Journal articles on the topic 'Nursing standards – Northwestern Canada'

Introduction: With ongoing medical advances and an increase in elderly and complex patients presenting to the Emergency Department (ED), there is a requirement for nurses to continue to gain new knowledge and skills to provide optimal patient care. Quality initiatives are frequently introduced with the goal of improving patient safety and the effectiveness of care delivery; some being provincial, while others are new requirements from Accreditation Canada. We sought the perspectives of emergency nurses regarding the importance of key ED processes and standards, and their impact on patient care and nurse efficiency. Methods: All Registered Nurses and Licensed Practical Nurses throughout the Edmonton Zone EDs were invited to complete an online survey consisting of 23 statements on nursing attitudes (10 on nursing duties) and beliefs (11 on the importance of Accreditation standards and their impacts; two that involved selecting the 5 most important nursing activities). The survey was constructed through an iterative approach. Response options included a 7-point Likert scale (‘very strongly disagree’ to ‘very strongly agree’). Median scores and interquartile ranges were determined for each survey statement. Results: A total of 433/1241 (34.9%) surveys were submitted. Respondents were predominantly Registered Nurses (91.4%), female (88.9%), and worked 0-5 years overall in the ED (43.7%). Overall, respondents were favourable (‘agree’ or ‘strongly agree’) towards the Accreditation Canada standards and other quality initiatives. They were, however, ‘neutral’ towards universal domestic violence screening, and whether there is a difference between Best Possible Medication History (BPMH) and med reconciliation. The top five nursing activities in terms of perceived importance were: vital sign documentation, recording of allergies, listening to patients’ concerns, hand hygiene, and obtaining a complete nursing history. Best Possible Medication History and the screening risk tools followed these. Conclusion: Despite their heavy workload, nurses strongly agreed on the importance of med reconciliation, falls risk, and skin care, but felt that improved documentation forms could support efficiency. Nursing perspective is valuable in informing future attempts to standardize, streamline, and simplify documentation, including the design and implementation of a provincial clinical information system.

Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare professionals (HCPs) have become familiar with exploring and acting upon patients’ wishes to hasten death (WTHD). In contrast to MAiD, the literature on the voluntary stopping of eating and drinking (VSED) is very limited and there are no standards of practice or legal guidance to support HCPs. In this article, the legal and ethical literature as regards VSED is critically reviewed and new standards of practice are proposed.

This paper reports the results of a national survey of palliative care nurses conducted following a meeting of nurses at the Fifth Canadian Palliative Care Association Conference in 1993. The intent of the survey was to obtain information about Canadian palliative care nurses's perceptions of practice and professional issues. Eighty percent of respondents believed that palliative care nurses should form a palliative care nurses’ organization, with the majority recommending that this occur under the auspices of the Canadian Palliative Care Association. Key issues of importance to palliative care nurses were identified. The two major issues of concern were (a) the need to develop standards of practice and (b) educational needs of palliative care nurses. Respondents also emphasized the importance of maintaining and fostering an interdisciplinary approach to palliative care. Results of this survey are to be further discussed at the Sixth Canadian Palliative Care Association Conference to be held in Halifax in October 1995.

ABSTRACT Objective: to present good practice guiding standards in nursing care to children intoxicated by household cleaners. Method: study with documentary nature, using narrative review, with literatures of technical-scientific evidence on the subject and protocols of a center for toxicological information in the northwestern region of Paraná. The good practice guiding standards were systematized and described in seven axes. Results: the procedures of reception related to family and obedience to ethical and relational aspects of care, primary assessment and measures for life support, nursing history and clinical epidemiological and laboratory anamnesis, decontamination measures, use of antidotes, symptomatic treatment and complementary exams and nursing guidelines for hospital discharge, regarding the structure and care process. Conclusion: adapted to the structural conditions and welfare services, this study may contribute to improve the quality of care and a more agile, efficient and complete care to the intoxicated person. Descriptors: Care Standard; Child Health; Poisoning; Poison Control Centers; Household Products; Nursing Care. RESUMOObjetivo: apresentar padrões orientadores de boas práticas na assistência de enfermagem a crianças intoxicadas por domissanitários. Método: estudo de natureza documental. Utilizou-se revisão narrativa, com literaturas de evidências técnico-científicas sobre o tema e protocolos de um centro de informação toxicológica do Noroeste do Paraná. Sistematizaram-se e se descreveram os padrões orientadores de boas práticas em sete eixos. Resultados: relacionaram-se os procedimentos para o acolhimento à família e obediência a aspectos éticos e relacionais do atendimento, avaliação primária e medidas de suporte à vida, histórico de enfermagem e anamnese clínica epidemiológica e laboratorial, medidas de descontaminação, uso de antídotos, tratamento sintomático e exames complementares e orientações de enfermagem para alta hospitalar, no tocante à estrutura e ao processo de atendimento. Conclusão: espera-se que, adaptado às condições estruturais e assistenciais dos serviços, este estudo possa contribuir para melhorar a qualidade da assistência e para que o atendimento ao intoxicado se torne mais ágil, eficaz e completo. Descritores: Padrão de Cuidado; Saúde da Criança; Envenenamento; Centros de Controle de Intoxicações; Produtos Domésticos; Cuidados de Enfermagem. RESUMEN Objetivo: presentar normas rectoras de las buenas prácticas en la atención de enfermería a los niños intoxicados por limpiadores domésticos. Método: estudio de carácter documental, utilizandóse revisión narrativa, con literaturas técnico-científicas sobre el tema y los protocolos de un centro de información toxicológica en la región noroeste de Paraná. Las normas rectoras de la buena práctica fueron sistematizadas y descritas en siete ejes. Resultados: los procedimientos para la recepción refieren a la familia y la obediencia a los aspectos relacionales y éticos de la atención primaria, la evaluación y las medidas de apoyo a la vida, la historia de la enfermería y la anamnesis clínica, epidemiológica y de laboratorio las medidas de descontaminación, uso de antídotos, tratamiento sintomático y exámenes complementarios y de enfermería al alta hospitalaria, directrices sobre la estructura y el proceso de cuidados. Conclusión: adaptado a las condiciones estructurales y de servicios de bienestar, este estudio puede contribuir a mejorar la calidad de la atención y para un servicio al intoxicado más ágil, eficiente y completa. Descriptores: Nivel de Atención; Salud del Ninõ; Envenenamiento; Centros de Control de Intoxicaciones; Productos Domésticos; Atención de Enfermería.

The Bylot Supergroup, northern Baffin Island, contains >1500 m of platform, shelf, and slope carbonates deposited between ~ 1270 and ~ 723 Ma. Limited chronostratigraphic data have led to the broad correlation of the Bylot Supergroup with predominantly Neoproterozoic successions in northern and western Laurentia; yet, detailed correlation has been impossible given biostratigraphic and lithostratigraphic limitations. Carbon-isotope chemostratigraphy represents a potential dataset to constrain such interregional correlations. Carbon isotopic data from the Bylot Supergroup and broadly coeval successions from Somerset Island and northwest Greenland reveal distinct stratigraphic trends in δ13C, with intervals of moderate 13C enrichment (+3.5 ± 1‰) punctuated by excursions to slightly negative values (-1.0 ± 1‰). Although the scale of the observed variation is muted relative to Neoproterozoic standards, the dissimilarity of values to those recorded in northwestern Laurentia suggests that these strata delineate a discrete depositional interval. Comparison of isotopic values with published data indicates that δ13C values between approximately -1.0 and +4.0‰ are characteristic of the interval between ~ 1300 and ~ 800 Ma. This pattern is distinct from that of younger Neoproterozoic successions, which typically record values >+5‰, and older Mesoproterozoic successions, which record values near 0‰, and suggests that these moderately positive values may be useful for broad time correlation. Compilation of new and published data permits the tentative reconstruction of a global Mesoproterozoic carbon isotopic curve.

The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the “universe of developmental care” conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission’s requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.

The use of age-appropriate care as an organized framework for care delivery in the NICU is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the “universe of developmental care” conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the NICU. These guidelines were recently revised and expanded. In alignment with the Joint Commission’s requirement for healthcare professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of these core measures require a strong framework for institutional operationalization presented in these guidelines. Part B will present the recommendations and justification of each steps behind the present guidelines to facilitate their implementation.

