 So welcome everyone. We're going to start in just one minute. Welcome to the seminar series, the health law seminar series. This is the second seminar in the series. Welcome to everyone. I'm going to introduce our speaker in just one minute or perhaps Holly while I introduce you can get the slides set up as we work on this technology. So if you set it up to do the slideshow share before you share your screen, that's probably helpful. Yeah, that's good. Okay. Can you play with that while I, while I introduce you. So welcome everyone. It's great to have you here on this Friday in October. My name is Jennifer Llewellyn. I'm a professor here at the Schulich School of Law, and, and I'm the director of the restorative research innovation and education lab here at Schulich. So we just, we're just going to do a couple of tech things, and then I'll introduce Holly. That's perfect. We can see them perfectly now, Holly. That's great. So it is, it is my pleasure to welcome you to this second health loss seminar in the series, just as a reminder so you can mark your calendars. And I'll remind you again at the end, the next in the series will be on October 29th and Ingrid Waldron will be our speaker. But this morning it's my pleasure to be here and to be able to host this health loss seminar and to welcome Dr. Holly Northam to give us our seminar this afternoon. Holly is the inaugural distinguished international visiting fellow at the restorative research innovation and education lab here at the Schulich School of Law as she brings over 30 years of clinical experience to her research and teaching practice. And she's currently a senior lecturer and the discipline lead for nursing at the Faculty of Health at the University of Canberra in Australia. Her research and work is shaped by a strong social justice focus that's underpinned by her professional identity as both a nurse and a midwife. Holly's approaches to her research are framed using the lens of both hope and a restorative approach to support and enable flourishing in health settings. And this is reflected in the two main arms of her research. The first has explored experiences of organ donation and transplantation. And the second is related to her engagement with the Collaborative Indigenous Research Initiative at the University of Canberra where Holly and her team have received funding to identify restorative practices for the new University of Canberra Hospital. The ongoing relationship that has ensued between her research team, the Nanowell elders who are the traditional owners of the Australian Capital Territory and the elders in Wanganui, New Zealand has been transformational and enabled cultural safety and health care. And she's going to share some of that work with us this morning. These ideas of course always circle back for Holly to the foundational role that early childhood plays in predicting future health. Holly is also an active member and leader within the Canberra restorative community, which is part of the international learning community for a restorative approach that's hosted here at the restorative lab at Chulek. She was the recipient in 2019 of the Medal of the Order of Australia for her work. So I know Holly's been very disappointed that she isn't able to be here in person to take up her role in residency as the international visitor, but the world being what it is, we have agreed to try to do this fellowship virtually and to ensure that there's a chance for it to be in person one day. She is nonetheless really excited to make connections in a virtual way with those within this thriving health and social justice community of scholars, researchers and practitioners. And so really excited to have this opportunity of the health seminar to be able to share some of her ideas with you and hoping that will lead to some contacts and connections during her time as the fellow. She's coming to us from Canberra. It is currently 2 a.m. in the morning in Canberra on Saturday. So this is a clear sign of her interest and dedication to the work and excitement to be here with all of you and a clear evidence of the fortitude of nurses who spent much of their life working on the night shift. So she assures us this will be no problem. So welcome Holly. Holly's going to present for about 40 minutes. During her presentation, if questions come to you that you're interested in, please enter them in the question and answer box that you can locate at the bottom of your screen. I'll follow along with those and try to ensure that I pose them with as much enthusiasm as you're asking them at the end of her presentation. And we really look forward to this opportunity to hear from Holly and then to hear from you. So I'll turn it over to you, Holly. Thank you so much, Jennifer. First off, before I get started, it's really important to me to acknowledge the Miqwak people who are the unceded custodians and owners of the Miqwaki where the Dalhousie University is located. And I'd also like to acknowledge that here in Canberra in Australia, the Manawal people who have cared for our country here for over 60,000 years are the traditional custodians of our land where I'm located. And I'd like to thank them and their elders who give us safe passage across their lands. I'd also like to acknowledge any other Indigenous people who are part of the listening audience today and acknowledge each one of you for your ancestors and my ancestors and all our families who have brought us to this moment. Our co-researchers and the people who provide us with the knowledge and wisdom that we build on. And my sincere thanks to the opportunity to speak with you today. My special thanks to Professor Jennifer Lawella who is extraordinary, great generosity and knowledge and wisdom and trust to have me here today. And I'd like to send a special humour to Professor Deep Saini, the President of Dalhousie. He was our previous Vice-Chancellor here at the University of Canberra and we miss him. So framing my work today that I'm going to be talking about, I'd like to take through a journey about the use of restorative approaches in my practice and how it's been a bit of a journey of exploration. So as Jen has previously mentioned, there are two arms to the research. There's the organ donation work and then it's moved into a greater understanding of Indigenous peoples and the lives and impact of colonisation here in Australia. So this is where I come from at the moment. I'm located just near the University of Canberra and I'd like to start by talking about acknowledgement. We do acknowledgement at the beginning of any of our lectures and our meetings to say that here, particularly where I'm located, this is a country that's been invaded and there's much that we don't know about the past. In Australia, we've hidden the past pretty effectively for the Australian population. And so people like Melissa Sweeter did this thesis where she looked at the problems of medical incarceration of how we've actually created extraordinary harms to the First Nations in Australia over many, many years. And these harms continue with a significant gap in life expectancy between non-Indigenous and Indigenous Australians. So the work and the underpinnings of this talk today will be about we have this past, we have this challenge in our healthcare system that is sitting there like a