Academic literature on the topic 'Institutional care Employees Training of Australia Evaluation'

Regional anaesthesia is a fundamental aspect of anaesthesia practice. Structured Fellowships in regional anaesthesia facilitate the development of expert clinicians, scholars and future leaders. The Australian and New Zealand College of Anaesthetists accredits training sites for the final year of Fellowship training but does not outline specific guidance for subspecialty training. Based on evidence from a systematic literature review and best-practice medical education principles, the ideal structure for a regional anaesthesia Fellowship programme in Australia and New Zealand is outlined in four categories: (a) structure and duration of training; (b) educational aspects; (c) institutional organization; (d) evaluation and improvement. Departments may use this resource to help design, implement and improve their Fellowship programmes while trainees may employ it as a reference to achieve their learning goals at any training stage. Continuing professional education plays a central role in achieving and maintaining mastery of regional anaesthesia competencies.

This article is relevant in the framework of the study educational training importance and the ability to communicate with adolescents with severe multiple developmental and behavioral disorders (SMDD) in adults working for inpa- tient social service institution (ISSI). The survey of communication and behavioral skills in adolescents with SMDD living in ISSI presented. The study involved 60 employees, 28 adolescents with SMDD, 20 parents of special children. Methods used: Communication Matrix, cyclogram «Review of the day», evaluation sheet «Table of interests». A spe- cific case of employee training and introduction of Augmentative and Alternative Communication techniques into an individual form of work with the student and the impact of these activities on improving her behavior demonstrated. The experimental data presented in this article can be used for work with ISSI to increase the communication skills available to students with SMDD. Also, the article includes the description of the work on improvement of the qual- ity of life of adolescents with SMDD that are in inpatient institutional care. It has been established that children and adolescents with SMDD living in the ISSI have persistent impairments in mastering skills, identifying their com- munication mechanisms.

Background: According to the WHO, hand hygiene is the primary measure to reduce infections. It is a simple act, but the lack of compliance among healthcare workers has been a great concern for all healthcare facilities. Healthcare facilities can perform a situation analysis of hand hygiene promotion and practices according to a set of indicators designed by the WHO in the form of a hand hygiene self-assessment framework. Results can be used to identify areas of improvement and to develop an action plan and strategies accordingly. Low- or middle-income country (LMIC) initial scoring within this framework was 195 points (ie basic level); thus, we aimed to achieve the advanced level, with a score of > 375. Methods: The WHO hand hygiene self-assessment framework is a diagnostic tool to identify key issues requiring attention and improvement. Repeated assessments are done to document the progress over time, which allows a health-care facility to track their progress in hand hygiene resources, to conduct promotion activities, to plan their actions, and to achieve improvement and sustainability. We developed an action plan under each category of WHO framework that included: system change, training and education, evaluation and feedback, reminders in workplace, and institutional safety climate for hand hygiene. We implemented the following measures: point-of-care hand hygiene stations were made available at all bedsides; mandatory training was introduced for all healthcare workers, and consumption of hand rub or hand sanitizers and liquid soap was monitored as a consumption indicator. In addition, posters were placed in all wards and clinics, time was dedicated for HH promotion, and a May 5th plan was implemented. HH leaders, role models, and champions were identified from each discipline. Patients were involved in HH promotion; HH leaflets were given to patients, HH e-learning tools were implemented, and a system for personal accountability was initiated, as well as a buddy system for new employees. Results: After implementation of multiple strategies in each section of the WHO self-assessment framework, we our overall score increased from basic (ie, 195) to advanced (ie, 395). In addition, category score increased in system change from 60 to 85, in training and education from 35 to 100, in evaluation and feedback from 52.5 to 100, in reminders in workplace from 17.5 to 45, and in institutional safety climate from 30 to 65. Conclusions: The WHO hand hygiene self-assessment framework should be utilized by all the hospitals in LMICs as a guide to improve hand hygiene levels.Funding: NoneDisclosures: None

