This chapter introduces First Nations approaches to health care that have relevance for the Australian and Aotearoa New Zealand contexts. It examines the historical influences that impacted the health and well-being of First Nations in these countries and considers the need for adopting First Nations approaches to health care practice such as cultural safety, cultural responsiveness and other cultural frameworks. Several of the principles for practice are transferrable to international First Nations communities as well as culturally and linguistically diverse populations.

Cultural competence and cultural safety support health professionals to recognise everyone as unique in order to promote optimal health outcomes. This allows for the acknowledgement of diversity that exists within and between individuals and groups in health care. In practice, this represents the broader understanding of culture in health care, and encompasses the dynamic influences of culture on attitudes, values and beliefs. Alongside culture, the understanding of diversity is inclusive of – yet not exclusive to – age and generation, sex and gender identity, socio-economic status, occupation, ethnicity or migrant experience, religion or spirituality, and ability or disability.

Throughout this guide, you will find that, in addition to their ideological or theoretical foundations, most of the considerations, discussions and decisions you participate in through the editing process are necessarily framed within a moral or ethical lens. Here, I differentiate between the terms:

• moral – personal/individual conceptions of right and wrong, and how we should live – and

• ethical – upholding standards for right and wrong/good and bad in a particular setting.

The focus of this chapter is culture, and in particular developing nursing care that is culturally sensitive and culturally safe. In the vignette above, Li Wong’s family requested that information about her illness and prognosis be withheld from her because she was vulnerable, and they believed she would be severely affected by this information and the implications of it for her future well-being. In their view, emotional stability and well-being were essential to improving health. But to many nurses in Australian culture, the idea of concealing the truth from Li Wong would seem improper. Truthfulness underpins our practices of informed consent. In Australia, a patient is expected to give fully informed consent before treatment is provided, and should be provided with information about the risks and benefits of a procedure; otherwise, the nurse may be liable for assault (see Chapter 5). Truthfulness also forms the basis of clear communication and trust in the nurse–patient relationship.

There are many ways of being Māori. Ethnicity in New Zealand has now moved to a more contemporary approach of self-identification that assumes ethnicity is not static and predetermined. This means that any combination of physical features, cultural beliefs and ways of living can be found in people who self-identify as Māori. For Māori, health and culture are intricately linked, so there are vital aspects of te ao Māori (the Māori worldview) that must be understood in relation to their mental health experiences in order to provide safe and effective care. In this chapter we discuss how practitioners from all cultural backgrounds can engage with tangata whaiora and whānau in mental health and addiction settings. It will be helpful for people practising in the New Zealand context, as well as those who encounter people of Māori descent in Australia or elsewhere. It will assist practitioners to consider how institutional racism might influence their ability to care for Māori, and will encourage the exploration of personal cultural beliefs to transcend this.

There are many ways of being Māori. Ethnicity in New Zealand has now moved to a more contemporary approach of self-identification that assumes ethnicity is not static and predetermined. This means that any combination of physical features, cultural beliefs and ways of living can be found in people who self-identify as Māori. For Māori, health and culture are intricately linked, so there are vital aspects of te ao Māori (the Māori worldview) that must be understood in relation to their mental health experiences in order to provide safe and effective care. In this chapter we discuss how practitioners from all cultural backgrounds can engage with tangata whaiora and whānau in mental health and addiction settings. It will be helpful for people practising in the New Zealand context, as well as those who encounter people of Māori descent in Australia or elsewhere. It will assist practitioners to consider how institutional racism might influence their ability to care for Māori, and will encourage the exploration of personal cultural beliefs to transcend this.

This chapter covers the systems and services aimed at supporting Māori, Aboriginal and Torres Strait Islander children, their families and communities in achieving optimal health and wellbeing outcomes. New Zealand and Australia are separate countries with distinct colonial histories, policies, healthcare systems, practices and ways of life, although their First Peoples may share common experiences. Contemporary health services in each country are also separate and unique, so the content in this chapter is provided in discrete sections. Throughout the chapter, you will be able to identity key concepts related to the delivery of care that is culturally safe for Māori tamariki (children) and rangatahi (young people). This includes a whānau (family) and community approach to health and wellbeing. The Aboriginal and Torres Strait Islander authors use their cultural lens of knowing, being and doing through Aboriginal ways to highlight the key challenges in relation to meeting the needs of Aboriginal and Torres Strait Islander children and their connections . The authors bring to your attention cultural awareness, sensitivity, and safety in paediatric settings.

Although most children in Australia and New Zealand enjoy a long life expectancy and high level of wellbeing, paediatric death remains a sad reality for some families, and end-of-life care for children presents an important and challenging area of paediatric nursing practice. Paediatric palliative care begins when a disease is first diagnosed and continues throughout the illness trajectory. It therefore includes, but is not limited to, end-of-life care. Paediatric end-of-life care is the care provided to the child and family towards the end of a child’s life and includes care of the child’s body and support for the family following the child’s death. Although there are distinctions between the two terms, in this chapter they will be used interchangeably. This chapter provides a beginning understanding of some of the common symptoms experienced by, and concerns for, children in end-of-life care and their management, including pain, the management of side-effects of opioids, fatigue, dyspnoea, gastrointestinal disturbances and anxiety. It also discusses communication with dying children and adolescents, and the importance of family communication and support.

