The politics of resistance to workplace cultural diversity education for health service providers : an Australian study

This qualitative study has as its focus an exploration of health service providers\u27 perceptions and experiences of the processes and implications of delivering workplace cultural diversity education for staff. Data were obtained from conducting in-depth individual and focus group interviews with a purposeful sample of 137 healthcare professionals, recruited from over 17 different organizational sites. Participants included cultural diversity educators, ethnic liaison officers, health service managers, nurses, health interpreters, allied health professionals, and community-based ethnic welfare organization personnel working in or with select metropolitan health services in Victoria, Australia. Analysis of the data revealed that workplace cultural diversity education in healthcare is a significant site of resistance and struggle. \u27Resistance\u27 was expressed in several forms including: the problematization of resources and staff availability to attend cultural diversity education forums; indifferent failure to recognize cultural imperatives in healthcare; deliberate refusal to recognize cultural imperatives in healthcare; selective recognition of cultural imperatives in healthcare (\u27facts sheets\u27 only); and the angry rejection of cultural imperatives in healthcare. \u27Struggle\u27, in turn, largely involved cultural diversity educators having to constantly \u27cajole and convince\u27 (and even manipulate) staff to attend cultural diversity education forums and using a \u27velvet glove and iron fist\u27 approach to teaching staff who remained resolute in their resistance when participating in educational forums. An important implication of this study is that the politics of workplace cultural diversity education - and the \u27politics of resistance\u27 to such programs - need to be better recognized and understood if the status quo is to be successfully challenged and changed. The need for critical debate and further comparative research on the subject are also highlighted. <br /

Health care provider and consumer understandings of cultural safety and cultural competency in health care : an Australian study

There is increasing recognition in Australia that racial and ethnic minority groups experience significant disparities in health and health care compared with the average population and that the Australian health care system needs to be more responsive to the health and care needs of these groups. The paper presents the findings of a year long study that explored what providers and recipients of health care know and understand about the nature and implications of providing culturally safe and competent health care to minority racial and ethnic groups in Victoria, Australia. Analysis of the data obtained from interviewing 145 participants recruited from over 17 different organizational sites revealed a paucity of knowledge and understanding of this issue and the need for a new approach to redress the status quo.<br /

Ethnospecific health and care: a critical ethnographic study of a Greek nursing home

© 1999 Dr. Olga KanitsakiThis abstract examines how a Greek ethnospecific nursing home functions – situated within a health care system that operates within an English-language, and Anglo/ Australian derived culture. The nursing home was examined within a critical science paradigm guided, however, by Bourdieu’s reflexive sociology. Critical ethnography as a research method was combined with Greek forms of speech in order to accommodate Greek women’s forms of social interaction and oral culture and to avoid imposing an alien research process on participants. Group discussions, formal and informal interviews, participant observation in a variety of forms and document examination were the approaches used to collect data in the field. A key and controversial finding of this inquiry is that the delivedry of ethnospecific aged care is heavily constrained and ultimately undermined – by the policies and practices of the Australian and dominant culture that was transposed in the nursing home, via the distribution of capital that privilege dominant groups in Australia. Because of this residents and carers remained structurally excluded from participation and decision making processes and located at the bottom of the institutional hierarchy. This inevitably helped, particularly in regards to Greek women carers, and domestic staff, including Greek speaking registered nurses, not only to maintain but increase their negative ethnic experiences, historical oppression and exploitation. Nevertheless, ethnospecific care was provided to the residents at the cultural expressive level reflecting larger society’s tolerance of a conservative multiculturalism. Significant Greek cultural care, was mediated through the Greek carers, domestic staff and residents dispositions (habitus) that contextualised their interactions, relationships and practices, enabling their past (and because of this themselves) to live in the present in a meaningfull and dynamic way. For this reason, ethnospecific services, even when constrained by external socio-cultural and political hegemony, has more to offer the Greek aged than do mainstream aged care services

Ethnospecific health and care: a critical ethnographic study of a Greek nursing home

