Nurses and midwives are providing care to a culturally diverse society. However, culture is a socially shared view and behavior practiced in a certain society and considered to be dynamic and not universal. This review seeks to analyze and synthesize evidence on cultural aspects of comfort in the perinatal period to provide definition of cultural maternal comfort in nursing and midwifery practice. An integrative review conducted following Whittemore and Knafl. Systematic searches in CINAHL and Scopus databases generated 10 studies for review. After all eligible articles had been identified, data extraction and inductive thematic analysis were performed. The cultural aspect of maternal comfort includes culturally effective communication, culturally supportive environment, cultural practice for physical symptom relief, cultural expectation of functionality, family and community involvement, and cultural safety and security. When health-care professionals, particularly nurses and midwives, understand a woman's cultural background, they promote trust, enhance communication, and ultimately improve childbearing and childbirth experiences.

Well-implemented vaccination programs can reduce infectious disease burden in an equitable and cost-effective manner. This rapid review used a strengths-based approach to identify enablers and barriers to vaccination for Aboriginal and Torres Strait Islander children aged 0-5years, and identify the characteristics of effective programs to improve vaccination coverage and timeliness. Databases and grey literature sources were searched for articles published between 2013 and 2025. Following screening, an inductive coding process informed by Braun and Clarke's reflexive thematic analysis was utilised to consolidate qualitative data. Twelve studies discussing enablers, barriers and characteristics of successful programs to increase vaccination rates were included. These studies were heterogenous in design and population. Despite variability between settings and communities, service access barriers, such as lack of adequate transport and opening hours, were commonly cited throughout the included studies, as well as lack of cultural safety. This review emphasises the value of community ownership and local responsiveness of programs aimed at increasing vaccination timeliness and coverage, and the importance of strengthening the Aboriginal and Torres Strait Islander health workforce.

Childhood immunisation coverage in Aotearoa New Zealand (NZ) is not meeting recommended targets. Enrolment and engagement with primary care are associated with timely immunisation uptake, yet enrolment and immunisation are inequitable, with Māori and Pacific children less likely to be enrolled and receive their 6-week vaccinations on time. This study aimed to understand healthcare providers' perceptions of barriers and enablers to primary healthcare enrolment from birth and provide recommendations to support enrolment, engagement, and immunisation, particularly for Māori whānau (families). This qualitative study, guided by a Kaupapa Māori-aligned methodology, involved interviews and focus groups to explore barriers and enablers to enrolment from the perspective of people working within the NZ healthcare sector (n=27). Analysis was undertaken using qualitative content analysis. Many participants expressed that the current system was contributing to inequitable enrolment and immunisation of pēpi (infants). Four categories were constructed: health services may not be accessible or practical for whānau; perceived complexity and skill shortages; the need to prioritise communication and engagement; and services must be built on cultural safety and trust. Reasons for inadequate enrolment include poorly designed systems, limited resourcing, and inconsistent approaches. Enrolment needs to be simplified, with integrated and automated systems to reduce administrative burden for staff. Flexible whānau-centred practices can help support enrolment, engagement, and immunisation of pēpi.

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately impacted by HIV and other sexually transmitted infections (STIs). Recent biomedical innovations such as HIV pre-exposure prophylaxis, STI vaccines and testing offer new prevention tools. However, realising these benefits hinges on GBM disclosing their sexuality and receiving appropriate support from healthcare providers (HCPs). We aimed to understand GBM's experiences of sexual healthcare in Aotearoa New Zealand. We conducted an inductive thematic analysis of free-text responses to the Sex and Prevention of Transmission Study, a large and diverse national cross-sectional behavioural surveillance survey of GBM in 2022. Data from 422 participants reporting negative experiences when discussing their sexuality and sexual health with HCPs were examined. Overall, 19.1% reported a negative experience discussing their sexuality with an HCP. Six themes were derived from participants' experiences. Negative reactions to GBM's sexuality and sexual health needs centred around four themes: (1) judgement and prejudice, (2) disrespect, (3) discrimination, and (4) inexperience and skill deficits. Additionally, two themes related to: (5) participants' views about how their HCP's demographic characteristics (e.g. age, gender, religion, sexual orientation) might underpin their behaviour, and (6) consequences of GBM's negative experiences (changing HCPs, forgoing sexual health services, suffering poor mental and physical health). In the era of biomedical HIV/STI prevention, GBM's ability to communicate about their sexuality and sexual health will be a key antecedent to eliminating HIV and STI transmission. Strategies spanning health workforce training and targeted service expansion are needed to improve experiences of sexual healthcare services for GBM. Heterosexist environments that underpin judgement and prejudice, disrespect, discrimination and lack of skill must be addressed; cultural competence and safety must support diverse HCPs to improve delivery; and the consequences for those whose care is compromised by negative healthcare experiences must be mitigated.

