Review Article

Understanding and responding to racism and the provision of culturally safe care by interdisciplinary health professionals in the aged care sector in regional, rural and remote areas: a scoping review


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Deborah Magee
1 RN, BN, M Phil, Scholarly Teaching Fellow * ORCID logo

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Marguerite Bramble
2 PhD, Associate Professor of Nursing ORCID logo

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Holly Randell-Moon
3 PhD, Senior Lecturer ORCID logo

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Jola Stewart-Bugg
4 PhD, Head of Discipline – First Nations Health

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Julian Grant
5 PhD, Professor of Nursing, Associate Dean Research ORCID logo


1, 2, 4 School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Panorama Ave, Bathurst, NSW 2795, Australia

3 School of Indigenous Australian Studies, Charles Sturt University, 8 Tony McGrane Place, Dubbo, NSW 2830, Australia

5 Faculty of Science and Health, Charles Sturt University, Panorama Ave, Bathurst, NSW 2795, Australia

ACCEPTED: 8 October 2023

early abstract:

In the spirit of reconciliation, the writers acknowledge the Traditional Custodians of Country throughout Australia and their connections to land, sea, waterways, and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

This scoping review was undertaken to obtain conceptual clarification about how racism and cultural safety are understood by interdisciplinary health professionals globally in the aged care sector in regional, rural, and remote areas. There is evidence in Australia and internationally that racism is a factor impacting significantly on the health of First Peoples and other racialized minorities. Recent policy changes in Australia have required the ability of health professionals to integrate cultural safety into their practice to mitigate racism and improve the health of older First Peoples and older people from diverse ethnic and cultural groups. This review included literature published in English from 1990, including published primary studies, systematic, integrative, and narrative reviews, meta-analyses, theses, policy documents, guidelines, position statements and government literature. Ovid (Medline), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health Database, and Informit were used in the full search. The most recent search of all databases was undertaken on 9 May 2022. Ten papers were included in the review, following the exclusion of 376 papers. A title and abstract search of the reference lists of papers included in the review identified no additional papers.
Ten papers were included in the review from Australia, Canada, the United States, Norway, and England. The literature reviewed suggests that health professionals in the aged care sector in regional, rural, and remote areas in Australia, Canada, the United States, Norway, and England use alternative terms to ‘racism’ and ‘racist,’ such as institutional marginalisation. The absence of explicit reference to racism aligns with critical race research that argues implicit bias and institutional racism are often separated from an individualised understanding of racism. That is, practitioners may understand racism as something that is perpetrated by individuals in an otherwise ‘neutral’ health setting’.

There is also a lack of clarity on how culturally safe care is understood, even though individual care plans are viewed as instrumental in establishing the needs and preferences of the consumers. Within the literature surveyed, barriers to providing quality and culturally inclusive care include disengaged management, insufficient human and material resources, language barriers and a lack of education focused on the needs of older individuals and groups with various cultural and spiritual needs.

Additionally, the review does not clearly illuminate what health professionals understand to be racist thinking or behaviour and how it is responded to in practice. Likewise, there is limited information about health professionals’ understanding of cultural safety and how to provide culturally inclusive care. While work is beginning on developing standards for cultural safety training in an Australian context, there are also opportunities to consider how these should be applied or adapted to residential and community aged care to best meet the needs of a diverse consumer base and workforce.

Keywords: aged care, cultural safety, racism, regional, remote, rural.