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Adverse events associated with failed airway management may have catastrophic consequences, and despite many advances in knowledge, guidelines and equipment, airway incidents and patient harm continue to occur. Patient safety incident reporting systems have been established to facilitate a reduction in incidents. However, it has been found that corrective actions are inadequate and successful safety improvements scarce. The aim of this scoping review was to assess whether the same is true for airway incidents by exploring academic literature that describes system changes in airway management in high-income countries over the last 30 years, based on findings and recommendations from incident reports and closed claims studies. This review followed the most recent guidance from the Joanna Briggs Institute (JBI). PubMed, Ovid MEDLINE and Embase, the JBI database, SCOPUS, the Cochrane Library and websites for anaesthetic societies were searched for eligible articles. Included articles were analysed and data synthesised to address the review's aim. The initial search yielded 28,492 results, of which 111 articles proceeded to the analysis phase. These included 23 full-text articles, 78 conference abstracts and 10 national guidelines addressing a range of airway initiatives across anaesthesia, intensive care and emergency medicine. While findings and recommendations from airway incident analyses are commonly published, there is a gap in the literature regarding the resulting system changes to reduce the number and severity of adverse airway events. Airway safety management mainly focuses on Safety-I events and thereby does not consider Safety-II principles, potentially missing out on all the information available from situations where airway management went well. [ABSTRACT FROM AUTHOR]

Background: This paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors' social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care. Methods: The AKction – Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken. Results: Four phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health—oral health cultural safety and clinical education was developed. Conclusion: This codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up. Trial registration: NHMRC PAR 2004389. [ABSTRACT FROM AUTHOR]

Cultural safety is increasingly recognised as imperative to delivering accessible and acceptable healthcare for First Nations Peoples within Australia and in similar colonised countries. A literature review undertaken to inform the inaugural Caring for Australians with Renal Insufficiency (CARI) guidelines for clinically and culturally safe kidney care for Aboriginal and Torres Strait Islander peoples revealed a timeline of the emergence of culturally safe kidney care in Australia. Thirty years ago, kidney care literature was purely biomedically focused, with culture, family and community viewed as potential barriers to patient 'compliance' with treatment. The importance of culturally informed care was increasingly recognised in the mid‐1990s, with cultural safety within kidney care specifically cited from 2014 onwards. The emergence timeline is discussed in this paper in relation to the five principles of cultural safety developed by Māori nurse Irihapeti Ramsden in Aotearoa/New Zealand. These principles are critical reflection, communication, minimising power differences, decolonisation and ensuring one does not demean or disempower. For the kidney care workforce, culturally safe care requires ongoing critical reflection, deep active listening skills, decolonising approaches and the eradication of institutional racism. Cultural safety is the key to truly working in partnership, increasing Indigenous Governance, respectful collaboration and redesigning kidney care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand that preserving action or process when coding gerunds in constructivist grounded theory research can help discover the participants’ main concerns, which provide context for the substantive theory • To appreciate that looking for and recognising gerunds in qualitative data can be confusing for novice researchers • To benefit from an example of coding gerunds to gain deeper insights and depth to qualitative data analysis. Background: Coding for gerunds is useful in developing theory in grounded theory. However, it can be confusing for the novice researcher to recognise these words, which consider actions more abstractly. Aim: To explain how to identify, analyse and code gerunds, using the example of a constructivist grounded theory study investigating the design of operating rooms. Discussion: Coding for gerunds helped to illustrate participants’ actions and sequences in the example study and added depth to the researcher’s understanding of certain topics. Conclusion: Coding gerunds can improve the insights obtained in grounded theory studies. Implications for practice: This article may encourage nurse researchers to focus on actions to add depth to their qualitative analyses. [ABSTRACT FROM AUTHOR]

Background: Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method: Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Results: The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion: The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care. We have co-designed Health Journey Mapping tools and resources with First Nations patients and families and with First Nations and non-First Nations healthcare professionals to address current gaps in care. These pragmatic, strengths-based tools and resources enhance and incorporate cultural safety, continuous quality and improvement and comprehensive care and can be used collaboratively by healthcare consumers and professionals to assess and improve the quality, access, experiences and outcomes of care. [ABSTRACT FROM AUTHOR]

Patient journey mapping is an emerging field of research that uses various methods to map and report evidence relating to patient experiences and interactions with healthcare providers, services, and systems. This research often involves the development of visual, narrative, and descriptive maps or tables, which describe patient journeys and transitions into, through, and out of health services. This methods corner paper presents an overview of how patient journey mapping has been conducted within the health sector, providing cardiovascular examples. It introduces six key steps for conducting patient journey mapping and describes the opportunities and benefits of using patient journey mapping and future implications of using this approach. [ABSTRACT FROM AUTHOR]

Context The 'inaugural' Caring for Australian and New Zealanders with Kidney Impairment (CARI) guidelines for First Nations Australians provide recommendations on caring for First Nations Peoples with chronic kidney disease (CKD). Informed by targeted national community consultations, the guidelines include the historical context, detailed advice on culturally safe kidney healthcare, screening and referral of CKD. Public awareness and education initiatives, self- management programs, and models of care are all reported on. Objectives The CARI guidelines were developed in response to significant challenges and inequities experienced by First Nations Peoples over many years. Specific recommendations and suggestions aim to improve clinicians' understanding of historical and contemporary factors contributing to the social and health inequities underpinning the over-representation of First Nations Peoples with CKD. These guidelines provide comprehensive support for health professionals in all service and care environments to better respond to the care needs of First Nations Peoples. Key findings The CARI guidelines highlight the need to provide culturally safe clinical care and explicitly cite the need to address institutional racism and improve cultural safety training for all renal service providers. They specifically recognise the importance of kinship, and equitable access to transport and accommodation services. They also focus on keeping people on Country where possible, including increased nurse-supported and Aboriginal health practitioner-supported dialysis services. Conclusion The CARI guidelines provide recommendations on how to improve clinical kidney care delivery for and with First Nations Peoples by ensuring more responsive models of care. [ABSTRACT FROM AUTHOR]

Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m², and a sustained decrease in eGFR, > 10 mL/min/1.73 m² per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services. [ABSTRACT FROM AUTHOR]

Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2, and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services. [ABSTRACT FROM AUTHOR]

Keywords: Kidney transplantation; Kidney diseases; Health policy; Healthcare disparities; Racism; Health services; Cultural competency EN Kidney transplantation Kidney diseases Health policy Healthcare disparities Racism Health services Cultural competency S11 S14 4 10/17/23 20231002 NES 231002 Inequities persist for Aboriginal and Torres Strait Islander people accessing health services in Australia, as evidenced by kidney health outcomes and the consistently lower rate of access to kidney transplantation experienced by Aboriginal and Torres Strait Islander people.[1] The Australian Government has endeavoured to address this persisting inequity in access to kidney transplantation by establishing the National Indigenous Kidney Transplantation Taskforce (NIKTT), and tasking them to evaluate cultural bias interventions in Australia, with a focus on kidney services. Kidney transplantation, Kidney diseases, Health policy, Healthcare disparities, Racism, Health services, Cultural competency. [Extracted from the article]

Background: Disrespect and abuse violates women's basic human rights and autonomy and can traumatize women who are already in a vulnerable position during childbirth and deter them from utilizing skilled care for future childbirth. This study explored women's perspectives on the acceptability of disrespect and abuse during facility-based childbirth in Ethiopia. Methods: A qualitative descriptive design using five focus group discussions and fifteen in-depth, semi-structured, interviews was conducted with women between October 2019 to January 2020 in north Showa zone of Oromia region, central Ethiopia. Using purposive sampling, women who had given birth at public health facilities of North Showa zone during the twelve months preceding data collection were recruited, regardless of birth outcome. Inductive thematic analysis using Open Code software was used to explore the perspectives of participants. Results: While women reject disrespectful and abusive acts during childbirth generally, they may consider some disrespectful acts as acceptable and or necessary under certain circumstances. Four emerging themes were identified. (1) Disrespect and abuse is not acceptable, (2) Disrespectful and abusive actions are acceptable only if intended to save lives, (3) Disrespectful and abusive actions are an accepted part of everyday practice to prevent complications and adverse outcomes, (4) Disrespectful and abusive actions are necessary to discipline disobedient women. Conclusion: Women's perceptions of disrespectful and abusive acts of care providers is deeply rooted within the context of violence in Ethiopia and the societal hierarchies that have systematically disempowered women. Given the pervasiveness of disrespect and abusive actions during childbirth, policymakers, clinical managers and care providers must take these essential contextual and societal norms into account and devise comprehensive clinical interventions that addresses the root causes. [ABSTRACT FROM AUTHOR]

Aim: To identify how patient journey mapping is being undertaken and reported. Design: A scoping review of the literature was undertaken using JBI guidance. Data Sources: Databases were searched in July 2021 (16th–21st), including Ovid's Medline, Embase, Emcare and PsycINFO; Scopus; Web of Science Core Collection, the Directory of Open Access Journals; Informit and; ProQuest Dissertations and Theses Global. Review Methods: Eligible articles included peer‐reviewed literature documenting journey mapping methodologies and studies conducted in healthcare services. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full‐text articles. A table was used to extract data and synthesize results. Results: Eighty‐one articles were included. An acceleration of patient journey mapping research was observed, with 76.5% (n = 62) of articles published since 2015. Diverse mapping approaches were identified. Reporting of studies was inconsistent and largely non‐adherent with relevant, established reporting guidelines. Conclusion: Patient journey mapping is a relatively novel approach for understanding patient experiences and is increasingly being adopted. There is variation in process details reported. Considerations for improving reporting standards are provided. Impact: Patient journey mapping is a rapidly growing approach for better understanding how people enter, experience and exit health services. This type of methodology has significant potential to inform new, patient centred models of care and facilitate clinicians, patients and health professionals to better understand gaps and strategies in health services. The synthesised results of this review alert researchers to options available for journey mapping research and provide preliminary guidance for elevating reporting quality. [ABSTRACT FROM AUTHOR]

Background: Quality and safety in Australian healthcare is inequitably distributed, highlighted by gaps in the provision of quality care for Aboriginal and Torres Strait Islander children. Burns have potential for long-term adverse outcomes, and quality care, including culturally safe care, is critical to recovery. This study aimed to develop and apply an Aboriginal Patient Journey Mapping (APJM) tool to investigate the quality of healthcare systems for burn care with Aboriginal and Torres Strait Islander children.Study Design: Interface research methodology, using biomedical and cultural evidence, informed the modification of an existing APJM tool. The tool was then applied to the journey of one family accessing a paediatric tertiary burn care site. Data were collected through yarning with the family, case note review and clinician interviews. Data were analysed using Emden's core story and thematic analysis methods. Reflexivity informed consideration of the implications of the APJM tool, including its effectiveness and efficiency in eliciting information about quality and cultural safety.Results: Through application of a modified APJM tool, gaps in quality care for Aboriginal and Torres Strait Islander children and families were identified at the individual, service and system levels. Engagement in innovative methodology incorporating more than biomedical standards of care, uncovered critical information about the experiences of culturally safe care in complex patient journeys.Conclusion: Based on our application of the tool, APJM can identify and evaluate specific aspects of culturally safe care as experienced by Aboriginal and Torres Strait Islander peoples and be used for quality improvement. [ABSTRACT FROM AUTHOR]

