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106 LAYING THE FOUNDATION
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UNIT 1
communities (CATSINaM, 2017a). For registered nurses (RNs), partnerships are
important for determining priorities, care planning and person-centred practice
(NMBA, 2016). Blignault et al. (2021) state that the development of the Aboriginal
Transfer of Care (ATOC) model relied on partnerships between mainstream
hospitals and services with First Nations community organisations, First Nations
hospital liaison ofcers, First Nations researchers and First Nations public servants
(seeFigure 4.2). In delivering culturally safe care, partnerships mean actively involving
Aboriginal and Torres Strait Islander peoples in the decision-making processes. This
means working with:
> ACCHOs in health care and social services
> CATSINaM
> IAHA
> National Association of Aboriginal and Torres Strait Islander Health Workers and
Practitioners (NAATSIHWP)
> Australian Indigenous Doctors Association (AIDA)
> other organisations that can be found on the Australian Indigenous
HealthInfoNet (https://healthinfonet.ecu.edu.au).
Working in ‘partnership’ means thinking about concepts of respect, holistic
health, relationality and cultural connections, and reexivity.
Respect
I love my heritage. I love to celebrate my heritage. It’s what connects me to all of
you here today. It’s what connects me to the land.
Respect is at the heart of First Nations’ cultures, and it is actively reinforced at
all levels (Korff, 2022). In Australia, it is standard protocol when speaking or
introducing ourselves to show respect and acknowledge Country, Elders, ancestors
and spirits of the place on which we speak. Showing this respect establishes and
afrms the identity of the speaker, honours positive connections between peoples
and recognises the identity and knowledge of others.
An Acknowledgment of Country (different from a Welcome to Country)
can be given by non-Indigenous people. It is an opportunity to introduce yourself
and show your respect for Country and the waters that you are on, and pay respects
to Traditional Custodians of the peoples who have a continuing connection to
Country and have done so for over 60000 years. An Acknowledgment of Country
usually takes place at the beginning of an event. An Acknowledgment can also be
printed in publications like this book (see an example in the imprint), in the credits
of lms and television shows, and so on.
A Welcome to Country is a ceremony performed by Traditional Custodians
to welcome visitors to ancestral land. Unlike an Acknowledgment of Country, this
sacred ceremony is conducted by a descendant of the Country that you are on. If no
Traditional Custodian is available, an Aboriginal and Torres Strait Islander person
from a different clan or a non-Indigenous person can deliver an Acknowledgment
ofCountry.
[Welcome to Country and Acknowledgement of Country] is a very important way
of giving Aboriginal people back their place in society … It’s paying respect, in
a formal sense, and following traditional custom in a symbolic way – Aunty Joy
Murphy Wandin, Aboriginal Elder of the Wurundjeri people.
Barty in Goodwin (2022)
Keynoteworthy (2019)
Another sign of respect is to consider holistic world views held by Aboriginal
and Torres Strait Islander peoples, when you commence a health assessment and
physical examination. Standard 4.1 directs the RN to conduct ‘assessments that are
holistic as well as culturally appropriate’ (NMBA, 2016, p. 5).
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES’ HEALTH 107
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Holistic health
Aboriginal health does not mean the physical wellbeing of an individual, but
refers to the social, emotional, and cultural wellbeing of the whole community.
For Aboriginal people this is seen in terms of the whole-life-view. Health care
services should strive to achieve the state where every individual is able to achieve
their full potential as human beings and must bring about the total wellbeing of
their communities.
Gee, Dudgeon, Schultz, Hart & Kelly (2014, p. 56)
In nursing and healthcare literature, the term ‘social and emotional wellbeing’
(SEWB) is used because it reects the perspective of Aboriginal and Torres Strait
Islander peoples about the interrelatedness of all dimensions of ‘being, knowing
and doing’ (Gee et al., 2014). Western biomedical medicine typically separates the
body (physical health), psychology (mental health) and spirituality of the person;
the spiritual health of the individual is often not considered at all in the Western
treatment and healing process. Medical specialties have been developed around
various parts of the body. For example, there are medical practitioners who are
experts in specialised areas, such as ophthalmic, cardiovascular, musculoskeletal or
neurological. Individuals are seen and treated without reference to their families,
communities, kinship systems, connection to Country, lore or culture.
