The health outcomes and health needs of Aboriginal and Torres Strait Islander peoples living in remote communities are different to those living in regional and urban communities. This chapter discusses the role of remote area nurses (RANs) and their scope of practice, along with the challenges they may face while working in remote Indigenous communities. It establishes the need for RANs to integrate with the community and lead health initiatives. The work RANs may undertake is discussed, as well as the additional qualifications, including immunisation, sexual health endorsements and x-ray licences, which may be of benefit. The chapter discusses the different burden of disease and injury in remote Aboriginal and Torres Strait Island communities, and the holistic way these communities often perceive health. The chapter calls for cultural safety in remote area nursing, and suggests that respecting differences in culture, communication and health education is critical. The author concludes by reflecting on her own experience as a remote area nurse.

This chapter introduces nursing and midwifery students to the history and current state of Aboriginal and Torres Strait Islanders’ health. It considers the deficit discourse that is often used to describe Indigenous health, which negatively contrasts Indigenous health with the health of non-Indigenous Australians. The chapter emphasises the importance of understanding the history of Indigenous health, both from pre-colonisation and in the years following. It discusses the recent Uluru Statement from the Heart and the history of the Stolen Generations, and examines the effects on Aboriginal and Torres Strait Islander health. The chapter discusses the current health gap that exists between First Nations people and non-Indigenous Australians, and how the Closing the Gap initiative aims to improve Indigenous health outcomes to the level of non-Indigenous Australians. The chapter portrays health as a social justice issue and encourages a human rights approach to health. It concludes by detailing the personal stories of two First Nations nurses to demonstrate the positive effect Indigenous nurses and midwives can have on the health of Aboriginal and Torres Strait Islander peoples.

This chapter introduces readers to Indigenous-led research, with a particular focus on qualitative methods. It begins by discussing the history of Indigenous research, which has not always been ethical or culturally appropriate, before discussing the relatively recent push for change as Indigenous people advocated for research by, for and about Indigenous people. This has seen an increase in culturally safe research, where the needs of Indigenous communities are considered throughout the research process. It provides guidance for nurses and midwives to begin research projects, and considers how they can apply ethical research in Aboriginal and Torres Strait Islander communities. The chapter then considers common qualitative methods that can be used, before discussing how to undertake a culturally safe qualitative research project by understanding community protocols and engaging the community. The chapter guides readers through the process of ethics approvals, identifying and recruiting participants, conducting focus groups and displaying findings.

This chapter discusses Indigenous birthing practices in remote locations. It begins by considering the traditional practices of Aboriginal and Torres Strait Islander women and the importance of Grandmothers’ Law. It explores traditional practices and taboos around diet, labour, family and breastfeeding for pregnant and post-partum women. It then discusses the changes implemented after colonisation as missionaries became more common and Indigenous women were made to leave their communities and families to give birth in hospitals in larger regional locations. The chapter guides readers through providing culturally safe care to pregnant Aboriginal and Torres Strait Islander women, before looking at the shift to reopening birthing centres in remote locations to allow Indigenous women to once again safely give birth on Country.

This chapter explores the care of Elders and older Aboriginal and Torres Strait Islander peoples. It discusses the shorter lifespan and earlier prevalence of chronic conditions, including dementia, in Indigenous Australians. The chapter calls for a human rights approach to caring for older Aboriginals and Torres Strait Islander people and promotes patient-centred care that considers the rights of Indigenous peoples. It explores the current health policies and strategies implemented within Australia, which provide guidance on caring for older Indigenous Australians. The importance of nurses providing culturally safe aged care and palliative care is discussed.

This chapter discusses the role of community controlled health services in the Australian healthcare system and their contribution to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It begins by exploring the establishment of community controlled health services in Brisbane in response to the different health needs of Indigenous people at the time. The chapter then discusses the concept of community control, defining it as being by the community, for the community. Aboriginal community controlled health organisations (ACCHOs) are led by, based in and governed by Indigenous communities. The chapter discusses the experience of working in a community controlled clinic as part of a multidisciplinary team. Key health services, including the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Queensland Aboriginal and Islander Health Council (QAIHC), and their contribution to culturally safe care, are discussed in detail. The chapter concludes by considering recent changes to the Australian healthcare sector and future opportunities for ACCHOs.

This chapter discusses midwifery practices in relation to Aboriginal and Torres Strait Islander women in urban and regional areas. It begins by considering the challenges Indigenous women face when they experience maternity care in mainstream healthcare settings, and the importance of providing and receiving culturally safe maternity care. Traditional birthing practices used by Aboriginal and Torres Strait Islander women prior to colonisation are discussed. The chapter provides an overview of maternal and neonatal health today by considering statistics related to the health of Indigenous mothers and infants, fertility rates and gestational issues Aboriginal and Torres Strait Islander women may face, along with recent improvements in antenatal care and infant health outcomes. Current birthing practices are discussed, before Indigenous-led models of care are presented as ways to provide culturally safe care to pregnant Aboriginal and Torres Strait Islander women. The chapter considers the role of Indigenous nurses and midwives in contributing to better maternal outcomes for Indigenous women and their babies, and provides concrete ways in which all nurses and midwives can provide culturally safe care.