Current healthcare systems often fail to recognise and address the healthcare needs of First Nations People, resulting in unacceptable gaps in health outcomes. Biomedical frameworks used to examine chronic conditions, like chronic kidney disease (CKD), focus on ill health rather than on the strengths First Nations People use to be resilient and sovereign. Healthcare systems, staff and researchers need to collaborate with First Nations People to understand and value lived experiences to best address health and wellbeing needs. This research was carried out within Aboriginal Kidney care together: improving outcomes now (AKction). Using decolonised methods and a participatory action approach, research yarning and thematic analysis were collaboratively conducted to map the health journey of an Aboriginal woman with lived experience of kidney disease. The woman utilised a range of strengthening factors to maintain resilience during her kidney health journey, including Ngolun/connections (to land, language, culture, spirit and ancestors; family; people who understood experiences; strong women; supportive health staff; community), Kunulun/actions (engaging with culture, taking control, advocacy and support, sharing knowledge) and Peranbun/positive mindset (identity, choosing to be strong, outlook on situation, focus). Lacking these strengths and life stressors contrastingly acted as a barrier to her resilience. The woman's journey acts as a case study providing recommendations for improving First Nations People's kidney care by applying a person-centred approach. Recommendations include the need for relevant community kidney health education and awareness, early testing, treatment options on country, peer support, First Nations People healthcare staff, post-transplantation support, and holistic healthcare addressing the patients' social and emotional wellbeing. [ABSTRACT FROM AUTHOR]

Background: Increasingly, people are using social media (SM) to express grief, and researchers are using this data to investigate the phenomenon of mourning. As this research progresses, it is important to understand how studies are being conducted and how authors are approaching ethical challenges related to SM data. Objective: The aim of this review was to explore how SM data are being used to research experiences of mourning through the following questions: a) 'Which topics related to mourning are being studied?'; b) 'What study designs have been used to analyse SM data'; c) 'What type of data (natural or generated) have been used?'; and d) 'How are ethical decisions being considered?'. Methods: The JBI Scoping Review methodology guided this review. Eligibility criteria were determined using the PCC framework, and relevant key words and phrases derived from these criteria were used to search eight databases in September 2021 (CINAHL, Embase, LILACS, OpenGrey, ProQuest, PsycINFO, PubMed and Scopus). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were used to report the results of this review. Results: Database searches resulted in 3418 records, of which, 89 met eligibility criteria. Four categories of grief and mourning were identified. Most records were qualitative in nature and used natural data. Only 20% of records reported ethics approval by an Institutional Review Board, with several including measures to protect participants, for example, using pseudonyms. Conclusions: This unique review mapped the diverse range of mourning-related topics that have been investigated using SM data and highlighted the variability in approaches to data analysis. Ethical concerns relating to SM data collection are identified and discussed. This is an emerging and rapidly changing field of research that offers new opportunities and challenges for exploring the phenomenon of mourning. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander (hereinafter respectfully termed Aboriginal) people have a greater incidence of stroke at a younger age than non-Indigenous people in Australia. The needs and preferences of Aboriginal people for rehabilitation and longer-term support remain largely unknown. To identify the long-term rehabilitation needs of Aboriginal people who have a stroke, from the perspectives of Aboriginal persons with stroke and health care providers. Aboriginal people who had experienced stroke in the previous three years were interviewed to obtain their experiences of rehabilitation care. Health professionals who provided care in each of six designated hospitals and nearby community health sites were involved in focus groups and individual interviews. Information obtained was thematically analyzed separately for Aboriginal people with stroke and health professionals, and compared using Nvivo. Among six Aboriginal people with stroke and 78 healthcare providers, four main themes emerged: the importance of family; variable access to services; the impact of stroke on Aboriginal peoples' lives; and making positive choices. Communication and involvement of family was highlighted as essential for a shared understanding, particularly when making decisions about participating in short and long-term rehabilitation. Co–morbidities, conflicting priorities, and inadequate or inflexible services and transport compounded issues with changing life roles. Stories of resilience were also shared. Aboriginal people report making positive lifestyle changes, but experience significant unmet rehabilitation needs. Addressing issues of communication, advocacy and flexible delivery should improve some of the shortfalls in service provision, particularly in regional and remote areas. [ABSTRACT FROM AUTHOR]

Background: It is increasingly evident that disrespect and abuse of women during facility-based childbirth is a violation of a woman's rights and a deterrent to the use of life-saving maternity care. Understanding care providers' perspectives of disrespect and abuse during facility-based childbirth is an essential element to aid in fully comprehending the problem and its underlying complexities. Objective: To explore care providers' perspectives of disrespect and abuse during facility-based childbirth. Methods: This study used a qualitative descriptive design involving fifteen in-depth, semi-structured, interviews conducted between 5 October 2019 and 25 January 2020 in north Showa zone of Oromia region, central Ethiopia. Purposive sampling enabled health care professionals working in maternity units of health facilities who have direct involvement in care of women during pregnancy and labor to be recruited. Thematic analysis using Open Code software was used to explore the perspectives of participants. Results: Four themes were identified. 1) Disrespect and abuse breaches professional standards, 2) Disrespectful and abusive actions are justified at times to save the mother and her baby, 3) Disrespect and abuse is used as a tool to assert power, and 4) Disrespect and abuse arise from health system deficiencies. Conclusion: Disrespect and abuse is triggered by underlying beliefs about risk versus care, provider attitudes, stress and burnout, and health service structural issues including a lack of medicines and supplies. A number of strategies could improve the quality of maternity care, including training providers how to manage difficult and complex situations, addressing root causes of disrespect and abuse, and increasing access to resources. [ABSTRACT FROM AUTHOR]