A Queensland Health report points out that Māori and Pacific Island communities in Queensland are vulnerable due to social disadvantage and limited health service access. The researcher applies decolonisation and cultural safety models, emphasising the importance of understanding the historical, political, and socio-contextual determinants of these groups. Ethical considerations as applied in this research must be flexible and culturally safe, focusing on a reflective and respectful approach to data collection. The literature review is based on Charmaz's constructivist contextual framework, which underpins and later reveals that the socio-contextual determinants for Māori and Pacific Island communities in Queensland are multifaceted, with one direct factor being disengagement from child and family health services. To explore this, qualitative research used both decolonisation and cultural safety methodologies, with a focus on ethical considerations and the service user's experience, specifically examining how care is delivered, and not just the type of care provided. Embracing a decolonial perspective, the Talanoa method guided the data collection process. This involved interviewing 29 Māori and Pacific Island families in Townsville and Brisbane, as well as eight child health service providers in these areas. During data analysis, key interpretations were informed by conceptualisations of culturally safe health service delivery, supported by Charmaz's constructivist grounded theory, which aligns with the cultural safety methodology. The data analysis revealed key themes, including power dynamics, positionality, and identity versus cultural differences, the deficit discourse of trans-culturalism, and cultural disconnection in the portrayal of health service delivery to Queensland Māori and Pacific Island families. In this research context, trans-culturalism is associated with a deficit discourse. The application of the theoretical framework of cultural safety and decolonisation was two-fold; it reveals the importance of working in partnership and reveals significant power imbalances, causing a lack of engagement between service users and service providers. Furthermore, it reveals the unexamined privileges of service providers and the inherent marginalisation of service users. Of significance to the research problem statement, the 'lack of uptake of health service delivery', the grounded theoretical and traditional perspectives of cultural safety and decolonisation shift the focus from service users (Māori and Pacific Island communities) to explore the experiences of child health service providers in their interactions with Māori and Pacific Island families. The analysis uncovered misconceptions and a tendency to assume that healthcare delivery using a trans-cultural approach was culturally safe. Unearthing an understanding that challenges the deficit discourse of trans-culturalism to comprehend participants' positionality is essential for resolving and addressing the health issues faced by Queensland Māori and Pacific Island families accessing services. This recognition indicates an ongoing reliance on colonial imposition rather than promoting (a principle of cultural safety) self-determination in access to health service delivery for Queensland Māori and Pacific Island families.

