Aim/Objective: First Nations people in Queensland continue to experience poorer health outcomes compared to non-First Nations people despite over 30 years of public health policy efforts. Research has consistently shown that participation of First Nations peoples in the health workforce, particularly in leadership has a positive impact on health outcomes, by driving system reform, improving Cultural Safety and supporting a more holistic approach to social and emotional and wellbeing. To address health inequities in Queensland, under new legislation, hospital and health services are required to increase their First Nations health workforces to at least commensurate with the local First Nations population across all disciplines and levels.
Methods: In 2022/23 under the leadership of First Nations Nursing Director and in partnership with other First Nations nurses and midwives, Office of the Chief Nursing and Midwifery Officer (OCNMO) co-designed a First Nations nursing and midwifery workforce strategy (the strategy) to set the strategic direction for growing the First Nations nursing and midwifery workforce and addressing systemic barriers that contribute to health inequities.
Results: The key principles identified through the co-design process were: First Nations leadership, cultural identify and integrity, sovereignty and self-determination, partnership and collaboration, equity and access and evidence and data. The strategy has four priority areas, including increasing First Nations nurses and midwives working for Queensland Health, retaining First Nations nurses and midwives through increased supports and improved Cultural Safety, building First Nations leadership, and delivering culturally safe care through innovative models and positions.
Conclusion: As the principal advisor on all matters related to nursing and midwifery, OCNMO is perfectly placed to lead strategies to realise the vision that First Nations nurses and midwives are visible, valued and commensurate to need. The strategy together with other First Nations health workforce strategic frameworks will guide a consistent approach to First Nations nursing and midwifery growth and advancement over the next five years.

Practice-based professions are regulated by the Australian Health Practitioner Regulation Agency (AHPRA) and National Boards, which include a shared code of conduct for cultural safety. However, this definition is very broad and assumes that students know what specific action is required to deliver culturally safe care, and few studies have explored the integration or translation of cultural safety into practice (McGough et al., 2022). Nursing, midwifery, paramedicine and oral health therapy students in the Curtin School of Nursing are introduced to the concept of cultural safety in their first year of study and complete a stand-alone Indigenous health unit to examine the contexts of local, national and global indigenous populations; the impact of specific policies and historical events on Indigenous Australians, and the effects of these policies on health, illness and disability, and health care access. However, despite inclusion in curricula, the enduring effects of purported transformative learning outcomes and the link with cultural capability development, translation to practice, and outcomes for Aboriginal and Torres Strait Islander people is unclear (Bullen & Roberts, 2021).
This study addresses this gap through the research question, “What are the factors influencing health students’ translation of cultural safety into practice”? Understanding the student experience of translating cultural safety into their clinical practice will assist with highlighting areas of existing strength and identifying where further curriculum development is required.
References
Bullen, J. and Roberts, L.D., 2021. Transformative learning within Australian Indigenous studies: a scoping review of non-Indigenous student experiences in tertiary Indigenous studies education. Higher Education Research & Development, 40(1), pp.162-177.
McGough, S., Wynaden, D., Gower, S., Duggan, R. and Wilson, R., 2022. There is no health without cultural safety: Why cultural safety matters. Contemporary Nurse, 58(1), pp.33-42.

Aim: For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Seven models of primary care were identified. We hypothesised patient health outcomes for Māori would differ between models of general practice.
Methods: Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy (≥55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care.
Results: 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices.
Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendance, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points).
Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients.
The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five-times more patients in high deprivation areas, and with more multimorbidity.
Conclusions: Māori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of practice. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori in all models of general practice.

Aboriginal and Torres Strait Islander Peoples health and wellbeing is everyone’s business, not simply the responsibility of First Nations academics who already carry a vast cultural load. Cultural Safety requires integration in all domains of nursing and midwifery education for reform in Aboriginal and Torres Strait Islander health education. There had been attempts at an individual subject level to improve content, yet no overview of the specific content added. We were also mindful that Aboriginal and Torres Strait Islander students may not self-identify if there was no visible reason to believe they can expect to experience cultural safety.
Aim/Objective: This project aimed to;
Establish the current state of First Nations Health content in specialty nursing subjects by using ‘Yindymarra’ (respect) in bringing a First Nations lens to our curriculum.
Establish a pathways for students to identify safely.
Method: The University of Melbourne Department of Nursing established a working group in 2023 to lead a revision of curriculum. An audit of all subject content in 7 specialty courses included 29 subjects to establish if there was learning outcomes, content, and First Nation Peoples health perspectives included.
Results: Less than half the courses have First Nations Academic represented at refence meetings, a third of subjects had content but only half was informed by a First Nations Academic.
Discussion: Ideally, all First Nations students should feel safe enough to self-identify if they want to. This review used the principle of ‘Yindymarra’ (respect) to bring a First Nations lens to our curriculum and avoiding the ‘tick-box’ approach. The audit has revealed we need a considered approach to improve the curriculum and this data provides a baseline to inform this process.
Conclusion: Aboriginal health is everyone’s business in the Department of Nursing and the audit was useful to begin to explore curriculum improvements.
Keywords: First Nations, Health, Education, Cultural Safety