Global Journal of Nursing & Forensic Studies
Open Access

Culturally safe care; Indigenous health; Forensic nursing; Trauma-informed care; Systemic racism; Health equity; Indigenous self-determination; Colonialism; Health disparities; Aboriginal; Māori; Native American

Introduction

This review highlights the critical need for culturally safe forensic nursing services tailored specifically to Indigenous communities. It examines existing models and identifies significant barriers, including pervasive systemic racism, a profound lack of cultural understanding among healthcare providers, and geographical isolation, which collectively hinder access to care. The paper strongly argues for the implementation of integrated, community-led approaches that genuinely respect Indigenous self-determination and incorporate traditional healing practices to improve access and reduce health disparities in forensic care [1].

This qualitative study delves into the lived experiences of Indigenous women in rural and remote Canada as they seek sexual assault services, revealing significant systemic barriers they face. Findings from this research unequivocally demonstrate that colonial violence, racism, and the absence of culturally safe services actively impede both access to and the effectiveness of care. The article advocates for Indigenous-led, trauma-informed, and culturally responsive approaches to provide better support and achieve justice outcomes for survivors [2].

This scoping review comprehensively synthesizes existing evidence on culturally responsive and trauma-informed forensic mental health care designed for Aboriginal and Torres Strait Islander peoples. It meticulously identifies key components essential for effective service delivery, underscoring the vital need for deep cultural competency, the active addressing of historical trauma, and the meaningful integration of Indigenous healing practices within forensic settings. The review highlights current gaps in service provision and advocates for profound system-level changes aimed at enhancing equity and improving access for these populations [3].

A critical review explores the crucial process of decolonizing forensic mental health services specifically for Māori in Aotearoa New Zealand. It critiques the inherently Western-centric nature of current services and precisely identifies how both historical and ongoing colonization contribute substantially to persistent disparities in care and outcomes for Māori individuals. This paper passionately advocates for the integration of Māori worldviews, cultural practices, and Indigenous leadership as fundamental steps to create truly equitable and effective forensic mental health care [4].

This scoping review investigates the complex concept of reconciliation within the context of Indigenous children and youth health in Canada, including its direct implications for forensic health access. It powerfully reveals how systemic inequities, enduring colonial practices, and intergenerational trauma profoundly affect health outcomes and significantly hinder engagement with health services. The findings underscore the urgency of adopting culturally safe, trauma-informed approaches and upholding Indigenous self-determination to effectively address health disparities and improve access to equitable care, including specialized forensic support [5].

A systematic review meticulously investigates service provision for Aboriginal women who have experienced violence in Australia, with direct and significant relevance to forensic nursing access. It pinpoints substantial gaps in culturally safe and trauma-informed services, critically highlighting how systemic barriers, including pervasive racism and a lack of understanding of Indigenous kinship structures, actively hinder women's engagement with much-needed support. The review emphatically emphasizes the urgent necessity for services that are thoughtfully designed and delivered in genuine partnership with Aboriginal communities to truly improve health equity and access to specialized care [6].

This scoping review synthesizes literature on culturally responsive care for Native American survivors of sexual assault, a population that frequently encounters significant barriers to accessing forensic nursing services. It identifies a clear need for culturally informed approaches that explicitly acknowledge historical trauma, strategically incorporate traditional healing practices, and directly address systemic inequities embedded in healthcare access. The review calls for greater collaboration with tribal communities and for comprehensive, culturally competent training for forensic nurses to effectively enhance equity and improve outcomes for survivors [7].

A critical review examines health and justice initiatives specifically for Indigenous women within the Canadian criminal justice system, highlighting their profound implications for access to essential forensic nursing services. It exposes how colonial policies, entrenched systemic discrimination, and various social determinants of health contribute alarmingly to disproportionate incarceration rates and significantly poor health outcomes, particularly those related to violence and trauma. The paper advocates for a fundamental paradigm shift towards culturally safe, Indigenous-led, and gender-responsive approaches to meaningfully improve health equity and justice for Indigenous women [8].

This article focuses directly on understanding and effectively addressing inequities prevalent in forensic and correctional nursing care for Indigenous peoples, tackling the core topic head-on. It identifies systemic biases, a critical lack of cultural safety, and the pervasive impact of historical trauma as primary drivers leading to disparities in care quality and access within these crucial forensic and correctional settings. The authors strongly advocate for comprehensive education, significant policy changes, and the widespread adoption of Indigenous-led service models to achieve genuine health equity and substantially improve forensic nursing outcomes for Indigenous populations [9].