cancer. And what I'd like to share with you is the way that I'm trying to approach it as a health professional and as a researcher, but also as a person. This is lifelong work when we do restorative work. So this is my wonderful colleagues at the University of Canberra. We all came together for Reconciliation Day and we all made a stand to call for action against Black, about deaths in custody and the importance of saving Black lives who have been quite seriously impacted by our institutional racism and violence. So we've got a great team. And as non-Indigenous people, we've worked very hard to stand by and to stand up for and recognize justice when we see it. And as a nurse and a midwife, this is a critical part of the role of forming a relationship with the community, which is honest and trusting and respectful. So where we started from is quite a few years ago I started doing a PhD on looking at the experience of families when they were faced with organ donation decisions. So when we think about bashing the intensive care units of hospitals, we know that this is a challenging area of experience for many people. And there's a lot of assumptions in the healthcare system about why people make decisions and how those decisions are made and how it works. And the general people who report on those decisions are the doctors and nurses who are witness to the decision-making process. So my PhD actually explored what it was like for families to make the decisions and what happened for those families and the decisions. And it became clear after chatting at length and with great respect and listening to nine families that it was a complicated situation for people as they passage through the healthcare system. This little complicated screen is sharing a little bit about what it was like for families. So we sort of in a hospital, we often think, oh, you know, we have planned, we have we have processes and we have events that happen and we we are in control of the situation. Families come in at a crisis event and they're suddenly caught up in the way that hospitals work. And so information might not be clear. Suddenly they happen to do things that they're not expecting to have to do. And they're wanting to fit in. They want you to conform. They don't they don't want to rock the boat because they are feeling very vulnerable. There's a change in the power structures. They lose power and they're relative who might be dying. But the power is completely lost. So the families and this is a little touch on this briefly, because I want to talk about other things. But the family is going to what seems to them like a fog, like they're drowning, they're trying to find information, they're trying to to work out what's happening. They managed to to struggle through trying to to fit into the to the way we run the health care system, the way we run hospitals. For them, time stands still. They might be left outside in the waiting room and told somebody, we'll be back in a few minutes to see you, but that time might take on for hours. That time might be about wishing that they hadn't spent that last five minutes with their loved one doing the things that they've done rather than spending that time telling them they love them. There's all these things that happen with the time and stopping the clocks. And within that period, then they go through a stage where they're wanting to find that the trust is protected, that the health care system is looking after them. There are many themes around hope that emerge. Hope that things will get better. Hope that there's not suffering. Hope for a good outcome. And then there's the reality of being in the hospital system and the way people sometimes engage with the patients and their families where themes that came through that they felt that their loved one was almost considered like a sack of body parts and that people were sacrificing a piece of death in the experience of making open donation decisions. So this is pretty powerful stuff for me. And it did be influenced me. And I spent the spending time at RegNet, the regulatory institutions network at the ANU, which is where I had the wonderful privilege of meeting Professor Valerie Braithwaite and Professor John Braithwaite and Jennifer Llewellyn. And it's fair that I start to learn about restorative justice, restorative practices, and started to think about how maybe this could apply in the hospital setting to the families that were going through this absolute chaos, trying to work out a way through to have a good outcome or the best outcome they could manage for themselves and their families. So this was a difficult thing to be managing and trying to work out. Well, we know the system is what the system is. So how do we change the system? How do we make it safer for families? And how does it become more responsive to the people who are going through those crisis events? And we're looking at the where trust set and where hope set and where that idea of deep hope, which is a palliative care concept about that idea of hope beyond death, of being able to envisage something beyond what you can conceive as your lifetime. Those are really important factors, things that emerged as families tried to come to decisions that were right for them and their families. And much of that decision making evolved around placing that meaning for what was going to happen next in their life to get it right. And many of them were very fearful about having memories that would include guilt for not easing the suffering of their loved one. So this is where restorative justice ideas started to really take seed. There were families, one family had had a relative who died in the hospital because they'd suicided in the hospital under the care of the mental health team. That family was devastated by the way that their care was provided. There are other families who had really great experiences were filled with trust, were filled with hope because they knew that everybody had done everything they possibly could with them. So going on from that area, and I'll just give you a little example of a statement from one of the families that sort of captures the pain and the suffering which can be there, but as health professionals we don't even recognize because we're so caught up in the moment of doing our job. So in this particular quote, it was one of the patient's mothers who was in the middle of the night, about this time of night in Australia in the intensive care unit and she was watching the monitor and sitting with the loved one and the doctor arrived, intensive care specialist didn't even say hello when he came in the room. He just went to testing and by testing she was talking about brain death testing. It's almost like it becomes not a person anymore. It's not my daughter, it's not someone's loved one but it's a patient they're attending to. When I said to him about her high blood pressure he just said and I don't think he even turned around something like she'll be dead in a day or two and I just burst into tears. He explained why then and apologized but he could have handled that nicer and then another mother talking about that suddenly having that realization that she'd agreed on forms that her son could be an organ donor and she told the son tick the box you can you know we'll all become organ donors when we don't need