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Aim: The aim of this revision was to update the Remote Area Nurse (RAN) Model of Consultation (MoC) and was prompted by publication of the National Rural and Remote Nursing Generalist Framework (2013–2018), shifts in RAN workforce patterns, community health patterns and technology use. Context: Rural and remote residents face higher rates of hospitalisations, deaths and poorer access to health care with a significant burden of avoidable fatal conditions among Aboriginal and Torres Strait Islander peoples. Health care is mostly provided by RANs and Aboriginal and Torres Strait Islander Health Practitioners (ATSIHPs), addressing diverse health needs, a mobile population and navigating cross‐cultural situations. Despite challenges such as clinician shortages, RANs manage a significant portion of non‐emergency consultations. The RAN MoC was developed to ensure comprehensive, systematic and person‐centred care and to mitigate risk to the client, the nurse and the health service. Approach: The 11 expert panel members, all authors, revised the RAN MoC through a series of Microsoft Teams meetings, one face‐to‐face meeting and an exchange of emails. The principles were reorganised under the four domains of the National Rural and Remote Nursing Generalist Framework and mapped against the National Safety and Quality Primary and Community Health Care Standards. Conclusion: The revised RAN MoC is designed to provide evidence based culturally informed care, standardise RAN consultation best practice and improve the health outcomes of their clients. With the increased turnover and number of nurses 'new' to remote, more innovative approaches to education and dissemination of the model is necessary. [ABSTRACT FROM AUTHOR]

An increase in the number of Indigenous health professionals is one way to help reduce the poor health outcomes of Australia's Indigenous people. However, while Indigenous students are enrolling in Australian tertiary undergraduate nursing courses in increasing numbers, their completion rates remain lower than non-Indigenous students and many barriers hinder course completion. This critical interpretive qualitative study explores academic staff perceptions of factors enabling successful course completions by Indigenous nursing students from universities in Queensland, Australia. Content analysis of data revealed five themes: (a) Individual student characteristics; (b) Institutional structures, systems, and processes; (c) Relationships, connections, and partnerships; (d) Family and community knowledge, awareness, and understanding; and (e) Academics' knowledge, awareness, and understanding. To increase the number of Indigenous nurses, strategies such as appointing Indigenous nursing academics; partnerships between nursing schools and Indigenous Education Support Units, and the implementation of tailored cross-cultural awareness programs for nurse academics are proposed.

As Australian universities move towards the mandatory inclusion of First Peoples content into undergraduate health professional programs, it is imperative to evaluate course impact and quality of teaching. A discrete First Peoples Health course underpinned by The Aboriginal and Torres Strait Islander Health Curriculum Framework was evaluated using the Cultural Capability Measurement Tool (CCMT). Tool items reflect the five core cultural capabilities outlined in "The Framework" (Respect, Communication, Safety and Quality, Reflection, and Advocacy). All enrolled students (n = 297) were invited to complete an online survey before and after the course. Students' experience of course quality was assessed using a university-generated online survey. Completed surveys could be matched for 87 students (29.3% response rate). Mean increase in CCMT scores from baseline to post-course was 10.85 (95% CI 8.84, 12.86). The eta squared statistic (?[superscript 2] = 0.57) indicated a large effect. Students' satisfaction with course quality was high (M = 4.1 SD = 0.96). Free text comments indicated that students valued small group teaching and reflective processes. Improved CCMT scores suggest development in students' cultural capability. Further research needs to examine the extent to which students can sustain development of their cultural capabilities in practice.

For Indigenous scholars in health sciences, finding "ways of doing" research that value Indigenist knowledge is an important consideration. Indigenist research methodology offers a useful alternative to mainstream research approaches that draw upon orthodox Western knowledge systems. However, as Indigenous research approaches have only recently entered the academic discourses of health science, few courses currently exist to support Indigenous students and their supervisors who work in this area. While negotiating Indigenist methodologies is challenging, more Indigenous scholars are recognising the importance of doing so. This paper will outline some of the issues experienced by two Indigenist research students coming to terms with the relevance of an Indigenist research approach to their study, as well of those of their supervisor, the third author of the paper.

An editorial is presented on the significance of the Indigenous Voice to Parliament referendum for Australian nurses. It emphasizes the challenges of systemic racism and promoting healthcare equity. It highlights the collaboration between the nursing and midwifery professions with Aboriginal and Torres Strait Islander Peoples and their support for the referendum's impact on health outcomes.

