Reconciliation in palliative care: an Australian Aboriginal nurse perspective

National Palliative Care Week 2021, followed by National Reconciliation Week, provide an opportunity to reflect and think about the future of palliative care and reconciliation in Australia.

From my perspective, as an Australian Aboriginal palliative care nurse, reconciliation and palliative care are intertwined. The burden of disease and poor uptake and acceptance of palliative care in the Aboriginal and Torres Strait Islander communities must continue to be addressed with approaches that are multifaceted, informed by cultural knowledge and traditions and with an awareness of our national history in the context of the centuries of disenfranchisement that has occurred.

I think it is essential to form a proud and shared national identity, by ensuring past injustices are not repeated and by utilising the cultural knowledge of Aboriginal and Torres Strait Islanders to inform our ways of delivering palliative care services.

It is such a pleasure to be able to witness the efforts and drives for social change and reflexivity as an approach to reconciliation within the Australian palliative care sector; to be a voice, I hope to maximise health and wellbeing for Aboriginal and Torres Strait Islanders and improve the uptake and acceptance of palliative care and to help shift the socio-historical barriers of colonialisation, racism, systemic suppression of traditional health knowledge and practices and the inequitable delivery of health care.

Encouragingly, there is opportunity to participate in models of care and research initiatives for Aboriginal and Torres Strait Islanders that are designed to inform coping skills, awareness, foster client-centred experiences and embed cultural knowledge and connection as holistic cures to heal suffering through years of disconnection.

Care at home, in community, or on country can deliver self-transcendence, motivate connectedness, meaning, purpose and contribution, which is essential when providing palliative care for Aboriginal and Torres Strait Islanders. I see a shift from the pervasive paternalistic biomedicine models that can be seen even in palliative care and a move towards establishing equality and equity in the development of community-based palliative care programs.

This approach is especially evident in projects such as caring@home for Aboriginal and Torres Strait Islander Families. These models of care have the capacity to:

• entwine cultural knowledge, preferences, autonomy and decision making by fostering culturally responsive care and resources in preferred care settings
• encapsulate culturally responsive palliative care and finishing up in preferred and self-directed places by empowering self-efficacy, relationships to family, peers, community and country which are so meaningful to Aboriginal and Torres Strait Islanders during end stage disease and illness.

Finishing up using resources such as those from caring@home for Aboriginal and Torres Strait Islander Families can facilitate connection to country, family and community. It allows collaborative healing through recognising the tens of thousands of years of ancestral knowledge and practices that Aboriginal and Torres Strait Islander culture brings through beliefs, rituals, language, ceremony and traditions to our health and wellbeing in our most vulnerable moments.

Kat is a very proud Worimi Woman of Northern New South Wales, Newcastle and Port Stephens region. For the last 10 years, she has specialised in community, inpatient and acute palliative care and palliative care for vulnerable and aged care populations. Kat's recent Masters studies have been dedicated to researching and gaining experience of delivering specialist community palliative care to Aboriginal and Torres Strait Islander people, understanding the factors that facilitate and hinder its uptake for mob and being a strong leader and voice to enhance the appropriateness and acceptance of specialist palliative care for Aboriginal and Torres Strait Islander people.