Background: Appropriate choice of research design is essential to rightly understand the research problem and derive optimal solutions. The Comorbidity Action in the North project sought to better meet the needs of local people affected by drug, alcohol and mental health comorbidity. The aim of the study focused on the needs of Aboriginal peoples and on developing a truly representative research process. A methodology evolved that best suited working with members of a marginalised Aboriginal community. This paper discusses the process of co-design of a Western methodology (participatory action research) in conjunction with the Indigenous methodologies Dadirri and Ganma. This co-design enabled an international PhD student to work respectfully with Aboriginal community members and Elders, health professionals and consumers, and non-Indigenous service providers in a drug and alcohol and mental health comorbidity project in Adelaide, South Australia. Methods: The PhD student, Aboriginal Elder mentor, Aboriginal Working Party, and supervisors (the research team) sought to co-design a methodology and applied it to address the following challenges: the PhD student was an international student with no existing relationship with local Aboriginal community members; many Aboriginal people deeply distrust Western research due to past poor practices and a lack of implementation of findings into practice; Aboriginal people often remain unheard, unacknowledged and unrecognised in research projects; drug and alcohol and mental health comorbidity experiences are often distressing for Aboriginal community members and their families; attempts to access comorbidity care often result in limited or no access; and Aboriginal community members experience acts of racism and discrimination as health professionals and consumers of health and support services. The research team considered deeply how knowledge is shared, interpreted, owned and controlled, by whom and how, within research, co-morbidity care and community settings. The PhD student was supported to co-design a methodology that was equitable, democratic, liberating and life-enhancing, with real potential to develop feasible solutions. Results: The resulting combined Participatory Action Research (PAR)-Dadirri-Ganma methodology sought to create a bridge across Western and Aboriginal knowledges, understanding and experiences. Foundation pillars of this bridge were mentoring of the PhD student by senior Elders, who explained and demonstrated the critical importance of Yarning (consulting) and Indigenous methodologies of Dadirri (deep listening) and Ganma (two-way knowledge sharing), and discussions among all involved about the principles of Western PAR. Conclusions: Concepts within this paper are shared from the perspective of the PhD student with the permission and support of local Elders and Working Group members. The intention is to share what was learned for the benefit of other students, research projects and community members who are beginning a similar journey. [ABSTRACT FROM AUTHOR]

Background: Every woman is entitled to respectful care during pregnancy and childbirth as a basic human right. However, not all women are being treated equally well. Case Presentation: This case study highlights some of the common disrespectful practices that women face. This is a testimony of a 28-year-old mother of two, narrated in her own words. The data were collected during an in-depth interview in November 2019. The interview was conducted in her house and her name has been changed to protect her identity. The interview was audio-taped using a digital voice recorder, later transcribed, and translated verbatim from the local language – Amharic, to English. Conclusion: This woman's story highlights the unfortunate reality for some women. Five themes emerged from her narrative: denial of care: the provider left her unattended at a critical moment and denied her the care that she came for; non-consented care: she did not consent to the episiotomy; non-dignified care: she was carried by her arms and legs to the delivery couch, and left naked and bleeding on the couch after birth; taking a sick baby home without medical assistance: she was forced to leave the hospital even though her child had breathing difficulties and was not able to suck or breastfeed; and loss of trust in care providers: for her second birth this woman went to a facility where a relative works, as she no longer trusted these providers. [ABSTRACT FROM AUTHOR]

Aims: To describe strategies nursing leaders use to promote evidence‐based practice implementation at point‐of‐care using data from health systems in Australia, Canada, England and Sweden. Design: A descriptive, exploratory case‐study design based on individual interviews using deductive and inductive thematic analysis and interpretation. Methods: Fifty‐five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. Results: Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence‐based practice implementation. Nursing leaders actively promote evidence‐based practice implementation, work to influence evidence‐based practice implementation processes and integrate evidence‐based practice implementation into everyday policy and practices. Conclusion: The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence‐based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence‐based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship‐focused approaches nursing leaders take towards promoting evidence‐based practice implementation. Impact: This study explored how nursing leaders promote evidence‐based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence‐based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness. [ABSTRACT FROM AUTHOR]

Respectful maternity care is a fundamental human right, and an important component of quality maternity care. The aim of this study was to quantify the frequency and categories of D&A and identify factors associated with reporting D&A among women in north Showa zone of Ethiopia. A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous 12 months in North Showa zone of Ethiopia. A digital (tablet-based) structured and researcher administered tool was used for data collection. Frequencies of D&A items organised around the Bowser and Hill categories of D&A and presented in the White Ribbon Alliance's Universal Rights of Childbearing Women Framework were calculated. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value <0.05 and odds ratio values with 95% confidence interval. All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were physical abuse 435 (100%), non-consented care 423 (97.2%), non-confidential care 288 (66.2%), abandonment/neglect (34.7%), non-dignified care 126 (29%), discriminatory care 99 (22.8%) and detention 24 (5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Hospital birth showed consistent association with all forms of disrespect and abuse. Expanding the size and skill mix of professionals in the hospitals, sensitizing providers consequences of disrespect and abuse could promote dignified and respectful care. [ABSTRACT FROM AUTHOR]