IntroductionIn the Greater Mekong Subregion, community health workers, known as malaria volunteers, have played a key role in reducing malaria in the control phase, providing essential malaria services in areas with limited formal healthcare. However, the motivation and social role of malaria volunteers, and testing rates, have declined with decreasing malaria burden and reorientation of malaria programmes from control to elimination. Provision of additional interventions for common health concerns could help sustain the effectiveness of volunteers and maintain malaria testing rates required for malaria elimination accreditation by the WHO.Methods and analysisThe Community-delivered Integrated Malaria Elimination (CIME) volunteer model, integrating interventions for malaria, dengue, tuberculosis, childhood diarrhoea and malaria Rapid Diagnostic Test (RDT)-negative fever, was developed based on global evidence and extensive stakeholder consultations. An open stepped-wedge cluster-randomised controlled trial, randomised at the volunteer level, will be conducted over 6 months to evaluate the effectiveness of the CIME model in Myanmar. One hundred and forty Integrated Community Malaria Volunteers (ICMVs, current model of care) providing malaria services in 140 villages will be retrained as CIME volunteers (intervention). These 140 ICMVs/villages will be grouped into 10 blocks of 14 villages, with blocks transitioned from control (ICMV) to intervention states (CIME), fortnightly, in random order, following a 1-week training and transition period. The primary outcome of the trial is blood examination rate determined by the number of malaria RDTs performed weekly. Difference in rates will be estimated across village intervention and control states using a generalised linear mixed modelling analytical approach with maximum likelihood estimation.Ethics and disseminationThe study was approved by Institutional Review Board, Myanmar Department of Medical Research (Ethics/DMR/2020/111) and Alfred Hospital Ethics Review Committee, Australia (241/20). Findings will be disseminated in peer-review journals, conferences and regional, national and local stakeholder meetings.Trial registration numberNCT04695886

Abstract Background Healthcare-associated infections (HAIs) are associated with high rates of morbidity and mortality, which translates into an increase in the days of hospitalization and costs of care. The research of hand hygiene in health workers demonstrate that this action decreases the spread of pathogens; however, the compliance of hand hygiene remains low among health workers. Hand hygiene is a cheap method to prevent infections. It has been estimated that the total cost of hand hygiene promotion represents <1% of the costs associated with the HAIs. Our goal is to strengthen the culture of hand hygiene (In and Out) in all health professionals in a period of 90 days, achieving a 90% compliance. Methods The ABC Medical Center is a high specialty hospital, on average it has 465 beds. The program led by the Epidemiology Unit was formed by a multidisciplinary team with the patriation of leaders of different areas (Epidemiology, Nursing, Physicians, Human resources, Quality and Teaching). We used the “WHO Guidelines on Hand Hygiene in Health Care” consisting of: (1) system change, (2) training for employees, (3) evaluation and feedback, (4) a reminder at the workplace, (5) institutional security climate, (6) monitoring of the compliance to hand hygiene: The monitoring of the evaluation personnel was carried out in two stages, when entering and leaving the patient’s room. Results A total of 9,732 observations were made, of which 55.32% went to the nursing staff, 22.80% to doctors and 21.87% to the hospital staff. The compliance of the hand hygiene at the beginning of the program was 70%, by the and the 91% was reached. Sustainability has been maintained through continuous campaigns of the importance of hand hygiene reaching a 98% adherence to hands hygiene in 2018. The behavior of HAIs is notorious since at the beginning of the program there was a rate of 0.95 and by 2018, with the increase in compliance to hand hygiene, it decreased to 0.56. Conclusion The 90/90 Hand Hygiene program is a pioneer in its modality for the implementation of the program in a short period of time and excellence in its scope. It is confirmed that leadership is essential and strategic to ensure quality and safety in patient care. Through the incentive to the staff a clear sense of participation and belonging to the institution is achieved Disclosures All authors: No reported disclosures.

