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Cultural safety and nursing education in Aotearoa and Te Waipounamu : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing /
Abstract
Thesis (Ph.D.)--Victoria University of Wellington, 2002. Includes bibliographical references.
... Culture is dynamic and mobile and changes according to time, individuals and groups. [30] There is a tendency within healthcare to equate culture with essentialized notions of race and ethnicity, which can lead to practices that separate culture from its social, economic and political context. Narrow conceptualizations of culture and identity may limit the effectiveness of particular approaches, and a focus on specific cultural information may inadvertently promote stereotyping. ...
... Cultural Awareness a beginning step towards understanding that there is difference. Many people undergo courses designed to sensitise them to formal ritual rather than the emotional, social, economic and political context in which people exist [30] [is] concerned with having knowledge about cultural but, more specifically, ethnic diversity. [32] an individual's awareness of her/his own views such as ethnocentric, biased and prejudiced beliefs towards other cultures (p. ...
... [60] Cultural Safety is an outcome of nursing and midwifery education that enables safe service to be defined by those that receive the service [30] a focus for the delivery of quality care through changes in thinking about power relationships and patients' rights [32] The skill for nurses and midwives does not lie in knowing the customs of ethnospecific cultures. Rather, cultural safety places an obligation on the nurse or midwife to provide care within the framework of recognizing and respecting the difference of any individual. ...
Background:
Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.
Methods:
A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa - Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.
Results:
Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the 'taken for granted' power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming 'competent' in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.
Conclusions:
A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.
... Cultural safety was developed primarily by Maori nurse educators and Maori nurses (Hill, 1991;Ramsden 1990Ramsden , 2001Ramsden , 2002. The need for cultural safety came from concerns that in New Zealand both the education system and the health system were failing to meet the educational needs of Maori nursing students, and the needs of Maori who were using health services. ...
... The need for cultural safety came from concerns that in New Zealand both the education system and the health system were failing to meet the educational needs of Maori nursing students, and the needs of Maori who were using health services. Over time the notion of cultural safety has been further developed to embrace the need for nurses to deliver culturally safe care for all New Zealanders (Nursing Council of New Zealand, 1996, 2002. ...
... First, is a preparedness by health professionals to examine their own cultural values and attitudes, and in particular how these may affect the relationship between people in a health care setting. Second, is an understanding of the impact on the social and economic lives of Maori people, of the Treaty of Waitangi and its associated, historical, political and social processes, and the third is demonstrable flexibility in helping relationships between culturally different people (Ramsden, 2002;Nursing Council of New Zealand, 2002). ...
This paper describes the processes and challenges presented when Pakeha lecturers supervised a research project undertaken by Maori and Pacific nursing students in a New Zealand Bachelor of Nursing programme. It reflects on the reality of translating institutional policies from paper to practice and is situated in the framework of the Treaty of Waitangi and cultural safety. Cultural safety is a nursing concept that focuses on power in health-care relationships. People involved in the project experienced degrees of vulnerability in different cultural contexts, in terms of cultural identity, personal, professional and cultural values and beliefs, nursing and psychology knowledge and academic and institutional policies and practices. Culture is used in a broad sense and not confined to ethnicity. Various issues encountered during the project are identified, and examples of difficult experiences discussed. The paper concludes that working across broad cultural borders requires working with the complexities of multiple realities and discourses. This paper describes a research project carried out within a framework of the Tiriti of Waitangi and cultural safety and then reflects on some critical aspects of this research and the experience of two lecturers, one a psychology lecturer, the other a nursing lecturer. The psychology lecturer was the research group supervisor. The project was undertaken by a group of Maori and Pacific nursing students and involved carrying out a qualitative health research project with Maori and Pacific people as the participants. The students named their project the Hauora Pacific Smokefree Project. The group amalgamated assessments in nursing professional practice, health promotion, and psychology courses in the final semester of a Bachelor of Nursing degree and formed part of a student assessment project.
