of Aboriginal and Torres Strait Islander people. When working in partnership with First Nations communities and health workers, nurses are better able to deliver truly patient-centred care that is a powerful force for change.
As governments debate strategies and implement policies to improve the health of Aboriginal and Torres Strait Islander people, nurses find themselves on the frontline of change. Every day, nurses face the reality behind the statistics that show First Nations people have higher rates of mortality and morbidity: between 2018-2022, the age-standardised death rate for First Nations people was nearly two times higher for all causes of death. First Nations people also have higher rates of hospitalisation for most health conditions, yet are more likely to leave the hospital against medical advice.
Nurses have to acknowledge the complex cultural and historical factors that have compounded disadvantage and distrust — as well as the holistic approach comprising body, mind, and spirit — that First Nations people take to their health and well-being.
Having the foundations in place to deliver truly patient-centred care empowers nurses to bring about positive change, including change in critical targets as outlined in the National Agreement on Closing the Gap:
- Life expectancy: To close the gap, which is 8 to 14 years lower than among non-Indigenous Australians, within a generation — by 2031
- Healthy and strong children: To increase the proportion of Aboriginal and Torres Strait Islander babies with healthy birthweights to 91%
Creating culturally safe care
The commitment to providing culturally safe care is embedded in nursing’s standards of practice and codes of conduct.
First and foremost is the recognition that all Aboriginal and Torres Strait Islander people have the right to access health services that are free of racism.
To ensure culturally safe care, nurses must be mindful of a patient’s belief system and be aware of their own cultural filters and how those filters affect their judgment, behaviour, and decisions.
Nurses must also work with First Nations organisations and health professionals to ensure an ethical and just approach to evidence-based practice.
Nurses should provide care in consultation with First Nations healthcare workers, including nurses and support officers. Successful models of collaboration start with recognition of mutual competence, and they incorporate:
- A focus on the well-being of the person receiving care
- Shared decision-making
- Working in partnership to a common goal
- Trust and autonomy
Empowering First Nations nurses
In 2021, the most recent national census, 5,037 Aboriginal and Torres Strait Islander nurses and midwives were registered in Australia — up from 2,434 in 2013.
Even though nurses and midwives accounted for 54% of the increase in overall number of Aboriginal and Torres Strait Islanders employed in health-related professions, there is still a long way to go because they represent only 1.8% of the health workforce despite being 3.2% of the population.
The situation is even more critical in remote areas, where the need is perhaps the greatest, with just 366 Aboriginal and Torres Strait Islander health professionals registered per 100,000 population compared with 1,245 per 100,000 in major cities.
Research indicates that Indigenous health professionals build better rapport and greater trust with Indigenous patients and may serve to improve appointment attendance and acceptance of treatment and assessment advice.
As part of the commitment to Closing the Gap, governments worked with Aboriginal and Torres Strait Islander people on a national health workforce plan that has set an ambitious target of 3.43% of the national health workforce by 2031.
Programs such as Murdoch University’s Moorditj Kaartdijin, Moorditj Warlang (good/strong knowledge, good/strong health) are helping hospitals deliver more inclusive and more culturally diverse workplaces.
Ensuring better communication
One of the barriers to delivering patient-centred care in Aboriginal and Torres Strait Islander communities is communication, with research showing poor communication can lead to adverse events and poor quality of care. There are more than 160 Aboriginal and Torres Strait Islander languages are spoken in Australia, with an estimated 60% of Aboriginal and Torres Strait Islander people in the Northern Territory alone speaking a language other than English at home.
An interpreter may be recommended for complex medical communications. However, only a small proportion of patients estimated to require an interpreter receive access to one. A pilot study that embedded interpreters at Royal Darwin Hospital found that making them consistently available improved the experience of Aboriginal and Torres Strait Islander patients.
It is essential that the wider community of nurses adapt modes of communication as required. Nurses should ask about best practices at their workplace and seek out professional resources for communicating effectively. Recommended strategies include avoiding medical jargon, simplifying forms and written information, allowing time for silence and response, and checking to ensure that conveyed information has been understood.
Communication is not, however, merely about spoken language. Nurses can build rapport — and trust — beginning with their very first interaction with the way they greet people, the body language they adopt, and the respect they show. In culturally safe practice, those behaviours extend beyond the patient — to the family and the community.
Working together
While government, industry, and education sectors are working to build the numbers of Aboriginal and Torres Strait Islander people working in the health sector, nurses can continue to lead from the front. By listening to patients and their families, by showing respect for patients’ and their families’ beliefs and their communities, and by collaborating with First Nations colleagues, nurses show that culturally safe care is at the front and centre of healthcare.
Find out more about how Lippincott® Solutions can support nurses in Australia’s healthcare settings.