Cultural safety is a key component of quality general practice for Aboriginal and Torres Strait Islander peoples; however, few tools exist to assess this from the patient's perspective. This study aimed to explore the qualities of a general practitioner (GP) that support culturally safe consultations, as described by Aboriginal and Torres Strait Islander peoples, and to examine how these align with two consultation models: the Calgary-Cambridge Guide and clinical yarning. A mixed methods approach was used, including a survey, qualitative interviews and a modified nominal group technique (mNGT). Participants were Aboriginal and Torres Strait Islander peoples who had previously engaged with general practice care. Data were both described and analysed thematically. In total, 131 Aboriginal and Torres Strait Islander peoples participated (70 in the survey and interview; 43 in mNGT to validate the findings; and 18 in three separate mNGTs to rate desirable attributes of a GP). Participants identified several qualities underpinning a safe GP consultation. Within the top five attributes in the mNGT were universal skills - clinical competence, avoidance of jargon and attentive listening - alongside welcoming patients with a greeting and avoiding stereotyping. Although there was strong emphasis on respectful, individualised care, preferences varied significantly, highlighting the limitations of a generic approach to consultation skills. Some findings challenged core assumptions regarding clinical yarning and elements of cultural safety training. We propose a refined, integrated consultation model that enhances the Calgary-Cambridge Guide with relational elements of the social yarn, particularly during initiation of the consultation. This integrated model, grounded in Aboriginal and Torres Strait Islander peoples' perspectives yet familiar to GPs and academics, offers a promising foundation for culturally safe practice and assessment, with potential applicability across other diverse populations.

Background Cultural safety is a core value of nursing and midwifery practise however limited research has examined how students integrate and translate the principles of cultural safety into clinical practise. There is limited evidence exploring how curriculum content shapes students' attitudes and behaviours. Aim This study aimed to explore nursing and midwifery students understanding of cultural safety and their perception of how that translated into their clinical practice. Design A two-phase qualitative exploratory design was employed comprising semi structured interviews followed by an online qualitative survey data were analysed deductively using the capability opportunity motivation (COM-B model). To our knowledge this is the first study to use this framework to explore the barriers and facilitators influencing students' translation of cultural safety into practice. Findings Seventeen nursing and midwifery students participated. Students' capacity to translate cultural safety principles were shaped by the interaction of capability opportunity and motivation capability was enhanced through understanding of cultural safety including historical an end to generational trauma and through critical self-reflection. Opportunity was strengthened by supportive educational and clinical environments including mentorship and role modelling. Motivation was influenced by increased awareness or colonisation a sense of humility and commitment to avoiding harmful practices with some students expressing willingness to question and challenge organisation systems. As participants with nonindigenous, the findings therefore reflect their perceptions and interpretations. Conclusion Preparing students to meet professional expectations for culturally safe practice requires expanded culturally informed curricula an intentionally designed learning experiences across classroom and clinical context. When learning experiences support the application of cultural safety principles students have better position to translate theoretical knowledge into practise. Collectively these findings highlight the need for alignment between individual learning educational design and culturally safe clinical environments.

Simulation-based learning is a core component of health professional education, yet designing simulations that are culturally responsive, educationally robust, and locally relevant remains challenging. Existing international standards reflect the cultural contexts in which they were developed and provide limited guidance for adapting simulation design for Australia and Aotearoa New Zealand, including effective inclusion of Australian First Nations and New Zealand Māori perspectives. The Quality Simulation Assurance Framework (QSAFe) was developed to address this gap and support culturally safe, high-quality simulation design. This study explored two research questions: (1) How do participants evaluate the applicability of the framework, including its relevance and feasibility, to their simulation practice? and (2) How does the framework support users in their design and delivery of quality simulation, including perceived helpfulness, value, and educative impact? A pilot evaluation was conducted across five tertiary institutions. Twenty-six educators used the framework to benchmark an existing simulation-based learning activity, and four participated in semi-structured interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were examined using reflexive thematic analysis to explore perceptions of applicability and educative value. Participants reported that the framework and supporting materials were broadly applicable to their simulation practice. Most participants rated their experience positively and indicated an intention to use the framework in future design or documentation. Four themes described the framework's perceived value: usability, promoting best practice, supporting reflection on design, and encouraging consistent learner experience. Although the consultation and co-design element of the framework received the lowest quantitative relevance rating, findings showed this element to be least understood, particularly in relation to cultural safety and Australian First Nations and New Zealand Māori inclusion. Participants suggested improvements such as a brief orientation, video walkthroughs, and an online version with embedded guidance. Limitations included a small sample, incomplete survey responses, and challenges recruiting interview participants. The Quality Simulation Assurance Framework appears feasible, useful, and educative, supporting more consistent and culturally responsive simulation design. Further refinement should focus on strengthening guidance for co-design with Australian First Nations and New Zealand Māori and enhancing usability.

