Can a white nurse get it? 'Reflexive practice' and the non-Indigenous clinician/researcher working with Aboriginal people.

CONTEXT: Reflexivity is crucial for non-Aboriginal researchers working with Aboriginal people. This article describes a process of 'reflexive practice' undertaken by a white clinician/researcher while working with Aboriginal people. The clinician/researcher elicited Aboriginal people's experience of being haemodialysis recipients in rural Australia and their perceptions of their disease and treatment. The aim of this article is to report the methods used during this qualitative project to guide the researcher in conducting culturally appropriate health research with Aboriginal people. The goal of this work was to improve health services, informed and guided by the Aboriginal recipients themselves. The article describes the theory and methods used to develop reflexive skills. It also reports how the clinician/researcher managed her closeness to the topic and participants (some being patients under her care) and the processes used to ensure her subjectivity did not interfere with the quality of research. ISSUES: Three layers of reflexive practice are described: examining self within the research, examining interpersonal relationships with participants, and examining health systems. The alignment of the three 'lenses' used to describe the study is exposed. Complex insider/outsider roles are explored through multiple layers of reflexive practice. Regular journal writing was the primary tool used to undertake this reflexive practice. An Aboriginal advisory group and co-investigators collaborated and assisted the clinician/researcher to scrutinise and understand her positioning within the study. Researcher positioning, power and unequal relationships are discussed. Issues such as victim blaming and the disconnect between clinicians' views about treatment compliance and Aboriginal peoples' prioritisation of family obligations for before treatment are presented. LESSONS LEARNED: Aboriginal patients must negotiate a health services system where racism and victim blaming are institutionalised, but the effect of these on the research relationship can be mitigated through reflexive practice. Using a framework for relational accountability that incorporates respect, responsibility and reciprocity can enable non-Aboriginal clinicians and/or researchers to work effectively with Aboriginal patients. These results may assist clinicians and policy makers develop strategies for improving quality of care.