them anymore and they have a big family lunch and everybody tick the box and fill that forms. All of a sudden she was in a situation where she knew her son wasn't going to survive. She knew that she'd signed paperwork to say he was going to be an organ donor and she suddenly thought oh my goodness they're going to take his eyes and she hadn't thought about that. It's not something that even can sit across to mind until appointment she suddenly realized this was all happening and she had no idea how the process worked what was going to happen next to how she'd manage it. So these are real life examples of what it's like to be a family member in the hospital situation in the hospital environment and it's often these stories are things that we don't hear generally as nurses working within the system and doctors working within the system but these are the experiences that families have and these are areas where I believe that using restorative approaches we can start to change for the way we deliver care. So schools hospitals and prisons are driven much for same kind of processes they're authoritarian there's your dress code emphasis on silence and order you've got to walk in line you've got to fit in that you lose your individual autonomy there's a power loss there's always a power loss there's a bridge freedoms the power belongs with the people who are running the institutions it doesn't sit with the people who are in need of the institutions and this is a really important part of the work that we're doing. So there are cultures of fear within these institutions between particularly in the health care setting we know that people are fearful of speaking up if they're a patient or a family member the fear they don't want to get the staff off side because that might not be good for the care of their loved one they might have fit in and to the staff they're fearful that they're going to do something wrong they're fearful that you know if they do something wrong what's going to happen to them so there's a lot of processes now being implemented around sentinel events to try to make it easier for people to divulge when they've made a mistake so that that mistake can be mitigated against and care corrected so these are all areas where there are restorative practices currently taking place on and but there is a huge potential to do this better so the work that I look at and think about and and and plan and plot around is that idea of that deep hope that I've mentioned previously that hope that is durable and it often thrives even in the face of imminent death because we see that hope well I believe I saw it in the data and in the experiences of the families who are making organ donation decisions at the end of life but I've also seen this hope some of the amazing elders that I work with who have gone through extraordinary trauma in their lifetimes but I've heard stories which have broken my heart and brought it back together again because I've seen how they've managed to recreate and to grow and to have extraordinary graciousness in the face of having had suffering to have formed an idea of something that's better and this has helped to give them not resiliency it's far beyond resiliency it's it's a way of moving forward which is incredibly productive to it for our society so this is where I became linked into the Canberra restorative community wonderful community and and a very powerful group of amazing people who are helping to to do good work and that community is linked in with the international learning community by using the principles of restorative justice to underpin relational practice in all areas of governance to improve community well-being so just so the work that I'm involved in is about healing difficult healthcare relationships and improving relationship cultures for health professionals that impact on clinical practice and the patients and the community and staff and the well-being of basically all of us because each one of us we are in relationships so if we happen to be the nurses caring for the patient and the family and things aren't going well we do sometimes carry that home it's not good if we don't get that healthcare relationship right there is regret there is burnout and there is moral dissonance after a period of time so this research that we're involved in brings together for the lots of bodies of previously under connected research the idea of workplace bullying in hospitals preventable medical harms in hospitals and restorative practices for dealing with conflict and harm apply to most vulnerable voices in those systems what I've learned working with our indigenous colleagues is that indigenous research approaches reveal strengths that uncover new ways to engage in healthcare relationships by using decolonising approaches really unpacking who you are and what helps to inform the way you are and you behave and you interact with your institutions is really a great space for seeking out where restorative justice resides and restorative practice can really start to alleviate some of the harm so my I propose in our talk today that we can actually use restorative practice to anticipate and prevent harms and this is the hope that I have for the work that we're involved in but we can actually rather than being always jumping in and trying to solve a problem when it's that develops is we can actually anticipate it because we can hear the voices early to know what something is coming that we can have those conversations to mitigate the harm before it becomes a problem and that way we can build just principled relationships of trust and depote the silenced excluded and disempowered populations we have conversations it's about listening and learning so there's plenty of evidence out there about problems problems in relationships problems about not listening sufficiently to patients and staff not hearing what's actually happening within an institution there and obviously very huge social costs associated with that human costs but also financial costs and I know our health systems at the moment are all struggling under the costs of everything including COVID but I suggest that we could be if we get our personal relationships right within the health care system we could be saving an awful lot of money and this is work that was undertaken in New Zealand we know in Australia the impact of racial discrimination is is causing it's contributing to the gap in equity of social outcomes and health outcomes we see this in children we see it in adults this is very recent research which has just been published from the Australian National University huge data set over 8,000 participants and it really showed how discrimination and racism was impacting the health and well-being of many Aboriginal and Torres Strait Islander peoples and that this was actually happening in the health care system predominantly so certainly in Australia we've got a lot to do to learn about our history it's it has been silenced and it's been hidden people of my generation who were never taught our real history and part of the work that I do as an edness educator is to teach about the real history of of Australia and the invasion because it actually was an invasion and that's not what we've been taught but that's actually what happened there were many many battles and it wasn't done