There is an inextricable link between cultural and clinical safety. In Australia high‐profile Aboriginal deaths in custody, publicised institutional racism in health services and the international Black Lives Matter movement have cemented momentum to ensure culturally safe care. However, racism within health professionals and health professional students remains a barrier to increasing the number of Aboriginal and Torres Strait Islander Health professionals. The Australian Health Practitioner Regulation Agency's Aboriginal and Torres Strait Islander Health Strategy's objective to 'eliminate racism from the health system', and the recent adoption of the Aboriginal and Torres Strait Islander peoples led cultural safety definition, has instigated systems level reflections on decolonising practice. This article explores cultural safety as the conceptual antithesis to racism, examining its origins, and contemporary evolution led by Aboriginal and Torres Strait Islander peoples in Australia, including its development in curriculum innovation. The application of cultural safety is explored using in‐depth reflection, and the crucial development of integrating critical consciousness theory, as a precursor to culturally safe practice, is discussed. Novel approaches to university curriculum development are needed to facilitate culturally safe and decolonised learning and working environments, including the key considerations of non‐Indigenous allyship and collaborative curriculum innovations and initiatives. [ABSTRACT FROM AUTHOR]

Objective. Health practitioners' Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. This research assessed all Codes for cultural safety specific content. Methods. Following the release of the Australian Health Practitioner Regulation Agency's (Ahpra) Health and Cultural Safety strategy 2020-25, the 16 Ahpra registered health practitioner Board Codes of Conduct and professional Codes of Ethics were analysed by comparing content to Ahpra's new cultural safety objectives. Two Codes of Conduct, Nursing and Midwifery, met these objectives. The Aboriginal and Torres Strait Islander Health Practitioners Code partially met these objectives. Results. Most Codes of Conduct (14 of 16) conflated Aboriginal and Torres Strait Islander peoples with culturally and linguistically diverse (CALD) communities undermining the sovereignty of Australia's First Peoples. Eleven professions had a Code of Ethics, including the Physiotherapy Code of Conduct, which outlined the values and ethical principles of practice commonly associated with a Code of Ethics. Of the 11 professions with a Code of Ethics, two (Pharmacy and Psychology) articulated specific ethical responsibilities to First Peoples. Physiotherapy separately outlined cultural safety obligations through their reconciliation action plan (RAP), meeting all Ahpra cultural safety objectives. The remaining eight advocated respect of culture generally rather than respect for Aboriginal and Torres Strait Islander cultures specifically. Conclusions. The review identified multiple areas to improve the codes for cultural safety content for registered health professions, providing a roadmap for action to strengthen individual and systems practice while setting a clear regulatory standard to ensure culturally safe practice becomes the new norm. It recommends the systematic updating of all professional health practitioner Board Codes of Conduct and professional Codes of Ethics based on the objectives outlined in Ahpra's Cultural Safety Strategy. [ABSTRACT FROM AUTHOR]

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Background: With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements., Methods: Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation., Discussion: Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up., Trial Registration: Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020)., (© 2023. The Author(s).)

Background: Racism is responsible for health inequity and the harm perpetrated upon Aboriginal and Torres Strait Islander peoples by white institutions, building on attitudes and beliefs dominated by assumptions of white superiority. The National Aboriginal and Torres Strait Islander Health Curriculum Framework 'Curriculum Framework', released in 2014, was introduced to provide a framework for nursing programs and included the introduction of discrete Aboriginal and Torres Strait Islander health courses to draw attention to the relationship between racism health outcomes of Aboriginal and Torres Strait Islander peoples within health care settings., Methods: Using an Indigenist research paradigm with Colonial Critical Race Theory as the methodology and framework, this study presents a document analysis of discrete Aboriginal and Torres Strait Islander health courses taught in undergraduate nursing programs at 31 Australian Universities., Results: This work draws on the collective activism of Aboriginal and Torres Strait Islander nurses in challenging the systemic racism embedded in the Australian nursing curriculum. We demonstrate the utility of the Racial Segregation Audit Tool (RSAT), as an innovative approach to identify and respond to racism embedded in course learning outcomes., Conclusions: This study explores and uncovers how the learning outcomes assert the social construction of race as a tool of oppressive segregation.

