Cultural Safety Of Healthcare: Understanding The Principles And Importance

The Four Principles of Cultural Safety and Its Origin

Question:

This assignment involves the collection and analysis of media material on a current cultural safety in health issue(s). You are required to link contemporary issues as presented in the media with those discussed in the unit outline and in the readings. It is advisable to start thinking about your topic and collecting your material from early in the semester. Discuss this with your lecturer prior to commencing the activity. 
 

Cultural safety of healthcare is defined as the effective practice of nursing of a family or person from a different culture and is determined by the family or person. It originates in the education of nursing and the culture ranges from generation or age, sexual orientation, gender, religious beliefs, disabilities and occupation. A cultural practice can be deemed unsafe when an action is demeaning for the cultural identity of a family or person. There are four different principles of cultural safety (Canuto et al., 2013). The first principle aims for improving the well-being and health status of the people of New Zealand, as the evolution of the concept took place in New Zealand. The second principle aims at improving the health services delivery. The third principle aims at focusing the on the differences between the people who are undergoing the treatment and accepted the differences. The fourth principle aims at understanding the importance of health services and its impacts on the families and individuals (Brown et al., 2015).

Cultural safety goes beyond the cultural sensitivity concept for analyzing the imbalances in power and institutional discrimination. There exist much debate and confusion regarding the separation of cultural safety from the concepts of cultural awareness, cultural competency, cultural appropriateness and cultural sensitivity. Cultural safety has been renamed as the critical social theory and it is not different from making the people aware of the economic and socio-political issues in the society and helps to recognize the impact of these issues on the people (Smith et al., 2015). The present assignment deals with the media analysis of health issues in cultural safety. The health issue in this assignment is the healthcare crisis faced by the Aboriginals and the Torres Strait Islanders in Australia. 

This is a media report issued by the Australian human rights commission that aims at establishing a healthy environment for ensuring cultural safety for the Torres Strait Islander and Aboriginal organizations and communities. It also ensures cultural security by the external parties like non-government and industrial organizations and government for the above-mentioned organizations and communities. Cultural security and safety are demonstrated through a collection of case studies that highlights the promising healthcare practices occurring through government partnerships and communities. The case studies help to provide the practical strategies and remind that with the right support, the communities can develop their own problem solving abilities, associated with health. The problems of lateral violence can also be addressed in this manner. VACCA (Victorian Aboriginal Child Care Agency) illustrates the cultural safety concept as the context for the promotion of mainstream healthy environments that are competent culturally. However, it should also be ensured that the community environments for the Aboriginals should be culturally safe and should promote cultural strengthening that is focused on a healthy community.

Cultural Safety versus Other Cultural Concepts

Mercer (2013) opined that there has been significant health inequity experienced by the Aboriginal Australians when compared to the non-Aboriginal Australians. Collaborating and engaging with these less privileged Australians has led to finding a way for reducing this gap in health inequity. The health policy of Australia contains strategies for increasing the amount of Torres Strait Islander and Aboriginal people for participating in the delivery of the healthcare services. This provides for increasing the opportunities of the population for self-determining the practices and policies effecting the cultural provision of the people.

The media report states that cultural safety and security for the Aboriginals and Torres Strait Islanders are the basic requirements for the population for their intrinsic development and healthy environment. This can bring down the probabilities of lateral violence significantly by reducing the inequalities between the aboriginals and the non-aboriginals, thereby promoting the levels of health among the aboriginals (Dudgeon, 2016). However, this should not remain confined only to the sector of health and it should include all the important parameters that lead to the chances of developing lateral violence, due to deprivation. Although, the media and the article have discussed about the healthcare issues, but further activities are required for engulfing the other essential issues like education, food security and other citizen rights (Smith et al., 2015). The development and prosperity of a nation depend on the progress of its citizens and this is possible only by providing cultural safety and better health to all. 

This is a media release by the Australian Institute of Health and Welfare that deals with the concerns in the access of healthcare and the inequalities by providing special provisions to the indigenous population globally. The health services, regulatory bodies and professionals examine the health outcomes and the healthcare needs of these groups and possible ways to meet those needs. There is enough evidence that suggest the inequalities in healthcare and health status between the non- Indigenous and Torres Strait Islanders and Aboriginals in Australia. The inequalities are most prominent for the communicable and chronic diseases, mental health, life expectancy and infant health. These inequalities are strengthened by several factors and the biggest of these factors are external and lies beyond the system of healthcare. Evidence have also shown that quality healthcare is not equally accessible that are because of ethnicity has also significantly contributed towards the health disparities. It has been long a subject of research globally about the provision of health services that are ethnocentric and the negative impact it has on the indigenous population and their health status. There is a dearth of indigenous health workers in the delivery systems of healthcare that is a major source of under utilization of the healthcare services. Evidence have shown that the health disparities between the non-indigenous and indigenous Australians are connected to accessibility and this is influenced by the geographic, economic and socio-cultural factors. Therefore, the practitioners, services and systems should increase their ability to work on patient diversity.  

