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Background: Indigenous representation is essential to ensure the health workforce is culturally capable and safe for Indigenous patients. However, Indigenous Peoples remain underrepresented in tertiary education and the health workforce., Aim: This aim of this paper is to offer an unmediated, Aboriginal nurses' perspective, on the experience, barriers and challenges of undertaking a Bachelor of Nursing degree., Design: Referenced reflection., Results: Education providers must be culturally capable themselves before teaching Indigenous content and facilitating sensitive classroom discussions. Financial, social and educational support is crucial to equip Indigenous students for tertiary study., Conclusion: To retain Indigenous students and contribute to a culturally capable workforce, it is imperative to listen and respond to Indigenous Peoples voices to shape learning experiences and support.

Internationally Australia is considered one of the safest countries in the world for women to birth in. However, Aboriginal women in Australia have a much higher incidence of perinatal mortality and morbidity. One strategy to address this higher mortality and morbidity is to increase the numbers of Indigenous people working in healthcare. This paper discusses cultural competence in healthcare programs and higher education, including a reflection on midwifery education from the perspective of an Indigenous undergraduate midwife.

With the increasing burden of chronic kidney disease (CKD) in New Zealand (NZ) the number of people requiring pre-dialysis care is increasing. Pre-dialysis nurses play a central role in the delivery of this care. This paper describes and discusses what pre-dialysis nurses perceive to be key influences on effective pre-dialysis nursing care in NZ. It is based on findings from a wider qualitative study that interviewed the majority of NZ pre-dialysis nurses. Following inductive data analysis four main influences were identified. They were: having time from referral to commencement of renal replacement therapy (RRT) to provide adequate education and support; having good access to cultural and other supports and an understanding of differing cultural views of health; the importance of good inter-professional relationships; and support from nursing management and doctors to advance professionally. With the knowledge of the projected increase in patients with CKD, we argue that it is important to ensure the positive aspects of these influences are enhanced in order to ensure effective pre-dialysis nursing care, nurse satisfaction and professional advancement.

Increasingly, with globalization, various countries including Canada are becoming ethno-racially and culturally diverse. Health professionals face the challenge of working effectively across these ethno-racial and cultural boundaries. In acknowledgement of the need to generate knowledge that informs the development of effective health care policies, this paper discusses the findings of a qualitative study that examined the childbirth experiences of African-Canadian women. The meaning of childbirth, which is the primary focus of this paper, includes: sense of responsibility, childbirth as a positive life event, the uniqueness of childbirth as a life experience, childbirth as a bitter-sweet paradox, and childbirth as a spiritual event. The paper will conclude with a discussion of study implications including the need to provide opportunity for nurses to learn about the client's values, beliefs, and practices. This is necessary for the attainment of desired health outcomes such as having a healthy mother and the safe birth of a healthy baby.

Most health care organisations aspire to develop a culturally competent workforce. Australian nurses are bound by professional standards to achieving this goal and there is a clear commitment by lead organisations to deliver nursing care that is mindful about respecting cultural diversity (ANMC, 2005). The development of a nursing workforce that is equipped with knowledge and an embedded attitude of cultural sensitivity and safety is a nursing workforce that will bring about positive change and improved consumer experiences (Chenoweth, Jeon, Goff, & Burke, 2006). This paper will reflect on current discussion about cultural competence from the perspective of an Indigenous nurse, and present a personal learning pathway toward a goal of cultural competence.

The challenge for the future is to embrace a new partnership aimed at closing the gap between Indigenous and non-Indigenous Australians on life expectancy, educational achievement and employment opportunities. Significant improvements in contemporary Indigenous health care can be achieved through culturally safe health education programs for Indigenous students. However, while participation rates of Australian Indigenous students in the higher education sector are increasing, attrition rates are markedly higher than those of the general student population. This paper focuses on a unique degree program that is offered exclusively to Indigenous students in the field of mental health in the School of Nursing, Midwifery and Indigenous Health, Charles Sturt University. This qualitative exploratory study aimed to identify strategies that were especially helpful in sustaining students in the program and to identify and address barriers to the retention of students, to empower students to better prepare for the university environment and to inform academics within the course about areas that could be improved to provide a more culturally safe learning environment. The first stage of the study utilised focus group interviews with 36 Indigenous students across all three years of the program. The findings of the study addressing the issues of culturally appropriate pedagogy, curricula and cultural safety in the mental health degree program are discussed.

