Understanding and responding to racism and the provision of culturally safe care by interdisciplinary health professionals in the aged care sector in regional, rural and remote areas: a scoping review
Bibliographic record
Abstract
INTRODUCTION: This scoping review was undertaken to obtain conceptual clarification about how racism and cultural safety are understood by interdisciplinary health professionals globally in the aged care sector in regional, rural and remote areas. There is evidence in Australia and internationally that racism is a factor impacting significantly on the health of First Peoples and other racialised minorities. Recent policy changes in Australia have required health professionals to integrate cultural safety into their practice to mitigate racism and improve the health of older First Nations Australians and older people from diverse ethnic and cultural groups. METHODS: This review consisted of literature published in English from 1990, including published primary studies; systematic, integrative and narrative reviews; meta-analyses; theses; policy documents; guidelines; position statements; and government literature. Ovid (MEDLINE), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health Database, and Informit were used in the full search. The most recent search of all databases was undertaken on 9 May 2022. Ten papers were included in the review, following the exclusion of 376 papers. A title and abstract search of the reference lists of papers included in the review identified no additional papers. RESULTS: Ten papers were included in the review from Australia, Canada, the US, Norway and England. The literature reviewed suggests that health professionals in the aged care sector in regional, rural and remote areas in Australia, Canada, the US, Norway and England use alternative terms to 'racism' and 'racist', such as 'institutional marginalisation'. DISCUSSION: The absence of explicit reference to racism aligns with critical race research that argues implicit bias and institutional racism are often separated from an individualised understanding of racism. That is, practitioners may understand racism as something that is perpetrated by individuals in an otherwise 'neutral' health setting. There is also a lack of clarity on how culturally safe care is understood, even though individual care plans are viewed as instrumental in establishing the needs and preferences of the consumers. Within the literature surveyed, barriers to providing quality and culturally inclusive care include disengaged management, insufficient human and material resources, language barriers and a lack of education focused on the needs of older individuals and groups with various cultural and spiritual needs. Additionally, the review does not clearly illuminate what health professionals understand to be racist thinking or behaviour and how it is responded to in practice. Likewise, there is limited information about health professionals' understanding of cultural safety and how to provide culturally inclusive care. CONCLUSION: While work is beginning on developing standards for cultural safety training in an Australian context, there are also opportunities to consider how these should be applied or adapted to residential and community aged care to best meet the needs of a diverse consumer base and workforce.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".