Providing safe, compassionate care of all patients through our ED is our core business. The creation of consistent culturally safe care for our indigenous patients however remains a big challenge – and also a great opportunity for growth in all of our EDs. WRaP EM talks with ED Nurses Kitty Synot, Wamba Wamba woman and Jess Payne, Yuwaalaraay woman about their expertise in creation of meaningful change and patient care optimization in her work place at Gold Coast University Hospital and through the Transforming ED to Cultural Safety (TECS) project.
- Why do you think we need to optimize cultural safety in our EDs?
Aboriginal and Torres Strait Islander people have a historical mistrust of government organisations. Historic experiences such as racism, miscommunication and mistreatment have influenced the level of distrust, which is reflected in the fact that Aboriginal and Torres Strait Islander patients are five times more likely to leave hospital against medical advice. As the front door to the hospital, Emergency departments are central to how a health service is perceived and can ‘set the scene’ for the entire health journey. How we as Emergency departments treat our first nations patients can be instrumental in their health perception and health journey.
- What can all ED staff do to make sure we help our indigenous colleagues to thrive in our workplaces?
Our ED staff need to be open-minded and willing to re-learn history to increase their understanding and to acknowledge the value of traditional knowledge and ways of doing that Aboriginal and Torres Strait Islander staff bring to the care of all patients. As Aboriginal and Torres Strait Islander staff are severely underrepresented in emergency departments it is important that they are supported in their career progression, including given opportunities for career development. Increasing the Aboriginal and Torres Strait Islander staff in the workforce is acknowledged as a fundamental element in making health care more culturally safe for Aboriginal and Torres Strait Islander peoples.
2.b Optional question – what has been one thing that has helped you thrive in your roles as ED nurse?
The support of each other as Aboriginal women has made us feel safe and empowered in this space. This has been more than just a project for us, this is something we live and breathe that affects us and our family’s day in day out.
- Tell us about one application of how you have optimized the cultural safety in your ED?
We have developed and more streamlined process of identifying our Aboriginal and Torres Strait Islander patients. It is now part of the triage process and the ‘do you identify’ question is asked to every patient at the same as DOB/medical history/allergies.
We have also held many education sessions with nurses and doctors on cultural safety, identifying patients and on significant dates such as NAIDOC week. We have organised Indigenous specific shirts for the department and have collaborated with other providers for department artwork.
- Once a patient identifies as ATSI, it is ideal to then offer the services of an indigenous liaison office. However, there are many smaller EDs who may not have the availability of this service at all. Even the larger EDS don’t have availability out of normal office hours a lot of the time. What can EDs do to help with the patient journeys if they do not have this service to patients?
Even GCUH being the busiest emergency department in the country has limited resources in this space. We have 3 HLOs over two campuses (GCUH and Robina) who are rostered mon-fri 0800-1630. It is still important to refer these patients to the HLO service even if after hours via voicemail or email as they have the ability to touch base with patients via phone or at a later date. Staff can try to develop a culturally safe rapport with patients, try to be understanding and open to learning their stories. Respect the patients cultural way of doing things, and understand that this may be a different way to mainstream healthcare. Staff can use this as a opportunity to connect with the individual and show that our health service is more than just collecting date.
But also, complete a riskman/incident report if there isn’t culturally available care!
- What are the top two resources you would recommend for ED staff who want to learn more about cultural safety in the ED?
Engage with the Aboriginal and Torres Strait Islander colleagues/ HLOs are a great support.
CATSINAM – Congress of Aboriginal and Torres Strait Islander Nurses and Midwives
LINMEN – leaders in Indigenous Nursing and Midwifery education network
AIDA – Australian Indigenous Doctors’ Association
Perhaps could put some TECS resources in here esp for those readers outside of QLD?