Co-Creating the Diabetes Mobile Clinic: A Community-Grounded Model for Equitable Diabetes Care in Calgary.

We evaluated a Collaborative Online International Learning (COIL) programme in enhancing nursing students' intercultural sensitivity and understanding of cultural safety. From April to May 2024, nursing students in Japan, the United Kingdom, and New Zealand completed a COIL module integrating Virtual Empathy Museum exploration, Padlet discussions, and live debriefings. A convergent mixed-methods design was adopted. Multi-source qualitative data were thematically analysed and integrated with pre/post Intercultural Sensitivity Scale (ISS) scores compared using Wilcoxon signed-rank tests. Students reported a deeper understanding of cultural safety, appreciated diverse perspectives in nursing care, and valued the opportunity for cross-cultural learning. ISS scores showed no significant change, although Intercultural Attentiveness significantly improved among Japanese students. This programme has the potential to develop intercultural sensitivity, cultural safety awareness, and support culturally congruent learning across continents. Further studies with larger samples and longer follow-up are needed to assess scalability and longer-term outcomes.

Indigenous health and cultural safety in interdisciplinary tertiary education: A multi-method evaluation of student learning.

The ongoing Israel-Palestine conflict has significant consequences for children, youth and families from diverse communities in North America. In a time of widening social polarization, many children and youth are implicated in reiterations of the conflict at home, at school or in their neighborhoods. This divisive context has numerous indirect and direct clinical consequences requiring clinicians' awareness, attunement, and skillful response. Building on clinical experiences in Quebec (Canada), this paper questions the cultural safety of clinical interventions at three levels. First, the conflict can alter the therapeutic alliance in unspoken ways, requiring ongoing attention to cultural and contextual securitization. Second, because of its potentially traumatic impact, the conflict can influence symptom presentation in subtle or overt ways. Third, the internalization of the conflict can prompt forms of challenging acting-out, potentially eliciting stigmatizing clinical or social responses. Overall, preserving cultural safety in this context requires favouring a systemic assessment of the patient and their lived experiences, considering simultaneously the family, school and community context. Minimizing silence and avoidance by addressing the possible distress and divisions-or indeed outright divergences-within clinical and school teams may foster a respectful and safe enough environment, in spite of the differences in meaning within and across heterogeneous communities.

As Taiwanese society grows increasingly diverse and inclusive, the challenges faced in frontline clinical care are expanding beyond treating physical illnesses to include how to effectively embrace the life narratives and health beliefs of diverse populations. Although the long-standing emphasis on "cultural sensitivity" and "cultural competence" in the medical profession has encouraged healthcare professionals to learn about the customs and taboos of different cultures, research findings remind us that culture is not a fixed label. Lacking critical reflection on power imbalances, the accumulation of such knowledge may lead to the emergence and entrenchment of other forms of stereotyping (Curtis et al., 2019). The theme of this issue, "Cultural Safety in Nursing Practice", sincerely invites readers to reflect on whether our current standardized healthcare processes have unintentionally silenced certain voices. The articles featured in this issue provide accessible yet in-depth analyses of the multiple dimensions of cultural safety. At the theoretical level, we see how cultural safety resonates with emancipatory theory, cautioning against medical hegemony and advocating for returning to patients the authority to define their quality of care. In terms of practical application and implementation, cultural safety requires nurses to engage in critical self-reflection, active listening, and shared decision-making, thereby reconstructing a more equitable power relationship between healthcare providers and patients. Meanwhile, educational systems should strengthen the cultural teaching competencies of educators in the realms of foundational knowledge, facilitation skills, and curriculum design to foster more-inclusive learning environments. Ultimately, cultural safety must extend beyond the individual level into the organizational and policy levels as well. In one of the articles, the Indigenous Peoples Health Act (2023) is used to illustrate how respect for culture may be incorporated into healthcare indicators and administrative processes, suggesting a foundation for building a people-centered healthcare system that promotes health equity and social justice. Establishing a culturally safe care environment is a transformative process for healthcare professionals in diverse societies. However, cultural safety is not a one-time technical achievement. Thus, nursing practice must shift from merely "understanding cultural differences" to "examining the safety of care" by prioritizing the subjective experiences of care recipients and reconstructing power relations between providers and patients (Kaphle et al., 2022). Through the practical strategies introduced in this issue, we hope to inspire self-reflection and encourage all readers to become agents of change. Ultimately, every individual entering the healthcare system should feel seen and heard, and be able to receive care that is respectful of their cultural context within an environment of dignity.

