Which Cultural Safety Strategies Are Making a Difference? Exploring Hospital Initiatives for First Nations Peoples in Australia. A Scoping Review

ABSTRACT

Aim

To explore the barriers, facilitators, and outcomes of strategies that have been implemented to improve the experience of cultural safety for First Nations inpatients in the Australian hospital setting.

Design

Scoping review.

Methods

Guided by the Joanna Briggs Institute scoping review methodology and reported using PRISMA-ScR, six databases were searched with data extracted and synthesised.

Data Sources

Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Informit, Medline, ProQuest and Scopus databases. Searches were undertaken in March 2024.

Results

Forty-three articles representing 39 studies were included. Strategies were categorised as governance, service delivery, hospital environment, clinician education, and First Nations workforce. First Nations researchers were co-authors in most studies, and emergent themes were grounded in First Nations priorities, with an emphasis on developing the First Nations health workforce. Findings included (i) First Nations health staff being identified as cultural brokers between First Nations patients and non-First Nations clinicians; (ii) experiences of cultural safety being amplified when First Nations and non-First Nations health staff worked together; and (iii) strong governance being critical to addressing institutional racism and enabling cultural safety.

Conclusions

Embedding the voice of First Nations peoples in governance and an organisational commitment to strengthening the First Nations workforce are essential drivers for implementing cultural safety strategies in Australian hospitals.

Implications for the Profession and/or Patient Care

Working together respectfully and collaboratively offers a pathway forward for First Nations and non-First Nations health service clinicians and management to deliver culturally safe hospital care.

Impact

Culturally safe hospital care is integral to promoting the health of First Nations people. This study maps cultural safety strategies used in the Australian inpatient hospital setting, explores if and how these strategies have improved cultural safety and identifies barriers and facilitators to implementation. Fostering approaches to support understanding and respect between First Nations and non-First Nations clinicians and staff is integral to promoting culturally safe hospital care. Hospital leadership, policymakers and staff can benefit from understanding the drivers of culturally safe hospital care.

Reporting Method

Reported using PRISMA-ScR.

Patient or Public Contribution

Guidance on this research was received from Aboriginal leaders at the first author's hospital workplace.

Protocol Registration

A research protocol was prepared in advance and registered: https://osf.io/sfzby/?view_only=03c2349ebdae4a7ba95a621d9b7e8bc4.