Healthcare education and practice has significantly been impacted by COVID-19. This includes the challenge on pedagogical approaches that highlight the potential of technology to facilitate innovative new approaches in response to social distancing, lockdowns, remote learning and improving the patient experience and positive outcomes. Many of these innovative approaches are not fundamentally new but are now seeing relevance beyond early adopters to mainstream implementation. This presentation draws upon collaborations with educational researchers and technologists that have explored the integration of technology into healthcare education and practice. COVID-19 Adversity to Opportunity Many healthcare programmes required reenvisaging teaching and learning approaches in response to COVID-19 restrictions. This had a particular impact on the development of interpersonal and practical knowledge and skills essential for healthcare graduates. The limited access to on-campus learning provided an opportunity for both institutional and individual evaluation of pedagogical practices. The affordances of traditional, didactic, and “hands-on” skills were compared with those that could be facilitated using online asynchronous/ synchronous strategies. A particular concern was the development of the interpersonal and practical skills required in safe and effective healthcare practice. Alongside easing of restrictions, these skills were adapted using online demonstrations within the limits of socially distanced “bubbles”, telehealth and limited clinical placements. Reconsideration of summative assessments was also required- with the introduction online synchronous and asynchronous verbal assessments, and asynchronous submissions of practical skills online (Cochrane et al., 2021; Narayan et al., 2021). In the prospect of COVID-19 restrictions continuing to lift, it is envisioned that most of the reenvisaged pedagogical approaches to healthcare education will persist, without compromising student critical thinking or practical skills. Interprofessional Collaboration This presentation will highlight the importance of interprofessional collaboration in healthcare curriculum design using a Design-Based-Research methodology (Chen et al., 2020; Kartoğlu et al., 2020) to facilitate authentic learning and develop self-determined learning capabilities for healthcare professionals. DBR- Design Principles in response to COVID Transferable design principles will be introduced for enhancing healthcare education that will improve practice in a COVID19 world, particularly drawing from eight healthcare projects including: STUDIO602 – enhancing clinical practice with mobile technologies (Cochrane & Sinfield, 2021), developing a virtual reality handover experience for healthcare students (Cochrane et al., 2018), using immersive reality to develop critical thinking in clinical health education (Stretton et al., 2018), enhancing first responder clinical simulation education using immersive reality and biometrics (Cochrane et al., 2020), designing authentic learning for graduate entry nursing students (Macdiarmid et al., 2021), designing public and environmental health education (Kersey et al., 2018), Biomedical engineering (Lam et al., 2021), and physiology education (Fabris et al., 2019). References Chen, W., Sandars, J., & Reeves, T. C. (2020). Navigating complexity: The importance of design-based research for faculty development. Medical Teacher, 1-3. https://doi.org/10.1080/0142159X.2020.1774530 Cochrane, T., Aiello, S., Cook, S., Aguayo, C., & Wilkinson, N. (2020). MESH360: A framework for designing MMR enhanced Clinical Simulations [Journal]. Research in Learning Technology, 28(Mobile Mixed Reality - Themed Collection). https://doi.org/10.25304/rlt.v28.2357 Cochrane, T., Narayan, V., Aiello, S., Birt, J., Cowie, N., Cowling, M., Deneen, C., Goldacre, P., Alizadeh, M., Sinfield, D., Stretton, T., & Worthington, T. (2021, 29th November- 1st December 2021). Post Pandemic Socially Constructed Blended Synchronous Learning: Vignettes from the Mobile Learning SIG. ASCILITE 2021: 38th International Conference on Innovation, Practice and Research in the Use of Educational Technologies in Tertiary Education, University of New England (UNE), Armidale, Australia. Cochrane, T., & Sinfield, D. (2021). STUDIO602: A model for designing real world collaborations between Higher education and Industry. In K. MacCallum & D. Parsons (Eds.), Industry Practices, Processes and Techniques Adopted in Education - Supporting innovative teaching and learning practice (Vol. In preparation). Springer. http://davidparsons.ac.nz/industry-in-ed/ Cochrane, T., Stretton, T., Aiello, S., Britnell, S., Cook, S., & Narayan, V. (2018). Authentic Interprofessional Health Education Scenarios using Mobile VR [Journal]. Research in Learning Technology, 26, 2130. https://doi.org/10.25304/rlt.v26.2130 Fabris, C. P., Rathner, J. A., Fong, A. Y., & Sevigny, C. P. (2019). Virtual Reality in Higher Education. International Journal of Innovation in Science and Mathematics Education (formerly CAL-laborate International), 27(8). Kartoğlu, Ü., Siagian, R. C., & Reeves, T. C. (2020). Creating a "Good Clinical Practices Inspection" Authentic Online Learning Environment through Educational Design Research. TechTrends : for leaders in education & training, 1-12. https://doi.org/10.1007/s11528-020-00509-0 Kersey, K., Lees, A., Conn, C., Cochrane, T., Narayan, V., & Williams, M. (2018). “Context matters”: The