Background and Purpose: The Edinburgh Postnatal Depression Scale (EPDS) was created specifically to screen for perinatal depression. The purpose of this study was to assess the psychometric properties of the EPDS for use in a population of pregnant and postpartum 14- to 24-year-olds in Canada. Methods: The Standards for Educational and Psychological Testing was used as the psychometric framework to assess the validity, reliability, and acceptability of responses obtained using the EPDS with pregnant and postpartum adolescents and young adults. Results: There were 102 young women who were surveyed. Principal component analysis supported the EPDS as a 2-dimensional instrument. Test scores also showed the EPDS to be reliable and acceptable. Conclusions: The EPDS was found to be a psychometrically sound tool for use in this population of young childbearing women.

Work relationships between registered nurses (RNs) and practical nurses (LPNs) are changing as new models of nursing care delivery are introduced to create more flexibility for employers. In Canada, a team-based, hospital nursing care delivery model, known as Care Delivery Model Redesign (CDMR), redesigned a predominantly RN-based staffing model to a functional team consisting of fewer RNs and more LPNs. The scope of practice for LPNs was expanded, and unregulated health care assistants introduced. This study began from the standpoint of RNs and LPNs to understand their experiences working on redesigned teams by focusing on discourses activated in social settings. Guided by institutional ethnography, the conceptual and textual resources nurses are drawing on to understand these changing work relationships are explicated. We show how the institutional goals embedded in CDMR not only mediate how nurses work together, but how they subordinate holistic standards of nursing toward fragmented, task-oriented, divisions of care.

This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.

AbstractObjectiveThe road to legalization of Medical Assistance in Dying (MAID) across Canada has largely focused on legislative details such as eligibility and establishment of regulatory clinical practice standards. Details on how to implement high-quality, person-centered MAID programs at the institutional level are lacking. This study seeks to understand what improvement opportunities exist in the delivery of the MAID process from the family caregiver perspective.MethodThis multi-methods study design used structured surveys, focus groups, and unstructured e-mail/phone conversations to gather experiential feedback from family caregivers of patients who underwent MAID between July 2016 and June 2017 at a large academic hospital in Toronto, Canada. Data were combined and a qualitative, descriptive approach used to derive themes within family perspectives.ResultImprovement themes identified through the narrative data (48% response rate) were grouped in two categories: operational and experiential aspects of MAID. Operational themes included: process clarity, scheduling challenges and the 10-day period of reflection. Experiential themes included clinician objection/judgment, patient and family privacy, and bereavement resources.Significance of resultsTo our knowledge, this is the first time that family caregivers’ perspectives on the quality of the MAID process have been explored. Although practice standards have been made available to ensure all legislated components of the MAID process are completed, detailed guidance for how to best implement patient and family centered MAID programs at the institutional level remain limited. This study provides guidance for ways in which we can enhance the quality of MAID from the perspective of family caregivers.

Registered nurses in psychiatric-mental health nursing continuously balance the ethical principles of duty to do good (beneficence) and no harm (non-maleficence) with the duty to respect patient choices (autonomy). However, the problem of nurses’ level of control versus patients’ choices remains a challenge. The aim of this article is to discuss how nurses accomplish their simultaneous responsibility for balancing patient safety (beneficence and non-maleficence) with patient choices (autonomy) through the theory of protective empowering. This is done by reflecting on interview excerpts about caring from 17 registered nurses taking part in a grounded theory study conducted in three acute urban psychiatric hospital settings in Canada. The interplay between the protective and empowering dimensions of the theory of protective empowering was found to correspond with international, national, and local nursing codes of ethics and standards. The overall core process of protective empowering, and its associated reflective questions, is offered as a new lens for balancing patient safety with choices.

Background: Post-streptococcal glomerulonephritis (PSGN) is a rare immune-mediated condition that typically occurs in children as a result of group A streptococcus (GAS) infection. PSGN is not considered a disease of public health significance, or reportable, in Canada. Higher incidence of PSGN has been described among Indigenous people in Canada. No national or provincial guidance exists to define or manage PSGN outbreaks. Objective: To describe an outbreak of seven paediatric cases of PSGN in a remote First Nations community in northwestern Ontario and the development of a community-wide public health response. Methods: Following a literature review, an intervention was developed involving screening of all children in the community for facial or peripheral edema or skin sores, and treatment with antibiotics if noted. Case, contact and outbreak definitions were also developed. The purpose of the response was to break the chain of transmission of a possible nephritogenic strain of streptococcus circulating in the community. Relevant demographic, clinical and laboratory data were collected on all cases. Outcome: Seven paediatric cases of PSGN presented to the community nursing station between September 25 and November 29, 2017. Community-wide screening for skin sores was completed for 95% of the community’s children, including 17 household contacts, and as a result, the last of the cases was identified. Nineteen adult household contacts were also screened. Ten paediatric contacts and two adult contacts with skin sores were treated with one dose of intramuscular penicillin, and six paediatric contacts received oral cephalexin. No further cases were identified following the screening. Conclusion: PSGN continues to occur in Indigenous populations worldwide at rates higher than in the overall population. In the absence of mandatory reporting in Canada, the burden of PSGN remains underappreciated and could undermine upstream and downstream public health interventions. Evidence-based public health guidance is required to manage outbreaks in the Canadian context. The community-based response protocol developed to contain the PSGN outbreak in this First Nations community can serve as a model for the management of future PSGN outbreaks.

Introduction: Simulation-based learning (SBL) is a practical and efficient learning method that involves the replacement of a portion of clinical education with quality simulation experiences. It has been utilised in various countries, such as the United States, Canada, and South Korea. However, based on current regulations in Japan, clinical education cannot be replaced with simulation experience. For future curriculum integration, it is necessary to clarify the current use of SBL and tackle systematic educational strategies of SBL. Therefore, this national survey aimed to clarify the prevalence and practices of SBL in undergraduate nursing education programs in Japan. Methods: This article presents the results of our national survey in Japan. It presents the questionnaire based on the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice and demonstrates the use of simulation-based learning in Japanese undergraduate nursing programs. Results: Overall, the schools using simulation-based education (SBE) comprised 346 schools (82.4%) of the sample. Those equipped with high-fidelity simulators were 146 schools (27.6%); the rest owned medium-fidelity simulators. Almost all undergraduate nursing education systems were equipped with simulators, however, the frequency of use was low. SBL was incorporated into the curriculum at many undergraduate nursing education institutions, and awareness of the INACSL Standard of Best Practice: SimulationSM was extremely low. Conclusion: This study shows that SBL is not properly utilised in undergraduate nursing programs, even though many schools are equipped with simulators. Thus, further study on barriers to simulator use is needed.

Summary Objectives: To develop evidence-based standardized care plans (EB-SCP) for use internationally to improve home care practice and population health. Methods: A clinical-expert and scholarly method consisting of clinical experts recruitment, identification of health concerns, literature reviews, development of EB-SCPs using the Omaha System, a public comment period, revisions and consensus. Results: Clinical experts from Canada, the Netherlands, New Zealand, and the United States participated in the project, together with University of Minnesota School of Nursing graduate students and faculty researchers. Twelve Omaha System problems were selected by the participating agencies as a basic home care assessment that should be used for all elderly and disabled patients. Interventions based on the literature and clinical expertise were compiled into EB-SCPs, and reviewed by the group. The EB-SCPs were revised and posted on-line for public comment; revised again, then approved in a public meeting by the participants. The EB-SCPs are posted on-line for international dissemination. Conclusions: Home care EB-SCPs were successfully developed and published on-line. They provide a shared standard for use in practice and future home care research. This process is an exemplar for development of evidence-based practice standards to be used for assessment and documentation to support global population health and research.