Systemic racism has a profound negative impact on the health outcomes of Australia's First Nations peoples, hereafter referred to as Aboriginal and Torres Strait Islander peoples, where racism and white privilege have largely become normalised and socially facilitated. A national framework is being mobilised within the tertiary-level nursing curriculum to equip future health professionals with cultural capabilities to ensure culturally safe, equitable health care for Aboriginal and Torres Strait Islander peoples. In 2019, nurses comprised more than half of all registered health professionals in Australia, and current national standards for nursing state that Australian universities should be graduating registered nurses capable of delivering care that is received as culturally safe. It is therefore critical to evaluate where learning objectives within nursing curricula may lead to the reinforcement and teaching of racist ideologies to nursing students. This protocol outlines a framework and methodology that will inform a critical race document analysis to evaluate how learning objectives assert the social construction of "race" as a tool of oppressive segregation. The document analysis will include each discrete Aboriginal and Torres Strait Islander health course within all undergraduate nursing programs at Australian universities. The approach outlined within this protocol is developed according to an Indigenous research paradigm and Colonial Critical Race Theory as both the framework and methodology. The purpose of the framework is a means for improving health professional curriculum by reducing racism as highlighted in nation-wide strategies for curriculum reform.

Background : Collaborative, Indigenous-led pedagogical and research approaches in nursing education are fundamental to ensuring culturally safe curriculum innovations that address institutional racism. These approaches privilege, or make central, Indigenous worldviews in the ways healthcare practices are valued and assessed. With the aim of informing excellence in cultural safety teaching and learning, and research approaches, this study draws on the experiences and key learnings of non-Indigenous nursing academics in the collaborative implementation of First Peoples Health interprofessional and simulation-based learning (IPSBL) innovations in an Australian Bachelor of Nursing (BN) program. Methods : An Indigenous-led sequential mixed method design was used to investigate non-Indigenous nursing academics' experiences in the design, development and delivery of two IPSBL innovations. A validated survey (the Awareness of Cultural Safety Scale, (ACSS)) was administered to nursing academics before and after the innovations were delivered. Phenomenological interviews were also conducted following the implementation of the innovations. Results : Of the 27 staff involved in the delivery of the innovations, six nursing academics completed both pre-and post-surveys (22%). Nine (33%) participated in phenomenological interviews. There was a non-significant trend towards improved scores on the ACSS following the delivery of the innovations. Nursing academics' perceptions of the innovations' relevance to their practice were enhanced. An increased awareness of culturally safe academic practices was reported among those actively involved in innovations. Impact statement : Indigenous-led approaches in teaching and research promote excellence within mandatory cultural safety education for nurses and midwives. Conclusions : This study confirms the importance of educating the educators about cultural safety in teaching and learning, and research approaches. It also provides important insights into how non-Indigenous nursing academics can work within Indigenous-led pedagogical and research approaches to design culturally safe curriculum innovations.

