Implementation and Evaluation of Cultural Safety Initiatives in Australian Hospital Settings: A Scoping Review.

Introduction: The aim of this scoping review was to synthesize and summarize existing evidence for implementing and evaluating Cultural Safety initiatives in Australian hospitals for Aboriginal and Torres Strait Islander peoples. The rationale for this work was to establish guidelines for best practice in providing culturally safe care across hospital and health services.

Methodology: A systematic search guided by PRISMA Extension for Scoping Reviews was conducted across five databases: CINAHL, Scopus, MEDLINE, Embase, and Informit. Reference lists and citations of eligible studies were also examined. Studies were eligible for inclusion if they were in English and discussed the implementation and/or evaluation of Cultural Safety initiatives in Australian hospitals. Evaluations assessing both health care staff and patient perspectives were included. Studies were excluded if they presented future implementation protocols or initiatives among health care students. No date limiters were applied due to the small body of available literature.

Results: Nine studies met the criteria and were included in this review. Five themes emerged: (a) process of implementation; (b) process of evaluation; (c) change in health professional's behavior; (d) change in patient behavior; and (e) future recommendations.

Discussion and conclusions: Validated implementation frameworks and evaluation tools are needed for integrating Cultural Safety initiatives into Australian hospital settings. This review has highlighted that despite the availability of evidence-based tools, their use was lacking. This scoping review also highlighted that evaluation of Cultural Safety initiatives is primarily focused on the attitudes and knowledge of health professionals, rather than patient experience. As Cultural Safety is determined by recipients of care, future evaluation of initiatives should prioritize patient perspectives.