Introduction/Innovation Concept: Inter-professional education (IPE) involves ‘occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care’. Current literature has found IPE to increase knowledge and skills, improve attitudes towards other professions, and to promote superior clinical outcomes. Health Canada has collaborated to form accreditation standards to support IPE in Canadian medical schools. The proposed educational innovation termed the ‘nursing shift,’ based out of Kelowna General Hospital’s Department of Emergency Medicine, in partnership with UBC’s Southern and Island Medical Programs, endeavors to enhance IPE in our institution. Methods: This nursing shift was first trialed with third year medical students as a pilot rotation beginning in March of 2016. Based on overwhelmingly positive results obtained from narrative feedback, a formal rotation with the same structure will be implemented in the form of a prospective cohort study with 48 medical students from two UBC sites. One group will attend a nursing shift, while the other group will complete the standard emergency medicine rotation without this nursing shift. Impact will be measured using a mixed-method analysis where students will be asked to provide both quantitative feedback in the form of a questionnaire, and qualitative feedback in the form of a narrative response. The primary outcome will be quantitative score differences between the groups of students, and the secondary outcome will be qualitative results for those who completed the nursing shift. Curriculum, Tool, or Material: The innovative educational concept consists of an 8-hour nursing shift where medical students spend the first 4 hours at triage with a nurse learning about patient intake. The remaining 4 hours are in the emergency department where students collaborate with a nurse on a number of tasks including preparing and administering medications, starting intravenous lines, and inserting Foley catheters. Conclusion: Healthcare systems are shifting to a more collaborative team oriented approach, and IPE has been shown to prepare students for this changing workplace. We seek to understand third year medical students’ experience of the nursing shift, and to evaluate any changes in attitudes towards inter-professional collaboration after engaging in this intervention. Evaluation of this novel implementation will enable us to assess and optimize the nursing shift, and if it is well received, encourage widespread adoption.

Background: Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities. Objectives: To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks. Methods: Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients. Results: The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100 000 inhabitants. The ideal ratio, according to estimated needs, is 171:100 000. The figure breakdown is as follows: 20:100 000 for long-stay hospital units, 20:100 000 for nursing homes, 40:100 000 for group homes, 40:100 000 for private hostels or foster families, and 51:100 000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces. Discussion: Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges. Conclusions: It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization.

Current e-Health portal platforms provide support for patients only if they have previously registered and received service from a healthcare facility (e.g., hospital, healthcare clinic, etc.). These portals are usually connected to a central EMR/EHR system linked to a central system. Furthermore, these portals are restrictive in that they are only accessible by these patients at the exclusion of parents, relatives and others that participate in providing care to the patient. Further complications include the increasing demand from our healthcare systems for patients to receive more off-site, non-primary, in-homecare, and/or specialized healthcare services at home (e.g., therapy, nursing, personal support, etc.). Lastly, an increasing number of people would like to have more autonomy over their health in terms of increased access to their own medical records and the services they receive. In this work, we addressed these limitations by creating MyHealthPortal – a patient portal aimed at non-primary care, in-homecare, and/or special healthcare for patients. MyHealthPortal can assist homecare and clinic-based healthcare services along with the benefits of existing portals (e.g., online appointment scheduling, monitoring, and information sharing). MyHealthPortal is secure, robust, flexible and user-friendly. We developed it in partnership with our industry partner, Closing the Gap Healthcare. Closing the Gap is a prominent homecare and clinic-based healthcare service provider that became the first homecare agency to score 100% on standards from accreditation Canada and was awarded the exemplary standing. In this paper we present MyHealthPortal, the architectural framework that we designed and developed to support the system, and the results of a usability study conducted from real field studies. Our system was tested in a variety of conditions and achieved SUS usability scores of 92.5% (high).

Valid, reliable, and acceptable tools for assessing self-reported competence in evidence-informed decision-making (EIDM) are required to provide insight into the current status of EIDM knowledge, skills, attitudes/beliefs, and behaviours for registered nurses working in public health. The purpose of this study was to assess the validity, reliability, and acceptability of the EIDM Competence Measure. A psychometric study design was employed guided by the Standards for Educational and Psychological Testing and general measurement development principles. All registered nurses working across 16 public health units in Ontario, Canada were invited to complete the newly developed EIDM Competence Measure via an online survey. The EIDM Competence Measure is a self-reported tool consisting of four EIDM subscales: 1) knowledge; 2) skills; 3) attitudes/beliefs; and 4) behaviours. Acceptability was measured by completion time and percentage of missing data of the original 40-item tool. The internal structure of the tool was first assessed through item-subscale total and item-item correlations within subscales for potential item reduction of the original 40-item tool. Following item reduction which resulted in a revised 27-item EIDM Competence Measure, a principal component analysis using an oblique rotation was performed to confirm the four subscale structure. Validity based on relationships to other variables was assessed by exploring associations between EIDM competence attributes and individual factors (e.g., years of nursing experience, education) and organizational factors (e.g., resource allocation). Internal reliability within each subscale was analyzed using Cronbach’s alphas. Across 16 participating public health units, 201 nurses (mean years as a registered nurse = 18.1, predominantly female n = 197; 98%) completed the EIDM Competence Measure. Overall missing data were minimal as 93% of participants completed the entire original 40-item tool (i.e., no missing data), with 7% of participants having one or more items with missing data. Only one participant (0.5%) had >10% of missing data (i.e., more than 4 out of 40 items with data missing). Mean completion time was 7 minutes and 20 seconds for the 40-item tool. Extraction of a four-factor model based on the 27-item version of the scale showed substantial factor loadings (>0.4) that aligned with the four EIDM subscales of knowledge, skills, attitudes/beliefs, and behaviours. Significant relationships between EIDM competence subscale scores and education, EIDM training, EIDM project involvement, and supportive organizational culture were observed. Cronbach’s alphas exceeded minimum standards for all subscales: knowledge (α = 0.96); skills (α = 0.93); attitudes/beliefs (α = 0.80); and behaviours (α = 0.94).

Background Women are the fastest growing population in Canadian prisons. Incarceration can limit access to essential health services, increase health risks and disrupt treatment and supports. Despite legal requirements to provide care at professionally accepted standards, evidence suggests imprisonment undermines sexual and reproductive health. This scoping review asks, “What is known about the sexual and reproductive health of people incarcerated in prisons for women in Canada?” Methods We use the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched include MEDLINE, CINAHL, PsycINFO, Gender Studies Abstracts, Google Scholar and Proquest Dissertations and grey literature. The search yielded 1424 titles and abstracts of which 15 met the criteria for inclusion. Results Conducted from 1994–2020, in provincial facilities in Ontario, British Columbia, Alberta and Quebec as well as federal prisons, the 15 studies included qualitative, quantitative and mixed methods. The most common outcomes of interest were related to HIV. Other outcomes studied included Papanicolaou (Pap) and sexually transmitted infection (STI) testing, contraception, pregnancy, birth/neonatal outcomes, and sexual assault. Conclusion Incarceration results in lack of access to basic services including contraception and prenatal care. Legal obligations to provide sexual and reproductive health services at professionally acceptable standards appear unmet. Incarceration impedes rights of incarcerated people to sexual and reproductive health.

Introduction: Accreditation is one of the most important tools to improve the quality of education in nursing. This study has made a comparative comparison of the accreditation model of the Bachelor of Nursing training program in Iran, Canada and the United States. Methods: A descriptive and comparative study was conducted in 2021. keywords like "accreditation", "undergraduate nursing", "educational program or curriculum", "Canada", "Iran", and "America" were searched in Persian and English via relevant sites and the Bereday model in 4 stages of description, interpretation, proximity, and comparison was used for comparative comparison. Results: Accreditation in the Iranian model is more focused on managerial, structural and administrative standards. In the American model, it focuses on global developments in the field of health, providing educational programs with intercultural and transnational perspectives, interprofessional cooperation, distance education, evaluating learning outcomes and using its results in the development of education. The Canadian model focuses on participatory management, inspirational leadership, development of nursing professional competencies tailored to community health needs, team care in various areas of prevention, treatment and rehabilitation, interprofessional training, independence and freedom of action in budgeting for faculty members. Conclusion: Between the three study models, the Canadian and American models totaly specializes in nursing, and of course the Canadian model is more comprehensive, and since there are no specific accreditation standards for nursing in Iran, these two programs can be used as a suitable model to be taken.

Rapidly increasing enrollment in Canadian schools of nursing has triggered the development of innovative clinical placement sites. There are both opportunities and challenges inherent in the delivery of clinical nursing education in diverse community settings. As part of the Canadian Association of Schools of Nursing’s (CASN) ongoing work to assist its members and ensure baccalaureate graduates are prepared to meet the Canadian Community Health Nursing Standards of Practice at an entry-to-practice level, the CASN Sub-Committee on Public Health (funded by the Public Health Agency of Canada) conducted extensive national consultations with representatives from both academic and practice settings, as well as key national organizations. The resultant Guidelines for Quality Community Health Nursing Clinical Placements, released by CASN in 2010, aim to provide direction to Canadian schools of nursing and practice settings in addressing the challenges and opportunities arising from the changing context of community health nursing student clinical placements.