challenges and opportunities of designing tertiary public and environmental health education in South Auckland. Pacific Health, 1(1), 1-12. https://doi.org/https://doi.org/10.24135/pacifichealth.v1i1.8 Lam, L., Cochrane, T., Rajagopal, V., Davey, K., & John, S. (2021). Enhancing student learning through trans-disciplinary project-based assessment in bioengineering. Pacific Journal of Technology Enhanced Learning, 3(1), 4-5. https://doi.org/10.24135/pjtel.v3i1.80 Macdiarmid, R., Winnington, R., Cochrane, T., & Merrick, E. (2021). Using educational design research to develop authentic learning for Graduate Entry Nursing students in New Zealand. Nurse Education in Practice, 102965. https://doi.org/10.1016/j.nepr.2021.102965 Narayan, V., Cochrane, T., Aiello, S., Birt, J., Cowie, N., Cowling, M., Deneen, C., Goldacre, P., Alizadeh, M., Sinfield, D., Stretton, T., & Worthington, T. (2021, 29 November - 1 December). Mobile learning and socially constructed blended learning through the lens of Activity Theory. ASCILITE 2021: 38th International Conference on Innovation, Practice and Research in the Use of Educational Technologies in Tertiary Education, University of New England (UNE), Armidale, Australia. Stretton, T., Cochrane, T., & Narayan, V. (2018). Exploring Mobile Mixed Reality in Healthcare Higher Education: A Systematic Review [Journal]. Research in Learning Technology, 26, 2131. https://doi.org/10.25304/rlt.v26.2131

Indigenous cross-cultural training has been around since the 1980s. It is often seen as a way to increase the skills and competency of staff engaged in providing service to Indigenous clients and customers, teaching Indigenous students within universities and schools, or working with Indigenous communities (Fredericks and Bargallie, “Indigenous”; “Which Way”). In this article we demonstrate how such training often exposes power, whiteness, and concepts of an Indigenous “other”. We highlight how cross-cultural training programs can potentially provide a setting in which non-Indigenous participants can develop a deeper realisation of how their understandings of the “other” are formed and enacted within a “white” social setting. Revealing whiteness as a racial construct enables people to see race, and “know what racism is, what it is not and what it does” (Bargallie, 262). Training participants can use such revelations to develop their racial literacy and anti-racist praxis (Bargallie), which when implemented have the capacity to transform inequitable power differentials in their work with Indigenous peoples and organisations.What Does the Literature Say about Cross-Cultural Training? An array of names are used for Indigenous cross-cultural training, including cultural awareness, cultural competency, cultural responsiveness, cultural safety, cultural sensitivity, cultural humility, and cultural capability. Each model takes on a different approach and goal depending on the discipline or profession to which the training is applied (Hollinsworth). Throughout this article we refer to Indigenous cross-cultural training as “cultural competence” or “cultural awareness” and discuss these in relation to their application within higher education institutions. While literature on health and human services programs in Australia, Canada, New Zealand, and other nation states provide clear definitions of terms such as “cultural safety”, cultural competence or cultural awareness is often lacking a concise and consistent definition.Often delivered as a half day or a one to two-day training course, it is unrealistic to think that Indigenous cultural competence can be achieved through one’s mere attendance and participation. Moreover, when courses centre on “cultural differences” and enable revelations about those differences they are in danger of presenting idealised notions of Indigeneity. Cultural competence becomes a process through which an Indigenous “other” is objectified, while very little is offered by way of translating knowledge and skills into practice when working with Indigenous peoples.What this type of learning has the capacity to do is oversimplify and reinforce racism and racist stereotypes of Indigenous peoples and Indigenous cultures. What is generally believed is that if non-Indigenous peoples know more about Indigenous peoples and cultures, relationships between Indigenous and non-Indigenous peoples will somehow improve. The work of Goenpul scholar Aileen Moreton-Robinson is vital to draw on here, when she asks, has the intellectual investment in defining our cultural differences resulted in the valuing of our knowledges? Has the academy become a more enlightened place in which to work, and, more important, in what ways have our communities benefited? (xvii)What is revealed in a range of studies – whether centring on racism and discrimination or the ongoing disparities across health, education, incarceration, employment, and more – is that despite forty plus years of training focused on understanding cultural differences, very little has changed. Indigenous knowledges continue to be devalued and overlooked. Everyday and structural racisms shape everyday experiences for Indigenous employees in Australian workplaces such as the Australian Public Service (Bargallie) and the Australian higher education sector (Fredericks and White).As the literature demonstrates, the racial division of labour in such institutions often leaves Indigenous employees languishing on the lower rungs of the employment ladder (Bargallie). The findings of an Australian university case study, discussed below, highlights how power, whiteness, and concepts of “otherness” are exposed and play out in cultural competency training. Through their exposure, we argue that better understandings about Indigenous Australians, which are not based on culture difference but personal reflexivity, may be gained. Revealing What Was Needed in the Course’s Foundation and ImplementationThis case study is centred within a regional Australian university across numerous campuses. In 2012, the university council approved an Aboriginal and Torres Strait Islander strategy, which included a range of initiatives, including the provision of cross-cultural training for staff. In developing the training, a team explored the evidence as it related to university settings (Anning; Asmar; Butler and Young; Fredericks; Fredericks and Thompson; Kinnane, Wilks, Wilson, Hughes and Thomas; McLaughlin and Whatman). This investigation included what had been undertaken in other Australian universities (Anderson; University of Sydney) and drew on the recommendations from earlier research (Behrendt, Larkin, Griew and Kelly; Bradley, Noonan, Nugent and Scales; Universities Australia). Additional consultation took place with a broad range of internal and external stakeholders.While some literature on cross-cultural training centred on the need to understand cultural differences, others exposed the problems of focusing entirely on difference (Brach and Fraser; Campinha-Bacote; Fredericks; Spencer and Archer; Young). The courses that challenged the centrality of cultural difference explained why race needed to be at the core of its training, highlighting its role in enabling discussions of racism, bias, discrimination and how these may be used as means to facilitate potential individual and organisational change. This approach also addressed stereotypes and Eurocentric understandings of what and who is an Indigenous Australian (Carlson; Gorringe, Ross and Forde; Hollinsworth; Moreton-Robinson). It is from this basis that we worked and grew our own training program. Working on this foundational premise, we began to separate content that showcased the fluidity and diversity of Indigenous peoples and refrained from situating us within romantic notions of culture or presenting us as an exotic “other”. In other words, we embraced work that responded to non-Indigenous people’s objectified understandings and expectations of us. For example, the expectation that Indigenous peoples will offer a Welcome to Country, performance, share a story, sing, dance, or disseminate Indigenous knowledges. While we recognise that some of these cultural elements may offer enjoyment and insight to non-Indigenous people, they do not challenge behaviours or the nature of the relationships that non-Indigenous people have with Aboriginal and Torres Strait Islander peoples (Bargallie; Fredericks; Hollinsworth; Westwood and Westwood; Young).The other content which needed separating were the methods that enabled participants to understand and own their standpoints. This included the use of critical Indigenous studies as a form of analysis (Moreton-Robinson). Critical race theory (Delgado and Stefancic) was also used as a means for participants to interrogate their own cultural positionings and understand the pervasive nature of race and racism in Australian society and institutions (McLaughlin and Whatman). This offered all participants, both non-Indigenous and Indigenous, the opportunity to learn how institutional racism operates, and maintains discrimination, neglect, abuse, denial, and violence, inclusive of the continued subjugation that exists within higher education settings and broader society.We knew that the course needed to be available online as well as face-to-face. This would increase accessibility to staff across the university community. We sought to embed critical thinking as we began to map out the course, including the theory in the sections that covered colonisation and the history of Indigenous dispossession, trauma and pain, along with the ongoing effects of federal and state policies and legislations that locates racism at the core of Australian politics. In addition to documenting the ongoing effects of racism, we sought to ensure that Indigenous resistance, agency, and activism was highlighted, showing how this continues, thus linking the past to the contemporary experiences of Indigenous peoples.Drawing on the work of Bargallie we wanted to demonstrate how Aboriginal and Torres Strait Islander peoples experience racism through systems and structures in their everyday work with colleagues in large organisations, such as universities. Participants were asked to self-reflect on how race impacts their day-to-day lives (McIntosh). The final session of the training focused on the university’s commitment to “Closing the Gap” and its Reconciliation Action Plan (RAP). The associated activity involved participants working individually and in small groups to discuss and consider what they could contribute to the RAP activities and enact within their work environments. Throughout the training, participants were asked to reflect on their personal positioning, and in the final session they were asked to draw from these reflections and discuss how they would discuss race, racism and reconciliation activities with the governance of their university (Westwood and Westwood; Young).Revelations in the Facilitators, Observers, and