Author: Monica Lawrence
Lawrence, Monica, 2025 Cultural Safety in clinical, teaching and research practice in Australian Indigenous health: An auto-ethnography., Flinders University, College of Nursing and Health Sciences
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Background
This PhD study is an auto-ethnography. I draw on my journal entries caring for Aboriginal and Torres Strait Islander cardiac patients recorded over a 20-year period from 1999 to 2019 beginning with my nursing career working at a major metropolitan teaching hospital, my academic career teaching into the disciplines of nursing, midwifery and medicine, and my research experience in remote communities located in the Northern Territory and New South Wales, to theorise Cultural Safety in the workplace for health professionals, educators and researchers.
Study aims
The study aimed to identify how Cultural Safety is articulated in the clinical, teaching and research settings, drawing on the literature, my own auto-ethnography, and the insights from an Expert Aboriginal and Torres Strait Islander Advisory Panel of women.
Methodology and methods
Retrospective vignettes written either in the moment, soon after a particular situation or days after the event occurred form the basis of this study. These stories are analysed firstly in light of the research literature, then in response to the Expert Aboriginal and Torres Strait Islander Advisory Panel input and my own analysis. The Expert Aboriginal and Torres Strait Islander Advisory Panel is my response to Aileen Moreton-Robinson’s (2021) Talkin’ up to the white woman challenge.
Findings
Cultural Safety principles in the clinical setting were mapped to four domains, personal knowledge and skills required of the individual to practice Cultural Safety: interpersonal skills with the patient and family, interprofessional practice, and organisational and structural restrictions.
A major finding was the identification of structural components of Cultural Safety; for example, there needs to be a commitment from the organisation to action Cultural Safety principles through policy, procedures and resource allocation and to address post-colonial language, terminology and practice. Cultural Safety is not just an individual skill or orientation.
Cultural Safety in education focuses on university settings, education in clinical practice settings, access to policy, and accreditation. The themes identified include creating safe spaces in the classroom to enable emotional responses and questions to be managed in a culturally safe way, with racism being a major issue from institutional practices to student and staff interactions. Key ideas were the difficulty of managing white fragility and the whitewashing of Cultural Safety.
Cultural Safety in research raised key questions around governance and self-determination for local communities. Themes explored were; Cultural Safety and co-design methods to improve health services, Cultural Safety and research governance, and Cultural Safety and research methods. Key ideas that emerge were the dangers of medicalising culture, and governance.
In summing up the findings the thesis argues that for the non-Indigenous clinician, teacher or researcher the challenge is to take up the role of ally, or critical ally and be attuned to issues of racism. In taking up a position of critical allyship, Cultural Safety should be assured.
Keywords: Cultural Safety, Aboriginal and Torres Strait Islander, Indigenous, clinical, teaching, education, research, practice.
Subject: Nursing thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Nursing and Health Sciences
Supervisor: Professor Emeritus Eileen Willis