peacefully and it's never been ceded so this lack of recognition of dispossession is actually part of the major problem that's happening in the for the Indigenous community at the moment is they struggle there is no voice to Parliament there is no treaty there is no recognition that Aboriginal Torres Strait Islander people were here previously so this is a local problem in this in Canberra this is something that really affects our local population Australian Aboriginal people are amongst the most incarcerated in the world and locally Aboriginal mothers are 16.3 times more likely to have the child removed and put them out of home care and a non-Indigenous woman the children are likely to end up being incarcerated by the time they're 10 years of age it's a minimum age of incarceration at the moment and they'll often end up in in institutional care and suicide early or have mental health problems and die from other causes so this is a sad history and locally we can't walk past those statistics at what that contributed to the gap because as as healthcare professionals if we don't see if we don't hear and we don't act then we're part of the problem so the truth telling is important and and that's why you know I'm bringing this to your attention because we do have to say this because until we can actually admit to it and start to start to work on the healing we can't have that principled relationships we can't have just relationships we have to be honest so this is Australia this is all of our nations in Australia um I'm actually just down here tucked away in another world country and um as you can see there are about 500 nations prior to inversion so restorative justice restorative practice the way that we're using it in our work in the way we understand it it's a philosophy in action it replaces respect for relationships at the heart of every interaction it's a relational approach founded in the beliefs about the equality dignity and potential of all people and about just structures and systems that enable people to thrive and succeed together this is a definition it's used by Wonganui district health board and by the Wonganui district hospital and this is the hospital but um my colleagues and I went to see to learn from about how we could do a restorative hospital in Canberra now just to explain a little bit more about Australia and Aboriginal and Torres Strait Islander people the more that I learn the more that I think oh my goodness this is extraordinary this is so important and we should all be learning about this the definition of health according to Aboriginal and Torres Strait Islander peoples and this is a consensus agreement that was made um back in about 1989 there was a lot of work done to come up with this definition from the voices of the people who knew but health is not just about the physical well-being of the individual but the social emotional and cultural well-being of the whole community and this is a whole of life for you and it also includes the cyclical concept of life, death, life so that I both see that when you if you an individual is is unwell the whole community is unwell if the community is well the individual will flourish so everybody is connected and it's not just a moment in time it's not an interlude of somebody gets tonsillitis and and then they recover health is about all of life and it's and it's spiritual and it's connected to country and it's connected to um but into the generations it's who comes ahead of you and who comes behind so we've had lots of problems as I've just explained to you since just colonization about separations and all of those things and this is across the life cycle so what we look to see now is well what is a flourishing community how can we achieve it and how are we going to do this we've got to find out how to get that deep hope out there and what is it that the indigenous community is seeing which helps them to grow and to to to aim for a future and and that's what I've found has been quite remarkable in relationships that we've developed with the indigenous elders that I'm working with so there are a lot of knowledge there surprising things which I didn't know for instance the early colonizers would go to the aboriginal midwives and not to the colonizers midwives because they knew the babies and the mother and the women were much more likely to survive with the indigenous midwife and discovered that their life expectancy of first nations Australians was considerably higher than Europeans at the time when of colonization there are lots of amazing things that we've learned so and ways of learning and thinking and ways of thinking so the the approach that we're using is to truly look at you know trying to think about how how do we decolonize how am I decolonizing myself as I do this work and I'm working with others and so learning from people like Elizabeth Carlson and many others it you see that there is a power to to change the social contract between non-indigenous and indigenous peoples and in Australia I would say that you know this is really incredibly important and to earn trust so that we can actually engage in strong reciprocal relationships so it's there's all those questions why do you do what you do what's the purpose how do you do what you do and what the hell do you do we decided the best way to do it is to learn more from our restorative community which one went to Longanioi and they place a whanau or family at the centre of the service delivery and a really transformational approach of of managing a situation which was really tricky not like unlike one that we had in Canberra they had a health service which was under a lot of fire from the from the media from the community from within the health service it was costing a lot of money high stuff to know that things were difficult and they ended up they had a major inquiry and from the inquiry the direction came through that they would use restorative justice approaches and transformed the way they delivered they ran the institution and they delivered care and it would be guided and supported by the Marie Elders so in Canberra we thought oh that sounds amazing you better go over and learn about it because we were building a new hospital on our campus and we could imagine wouldn't it be fantastic if we could have a restorative hospital where we have human flourishing with compassion and advocacy the truth dignity and respect centred on the most vulnerable to empower relational healing and healthcare achieved by giving both the vulnerable and embedding restorative practice every bit of our nursing with free teaching learning and research so that was a dream this dream hasn't faded it's still got the dream so we headed off and I hope I haven't got very much time so I'll just quickly click through a couple of these slides but we were focusing on the idea of cultural safety amazing work by Europati Ramston in New Zealand in 2002 with her PhD looked and an unpacked cultural safety and looked through the lens of nursing and it was really powerful work that helped helps us today in Australia particularly in our relational work to see what cultural safety really is and it's about understanding how if a person is feeling safe through the experience of a recipient of the care so if the person tells you I don't feel safe then you know that they