This essay offers a perspective on a new and reinvigorated research agenda for the study of U.S. local governments. It reports on the ideas and reflections of a set of local government scholars with different vantage points and varied substantive interests. Seven paramount themes or directions for a research agenda were identified, all of which contain numerous threads and thrusts: local government finance and economic development, local government management, intergovernmental relations, collaboration, public engagement, social equity, and institutional design. The essay offers some reasons for optimism about the future of U.S. local governments while also identifying cause for concern. [ABSTRACT FROM AUTHOR]

Background: Working effectively with Aboriginal and Torres Strait Islander people is important for maximising the effectiveness of a health care interaction between and Aboriginal and Torres Strait Islander patients and a health professional. This paper presents a framework to guide health professional practice in Aboriginal and Torres Strait Islander health.Methods: This qualitative study was based in a social constructionist epistemology and was guided by a critical social research methodology. Two methods were employed: interviews with Aboriginal health workers and allied health professionals about their experiences of working together in Aboriginal health, and an auto-ethnography conducted by the researcher, a non-Aboriginal dietitian and researcher who worked closely with two Aboriginal communities while undertaking this research.Results: Interviews were conducted with 44 allied health professionals and Aboriginal health workers in 2010. Critical Social research, which involves the deconstruction and reconstruction of data, was used to analyse data and guided the evolution of themes. Strategies that were identified as important to guide practice when working respectfully in Aboriginal health included: Aboriginal and non-Aboriginal people working with Aboriginal health workers, using appropriate processes, demonstrating commitment to building relationships, relinquishing control, having an awareness of Aboriginal history, communication, commitment, flexibility, humility, honesty, and persistence. Reciprocity and reflection/reflexivity were found to be cornerstone strategies from which many other strategies naturally followed. Strategies were grouped into three categories: approach, skills and personal attributes which led to development of the Framework.Conclusions: The approach, skills and personal attributes of health professionals are important when working in Aboriginal health. The strategies identified in each category provide a Framework for all health professionals to use when working with Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the experiences of communication for staff providing cardiac care for Aboriginal and Torres Strait Islander patients in hospital and discuss potential improvements. Methods: Focus group discussions were performed with 58 multidisciplinary staff who provide care for Aboriginal and Torres Strait Islander cardiac patients in two metropolitan and two regional hospitals in South Australia and Northern Territory. Inductive thematic analysis was undertaken to identify staff perceptions of communication challenges and strategies for improvement. Results: There were five key themes: (1) communication is central to good care; (2) communication within busy clinical environments; (3) supporting a strong Aboriginal workforce; (4) a cultural as well as clinical focus; and (5) particular challenges working with patients from remote areas. Conclusions: Providing effective communication that is both clinically and culturally appropriate is often challenging within a busy and non-adaptive hospital environment. Moving beyond clinical tasks, increased Aboriginal and Torres Strat Islander health workforce and cultural competency, supporting coordinated care and improved skills are required to meet the communication needs of Aboriginal and Torres Strait Islander patients. What is known about this topic?: Communication between patients, their families and hospital staff is crucial for health care quality and safety. There is little understanding of the challenges and opportunities for staff to meet the communication needs of Aboriginal and Torres Strait Islander cardiac patients to address disparities in acute care settings. What does this paper add?: This paper discusses the barriers and potential improvements, as identified by hospital staff providing care to Aboriginal and Torres Strait Islander cardiac patients in both metropolitan and regional settings. What are the implications for practitioners?: Practitioners should be trained and supported in providing both clinically and culturally safe care for Aboriginal and Torres Strait Islander patients. This requires adequate time, two-way communication and resources to support and facilitate effective communication. [ABSTRACT FROM AUTHOR]

In the article the authors present insight on the implication of the Ockenden Report in 2020, about the serious failings in maternity care raised by two bereaved families in 2016 at the Shrewsbury and Telford maternity hospital, on midwifery practice. Topics include the Kirkup report about failings in maternity care in East Kent Hospital, two idealisms that midwives adhere to, and immediate and essential actions for midwives such as listening to woman and families.

Background: Alcohol use is a common phenomenon within Australian culture. While there has been significant focus on alcohol use among young Australians, there has been little on health promotion or early interventions focussing on older Australians. Methods: This paper presents the findings of an explorative study that used four interactive focus group workshops to ask the question: Is an existing World Health Organisation alcohol and drug screening tool called the Alcohol, Smoking and Substance Involvement Screening Test (originally developed for young people) acceptable and suitable for older people? The data were analysed based on the question using thematic coding. Results: Participants generally considered that they would be more comfortable talking with their health providers about their alcohol and drug use rather than filling out the Alcohol, Smoking and Substance Involvement Screening Test themselves. This suggests that the tool should be modified to accommodate the differences in health status that reflect life events of the different older age groups. Conclusion: Due to potential complex medical and diverse range of pharmacotherapies common among this age group, it is recommended that, if the tool is used, it be administered by health practitioners such as nurses. [ABSTRACT FROM AUTHOR]

The aim of this paper is to identify the kinds of ethical issues practitioners have to consider in participatory design (PD) practice and use these to inform a set of ethical principles, which can be used to guide practice. It begins by discussing the ways in which PD, as a discipline, has engaged with ethical issues in the past and looks at how other disciplines have identified ethical principles to support ethical practice. It, then, draws upon interviews with researchers who have the experience of collaborative and PD projects to identify ethical considerations that they have encountered in their work and uses these to propose a set of ethical principles. Finally, it ends with a discussion on how a principles-based approach can be combined with other approaches, such as the cultivation of virtues, to support ethical practice in PD. [ABSTRACT FROM AUTHOR]

