Confronting the Cultural Challenge of the Whiteness of Nursing: Aboriginal Registered Nurses' Perspectives.

Abstract This paper presents the findings of a study that that interviewed Aboriginal nurses to explore their experiences of the whiteness of nursing. Despite concerted efforts to improve the health of Aboriginal Australians, it still remains equivalent to third world countries. One strategy to address this that has been identified is to increase the participation rates of Aboriginal registered nurses within the Australian healthcare workforce. Presently Aboriginal nurses account for only a small percentage of the nursing workforce. While there has been research into the recruitment and retention strategies dedicated to improving the numbers of Aboriginal registered nurses, this paper focus on the experiences of Aboriginal registered nurses within Australia's mainstream healthcare system, where they are exposed and subjected on a daily basis to the 'whiteness of nursing'.

Confronting the cultural challenge of the whiteness of nursing: Aboriginal registered nurses' perspectives.

Abstract This paper presents the findings of a study that interviewed Aboriginal nurses to explore their experiences of the whiteness of nursing. Despite concerted efforts to improve the health of Aboriginal Australians, it still remains equivalent to third world countries. One strategy identified to address this is to increase the participation rates of Aboriginal registered nurses within the Australian healthcare workforce. Presently Aboriginal nurses account for only a small percentage of the nursing workforce. While there has been research into the recruitment and retention strategies dedicated to improving the numbers of Aboriginal registered nurses, this paper focus on the experiences of Aboriginal registered nurses within Australia's mainstream healthcare system, where they are exposed and subjected on a daily basis to the 'whiteness of nursing.'

Impact of the mining industry on the mental health of landholders and rural communities in southwest Queensland.

OBJECTIVE: We aimed to ascertain the extent of mental health problems in rural communities of southwest Queensland. METHODS: Twelve workshops were conducted within this region, asking community members about the issues which were affecting their mental health, the gaps in services and facilities, and suggestions as to how to strengthen their capacity to deal with mental health problems. RESULTS: The participants highlighted the higher cost of living through increased rental and goods and services costs. Non-resident workforces, putting a strain on housing availability and succession planning, were among key concerns. The rapid increase in population has also put strains on health services within these communities, highlighting the need for mental health resources and a greater clarification and coordination of available health services. CONCLUSIONS: The rural communities in this region are under sustained stress resulting from the incursion of the mining and coal seam gas industries. This has an impact on community mental health and wellbeing.

Nursing student's perceptions and understanding of intimate partner violence.

Intimate partner violence (IPV) is a significant health issue in the Australian population and nurses have a role in assessment, intervention and support of families. World Health Organization Statistics indicate that as many as 61% of women, under the age of 50 have been physically abused by their partners. As nurses are in a unique position to identify, assist and support women living with IPV a greater understanding of student nurse's knowledge and attitudes may assist undergraduate programs to ensure better preparation of nurses for this role. A nurse's readiness to manage IPV may be influenced by their knowledge, attitudes, beliefs and behaviors, largely related to their self-efficacy in identifying these women (i.e. via screening procedures) and providing effective interventions. Students from all levels of the undergraduate program of an Australian regional university were invited to participate in focus groups and a subsequent survey that explored their perceptions, attitudes and knowledge of IPV. The results showed students had limited and stereotypical beliefs regarding what constitutes IPV and who perpetrates it. They indicated that they were under prepared to deal with IPV situations in clinical practice but did identify communication as a core skill required. Nursing students may not understand the significance of the issues of IPV nor fully understand the social, economic and health impacts at an individual and societal level. This may result in further under detection of the problem. The results of this study indicate a number of important implications for undergraduate nursing education curricula.

Making sense of dementia: understanding amongst indigenous Australians.

INTRODUCTION: Dementia is a growing health and social concern for all Australians. Whilst the prevalence of dementia amongst Australia's indigenous people is unclear, there is some evidence that dementia rates are five times that of the general Australian population. To date no studies have examined dementia knowledge levels in indigenous communities. PURPOSE OF THE STUDY: This paper aims to explore indigenous Australians' understanding, knowledge and misconceptions of dementia. DESIGN AND METHODS: Hundered and seventy-four indigenous adults participated in a cross-sectional survey using a modified version of the Alzheimer's Disease Knowledge Test (ADK). The survey included demographic information, two open-ended questions and 20 multiple choice questions. Each ADK item was examined to identify responses that revealed commonly held correct beliefs, knowledge gaps and misconceptions. RESULTS: The overall level of understanding of dementia was poor. Younger participants were significantly more likely to have no knowledge of Alzheimer's Disease, whereas the other age groups were most likely to have at least some knowledge. It was also revealed that there are common misconceptions about Alzheimer's Disease held by both indigenous and non-indigenous communities. IMPLICATIONS: Culturally appropriate awareness campaigns and targeted educational interventions need to be implemented to improve the general level of understanding of dementia in indigenous communities.

Didgeridoos, songs and boomerangs for asthma management.