This article compares the professionalization and educational standards of Advanced Practice Nursing in the United States, Canada, Germany, Austria, and Switzerland with specific attention to geographical, political, and professional factors – both current and historical – influencing the evolution of these nurse leaders. A review of the literature, scientific articles, governmental regulatory texts, and legislative codes from each country, was performed. Patterns related to the geographical, political and professional context of nursing in each country were identified with comparative insights on the evolution of the discipline. Advancement of the nursing discipline is apparent in each country over the last century, although at differing rates. The disparity in development and level of autonomous practice for Advanced Practice Nurses in each country can be better understood in the context of historical, geographical, political and professional development. This review of the literature was combined with a comparative analysis and offers insights to inform nurses in education, leadership, practice, and advocacy interested in advancing the professionalization of advanced practice nursing internationally.

AbstractA scoping review of published literature and dialogue with international nurse practitioner educators and researchers revealed the education of nurse practitioner students varied within and between countries. This lack of cohesiveness hinders nurse practitioner role development and practice nationally and internationally. A rapid review of grey literature was conducted on nurse practitioner education standards in six countries (Australia, Canada, Finland, Norway, the Netherlands, and USA). Data were extracted from graduate level nurse practitioner education programs’ websites from each country (n = 24). Extracted data were verified for accuracy and completeness with a nurse practitioner educator from each program. Data were analyzed using content analysis. Variations in nurse practitioner education within and between countries were explored by comparing admission criteria, curricular content, clinical requirements, teaching methods, and assignment and evaluative methods. The findings will help inform education programs and further research about nurse practitioner education internationally.

Abstract Background Caring for older persons has become a global necessity to ensure functional ability and healthy ageing. It is of paramount importance that standards of care are monitored, especially for older persons who live in long term care facilities (LTCF). We, therefore, scoped and summarised evidence relating to standards and the quality of care for older persons in LTCFs in gerontological literature globally. Methods We conducted a scoping review using Askey and O’Malley’s framework, including Levac et al. recommendations. PubMed, CINAHL, Health Sources, Scopus, Cochrane Library, and Google Scholar were searched with no date limitation up to May 2020 using keywords, Boolean terms, and medical subject headings. We also consulted the World Health Organization website and the reference list of included articles for evidence sources. This review also included peer-reviewed publications and grey literature in English that focused on standards and quality of care for older residents in LTCFs. Two reviewers independently screened the title, abstract, and full-text of evidence sources screening stages and performed the data extraction. Thematic content analysis was used, and a summary of the findings are reported narratively. Results Sixteen evidence sources published from 1989 to 2017 met this study’s eligibility criteria out of 73,845 citations obtained from the broader search. The majority of the studies were conducted in the USA 56% (9/16), and others were from Canada, Hong Kong, Ireland, Norway, Israel, Japan, and France. The included studies presented evidence on the effectiveness of prompted voiding intervention for urinary incontinence in LTCFs (37.5%), the efficacy of professional support to LTCF staff (18.8%), and the prevention-effectiveness of a pressure ulcer programme in LTCFs (6.3%). Others presented evidence on regulation and quality of care (12.5%); nursing documentation and quality of care (6.3%); medical, nursing, and psychosocial standards on the quality of care (6.3%); medication safety using the Beer criteria (6.3%); and the quality of morning care provision (6.3%). Conclusion This study suggests most studies relating to standards and quality of care in LTCFs focus on effectiveness of interventions, few on people-centredness and safety, and are mainly conducted in European countries and the United States of America. Future studies on people-centerdness, safety, and geographical settings with limited or no evidence are recommended.

Abstract Aims The management of cardiovascular patients requires increasingly competent nursing professionals. In Italy, there are no specific postgraduate courses focused on specialist cardiac skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this. To delineate a set of core competencies to develop national educational interventions to ensure cardiac nurses in Italy achieve international standards. Methods and results A three-round e-Delphi study including a panel of 32 expert cardiac nurses from the UK, Canada, Australia, New Zealand, and Italy was conducted; 26 respondents completed all three rounds. The first round sought a list of five competencies from each participant which they were asked to prioritize in Round 2. In Round 3, they were asked to prioritize again with the knowledge of the priorities identified in Round 2. The final list of competencies was those achieving 70% agreement among participants. We identified 14 core competencies spanning a range of areas of competence including technical, interpersonal, health promotion, use of evidence, and management. Only minor differences were evident between the Italian and the international panel regarding the priority given to some core competences, such a leadership and taking patient history. Conclusion This is the first study in Italy to delineate cardiac nurses’ core competencies. As such, it provides a foundation for the development of postgraduate educational programmes for cardiac nurses including competencies that are congruent with international standards.

Abstract During the COVID-19 pandemic several issues were galvanized as global urgencies. One of which was racism, following reports that Black and low-income communities were disproportionately impacted by the pandemic (Public Health Agency of Canada, 2021) and the lack of race-based data in Canada (Ahmed et al.,2021). But it was the racially induced killing of George Floyd and others that brought global awareness through the Black Lives Matter movement of the extent of structural and institutional racism. We witnessed a convergence of protests regarding anti-Black racism, anti-Indigenous racism, anti-Asian racism, and more recently Islamophobia. These series of events have led to emerging and compelling questions from millennials and Generation Zs within the nursing classroom. Nursing education is called to embrace and draw upon multiple forms of pedagogies, methodologies, and theories that reflect and support student learning and enquiry (Coleman, 2020; Prendergast et al., 2020;). Nursing education’s longstanding history with colonial frameworks, practices, and standards (Holmes, 2008; McGibbon et al, 2014; Waite & Nardi, 2019), attests to the need to decolonize the nursing classroom, which in effect will decolonize colonial practices within clinical settings. One approach to assist nursing education in the classroom and workplace setting is introducing anti-Black racism (ABR) within the nursing curricula. ABR was coined by Akua Benjamin (2003) to explain the historical, lived experiences of African Canadians, and how colonial legacies in policies and institutions continue to mask racist practices. ABR creates spaces of resistances that can protect recipients and providers of the healthcare system and can disclose and rupture any invisible forms of inequitable practices. Based on the four tenets of ABR, which are, history, experience, invisibility, and legacy, ABR creates critical thinking and dialogues across multiple barriers, therefore providing opportunities for transformative learning and action. By implementing ABR within the nursing curricula, nurses may gain meaningful insights into the various ways racism plays out in the lived experiences of Black, Indigenous, and People of Colour by engaging the student into historical events and lived experiences that expound on varied forms of physical, mental and social enslavements. This presentation will conceptually illustrate the relevance of implementing anti-Black racism within Canadian nursing curricula as an effective strategy that can respond to issues pervading the current climate as well as support student learning and development. As nursing has an ethical responsibility to prepare and educate students to care and protect patients, nursing is also called upon to decolonize its classroom, reform educators and students, and create new practices that will reflect a new, post covid curricula. References Ahmed, R., Omer, J., Ishak, W., Nabi, K., & Mustafa, N. (2021). Racial equity in the fight against COVID-19: a qualitative study examining the importance of collecting race-based data in the Canadian context. Tropical Diseases, Travel Medicine and Vaccines, 7, 1-6. http://dx.doi.org/10.1186/s40794-021-00138-2 Benjamin, L. A. (2003). The Black/Jamaican criminal: The making of ideology (Publication No.305258209). [Doctoral dissertation, University of Toronto]. ProQuest Dissertations and Theses Global. Coleman, T. (2020). Anti-racism in nursing education: Recommendations for racial justice praxis. Journal of Nursing Education, 59(11), 642-645. doi: 10.3928/01484834-20201020-08 Holmes, D., Roy, B. & Perron, A. (2008). The Use of Postcolonialism in the Nursing Domain. Advances in Nursing Science, 31 (1), 42-51. doi: 10.1097/01.ANS.0000311528.73564.83 McGibbon, E., Mulaudzi, F. M., Didham, P., Barton, S., & Sochan, A. (2014). Toward decolonizing nursing: The colonization of nursing and strategies for increasing the counter‐narrative. Nursing inquiry, 21(3), 179-191. Public Health Agency of Canada. (2020). Social determinants and inequities in health for Black Canadians: A snapshot. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health/social-determinants-inequities-black-canadians-snapshot.html Prendergast, N., Abumbi, G., & Beausoleil, L. (2020). An open letter to CNA on the reality of racism in nursing. https://canadian-nurse.com/en/articles/issues/2020/august-2020/an-open-letter-to-cna-on-the-reality-of-racism-in-nursing. Waite, R., & Nardi, D. (2019). Nursing colonialism in America: Implications for nursing leadership. Journal of Professional Nursing, 35(1), 18-25. Nursing education’s longstanding history with colonial frameworks, practices, and standards (Holmes, 2008; McGibbon et al, 2014; Waite & Nardi, 2019), attests to the need to decolonize the nursing classroom, which in effect will decolonize colonial practices within clinical settings. One approach to assist nursing education in the classroom and workplace setting is introducing anti-Black racism (ABR) within the nursing curricula. ABR was coined by Akua Benjamin (2003) to explain the historical, lived experiences of African Canadians, and how colonial legacies in policies and institutions continue to mask racist practices. ABR creates spaces of resistances that can protect recipients and providers of the healthcare system and can disclose and rupture any invisible forms of inequitable practices. Based on the four tenets of ABR, which are, history, experience, invisibility, and legacy, ABR creates critical thinking and dialogues across multiple barriers, therefore providing opportunities for transformative learning and action. By implementing ABR within the nursing curricula, nurses may gain meaningful insights into the various ways racism plays out in the lived experiences of Black, Indigenous, and People of Colour by engaging the student into historical events and lived experiences that expound on varied forms of physical, mental and social enslavements. This presentation will conceptually illustrate the relevance of implementing anti-Black racism within Canadian nursing curricula as an effective strategy that can respond to issues pervading the current climate as well as support student learning and development. As nursing has an ethical responsibility to prepare and educate students to care and protect patients, nursing is also called upon to decolonize its classroom, reform educators and students, and create new practices that will reflect a new, post covid curricula.