This chapter discusses the role of community controlled health services in the Australian healthcare system and their contribution to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It begins by exploring the establishment of community controlled health services in Brisbane in response to the different health needs of Indigenous people at the time. The chapter then discusses the concept of community control, defining it as being by the community, for the community. Aboriginal community controlled health organisations (ACCHOs) are led by, based in and governed by Indigenous communities. The chapter discusses the experience of working in a community controlled clinic as part of a multidisciplinary team. Key health services, including the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Queensland Aboriginal and Islander Health Council (QAIHC), and their contribution to culturally safe care, are discussed in detail. The chapter concludes by considering recent changes to the Australian healthcare sector and future opportunities for ACCHOs.

This chapter considers cultural safety within the context of Australian nursing and midwifery practice, using Irihapeti Ramsden’s definition of cultural safety as a framework. The chapter begins by considering the effects of colonisation on the health of Aboriginal and Torres Strait Islander peoples, and how nurses must be aware of their patients’ cultures (which extend beyond ethnicity) in order to effectively treat them. The chapter discusses the journey practitioners take from cultural awareness through cultural sensitivity to achieve cultural safety. The chapter suggests that nurses must use self-reflection as a tool to understand their own beliefs, values and attitudes and how these may impact the healthcare they provide. This chapter is a call to all nurses and midwives to understand the differences between themselves and their patients, and to provide culturally safe care to all patients.

This chapter discusses Indigenous suicide and self-harm from a social and emotional wellbeing perspective. It begins by discussing current rates of suicide and intentional self-harm by Aboriginal and Torres Strait Islander people, compared with non-Indigenous Australians and international Indigenous communities. The chapter then considers contributing factors to Indigenous suicides, such as intergenerational trauma, poverty and loss of culture, traditions and practice. The chapter contrasts social and emotional wellbeing with Western concepts of mental health and suggests that social and emotional wellbeing is prioritised in Indigenous contexts because it more holistic and positive. The chapter discusses the importance of culturally safe care in Indigenous communities when creating mental health strategies and treatment plans, using the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023 as its basis.

Cultural competence and cultural safety support health professionals to recognise each individual as unique in order to promote optimal health outcomes (Hoare, 2019). This allows for the acknowledgement of diversity that exists within and between individuals and groups in health care (Australian Human Rights Commission, 2018; Nursing Council of New Zealand, 2011). In practice, this represents the broader understanding of culture in health care, and encompasses the dynamic influences of culture on attitudes, values and beliefs (Cox & Taua, 2017; Stein-Parbury, 2018). Health professionals have a responsibility to provide culturally competent and safe care based upon mutual respect for all people. A key consideration when working with individuals is to seek an authentic understanding of their cultural context. This may include family, significant others or a notable absence of kinship (Ramsden, 2002; Wepa, 2015). In this chapter, the discussion focuses on understanding culture, cultural diversity and the need for health professionals to integrate cultural competence into everyday care to support culturally safe practice.

Cultural competence and cultural safety support health professionals to recognise each individual as unique in order to promote optimal health outcomes (Hoare, 2019). This allows for the acknowledgement of diversity that exists within and between individuals and groups in health care (Australian Human Rights Commission, 2018; Nursing Council of New Zealand, 2011). In practice, this represents the broader understanding of culture in health care, and encompasses the dynamic influences of culture on attitudes, values and beliefs (Cox & Taua, 2017; Stein-Parbury, 2018). Health professionals have a responsibility to provide culturally competent and safe care based upon mutual respect for all people. A key consideration when working with individuals is to seek an authentic understanding of their cultural context. This may include family, significant others or a notable absence of kinship (Ramsden, 2002; Wepa, 2015). In this chapter, the discussion focuses on understanding culture, cultural diversity and the need for health professionals to integrate cultural competence into everyday care to support culturally safe practice.

Since refugee and forced migration experiences are marked by experiences of displacement, exile and resettlement, family therapy with child or youth patients from these families often encompasses complex dynamics and contexts. Each family member may present unique intra-generational, developmental, systemic experiences and individual narratives while the family adapts and copes within collective, familial and individual acculturation realities. By engaging with cultural hybridization and dynamics of identity, family therapists’ interventions often address resilience promotion as well as child protection issues. In addition, since advocacy and institutional collaboration remain common frameworks of care, therapeutic spaces would benefit from using cultural safety and cultural axis parameters in shaping intervention strategies with the refugee family. Engagement of these refugees and displaced migrant families is supported by considering multiple perspectives within each family and also within the therapists themselves or the teams who are involved in clinical mandates. This chapter uses case vignettes to illustrate some family cases.