Background: A university educated, First Peoples health workforce is paramount to improving health outcomes for Australia's First Peoples. However, a significant gap exists between the academic success of First Peoples and non-Indigenous students. The facilitation of culturally safe learning and teaching environments by academics is essential to closing this gap. There is little research on midwifery academics' understanding of Cultural Safety and the translation of this understanding in learning and teaching., Objectives: To explore the influence of yarning circles within a professional development program to enhance midwifery academics' awareness of Cultural Safety., Methods: A six-month staff development program which consisted of two workshops and a series of yarning circles was offered to all midwifery academics. Eight participants agreed to be interviewed after completion of the program. Interviews were transcribed verbatim, read and re-read, and analysed using a six staged thematic analysis process., Results: Six key themes centred on participants' Sense of Belonging, Sense of Safety, Sense Knowing, Sense of Support, Sense of Difference, and Sense of Challenge were identified. These concepts were supportive of participants' developing awareness of Cultural Safety., Conclusion: Yarning circles can encourage midwifery academics' awareness of Cultural Safety. Awareness is the first step towards becoming culturally safe. Yarning provided a safe and supportive space for challenging discussions and reflective learning about racism, white privilege, and difference. Midwifery academics described steps they could take to promote Cultural Safety in the classroom., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Problem: There are no validated tools to measure midwives' awareness of Cultural Safety., Background: Cultural Safety is an important component of midwifery practice. Measurement can inform practice and evaluate professional development strategies., Aim: To adapt and evaluate the Awareness of Cultural Safety Scale with the midwifery workforce., Methods: An online survey was distributed to members of Australian College of Midwives and Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. Measures included the Awareness of Cultural Safety Scale - Revised, Self-assessment of Cultural Knowledge and Perceptions of Racism scales., Findings: The revised Awareness scale had a Cronbach's alpha of 0.87. Principal Component Analysis with varimax rotation produced a three-factor structure accounting for 67% of variance. Awareness scores correlated with Self-assessment of Cultural Knowledge (r=0.22 p<0.03) and Perceptions of Racism (r=0.62 p<0.001) scales. Educators scored significantly higher on awareness compared to clinicians (t (1,80)=-3.09, p=0.003). Perceptions of Racism predicted Awareness of Cultural Safety scores (F (2,87) 29.25, adjusted r square=0.39 p<0.001 95% Confidence Interval=1.09, 1.93)., Discussion: The revised scale was a reliable and valid measure of Cultural Safety across a diverse sample of midwives. Midwives working in education settings have a higher awareness of Cultural Safety than clinical peers., Conclusion: The Awareness of Cultural Safety Scale can be used with midwives across practice settings. Professional organisations and education providers need to promote the professional responsibilities of midwives towards Cultural Safety in clinical practice and education., (Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: With persisting maternal and infant health disparities, new models of maternity care are needed to meet the needs of Aboriginal and Torres Strait Islander people in Australia. To date, there is limited evidence of successful and sustainable programs. Birthing on Country is a term used to describe an emerging evidence-based and community-led model of maternity care for Indigenous families; its impact requires evaluation., Methods: Mixed-methods prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland (2015-2019). Includes women's surveys (approximately 20 weeks gestation, 36 weeks gestation, two and six months postnatal) and infant assessments (six months postnatal), clinical outcomes and cost comparison, and qualitative interviews with women and staff., Discussion: This study aims to evaluate the feasibility, acceptability, sustainability, clinical and cost-effectiveness of a Birthing on Country model of care for Aboriginal and Torres Strait Islander families in an urban setting. If successful, findings will inform implementation of the model with similar communities., Trial Registration: Australian New Zealand Clinical Trial Registry # ACTRN12618001365257 . Registered 14 August 2018 (retrospectively registered).