Abstract Background Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies. Methods To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies. Discussion Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.

Background: Nurses have the ability to play an important role in patient safety related to antibiotic use and overuse but are often not involved in antimicrobial stewardship programs (ASP). Therefore, nurses need to be educated and trained in antimicrobial stewardship (AS) so that they can more competently contribute to safe patient care. Lewin’s change theory may be utilized as a framework for understanding the integration of nurses into these efforts. Objective of the Study: This integrative review is intended to explore the role of nurses in AS and discuss the importance of nurses needing to be educated, trained, and competent in this so that they can become more actively involved in such programs. Methodology: Articles were gathered from the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Google Scholar from June 2015 to December 2019. A five-year time frame was implemented to ensure that the most current information was included. Seventeen peer reviewed, written in English, original research studies that met the inclusion criteria (from the original 107 studies) and conducted in Australia, Canada, Scotland, South Africa, and the United States were included in this review. Results: The identified 17 recent studies focused on nursing and AS. Six major themes emerged, including nurses’ competency requirements and training related to AS, antimicrobial knowledge and educational gaps, perceived role of the nurse, nurses’ attitudes toward antimicrobial use, nurse and provider perspectives on ASPs, and nurses’ valuable contributions to AS. Discussion: This integrative review found that including nurses in AS would benefit ASPs and that finding ways for facilities to organize and implement such efforts is vital. This ties into the first stage of Lewin’s change theory of “unfreezing” and recognizing that the current (or old) way of practicing is in need of change. The literature reviewed provides evidence that nurses have the capacity to be an integral part of any ASPs and that they can help combat antimicrobial resistance in myriad ways when provided the necessary training and education. All studies reviewed found positive aspects to having nurse representation. However, there are gaps in antimicrobial based knowledge on the part of the nurses. Limitations: The limitations of this integrative review include the fact that the publications used were limited to a five-year timeframe and came specifically from nursing journals or have at least one nurse author contributor. Also, the current review included five international studies where the nurses’ scope and standards of practice may be different from those in the United States. A search of the grey literature reports related to AS was not conducted and could have provided additional valuable information as well. Conclusion and Recommendations: Nursing participation is needed in all ASPs. Empowering and educating nurses to feel confident and competent in this role will help to mitigate the overuse and misuse of antimicrobials. The ASPs most likely vary from institution to institution and future research should provide a framework for how to best disseminate information to nurses. Keywords: Antimicrobial Stewardship, Antibiotic Training, Nurses