While Western biomedical healthcare constructs of health and wellbeing are
typically focused on the individual and the absence of disease, Aboriginal and
Torres Strait Islander peoples’ view of health can be holistic. All social, emotional,
physical, cultural and spiritual dimensions of ‘being’ are inextricably linked and
interconnected to Country, cultures and spiritualities (Dudgeon, Bray, Smallwood,
Walker & Dalton, 2020). As the Fabric of Aboriginal and Torres Strait Islander
Wellbeing Model (see Figure 4.3) highlights, for many Aboriginal and Torres
Strait Islander peoples, the parts of life that are most important to wellbeing are
interwoven through their families, communities and cultures (Garvey et al., 2021).
CHAPTER 4
FIGURE 4.3 Fabric of Aboriginal and Torres Strait Islander Wellbeing Model
Note: this model takes inspiration from Aboriginal and Torres Strait Islander peoples’ weaving traditions whereby individual strands are
twined to ‘create fabrics that are both beautiful and strong, the parts of life that are most important to wellbeing for many Aboriginal and
Torres Strait Islander people are interwoven through their families, communities and culture.’ This model represents the characteristic that
the strength of wellbeing is derived from both the strength of the threads and their connections with each other.
GARV EY ET AL . (2021)
108 LAYING THE FOUNDATION
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Connection and belonging to family, kinships and
communities
Family and kinship systems have always been pivotal to the functioning and
wellbeing of ancestral and contemporary First Nations’ societies (Gee et al., 2014).
In fact, many believe family has been key to how First Nations cultures have
survived and continue to survive the effects of colonisation (Walker & Shepherd,
2008). For most Aboriginal and Torres Strait Islander peoples, families play an
important role in identity and sense of belonging and connectedness to kinship
and culture.
That extended family take it [family relationships] really seriously and want to
be engaged on that life. You will never be an only child. Here’s all your other
brothers and sisters … You’ve got all these other mothers and fathers to support
and teach you and that’s the strength of the system.
Kinship establishes where a person ts in their community, and Andrews
(2020) states that it helps determine a personal relationship as well as a
responsibility towards other people, the universe and Country. Underpinning
kinship is the understanding that everything is interrelated and interconnected;
that we are all family. Not only are we interconnected to other human beings,
but we are all part of creation, including stars, rocks, plants and animals; this
connection and belonging to a oneness is ‘Dreaming’ (Andrews, 2020). Kinship
systems are complex and incredibly rich and diverse. They serve to maintain
interconnectedness through cultural ties and reciprocal relationships. In turn, a
feeling of deep spiritual and cultural belonging is cultivated in the reciprocity of
these connections. If you would like to learn more about kinship systems, there are
online modules provided by Sydney University; see the ‘Further resources’ section
atthe end of the chapter.
While ancestral kinship structures remain important in many First Nations
communities today, it is critical to highlight that family and kinship is different for
every Aboriginal and Torres Strait Islander person, many of whom have retained
kinship connections. Those living in areas that were colonised earlier and most
intensively, or who are survivors of the Stolen Generations, may no longer have
large family or community groups. Many people living in urban settings still
maintain large family and community groups and have strong kinship ties with
family, regardless of where their extended family are living.
Only the Aboriginal or Torres Strait Islander person sitting in front of you can
tell you who they are and what their role is in the dynamics of their family kinship
and communities. As a healthcare professional, creating a safe and trusted space
and prioritising kinship and family systems in your practice delivery is a signicant
way in which you can build more respectful relationships with Aboriginal and
Torres Strait Islander peoples. Develop your knowing; that just as you love and value
your family (however you dene that), so do Aboriginal and Torres Strait Islander
peoples, and here we can nd shared ground with all human beings.
Riley (2014)
PUTTING IT IN CONTEXT
My rehab, my journey – Gadjigadji
Visit https://aci.health.nsw.gov.au/projects/my-rehab for information about the gadjigadji
(a Gamilaraay word meaning regrowth), and think about how cultures are shown in every
aspect of the project (ACI, 2022):
> What do you observe about the languages and artwork used?
> What do you notice about the consultation process and the implementation resources?
> Do you think these ways of ‘knowing, being and doing’ would benet other cultures?
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES’ HEALTH 109
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Connection and belonging to Country
We don’t own the land, the land owns us. The land is my mother, my mother
is the land. Land is the starting point to where it all began. It’s like picking up a
piece of dirt and saying this is where I started and this is where I’ll go. The land is
our food, our culture, our spirit and identity.
