已提议提供文化上安全的护理,以解决健康不平等问题,包括心理健康和成瘾领域。影响提供文化安全护理的因素仍未得到充分研究。本文探讨了影响主流居住成瘾康复中心为因纽特人提供文化上适当和优质护理的因素。
进行了一个仪器案例研究,由人种学和创造性的研究方法提供信息。在2018年3月至2020年1月之间进行了超过700小时的参与者观察,此外还进行了定性的半结构化访谈(34名参与者)和/或成员检查活动(17名参与者),共有42个人:20因纽特人居民,18名临床/专业人员,和4名临床/行政管理人员。进行了解释性主题分析,以检查可能影响因纽特人提供文化安全护理的因素。
根据与个体是否相关,确定并分类了十类相互关联的因素,programmal,组织,或系统水平。这些类别涵盖:(1)居民和工作人员的生活经历;(2)个人和关系素质和技能;(3)护理模式;(4)模型灵活性;(5)考虑关系方面的方式;(6)组织对所服务人口的敏感性;(7)人力资源和专业发展问题;(8)社会气候;(9)政治,关系,和资金环境;和(10)立法,监管,专业环境。虽然系统层面的因素通常会对文化安全的体验产生负面影响,其他层面的大多数因素既有有利的影响,也有不利的影响,取决于所检查的上下文和维度。
结果提供了对主流组织在与因纽特人合作时面临的挑战和障碍之间相互作用的见解,以及组织可以利用的机会和推动者来改善服务。本文有助于更好地了解在复杂的干预环境中向因纽特人提供文化安全成瘾计划的挑战和机遇。最后强调了在这种情况下需要改进的一些领域,以促进文化安全。
Provision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction. The factors that influence the provision of culturally safe care remain understudied. This paper explores the factors influencing the efforts of a mainstream residential addiction rehabilitation centre to provide culturally appropriate and quality care for Inuit.
An instrumental
case study was conducted, informed by ethnographic and creative research methods. Over 700 h of participant observation were carried out between March 2018 and January 2020, in addition to qualitative semi-structured interviews (34 participants) and/or member-checking activities (17 participants) conducted with a total of 42 individuals: 20 Inuit residents, 18 clinical/specialized staff, and 4 clinical/administrative managers. An interpretive thematic analysis was performed to examine the factors that may influence the provision of culturally safe care for Inuit residents.
Ten categories of interrelated factors were identified and classified according to whether they relate to individual, programmatic, organizational, or systemic levels. These categories covered: (1) residents\' and staff\'s life experiences; (2) personal and relational qualities and skills; (3) the model of care; (4) model flexibility; (5) ways in which relational aspects were considered; (6) sensitivity of the organization towards the population served; (7) human resources and professional development issues; (8) social climate; (9) political, relational, and funding climate; and (10) legislative, regulatory, and professional environment. While system-level factors generally had a negative effect on experiences of cultural safety, most factors at other levels had both favourable and unfavourable effects, depending on the context and dimensions examined.
The results offer insight into the interplay between the challenges and barriers that mainstream organizations face when working with Inuit, and the opportunities and enablers that organizations can build on to improve their services. This paper contributes to a better understanding of the challenges and opportunities to providing culturally safe addiction programs to Inuit within a complex intervention setting. It concludes by highlighting some areas for improvement to advance cultural safety in this context.