A critical policy analysis examines existing policies specifically related to culturally safe, trauma-informed forensic health services for Indigenous populations in Canada. It uncovers significant policy gaps and persistent systemic barriers that tragically perpetuate inequities in access and quality of care, especially for survivors of violence. The article advocates for the development of robust policy frameworks that unequivocally center Indigenous leadership, cultural safety, and trauma-informed principles to ensure the provision of equitable and effective forensic nursing services that genuinely align with ongoing reconciliation efforts [10].

Description

Indigenous populations around the globe consistently face profound systemic barriers when attempting to access culturally safe forensic health and nursing services. These barriers include pervasive systemic racism, a profound lack of cultural understanding among healthcare providers, and significant geographical isolation [1, 2, 7]. Colonial violence and historical trauma are consistently identified as foundational issues that undermine trust and access to effective care [2, 5, 7, 9]. Research highlights how the Western-centric nature of current forensic services often fails to meet the unique needs of Indigenous communities, leading to disparities in care and outcomes [4]. This becomes particularly evident in contexts like Canada, where colonial policies and systemic discrimination contribute to disproportionate incarceration rates and poor health outcomes for Indigenous women within the criminal justice system [8].

In rural and remote Canada, Indigenous women seeking sexual assault services encounter significant hurdles, with colonial violence and racism impeding effective care [2]. Similarly, a systematic review in Australia reveals substantial gaps in culturally safe and trauma-informed services for Aboriginal women who have experienced violence, noting how systemic barriers, including a lack of understanding of Indigenous kinship structures, hinder engagement with support [6]. For Māori in Aotearoa New Zealand, the call is strong to decolonize forensic mental health services, moving away from Western-centric models that perpetuate disparities [4]. Native American survivors of sexual assault also face significant barriers to forensic nursing, necessitating culturally informed approaches that recognize historical trauma and systemic inequities [7]. These regional insights collectively underscore a global pattern of service inadequacy.

A consistent and urgent recommendation across the literature is the necessity for culturally safe and trauma-informed approaches. This involves more than just cultural sensitivity; it requires integrating Indigenous healing practices, fostering cultural competency among providers, and actively addressing the impacts of historical trauma within forensic settings [1, 3, 7]. For Indigenous children and youth in Canada, reconciliation efforts must translate into culturally safe and trauma-informed care that acknowledges intergenerational trauma and supports self-determination [5]. Such approaches are seen as fundamental to improving support, achieving justice outcomes for survivors, and enhancing health equity for all Indigenous peoples interacting with forensic services [2, 6]. The understanding of inequities in forensic and correctional nursing care for Indigenous peoples points to systemic biases and the dire need for cultural safety [9].

Central to achieving equitable and effective forensic health care is the principle of Indigenous self-determination and leadership. Papers advocate for integrated, community-led approaches that respect Indigenous governance and traditional healing [1]. The decolonization of services, as highlighted for Māori, explicitly calls for the integration of Indigenous worldviews and leadership [4]. In Canada, Indigenous-led, gender-responsive approaches are crucial for improving health equity and justice for Indigenous women in the criminal justice system [8]. Furthermore, robust policy frameworks are advocated to center Indigenous leadership, cultural safety, and trauma-informed principles, ensuring equitable and effective forensic nursing services align with reconciliation efforts [10]. This holistic vision encompasses comprehensive education for healthcare providers and sustained policy changes to dismantle systemic barriers and foster genuine health equity [9].

Overall, the evidence compellingly demonstrates that significant systemic changes are required to address the deeply entrenched inequities in forensic health services for Indigenous populations. This includes a shift from Western-centric models to those co-designed and led by Indigenous communities, respecting their inherent rights and knowledge systems. The consistent call for culturally safe, trauma-informed, and Indigenous-led care models, supported by appropriate policy and education, represents a critical pathway toward improving access, quality of care, and ultimately, health and justice outcomes for Indigenous peoples globally [1, 3, 5, 9, 10].

Conclusion

Indigenous communities globally face critical barriers to accessing culturally safe forensic health and nursing services. Systemic racism, colonial violence, lack of cultural understanding, geographical isolation, and historical trauma consistently impede equitable care. Research across Canada, Australia, New Zealand, and for Native American populations highlights profound disparities in health outcomes and justice pathways for Indigenous peoples, particularly women and youth, who experience violence or encounter the criminal justice system. Current Western-centric service models are often inadequate, failing to address the unique cultural and historical contexts of Indigenous populations. A recurring theme is the urgent call for a paradigm shift towards integrated, community-led, and trauma-informed approaches. These strategies must respect Indigenous self-determination, incorporate traditional healing practices, and be guided by Indigenous leadership. Policy reforms, comprehensive education for healthcare providers, and genuine partnerships with Indigenous communities are crucial to decolonize services, close significant gaps in provision, and ensure forensic care is both accessible and culturally responsive. Ultimately, achieving health equity and justice for Indigenous peoples requires dismantling systemic barriers and embracing holistic, culturally grounded care models.

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