Within By understanding the impacts these events had, the

Within
the Physiotherapy setting, there is undeniably cultural bias and interpersonal discrimination
towards First People’s. Having said that, many physiotherapists are unaware
that their communication and/or mannerisms are offensive towards this
population. Another issue is not being aware of the cultural differences of First
Peoples, which leaves the practitioner at a disadvantage to provide healthcare
equality. A study by Gladman & Ryder (2015) found
that clinical academics and clinicians believe Australia’s healthcare model
does not meet the needs of First Peoples. Furthermore, at an institutional
level, most Physiotherapy Courses in Australian Universities lack a First
People’s subject or training. A great way to introduce this cultural safety
training is through Professional Development (PD) Workshops at the
institutional level, such as a hospital. 

 

This plan
involves the development and implementation of face-to-face cultural competency
workshops to be trialled at Toowoomba Base Hospital. This will be in the form
of five videos, after which there will be five 30-minute modules to be
completed weekly. After the five week period the participants will be asked to
write a short 300 word reflective journal using the principles of self-reflexivity
at the end of each fortnight for the next 16 weeks. The journals will discuss
interactions with First People’s as patients and what material from the PD
series they implemented and/or integrated into their practice to aid in the
service of their patients.

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These
videos were chosen as they explore the effects of western colonisation on the
health status of First Peoples and their relationships with health
professionals of the 21st century. By understanding the impacts
these events had, the Physiotherapist should be better equipped to treat with
patients who identify as First Peoples. The 5 videos are (Commonwealth
of Australia, 2014):

1.                 
The White Australia Policy

2.                 
Protection & Segregation

3.                 
Assimilation & Integration

4.                 
Self-determination & Self-management

5.                 
Indigenous Advancement Strategy

The
modules were specifically designed to provide Physiotherapists with ideas and
strategies of how to become more culturally capable when interacting with First
Peoples patients. The 5 modules are (Commonwealth of Australia, 2014):

1.                 
Respect

2.                 
Safety and Quality

3.                 
Reflection

4.                 
Communication

5.                 
Advocacy

During the 16 weeks, each patient that
identifies as a First People and has been treated by one of the participating
Physiotherapists at Toowoomba Base Hospital will be invited via phone call to
attend a group discussion at the end of the 20 weeks. Here patients can openly
discuss their experiences and if it differed from other physiotherapists or healthcare
professionals that did not participate. Furthermore, First People review patients
attendance rates will be compared with attendance records from 20 weeks prior
the PD workshop series.

Complications
between First Peoples and Physiotherapy practitioners have commonly occurred due
to the clinician failing to demonstrate or lack the skills of cultural safety. 
Being culturally
safe from a Physiotherapy perspective means allowing the patient’s
pre-existing cultural beliefs and desires to guide treatment options. This
requires the Physiotherapist to understand each patient’s cultural origins. In
addition, the practitioner themselves must know what cultural differences
they bring to the table and what potential subconscious power imbalances may evolve
from this (Taylor, Guerin 2010). First Peoples have faced racial discrimination
from healthcare professionals for decades which has resulted in First People’s
describing Western healthcare as alienating and foreign (Farrelly &
Lumpy, 2009). These negative psychosocial constructs have inherently lead to
ongoing poor relationships with healthcare professionals (Ziersch, Gallaher, Baum
& Bentley, 2011). It has been described that a ‘basic
trust’ is required to create positive and lasting relationships with
healthcare professionals and this can only begin with effective communication
(McMahon, 2007).
 
Ultimately,
to resolve the inequalities First Peoples face it has been widely contended
that healthcare professionals become more culturally sensitive and capable
(Zambas & Wright, 2016; Taylor
& Guerin, 2014). An example of this is in Fredricks
(2008) publication, which recalls a research project in Rockhampton that
interviewed First peoples women about cross-cultural training of health
professionals. One individual concluded that cultural capability training can
reduce the inequalities First peoples face, but requires a genuine individual
to make a change in their own practice (Fredricks, 2008). Fortunately, Physiotherapists
have daily opportunities to develop these skills compared with the general
public and it is in their best interest to reduce the anxiety they have
towards healthcare (Beach et al., 2005). This then
provides a safe clinical environment for First Peoples which should then
positively affect First People’s communities (Farrelly & Lumpy, 2009).
 
The
modules aim to improve the interactions between Physiotherapists and First
People’s patients through more diverse and safe communication styles and
patient centred outcomes. Ultimately, it will provide Physiotherapists with
the necessary knowledge and tools to become more culturally competent
practitioners and to create this ‘basic trust’. Applying these new techniques
should also help change current predispositions First Peoples have towards the
healthcare system, which in turn should assist in reducing the inequality and
inequity. Furthermore, the practitioner can use these principles within their
individual practice to provide a more multiculturally safe health service for
all.
 
As
previously mentioned, true cultural safety is being able to integrate the
patient’s experiences into the patient-clinician interaction (Taylor and Guerin, 2014). Ultimately, the onus is on the individual
physiotherapist to be proactive in their own practice to bring about change
to the inequality and inequity First People’s face in Australian healthcare.

The
two overarching objectives of this action plan are:

1. Improve the cultural competency of
Physiotherapists by increasing inter-cultural communication skills.

 2. Develop and nurture trustful and respectful
relationships with Australian Physiotherapists.

Specific
– Increase
physiotherapy cultural safety practice to improve First People’s relationships
and satisfaction with Toowoomba Hospital Physiotherapists.

Measurable
– Verbal
account of patient experiences at the group discussion level at the end of the 16-week
period. Aiming for positive experiences to compare with current literature of First
People’s experiences of Australian healthcare. Secondly, First Peoples review
patient attendance rates will be compared to 20 weeks prior the action plan
implementation and looking for a statistically significant difference (p