© 1999 Dr. Olga KanitsakiThis abstract examines how a Greek ethnospecific nursing home functions – situated within a health care system that operates within an English-language, and Anglo/ Australian derived culture. The nursing home was examined within a critical science paradigm guided, however, by Bourdieu’s reflexive sociology. Critical ethnography as a research method was combined with Greek forms of speech in order to accommodate Greek women’s forms of social interaction and oral culture and to avoid imposing an alien research process on participants. Group discussions, formal and informal interviews, participant observation in a variety of forms and document examination were the approaches used to collect data in the field. A key and controversial finding of this inquiry is that the delivedry of ethnospecific aged care is heavily constrained and ultimately undermined – by the policies and practices of the Australian and dominant culture that was transposed in the nursing home, via the distribution of capital that privilege dominant groups in Australia. Because of this residents and carers remained structurally excluded from participation and decision making processes and located at the bottom of the institutional hierarchy. This inevitably helped, particularly in regards to Greek women carers, and domestic staff, including Greek speaking registered nurses, not only to maintain but increase their negative ethnic experiences, historical oppression and exploitation. Nevertheless, ethnospecific care was provided to the residents at the cultural expressive level reflecting larger society’s tolerance of a conservative multiculturalism. Significant Greek cultural care, was mediated through the Greek carers, domestic staff and residents dispositions (habitus) that contextualised their interactions, relationships and practices, enabling their past (and because of this themselves) to live in the present in a meaningfull and dynamic way. For this reason, ethnospecific services, even when constrained by external socio-cultural and political hegemony, has more to offer the Greek aged than do mainstream aged care services

Population ageing and the politics of demographic alarmism : implications for the nursing profession

ObjectivesThis article provides a brief examination of the prejudices and politics framing current public debate on population ageing in Australia and the possible implications of this for the allocation of required health and social sector resources. The role and responsibility of nurses and professional nursing organisations to engage in and influence public policy debate concerning the health and social care of older people is highlighted.SettingAustraliaSubjectsAustralia\u27s ageing population and succeeding generations over the next 40 yearsPrimary argumentAccording to the Australian government, population ageing in Australia is poised to cause unmanageable chaos for the nation\u27s public services. The cost of meeting the future health and social care needs of older Australians is predicted to be unsustainable. Officials argue that government has a stringent responsibility to ration current and future resources in the health and social care sector, cautioning that if this is not done, the nation\u27s public services will ultimately collapse under the strain of the ever increasing demands placed on these services by older people. This characterisation of population ageing and its consequences to the nation\u27s social wellbeing may however be false and misleading and needs to be questioned.ConclusionThe nursing profession has a fundamental role to play in ensuring responsible debate about population ageing and contributing to public policy agenda setting for the effective health and social care of Australia\u27s ageing population.<br /

The ethics and practical importance of defining, distinguishing and disclosing nursing errors : a discussion paper

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of &lsquo;nursing error&rsquo;, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of &lsquo;nursing error&rsquo; fits with the new &lsquo;system approach&rsquo; to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is &lsquo;right&rsquo; for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.<br /

An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context

Cultural safety has been promoted by its New Zealand proponents as an effective process for managing cultural risk in health care and improving the cultural responsiveness of mainstream health services when delivering care to culturally diverse populations. Its effectiveness in this regard has not, however, been comprehensively investigated. A key purpose of this study was to explore and describe what is known and understood about the notion of cultural safety and its possible application to and in Australian health care domains. Findings from the study indicate that the notion of cultural safety is conceptually problematic, poorly understood, and underresearched and, unless substantially revised, cannot be meaningfully applied to the cultural context of Australia.<br /

Processes for disciplining nurses for unprofessional conduct of a serious nature : a critique

Aims: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies.Background: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses.Methods: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies.Results: Attitudinal considerations (e.g. whether a nurse understood the \u27wrongness\u27 of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors.Conclusion: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.<br /

The moral imperative of designating patient safety and quality care as a national nursing research priority

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.<br /

The problem of failing to provide culturally and linguistically appropriate healthcare

Analysing health policy explores Australian health policy using a novel, problem-orientated approach. It shows the problem-solving techniques that are used when developing policy and demonstrates the skills of analysis and decision making.Introductory chapters explain the problem-orientated approach to health policy development and introduce the policy making process. Case studies then explore developments in health policy in both priority and topical areas. Chapters illustrate how policy-makers respond to perennial and emerging policy problems and demonstrate problem-solving approaches to the conception, development and implementation of health policy.<br /