Participants’ Discussions? This section draws on data collected from the first course offered within the university’s pilot program. During the delivery of the in-person training sessions, two observers wrote notes while the facilitators also noted their feelings and thoughts. After the training, the facilitators and observers debriefed and discussed the delivery of the course along with the feedback received during the sessions.What was noticed by the team was the defensive body language of participants and the types of questions they asked. Team members observed how there were clear differences between the interest non-Indigenous participants displayed when talking about Aboriginal and Torres Strait Islander peoples and a clear discomfort when they were asked to reflect on their own position in relation to Indigenous people. We noted that during these occasions some participants crossed their arms, two wrote notes to each other across the table, and many participants showed discomfort. When the lead facilitator raised this to participants during the sessions, some expressed their dislike and discomfort at having to talk about themselves. A couple were clearly unhappy and upset. We found this interesting as we were asking participants to reflect and talk about how they interpret and understand themselves in relation to Indigenous people and race, privilege, and power.This supports the work of DiAngelo who explains that facilitators can spend a lot of time trying to manage the behaviour of participants. Similarly, Castagno identifies that sometimes facilitators of training might overly focus on keeping participants happy, and in doing so, derail the hard conversations needed. We did not do either. Instead, we worked to manage the behaviours expressed and draw out what was happening to break the attempts to silence racial discussions. We reiterated and worked hard to reassure participants that we were in a “safe space” and that while such discussions may be difficult, they were worth working through on an individual and collective level.During the workshop, numerous emotions surfaced, people laughed at Indigenous humour and cried at what they witnessed as losses. They also expressed anger, defensiveness, and denial. Some participants revelled in hearing answers to questions that they had long wondered about; some openly discussed how they thought they had discovered a distant Aboriginal relative. Many questions surfaced, such as why hadn’t they ever been told this version of Australian history? Why were we focusing on them and not Aboriginal people? How could they be racist when they had an Aboriginal friend or an Aboriginal relative?Some said they felt “guilty” about what had happened in the past. Others said they were not personally responsible or responsible for the actions of their ancestors, questioning why they needed to go over such history in the first place? Inter-woven within participants’ revelations were issues of racism, power, whiteness, and white privilege. Many participants took a defensive stance to protect their white privilege (DiAngelo). As we worked through these issues, several participants started to see their own positionality and shared this with the group. Clearly, the revelation of whiteness as a racial construct was a turning point for some. The language in the group also changed for some participants as revelations emerged through the interrogation and unpacking of stories of racism. Bargallie’s work exploring racism in the workplace, explains that “racism”, as both a word and theme, is primarily absent in conversations amongst non-Indigenous colleagues. Despite its entrenchment in the dialogue, it is rarely, if ever addressed. In fact, for many non-Indigenous people, the fear of being accused of racism is worse than the act of racism itself (Ahmed; Bargallie). We have seen this play out within the media, sport, news bulletins, and more. Lentin describes the act of denying racism despite its existence in full sight as “not racism”, arguing that its very denial is “a form of racist violence” (406).Through enhancing racial literacy, Bargallie asserts that people gain a better understanding of “what racism is, what racism is not and how race works” (258). Such revelations can work towards dismantling racism in workplaces. Individual and structural racism go hand-in-glove and must be examined and addressed together. This is what we wanted to work towards within the cultural competency course. Through the use of critical Indigenous studies and critical race theory we situated race, and not cultural difference, as central, providing participants with a racial literacy that could be used as a tool to challenge and dismantle racism in the workplace.Revelations in the Participant Evaluations?The evaluations revealed that our intention to disrupt the status quo in cultural competency training was achieved. Some of the discussions were difficult and this was reflected in the feedback. It was valuable to learn that numerous participants wanted to do more through group work, conversations, and problem resolution, along with having extra reading materials. This prompted our decision to include extra links to resource learning materials through the course’s online site. We also opted to provide all participants with a copy of the book Indigenous Australia for Dummies (Behrendt). The cost of the book was built into the course and future participants were thankful for this combination of resources.One