Objectives: To explore the experiences and outcomes of health professional students when undertaking education on Indigenous health., Design: An integrative systematic literature review., Data Sources: The search was undertaken from September 2017-November 2017. Six databases were searched: CINAHL, Scopus, Informit Health Collection, Informit Indigenous Collection, Proquest - Nursing and Allied Health Collection; and Proquest - Health and Medical Collection. Reference lists of all articles were scanned for further relevant articles., Review Methods: The search strategy was limited to English articles published in the previous decade. Articles were included if they focused on Indigenous health content provided to health professional university students, with a focus on Indigenous populations of Australia, New Zealand, Canada and the United States of America. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review. Studies were evaluated for methodological rigour using the CASP rating checklist. Both qualitative and quantitative data were coded using thematic qualitative analysis methods and presented as a meta-aggregation., Results: Twelve articles were included. Synthesis found significant variability in the ways Indigenous health issues were taught and integrated into health programs, particularly with regards to quality, methodological rigour of evaluation, pedagogical approaches and student experiences. Four themes were developed to describe student experiences and learning outcomes. These included: increasing knowledge of Indigenous health; emotional responses to content and teaching processes; perceived value of Indigenous health education; and cultural competence and critical thinking., Conclusions: Methodologically sound longitudinal studies are required to test if early changes in student knowledge and attitudes may be sustained. How students' 'increase in knowledge' translates to cultural capability is unclear, and there is a need for validated tools to measure this construct. A more sophisticated critique of how students emotionally engage with Indigenous health content, including understanding the relationships between 'discomfort' and transformative experiences is required., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Background: Health professional graduates require the capacity to work safely, both clinically and culturally, when delivering care to Indigenous peoples worldwide. In the Australian context, the Aboriginal and Torres Strait Islander Health Curriculum Framework (The Framework) provides guidance for health professional programs to integrate, teach and assess Aboriginal and Torres Strait Islander peoples' (First Peoples) health content. There is, however, a lack of validated tools that measure the development of students' cultural capabilities., Objectives: To validate the Cultural Capability Measurement Tool with a cohort of health professional students., Design: A descriptive cohort design was used., Setting and Participants: All students (N = 753) enrolled in a discrete First Peoples Health course at an Australian university were invited to complete the Cultural Capability Measurement Tool., Methods: The tool was tested for reliability, content and construct validity using confirmatory factor analysis; and concurrent validity using and the Cultural Understanding Self-Assessment Tool., Results: A sample of 418 (73% response rate) was recruited. Most participants were enrolled in the Bachelor of Nursing program (n = 369, 82%). The Cultural Capability Measurement Tool had a Cronbach's alpha coefficient of 0.86. A five-factor solution was confirmed which reflected the cultural capability domains and accounted for 51% of the variance. Scores correlated with students' cultural understanding (r = 0.28, p < 0.001)., Conclusions: Successful implementation of The Framework requires instruments to measure changes in students' cultural capabilities. Measuring nursing students' cultural capabilities can inform their development, identify areas of strengths and deficits for educators, and will ultimately contribute to the development of a culturally safe nursing workforce., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Midwives have a central role in closing the gap in health inequalities between Australias' First Peoples and other childbearing women. The Aboriginal and Torres Strait Islander Health Curriculum Framework (The Framework) identifies five core cultural capabilities (respect, communication, safety and quality, reflection and advocacy) to foster culturally safe health care., Aim: To use a decolonising, First Peoples-led approach to develop and validate a tool to measure the development students' cultural capabilities., Method: A pre- post intervention design was used. Development of the Cultural Capability Measurement Tool followed a staged process which centred on First Peoples' knowledges. This process included: item generation, expert review; a pilot, test-retest; and psychometric testing (reliability, factor analysis and construct validity). All third year midwifery students (n=49) enrolled in a discrete First Peoples health course were invited to complete the survey pre and post course., Findings: A response rate of 77.5% (n=38/49) pre-course and 30.6% (15/49) at post-course was achieved. The tool demonstrated good internal reliability (Cronbach alpha=.89-.91). Principal component analysis with varimax rotation produced a five-factor solution. A paired samples t-test revealed a significant increase from pre-course (mean 93.13, SD 11.84) to post-course scores (mean=100.53, SD 7.54) (t (14)=-2.79, p=.014)., Conclusion: A First Peoples approach was critical to tool development and conceptual validity. The 22 item Cultural Capability measurement Tool reflected the core cultural capabilities of The Framework. The draft tool appears suitable for use with midwifery students., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Marked differences exist between the maternal and neonatal outcomes of Australian Aboriginal and Torres Strait Islander women and their babies compared with the outcomes for other Australian women and their babies. Australian government policies underline the need to increase the number of practising Aboriginal and Torres Strait Islander midwives and nurses as a strategy for delivering culturally appropriate healthcare to improve health outcomes for Aboriginal and Torres Strait Islander families. Additional challenges are experienced by Aboriginal and/or Torres Strait Islander midwifery students providing Continuity of Care (COC) to Australian Aboriginal and/or Torres Strait Islander childbearing women. One such example is the challenge presented due to the close connections and relationships that exist within some Aboriginal and/or Torres Strait Islander cultures in terms of the maintenance of a professional relationship, in particular, the maintenance of professional boundaries. Whilst there is a growing body of evidence on the benefits to women of continuity of midwifery care models, little is known about the experiences of Aboriginal and Torres Strait Islander women who receive COC from Aboriginal and Torres Strait Islander midwifery students., Aim: To explore the experiences of Australian Aboriginal and Torres Strait Islander childbearing women who participated in a Continuity of Care journey with an Aboriginal and/or Torres Strait Islander Bachelor of Midwifery student., Methods: Exploratory, descriptive study using semi-structured interviews informed by an Indigenous Research Methodology., Findings: Thematic analysis identified four major themes: (i) communicating our way, (ii) the role of relationships, (iii) support and assistance and (iv) challenges of the system. The findings illustrated the benefits Aboriginal women experience as a result of having Aboriginal and/or Torres Strait Islander midwifery students provide Continuity of Care., Conclusion: Increasing the number of Australian Aboriginal and/or Torres Strait Islander midwives is essential to improving health outcomes for Australian Aboriginal and Torres Strait Islander childbearing women and their families. Caseload midwifery models with Aboriginal and Torres Strait Islander midwives across Australia are needed. Health services, in partnership with Universities and Aboriginal and Torres Strait Islander communities, have a vital role to play in the development and expansion of these models., (Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)