... Growing interconnectedness increases the need for improved tools and lexicon to manage ethnic, cultural and identity differences effectively and to prevent conflicts between groups. 1 Minorities and diverse groups often face health disparities rooted in cultural, racial or historical social factors. [2][3][4][5] Three related concepts address this issue: cultural safety emphasises the reduction of cultural assault 6 ; interculturality promotes collaborative solutions using diverse knowledges 7 and antiracism promotes racial equity. 8 Defining and measuring the impacts of these approaches is challenging due to overlapping meanings and outcomes. ...
... Many systematic reviews have identified the need for interventions around these topics and offered action guidelines, but there is no consensus on tools for measuring impact. 2 9-49 Māori nurses in New Zealand first proposed the concept of cultural safety to emphasise that healthcare services provided to Indigenous groups should not perpetuate colonial attitudes, but rather respect traditional identities and cultures. 6 Cultural safety is ...
Introduction
Cultural safety, interculturality and antiracism are crucial concepts in addressing health disparities of minority and diverse groups. Measuring them is challenging, however, due to overlapping meanings and their highly contextual nature. Community engagement is essential for evaluating these concepts, yet the methods for social inclusion and protocols for participation remain unclear. This review identifies experimental studies that measure changes resulting from culturally safe, intercultural or antiracist healthcare. The review will describe outcomes and additional factors addressed in these studies.
Methods and analysis
The study focuses on epidemiological experiments with counterfactual comparisons and explicit interventions involving culturally safe, intercultural or antiracist healthcare. The search strategy covers PubMed, CINAHL, Scopus, Web of Science, ProQuest, LILACS and WHO IRIS databases. We will use critical appraisal tools from the Joanna Briggs Institute to assess the quality of randomised and non-randomised experimental studies. Two researchers will screen references, select studies and extract data to summarise the main characteristics of the studies, their approach to the three concepts under study and the reported effect measures. We will use fuzzy cognitive mapping models based on the causal relationships reported in the literature. We will consider the strength of the relationships depicted in the maps as a function of the effect measure reported in the study. Measures of centrality will identify factors with higher contributions to the outcomes of interest. Illustrative intervention modelling will use what-if scenarios based on the maps.
Ethics and dissemination
This review of published literature does not require ethical approval. We will publish the results in a peer-reviewed journal and present them at conferences. The maps emerging from the process will serve as evidence-based models to facilitate discussions with Indigenous communities to further the dialogue on the contributing factors and assessment of cultural safety, interculturality and antiracism.
PROSPERO registration number
CRD42023418459.
... 49,50 Cultural safety is concerned with 'reflexivity, dialogue, reducing power differences, decolonization and regardful care, ' concepts that challenge the institutional norms of public health policy-making. 48,51 A key challenge for policy-makers is to reflect on how the policy-making process can -unintentionally -embed institutional racism, [51][52][53][54] especially with legislation that renders Aboriginal people 'legally invisible. ' 20,55 These challenges are further amplified in universal, population-wide policy processes where Aboriginal people are not a key focus. ...
... 22 An attitude that diminishes or disempowers Aboriginal cultural identity can create an environment that is alien, culturally unsafe and a dangerous place for First Nations peoples to be. 48,86 Our findings demonstrate the need for critical reflexivity in the institutional design of policy development processes so that they are culturally inclusive and address power imbalances and, thereby, enable genuine participation of Aboriginal peoples and culturally safe food and nutrition systems. ...
Background:
Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations' policy submissions, and (iii) the extent to which Aboriginal organisations' recommendations were addressed in final policy documents.
Methods:
Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents.
Results:
Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes.
Conclusion:
This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples' right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.
... This includes training in culturally safe care that is respectful of Aboriginal culture. The concept of cultural safety was developed by Irihapeti Ramsden [10] a Maori nurse in New Zealand. She recognised the role of power relations in health care where the detrimental effects of colonisation were reflected in differentials in power relations between non-Maori health professionals and Maori patients that negatively impacted on Maori health outcomes. ...