Preceptorship is a period in which newly qualified staff nurses receive support from an experienced nurse to smooth their transition into the service. District nurses (DNs) from the authors' trust informally expressed the need for a better transition between the completion of district nursing education and entry into the workforce. Hence, a structured preceptorship programme was developed and delivered. This article describes this service initiative and its evaluation by preceptors (n=14) and preceptees (newly qualified DNs; n=13). Both groups valued having a structured preceptorship programme. Preceptees agreed that having a named preceptor was very important, and preceptors felt that the role which they played was rewarding. Both groups felt that the role of the DN was a specialist role and that the preceptorship programme helped to support newly qualified staff make the transition into qualified DNs, clinical team leaders and, ultimately, caseload holders. A large-scale study of DN practice is required to develop a national consensus on the structure and content of preceptorship programmes for district nursing. [ABSTRACT FROM AUTHOR]

Drawing on multiple qualitative case studies of evidence‐based health care conducted in Sweden, Canada, Australia, and the United Kingdom, the authors systematically explore the composition, circulation, and role of codified knowledge deployed in the organizational enactment of evidence‐based practice. The article describes the "chain of codified knowledge," which reflects the institutionalization of evidence‐based practice as organizational business as usual, and shows that it is dominated by performance standards, policies and procedures, and locally collected (improvement and audit) data. These interconnected forms of "evidence by proxy," which are informed by research partly or indirectly, enable simplification, selective reinforcement, and contextualization of scientific knowledge. The analysis reveals the dual effects of this codification dynamic on evidence‐based practice and highlights the influence of macro‐level ideological, historical, and technological factors on the composition and circulation of codified knowledge in the organizational enactment of evidence‐based health care in different countries. [ABSTRACT FROM AUTHOR]

Precision medicine initiatives, such as Cancer Breakthrough 2020, promise to improve cancer outcomes by tailoring treatment to an individual's genes, environment, and lifestyle. This promise will fall short unless researchers successfully engage diverse communities, including those with histories of medical and research abuse. We examined a rural Alaska Native community's viewpoints about biospecimen collection and storage; interest and recall in reporting family health history; and interest and engagement in biospecimen collection for conducting a genetic test for cancer. In 2014, four focus groups were held with 28 adult Alaska Native rural community members. Thematic analysis was performed after establishing a coding scheme by team consensus. Study participants shared interest in engaging in genetic cancer research and suggested ways to improve community engagement in research. These included transparency and continuous communication with researchers at all stages of the research, clear communication about the intent of the research, and that research and results take into consideration the community's needs. These suggestions may be beneficial for future efforts to expand precision medicine research in Alaska Native communities and similar, diverse populations. [ABSTRACT FROM AUTHOR]

Background: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. Objectives: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. Method: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. Findings & Discussion: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. Conclusion: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team. [ABSTRACT FROM AUTHOR]

Objective: To synthesize peer-reviewed knowledge on the frequency of different types of chemotherapy medication errors. Methods: The data were collected from studies published between January 1, 2000, and March 3, 2018, and are identified through online resources such as Medline/PubMed, PubMed Central, Agency for Healthcare Research, and Quality and the Cochrane Library. The manuscripts published in peer-reviewed scientific journals in English language were included in the study. Initially, 19,723 articles were retrieved and finally 11 were found to be eligible to include in the review and were assessed for quality. Error percentages were calculated from the ratio of error type (numerator) to sample size (denominator: medication orders or prescriptions). Results: Overall, the chemotherapy medication errors ranged from 0.004% to 41.6% among various studies. Chemotherapy medication errors ranged from 0.1% to 24.6% in prescribing, 0.40% to 0.50% in preparation, 0.03% in dispensing, and 0.02% to 0.10% in administering phases. Conclusion: Prescribing phase had the highest number of chemotherapy medication errors reported, and least was reported during dispensing phase. We also noticed a need for harmonization for reporting of medication errors. [ABSTRACT FROM AUTHOR]

This paper describes the rationale and process for developing a set of Aboriginal patient journey mapping tools with Aboriginal patients, health professionals, support workers, educators and researchers in the Managing Two Worlds Together project between 2008 and 2015. Aboriginal patients and their families from rural and remote areas, and healthcare providers in urban, rural and remote settings, shared their perceptions of the barriers and enablers to quality care in interviews and focus groups, and individual patient journey case studies were documented. Data were thematically analysed. In the absence of suitable existing tools, a new analytical framework and mapping approach was developed. The utility of the tools in other settings was then tested with health professionals, and the tools were further modified for use in quality improvement in health and education settings in South Australia and the Northern Territory.A central set of patient journey mapping tools with flexible adaptations, a workbook, and five sets of case studies describing how staff adapted and used the tools at different sites are available for wider use. [ABSTRACT FROM AUTHOR]

Background Transthoracic intracardiac catheters are frequently inserted in children during congenital heart surgery for monitoring and vascular access purposes. Their use entails a small potential risk. Aim We aimed to evaluate both catheter-associated morbidities related to maintenance and removal of transthoracic intracardiac catheters in pediatric cardiac patients, and predictors for catheter-associated adverse events. Methods Single-center retrospective cohort study of prospectively collected data of children aged 0-14 years receiving a transthoracic intracardiac catheter inserted in the operating room during 7 consecutive years at the University Children's Hospital Zurich. Results A total of 115 transthoracic intracardiac catheters were placed in 112 patients: 45 right atrial, 68 left atrial, and 2 pulmonary artery catheters. Five catheters (4.3%) had to be removed due to catheter-associated adverse events (infection, 2; nonfunction, 2; and leakage 1). After catheter removal, 19% of patients suffered adverse events, these were minor in 16 (14%) and serious in 6 (5.1%) (symptomatic bleeding in four (3.5%) patients, pericardial tamponade leading to death in one (0.8%), and tension pneumothorax in one (0.8%)). Catheter position in the right atrium and the need for platelet transfusion prior to removal were risk factors for adverse events. Conclusions Transthoracic intracardiac catheters are useful in the management of specific patient groups with complex congenital heart defects. Adverse events do occur; most of them do not require intervention. The insertion technique plays an important role in avoiding adverse events. Strict guidelines for the use and removal of transthoracic intracardiac catheters are required. Low platelet count should delay catheter removal. The wealth of information and therapeutic options offered by these catheters appear to outweigh the associated potential adverse events in this specific patient group. [ABSTRACT FROM AUTHOR]