This chapter considers cultural safety within the context of Australian nursing and midwifery practice, using Irihapeti Ramsden’s definition of cultural safety as a framework. The chapter begins by considering the effects of colonisation on the health of Aboriginal and Torres Strait Islander peoples, and how nurses must be aware of their patients’ cultures (which extend beyond ethnicity) in order to effectively treat them. The chapter discusses the journey practitioners take from cultural awareness through cultural sensitivity to achieve cultural safety. The chapter suggests that nurses must use self-reflection as a tool to understand their own beliefs, values and attitudes and how these may impact the healthcare they provide. This chapter is a call to all nurses and midwives to understand the differences between themselves and their patients, and to provide culturally safe care to all patients.

This edition of Yatdjuligin was written in 2020, the Year of the Nurse and Midwife. It was also written during the first global pandemic for more than 100 years – COVID-19. In this year, while the professions of nursing and midwifery were celebrated, the reality was that nurses and midwives were working in unprecedented times on the front line across the globe.

This chapter looks at the professional roles Aboriginal and Torres Strait Islander health workers and health practitioners play in the industry. It begins by looking at how the Indigenous health worker role evolved as a way to bridge the gap between Indigenous patients and healthcare professionals, and their role in contemporary medical settings. It considers the nursing and midwifery guidelines and frameworks that regulate Aboriginal and Torres Strait Islander health workers and health practitioners and provide guidance for collaboration with other healthcare workers. It concludes by discussing the challenges and opportunities of interprofessional practice when providing culturally safe care to Indigenous patients.

This chapter discusses Indigenous suicide and self-harm from a social and emotional wellbeing perspective. It begins by discussing current rates of suicide and intentional self-harm by Aboriginal and Torres Strait Islander people, compared with non-Indigenous Australians and international Indigenous communities. The chapter then considers contributing factors to Indigenous suicides, such as intergenerational trauma, poverty and loss of culture, traditions and practice. The chapter contrasts social and emotional wellbeing with Western concepts of mental health and suggests that social and emotional wellbeing is prioritised in Indigenous contexts because it more holistic and positive. The chapter discusses the importance of culturally safe care in Indigenous communities when creating mental health strategies and treatment plans, using the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023 as its basis.

This chapter considers the concept of social and emotional wellbeing in mainstream mental health services by deliberately approaching mental health from within an Aboriginal and Torres Strait Islander context, rather than the standard biomedical perspective. It discusses the political, social and cultural determinants of First Nations social and emotional wellbeing and how, throughout history, these have contributed to a stigma surrounding Aboriginal and Torres Strait Islanders. The chapter emphasises the importance of cultural connection in improving social and emotional wellbeing, and suggests prioritising cultural connection to people and place, culture and the natural environment when treating First Nations patients. Social and emotional wellbeing is discussed within the context of mainstream mental healthcare, calling for trauma-informed care and a strengths-based approach. The chapter explores various threats to social and emotional wellbeing, including Sorry Business and Sad News, and imprisonment, before suggesting ways for healthcare professionals to promote social and emotional wellbeing in their care of Aboriginal and Torres Strait Islander people.

This chapter focuses on quantitative research that is Indigenous-led and Indigenous-focused. It begins by discussing quantitative research in the context of Indigenous people to reject the commonly held assumption that quantitative research methods are less appropriate than quantitative methods in Indigenous contexts. It considers the importance of using an Indigenous methodology rather than a Western research methodology. The chapter differentiates between various research methodologies before focusing on the Indigenous research methodology in Australia. It highlights the importance of working with Aboriginal and Torres Strait Islander communities, considering Indigenous worldviews during research, and conducting research with political integrity. The chapter uses two case studies of Indigenous quantitative research to guide readers through the process and explain how to display and interpret results, and provides detailed guidance on using chi-squared tests to interpret results.

This chapter discusses the history of Aboriginal and Torres Strait Islander healthcare, from pre-invasion to contemporary healthcare systems. The chapter begins by discussing the social determinants of health and how these contribute to health inequities. It then uses historical journals and evidence from early Australian explorers to consider the health status and health system of Aboriginal and Torres Strait Islanders prior to 1788, demonstrating that Indigenous Australians had health systems in place pre-invasion. The chapter then discusses how Indigenous Australians’ health changed once Australia was established as a convict colony, through the introduction of diseases, dietary changes and the movement of Indigenous Australians into reserves and lock hospitals. The chapter continues to look at Indigenous health along the timeline post-colonisation, and considers the contemporary increase of community controlled health systems in Indigenous communities and the Closing the Gap initiative, which aims to eliminate the differences in health outcomes between Indigenous and non-Indigenous Australians.