... After the workshop, an increase in reported confidence in applying culturally safe practices was found for most items (4, 5, 7-11, 13, 14) and this improvement was also found 2 months later for the same items, apart from one (10). This pattern of sustained improvement was also evident in the sub-scales identified in the instrument, Relationships, Communication and Awareness, which all improved after the workshop and persisted to 2 months after the workshop. ...
Abstract Background Aboriginal Australians have worse cancer survival rates than other Australians. Reasons include fear of a cancer diagnosis, reluctance to attend mainstream health services and discrimination from health professionals. Offering health professionals education in care focusing on Aboriginal patients’ needs is important. The aim of this paper was to evaluate whether participating in a workshop improved the confidence of radiation oncology health professionals in their knowledge, communication and ability to offer culturally safe healthcare to Aboriginal Australians with cancer. Methods Mixed methods using pre and post workshop online surveys, and one delivered 2 months later, were evaluated. Statistical analysis determined the relative proportion of participants who changed from not at all/a little confident at baseline to fairly/extremely confident immediately and 2 months after the workshop. Factor analysis identified underlying dimensions in the items and nonparametric tests recorded changes in mean dimension scores over and between times. Qualitative data was analysed for emerging themes. Results Fifty-nine participants attended the workshops, 39 (66% response rate) completed pre-workshop surveys, 32 (82% of study participants) completed post-workshop surveys and 25 (64% of study participants) completed surveys 2 months later. A significant increase in the proportion of attendees who reported fair/extreme confidence within 2 days of the workshop was found in nine of 14 items, which was sustained for all but one item 2 months later. Two additional items had a significant increase in the proportion of fair/extremely confident attendees 2 months post workshop compared to baseline. An exploratory factor analysis identified three dimensions: communication; relationships; and awareness. All dimensions’ mean scores significantly improved within 2 days (p
... That would mean that all cultures, including the dominant, would be identified as cultural and media, especially in former colonies, would represent the cultures of the indigenous people and other groups with the same assumption of normality and richness with which the dominant culture is represented. Unfortunately that is not the case in New Zealand (ECOSOC United Nations Economic and Social Council, 2006; Ramsden, 2000 Ramsden, , 2002 Wepa, 2005 Wepa, , 2007) and consequently, at all times, psychologists must be alert to that which undermines their efforts to develop cultural competence so they can resist effectively. Individuals who are monocultural and monolingual, like the majority of Pākehā New Zealanders (Bellett, 1995), are especially vulnerable to such impacts as they have no easily accessible point from which they can identify the " media saturated world " (Chamberlain & Hodgetts, 2008) as cultural and, therefore, struggle to identify the framing culture. ...
... A practice that renders invisible the privilege Pākehā receive from living in a system based on their values and encourages defensive reactions among Pākehā when challenged about Pākehā power and control. The mass media-promoted challenges to cultural safety initiatives provide a clear example of this (Ramsden, 2000Ramsden, , 2002). Those challenges were grounded in the subjective responses of particular students whose interpretations of their training were granted sufficient authority to support the story and to encourage fears that Māori were taking over the training of nurses and midwives. ...