Discussions of the economic theory of planned obsolescence—the purposeful embedding of redundancy into the functionality or other aspect of a product—in the 1980s and 1990s often focused on the impact of such a design strategy on manufacturers, consumers, the market, and, ultimately, profits (see, for example, Bulow; Lee and Lee; Waldman). More recently, assessments of such shortened product life cycles have included calculations of the environmental and other costs of such waste (Claudio; Kondoh; Unruh). Commonly utilised examples are consumer products such as cars, whitegoods and small appliances, fashion clothing and accessories, and, more recently, new technologies and their constituent components. This discourse has been adopted by those who configure workers as human resources, and who speak both of skills (Janßen and Backes-Gellner) and human capital itself (Chauhan and Chauhan) being made obsolete by market forces in both predictable and unplanned ways. This includes debate over whether formal education can assist in developing the skills that make their possessors less liable to become obsolete in the workforce (Dubin; Holtmann; Borghans and de Grip; Gould, Moav and Weinberg). However, aside from periodic expressions of disciplinary angst (as in questions such as whether the Liberal Arts and other disciplines are becoming obsolete) are rarely found in discussions regarding higher education. Yet, higher education has been subsumed into a culture of commercial service provision as driven by markets and profit as the industries that design and deliver consumer goods. McKelvey and Holmén characterise this as a shift “from social institution to knowledge business” in the subtitle of their 2009 volume on European universities, and the recent decade has seen many higher educational institutions openly striving to be entrepreneurial. Despite some debate over the functioning of market or market-like mechanisms in higher education (see, for instance, Texeira et al), the corporatisation of higher education has led inevitably to market segmentation in the products the sector delivers. Such market segmentation results in what are called over-differentiated products, seemingly endless variations in the same product to attempt to increase consumption and attendant sales. Milk is a commonly cited example, with supermarkets today stocking full cream, semi-skimmed, skimmed, lactose-free, soy, rice, goat, GM-free and ‘smart’ (enriched with various vitamins, minerals and proteins) varieties; and many of these available in fresh, UHT, dehydrated and/or organic versions. In the education market, this practice has resulted in a large number of often minutely differentiated, but differently named, degrees and other programs. Where there were once a small number of undergraduate degrees with discipline variety within them (including the Bachelor of Arts and Bachelor of Science awards), students can now graduate with a named qualification in a myriad of discipline and professional areas. The attempt to secure a larger percentage of the potential client pool (who are themselves often seeking to update their own skills and knowledges to avoid workforce obsolescence) has also resulted in a significant increase in the number of postgraduate coursework certificates, diplomas and other qualifications across the sector. The Masters degree has fractured from a research program into a range of coursework, coursework plus research, and research only programs. Such proliferation has also affected one of the foundations of the quality and integrity of the higher education system, and one of the last bastions of conventional practice, the doctoral degree. The PhD as ‘Gold-Standard’ Market Leader? The Doctor of Philosophy (PhD) is usually understood as a largely independent discipline-based research project that results in a substantial piece of reporting, the thesis, that makes a “substantial original contribution to knowledge in the form of new knowledge or significant and original adaptation, application and interpretation of existing knowledge” (AQF). As the highest level of degree conferred by most universities, the PhD is commonly understood as indicating the height of formal educational attainment, and has, until relatively recently, been above reproach and alteration. Yet, whereas universities internationally once offered a single doctorate named the PhD, many now offer a number of doctoral level degrees. In Australia, for example, candidates can also complete PhDs by Publication and by Project, as well as practice-led doctorates in, and named Doctorates of/in, Creative Arts, Creative Industries, Laws, Performance and other ‘new’ discipline areas. The Professional Doctorate, introduced into Australia in the early 1990s, has achieved such longevity that it now has it’s own “first generation” incarnations in (and about) disciplines such as Education, Business, Psychology and Journalism, as well as a contemporary “second generation” version which features professionally-practice-led Mode 2 knowledge production (Maxwell; also discussed in Lee, Brennan and Green 281). The uniquely Australian PhD by Project in the disciplines of architecture, design, business, engineering and education also includes coursework, and is practice and particularly workplace (or community) focused, but unlike the above, does not have to include a research element—although this is not precluded (Usher). A significant number of Australian universities also currently offer a PhD by Publication, known also as the PhD by Published Papers and PhD by Published Works. Introduced in the 1960s in the UK, the PhD by Publication there is today almost exclusively undertaken by academic staff at their own institutions, and usually consists of published work(s), a critical appraisal of that work within the research context, and an oral examination. The named degree is rare in the USA, although the practice of granting PhDs on the basis of prior publications is not unknown. In Australia, an examination of a number of universities that offer the degree reveals no consistency in terms of the framing policies except for the generic Australian Qualifications Framework accreditation statement (AQF), entry requirements and conditions of candidature, or resulting form and examination guidelines. Some Australian universities, for instance, require all externally peer-refereed publications, while others will count works that are self-published. Some require actual publications or works in press, but others count works that are still at submission stage. The UK PhD by Publication shows similar variation, with no consensus on purpose, length or format of this degree (Draper). Across Australia and the UK, some institutions accept previously published work and require little or no campus participation, while others have a significant minimum enrolment period and count only work generated during candidature (see Brien for more detail). Despite the plethora of named degrees at doctoral level, many academics continue to support the PhD’s claim to rigor and intellectual attainment. Most often, however, these arguments cite tradition rather than any real assessment of quality. The archaic trappings of conferral—the caps, gowns and various other instruments of distinction—emphasise a narrative in which it is often noted that doctorates were first conferred by the University of Paris in the 12th century and then elsewhere in medieval Europe. However, challenges to this account note that today’s largely independently researched thesis is a relatively recent arrival to educational history, being only introduced into Germany in the early nineteenth century (Bourner, Bowden and Laing; Park 4), the USA in a modified form in the mid-nineteenth century and the UK in 1917 (Jolley 227). The Australian PhD is even more recent, with the first only awarded in 1948 and still relatively rare until the 1970s (Nelson 3; Valadkhani and Ville). Additionally, PhDs in the USA, Canada and Denmark today almost always incorporate a significant taught coursework element (Noble). This is unlike the ‘traditional’ PhD in the UK and Australia, although the UK also currently offers a number of what are known there as ‘taught doctorates’. Somewhat confusingly, while these do incorporate coursework, they still include a significant research component (UKCGE). However, the UK is also adopting what has been identified as an American-inflected model which consists mostly, or largely, of coursework, and which is becoming known as the ‘New Route British PhD’ (Jolley 228). It could be posited that, within such a competitive market environment, which appears to be driven by both a drive for novelty and a desire to meet consumer demand, obsolescence therefore, and necessarily, threatens the very existence of the ‘traditional’ PhD. This obsolescence could be seen as especially likely as, alongside the existence of the above mentioned ‘new’ degrees, the ‘traditional’ research-based PhD at some universities in Australia and the UK in particular is, itself, also in the process of becoming ‘professionalised’, with some (still traditionally-framed) programs nevertheless incorporating workplace-oriented frameworks and/or experiences (Jolley 229; Kroll and Brien) to meet professionally-focused objectives that it is acknowledged cannot be met by producing a research thesis alone. While this emphasis can be seen as operating at the expense of specific disciplinary knowledge (Pole 107; Ball; Laing and Brabazon 265), and criticised for that, this workplace focus has arisen, internationally, as an institutional response to requests from both governments and industry for training in generic skills in university programs at all levels (Manathunga and Wissler). At the same time, the acknowledged unpredictability of the future workplace is driving a cognate move from discipline specific knowledge to what have been described as “problem solving and knowledge management approaches” across all disciplines (Gilbert; Valadkhani and Ville 2). While few query a link between university-level learning and the needs of the workplace, or the motivating belief that the overarching role of higher education is the provision of professional training for its client-students (see Laing and Brabazon for an exception), it also should be noted that a lack of relevance is one of the contributors to dysfunction, and thence to obsolescence. The PhD as Dysfunctional Degree? Perhaps, however, it is not competition that threatens the traditional PhD but, rather, its own design flaws. A report in The New York Times in 2007 alerted readers to what many supervisors, candidates, and researchers internationally have recognised for some time: that the PhD may be dysfunctional (Berger). In Australia and elsewhere, attention has focused on the uneven quality of doctoral-level degrees across institutions, especially in relation to their content, rigor, entry and assessment standards, and this has not precluded questions regarding the PhD (AVCC; Carey, Webb, Brien; Neumann; Jolley; McWilliam et al., "Silly"). It should be noted that this important examination of standards has, however, been accompanied by an increase in the awarding of Honorary Doctorates. This practice ranges from the most reputable universities’ recognising individuals’ significant contributions to knowledge, culture and/or society, to wholly disreputable institutions offering such qualifications in return for payment (Starrs). While generally contested in terms of their status, Honorary Doctorates granted to sports, show business and political figures are the most controversial and include an award conferred on puppet Kermit the Frog in 1996 (Jeffries), and some leading institutions including MIT, Cornell University and the London School of Economics and Political Science are distinctive in not awarding Honorary Doctorates. However, while distracting, the Honorary Doctorate itself does not answer all the questions regarding the quality of doctoral programs in general, or the Doctor of Philosophy in particular. The PhD also has high attrition rates: 50 per cent or more across Australia, the USA and Canada (Halse 322; Lovitts and Nelson). For those who remain in the programs, lengthy completion times (known internationally as ‘time-to-degree’) are common in many countries, with averages of 10.5 years to completion in Canada, and from 8.2 to more than 13 years (depending on discipline) in the USA (Berger). The current government performance-based funding model for Australian research higher degrees focuses attention on timely completion, and there is no doubt that, under this system—where universities only receive funding for a minimum period of candidature when those candidates have completed their degrees—more candidates are completing within the required time periods (Cuthbert). Yet, such a focus has distracted from assessment of the quality and outcomes of such programs of study. A detailed survey, based on the theses lodged in Australian libraries, has estimated that at least 51,000 PhD theses were completed in Australia to 2003 (Evans et al. 7). However, little attention has been paid to the consequences of this work, that is, the effects that the generation of these theses has had on either candidates or the nation. There has been no assessment, for instance, of the impact on candidates of undertaking and completing a doctorate on such facets of their lives as their employment opportunities, professional choices and salary levels, nor any effect on their personal happiness or levels of creativity. Nor has there been any real evaluation of the effect of these degrees on GDP, rates of the commercialisation of research, the generation of intellectual property, meeting national agendas in areas such as innovation, productivity or creativity, and/or the quality of the Australian creative and performing arts. Government-funded and other Australian studies have, however, noted for at least a decade both that the high numbers of graduates are mismatched to a lack of market demand for doctoral qualifications outside of academia (Kemp), and that an oversupply of doctorally qualified job seekers is driving wages down in some sectors (Jones 26). Even academia is demanding more than a PhD. Within the USA, doctoral graduates of some disciplines (English is an often-cited example) are undertaking second PhDs in their quest to secure an academic position. In Australia, entry-level academic positions increasingly require a scholarly publishing history alongside a doctoral-level qualification and, in common with other quantitative exercises in the UK and in New Zealand, the current Excellence in Research for Australia research evaluation exercise values scholarly publications more than higher degree qualifications. Concluding Remarks: The PhD as Obsolete or Retro-Chic? Disciplines and fields are reacting to this situation in various ways, but the trend appears to be towards increased market segmentation. Despite these charges of PhD dysfunction, there are also dangers in the over-differentiation of higher degrees as a practice. If universities do not adequately resource the professional development and other support for supervisors and all those involved in the delivery of all these degrees, those institutions may find that they have spread the existing skills, knowledge and other institutional assets too thinly to sustain some or even any of these degrees. This could lead to the diminishing quality (and an attendant diminishing perception of the value) of all the higher degrees available in those institutions as well as the reputation of the hosting country’s entire higher education system. As works in progress, the various ‘new’ doctoral degrees can also promote a sense of working on unstable ground for both candidates and supervisors (McWilliam et al., Research Training), and higher degree examiners will necessarily be unfamiliar with expected standards. Candidates are attempting to discern the advantages and disadvantages of each form in order to choose the degree that they believe is right for them (see, for example, Robins and Kanowski), but such assessment is difficult without the benefit of hindsight. Furthermore, not every form may fit the unpredictable future aspirations of candidates or the volatile future needs of the workplace. The rate with which everything once new descends from stylish popularity through stages of unfashionableness to become outdated and, eventually, discarded is increasing. This escalation may result in the discipline-based research PhD becoming seen as archaic and, eventually, obsolete. Perhaps, alternatively, it will lead to newer and more fashionable forms of doctoral study being discarded instead. Laing and Brabazon go further to find that all doctoral level study’s inability to “contribute in a measurable and quantifiable way to social, economic or political change” problematises the very existence of all these degrees (265). Yet, we all know that some objects, styles, practices and technologies that become obsolete are later recovered and reassessed as once again interesting. They rise once again to be judged as fashionable and valuable. Perhaps even if made obsolete, this will be the fate of the PhD or other doctoral degrees?References Australian Qualifications Framework (AQF). “Doctoral Degree”. AQF Qualifications. 4 May 2009 ‹http://www.aqf.edu.au/doctor.htm›. Australian Vice-Chancellors’ Committee (AVCC). Universities and Their Students: Principles for the Provision of Education by Australian Universities. Canberra: AVCC, 2002. 4 May 2009 ‹http://www.universitiesaustralia.edu.au/documents/publications/Principles_final_Dec02.pdf›. Ball, L. “Preparing Graduates in Art and Design to Meet the Challenges of Working in the Creative Industries: A New Model For Work.” Art, Design and Communication in Higher Education 1.1 (2002): 10–24. Berger, Joseph. “Exploring Ways to Shorten the Ascent to a Ph.D.” Education. The New York Times, 3 Oct. 2008. 4 May 2009 ‹http://nytimes.com/2007/10/03/education/03education.html›. Borghans, Lex, and Andries de Grip. Eds. The Overeducated Worker?: The Economics of Skill Utilization. Cheltenham, UK: Edward Elgar, 2000. Bourner, T., R. Bowden and S. Laing. “Professional Doctorates in England”. Studies in Higher Education 26 (2001) 65–83. Brien, Donna Lee. “Publish or Perish?: Investigating the Doctorate by Publication in Writing”. The Creativity and Uncertainty Papers: the Refereed Proceedings of the 13th Conference of the Australian Association of Writing Programs. AAWP, 2008. 4 May 2009 ‹http://www.aawp.org.au/creativity-and-uncertainty-papers›. Bulow, Jeremy. “An Economic Theory of Planned Obsolescence.” The Quarterly Journal of Economics 101.4 (Nov. 1986): 729–50. Carey, Janene, Jen Webb, and Donna Lee Brien. “Examining Uncertainty: Australian Creative Research Higher Degrees”. The Creativity and Uncertainty Papers: the Refereed Proceedings of the 13th Conference of the Australian Association of Writing Programs. AAWP, 2008. 4 May 2009 ‹http://www.aawp.org.au/creativity-and-uncertainty-papers›. Chauhan, S. P., and Daisy Chauhan. “Human Obsolescence: A Wake–up Call to Avert a Crisis.” Global Business Review 9.1 (2008): 85–100. Claudio, Luz. "Environmental Impact of the Clothing Industry." Environmental Health Perspectives 115.9 (Set. 2007): A449–54. Cuthbert, Denise. “HASS PhD Completions Rates: Beyond the Doom and Gloom”. Council for the Humanities, Arts and Social Sciences, 3 March 2008. 4 May 2009 ‹http://www.chass.org.au/articles/ART20080303DC.php›. Draper, S. W. PhDs by Publication. University of Glasgow, 11 Aug. 2008. 4 May 2009 ‹http://www.psy.gla.ac.uk/~steve/resources/phd.html. Dubin, Samuel S. “Obsolescence or Lifelong Education: A Choice for the Professional.” American Psychologist 27.5 (1972): 486–98. Evans, Terry, Peter Macauley, Margot Pearson, and Karen Tregenza. “A Brief Review of PhDs in Creative and Performing Arts in Australia”. Proceeding of the Association for Active Researchers Newcastle Mini-Conference, 2–4 October 2003. Melbourne: Australian Association for Research in Education, 2003. 4 May 2009 ‹http://www.aare.edu.au/conf03nc. Gilbert, R. “A Framework for Evaluating the Doctoral Curriculum”. Assessment and Evaluation in Higher Education 29.3 (2004): 299–309. Gould, Eric D., Omer Moav, and Bruce A. Weinberg. “Skill Obsolescence and Wage Inequality within Education Groups.” The Economics of Skills Obsolescence. Eds. Andries de Grip, Jasper van Loo, and Ken Mayhew. Amsterdam: JAI Press, 2002. 215–34. Halse, Christine. “Is the Doctorate in Crisis?” Nagoya Journal of Higher Education 34 Apr. (2007): 321–37. Holtmann, A.G. “On-the-Job Training, Obsolescence, Options, and Retraining.” Southern Economic Journal 38.3 (1972): 414–17. Janßen, Simon, and Uschi Backes-Gellner. “Skill Obsolescence, Vintage Effects and Changing Tasks.” Applied Economics Quarterly 55.1 (2009): 83–103. Jeffries, Stuart. “I’m a Celebrity, Get Me an Honorary Degree”. The Guardian 6 July 2006. 4 May 2009 ‹http://www.guardian.co.uk/music/2006/jul/06/highereducation.popandrock. Jolley, Jeremy. “Choose your Doctorate.” Journal of Clinical Nursing 16.2 (2007): 225–33. Jones, Elka. “Beyond Supply and Demand: Assessing the Ph.D. Job Market.” Occupational Outlook Quarterly Winter (2002-2003): 22–33. Kemp, D. ­New Knowledge, New Opportunities: A Discussion Paper on Higher Education Research and Research Training. Canberra: Australian Government Printing Service, 1999. Kondoh, Shinsuke, Keijiro Masui, Mitsuro Hattori, Nozomu Mishima, and Mitsutaka Matsumoto. “Total Performance Analysis of Product Life Cycle Considering the Deterioration and Obsolescence of Product Value.” International Journal of Product Development 6.3–4 (2008): 334–52. Kroll, Jeri, and Donna Lee Brien. “Studying for the Future: Training Creative Writing Postgraduates For Life After Degrees.” Australian Online Journal of Arts Education 2.1 July (2006): 1–13. Laing, Stuart, and Tara Brabazon. “Creative Doctorates, Creative Education? Aligning Universities with the Creative Economy.” Nebula 4.2 (June 2007): 253–67. Lee, Alison, Marie Brennan, and Bill Green. “Re-imagining Doctoral Education: Professional Doctorates and Beyond.” Higher Education Research & Development 28.3 2009): 275–87. Lee, Ho, and Jonghwa Lee. “A Theory of Economic Obsolescence.” The Journal of Industrial Economics 46.3 (Sep. 1998): 383–401. Lovitts, B. E., and C. Nelson. “The Hidden Crisis in Graduate Education: Attrition from Ph.D. Programs.” Academe 86.6 (2000): 44–50. Manathunga, Catherine, and Rod Wissler. “Generic Skill Development for Research Higher Degree Students: An Australian Example”. International Journal of Instructional Media, 30.3 (2003): 233–46. Maxwell, T. W. “From First to Second Generation Professional Doctorate.” Studies in Higher Education 28.3 (2003): 279–91. McKelvey, Maureen, and Magnus Holmén. Ed. Learning to Compete in European Universities: From Social Institution to Knowledge Business. Cheltenham, UK: Edward Elgar Publishing, 2009. McWilliam, Erica, Alan Lawson, Terry Evans, and Peter G Taylor. “‘Silly, Soft and Otherwise Suspect’: Doctoral Education as Risky Business”. Australian Journal of Education 49.2 (2005): 214–27. 4 May 2009. http://eprints.qut.edu.au/archive/00004171. McWilliam, Erica, Peter G. Taylor, P. Thomson, B. Green, T. W. Maxwell, H. Wildy, and D. Simmons. Research Training in Doctoral Programs: What Can Be Learned for Professional Doctorates? Evaluations and Investigations Programme 02/8. Canberra: Commonwealth of Australia, 2002. Nelson, Hank. “A Doctor in Every House: The PhD Then Now and Soon”. Occasional Paper GS93/3. Canberra: The Graduate School, Australian National University, 1993. 4 May 2009 ‹http://dspace.anu.edu.au/bitstream/1885/41552/1/GS93_3.pdf›. Neumann, Ruth. The Doctoral Education Experience: Diversity and Complexity. 03/12 Evaluations and Investigations Programme. Canberra: Department of Education, Science and Training, 2003. Noble K. A. Changing Doctoral Degrees: An International Perspective. Buckingham: Society for Research into Higher Education, 1994. Park, Chris. Redefining the Doctorate: Discussion Paper. York: The Higher Education Academy, 2007. Pole, Christopher. “Technicians and Scholars in Pursuit of the PhD: Some Reflections on Doctoral Study.” Research Papers in Education 15 (2000): 95–111. Robins, Lisa M., and Peter J. Kanowski. “PhD by Publication: A Student’s Perspective”. Journal of Research Practice 4.2 (2008). 4 May 2009 ‹http://jrp.icaap.org›. Sheely, Stephen. “The First Among Equals: The PhD—Academic Standard or Historical Accident?”. Advancing International Perspectives: Proceedings of the Higher Education Research and Development Society of Australasia Conference, 1997. 654-57. 4 May 2009 ‹http://www.herdsa.org.au/wp-content/uploads/conference/1997/sheely01.pdf›. Texeira, Pedro, Ben Jongbloed, David Dill, and Alberto Amaral. Eds. Markets in Higher Education: Rethoric or Reality? Dordrecht, the Netherlands: Kluwer, 2004. UK Council for Graduate Education (UKCGE). Professional Doctorates. Dudley: UKCGE, 2002. Unruh, Gregory C. “The Biosphere Rules.” Harvard Business Review Feb. 2008: 111–17. Usher R. “A Diversity of Doctorates: Fitness for the Knowledge Economy?”. Higher Education Research & Development 21 (2002): 143–53. Valadkhani, Abbas, and Simon Ville. “A Disciplinary Analysis of the Contribution of Academic Staff to PhD Completions in Australian Universities”. International Journal of Business & Management Education 15.1 (2007): 1–22. Waldman, Michael. “A New Perspective on Planned Obsolescence.” The Quarterly Journal of Economics 108.1 (Feb. 1993): 273–83.