know what they're talking about that they need to be able to feel safe enough to tell you that I don't feel safe but so that's where the nub comes so that work has has been important so our team who's brilliant Andy Rosalind Brown and many others Rowena Curie, Ned, Wayne, Mary, Mark, Tracy and many others have helped us to look at introducing restorative health practices to give voice accountability and healing value for Aboriginal and Torres Islander families and communities at New Public Hospital. We saw it was important to go first to Aboriginal and Torres Islander families because we'd worked out that they were the most vulnerable people in Canberra it was pretty obvious you go through population that's most at risk and you go okay if we can help you everybody will benefit so that logic has followed through and we can continue on that so the journey was great it was culture leading practice so we're advised by Andy Rosalind if we're going to one the new we take gifts we bring cultural gifts of thanks so a beautiful artwork created by the niece which we took with us and the artwork depicts two sisters and it's the idea of a sister hospital relationship and the two sisters are are joyful together they sometimes rub up against each other but they continue in their strong relationship our team was very excited and we headed off that's Auntie Ros, Wayne and Mark and when we arrived there we were they're even more excited and then we started to learn and we learned and we learned and we learned we had extraordinary privilege it was a deeply cultural and personal connections we learned things about ourselves that we've never known before and one of the things that was extraordinary from me was to see the respect that was shown to my colleagues who were First Nations and I was it was such a joyful event because of that deep respect which tragically was very hard to see in Australia but for my colleagues so we were invited to the Marae and we had such respect for our elders and we wish we had sharing about the sacred river the Wangan River which is a living entity and we learned about mana and so much more so these are just a few photos of the journey it was quite remarkable and we were so fortunate and we've got taught to row together in a waka this is a waka and we're taught that if you share your values and you co-create your values you can work together to get to the other side but if you don't all work together you'll never reach the end of your journey so those are the things that are core to a restorative hospital and core to the relationships that we have when we engage with with our community and their view as a final family's focus the health of an individual is only as good as the health of their whole family and the patient safety approach means with patient-centered family care it's same thing they have no existing hours come whenever you go some sleep over it's seeing the family as one so these are classic things that fit perfectly with our Aboriginal definition of health we thought oh this is looking really good and so that idea was scattered throughout the hospital but the family-centered care is what's really important so if you come to emergency department rather than what you'll have in our local emergency department usually but we're changing that is what's wrong with you you get instead how can I help you and your family and that changes the whole dynamic so it's about the ideas of leading the our culture and values leading practice and about choosing staff who fit the values and the practice of that community so so but Jen how am I going have I got much time left I don't yeah yeah you have about five minutes I've got five minutes okay I just wanted to take take you through just a couple of these things on this slide and it's about personal responsibilities that we've discovered that need to be part of that restorative approach when you're caring the families you're caring for community and the decolonizing anti-racist approaches so you have to be really it's about being really critical and really rigorous in self-assessment and this becomes part of seeing yourself as as a therapeutic tool so into when induction into the community it's being recognized and respecting the difference that we're all different that we're that we're equals and so that responsibility of fitting in with the community and understanding well-being knowing that each is different that each has a unique role and we're all accountable to work together to achieve their goals but the idea of cultural humility about knowing to what you don't know you say you don't know and about about trying to really remove that arrogance in the paternalism that was sometimes deeply embedded in our practices without us even realizing being responsible to respectfully acknowledge every person every time regardless of their social status so in Wonganui it was about teaching the emergency consultant that it's absolutely the appropriate thing to say good morning in Maori to the cleaner as you walk past and how are you going and how is your family we are all working together for the same purpose thinking of the other without assumptions or judgments and having empathy how can I help you and your family and listening to it really listening to understand what's most important to that person and the family so for instance it might be that they don't want to come to the hospital because they're worried about the the animal that's at home they pet juggle their pet cat that might need feeding they don't know what's going to happen to that animal so they refuse to come so these are all the important questions which are really important to the person so the homoana are the trusted deeply knowledgeable and navigators they move between the community and the hospital and these people are extraordinary because they become the connectors for patients and their families and a really important part of that process and they also fit it all fits in with the social determinants and thinking of needs so is the healthcare accessible is the transport food medications housing literacy rehab recovery so it's the whole social package so our healing restorative work is responding to what's most important to that person and their family and that is a different question to what we usually ask so the work that's been done there is going really well so they started by saying and one of the this is a physician who came from somewhere else when when I saw when I came there was a broken process it wasn't about that patients near families and we're on the front page of paper families were going a journey with us it was their loved one of themselves have been harmed and they got everybody to come on that journey and it was a proactive approach to restorative justice and it became a place where people wanted to work so that model is around if you can have a treaty if it's even if it's flawed it's better than done it's about decolonisation but in anti-racist and it's about connecting to country to elders to the spirit and being really showing visible signs of safety for people safe language safe spaces in one good newie the idea of water it was really helpful there are many environments and I think I'm just about out of time so I'm going to move through these last ones very quickly to say that the community is always really