Studies of mass media news materials show that the dominant culture is not recognised as a culture and that its role in shaping society is thereby naturalised. In marked contrast, portrayals of indigenous peoples and minority ethnic groups present individuals as (negatively) different and their culture is trivialised. This article describes how these patterns sabotage psychology practitioners' efforts to develop and maintain cultural competence. " Systems that are established by the newcomers [settlers] then ensure this redistribution continues until colonization is explicitly acknowledged and addressed " (Cram, 2009, p.210) B uilding on the findings of our studies of New Zealand media (Moewaka Barnes et al., 2005; Rankine et al., 2008) and the HRC funded project " Media, health and wellbeing in Aotearoa " (Gregory et al., 2011); this article aims to encourage psychologists to see and act on the implications of identified media practices for efforts to develop and sustain cultural competence. We outline the HRC study, briefly review relevant international media research, before describing how mass media routinely mask and normalise Pākehā culture. We show how the disparaging portrayals of Māori appear to justify the fragmented representations of Māori culture in the mass media and conclude with a discussion of how these practices threaten or undermine efforts to develop and sustain culturally competent practice. For " Media, health and wellbeing in Aotearoa " the authors collected a three-week, representative sample of New Zealand news media – print (metropolitan, regional and local newspapers), radio (RNZ, Radio Live, ZB network), and television (TVNZ, TV3, Prime, and MTS) that was analysed for content and themes. Those analyses were supplemented by focus group discussions about New Zealand media with Māori and non-Māori groups and interviews with journalists and media managers that were analysed thematically. The aim of the project was to explore the mass media treatment of Māori in national life, and to assess the impact of negative discourses about Māori on Māori wellbeing and on Māori/Pakeha relations.
... This requires the health provider's capacity to reflect on the impact of colonisation, as well as on their own culture, values, beliefs, attitudes and power to enable a change in the patientprovider interaction (McKivett et al., 2019;Nursing Council of New Zealand, 2011). Being the primary concept that acknowledges the experience of colonisation, power imbalances and reflection, it has particular importance to the delivery of healthcare to First Nations people (Brascoupé & Waters, 2009;Ramsden, 2002;Ramsden, 1992). Cultural safety has also been described as the next step after cultural competence (Brascoupé & Waters, 2009), and this highlights that cultural safety should be understood as a journey rather than a goal that can be achieved after a session of training. ...
... Structural violence: "Structural violence is one way of describing social arrangements that put individuals and populations in harm's way. . . The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people" (Farmer et al., 2006 safety involves promoting awareness of the impacts of sociopolitical and economic issues (Ramsden, 2002) and patients' rights (Papps & Ramsden, 1996). Structural competence has been developed by medical researchers and anthropologists and slowly being adopted nursing education (Woolsey & Narruhn, 2018, 2020. ...
American institutions of nursing education have integrated cultural competence as a pillar approach to addressing health disparities. The theoretical frameworks, priorities, and solutions that national organizations pursue and endorse have far-reaching implications. The American Association of Colleges of Nursing (AACN) is one such organization. The purpose of this project was to critically analyze the AACN’s Tool Kit of Resources for Cultural Competent Education for Baccalaureate Nurses to excavate dynamics related to language, power, and inequality. Findings of this critical discourse analysis indicate: (1) the centrality of the AACN’s assumed authority and lack of relationality with readers, (2) nursing insularity and narrow theorization of culture and power, and (3) the harm of whiteness and colonialism as pedagogy. Accountability and repair include transparency, taking note of resources and viewpoints available and endorsed on organization websites, and updating (or refuting) outdated and harmful approaches.
... The trope of 'I treat everyone the same' is often heard by health professionals and worn as a badge of honour. The concept of cultural safety is an effort to contravene such tropes [73,74]. McGibbon et al. [75] argue that nursing knowledge is steeped in an ethos of treating everyone equally, one-sizefits-all, with the assumption that, in a colonized country, the dominant culture, knowledge, experience and values are true and applicable across all cultures. ...
Inequitable social environments can illustrate changes needed in the social structure to generate more equitable social relations and behaviour. In Australia, British colonization left an intergenerational legacy of racism against Aboriginal people, who are disadvantaged across various social indicators including oral health. Aboriginal Australian children have poorer health outcomes with twice the rate of dental caries as non-Aboriginal children. Our research suggests structural factors outside individual control, including access to and cost of dental services and discrimination from service providers, prevent many Aboriginal families from making optimum oral health decisions, including returning to services. Nader's concept of ‘studying up’ redirects the lens onto powerful institutions and governing bodies to account for their role in undermining good health outcomes, indicating changes needed in the social structure to improve equality. Policymakers and health providers can critically reflect on structural advantages accorded to whiteness in a colonized country, where power and privilege that often go unnoticed and unexamined by those who benefit incur disadvantages to Aboriginal Australians, as reflected in inequitable oral health outcomes. This approach disrupts the discourse placing Aboriginal people at the centre of the problem. Instead, refocusing the lens onto structural factors will show how those factors can compromise rather than improve health outcomes.
