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Abstract: Aim: To explore the impact of culture on health, healthcare provision and its contribution towards health inequity experienced by some marginalised communities. Background: Health inequity is a global issue, which occurs across and within countries, and is the greatest barrier to worldwide health and the development of the human race. In response to this challenge, there is an international commitment to ensure universal health coverage based on the fundamental principle that individuals should be able to access healthcare services they need. Despite this, there is clear evidence that indigenous and other cultural minorities such as New Zealand Māori and Gypsy Roma Travellers still experience far poorer health outcomes when compared to the majority population. Furthermore, when they do access health care, their experiences are often not positive and this in turn results in reluctance to access preventative health care, instead accessing health services much later, reducing treatment options and compounding higher mortality rates. What is often not explored or examined is the impact of the different cultural beliefs of individuals in these communities and the nurses caring for them. Design: This is a position paper drawing upon research experience with New Zealand Māori and Gypsy Roma Travellers. We critically review the experiences of health inequity of marginalised communities. It does so by examining how these communities may have a different world view to the nurses caring for them, and it is this lack of understanding and valuing of alternative worldviews that contributes to the poorer health outcomes both communities face. Conclusion and relevance to clinical practice: As nurses work with many different individuals and groups, we have to find ways of ensuring a more embracing, culturally responsive healthcare environment which respects and values the beliefs of others. [ABSTRACT FROM AUTHOR]

Aims and objectives: To present a new etemic model of vulnerability. Background: Despite vulnerability being identified as a core consequence of health and health experiences, there has been little research exploring the meaning of vulnerability as a concept. Yet, being vulnerable is known to have dire physical/mental health consequences. It is therefore a fundamental issue for nurses to address. To date, the meaning of the term vulnerability has been influenced by the work of Spiers (Journal of Advanced Nursing, 31, 2000, 715, The Essential Concepts of Nursing: Building Blocks for Practice, 2005, Elsevier, London). Spiers identified two aspects of vulnerability: the etic (external judgment of another persons’ vulnerability) and the emic (internal lived experience of vulnerability). This approach has led to a plethora of research which has explored the etic (external judgment) of vulnerability and rendered the internal lived (or emic) experience invisible. Consequences of this, for marginalised communities such as Gypsy Roma Travellers include a lack of culturally sensitive services compounding health inequalities. Design: Position paper. Method: Drawing upon a qualitative phenomenological research study exploring the lived experience of vulnerability from a Gypsy Roma Travelling community (published previously), this paper presents a new model of vulnerability. This etemic model of vulnerability values both external and internal dimensions of vulnerability and argues for a fusion of these two opposing perspectives. Conclusions: If nurses and other health‐ and social care professionals wish to develop practice that is successful in engaging with Gypsy Roma Travellers, then there is a need to both understand and respect their community. This can be achieved through an etemic approach to understanding their vulnerability achieved by eliciting lived experience alongside the appreciation of epidemiological studies. Relevance to clinical practice: If nurses and health practitioners used this etemic approach to practice then it would enable both the development and delivery of culturally sensitive services facilitating health access to this community. Only then, will their poor health status be successfully addressed. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the lived experience of vulnerability of individuals within a Gypsy Roma Travelling community. Background People experience vulnerability whenever their health or usual functioning is compromised. This may increase when they enter unfamiliar surroundings, situations or relationships. One's experience of vulnerability can also be heightened through interactions between the individual and the society within which they live. Gypsy Roma Travellers are often identified as vulnerable owing to increased morbidity and mortality as well as their marginalised status within society. Yet little is known of the experiences of vulnerability by the individuals themselves. Without their stories and experiences, health professionals cannot effectively develop services that meet their needs. Design This descriptive phenomenological study sought to explore the lived experience of vulnerability in a Gypsy Roma Travelling community. Methods Seventeen Gypsy Roma Travellers were interviewed in 2013-2014 about their experiences of feeling vulnerable. This paper reports on the findings from the depth phase in which 13 individuals were interviewed. The interviews were conducted and analysed using Giorgi's descriptive phenomenological approach. Findings Six constituents of the phenomenon of vulnerability were identified as feeling: defined and homogenised as a group; pressurised to conform to live in a particular way; split in one's identity; a loss of one's heritage; discriminated, persecuted and threatened; and powerlessness. Relevance to clinical practice There is a wealth of evidence that Gypsy Roma Travellers experience high levels of morbidity and mortality, which has led to them being identified by health professionals and policy makers as a vulnerable community. Exploring their lived experience of vulnerability presents a different perspective regarding this concept and can help explain why they may experience poorer levels of physical and mental health. [ABSTRACT FROM AUTHOR]

Aims and objectives. A systematic review of published studies on service user involvement in undergraduate, preregistration general nursing education (excluding mental health-specific programmes). The objective is to examine how students are exposed to engagement with service users. Background. The requirement of service user involvement in all nurse education is policy expectation of health professional education providers, in response to the increased public and political expectations. Previous literature reviews have focused solely on mental health. Design. Systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines; timeframe 1997-2014; published in English. Methods. Search of CINAHL, Cochrane Review, Education Research Complete, Internurse, MEDLINE, PsychINFO, Scopus, SocINDEX and Web of Science yielded 229 citations; 11 studies met the review eligibility criteria. Results. Seven studies used qualitative methodology, two quantitative and two mixed methods. Studies from the United Kingdom dominated (n = 9), the remainder from South Africa and Turkey. The results are described using four themes: benefits and limitations of service user involvement; nursing student selection; education delivery; practice-based learning and assessment. Most studies were small scale; nine had less than 30 participants. Overall the evidence suggests that student, lecturers and service users valued service user involvement in nurse education, to provide an authentic insight into the illness experience. Logistical considerations around support and student cohort size emerged. Conclusions. This is the first systematic review to focus on service user involvement in general nurse education. It reveals that service user involvement commenced later and is more limited in general programmes as compared to equivalent mental health education provision. Most of the evidence focuses on perceptions of the value of involvement. Further research is required to more clearly establish impact on learning and clinical practice. Relevance to clinical practice. Service user involvement in nurse education is valued by stakeholders but preparation and support for those involved, including mentors is underestimated. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various reports in the issue on the topics including one on individual’s human rights including cultural rights, the other on Indigenous communities and the third on increasing morbidity and mortality rates.