Clifford et al. (2015) carried out a study that reviewed the methodological quality of the intervention designs for improving the healthcare cultural competency for the indigenous population of New Zealand, Australia, USA and Canada. The purpose of the study was to identify and recognize the health disparities among the non-indigenous and indigenous people. It was found that high rates of disease and illness in the indigenous population was due to the historical experiences of the people and social determinants of health. Evidence also show that there has been increased recognition of the cultural and social factors for the provision of healthcare to the indigenous population.

Media Report on Healthcare Crisis among Aboriginals and Torres Strait Islanders in Australia

From both the media release article and the scholarly journal, it was found that the strategy for decreasing the inequalities the access of healthcare is cultural safety. It also helps to improve the effectiveness and quality of care for the indigenous population. Embedding and developing cultural competence in the services of healthcare needs to focus on the awareness, knowledge, attitude, skills and behavior (Kuipers et al., 2014). In Australia, the cultural safety process has been descriptive and has been extended at the administrative and operational levels of service. However, there is a significant lack of evidence regarding the strategies that are efficient for the improvement of the healthcare delivery system to the Indigenous Australians that is culturally competent (Dickson & Manalo, 2014). In addition, there should be a coherent approach to the teaching and inclusion of cultural safety through national standards for the population.

This is a media article by The Age that demonstrates the stark reality of the Torres Strait Islander and the Aboriginal people is their life expectancy that was found to be ten years lesser than that of the Australians, who are non-indigenous. This is considered as a shame for the country as there still exists institutional racism, especially in the healthcare sector and it is the major barrier for the deprived population who seeks medical attendance. Cultural safety is just a word and people are dying young in the community. Since past 10 years, significant efforts are being applied for closing the gap and achieve health equality. However, progress has been seen in the health of the child and infant and there have improvements in the rates of immunization rates, more health checks and increased medicinal access. Gap closing programs have been developed for the people of the Torres Strait Islands and the Aboriginals so that they do not have to suffer the poorer and shorter lives in a blessed and rich nation like Australia. The people of this population have equal rights like the non-indigenous Australians for primary healthcare and the provided health services should address the emotional, cultural and social well-being of these communities in a holistic and appropriate manner. The demand of the dwellers is a health system that is culturally safe and free from any sort of institutional racism. Institutional racism has been a major barrier for the population in the sector of healthcare and to address this issue, a campaign name Close the Gap was launched. The campaign has been able to address this issue significantly and the health inequality is dealt with proper care. The healthcare professionals along with the nurses and doctors are working on closing the gap since health is very much required for their survival. 

According to Balaratnasingam et al. (2015), mentally health is equally important an issue of cultural safety as it is with physical health. Therefore, the authors conducted a study for exploring the emotional and social well-being of the Torres Strait Islanders and the Aboriginal Australians. Mental illness has also been found a reason for shorter life expectancy and there are no proper healthcare services for addressing the mental retardation. Unrecognized and serious has been noticed between the aboriginal patients and the non-aboriginal doctors. The health assessment reliability also faces a setback due to the lack of understanding and knowledge of the cultural differences of the health professionals in the region (Nelson et al., 2015). Therefore, it can be said that adequate training and education and training is required by the health professionals prior to getting engaged in the treatment of the patients of the Torres Strait Islands and the aboriginals. The health assessments must be carried out in an amiable atmosphere of cultural safety and respect. Culturally sensitive protocols and language have to be used for effective engagement of the people of this population by considering their belief system and worldviews (Dingwall et al., 2015).

Health Inequity among Aboriginal Australians: Collaborating to Reduce the Gap

This is a media release by the Telethon Kids Institute and deals with the mental health issues of the Torres Strait Islanders and the Aboriginals. Complimentary and consistent themes have been identified by the practitioners of mental health for the population that includes utilization of the primary care models and adopting an approach for community development. Cultural competence has a crucial role in the for providing cultural safety with care. In the light of cultural safety, it has been found that unrecognized and serious miscommunication is the prevalent for the interactions between the aboriginal patient and the non-aboriginal doctor, especially in the remote communities. If the practices are not culturally safe, there will be erosion ad diminution of the fundamental human rights and cultures of the indigenous people. It is essential to establish the protocols and practices for ensuring the practices that are culturally safe and appropriate for the indigenous community as per the Australian context. Cultural safety is the process of enhancing the communal and individual cultural identities that promote and empower the community and individual well-being. For creating a space that is cultural safe, critical reflexivity has to be developed for making the practitioners aware of the method of interaction and behavior to make the people from diverse culture safe and result in positive consequences. The colonial history of Australia and the circumstances contemporary to the indigenous population had laid down the foundation of the lack of services and access to the fundamental aspects of the indigenous population. Therefore, the wellbeing and mental health issues of this population had a setback and they did not have sufficient facilities for mental health improvement.