This article is part of the theme issue ‘Evolutionary ecology of inequality’.
... This inclusion is part of broader movements in nursing and midwifery towards culturally safe and humble care that have become foundations to practice and education in the past three decades ( Aboriginal Nurses Association of Canada et al., 2009 ;Te Tatau o te Whare Kahu: Midwifery Council, 2021b ). The frameworks of cultural safety and cultural humility were developed by indigenous and other health scholars of colour to address racial, colonial and other structural injustices in healthcare ( DeSouza, 2008 ;Fisher-Borne et al., 2015 ;Ramsden, 2002 ;Tervalon and Murray-García, 1998 ). These frameworks place emphasis on diversity https://doi.org/10.1016/j.midw.2023.103605 ...
Perinatal services are being challenged to acknowledge that not all pregnant and birthing people are women and to ensure the design and delivery of services that are inclusive of, and deliver equitable outcomes for, trans, non-binary, and other gender diverse people. This is posing unique challenges for midwifery with its women-centred philosophy and professional frameworks. This paper presents the critical reflections of midwifery educators located in two midwifery programmes in Aotearoa1 and Ontario Canada, who are engaged in taking up the challenge of trans and non-binary inclusion in their local contexts. The need to progress trans and non-binary inclusion in midwifery education to secure the human rights of gender diverse people to safe midwifery care and equitable perinatal outcomes is affirmed. We respond to an existing lack of research or guidance on how to progress trans and non-binary inclusion in midwifery education. We offer our insights and reflections organised as four themes located within the frameworks of cultural humility and safety. These themes address midwifery leadership for inclusion, inclusive language, a broader holistic approach, and the importance of positioning this work intersectionally. We conclude by affirming the critical role of midwifery education/educators in taking up the challenge of trans and non-binary inclusion to ensure a future midwifery workforce skilled and supported in the provision of care to the growing gender diverse population.
... Previous researchers cite the importance of practicing critical reflexivity in ensuring cultural safety [69] for First Nations Australians [70,71]. The reflexive data collected during the relational study (autoethnography and reflexivity) will be assessed by First Nations co-designers [26]. ...
Background
The colonization of Australia is responsible for complex layers of trauma for the First Nations peoples of the continent. First Nations Australians’ well-being is irrevocably tied to the well-being of the land. The application of a landscape-based approach to collaborative research shows promise in enabling genuine relationships that yield rich and informative data. However, there is a lack of practical evidence in the field of landscape research—research tied to First Nations Australians’ worldviews of landscape.
Objective
This study aims to deepen shared knowledges of well-being and healing on Australian soils. We aim to examine ritual co-design as a novel method for deepening these shared knowledges.
Methods
This research comprises a qualitative and participatory action research design operationalized through an Indigenist approach. It is a 2-phase project that is co-designed with First Nations Australians. Phase 1 of this project is a relational study that endeavors to deepen the theory underpinning the project, alongside the development of meaningful and reciprocal community connections. Phase 2 is a series of 3 participatory action research cycles to co-design a new communal ritual. This process seeks to privilege First Nations Australians’ voices and ways of knowing, which are themselves communal, ritual, and symbolic. The framework developed by psychiatrist Carl Jung informs the psychological nature of the enquiry. An Indigenist approach to landscape research recasts the Jungian frame to enable a culturally safe, context-specific, and landscape-based method of qualitative research.
Results
The research is in the preliminary stages of participant recruitment. It is expected that data collection will commence in late 2022.