important that but the sharing of information sharing of knowledge and culture this is Professor Deep Saini our ex-vice-chancellor and being presented presenting the waka between the two of them to Aunty Agnes O'Shea and my senior Honourable Elder this was the gift that was given to us from one good newie to bring home to say you all have to write together to keep a focus on the goal which is to have a thriving community so what we've learned is we applied to our relationships I work our teaching and we keep learning some more and we did have our blessing of then our Canberra Hospital of our University of Canberra Hospital was blessed by the elders before it was opened it has culturally safe places to go it has beautiful artwork and it has staff who are getting there where it was still got worked to but it's starting to really understand a restorative approach so as Aunty Agnes would say in the spirit of reconciliation we welcome you to an honorable country may the spirit of our ancestors embrace you and care for you throughout your healing journey in the words of the Nanawal people Nunayawaboh Yengog which means you may leave your footprints on our land and those are the wishes from our community for healing for everyone else and I will finish off there which is done thank you so much thanks so much Holly and look at that even at 2am you can manage to come in on the dot so it's one o'clock here and we have we have about 20 minutes to be able to talk offer some of the questions up to you wishing that this format allowed us to do that in person but I'll I'll do my best to to animate some of those questions just to let those of you who are listening know and there are some folks in in a classroom and some great many of you online so if you go down to the question and answer box I'm happy to to take those questions I wanted to ask one of clarification that came really early just so that so that I'm right in the definition I may have offered in the in the chat Holly someone asked from your initial slide where we were talking about the sort of places and spaces that this might be applicable what a Lazarus is yeah that these were the quarantine issues that I'm just looking here it but it wasn't the maritime travellers they you they actually would claim that they were for people with syphilis and various other STDs and things like that and they take them and place them in these remote locations on islands and various places around the country and unfortunately when they went back and they did and looked at the history they discovered that many of the people who'd been incarcerated in these medical institutions actually worked when they were diagnosed with a problem so one of the other questions that's come in Holly is whether or not you think it's important for nursing schools and medical schools more broadly to have more diverse student bodies specifically targeting indigenous students and I want to combine that question with inviting you to say a little bit more because I I do know from your research that you've tried to think about how that might show up in the new hospital and in the nursing school in terms of not only how it might encourage greater diversity in the student body so answer that question first but then how it is that you create a place and space for students to be able to be more inclusive more welcoming within the body so I'm thinking particularly about some of the work to build that capacity for cultural safety through yearning circles so I wanted to invite you to answer that do you think do you think that there should be more diverse student bodies how is that important to a restorative hospital to flourishing in health care and then maybe giving them a bit of a sense of some of that work that you've done now look that's really great it's critical to have the student voices and one of the biggest problems on the number of committees where we're trying to increase the number of Aboriginal and Torres Strait Islander students who've been nursing in McBethry and particularly through to completion I'm really excited one of our students who's been who is a Wiradjuri woman she's she's remarkable she's now president of our nurse's society here at the university but we have set up a a bit of a research project which we're struggling with a little bit I'll be perfectly honest it's called it's a community of practice for Aboriginal and Torres Strait Islander students and I think we're probably a bit too heavy weight with academics I think I think we probably need to step right back and allow the students to do what the students want to do but of course it's been complicated by COVID at the moment our students aren't allowed on campus and we've been trying to run this work over the last few months and although we've gone to Zoom meetings they're not highly attended but then again it goes back to those ideas of cultural safety and making it so in fact I've just finished writing something today about one of the metrics to measure cultural safety particularly in our universities I think should be the number of students who are actually willing to divulge that they are First Nations in Australia there were policies around around the simulation that simulation and actually genocide which were designed to effectively breed out the sounds horrible but this is what it was to breed out the aboriginality from the community so that that and anybody that was fair skin they would be taken away and put in an institution they wouldn't be able to speak language the identity would effectively be removed Auntie Ross who's an elder in residence at the university is one of those people who went through that process and so many of our students who are within the school don't know that they're actually Aboriginal and Torres Strait Islander students within the school body and and so you know we know at the moment that we have 22 that identify but and by identified means it's on their university record but they might not necessarily feel comfortable about telling people because they're fearful of racism and they're fearful of being to say oh you can't be Aboriginal because you don't look Aboriginal so it's trying to bring us to a space where we can make that safe so within our teaching of Indigenous health we we try to make that lovely safe space so that our First Nations students can can feel comfortable to say well actually I am Aboriginal and this is my story in and we've been very excited over the last two years but the right the number of students who are happy to divulge seems to be going up and up and up so the more that that happens then the more that they'll be happy to get together in groups and and forms associations and and and but it's it's a painfully slow process I hope that helps to answer that question. I mean I find important and compelling around around thinking about how it is that we don't simply increase numbers but we ensure that we are increasing the capacity for belonging and for engagement and for genuineness of participation and so those two things one would think are directly related. I do know and Brenda Morrison has asked in the question box to invite you to tell us a bit about the concept of deep listening and how this concept is introduced to healthcare professionals and she's thinking here too along as the lines of wanting to hear a bit about