Cultural Safety

This paper explores the critical role, experience, and wisdom of traditional healers in providing culturally-safe dementia care for Indigenous populations in North America, particularly as the prevalence of dementia in these communities continues to rise. It highlights the varying perceptions of dementia across cultures; for instance, while Western medicine often views it as a disease, many Indigenous cultures interpret it as a spiritual transition within the life cycle. A literature review conducted from 2000 to 2025 indicates that the marginalization of traditional healers within formal healthcare systems significantly hinders the delivery of culturally sensitive dementia care. Community-led models illustrate that the integration of traditional healing methods with contemporary practices is vital for offering respectful care to Indigenous people living with dementia. These models are grounded in concepts such as co-design, relational accountability, and “Two-Eyed Seeing,” which establish traditional healers as crucial partners in the care process. The World Health Organization (WHO) formally recognized traditional healers as “community stakeholders” for dementia care and prevention globally. However, without the engagement and empowerment of traditional healers in the screening and diagnosis process of dementia, the implementation of the WHO Global Action Plan (2017–2025) on the public health response to dementia will be hindered, as these traditional healers are essential community stakeholders and allied partners for dementia care and prevention worldwide. The paper advocates for systemic reforms to support traditional healers and promote Indigenous self-determination in dementia care and calls for the development of medical education specifically tailored for traditional healers to establish a biocultural dementia care model that encompasses community support systems, spiritual approaches, a dementia-friendly environment, language preferences, and Indigenous culture, including arts, sciences, and philosophy.

PRE-REVIEW DRAFT: This article examines how 'Beautiful British Columbia magazine' (1959–1983) constructed the Canadian Okanagan as an exceptional landscape through transplanted European aesthetic ideals. Drawing on ecocriticism and visual culture analysis, it argues the publication's photography and editorial framing naturalized settler claims to unceded Syilx territory while cementing the region's enduring cultural mythology.

Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations.Using an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff (n = 7...

Objective To synthesise and appraise the design and impact of peer-reviewed evaluations of Indigenous cultural safety training programmes and workshops for healthcare workers in Australia, Canada, New Zealand and/or the United States. Design Systematic review.

The article describes national, regional and community-level activities that contributed to the Manitoba First Nation partnership in maternal and child health programming. The activities reveal a potential for health change that is possible through working together across jurisdictional boundaries. Although we are only in the early phases of program implementation, the Manitoba First Nation Strengthening Families Maternal Child Health Program already suggests considerable successes and measurable outcomes. The article encourages development of further partnerships in the promotion of First Nation health and wellness programming.

As planetary health challenges intensify, Canadian nurses are increasingly called to act for human health, health equity, and the health of the living world upon which humans depend. This integrative review explores how Canadian nurses have engaged with environmental justice and equity in the context of planetary health (including environmental health and climate change) over the past 25 years. Guided by Whittemore and Knafl's five-phase framework, 52 documents were analyzed from databases including CINAHL, MEDLINE, GreenFILE, Environment Index, Web of Science, and grey literature sources. Two overarching concept areas emerged: Environmental Equity and Justice in Nursing and Nursing for Planetary Health. Findings were organized across research, education, advocacy, and practice domains. Although the term "environmental justice" was used infrequently, its principles were widely reflected across the literature, with Indigenous environmental justice emerging as a distinct and critical area of emphasis. Nurses' primary contributions were situated in advocacy and education. The review highlights key gaps and future directions, including the need to diversify research methodologies, strengthen community-based collaborations, address health impacts among equity-denied populations, and integrate biodiversity, spirituality, and faith into nursing for planetary health. Developing environmental justice-informed planetary health nursing theory is also identified as an important next step. By grounding the profession in environmental justice, nursing is better positioned to engage with and respond to the complex, interrelated health challenges facing people, communities, and ecosystems on a rapidly changing planet.

The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced “Dahl-beer-weer gum-um-be-goo” in the Gumbaynggirr language means ‘safe children’) model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety ...

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The story of land-based immersion learning for nursing students in remote First Nations communities is told through the stories of ten authors. We represent a collaboration between First Nations Knowledge Keepers, nursing students, and nursing faculty. Our inquiry draws on Indigenous knowledge paradigms and research methodologies. Currently in the preliminary stages of gathering our findings, we are learning how transformation happens through culturally safe relationships and ethical learning spaces. We are learning that inquiry requires commitment, authenticity, and a respect for differences. Most importantly, we are learning that nurses need to uncover ingrained and colonized assumptions in order to imagine new possibilities for learning and inquiring with Indigenous people and communities. 

Background: There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. Methods: We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/ small-town and on-reserve contexts. Results: The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. Discussion: Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. Conclusions: Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.

Background: Increasingly, U.S. grandparents are raising their grandchildren. In Hawai‘i, 12% of Native Hawaiian grandparents live with grandchildren, compared to 7% of grandparents in all races combined in the state, and to 3.6% of grandparents in the total U.S. Although strong family-centric cultural values may provide Native Hawaiian grandparents with caregiving benefits, a generally poor health profile suggests they may also face challenges in this role. In this study, we talked to Native Hawaiian grandparents raising grandchildren (GRG) about the benefits and challenges of their caregiving experiences. Method: Three focus groups were conducted with Native Hawaiian grandparents (n=33) in Hawai‘i who were 55 years of age or older and caregivers to their grandchildren. Findings: The most prevalent themes voiced by