ISSUE ADDRESSED: In Australia, asthma is more prevalent among Indigenous than non-Indigenous people. Awareness of asthma and compliance with management plans are poor, as is engagement with health services in general. The study explored whether offering culturally appropriate music lessons could enhance asthma awareness and engagement to improve asthma and general wellbeing. METHODS: Two studies undertaken in 2007 and 2009 offered music lessons to Indigenous asthmatics in a junior school and a senior school, an Aboriginal Medical Service and a community centre. Males were taught the didgeridoo and females singing and clap sticks. Associated activities of painting and boomerang throwing were offered. At regular intervals participants were assessed for their asthma status. At completion participants reported on the benefits of the study. RESULTS: Excellent retention occurred in Study 1 for adolescents and junior males but was poor for junior females and adults. Contributory factors to retention were parental and school support for minors and other health factors for adults. Respiratory function improved in males and both males and females reported increased wellbeing. In Study 2 retention of all participants was excellent. In addition there was increased engagement of both participants and their families with medical services. In both studies awareness of asthma and compliance with asthma management plans increased. Social skills improved as did cultural awareness. CONCLUSION: The offering of music lessons is a culturally appropriate and enjoyable intervention to promote asthma, general health awareness and engagement with medical services.

Didgeridoo playing and singing to support asthma management in Aboriginal Australians.

CONTEXT: Asthma affects over 15% of Australian Aboriginal people. Compliance in asthma management is poor. Interventions that will increase compliance are required. PURPOSE: The purpose of the study was to determine whether Aboriginal children, adolescents and adults would engage in music lessons to increase their knowledge of asthma and support management of their asthma. METHODS: Participants were recruited from schools and through the local Aboriginal Medical Service. All participants identified as Aborigines and were diagnosed as being asthmatic. The intervention was a 6-month program of once weekly music lessons using a culturally significant wind instrument, the didgeridoo, for males and singing lessons for females. FINDINGS: High school students enthusiastically engaged and had excellent retention in what they considered to be a most enjoyable program. Respiratory function improved significantly in both junior and senior boys who also reported a noticeable improvement in their health. Similar but less significant improvement was seen in the high school girls, although like the boys, they too perceived an improvement in their asthma. CONCLUSIONS: The project demonstrated that music has great potential for engaging and thus supporting asthma. Furthermore, cultural awareness was increased by those playing the didgeridoo and social skills were noticeably improved in the girls. Similar culturally appropriate activities have applications far beyond Aboriginal communities in Australia.

Enhancing the knowledge and skills of Advisory and Extension Agents in mental health issues of farmers.

OBJECTIVES: The aim of this study was to increase knowledge and skills of Advisory and Extension Agents (AEAs) in recognizing the symptoms of mental disorders, providing initial help, and offering the referral pathway for appropriate professional help. METHOD: Mental Health First Aid (MHFA) training was provided to AEAs and knowledge and skills pre-training were compared to 6-months post-training. RESULTS: The MHFA training improved the AEAs' ability to recognize a mental disorder, it increased their confidence level in providing help to someone with a mental health problem, it decreased social distances and positively changed their beliefs about treatment. CONCLUSION: MHFA training is effective in enhancing the mental health knowledge and skills of AEAs. The agents, who are a main line of contact of farmers, are able to recognize mental disorders of people and help them appropriately. They are more willing to work with stigmatized people and know who to refer people to for help.

Mental health of farmers in Southern Queensland: issues and support.

OBJECTIVE: To inform the development of an initiative designed to support the mental well-being of farmers in Queensland. DESIGN: Interactive focus groups. SETTING: Rural and remote Queensland. PARTICIPANTS: Health professionals, farmers and representatives of organisations and agencies working with farmers. MAIN OUTCOME MEASURES: Determination of factors contributing to the declining mental health of rural landholders. Content material for inclusion into mental health first aid programs held for field officers. RESULTS: Key areas identified to contribute to the decline in mental health of farmers were: increasing isolation in its varying forms, the ongoing drought, increased government regulations and widening of the schism between urban and rural Australians. The issues that affect farmers are recognised to have a 'knock-on' effect on the people who interact with them. In particular, rural support organisations are concerned for the well-being of their staff, prompting some to begin to put protocols in place to address their staff need for mental health support. Additional mental health training of field officers that involves awareness, recognition, communication skills, understanding and empathy was recognised by participants to be beneficial. CONCLUSION: Training of field officers was considered to be of benefit to the support of farmers. An understanding of the various and diverse issues that rural landholders face should be a fundamental component of that training.

Rural men and mental health: their experiences and how they managed.

There is a growing awareness that a primary source of information about mental health lies with the consumers. This paper reports on a study that interviewed rural men with the aim of exploring their mental health experiences within a rural environment. The results of the interviews are a number of stories of resilience and survival that highlight not only the importance of exploring the individuals' perspective of their issues, but also of acknowledging and drawing on their inner strengths. Rural men face a number of challenges that not only increase the risk of mental illness but also decrease the likelihood of them seeking and/or finding professional support. These men's stories, while different from each other, have a common thread of coping. Despite some support from family and friends, participants also acknowledged that seeking out professional support could have made the recovery phase easier. Mental health nurses need to be aware, not only of the barrier to professional support but also of the significant resilience that individuals have and how it can be used.

