Among the various aspects associated with nursing or health care, cultural safety is a very important aspect associated with nursing. Culture is integral part of the personality trait of any individual, the culture reflects the personal beliefs, values, thoughts and principles. The culture is the most fundamental tie of an individual with their origin and heritage, providing a sense of belonging and togetherness (Fraser et al., 2018). Hence, undoubtedly the importance of culture and the cultural identity of the individuals is imperative and hence, the health care services also must provide utmost attention to cultural safety, especially when providing care to the ethnic minorities. The concept of cultural safety and respect for cultural identities in nursing care is not a new concept, but has been in practice for a decade or more. Although, there is very little understanding among the nurses about the perspective of the aboriginals or ethnic minorities (Gerlach, Browne & Greenwood, 2017). This essay will attempt to explore the concept of cultural safety from the perspective of aboriginals and then illustrate the guidelines of culturally safe practice in nursing for Aboriginals and Torres Strait Islanders.
Cultural safety refers to concept of care which is developed around the principles of cultural awareness and cultural sensitivity. The concept of cultural safety has originated primarily from the care principles designed for the Maori in New Zealand. However, the revolutionary concept has now been embraced by the health care departments across the globe for providing care to the culturally diverse populations. Australia is one such nation which has incorporated the concepts of cultural safety extensively to reform the care for first people of Australia, encompassing 3.3% of the total society (Mkandawire-Valhmu, 2018). The concept of aboriginal care in Australia is guided by the NATISHWA framework that provides the a systematic guideline for the nurses to carry out practice with approaches that not just respects the cultural identity and dignity of the aboriginals, but also foster healing in a culturally appropriate manner (Natsihwa.org.au, 2018). The Australian concept of the cultural safety is described as a process, with the first step being cultural awareness followed by cultural sensitivity to cultural safety.
The principles of cultural safety as defined by the NATISHWA framework includes interconnected domains or elements. The first principle is aboriginal self-determination, which is the ongoing process of establishment of choice for the aboriginals so that they can freely determine their political status and freely pursue their economic, social and cultural development. The next principle is social and restorative justice, which is associated with providing the opportunity for the aboriginals to be able to avail the social benefits and privileges equally. The third principle of cultural safety is equity, a very important aspect of cultural safety (Natsihwa.org.au, 2018). The principle of equity is associated with access and equity, which refers to the idea that all Australians, regardless of the race, religion, culture, ethnicity and language, can avail complete access to all the services that they are entitled. The next principle is negotiated partnership, which refers to the right of the aboriginal to be able to partner in the decision making that involves them or their rights and status in the society. The next two principles are transparency and reciprocity, which is associated which provides a sense of equality to the aboriginals by sharing information actively and allowing them to reciprocate their choices and point of views in the decision making process. The next two principles are accountability and sustainability, which is associated with reforming and redesigning the care services with respect to the accountability to safeguard the best interests of the aboriginals in the society and sustaining their cultural identity. The last two principles are Political Bipartisanship and Cultural Contextuality, where Cultural contextuality refers to the acknowledges the importance of engaging with the local Aboriginal and Torres Strait Islander community to gain insight into and understand the impact of contact history and how it has shaped and influenced the life experience of peoples. And the political bipartisanship is an equilibrium in the political or policy making dilemmas by the both parties, where the aboriginals are to be provided the opportunity to put forth their views and prioritizing them in decision making involving them (Kellett & Fitton, 2017).
The aboriginals are the first people of Australia and they have lived in the nation for at least 40000 years before the European colonization overtook the mainlands of Australia (Brown, Middleton, Fereday & Pincombe, 2016). The colonization period bears a history of trauma, torture and loss for the aboriginals and even though the self-determination and land restoration movements have attempted to improve the societal status of the aboriginals in the Australian society, the discrimination and bullying is still persistent. Even in the health care sector, the inequality, discrimination and accessibility are the most common contributors to the lack of proper health care services for the aboriginals in the society (McGough, Wynaden & Wright, 2018). The cultural safety requirement for the aboriginals are associated with many principles and domains. First and foremost, the care professionals will have to be extremely respectful and compassionate in the communication and care approach, and respect their unique cultural identity and dignity. Along with that, the care professional have to also adhere to the cultural beliefs and norms while planning and implementing the care activities for the aboriginal patients. Furthermore, consent and decision making is a very important aspect of the care scenario for aboriginal patients, hence the care professionals will have to prioritize taking informed consent from the patient while planning care, and along with that, involving the in the care planning procedure and providing them the decisive powers are a very important aspect of care delivery for the patients. Along with that, it is also very important for the nurses to implement both verbal and nonverbal cues of effective communication with the aboriginal patients. Lastly, traditional healing is a vital component of the cultural identity of the aboriginals, and the care providers including nurses have to incorporate traditional healing aspects in the care to make the aboriginal patients feel important valued and empowered (Dell, Firestone, Smylie & Vaillancourt, 2016).
The cultural safety guidelines are a fundamental and integral aspects of the training of the Australian nursing workforce. Considering the NATISHWA framework firstly, along with that 10 principles of cultural safety, there are also 8 domains of culturally safe practice namely country and community, local cultural contecxtuality, recognising & valuing the role of aboriginal and Torres Strait islander health workers, individual reflection, systemic reflection, equity and sustainability, collaboration and co-operation and monitoring and evaluation. These domain guide and direct the nurses in developing a safe and culturally responsive care environment for the aboriginals which respects and empowers their cultural uniqueness (Natsihwa.org.au, 2018).