Economic development strategies aimed at attracting highly skilled workers through investment in urban amenities are gaining momentum throughout the United States. However, most of the foundational research for the approach was tested in very large cities, both in the United States and abroad. Based on quality of place (QOP) variables suggested from previous research, confirmatory factor analysis was used to generate a set of factors for a selection of small and midsized U.S. cities, and linear regression was used to relate these factors to the presence of college-educated populations, younger college-educated populations, and adult population growth. The results indicated that some of the QOP factors associated with better human capital outcomes in prior literature focusing on larger cities were also significant predictors of better human capital outcomes in midsized cities. The relationship between these factors and development outcomes for small cities was much weaker. [ABSTRACT FROM AUTHOR]

Current literature does not consistently show a benefit to providing medication cost information to inpatient health care prescribers. This study assessed the effectiveness of computerized provider order entry alerts that displayed the cost of a high-cost medication alongside a lower cost alternative, targeting 3 high-cost medications. Medication utilization during the one year prior to the intervention was compared to usage in the year after implementation. Reduced utilization of high-cost medications was found when comparing pre to post. Ipratropium hydrofluoroalkane and fluticasone hydrofluoroalkane metered dose inhaler utilization were reduced by 29% and 62%, respectively ( P < .001 for both). A 71% decrease in intravenous chlorothiazide was observed ( P < .001); however, its effect was unable to be separated from implementation of a heart failure diuretic protocol during the study period. Overall, these results suggest computerized medication cost alerts that recommend a lower cost therapeutic alternative are effective in changing prescribing practices. [ABSTRACT FROM AUTHOR]

Context: As four non -- Indigenous nurses working in kidney care, education, and research, we have realised that once you know something, you cannot un-know it. We all seek to improving kidney care experiences and outcomes for and with Indigenous patients, families, communities, and health professionals. We have each gone on individual learning journeys and learnt that working in true partnerships with Indigenous people is central to ensuring that the continuing impacts of colonisation are lessened, cultural safety is enabled, and decolonisation of our health care services occurs. Objectives: To chronicle our learning, challenges, and our quandaries as we attempt to actively decolonise kidney care. We reflect on our role, positioning and how best to work in partnership and use our 'positioning power' for good. Key messages: How can we as renal health professionals become brave enough to help instigate effective changes and walk forward with our eyes wide open, knowing fully what the implications might be. How do we ensure our actions are not just labelled as 'being difficult' but productively moving forward? We share our strategies including co-authoring a cultural bias document, revising cultural education training, establishing new models of care including dialysis in an Aboriginal hostel and CARI guidelines development. Conclusion: Listening to Indigenous voices, and ensuring they are heard, advocating, and walking together are steps forward in ensuring Indigenous peoples experience better kidney care. We recognise the need to become clearer about what our roles are and what a shared vision could be. [ABSTRACT FROM AUTHOR]

Objective: This study identified barriers to and facilitators of mental health (MH) and alcohol and drug (AOD) comorbidity services, in order to drive service improvement.Method: Participatory action research enabled strong engagement with community services, including Aboriginal and refugee groups. Surveys, interviews and consultations were undertaken with clinicians and managers of MH, AOD and support services, consumers, families, community advocates and key service providers. Community participation occurred through consultation, advisory and working party meetings, focus groups and workshops.Results: Barriers included inadequate staff training and poor community and workforce knowledge about where to find help. Services for Aboriginal people, refugees, the elderly and youth were inadequate. Service fragmentation ('siloes') occurred through competitive short-term funding and frequent re-structuring. Reliance on the local hospital emergency department was concerning. Consumer trust, an important element in engagement, was often lacking.Conclusions: Comorbidity should be core business of both MH and AOD services by providing consistent 'no wrong door' care. Non-governmental organisations (NGOs) need longer funding cycles to promote stability and retain skilled workers. Comorbidity workforce training for government and NGO staff is required. Culturally appropriate comorbidity services are urgently needed. Despite the barriers, collaboration between clinicians/workers was valued. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface. Methods: Thirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data. Results: Interviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual). Conclusions: A health professional's practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity. [ABSTRACT FROM AUTHOR]

In South Australia, Aboriginal people make up 2.4% of the total population and experience chronic kidney disease (CKD) at disproportionately higher levels, and at younger ages, than non-Aboriginal people, linked to a complex mix of chronic conditions and lower access to social determinants of health. Nurses providing care for Aboriginal people in urban, rural and remote dialysis and renal units bring various levels of experience and knowledge. Renal educators/ facilitators strive to prepare nurses to respond to the unique individual, family and cultural priorities as well as clinical needs of all patients, but are challenged by a lack of local and Aboriginal-specific resources and supportive theoretical frameworks. This project aimed to develop a more responsive education package to increase cultural and clinical competence and safety of new, existing and future staff. It involved a renal focus group reviewing the current renal education curriculum and resources available within South Australia, and comparing the information within these to recent Aboriginal patient journey experiences. Participatory action research and concepts of symbiotic clinical education and mutually reinforcing relationships underpinned all activities. A draft education package that included recent case studies and patient journey mapping tools developed through the Managing Two Worlds Together project was tested with students, reviewed and adapted. A supportive theoretical framework was developed that brought together Benner’s five stages of clinical competence, a range of cultural models, and Aboriginal patient journey priorities. How and why the framework was developed by the renal group is discussed, with rationale given to the placement of clinical and cultural models within it. [ABSTRACT FROM AUTHOR]