Collaborative voices: ongoing reflections on nursing competencies.

In a rapidly changing Australian health care environment, providers of undergraduate nursing programs are continually upgrading their assessment methods to ensure that graduates are competent and safe to practice. Competence assessment is based on the existing Australian Nursing and Midwifery Council (ANMC) Competency Standards for Registered Nurses. It is acknowledged that there are issues surrounding the validity and reliability of current assessment methods, primarily due to organisational constraints both at the University and the service provider level. There are a number of highly reliable tools available that enable assessment of nursing students in the psychomotor domain. Assessment in other domains is less precise. This paper explores some of the issues relating to competence assessment processes in order to promote discussion and discourse between educators, facilities and policy makers. It is envisaged that increased debate will result in an enhanced level of academic and clinical preparation for the upcoming nursing workforce in this country.

How young people from culturally and linguistically diverse backgrounds experience mental health: some insights for mental health nurses.

This article reports on part of a study that looked at the mental health of culturally and linguistically diverse (CALD) young people. The research sought to learn from CALD young people, carers, and service providers experiences relevant to the mental health of this group of young people. The ultimate goal was to gain insights that would inform government policy, service providers, ethnic communities and most importantly the young people themselves. To this end, qualitative interviews were undertaken with 123 CALD young people, 41 carers and 14 mental health service providers in Queensland, Western Australia and South Australia. Only one aspect of the study will be dealt with here, namely the views of the young CALD participants, which included risk factors, coping strategies and recommendations about how they could be supported in their struggle to maintain mental health. One of the most important findings of the study relates to the resilience of these young people and an insight into the strategies that they used to cope. The efforts of these young people to assist us in our attempts to understand their situation deserve to be rewarded by improvements in the care that we provide. To this end this article sets out to inform mental health nurses of the results of the study so that they will be in a position to better understand the needs and strengths of their CALD clients and be in a better position to work effectively with them.

Why nurses are resigning from rural and remote Queensland health facilities.

This paper presents a selection of the results reported in the study "Factors Influencing the Recruitment and Retention of Rural and Remote Area Nurses in Queensland" (Hegney et al 2001). The main aim of this study was to determine why nurses in those rura and remote areas of Queensland that reported higher than State average turnover rates between February 1999 and May 2000, chose to leave their employment. The study therefore investigated the factors that influenced nurses' decisions to leave rural and remote area practice, the factors that influenced them to remain in practice and those factors nurses considered irrelevant to leaving or staying in rural/remote area nursing. This paper reports those factors the participants believed influenced them to leave rural and remote area nursing in Queensland. While the findings cannot be generalised to the Australian nursing workforce or to nurses not employed by Queensland Health, the study does confirm the findings of prev ous Australian research and formulates recommendations to assist future nursing workforce planning and policy.

Why nurses are attracted to rural and remote practice.

This is the second paper of a larger study that examined the factors influencing the decisions of rural and remote area nurses, formerly employed by Queensland Health, to leave or to remain in this area of nursing. The study was a cross-sectional survey that gathered data from nurses who had resigned from permanent positions in Queensland Health during the period February 1999 to May 2000. This paper reports only those factors that influenced their decision to remain in rural and remote area practice, which can be categorised into personal, professional and rural influences. The results of this study are congruent with previous national and international research findings into these issues for nurses in rural and remote areas. The paper makes recommendations to attract nurses to the rural and remote work force.

Retaining rural and remote area nurses. The Queensland, Australia experience.

Because higher-than-average turnover rates for nurses who work in remote and rural areas are the norm, the authors conducted a study to identify professional and personal factors that influenced rural nurses' decisions to resign. Using a mail survey, the authors gathered qualitative and quantitative data from nurses who had resigned from rural and remote areas in Queensland, Australia. Their findings, categorized into professional and rural influences, highlight the importance of work force planning strategies that capitalize on the positive aspects of rural and remote area practice, to retain nurses in nonmetropolitan areas.

Discharge planning from the acute sector for people over the age of 65.

This paper reports the findings relating to discharge planning from a larger study (Hegney et al 2001) that aimed to investigate options to improve care co-ordination between the aged, community, acute and primary care sectors for the elderly residents of a large provincial town. The data, which were collected from a wide variety of aged care stakeholders in the region, are consistent with previous Australian studies. First, it appears that inappropriate discharge from acute hospitals occurs in Toowoomba because there is a perceived lack of information regarding the available community care options and a lack of suitable models to support people's care needs within their own homes. Second, inappropriate discharge practices from acute hospitals occur due to a lack of knowledge and communication on the part of health professionals employed in these settings with regard to the on-going health care needs of elderly people. Third, there is little discharge planning occurring that includes the general practitioner in post-discharge care. Finally, inappropriate discharge can also be attributed to the lack of sub-acute/step-down/rehabilitation options and long waiting lists for community home care services in the region.