Knight (1996)
Connection is paramount in Aboriginal and Torres Strait Islander peoples’
understanding of the world, and connection to family, kinship, cultures and
Country. For millennia, there has been a deep knowing in First Nations cultures
that all living connections and ancestral relationships between the natural elements
of Country, plants, animals, rivers, stars and people make life possible. Many
Aboriginal and Torres Strait Islander peoples do not separate themselves from the
lands and waters from which they descend. This connection and belonging to
Country dene the reciprocal responsibility to care for Country, rather than having
ownership or possession of it, and it is considered a privilege to do so (Korff, 2022).
For many Aboriginal and Torres Strait Islander peoples, being on Country is a
deep and fundamental spiritual experience. In this environment, ceremonies and
rituals can be practised, Dreaming can be shared, and sacred sites can be visited. It is
through the performance of ceremonies and storytelling that contact is made with
ancestral spirits and guidance and ancient wisdom can be drawn upon (Korff, 2022).
With colonisation, many ancestral groups were forcibly removed from Country
so that the British could exploit the wealth and resources of the land. Although
many Aboriginal and Torres Strait Islander peoples have been relocated and no
longer live on Country, it cannot be emphasised enough that this does not diminish
one’s cultural and spiritual connections to Country.
One of the initiatives to celebrate cultural diversity is the campaign Know Your
Country where nurses can, for example, add an email banner to acknowledge the
Country they are working on (Know Your Country, 2022). Although a simple activity, it
shows reexivity in thinking about the cultural context of the healthcare service.
CHAPTER 4
Reexivity
Standard 1.2 of the ‘Registered nurse standards for practice’ requires nurses to think
critically and analyse nursing practice. This involves ‘reection on experiences,
knowledge, actions, feelings and beliefs to identify how these shape practice’
(NMBA, 2016, p. 3). It is important to clarify what is meant by ‘reection’ and to
compare this to ‘reexivity’ (see
self-awareness, of identifying and developing an understanding of self-identity in
relation to others. Moving into critical thinking means deeper exploration of your
held beliefs and how they may impact on care provision. Then, analysing your held
beliefs and the social context in which they occur can move you into meaningful
Basic reection
• Identication of own
identity, culture, and
worldviews (self-identity)
• Develop understanding
that own culture and
worldview can impact
interactions with others
(relationality)
FIGURE 4.4 Spectrum of reexive practice
DAWSON, L ACCOS -BARR ETT, HAM MOND & RUMB OLD (202 2)
Figure 4.4). Basic reection is about developing
Critical reection
• Identication of own
beliefs, biases, and
attitudes (held beliefs)
• Identication of own
power and privilege
(held beliefs)
• Analysis of how own
beliefs, biases,
attitudes, power and
privilege impact on care
provision (relationality)
• Critical reection on
own beliefs, biases,
attitudes, power, and
privilege (held beliefs)
• Analysis of the social,
historical, political, and
discursive factors that
have shaped them
(context)
• Analysis of impact they
have on care provision
(relationality)
Reexivity
110 LAYING THE FOUNDATION
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actions for changing your practice with diverse people and those meaningful
actions typify reexivity (see the ‘Communication in clinical practice’ section).
If unconscious bias and racism can be considered a sickness, then reexivity
would be the medicine. Ongoing critical self-reection and reduction of the power
differences are central to being culturally safe and responsive. It is a lifelong journey,
as the late Uncle Kevin Gilbert (1988) says, to:
develop all people and encompass them in a code of spiritual being and national
conduct, which not only reects the very essence of life itself and the ultimate
continuum for Being, but also will enable us, upon attainment, to project that
magnanimity of spirit throughout the world.
As IAHA (2019, p. 4) highlight, ‘Cultural safety does not necessarily require
the study of any culture other than one’s own …’ and how you study yourself is
a matter of what tool and process best resonates with you. See the ‘Reection in
Practice’ box following for an example of a tool you might use to take this learning
and critical reection deeper.
While critical reection will ensure that you unpack the inner workings of your
stereotypes, biases, norms, assumptions and belief systems, and question where they
came from, being ‘reexive’ is about doing activities that transform nursing practice.
Stereotypes
It is important to recognise that we are a product of our environment and that our
brains categorise the world based on our experiences. This ‘grouping’ of information
is an efcient way for our brains to process and store vast knowledge and avoid
being overloaded. However, this natural tendency for our brain to categorise the
world means that we often oversimplify social groups based on visible features
(e.g. skin colour, gender, sex and age). These are known as ‘stereotypes’ and are
constructed from direct personal experience, or more commonly, from other people
or the media. Although this a natural way that our brains organise themselves,
itcan be detrimental to the person being stereotyped.