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”. Focus on Health Professional Education: A Multi-Disciplinary Journal 13.1 (2011): 1-12.Anning, Beres. “Embedding an Indigenous Graduate Attribute into University of Western Sydney’s Courses”. Australian Journal of Indigenous Education 39 (2010): 40-52.Asmar, Christine. Final Report on the Murrup Barak of Indigenous Curriculum, Teaching and Learning at the University of Melbourne, 2010-2011. Murrup Barak – Melbourne Institute for Indigenous Development, University of Melbourne, 2011.Bargallie, Debbie. Unmasking The Racial Contract: Everyday Racisms and the Impact of Racial Microaggressions on “Indigenous Employees” in the Australian Public Service. Aboriginal Studies Press, 2020. Behrendt, Larissa. Indigenous Australia for Dummies. Wiley Publishing, 2010.Behrendt, Larissa, Steven Larkin, Robert Griew, Robert, and Patricia Kelly. Review of Higher Education Access and Outcomes for Aboriginal and Torres Strait Islander People: Final Report. Department of Employment, Education and Workplace Relations, 2012.Brach, Cindy, and Irene Fraser. “Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model”. Medical Care Research and Review 57.sup 1 (2000): 181-217.Bond, Chelsea. “When the Object Teaches: Indigenous Academics in Australian Universities”. Right Now 14 (2014). <http://rightnow.org.au/opinion-3/when-the-object-teaches-indigenous-academics-in-australian-universities/>.Bradley, Denise, Peter Noonan, Helen Nugent, and Bill Scales. Review of Australian Higher Education. Australian Government, 2008.Butler, Kathleen, and Anne Young. Indigenisation of Curricula – Intent, Initiatives and Implementation. Canberra: Tertiary Education Quality and Standards Agency, 2009. 20 Apr. 2020 <http://www.teqsa.gov.au/news-publications/publications>.Campinha-Bacote, Josepha. “A Model and Instrument for Addressing Cultural Competence in Health Care”. Journal of Nursing Education 38.5 (1999): 203-207.Carlson, Bronwyn. The Politics of Identity – Who Counts as Aboriginal Today? Canberra: Aboriginal Studies Press, 2016.Delgado, Richard, and Jean Stefancic. Critical Race Theory: An Introduction. New York University Press, 2001.DiAngelo, Robin. “Nothing to Add: A Challenge to White Silence in Racial Discussions”. Understanding and Dismantling Privilege 11.1 (2012). <http://www.wpcjournal.com/article/view/10100/Nothing%20to%20add%3A%20A%20Challenge%20to%20White%20Silence%20in%20Racial%20Discussions>.Frankenburg, Ruth. White Women, Race Matters: The Social Construction of Whiteness. Minneapolis: University of Minnesota Press, 1993.Fredericks, Bronwyn. “The Need to Extend beyond the Knowledge Gained in Cross-Cultural Awareness Training”. The Australian Journal of Indigenous Education 37.S (2008): 81-89.Fredericks, Bronwyn, and Debbie Bargallie. “An Indigenous Cultural Competency Course: Talking Culture, Care and Power”. In Cultural Competence and the Higher Education Sector: Perspectives, Policies and Practice, eds. Jack Frawley, Gabrielle Russell, and Juanita Sherwood, Springer Publications, 295-308. <https://link.springer.com/book/10.1007%2F978-981-15-5362-2>.Fredericks, Bronwyn, and Debbie Bargallie. “‘Which Way? Talking Culture, Talking Race’: Unpacking an Indigenous Cultural Competency Course”. International Journal of Critical Indigenous Studies 9.1 (2016): 1-14.Fredericks, Bronwyn, and Marlene Thompson. “Collaborative Voices: Ongoing Reflections on Cultural Competency and the Health Care of Australian Indigenous People”. Journal of Australian Indigenous Issues 13.3 (2010): 10-20.Fredericks, Bronwyn, and Nereda White. “Using Bridges Made by Others as Scaffolding and Establishing Footings for Those That Follow: Indigenous Women in the Academy”. Australian Journal of Education 62.3 (2018): 243–255.Gorringe, Scott, Joe Ross, and Cressida Fforde. Will the Real Aborigine Please Stand Up? Strategies for Breaking the Stereotypes and Changing the Conversation. AIATSIS Research Discussion Paper No. 28. Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS), 2011.Hollinsworth, David. “Forget Cultural Competence: Ask for an Autobiography”. Social Work Education: The International Journal 32.8 (2013): 1048-1060.hooks, bell. Feminist Theory: From Margin to Centre. London: Pluto Press, 2000.Kinnane, Stephen, Judith Wilks, Katie Wilson, Terri Hughes, and Sue Thomas. Can’t Be What You Can’t See: The Transition of Aboriginal and Torres Strait Islander Students into Higher Education. Final report to the Australian Government Office for Learning and Teaching. Canberra: Office of Learning and Teaching, 2014.Lentin, Alana. “Beyond Denial: ‘Not Racism’ as Racist Violence”. Continuum 32.1 (2018): 1-15.Leonardo, Zeus, and Ronald L. Porter. “Pedagogy of Fear: Toward a Fanonian Theory of ‘Safety’ in Race Dialogue”. Race Ethnicity and Education 13.2 (2010): 139-157.Lorde, Audrey. Sister Outsider: Essays and Speeches. Crossing Press, 1984.McIntosh, Peggy. White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences through Work in Women's Studies. Wellesley College, Center for Research on Women, 1988.McLaughlin, Juliana, and Sue Whatman. “The Potential of Critical Race Theory in Decolonizing University Curricula”. Asia Pacific Journal of Education 31.4 (2011): 365-377.Moreton-Robinson, Aileen. The White Possessive: Property, Power, and Indigenous Sovereignty. University of Minnesota Press, 2015.Sargent, Sara E., Carol A. Sedlak, and Donna S. Martsolf. “Cultural Competence among Nursing Students and Faculty”. Nurse Education Today 25.3 (2005): 214-221.Sherwood, Juanita, and Tahnia Edwards. “Decolonisation: A Critical Step for Improving Aboriginal health”. Contemporary Nurse 22.2 (2016): 178-190.Spencer, Caroline, and Frances L. Archer. “Surveys of Cultural Competency in Health Professional Education: A Literature Review”. Journal of Emergency Primary Health Care 6.2 (2008): 17.Universities Australia. National Best Practice Framework for Indigenous Cultural Competency in Australian Universities. Universities Australia, 2011. <http://www.universitiesaustralia.edu.au/lightbox/1312>.University of Sydney. National Centre for Cultural Competence, 2016. <http://sydney.edu.au/nccc/>.Westwood, Barbara, and Geoff Westwood. “Aboriginal Cultural Awareness Training: Policy v. Accountability – Failure in Reality”. Australian Health Review 34 (2010): 423-429.Young, Susan. “Not Because It’s a Bloody Black Issue! Problematics of Cross Cultural Training”. In Unmasking Whiteness: Race Relations and Reconciliation, ed. Belinda McKay, 204-219. Queensland Studies Centre, University of Queensland Press, 1999.