unexpected concern raised by participants was that the course should not be “that hard”, and that we should “dumb down” the course. We were astounded considering that many participants were academics and we were confident that facilitators of other mandatory workplace training, for example, staff Equal Employment Opportunity (EEO), Fire Safety, Risk Management, Occupational Health and Safety, Discrimination and more, weren’t asked to “dumb down” their content. We explained to the participants what content we had been asked to deliver and knew their responses demonstrated white fragility. We were not prepared to adjust the course and dumb it down for white understandings and comfortabilities (Leonardo and Porter).Comments that were expected included that the facilitators were “passionate”, “articulate”, demonstrated “knowledge” and effectively “dealt with issues”. A couple of the participants wrote that the facilitators were “aggressive” or “angry”. This however is not new for us, or new to other Aboriginal women. We know Aboriginal women are often seen as “aggressive” and “angry”, when non-Indigenous women might be described as “passionate” or “assertive” for saying exactly the same thing. The work of Aileen Moreton-Robinson in Australia, and the works of numerous other Aboriginal women provide evidence of this form of racism (Fredericks and White; Bargallie; Bond). Internationally, other Indigenous women and women of colour document the same experiences (Lorde). Participants’ assessment of the facilitators is consistent with the racism expressed through racial microaggression outside of the university, and in other organisations. This is despite working in the higher education sector, which is normally perceived as a more knowledgeable and informed environment. Needless to say, we did not take on these comments.The evaluations did offer us the opportunity to adjust the course and make it stronger before it was offered across the university where we received further evaluation of its success. Despite this, the university decided to withdraw and reallocate the money to the development of a diversity training course that would cover all equity groups. This meant that Aboriginal and Torres Strait Islander peoples would be covered along with sexual diversity, gender, disability, and people from non-English speaking backgrounds. The content focused on Aboriginal and Torres Strait Islander peoples was reduced to one hour of the total course. Including Aboriginal and Torres Strait Islander peoples in this way is not based on evidence and works to minimise Indigenous Australians and their inherent rights and sovereignty to just another “equity group”. Conclusion We set out to develop and deliver a cross-cultural course that was based on evidence and a foundation of 40 plus years’ experience in delivering such training. In addition, we sought a program that would align with the university’s Reconciliation Action Plan and the directions being undertaken in the sector and by Universities Australia. Through engaging participants in a process of critical thinking centring on race, we developed a training program that successfully fostered self-reflection and brought about revelations of whiteness.Focusing on cultural differences has proven ineffective to the work needed to improve the lives of Indigenous Australian peoples. Recognising this, our discussions with participants directly challenged racist and negative stereotypes, individual and structural racism, prejudices, and white privilege. By centring race over cultural difference in cultural competency training, we worked to foster self-revelation within participants to transform inequitable power differentials in their work with Indigenous peoples and organisations. The institution’s disbandment and defunding of the program however is a telling revelation in and of itself, highlighting the continuing struggle and importance of placing additional pressure on persons, institutions, and organisations to implement meaningful structural change. ReferencesAhmed, Sara. On Being Included: Racism and Diversity in Institutional Life. Duke University Press, 2012.Anderson, Ian. “Advancing Indigenous Health through Medical Education”. 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Abstract Background Research codesign is generally defined as end-users’ involvement in planning, implementation, and evaluation of projects. Recently, there has been a growing interest in codesign to maximise research acceptability, applicability, and impact and to address longstanding issues around power and depth of involvement. Frameworks have been developed to assist in understanding research codesign processes at a project level. However, little is known about how university based researchers construct or adopt a coherent approach to sustain research codesign in governance, methodological approaches, and practice. This study investigated the perspectives of researchers within a newly formed research institute about principles and practices of research codesign in the context of their previous and current projects. We also investigated their perceptions of institution-level enablers and barriers to codesign. University based researchers are our primary focus here and we intend to consult other stakeholders in future work. Methods Using an interview guide informed by exploratory work and a scoping review of the literature, we conducted 15 individual interviews with Caring Futures Institute (CFI) leaders