There are still some persistent negative stereotypes about Aboriginal and Torres
Strait Islander peoples, which have largely been perpetuated and reinforced by the
Australian media. In fact, the Portrayal of Indigenous health in selected Australian
media study found that 74per cent of articles about our health focused on
negative stories within First Nations communities (Stoneham, Goodman & Daube,
2014). Specically, the media is often saturated with stories of the poor health of
Aboriginal and Torres Strait Islander peoples that focus on alcohol, child abuse,
petrol snifng, violence, crime and deaths in custody. In healthcare practice, these
stereotypes become dangerous, as they directly impact on the type of treatments
that are provided. For example, Aboriginal and Torres Strait Islander peoples are a
third less likely to receive the same care as non-Indigenous people with the same
condition (RACP, 2005). If bias and stereotypes go unaddressed and unquestioned,
personally and within the healthcare profession, they have the potential to manifest
REFLECTION IN PRACTICE
Bass Model of Holistic Reection
The Bass Model of Holistic Reection (Figure 4.5) (Bass, Sidebotham, Sweet & Creedy,
2022) helps you to understand and practise your reective skills. Use the template plus
the ‘Spectrum of reexive practice’ (Figure 4.4) to reect on a recent event involving an
Aboriginal or Torres Strait Islander person in which you demonstrated a reected ability to
improve, or demonstrated the need for further learning or development.
> Were you able to identify your own critical reection?
> What beliefs, biases, attitude, power and privilege could you discern?
> How did it impact on the interaction with the other person?
>>
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>>
SELF -
AWARENESS
Inner
CHAPTER 4
HOLISTIC
REFLECTIVE
PRACTICE
(synthesis &
integration)
MAKING
MEANING
(evaluation
& analysis)
FIGURE 4.5 Bass Model of Holistic Reection
REFLEXIVE
CRITICAL
REFLECTION
REFLECTION
AWARENESS
SELF, OTHERS
& SOCIETY
KNOWING
(holistic ways
of knowing,
being &
doing)
MAKING
SENSE & PLACE
(remembering)
REFLECTION
(thoughts &
feelings)
BASS, S IDEBOT HAM, SWE ET & CREED Y (2021)
in maltreatment, miscommunication and racism (both individual and systemic)
towards Aboriginal and Torres Strait Islander peoples.
It is important to become aware of our biases and to mitigate the impact that
beliefs and attitudes have on our behaviour towards specic groups of people. Many
of our stereotypes are unconscious and we may not even be aware of holding them,
as demonstrated in the Harvard Project’s Implicit Association Test (Project Implicit,
2011) in the following ‘Putting it in context’ box.
PUTTING IT IN CONTEXT
Implicit Association Test (IAT)
Project Implicit is a non-prot organisation and international collaboration between
researchers who are interested in implicit social cognition, thoughts and feelings outside
of conscious awareness and control. The goal of the organisation is to educate the public
about hidden biases and to provide a ‘virtual laboratory’ for collecting data on the internet.
The IAT for social attitudes has been developed as a tool for exploring the unconscious
roots of thinking and feeling and allows individuals to gain greater awareness about their
own unconscious preferences and beliefs.
You can undertake the test at https://implicit.harvard.edu/implicit/.
112 LAYING THE FOUNDATION
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Power and privilege
If you categorise the world based on your experiences, and you have never
experienced racism and the subsequent barriers that emerge because of your skin
colour, then these experiences are essentially invisible to you. Not being subjected
to these experiences is considered a ‘privilege’ that is not afforded to those with
darker skin, and this is commonly called ‘white privilege’. Non-Indigenous white
people have privilege in choice, advantages and resources that work in their favour,
as opposed to people of colour who experience a multitude of barriers to gaining
access to the same resources. These barriers, which are rooted in historical inequity,
include systems, policies and laws that disenfranchise and impoverish Aboriginal
and Torres Strait Islander peoples (Mayes, 2020). Non-Indigenous white people are
not forced to question their behaviours because the system is established with them
at the centre, as ‘normal’ (e.g. non-Indigenous children are seldom taught that they
might be discriminated against by police, social services or health systems
because of the colour of their skin, whereas Aboriginal and Torres Strait Islander
children are).
In the context of the healthcare system, when referring to a person as having
‘privilege’, it is about the access they have to resources. Those with more power
have access to things that those without power, typically members of marginalised
groups, do not have access to (PCC4U, 2022). The idea of ‘unearned access’ is
where the inequity lies because access is based on an identity someone holds that
has traditionally been associated with power. Here, ‘power’ refers to the capacity
that a person must exercise control over others, deciding what is best for them,
and deciding who will have access to resources, all of which are discussed in the
‘History’ section of this chapter.
