title: Exploring the emotional dimension of non-Indigenous health student learning in First Peoples cultural safety education: An Indigenist mixed methods approach.
Creators: name: Mills, Kyly M
Publisher: name: Griffith University
Year: 2021
Subjects: subject: First Peoples
subject: emotional responses
subject: cultural safety education
subject: health professional students
subject: pedagogy of discomfort
subject: Decolonised

description: Health professionals have a vital role in providing health services to First Peoples, in a culturally safe way that respects First Peoples histories, cultures, perspectives and identities. Including First Peoples health and cultural safety content in pre-registration health professional curricula may increase graduates’ skills, attributes, and knowledge to provide clinically and culturally safe care. In addition, a culturally safe workforce has the potential to reduce health inequities and social disadvantage for First Peoples. Recent research suggests that for students to experience transformative learning, some discomfort with First Peoples cultural safety content is necessary. Despite this, there remains a dearth of research that explores students’ emotional responses in a meaningful way. Further, there has been limited research about pedagogies that enable educators to navigate these emotional responses in the classroom. Finally, there are few validated and robust measures that account for the emotional dimension of learning in cultural safety education in Australia. This PhD program of research attempted to address these gaps by using an Indigenist mixed-methods sequential exploratory design that included six studies. Study results are either published or under review. Study 1 was a systematic review of the literature that explored the experiences and outcomes of health professional students when undertaking education on First Peoples health. Findings identified the included studies did not analyse how students emotionally engage with First Peoples health content and did not identify relationships between ‘discomfort’ and transformative learning experiences. Study 2 applied the pedagogy of discomfort (Boler, 1999) as a framework to better understand the emotional dimension of learning by non-indigenous health students after completing a First Peoples health course. This study found that while students expressed discomfort when learning about key cultural safety concepts, the extent of transformative learning varied. Study 3 involved an integrative Health professionals have a vital role in providing health services to First Peoples, in a culturally safe way that respects First Peoples histories, cultures, perspectives and identities. Including First Peoples health and cultural safety content in pre-registration health professional curricula may increase graduates’ skills, attributes, and knowledge to provide clinically and culturally safe care. In addition, a culturally safe workforce has the potential to reduce health inequities and social disadvantage for First Peoples. Recent research suggests that for students to experience transformative learning, some discomfort with First Peoples cultural safety content is necessary. Despite this, there remains a dearth of research that explores students’ emotional responses in a meaningful way. Further, there has been limited research about pedagogies that enable educators to navigate these emotional responses in the classroom. Finally, there are few validated and robust measures that account for the emotional dimension of learning in cultural safety education in Australia. This PhD program of research attempted to address these gaps by using an Indigenist mixed-methods sequential exploratory design that included six studies. Study results are either published or under review. Study 1 was a systematic review of the literature that explored the experiences and outcomes of health professional students when undertaking education on First Peoples health. Findings identified the included studies did not analyse how students emotionally engage with First Peoples health content and did not identify relationships between ‘discomfort’ and transformative learning experiences. Study 2 applied the pedagogy of discomfort (Boler, 1999) as a framework to better understand the emotional dimension of learning by non-indigenous health students after completing a First Peoples health course. This study found that while students expressed discomfort when learning about key cultural safety concepts, the extent of transformative learning varied. Study 3 involved an integrative systematic literature review to determine the scope and availability of tools used to measure the emotional constructs of undergraduate health students’ learning in First Peoples cultural safety education or similar educational settings. Although students’ emotional responses were measured, processes that encouraged students to reflect upon those reactions were not incorporated by researchers or educators within the classroom. Study 4 developed and tested a measure of student emotion using an approach that centred cultural safety tenets and First Peoples’ perspectives, values and lived realities. The Student Emotional Learning in Cultural Safety Instrument (SELCSI) was found to be valid and reliable. While use of the tool may contribute to understanding how health professional students learn to practice in culturally safe ways, it was imperative to develop appropriate, emotion-informed pedagogy. Study 5 incorporated First Peoples’ knowledges to interpret and theorise non-Indigenous health students’ emotional learning experiences within a cultural safety course. A qualitative analysis of free-text responses by students collected in conjunction with the SELCSI was conducted. The synthesis of non-Indigenous health students’ emotions in the classroom was metaphorically represented by a river in Kamilaroi Country during drought, flood, and when the waters clear. Study 6 evaluated a unique, brief, culturally-informed intervention using the SELCSI. The intervention involved health students’ written reflections and perceptions of comfort with workshop content, using a gawugaa-gii-mara (head, heart, hands) written response form. As part of the intervention, responses collected on this form were analysed and used to prompt discussion in a series of four workshops in the First Peoples’ cultural safety course. Findings connect the river metaphor to recognisable emotional responses from students (gii) and what this may represent or ‘look’ like in the classroom (gawugaa), along with practical emotion-based strategies that can be implemented by educators in the cultural safety classroom (mara). There are future implications for educational pedagogies and spaces that are safe and address the emotional dimension of learning in cultural safety education. Properly understood, the inclusive planning, delivery and evaluation of education about First Peoples’ health and cultural safety could have significant flow-on benefits for First Peoples and communities. Students must be guided safely through this content using innovative First Peoples’ emotional pedagogy. Future longitudinal studies are required to determine if students’ understanding of cultural safety is sustained as they move into the healthcare workforce and ascertain whether their practice contributes to tangible change in healthcare outcomes for First Peoples.