In the mental health context, nurses navigate multifaceted boundaries every day in an effort to develop and maintain the therapeutic relationship; an endeavour that is breathtaking in its complexity. In this paper, I adopt an unconventional form of writing to explore the individual nature of cultural boundaries, and uncover hidden messages that impact on our efforts to build connections across cultures and ethnicities in mental health settings. Presented as a play, the conversation between protagonists explores cultural competence alongside the notion of 'discovery', and the potential of the Tidal Model to provide a vehicle for successful cultural boundary surfing.

Culturally safe research processes, methodologies, and mutually aligned research endeavours are a fundamental right of those being researched. Vulnerable populations are at risk of experiencing inequalities in health experiences and health outcomes, and research beneficial to those being researched is crucial to address disparities. Often vulnerable populations are exposed to research that is driven by dominant epistemologies, research methodologies, and socio-cultural lenses that can exacerbate their vulnerability, negating their socio-cultural reality. In this paper it is contended that researchers should review the way in which research is constructed and developed by creating a culturally safe space for research to occur with those who are vulnerable. A framework based on partnership, participation, protection, and power is presented as a way of creating culturally safe research.

Aboriginal people currently remain the most vulnerable and sickest population within Australian society and therefore are frequent users of the Australian health system. In this paper I will discuss the importance of the role of Aboriginal and non-Aboriginal nurses in diminishing the negative ramifications of perceived racism that can be felt by patients. This exemplar will explore an example of perceived racism through the eyes of an Aboriginal nurse. Intrinsic to this exemplar is the role Aboriginal nurses can play as experienced, culturally safe clinicians and educators to their peers; and facilitators of the patient's ability to adequately access and consent to care.

Nursing education faces many challenges as a result of the population's increased cultural diversification. Of primary importance is the need to prepare culturally competent nurses to provide care in both urban and remote rural areas. This paper presents a HRSA funded program that utilises simulations to provide culturally diverse learning opportunities for both university-based and distance learning students. Cases are developed using focus groups and individual interviews. The information is used with standardised patients to develop vignettes that are loaded into a web-based virtual hospital where students conduct interviews with culturally diverse patients. The information obtained during the interview is then used to provide hands-on care to a high performance simulator (simulated mannequin). The encounters are videotaped for use in debriefing sessions with the students, for educational programs in the classroom, and for video-streaming to web-based distance students. Students in the debriefing sessions and classroom participate in a review of the videotape using the Personal Response System to respond to question. Through the culturally enhanced integrated simulation, students have an opportunity to address clinical situations and the impact of culture in a relatively safe non-threatening environment where the impact of their biases can be explored.

A culturally appropriate health service is contingent on the inclusion of client's cultural beliefs and practices into intervention plans. Not establishing key cultural beliefs and practices risks providing a health service that lacks relevance and compromises its efficacy for its recipients. Anecdotally, cultural appropriateness and acceptability of health services is often lacking for Māori women (indigenous to Aotearoa New Zealand), hindering positive health experiences and outcomes. This paper explores an aspect of findings of research undertaken with Māori women to discover what was important for their health and well-being, and their interactions with mainstream health services. Data from semi-structured interviews with 38 Māori women was used to generate a Glaserian grounded theory informed by a Māori-centred approach to explain the weaving of their health and well-being. It explains, in part, the importance of determining Māori women's cultural worldviews and practices when assessing and planning effective interventions. Cultural safety and cultural competence will be explored as vehicles to improve culturally appropriate and acceptable health care for indigenous women.