Conclusions
It is expected that this qualitative and co-designed project will strengthen the cross-cultural co-designer relationships and that the data gathered from these relationships, and the accompanying practical outcomes, will provide new insight into the interaction between human and landscape well-being. The field of landscape research is in an embryonic phase. This new field is embedded in the understanding that First Nations Australians’ well-being is irrevocably tied to the well-being of the land, and this study seeks to build on this evidence base. A strength of this research is the relational methodology, in which First Nations Peoples’ needs and desires will inform future research directions. It is limited by its context specific nature; however, it is expected that findings will be usable in guiding future research directions in the multidisciplinary field of landscape research.
International Registered Report Identifier (IRRID)
PRR1-10.2196/36328
... In the UK, nurse educators are not representative of the diverse national population, which can be a challenge as they may lack insight into diversity (Solanke, 2017). As recommended by Ramsden (2002) in accordance with cultural safety, nurse educators need to embrace post-modernism, critical social theory and transcultural nursing theory in their teaching. These theories enable nurse educators to self-critique and offer a roadmap for embedding diversity into all activities, not only clinical activities, but also teaching and learning activities. ...
Objective
To explore health disparity in on‐campus undergraduate nurse education through the analysis of teaching and teaching material exploring pressure injuries.
Background
As a discipline, nursing espouses ideologies of inclusion, equity and valuing diversity. However, little is known about how these ideologies translate into clinical care. Pressure injury prevention is a routine aspect of nursing care; yet, there is evidence of inequity in relation to clinical care and patient assessment, as people with darker skin tones have a higher prevalence of severe pressure injuries before detection of damage occurs. Despite limited literature being available surrounding the topic of pressure injuries and skin tone diversity, it remains the responsibility of nurse educators to address contemporary issues and health disparity within the nursing curriculum.
Design
A multiple method collective case study. The STROBE checklist was followed in reporting this study.
Methods
Documentary and observational data of lectures regarding pressure injuries were collected during 2017 and 2018 from five Higher Education Institutes in England delivering approved nursing undergraduate programmes.
Results
Documentary analysis confirmed all Higher Education Institutes overwhelmingly directed teaching and learning activities about pressure injury towards people with Caucasian skin tones. Observation of teaching indicated all teaching sessions only contained brief, separate and superficial information on people with pressure injuries and darker skin tones. There was no discursive language or awareness of colour or colour blindness.
Conclusion
Radical critique of all teaching and learning activities needs to occur, to help explore, improve and meaningfully and authentically include diversity and inclusivity in nurse education, and in particular, how people across the skin tone spectrum are included and represented in teaching and learning activities.
Relevance to clinical practice
Critical examination of current teaching practice is crucial to address disparity and ensure care for people with darker skin tones is optimised.
Nurse educators have a responsibility to educate for the care needs of all, as the quality of nurse education has a direct impact on care delivery and health disparity.
This paper highlights the importance of addressing skin tone diversity and offers the opportunity for reflective practice, not just in formal education, but in clinical settings by preceptors and senior staff.
... The importance of people's cultures has been evident in the nursing literature since the 1970s when Madeleine Leininger introduced transcultural nursing (Leininger, 1970). Since then, the role of culture has become an integral part of nursing practice with cultural competence (Campinha-Bacote, 2011, 2019); cultural humility (Isaacson, 2014;Yeager & Bauer-Wu, 2013); cultural responsiveness (Gill & Babacan, 2012;Wilson, Heaslip, & Jackson, 2018); and cultural safety (Anderson et al., 2003;Ramsden, 2002;Wilson, 2008); all becoming part of the nursing lexicon. To be culturally safe requires nurses to act in respectful ways that uphold the rights and dignity of those from a different culture. ...