Given that we all learn and are shaped by experiences, not understanding
that this unconscious privilege and power exists makes it easier to be unaware of
or deny its existence. This ignorance can be toxic if you then hear other groups
getting ‘advantages’ that you do not get. For example, there are many stereotypes
circulating that Aboriginal and Torres Strait Islander peoples receive free loans, cars,
houses and jobs; although untrue, they serve to create negative attitudes towards
Aboriginal and Torres Strait Islander peoples (Pedersen, Dudgeon, Watt &
Grifths, 2006).
The only way to reveal the unconscious world in which you live is by taking a
deep, honest and inward journey to becoming aware of the unconscious dimensions
of yourself. This can be achieved through reexivity and making changes to your
clinical practice.
COMMUNICATION IN CLINICAL PRACTICE FOR HEALTH
ASSESSMENT AND PHYSICAL EXAMINATION
‘Unsafe cultural practice comprises any action which diminishes, demeans or
disempowers the cultural identity and wellbeing of an individual’ (NCNZ, 2011,
p. 7). The ‘Registered nurse standards for practice’ contain many aspects of practice
that you will be expected to full throughout your nursing career. This includes
being responsive to Australia’s cultural and linguistic diversity, and to the diverse
cultures of Aboriginal and Torres Strait Islander peoples. At universities, nurses are
required to learn about First Nations’ professional capability: the capacity to work
effectively with and for Aboriginal and Torres Strait Islander peoples (Page, Trudgett
& Bodkin-Andrews, 2019). In this section are examples of what culturally safe and
responsive practice can look like, and some techniques associated with culturally
safe communication, such as the RN Standard 2.2 ‘communicates effectively, and is
respectful of a person’s dignity, culture, values, beliefs and rights’ (NMBA, 2016,
p. 5; see Chapter 2).
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Shared decision-making
To create equal, two-way sharing of knowledge we must nd the space where ‘two
streams’ meet equally. This means we need to remove the underlying belief that
you, as the clinician, are the one with all the knowledge and therefore power in
the healthcare interaction. In fact, the Aboriginal or Torres Strait Islander person
receiving care has incredible cultural knowledge and wisdom to bring to the
exchange. In
with First Nations stakeholders to ensure that whatever health choices Aboriginal
and Torres Strait Islander peoples make, they can feel safe and trusted to make
informed decisions based on each person’s values and beliefs. The different stages
of the patient journey, incorporated with yarning, ensures shared decision-making,
and opening of doors to nding a safe and effective way to health and wellbeing.
In turn, this supports the ‘purpose and control’ weave of the Fabric of Aboriginal
and Torres Strait Islander Wellbeing Model (refer to
What does shared decision-making and a meaningful journey look like? The
Daalbirrwirr Gamambigu (Safe Children) Model of care is one way to map out how
cultural safety can be embedded in the patient journey through paediatric EDs
(Flemington et al., 2022). The aim is for a culturally safe patient journey where First
Nations ‘families experience respect, dignity and empowerment in their patient
journey’ (Flemington et al., 2022). Developing a culturally safe patient journey
(see
Figure 4.6) was based on extensive stakeholder yarning, partnerships with a
range of service providers, inclusion of Aboriginal people in all aspects of the
project, and testing with over 50 Aboriginal and non-Indigenous nurses and health
professionals. The patient journey shows the points and pathways where nurses
(and other staff) interact with First Nations families.
Figure 4.6, you will see a patient journey model that was developed
Figure 4.3).
CHAPTER 4
FIGURE 4.6 Culturally safe patient journey
FLEM INGTON E T AL. (202 2)
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It is at these points and pathways that nurses can be culturally responsive. While
you have developed your ‘knowing’ and your ‘being’, here we explore how this
applies to your ‘doing’. What are the ingredients to building connection, trust and
respectful two-way relationships with Aboriginal and Torres Strait Islander peoples?
It often begins with surrendering your ways of ‘knowing, being and doing’ and
rebuilding yourself in ways of dadirri, yarning and shared decision-making; all of
which are holistically interconnected.