Background-The incidence of non-AIDS-defining cancers has increased significantly among persons living with HIV (PLHIV). Screening education is recommended. Purpose-Social learning, minority stress, and cultural safety theories informed this pilot to assess the feasibility of a colorectal cancer screening intervention targeted to PLHIV, with additional tailoring for relevance to Native Hawaiians, a group with low participation in cancer screening. Method-The targeted education included behavioral modeling and barriers counseling in a culturally safe environment. Using a 2-group, pre/posttest design, AIDS service organizations were randomized to culturally responsive or standard education. AIDS service organizations consumers recruited through venue-based promotions were the unit of analysis. Knowledgeattitudes-practices, fecal occult blood test screening completion, and intervention feasibility were measured. Results-Treatment arm participants, regardless of ethnicity, adhered to fecal occult blood test instructions and achieved increases in screening knowledge, attitudes, and practices. Relevance and acceptability of the educational intervention were endorsed. Discussion-The culturally responsive intervention was successful in this group of PLHIV. Additional tailoring may be needed to reach PLHIV who do not participate in organizational activities. Practice-This culturally responsive intervention shows promise for efficacy testing in a broader PLHIV population. Constituentinvolving strategies were central to its development and delivery. The increasing incidence of non-AIDS-defining cancers (NADCs) is of significant concern in the present landscape of cancer control for persons living with HIV (PLHIV). NADCs are all malignancies other than invasive cervical cancer, Kaposi's sarcoma, and non-Hodgkin's lymphoma, the latter of which are defining conditions for a diagnosis of AIDS. Between 1991 and 2005, NADC cases in PLHIV increased 3-fold, whereas incidence of AIDS-defining cancers dramatically declined. 5 Ten NADCs appear to contribute substantially to the cancer burden among PLHIV, including anal, colorectal, liver, lung, mouth and throat, renal, skin, and vaginal cancers; Hodgkin's lymphoma; and leukemia. As in the seronegative population, NADCs among PLHIV tend to be associated with older age. However, PLHIV are more likely to develop NADCs at a younger age than persons who are

In Canada, cultural safety (CS) is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples’ encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how CS for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted, and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, although l...

Culturally safe health practitioners are essential for effective service provision to culturally diverse populations, including Indigenous Australians. Therefore, cultural safety education during training as a health care professional is an essential component in helping improve the health of Indigenous Australians. This study examined whether the implementation of an Indigenous cultural safety education workshop increased self-rated cultural safety knowledge and attitudes of allied health students. The study employed a quantitative before-and-after design using pre- and post-surveys to determine the level of attitudinal change in students who attended a day long workshop. The study sample consisted of 1st year (n = 347) and 4th year (n = 149) allied health students at a regional Australian university over the years 2007–2011. Whilst the results of this current study are varied in terms of achieving positive change across all of the taught items of knowledge and attitude, they provi...

Etuaptmumk is the L'nuwey (Mi'kmaw) term for Two-Eyed Seeing, often described as integrating the strengths of Indigenous knowledge and Western perspectives for co-learning or inquiry. This paper frames Etuaptmumk/Two-Eyed Seeing (E/TES) as the L'nuwey (Mi'kmaw) eye and its knowledge foundation's sources of strength, rather than conceptualizing our cultural knowledge within Western frameworks. It explores the sources of L'nuwey knowledge and how it is acquired within a L'nuwey worldview. It enables L'nuwey knowledge systems to collaborate by converging our knowledge with Western perspectives through empirical inquiry, while maintaining the integrity of all knowledge strengths. Literature, mainly non-Indigenous, most often describes E/TES within Western-based categories as a theory, methodology, or concept, drawing on both Indigenous and Western perspectives. According to our worldview, Etuaptmumk cohesively integrates all of them when applying our L'nuwey knowledge and furthering knowledge development in L'nuwey research. In this study, E/TES serves as the basis for Two-Spirit research, integrating our L'nuwey worldview as fully as possible while balancing Western-based methods. Ultimately, Etuaptmumk is actively applied in an ungendered, fluid, and non-linear manner, contributing to the decolonization of sexuality and gender, and supporting the preservation, revitalization, or regeneration of L'nui'suti (Mi'kmaw language) and our knowledge development for L'nuwey research in Mi'kma'ki.

D’Antoine H1*, Abbott P2, Sherwood J3, Wright M4, Bond C5, Dowling C6, Lehmann D7, Eades A8, Bessarab D9 (2019) 1. Menzies School of Health Research, 2. Western Sydney University, 3. The University of Sydney, 4. Curtin University, 5. The University of Queensland, 6. Curtin University 7. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia 8. University of Western Australia 9. The George Institute for Global Health

Activists and scholars have long highlighted the precarity of migrant agricultural workers (MAWs) in Canada and the unique threat it poses to this group's health and wellbeing. In response, the Canadian government recently launched a series of targeted programming and services for this population. However, little research has explored the effectiveness of these initiatives within the broader support landscape. Our qualitative narrative research involving 165 MAWs in Southern Ontario aimed to explore the extent to which support services (i.e. health, legal, community) mitigate and address MAWs' key needs, as well as the mechanisms through which these support organizations achieve this. Drawing on the concept of cultural safety and the collective voices of participants, our team identified two key dimensions to inform a more comprehensive approach to service delivery for this population: alignment, which focuses on priority needs, and accessibility, which anticipates and mitigates barriers to help-seeking. Our work points to the value of expanding how we envision service provision, while simultaneously addressing the intricate structural inequities that create the need for accompaniment in the first place. A cultural safety approach necessitates situating temporary migrant programs and their service provisions within political and historical contexts while advocating for sustained support frameworks and fostering deeper engagement with MAWs, who ultimately determine when cultural safety is achieved.