Strength from a look within

Reflective practice should be a tool for building resilience against racism in nursing and midwifery, attendees at the recent CATSINaM conference were told.

Griffith University professor of first peoples health Roianne West delivered the presentation, following recent membership forums at which racism within the workplace dominated conversation.

West, who recently took up an appointment as the Queensland director of the CATSINaM board, toured the state with the organisation’s chief executive prior to the conference, conducting forums with CATSINaM members. Many raised racism as a concern.

West says the members’ responses to racism were quite profound and that the issue caused a significant amount of distress, including making them feel sick, frustrated, disillusioned and helpless.

“This prompted me to think seriously about the strategies that I had developed in my 15 years in the profession in order to get where I had, considering I was well aware that racism is definitely alive and well in nursing and midwifery, as it is in society,” West says.

“It was at that point that I made a conscious decision that I was not going to let experiences of racism stop me from helping my people. Rather, I used the experiences of racism and the emotions that were invoked as a consequence of racism and channeled them into positive actions as opposed to negative actions.”

West says reflective practice has the potential to assist Indigenous nurses and midwives in better understanding their own behaviour, building on strengths and identifying areas that require further work and appropriate action in experiences of racism.

“The aim is to develop professional actions that are aligned with personal beliefs and values,” she says. “Understanding reflection is important, as it will assist Indigenous nurses and midwives in unveiling a range of skills they can use to develop their personal and professional skills and competencies towards building resilience against racism in the professions.

“Of particular importance in this context of experiences of racism is critical reflection as it refers to … exposing some of the assumptions, beliefs and values that underlie the construction of our worldview, as the nation’s First Peoples and the oldest living culture in the world, about other people, the workplace and ourselves.”

Using the framework developed in 1985 by David Boud and colleagues, she conducted her own reflection on her practice, using three key steps: recollection; attending to emotions; and re-evaluating experience.

As part of the first phase, West recalled times when racism was evident and blatant. She realised that despite what she initially thought when graduating, “being a registered nurse actually further exposed me to the rawness of racism rather than make me exempt”.

“Being an RN directly challenged the stereotypes and myths about Indigenous Australians,” she says. “The bachelor of nursing ticket exposed me more to racism because it challenged people’s ideas of what Aboriginal Australia was.”

West said the process shifted her thinking, as she realised it wasn’t about the individual who was perpetuating the racism – it was more complex.

“Nurses and midwives are part of Australian society, and there is a lot of racism in society,” West says. “I like to think the racism for the most part is not intentional in nursing and midwifery, as people come into nursing and midwifery to care and make a difference to people’s lives. I think the racism is based on ignorance and misinformation and that the nursing and midwifery profession have a lot of work to do in the area if we truly want to work towards closing the gap in health outcomes between Indigenous and non-Indigenous Australians.”

By encouraging Indigenous nurses and midwives to reflect on their practice, West hopes to increase the number of Indigenous people entering nursing and midwifery and decrease the number leaving. It’s a challenge made more difficult by the competing obligations she knows these professionals will face.

“As an Aboriginal nurse, you walk a fine line between your obligations to the nursing profession and your cultural obligations to your people, with the greatest pressure being the consequences if you don’t adhere to one or the other.

“This experience significantly changed the way I thought both professionally and personally, as I realised that I did not have to choose between one or the other. I realised that I was in a position to bring together both sets of obligations and knowledge systems.

“The challenge that lay ahead was how I was going to go about doing that.”

She encourages all Indigenous nurses and midwives to use this process of “learning through and from experience” as a strategy to deal with racism. She explains without these unique experiences, she would not be in the position to “make a significant difference to the profession of nursing, specifically the profession’s contribution to the betterment of the health of Australia’s Aboriginal people”.

“I would not have had the opportunity to critically evaluate, hence recognise, the resilience and coping mechanisms that I already had and further develop them. Specifically, [my experiences made possible] my transition from an unconscious awareness to a conscious awareness to deliberate actions.

“[It was] recognition of the interrelatedness of your thoughts, emotions and behaviours and the absolute power of the three intertwined.”

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