Objectives: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non-Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences.Design: Analysis of administrative data with logistic regression modelling to assess the relationship between Aboriginal status and the decision to undertake diagnostic angiography. A detailed medical record review of Aboriginal admissions was subsequently undertaken.Setting: Emergency ACS admissions to SA cardiac catheterisation hospitals, 2007-2012.Participants: 13 701 admissions of patients with an ACS, including 274 Aboriginal patients (2.1%).Major Outcome Measures: Rates of coronary angiography and revascularisation; documentation of justification for non-invasive management.Results: After adjustment for age, comorbidities and remoteness, Aboriginal patients presenting with an ACS were significantly less likely than non-Aboriginal patients to undergo angiography (odds ratio [OR], 0.4; 95% CI, 0.3-0.5; P < 0.001). There was no significant difference in the rates of revascularisation for Aboriginal and non-Aboriginal patients who had undergone angiography. Reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non-cardiac (16%), non-invasive test performed (8%), and discharge against medical advice (11%); the reasons were unclear for 36% of Aboriginal patients.Conclusions: After controlling for age and other factors, the rate of coronary angiography was lower among Aboriginal patients with an ACS in SA. The reasons for this disparity are complex, including patient-related factors and their preferences, as well as the appropriateness of the intervention. Improved consideration of the hospital experience of Aboriginal patients must be a priority for reducing health care disparities. [ABSTRACT FROM AUTHOR]

In Australia, rural and remote Aboriginal people with renal disease undergo complex patient journeys. Experienced renal nurses provide patient-centred care, working with patients and their families to identify their priorities and the barriers and enablers to quality care. They coordinate patient journeys, utilising their knowledge of staff and services across the health system. But how is this knowledge and these skills shared with peers and hospital systems? This paper discusses how two senior renal nurses, one in a regional dialysis unit and one in a metropolitan renal ward, joined with peers to form a renal nurse focus group with the aim of improving the coordination and quality of Aboriginal patient journeys and care experiences. Using the opportunities provided through the Managing Two Worlds Together project, they adapted and modified a set of patient journey mapping tools, working with key stakeholders (patients, families, staff) to map individual journeys and critical incidents from multiple perspectives. Each journey was compared to standards of care, and written up as a case study, enabling both the process and findings to be communicated with peers and students. Working as a focus group provided safe spaces for nurses to discuss the current gaps in care, and the mapping tools provided a logical structure for making sense of complexity and identifying appropriate actions for improvement. This collaborative approach to knowledge making enabled these experienced nurses to ‘bottle their knowledge and share it’, as they combined their own tacit clinical knowledge with explicit evidence and external knowledge. [ABSTRACT FROM AUTHOR]

Objectives. To determine and compare the incidence of cancer among the 8 Arctic States and their northern regions, with special focus on 3 cross-national indigenous groups – Inuit, Athabaskan Indians and Sami. Methods. Data were extracted from national and regional statistical agencies and cancer registries, with direct age-standardization of rates to the world standard population. For comparison, the ''world average'' rates as reported in the GLOBOCAN database were used. Findings. Age-standardized incidence rates by cancer sites were computed for the 8 Arctic States and 20 of their northern regions, averaged over the decade 2000–2009. Cancer of the lung and colon/rectum in both sexes are the commonest in most populations. We combined the Inuit from Alaska, Northwest Territories, Nunavut and Greenland into a ''Circumpolar Inuit'' group and tracked cancer trends over four 5-year periods from 1989 to 2008. There has been marked increase in lung, colorectal and female breast cancers, while cervical cancer has declined. Compared to the GLOBOCAN world average, Inuit are at extreme high risk for lung and colorectal cancer, and also certain rare cancers such as nasopharyngeal cancer. Athabaskans (from Alaska and Northwest Territories) share some similarities with the Inuit but they are at higher risk for prostate and breast cancer relative to the world average. Among the Sami, published data from 3 cohorts in Norway, Sweden and Finland show generally lower risk of cancer than non-Sami. Conclusions. Cancer among certain indigenous people in the Arctic is an increasing public health concern, especially lung and colorectal cancer. [ABSTRACT FROM AUTHOR]

Objective. To investigate how policy requiring cultural respect and attention to health equity is implemented in the care of rural and remote Aboriginal people in city hospitals. Methods. Interviews with 26 staff in public hospitals in Adelaide, South Australia, were analysed (using a framework based on cultural competence) to identify their perceptions of the enabling strategies and systemic barriers against the implementation of official policy in the care of rural Aboriginal patients. Results. The major underlying barriers were lack of knowledge and skills among staff generally, and the persistent use of 'business as usual' approaches in their hospitals, despite the clear need for proactive responses to the complex care journeys these patients undertake. Staff reported a sense that while they are required to provide responsive care, care systems often fail to authorise or guide necessary action to enable equitable care. Conclusions. Staff caring for rural Aboriginal patients are required to respond to complex particular needs in the absence of effective authorisation. We suggest that systemic misinterpretation of the principle of equal treatment is an important barrier against the development of culturally competent organisations. [ABSTRACT FROM AUTHOR]