Indigenous nurses' practice realities of cultural safety and socioethical nursing.

BACKGROUND: Persistent healthcare emphasis on universal moral philosophy has not advantaged indigenous and marginalised groups. Centralising cultural components of care is vital to provide ethical healthcare services to indigenous people and cultural minorities internationally. Woods' theoretical explication of how nurses can integrate cultural safety into a socioethical approach signposts ethical practice that reflects culturally congruent relational care and systemic critique. AIM: To demonstrate the empirical utility of Woods' ethical elements of cultural safety within a socioethical model, through analysis of indigenous nurses' practice realities in Aotearoa New Zealand. RESEARCH DESIGN: The study used a qualitative indigenous narrative inquiry. PARTICIPANTS AND RESEARCH CONTEXT: Participants were recruited nationally. Twelve Maori registered nurses and nurse practitioners were interviewed. All participants provided direct care in either primary or secondary health services. ETHICAL CONSIDERATIONS: Research approval was gained from the Human Ethics Committee of the lead author's tertiary institution. Participation was voluntary, and written informed consent was obtained. FINDINGS: Analysis highlighted the following: (1) cultural needs, which for Maori were integral to care, were easily subsumed by clinical care being prioritised; (2) ethical care by non-indigenous nurses requires critical reflection about broader equity issues that impact Maori disengagement from healthcare; (3) retention of indigenous nurses was seen as essential because their advocacy and the cultural 'fit' for Maori contributed to positive healthcare outcomes; and (4) committed leadership ensured culturally safe care was not eroded through workplace efficiencies. DISCUSSION: The data provide rich representation of Woods' model. The data indicate that nurses must engage reflexively with a relational ethic of care and social justice dimensions in order to deliver culturally safe care. CONCLUSION: Woods' model provides a critical lens for nurses to examine their relational practice and systemic factors that enhance or detract from culturally safe care when caring for members of any indigenous group.

Role-modelling and the hidden curriculum: New graduate nurses' professional socialisation.

AIMS AND OBJECTIVES: To explore new graduate nurses' experiences of professional socialisation by registered nurses in hospital-based practice settings, and identify strategies that support professional identity development. BACKGROUND: Professionalism is reinforced and stabilised in the clinical environment through the "hidden curriculum", with major learning coming from practice role-models. New graduates observe attitudes, behaviours, decision-making and skills, and gain feedback from registered nurses, which they translate into their own practice. Professional socialisation occurs through encounters with desirable and undesirable role-modelling; both are significant in professional identity formation. DESIGN: Qualitative descriptive design. METHOD: Data collection was undertaken through semistructured interviews with five new graduate nurse participants. A general inductive approach guided analysis. The meaningful descriptions gained provided insight into their experiences. RESULTS: Three main themes identified from the data include: "Lessons from the wilderness"; "Life in the wild"; and "Belonging to a wolf pack". The data set highlighted the major transitional process from student identity to registered nurse. CONCLUSIONS: New graduates' rethinking of beliefs and professional nursing identities were influenced by organisational pressures and experienced nurses' role-modelling practices contrary to professional values. Despite encountering a range of professional behaviours, attitudes and dilemmas, new graduates were capable of moral agency and critical thinking. However, they rapidly acculturated and described compromises to cope. To promote high morale and a sense of belonging, a concerted effort is required by all nurses to facilitate the socialisation process to encourage self-authorship. RELEVANCE TO CLINICAL PRACTICE: A well-developed professional identity enhances nursing as a profession, contributing towards better healthcare delivery and outcomes. It is critically important how professional values are learnt within the culture of nursing. Tensions in clinical practice need to be understood better to avoid moral distress caused by dissonance between expectation and experience. It is advantageous to increase early positive socialisation.