- Title
- An Aboriginal cultural safety framework for New South Wales hospitals
- Creator
- Elvidge, Elissa
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (Phd)
- Description
- Globally, there is a wide range of culture-based frameworks used to reduce health disparities. While this has resulted in a diverse research environment, empirical measures of the effectiveness of many of these approaches are scarce. Increasingly, public health policies are incorporating cultural safety approaches to reorientate health systems towards providing more equitable care to people from marginalised communities. However, the conceptual ambiguity of the term ‘cultural safety’ requires a more systematic examination of its meaning. Further, the complexity and lack of empirical measures of cultural safety necessitate the development of valid and reliable measures based on patient perspectives. The study presented in this thesis involved a mixed-methods approach using semi-structured interviews and a survey subject to exploratory factor analysis to inform the development of a cultural safety framework. Interviews were conducted at two Australian hospitals located in New South Wales (NSW). A total of 50 staff were interviewed over a two-month period. Participants included health workers from a diverse range of roles, including chief executive officers, executive board members, specialist physicians, nurses, medical students, social workers and administrative and service support staff. During the interviews, participants were asked to describe their understanding and practice of cultural safety. Transcripts were analysed using applied thematic analysis in which several key themes were identified. Overall, interviewees had a modest understanding of cultural safety and provided a range of examples of how they incorporated cultural safety in practice. Some staff appeared unwilling to be culturally responsive or had observed practices resulting in the provision of culturally unsafe care. Aboriginal workers experienced distinct challenges with respect to their own and their patients’ cultural safety, with many interviewees reporting experiencing racism in the workplace. The implementation of cultural safety appeared to be compromised by what clinicians could do within the structural restrictions of the system. The conflict between governance structures and the agency of individual staff members was identified as a significant barrier impeding the implementation of health policies that seek to enhance patient cultural safety. For the quantitative arm of the study, Aboriginal and/or Torres Strait Islander patients attending NSW hospitals were invited to participate in a survey designed to measure cultural safety from the patient perspective. Using targeted recruitment strategies, participants were selected from two tertiary hospitals. Opportunistic recruitment was also undertaken to enlist patients attending NSW hospitals outside of the target sites. In total, 316 surveys were analysed using exploratory factor analysis, which showed adequate internal and external consistency of domains. Overall, it was found that the survey provides a robust measurement of cultural safety. In addition to exploratory analysis, a cultural safety score was produced for each hospital site. Results from the qualitative survey questions reveal that the support of family and Aboriginal staff is important in determining culturally safe experiences. Both the qualitative and quantitative findings were used in the development of a cultural safety framework for NSW hospitals. This framework may be a valuable tool for measuring and guiding cultural safety initiatives in Australian hospitals.
- Subject
- cultural safety; racism; institutional racism; cultural competence; health policy; hospital governance; equity; framework; Aboriginal health; Indigenous health
- Identifier
- http://hdl.handle.net/1959.13/1446532
- Identifier
- uon:42899
- Rights
- Copyright 2021 Elissa Elvidge
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 301 KB | Adobe Acrobat PDF | View Details Download |