I want to begin by acknowledging the tremendous work nurses are undertaking at the frontline of healthcare throughout the world currently. I also want to pay my respects to those nurses and their families and friends who have sadly lost their lives from COVID‐19 emphasising the risks our workplaces present. The work of all nurses globally reinforces their pivotal role in healthcare during this time of crisis precipitated by the COVID‐19 pandemic – something I never thought we would see to this scale in our lifetime.
... Cultural safety is a term that originated in New Zealand in response to the poor health status of the Maori Indigenous people. 1 The definition of cultural safety is contested with some scholars defining it in terms of small actions which were usually not defined in policy and procedures within the organisation. 2 Other scholars have defined cultural safety as the standard to which nurses and midwives should seek to aspire. ...
Background:
Aboriginal and Torres Strait islander(1) women face considerable health disparity in relation to their maternity health outcomes when compared to non-Aboriginal women. Culture and culturally appropriate care can contribute to positive health outcomes for Aboriginal women. How midwives provide culturally appropriate care and how the care is experienced by the women is central to this study.
Aim:
To explore the lived experiences of midwives providing care in the standard hospital care system to Aboriginal women at a large tertiary teaching hospital.
Methods:
An interpretive Heideggerian phenomenological approach was used. Semi-structured interviews were conducted with thirteen volunteer midwives which were transcribed, analysed and presented informed by van Manen's approach.
Findings:
Thematic analysis revealed six main themes: "Finding ways to connect with the women", "building support networks - supporting with and through Aboriginal cultural knowledge", "managing the perceived barriers to effective care", "perceived equity is treating women the same", "understanding culture" and "assessing cultural needs - urban versus rural/remote Aboriginal cultural needs".
Conclusion:
The midwives in this study have shared their stories of caring for Aboriginal women. They have identified communication and building support with Aboriginal health workers and families as important. They have identified perceived barriers to the provision of care, and misunderstanding around the interpretation of cultural safety in practice was found. Suggestions are made to support midwives in their practice and improve the experiences for Aboriginal women.
... Nurses of Maori ethnicity may face particular challenges in the transition experience if either the established nurses or organisation are poorly disposed toward the foundational principles of Treaty partnership, participation and protection, or insensitive with regard to cultural safety. The articulation of the concepts of cultural safety (Ramsden, 2002) and adoption of Treaty of Waitangi principles as a foundation of nursing education sanctioned by the Nursing Council of New Zealand could appropriately be regarded as a safeguard and encouragement to the free expression of cultural identity by Maori nurses in Aotearoa New Zealand. The concepts of cultural safety, however, " extend beyond cultural awareness and cultural sensitivity " (Nursing Council of New Zealand, 2009, p 2) to an awareness of the individual as a unique cultural expression of a complex admixture of components including age, ethnicity, gender, socioeconomic, spiritual and sexual orientation. ...
... The observation trained them to conduct both precise and contextual observation, and the interview directed them to ways of creating a dialogical environment that enables them to hear and understand the interviewees' complex points of view. In both genres the students acquired tools for reflective observation, which is of vital importance for future nurses, since the ability to identify opinions and attitudes that guide nurses in their contact with patients is necessary for ensuring relationships of trust with them in order to provide treatment in which the patient feels secure (Ramsden, 2002). Thus, training the students in qualitative research and nursing became one. ...
Background:
Prior work has shown that a greater proportion of First Nations patients than non-First Nations patients arrive by ambulance to emergency departments in Alberta. The objective of this study was to understand First Nations perspectives on transitions in care involving paramedics, and paramedic perspectives on serving First Nations communities.
Methods:
Participants for this participatory qualitative study were selected by means of purposive sampling through author networks, established relationships and knowledge of the Alberta paramedicine system. First Nations research team members engaged First Nations community organizations to identify and invite First Nations participants. Four sharing circles were held virtually in July 2021 via Zoom by the Alberta First Nations Information Governance Centre. We analyzed the data from the sharing circles using a Western thematic approach. The data were reviewed by Indigenous researchers.
