Understanding and responding to racism and the provision of culturally safe care by interdisciplinary health professionals in the aged care sector in regional, rural and remote areas: a scoping review.

INTRODUCTION: This scoping review was undertaken to obtain conceptual clarification about how racism and cultural safety are understood by interdisciplinary health professionals globally in the aged care sector in regional, rural and remote areas. There is evidence in Australia and internationally that racism is a factor impacting significantly on the health of First Peoples and other racialised minorities. Recent policy changes in Australia have required health professionals to integrate cultural safety into their practice to mitigate racism and improve the health of older First Nations Australians and older people from diverse ethnic and cultural groups. METHODS: This review consisted of literature published in English from 1990, including published primary studies; systematic, integrative and narrative reviews; meta-analyses; theses; policy documents; guidelines; position statements; and government literature. Ovid (MEDLINE), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health Database, and Informit were used in the full search. The most recent search of all databases was undertaken on 9 May 2022. Ten papers were included in the review, following the exclusion of 376 papers. A title and abstract search of the reference lists of papers included in the review identified no additional papers. RESULTS: Ten papers were included in the review from Australia, Canada, the US, Norway and England. The literature reviewed suggests that health professionals in the aged care sector in regional, rural and remote areas in Australia, Canada, the US, Norway and England use alternative terms to 'racism' and 'racist', such as 'institutional marginalisation'. DISCUSSION: The absence of explicit reference to racism aligns with critical race research that argues implicit bias and institutional racism are often separated from an individualised understanding of racism. That is, practitioners may understand racism as something that is perpetrated by individuals in an otherwise 'neutral' health setting. There is also a lack of clarity on how culturally safe care is understood, even though individual care plans are viewed as instrumental in establishing the needs and preferences of the consumers. Within the literature surveyed, barriers to providing quality and culturally inclusive care include disengaged management, insufficient human and material resources, language barriers and a lack of education focused on the needs of older individuals and groups with various cultural and spiritual needs. Additionally, the review does not clearly illuminate what health professionals understand to be racist thinking or behaviour and how it is responded to in practice. Likewise, there is limited information about health professionals' understanding of cultural safety and how to provide culturally inclusive care. CONCLUSION: While work is beginning on developing standards for cultural safety training in an Australian context, there are also opportunities to consider how these should be applied or adapted to residential and community aged care to best meet the needs of a diverse consumer base and workforce.

Improving student success and retention in first-year nursing through embedded tutor support.

BACKGROUND: Nursing students from diverse or equity backgrounds are less likely to possess the required skills to ensure success in their studies. This research explores the impact of embedded support on student learning in a first-year foundational subject, Contexts of Nursing, in an undergraduate nursing degree.t. METHODS: The Embedded Tutor Program offers specialised tutoring support for first-year undergraduate students. Embedded tutors, with backgrounds as registered nurses and academics, provided online one-on-one feedback to students on draft assessment tasks. Outreach contact was provided to students at risk of failing. A Pearson's Chi-squared test was used to assess the impact of tutor support on grade distribution and a paired student t-test was used to assess the difference in cumulative marks for students from equity backgrounds. Statistical significance was set at p < 0.05. Feedback provided by students, tutors and staff in an online anonymous survey was thematically analysed. RESULTS: There was a significant grade shift for the 267 students who met with an embedded tutor (p < 0.05). Students who were a member of an Australian Government identified equity group had a significant increase in their cumulative mark if they met with a tutor of 9-17 % (p < 0.05). This improvement in cumulative mark was maintained for students with cumulative equity factors. The overwhelming majority of students who were identified as at risk of failing and met with a tutor following outreach support received a passing grade. Students reported growing skills and confidence in academic literacy was a key benefit of the program. CONCLUSION: A shared approach to delivering education has a positive effect on the experience of learning. The combined efforts of the subject convenor, embedded tutors, and extended student service roles within the University resulted in outcomes that were positive for student learning. Determining student capacity for learning extended beyond a student's consideration of grades or their progression in the program to include the development of self-efficacy.

Celluloid zombies: A research study of nurses in zombie-focused feature films.

AIM: To explore how nurses, who are the principal character of zombie-focused feature films are portrayed. DESIGN: A mixed methods study with a quantitative exploration of 44,000 feature film synopsis and additional online material for films made between 1900 and 2018 was used. Zombie-focused films (485) were reviewed for their genre, county, year of production, and plot-lines. Ten zombie films featuring nurses in key roles were analysed via an interpretive, qualitative thematic analysis. The study was undertaken between May 2018 - November 2018. METHOD: A quantitative review of film synopses and relevant movie specific web sites or key literature for the word, 'zombie' and/or 'zombie nurse' and an interpretive, qualitative thematic analysis of nurse specific zombie films. RESULTS: Most of the 485 zombie-focused films located were produced or co-produced in the USA. Only 115 zombie-focused feature films were identified with health professionals, of these, 27 films featured nurses, 10 with nurses in the main role. Nurses were portrayed as romantic, sexualized, caring, self-sacrificial and strong or evil, however, the over-arching representation of nurses in zombie films was tied to the depravity from which zombie sub-culture is based. CONCLUSION: Few zombie films feature nurses in the main role. However, the negative, violent and deprived nature of this genre offers a poor reflection on nursing. IMPACT: How nurses are portrayed in films is important because it influences how the public, patients, and nurses themselves view their profession and role. Understanding the way nurses are portrayed may help professional bodies to better prepare recruitment material.

Plerixafor mobilization leads to a lower ratio of CD34+ cells to total nucleated cells which results in greater storage costs.

BACKGROUND: Plerixafor (Mozobil, AMD3100) with granulocyte-colony stimulating factor (G-CSF) mobilizes more CD34+ cells/kg compared to G-CSF alone. Given that plerixafor enhances mobilization of multiple white blood cell lineages, we determined if more storage space is required for products collected from patients mobilized with plerixafor. METHODS: A review of the medical records of 15 patients mobilized with chemotherapy and G-CSF (control) and 14 patients mobilized with plerixafor plus G-CSF (plerixafor) was performed. Data on demographics, baseline characteristics, CD34+ cells/kg, total nucleated cells, total mononuclear cells, total apheresis sessions, and total bags for storage were collected. Mean values were determined and compared using Student's t-test. RESULTS: We found that the proportion of CD34+ cells among total nucleated cells was less in the plerixafor group compared to the control group (P = 0.0427). More nucleated cells (10.7 x 10(10) vs. 7.1 x 10(10), P =0.0452) and mononuclear cells (9.7 x 10(10) vs. 5.9 x 10(10), P = 0.0059) were mobilized with plerixafor plus G-CSF. However, there was no significant difference in CD34+ cells/kg, total CD34+ cells or the proportion of mononuclear cells among total nucleated cells between the two groups. More storage bags were required for the plerixafor group compared to the control group (15 vs. 9, P = 0.0299). CONCLUSION: Mobilization with plerixafor plus G-CSF resulted in a smaller proportion of CD34+ cells collected and a greater number of storage bags. An increase in the number of bags required for stem cell storage may be logistically problematic and will also lead to increased costs for storage of stem cells.