Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients.
Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients.
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DOI：
10.1136/bmjopen-2020-038168
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发表时间：
2020-09-29
期刊：
影响因子：
2.9
通讯作者：
Firestone M
中科院分区：
文献类型：
--
作者：
Churchill ME;Smylie JK;Wolfe SH;Bourgeois C;Moeller H;Firestone M
文化安全是一个土著概念，可以改善向加拿大土著和非土著人民提供保健服务的方式。本研究探讨了如何土著和非土著客户在城市，土著为重点的助产实践在多伦多，加拿大（第七代助产士多伦多，SGMT）概念化和体验文化安全的护理。与SGMT的前客户进行了访谈，作为对该业务进行更大评估的一部分。参与者是有目的地招募的。采访被转录和分析的主题使用迭代，共识为基础的方法和一个关键的，自然的，和非殖民化的透镜。在20次访谈后达到饱和（n=9名土著参与者，n=11名非土著参与者）。出现了三个文化安全领域。每个领域包括几个主题：关系和沟通（尊重和支持选择;与助产士建立个性化和持续的关系;与过去的经验不同）;分享知识和实践（感觉了解怀孕、分娩和产后期的基本知识;并获得土著知识和协议）和文化安全空间（在实践中有宾至如归的感觉;并与物理空间建立相互联系）。虽然各群体都有一些共同的想法，但土著和非土著与会者之间的区别很明显。土著与会者将文化安全概念化，强调土著价值观、理解和方法在多伦多等城市的生存和复兴，并确认需要土著助产士。非土著参与者概念化的文化安全既一致，照亮黑人土著社区团结在文化安全，和分歧，展示了土著空间和土著为重点的助产护理的潜力，也有利于助产客户的白色欧洲血统。我们希望这里记录的积极影响激励评估人员和医疗保健提供者努力实现“文化安全”成为护理标准的未来。
Cultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care. Interviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens. Saturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants). Three domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent. The Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where ‘cultural safety’ becomes a standard of care.
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