the yarning circles of work that you've used to build community to build that place of cultural safety and acknowledge cultural traditions as part of capacity building and learning for students. I wonder if you might tell us a bit about that. Thanks so much Brenda for that question. Look it's it's really the idea of the deep listening is absolutely beautiful and I'm happy that you know I'll send you can send a link through Auntie Miriam Rose Ungamay who is a elder from the Northern Territory from has gifted it to the Australian people as a concept and it's a concept which is about you're listening listening for the seasons you're listening for the changes you're listening to the earth you're listening deeply and and you wait and you wait and you wait until you hit to the time is right and and it is absolutely gorgeous as a beautiful video clip that goes with it which I'll send as well but the idea and she her view is that as a gift to all Australians that this is what will help us to transform our country and to take it to where we need to be through through this healing process that we need to go through and so it's a must it is a beautiful concept so we bring that to the students in yarning circles so we start in our classes and it's a first-year unit teaching Indigenous health receipts really critical and important unit and and we start by by playing the segment on the dairy and and bringing them having them in the yarning circle before that starts so that in the yarning circle the idea is we sit in a circle all the all the devices are switched off put away and not available to to play with there's no disc in front so that your body is you have a full body language is exposed to each other each of us can see the other person and we're all equal everybody everybody's equal in the room it's led by an Indigenous elder and supported by a non-Indigenous staff member and who effectively works to make sure that the safety of the of the circle is kept and that if somebody is struggling that there's some there's somebody on the lookout to keep that safe and we start with an acknowledgement of country and respect a cultural respect is shown and then the person goes the yarn goes around the circle so everybody has a time to speak without interruption and and knowledge is created and shared and it's we find it's phenomenal for the students and particularly strangely now for international students because they feel much safer and even with English it's the second language they have to speak up in that setting and to and to be respected and the first couple of times it's it's a little hard for them but they get they indicate that they really love it and the feedback's fantastic so we love our Yarning circles and and they're taking off like there's no tomorrow and if I had my way I'd completely redesigned the university so that we didn't have this everywhere anymore we'd have beautiful with circular rooms so that you could come in and sit down and yarn it's fascinating to see it both from the perspective of how is it that you create safe spaces for people to learn and educate but I'm I'm thinking about the part of your presentation that was calling people in so to work in different ways as healthcare teams and and centering within the team of healthcare those who are receiving care right that changing that question from what's wrong with you to how can we help as as part of the team and so I immediately think about the kind of skills that that might be providing people to have different kinds of conversations and actually work as teams in different ways so fascinating there's a question from Marika Warren that and that I think helps us kind of think about this relational capacity that's that's been built in this restorative approach and the extent to which you've seen it be able to make a difference or is making a difference since you're still in the full throes of of COVID and how COVID was managed in hospitals compared to other facilities did this did this show up did the strength of some of these relationships in the work you've been doing show up in that period of time is it providing some kind of a a basis or a direction in terms of how you did respond or or might be responding that's a really great question Jen and it's and it's a tricky it's I mean it's almost impossible to know you really don't know but I am part of the research project at the moment where we're we've spoken to quite a few nurses who've been part of the COVID response and analysing the feedback it's not spoken of particularly from from the University Hospital it's not spoken of the that the behaviours and the practices are very much more very much more restorative approach that relate in the way that the talking about the families talking about trying you know that the suffering that people go through when they're excluded from coming to see their loved one and the efforts that they're going to to be able to bring families together with their dying relative despite the barriers to access and there's there's a lot in there and you go oh that's really it's really positive in it's it's it's not the the old-fashioned punitive approach of no no you're not allowed in there no this is a way about rules I was never going to do it but it was it's much more relationally responsive and but there's no way could make me generalizations on it it was interesting to have those kinds of conversations because I think Marika's question raises this you know both whether or not having taken that more restorative approach at the building of the hospital and the and the preparation of nursing they might have been better prepared for the complexities of COVID and those relationships that kind of looking at a lens that requires much attention to their teens but also to the sort of public health sphere but I it'll be really interesting to see if that the lessons of COVID actually reinforce the importance of the work that you're doing right the need for a different kind of approach to health care both within teens I wonder if you have any insights about whether you think there will be an opportunity in our recovery and in our lessons post COVID I wonder if that resonates for you I think so I think there's enormous opportunities actually and I think that COVID has created a such such a disruption in in everything in the way we see our relationships with other people in the way we interact with technology with with with our absences from contact with people and I think in the healthcare sector some of it I've been amazed and delighted by some of the senior leadership within Canberra health service and their approaches to suggestions around restorative approaches and and it's been you know you sort of think wow where did that come from it's really nice stuff where you sort of think that people are really thinking I think it's yeah I think they're thinking differently and they're starting to think differently and and it's really exciting from I can see a change for whatever reason there's certainly been a change over the last five years that's it's different but I can't you know we can't claim all of the glory for that but it's that there are ideas which are certainly permeating and starting to to create I think a much more positive approach. So one of Professor Sheila Wildman here at the School of Law is posing a question