Similarly, Congress of Aboriginal and Torres Strait Islander nurse and midwives is another notable authority to provide nursing care guidelines for patients belonging to the aboriginal background. However the most important contribution of the CATSINaM is to represent, advocate for and support Aboriginal and Torres Strait Islander nurses and midwives at a national level (Catsinam.org.au, 2018). Along with that, promoting a framework of cultural safety in the provision of care for Aboriginal and Torres Strait Islander people and communities is a very important is another contribution of the organization to the health care of aboriginals.
Similarly, the NMBA practice standards also play a pivotal role in guiding the nurses for practice in the aboriginal care scenario. The standard 1.3 of NMBA registered nurse practice standards state respecting all cultures and experiences, including role of family and community in designing the care for ATSI is a vital requirement for the nurses. Standard 2.2 discusses the need for nurses to communicate in a manner that is respectful to culture so that the patients are comfortable enough to express their needs. Standard 4.1 discusses the need for the nurses to conduct holistic and culturally appropriate assessments, so as to not violate their cultural aspects (Nursingmidwiferyboard.gov.au, 2018).
Ethical decision making:
Ethical decision making is concerned with the cultural safety as well, and the nurses also require to be making ethical decisions while providing culturally competent care to the aboriginals. The ICN code of ethics for nurses also define the importance of cultural competence and cultural safety (Icn.ch, 2018). The nurses are to provide a care environment that is respectful of the cultural identity of the individuals and provide information in a culturally competent manner. Along with that, the ethical decision making also relates to advocacy for aboriginal patients and promoting their health care needs in the policy making scenario as well. Hence, the nurses are also required to prioritize culturally safe ethical decision making in the care planning and implementation for aboriginals.
Conclusion:
On a concluding note, culture is a very important aspect of the life of an individual and in the context of health care as well, the cultural safety is needed to be restored in care planning and implementation. The NATISHWA framework is designed specifically to foster cultural safety for the aboriginals in Australia, the nurses are also guided about a culturally safe practice in different health care legislative elements such as the practice standards, code of conduct and ethical codes of practice. Similarly, NMBA and ICN also provides practice standards and code of conduct to guide the nurses. This essay has successfully outlined the cultural safety principles and the guidelines for nurses in foster cultural safety in their practice and be able to provide safe and effective care to the ATSI patients.
References:
Brown, A. E., Middleton, P. F., Fereday, J. A., & Pincombe, J. I. (2016). Cultural safety and midwifery care for Aboriginal women–A phenomenological study. Women and Birth, 29(2), 196-202. Doi: 10.1016/j.wombi.2015.10.013
Catsinam.org.au (2018). Position Statement: Embedding Cultural Safety across Australian Nursing and Midwifery. [Online] Retrieved from https://www.catsinam.org.au/static/uploads/files/embedding-cultural-safety-accross-australian-nursing-and-midwifery-may-2017-wfca.pdf [Accessed on 16th Dec]
Dell, E. M., Firestone, M., Smylie, J., & Vaillancourt, S. (2016). Cultural safety and providing care to Aboriginal patients in the emergency department. Canadian Journal of Emergency Medicine, 18(4), 301-305. Doi: 10.1017/cem.2015.100
Fraser, S., Grant, J., Mackean, T., Hunter, K., Holland, A. J., Clapham, K., … & Ivers, R. Q. (2018). Burn injury models of care: A review of quality and cultural safety for care of Indigenous children. Burns, 44(3), 665-677. Doi: 10.1016/j.burns.2017.10.013
Gerlach, A. J., Browne, A. J., & Greenwood, M. (2017). Engaging Indigenous families in a community?based Indigenous early childhood programme in B ritish C olumbia, C anada: A cultural safety perspective. Health & social care in the community, 25(6), 1763-1773. Doi: 10.1111/hsc.12450
Health.qld.gov.au (2018). Aboriginal and Torres Strait Islander Patient Care Guidelines. [Online] Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0022/157333/patient_care_guidelines.pdf [Accessed on 16th Dec]
Icn.ch (2018). International Council of Nurses. [Online] Retrieved from https://www.icn.ch/ [Accessed on 16th Dec]
Kellett, P., & Fitton, C. (2017). Supporting transvisibility and gender diversity in nursing practice and education: embracing cultural safety. Nursing inquiry, 24(1), e12146. Doi: 10.1111/nin.12146
McGough, S., Wynaden, D., & Wright, M. (2018). Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study. International journal of mental health nursing, 27(1), 204-213. Doi: 10.1111/inm.12310
Mkandawire-Valhmu, L. (2018). Cultural Safety, Healthcare and Vulnerable Populations: A Critical Theoretical Perspective. Routledge. Doi: 10.1097/CEH.0000000000000196
Natsihwa.org.au (2018). NATSIHWA. [Online] Retrieved from https://www.natsihwa.org.au/[Accessed on 16th Dec]
Nursingmidwiferyboard.gov.au (2018). Nursing and Midwifery Board of Australia – Registered nurse standards for practice. [Online] Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx [Accessed on 16th Dec]
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