With the acceleration of both globalization and population mobility, healthcare settings have become increasingly culturally diverse, presenting nurses with more complex cross-cultural challenges. Although cultural sensitivity promotes understanding and respect for cultural differences, its emphasis on knowledge accumulation limits its effectiveness in addressing the power imbalances and structural inequalities embedded in healthcare interactions. In contrast, cultural safety underscores that quality of care should be defined by patients' subjective experiences and highlights the important influence of power relations, critical self-reflection, patient autonomy, and structural contexts on care quality. In this article, the author examines the theoretical transition from cultural sensitivity to cultural safety in the nursing profession and analyzes the implementation of cultural safety in clinical practice, nursing education, and healthcare systems and its related challenges. The results of literature synthesis and analysis show that cultural safety facilitates the reconstruction of nurse-patient relationships, strengthens patient participation and trust, and provides a vital approach to addressing health inequities in multicultural societies. In the Taiwanese context, the health concerns of diverse populations, which include new immigrants, migrant workers, and transgender individuals, underscore the practical and policy implications of cultural safety. Future efforts should continue to integrate cultural safety into nursing education, clinical practice, and institutional design to develop culturally appropriate care models grounded in local contexts to further enhance care quality and promote health equity.

Cultural safety extends beyond physical protection to encompass moral considerations and the relational dimensions of care. The determination of whether healthcare is "safe" rests with patients rather than healthcare professionals, and only when patients feel respected, free from denigration, and assured their rights are upheld can care be considered culturally safe. Accordingly, healthcare education must cultivate respect in students for cultural diversity and prepare them to deliver equitable and culturally safe clinical care. In this article, a deconstructive perspective is used to examine the potential of using cultural safety as a framework for addressing health inequities. In practice, cultural safety represents a developmental process progressing from cultural awareness to cultural sensitivity and, ultimately, cultural competence. The cultural teaching capacity of educators may be strengthened through the three interrelated domains of foundational competence, facilitation skills, and curriculum design. Together, these can foster inclusive learning environments and support the development in students of culturally safe nursing practices, which are essential to enhancing quality of care and patient health and well-being.

With the increasing pace of globalization and transnational migration, healthcare systems are becoming more culturally diverse. In Taiwan, demographic changes have introduced increasing numbers of patients from diverse cultural backgrounds into clinical care environments, presenting new challenges for nursing practice. Cultural safety has emerged as an important framework for promoting equitable healthcare and improving the quality of patient care. Under this concept, patients' lived experiences and perceptions of care are used as central indicators of healthcare quality, and healthcare professionals are encouraged to reflect critically on the power dynamics and institutional biases within their healthcare interactions. In this article, the practical implications of cultural safety in nursing practice are discussed in the context of four culturally diverse populations in Taiwan: indigenous residents, migrant workers and other expatriates, sexual and gender minorities, and non-Taiwanese spouses and new immigrants. Language barriers, varied levels of health literacy, culturally shaped health beliefs, and limited social support are all factors that may influence patient trust, engagement in care, and adherence to treatment. When healthcare providers lack cultural sensitivity and reflective awareness, communication gaps and subtle forms of exclusion may occur in clinical encounters. Strengthening cross-cultural communication, encouraging patient participation in decision-making, fostering professional self-reflection, and creating institutional environments that support culturally safe practice are essential strategies to improving care. Therefore, cultural safety offers an important framework for developing strategies to enhance patient trust, improve care experiences, and advance health equity in multicultural healthcare settings.