and researchers at different career stages working across multiple areas of health, care, and social research. Qualitative thematic analysis was conducted. Results The researchers we interviewed were involved in projects ranging from large nationally funded projects to small studies funded by the university or PhD projects. Research codesign activities were generally part of larger researcher-led projects but there were a few examples of community-led projects. There was agreement amongst participants on the principles and perceived benefits of research codesign such as partnership, co-learning, and power sharing. Less agreement was found regarding the definition of research codesign and best terminology to be used. Themes reflecting the success of research codesign included pre-existing community relationships, communication skills, knowledge, and training on codesign, balancing power relationships, use of external facilitators, and adequacy of funding, time, and resources. Conclusions The study reaffirmed the complexity of research codesign from researchers’ perspectives and identified areas of potential action that may be beneficial for university based research institutions in building codesign skills, capacity and culture for example training, peer learning and funding support. Implications for practice improvement centre on a dual strategy of building practical capacity in researchers and integrating institutional dimensions (such as governance and leadership) into codesign frameworks. This can help to ensure research codesign is integrated into organisational culture and through the work of individual researchers.

Abstract Background For most parents, getting pregnant means having a child. Generally, the couple outlines plans and has expectations regarding the baby. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. Validating the grief of these losses has been a challenge to Brazilian society, which is evident considering the childbirth care offered to bereaved families in maternity wards. Positively assessed care that brings physical and emotional memories about the baby has a positive impact on the bereavement process that family undergoes. Therefore, this study aims to assess the effects supportive guidelines have on mental health. They were designed to assist grieving parents and their families while undergoing perinatal loss in public maternities in Ribeirão Preto, São Paulo state, Brazil. Method A mixed-methods (qualitative/quantitative), quasi-experimental (before/after) study. The intervention is the implementation of bereavement supportive guidelines for women who experienced a stillbirth or a neonatal death. A total of forty women will be included. Twenty participants will be assessed before and twenty will be assessed after the implementation of the guidelines. A semi-structured questionnaire and three scales will be used to assess the effects of the guidelines. Health care professionals and managers of all childbirth facilities will be invited to participate in focus group. Data will be analyzed using statistical tests, as well as thematic analysis approach. Discussion The Perinatal Bereavement guidelines are a local adaptation of the Canadian and British corresponding guidelines. These guidelines have been developed based on the families’ needs of baby memories during the bereavement process and include the following aspects: (1) Organization of care into periods, considering their respective needs along the process; (2) Creation of the Bereavement Professional figure in maternity wards; (3) Adequacy of the institutional environment; (4) Communication of the guidance; (5) Creation of baby memories. We expect that the current project generates additional evidence for improving the mental health of women and families that experience a perinatal loss. Trial registration RBR-3cpthr Plain English summary For many couples, getting pregnant does not only mean carrying a baby, but also having a child. Most of the time, the couple has already made many plans and has expectations towards the child. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. In Brazilian culture, validating this traumatic grief is very difficult, especially when it happens too soon. The barriers can be noticed not only by the way society deals with the parents’ grief, but also when we see the care the grieving families receive from the health care establishment. Creating physical and emotional memories might bring the parents satisfaction regarding the care they receive when a baby dies. These memories can be built when there is good communication throughout the care received; shared decisions; the chance to see and hold the baby, as well as collect memories; privacy and continuous care during the whole process, including when there is a new pregnancy, childbirth and postnatal period. With this in mind, among the most important factors are the training of health staff and other professionals, the preparation of the maternity ward to support bereaved families and the continuous support to the professionals involved in the bereavement. This article proposes guidelines to support the families who are experiencing stillbirth and neonatal death. It may be followed by childbirth professionals (nurses, midwives, obstetricians and employees of a maternity ward), managers, researchers, policymakers or those interested in developing specific protocols for their maternity wards.

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