and she works in the space and place of of mental healthcare and particularly with a care of centering those who their first voice and first experience and and so she's asked do you have examples of special challenges or techniques where this approach has been applied in terms of both cross-cultural and intersectional mental healthcare and how that how that might be being either approached or or centered in the work that's that's an area which is a huge challenge for us locally and in fact I've been connecting with Michael Power who's up in Queensland and a bit further north and he is involved in working on a forensic mental health program there for our Indigenous community the mental health problems are enormous and and I think that but at the university you know the discussions that we have around that are you can see that this is where we need to go but that we know we're near it in Wanganui one of the team members is a mental health nurse and she was chosen specifically because she's a mental health nurse and with a lot of experience working in Indigenous communities and there some of the findings from from Wanganui were great around it will put it this way when Tracy and and Wayne walked into the forensic unit and they're both experienced into walking into forensic units they were both got suspect they just couldn't believe the freedoms the way the care was delivered and a lot of the work that had been done there had been because the administration had changed their approach to how you know it was run by going to the the staff who worked there all the time and saying to them what do you think would work here well because they've been having problems with over you know these obvious restraints they've had violence they've had all sorts of other issues going on and the staff were given the opportunity to create their perfect world to say well I'd like to do this we could do this we could do this and they got to actually use their knowledge use their experience to say these things would make a difference so once it was clarified as to what the problems were and what they needed to address the the team were able to find their own solutions and that seemed to be a particularly powerful restorative approach and Holly do you think I'm going to ask the follow-up question that I'm going to assume as in Sheila's mind is is that you know clearly is important to have a more diverse view of those who are providing frontline care and and actually may know what helps rather than sort of top down but to what extent then might a restorative approaches next step or part of this be to find ways and what might the challenges be in those ways of actually hearing the voice of those who are receiving that care and who are need to be empowered to be able to participate fully and that those insights and those decisions around their own care and their own needs is that do you think that's part of what the the sort of a shift is do you see that as more challenging in the context of mental health because I know that's certainly what the shift is for for example in natal care and and and other health care so I'm wondering your thoughts about about where that is now and where it might go well I think from from from this work it was very there that was one of the critical things and when what the district health board did which very again we thought was outstanding is they would take every month when they had their meetings so the executive meetings rather than having a paper a paper presenting all of the complaints and the issues and the things that have been going on they'd actually be presented with a person telling them about their situation and what the problem had been so they're actually going face to face with the community to hear first hand what the story was and to come to some agreement as to what they could do to make it a bit better and on top of that and so you know I fell off my chair when I found out they were publishing in the local newspaper all the statistics of how many complaints they'd received how many compliments they'd received what the complaints were and what they're doing about it oh that's transparent so so I think you know those those ideas of transparency of you know sit with the organisation work I do one of the biggest challenges for our donor families here in Australia is they're often like our aborigin toaster at islander community often silenced and often for basically put away you know you've made a donation decision we'll go away thank you we've we've got what we need now which is I mean it's a wonderful decision and I fully support organisation but I also fully support a bit of reciprocity and acknowledgement for donor families and one of the themes that came through an amazing national inquiry into organ donation a couple of years ago was the fact that there is no complaints number there is no ability to put the complaint anywhere and and so when the national organisation is saying we get no complaints it was made very clear that the reason why you get no complaints is there is no ability to provide to make a complaint that's a good strategy if you don't want complaints that's right so so those are processes and institutions you know if you're doing a top-down bottom-up look you go where is the complaints process is it accessible to somebody actually check it on they put it in the rubbish bin what's the feedback loop so we presented to government a lovely new feedback loop on what they could do with you know this is how a complaint could go could be managed it could be then like you could talk come back to a person who's put the complaint to see that you're actually listening to them sorry that's great well we are we are at that time when when we have to allow people to go back to their day and I'm hoping allow you to perhaps go back to sleep or again an extremely early start on your day I did want to clarify Brenda's just ask as one final question she was just trying to clarify if your reference was to Dr. Michael Pearl is that who you meant in Queensland yeah I'll um I'll connect you yep great perfect so I want to thank you so much for being with us and and I really do hope this is a chance sort of to introduce you to the very thriving community of students and and researchers and scholars and practitioners and healthcare here in in Halifax and in Nova Scotia we're so fortunate to have this seminar series as a as a place in space that that community gets to connect and gather it's it's usually over some sandwiches and some chance to see each other's faces so we're hoping that the world allows that to be true again soon but I know that you're really interested and excited to have people connect with you especially during the period of your fellowship here where you're where you're really hoping to have the chance to to connect and learn along so I'd encourage people to be in touch with you they can they can find your email through the to the University of Canberra and and to thank all of you there were a group of people in a classroom watching and and another 40 or so online at the at the height of the presentation so a great community of people many thanks to all of you for joining us and we hope you'll join for the next health loss seminar on October 29th for Ingrid Waldron and and thanks very much Holly thank you so much bye everyone