Results:
Forty-four participants attended the 4 sharing circles (8-14 participants per circle), which ranged from 68 to 88 minutes long. We identified 3 major themes: racism, system barriers and solutions. First Nations participants described being stereotyped as misusing paramedic systems and substance using, which led to racial discrimination by paramedics and emergency department staff. Discrimination and lack of options to return home after care sometimes led First Nations patients to avoid paramedic care, and lack of alternative care options drove patients to access paramedic care. First Nations providers described facing racism from colleagues and completing additional work to act as cultural mentors to non-First Nations providers. Paramedics expressed moral distress when called on to handle issues outside their scope of practice and when they observed discrimination that interfered with patient care. Proposed solutions included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models.
Interpretation:
First Nations people face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities, and First Nations should lead in the design of and priority setting for paramedic services in their communities.
Issue addressed:
Improving equitable delivery of healthcare for Aboriginal people in northern Australian is a priority. This study sought to gauge patient experiences of hospitalisation and to identify strategies to improve equity in healthcare for Aboriginal patients. Aims were to validate an experience of care survey and document advice from Aboriginal interpreters.
Methods:
Medical charts of Aboriginal patients were audited for documentation of language and interpreter use. Aboriginal inpatients were surveyed using an adapted Australian Hospital Patient Experience Question Set. Multiple-choice responses were compared with free-text comments to explore validity. Semi-structured interviews were conducted with Aboriginal interpreter staff.
Results:
In 68 charts audited, primary language was documented for only 30/68 (44%) people. Of 73 patient experience survey respondents, 49/73 (67%) indicated satisfaction with overall care; 64/73 (88%) indicated hospital staff communicated well in multiple-choice responses. Respondents who gave positive multiple-choice ratings nevertheless reported in free text responses concerns relating to social-emotional support, loneliness, racism and food. Key themes from interviews included the benefits to patients from accessing interpreters, benefits of hospital-based support for interpreters and the need for further service re-design.
Conclusions:
The multiple-choice questions in the survey were of limited utility; free comments from respondents appeared to be more informative. Social and emotional wellbeing needs to be addressed in future experience-of-care evaluations. Aboriginal language and cultural needs can be better met by improved systems approaches. Aboriginal interpreters are uniquely placed to advise on this. SO WHAT?: Interventions to improve equity through increased language and cultural responsiveness are underway.
Aim:
The aim of this study was to investigate how medical unit nurses assess their knowledge about Muslim patients' dietary preferences and needs and Muslim patients' needs regarding food.
Design:
Mixed-method design.
Methods:
Two-part study. Part 1: Two focus group interviews and a survey answered by medical unit nurses. Part 2: In-depth interviews with ten immigrant patients (eight Asians and two Africans). Hermeneutic analysis of qualitative data and SPSS were used for descriptive analysis of the quantitative data.
Results:
The nurses' knowledge about acceptable and prohibited food within Islam appears to be simplistic and Muslim patients tended to be perceived as a homogenous group. Patients' distrust about the preparation and content of the food served may result in insufficient nutritional intake. Serving food that is acceptable to individual patients requires insight and is an essential part of culturally sensitive nursing care.
The concept of cultural safety involves empowerment of the healthcare practitioner and the patient. The determinants of 'safe' care are defined by the recipient of care. Cultural safety is linked to the principles of New Zealand's founding document, the Treaty of Waitangi. These are participation, protection and partnership. Cultural safety was initially a response to the poor health status of indigenous New Zealanders but has since broadened to encompass a wide range of cultural determinants. Importance is placed on identifying and evaluating one's own beliefs and values and recognising the potential for these to impact on others. Dissemination of cultural safety knowledge and practice outside of New Zealand is growing. This concept provides recognition of the indices of power inherent in any interaction and the potential for disparity and inequality within any relationship. Acknowledgement by the healthcare practitioner that imposition of their own cultural beliefs may disadvantage the recipient of healthcare is fundamental to the delivery of culturally safe care.
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