In addition to biomedical factors and individual health behaviors, historical trauma, colonial experiences, and social marginalization are all critical factors that shape profoundly the health inequities experienced by indigenous peoples. Therefore, it is critical that cultural contexts and indigenous perspectives be incorporated into both health policy formulation and healthcare provision processes, with "cultural safety" serving as a central guiding principle to ensure healthcare systems earn the trust and serve the needs of indigenous clients. Cultural safety emphasizes cultural awareness, sensitivity, and competence as well as the critical reflection upon and transformation of traditional power relations to promote a truly patient-centered model of care. In this paper, the practical challenges faced by healthcare and long-term care systems, including tensions between standardized procedures and cultural differences, are examined, and institutionalized strategies are proposed to enhance quality of care and reduce structural inequalities. Moreover, the pivotal roles of policy and legislation in advancing cultural safety are highlighted using Taiwan's Indigenous Peoples Health Act as an example. Establishing culturally safe care environments requires a comprehensive effort spanning policy, organizational structures, and education. Leveraging cultural respect and institutional support, this effort holds the potential to facilitate the transformation of healthcare systems and ultimately achieve the goals of diversity, inclusion, and health equity.

Piloting an Indigenous cultural safety online program: Baseline and endline survey results from health and social work faculties in Toronto, Canada

Nontechnical skills (NTS) are cognitive, social, and personal resource skills that support safe and effective performance in emergency care, with core NTS for paramedics being identified in international studies. However, system-specific priorities for Japanese paramedics have not been defined. This study aimed to establish expert consensus on the NTS considered most important for paramedics in Japan. We conducted a modified e-Delphi study. Of the 39 NTS ranked, 36 reached a consensus. The top five NTS included: teamwork, communication, interpersonal skills, situational awareness, and professionalism. Three NTS that did not meet rank-agreement criteria were: cultural safety, assertive, and freshness. We developed a consensus-based prioritized list of NTS for paramedics in Japan, reflecting both internationally recognized core skills and the Japanese prehospital context. These priorities provide a framework for paramedic education, professional development, and structured assessment, with the potential to contribute to improved performance and patient safety.

Graduating nursing students frequently encounter a disconnect between academic preparation and the realities of clinical practice, often feeling underprepared, overwhelmed, and emotionally vulnerable. Contributing factors include inconsistent curricula, variable teaching quality, and limited access to high-fidelity simulation and mentorship. This fragmented preparation framework undermines resilience and readiness for today's complex healthcare environments. The aim of this scoping review is to identify and map the existing gaps in nurse education that impact the preparedness of student nurses entering professional practice. A scoping review conducted in December 2024 and December 2025 mapped the existing literature on nursing education to identify research gaps. The review comprised a comprehensive search of CINAHL, Informit, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science, followed by analysis of the 81 relevant studies. The PRISMA-ScR guidelines ensured a systematic and transparent approach to the selection and inclusion of studies. The review identified overarching domains (curriculum, teaching, simulation, clinical education and student readiness) where specific barriers were evident, including the theory-practice gap, inconsistent supervision and feedback, limited evaluation transparency, and transition shock. Evidence suggests that integrating practice-proximal education (simulation and longitudinal placements) with structured supports (Dedicated Education Units, mentorship/residency programs) and robust feedback mechanisms provides a coherent pathway to strengthen graduate readiness and early-career outcomes. Nursing students face persistent challenges in achieving clinical readiness due to fragmented curricula, inconsistent pedagogy, and limited academic-clinical integration. Addressing these issues requires a future-focused, evidence-informed education model, such as the Professional Readiness and Education for Practice Framework, which embeds authentic clinical experiences, structured mentorship, cultural safety, and digital health competencies to prepare graduates for the realities of contemporary healthcare practice.