Parker & Milroy (2014) carried out a research work to make an overview of the mental health of the Torres Strait Islanders and the Aboriginals. The concepts of mental and physical health and wellbeing for this population were examined by the authors and discussed the possible ways to regain the mental and physical health. The social determinants and aboriginal health have been deteriorated over the years. Cardiovascular diseases and hospitalization rates were found to be 67% higher than the non-indigenous Australians. Rheumatic heart disease was 25 times higher for this population than the remaining Australians and same is the case for renal failure and diabetes. These statistics are alarming as the life expectancy was found to be 11.5 years and 9.7 years lower for males and females respectively when compared to the other Australians (Hepworth et al., 2015). Racism and poverty have been identified as one of the vital reason for this deteriorated condition of health as the aboriginal population of Australia have been deprived of safe drinking water, food, health, education, shelter and sanitation facilities. Therefore, for improving the mental health status of the indigenous population, healthcare facilities are not enough. There has to subsequent improvement in the areas of the other basic needs like food, clothing and shelter that can give them a better environment to improve their health and wellbeing (Hall et al., 2015). Cultural safety has to be provided to the patients with mental illness without any interference by racism.

Cultural Safety and Security as a Basic Requirement for Development and Prosperity

The author has critically reviewed the media articles and the related theories and models and reflected on the concept of cultural safety related to the healthcare issues among the population of Torres Strait Islanders and the Aboriginals. The application and conceptualization have to be developed comprehensively and critically for this population and the cultural safety capacity helps to transform and broaden the health equities. The responsibility of promoting health equity lies with the diverse members of the healthcare society like the educators, providers and the researchers. However, it is also reflected by the author that the aboriginal people should also come forward to their own rescue and change their attitude towards illness. They need to understand the importance and necessity of the medical treatment and follow the instructions delivered by the healthcare personnel. They should work in coordination with the medical staff to develop solutions that are mutually acceptable for solving their health problems. Working with the nursing and medical practitioners would promote the cultural safety practice. 

Conclusion

The concept of cultural safety goes beyond the concepts of cultural sensitivity and cultural awareness. It helps to empower the individuals and gives them the ability to achieve positive outcomes. It reflects the cultural recognition and identity and the impact it has on the on the professional practice and personal culture (Freeman et al., 2014). The indigenous population of Australia has been long deprived of the healthcare facilities and they faced subsequent health issues. However, there have been significant improvements in the scenario and healthcare professionals are working collectively, towards the cultural safety of the Australian aboriginals.  

References

Australian Institute of Health and Welfare. (2016). Aihw.gov.au. Retrieved 29 May 2016,

Balaratnasingam, S., Anderson, L., Janca, A., & Lee, J. (2015). Towards culturally appropriate assessment of Aboriginal and Torres Strait Islander social and emotional well-being. Australasian Psychiatry, 23(6), 626-629.

Brown, A., O’Shea, R. L., Mott, K., McBride, K. F., Lawson, T., & Jennings, G. L. (2015). A strategy for translating evidence into policy and practice to close the gap-developing essential service standards for Aboriginal and Torres Strait Islander cardiovascular care. Heart, Lung and Circulation, 24(2), 119-125.

Canuto, K. J., Spagnoletti, B., McDermott, R. A., & Cargo, M. (2013). Factors influencing attendance in a structured physical activity program for Aboriginal and Torres Strait Islander women in an urban setting: a mixed methods process evaluation (Doctoral dissertation, BioMed Central).

Chalmers, K. J., Bond, K. S., Jorm, A. F., Kelly, C. M., Kitchener, B. A., & Williams-Tchen, A. J. (2014). Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines. International journal of mental health systems,8(1), 1.

Chapter 4: Cultural safety and security: Tools to address lateral violence – Social Justice Report 2011 | Australian Human Rights Commission. (2016). Humanrights.gov.au. Retrieved 28 May 2016, 

Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review.International Journal for Quality in Health Care, 27(2), 89-98.

Dickson, M., & Manalo, G. (2014). The beyond borders initiative: Aboriginal, torres strait islander and international public health students: Engaging partners in cross-cultural learning. Education for Health, 27(2), 132.

Dingwall, K. M., Puszka, S., Sweet, M., & Nagel, T. (2015). “Like Drawing Into Sand”: Acceptability, Feasibility, and Appropriateness of a New eâ€ÂMental Health Resource for Service Providers Working With Aboriginal and Torres Strait Islander People. Australian Psychologist, 50(1), 60-69.

Dudgeon, P. (2016). Gender, Politics, and the State in Aboriginal Australia and Torres Strait Islands. The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies.

Ever, O. & Day, N. (2016). Our national shame: Closing the gap for Indigenous Australians is more important than ever.

Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S., & Francis, T. (2014). Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand journal of public health, 38(4), 355-361.

Hall, K., Chang, A. B., Otim, M., Anderson, J., Kemp, A., & O’Grady, K. A. (2015). General practitioner utilisation amongst urban Aboriginal and Torres Strait Islander children aged less than 5 years.

Hepworth, J., Askew, D., Foley, W., Duthie, D., Shuter, P., Combo, M., & Clements, L. A. (2015). How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care.International journal for equity in health, 14(1), 1-8.

Kuipers, P., Harvey, D., Lindeman, M., & Stothers, K. (2014). Aboriginal and Torres Strait Islander health practitioners in rural areas: credentialing, context and capacity building. Rural and remote health, 14(2897).