The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community.

BACKGROUND: Insufficient and inadequate housing remain serious and enduring problems in remote Aboriginal communities in the Northern Territory (NT) of Australia. Housing is recognised as a key determinant of persisting inequities between Aboriginal and other Australians in health, as well as education and employment outcomes which in turn impact on health. In our qualitative study exploring strengths and challenges related to early childhood in a remote NT community, insufficient housing emerged as the greatest challenge families experience in 'growing up' their children. METHODS: The "Growing up children in two worlds" study engaged Yolŋu (Aboriginal) and other researchers in a culturally responsive qualitative research process. Methods included video ethnography and in-depth interviews with six case study families as well as participant observation and interviews with a wide range of other community members. Data collection and analysis occurred through an iterative and collaborative process and the findings related to housing are the focus of this article. RESULTS: Concerns about crowded and insecure housing were pervasive in the study community where many families are, in effect, homeless. Most rely on extended family to provide accommodation and some never find a secure and stable space in which to bring up their children. Absence of control over their living conditions is a key element underlying many of the sources of distress associated with crowded housing. The lack of food security, sharing sickness and disturbances in the night affecting sleep are just some of the challenges that generate conflict between family members and impact on health, wellbeing, work and school attendance. Although interaction with other family members is highly valued, the ambition of most participants is for independent and secure accommodation in which they can safely 'grow up' their children. CONCLUSIONS: Yolŋu who live with the consequences of crowded and insecure housing want their voices to be heard. They best understand the challenges they face and their perspectives must inform the solutions. Equitable access to housing through sufficient and sustained investment in an integrated approach, engaging all stakeholders, is needed. This is essential to address persisting inequities between Aboriginal and non-Aboriginal Australians in health and other outcomes.

Building Yolŋu Skills, Knowledge, and Priorities into Early Childhood Assessment and Support: Protocol for a Qualitative Study.

BACKGROUND: Yolngu or Yolŋu are a group of indigenous Australian people inhabiting north-eastern Arnhem Land in the Northern Territory of Australia. Recent government policy addressing disparities in outcomes between Indigenous and other children in Australia has resulted in the rapid introduction of early childhood interventions in remote Aboriginal communities. This is despite minimal research into their appropriateness or effectiveness for these contexts. OBJECTIVE: This research aims to privilege Aboriginal early childhood knowledge, priorities and practices and to strengthen the evidence base for culturally responsive and relevant assessment processes and support that distinguishes "difference" from "deficit" to facilitate optimal child development. METHODS: This collaborative qualitative research employs video ethnography, participant observation and in-depth interviews, involving Aboriginal families and researchers in design, implementation, interpretation and dissemination using a locally developed, culturally responsive research approach. Longitudinal case studies are being conducted with 6 families over 5 years and emerging findings are being explored with a further 50 families and key community informants. Data from all sources are analyzed inductively using a collaborative and iterative process. The study findings, grounded in an in-depth understanding of the cultural context of the study but with relevance to policy and practice more widely, are informing the development of a Web-based educational resource and targeted knowledge exchange activities. RESULTS: This paper focuses only on the research approach used in this project. The findings will be reported in detail in future publications. In response to community concerns about lack of recognition of Aboriginal early childhood strengths, priorities and knowledge, this collaborative community-driven project strengthens the evidence base for developing culturally responsive and relevant early childhood services and assessment processes to support optimal child development. The study findings are guiding the development of a Web-based educational resource for staff working with Aboriginal communities and families in the field of early child development. This website will also function as a community-developed tool for strengthening and maintaining Aboriginal knowledge and practice related to child development and child rearing. It will be widely accessible to community members through a range of platforms (eg, mobile phones and tablets) and will provide a model for other cultural contexts. CONCLUSIONS: This project will facilitate wider recognition and reflection of cultural knowledge and practice in early childhood programs and policies and will support strengthening and maintenance of cultural knowledge. The culturally responsive and highly collaborative approach to community-based research on which this project is based will also inform future research through sharing knowledge about the research process as well as research findings.

Cultural safety as an ethic of care: a praxiological process.

New writings broadening the construct of cultural safety, a construct initiated in Aotearoa New Zealand, are beginning to appear in the literature. Therefore, it is considered timely to integrate these writings and advance the construct into a new theoretical model. The new model reconfigures the constructs of cultural safety and cultural competence as an ethic of care informed by a postmodern perspective. Central to the new model are three interwoven, co-occurring components: an ethic of care, which unfolds within a praxiological process shaped by the context. Context is expanded through identifying the three concepts of relationality, generic competence, and collectivity, which are integral to each client-nurse encounter. The competence associated with cultural safety as an ethic of care is always in the process of development. Clients and nurses engage in a dialogue to establish the level of cultural safety achieved at given points in a care trajectory.

Suboptimal care of the acutely unwell ward patient: a concept analysis.

AIM: This paper presents a concept analysis of suboptimal care of the acutely unwell ward patient. BACKGROUND: Acutely unwell patients exhibit abnormal vital signs which are either not recognized or are treated inappropriately. This is frequently termed 'suboptimal care'. However, use of the term 'suboptimal care' is ambiguous and not clearly defined. Critical review of this concept is required to ensure nurses have a better understanding of why and how suboptimal care occurs. DATA SOURCES: Electronic databases (CINAHL, Medline, Cochrane) were searched for literature related to suboptimal care of acutely unwell ward patients. Reference lists from relevant publications were reviewed. No date or language restrictions were imposed. Only articles relevant to suboptimal care of the acutely unwell adult ward patient were included. All literature reviewed was in English and was published between 1990 and 2009. METHOD: The Walker and Avant approach was used. RESULTS: The attributes of suboptimal care are delays in diagnosis, treatment or referral, poor assessment and inadequate or inappropriate patient management. These attributes are preceded by contextual antecedents which can be categorized into patient complexity, healthcare workforce, organization and education factors. Suboptimal care may have catastrophic consequences for patients such as death, Intensive Care Unit admission or cardiac arrests which are preventable or avoidable. CONCLUSION: For future research, investigators need to develop more objective measures which capture delays in the treatment and inappropriate or inadequate management of acutely unwell patients. This should occur through critical focus on the antecedents to suboptimal care.