Dadirri: deep listening
Drawing on her deep respect for Country and a unique and sacred identity
with the land, Aboriginal Elder, Dr Miriam-Rose Ungunmerr-Baumann of the
Ngangikurungkurr peoples from Daly River (Northern Territory), shares one of the
unique and special gifts of her people, ‘dadirri’ (pronounced da-did-ee). Dadirri is
a powerful practice of inner, deep listening and quiet, still awareness (Ungunmerr
Bauman, 1988). It facilitates deep reection and contemplation, which brings peace,
understanding and increased awareness as you tap into the deep spring that sits
inside all of us. In Australia, people from both First Nations and non-Indigenous
backgrounds have embraced the ancient practice of dadirri to support healing and
wellbeing and reveal pathways to new knowledge.
In our Aboriginal way, we learnt to listen from our earliest days. We could not live good
and useful lives unless we listened. This was the normal way for us to learn – not by
asking questions. We learnt by watching and listening, waiting and then acting …
We cannot hurry the river. We have to move with its current and understand its
ways …
We hope that the people of Australia will wait. Not so much waiting for us – to
catch up – but waiting with us, as we nd our pace in this world …
My people are used to the struggle, and the long waiting. We still wait for the
white people to understand us better. We ourselves had to spend many years
learning about the white man’s ways. Some of the learning was forced; but in
many cases people tried hard over a long time, to learn the new ways.
We have learned to speak the white man’s language. We have listened to what he
had to say. This learning and listening should go both ways. We would like people
in Australia to take time to listen to us. We are hoping people will come closer.
We keep on longing for the things that we have always hoped for – respect and
understanding …
To be still brings peace – and it brings understanding …
Our culture is different. We are asking our fellow Australians to take time to know
us; to be still and to listen to us …
Further information on the beautiful, contemplative practice that is dadirri can
be found in the ‘Further resources’ section at the end of the chapter.
Ungunmerr-Baumann (1988)
Yarning: cultural communication
Yarning is a free-owing reciprocal conversation that involves deep listening (dadirri)
to storytelling that creates new knowledge and understanding in an environment
where all participants feel safe and respected (Bessarab & Ng’andu, 2010). It embodies
and continues First Nations’ oral traditions and builds deep reection and empathy
among non-Indigenous participants (Lawrence & Paige, 2016).
As our ancestors knew, storytelling is a holistic process that engages the
heart, body, and spirit along with the mind. Telling our stories is one way of
making sense of our own experiences. Listening to others’ stories also helps
us to understand ourselves as we identify with their experiences. On the other
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hand, listening to stories around difference helps to promote empathy and
understanding, particularly between people of different cultures. It broadens our
knowledge. Storytelling has the power to disrupt stereotypes. It is difcult to judge
a person by his or her cultural membership once you have heard his or her story.
Lawrence & Paige (2016, p. 66)
Clinical yarning foregrounds First Nations cultural communication
preferences to the important aspects of healthcare conversations (Lin, Green&
Bessarab, 2016). It is a way of communicating that is culturally secure and
encourages deep listening, and helps to build a trusting relationship.
The ‘clinical yarning framework’ talks about three types of yarning, which are
captured in
Figure 4.7.
Social yarn
Show an interest in patient
(holistic)
Develop relationship
Find common ground or
connection
Two-way exchange —
sharing life experiences
CHAPTER 4
Keys to
Clinical Yarning
• Culturally secure
• Patient-centred
• Active listening
Management yarn
Provide direct, ‘straight-up’
health information
Use stories and metaphors to
explain health condition and
build motivation
Co-create the plan for care
FIGURE 4.7 Keys to clinical yarning
LIN, GRE EN & BESSA RAB (20 16)
• Build a trusting
relationship
Diagnostic yarn
Hear the patient’s ‘health story’
Use open-ended style
Allow silences
Interpret story through
health lens
To explore and learn how to apply clinical yarning into your practice,
there are free online modules available via the Clinical Yarning Project website
(seethe ‘Further resources’ section at the end of the chapter). A cultural yarning
process informed the ATOC model (Blignault et al., 2021) about strengths-based
communication. The ATOC model maps a patient journey for Aboriginal and Torres
Strait Islander peoples with chronic disease, and emphasises culturally responsive
teamwork, hospital support structures and partnerships with a range of community
service providers (Blignault et al., 2021). For shared decision-making, yarning is
important for nding a reciprocal way in making decisions with Aboriginal and
Torres Strait Islander peoples (ACI, 2021).
Keeping track of culturally safe practice
This chapter has introduced you to new ways of practising nursing. It is important
to demonstrate culturally safe practice for nursing accreditation and registration
(NMBA, 2016; ANMAC, 2019). One form of evidence is demonstration of cultural
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