Cultural Safety Position Statement: in context to Golden Glow Nursing
Background
Golden Glow Nursing, is one of Darwin’s most acclaimed private mobile-nursing organisations, which remains accredited of providing excellent home-support care, and community care for their clientele acknowledging the cultural diversity and needs of Australian Aboriginal population and the Torres-Strait-Islander (ATSI) populace delivering safe and healthy lifestyle requirements within their home premises (“about us | Golden Glow Nursing”, 2019). The organisation implements cultural safety in all its nursing practices supporting development and acknowledging the diverse political, historical, social, economic and ideological scenario that prevails in the Territory.
Cultural safety relates to a practice-based philosophy focusing on how health-professionals enact out their job, not on what they do. Systematic issues and social-health-determinants are focused upon to deliver care services to clientele irrespective of cultural differences, centred upon the unique needs (Marmot, & Bell, 2010).
Cultural safety in regard to the ATSI clientele, consists of a practice model, based upon communication, negotiation, power-sharing, dialogue, acknowledging uniform privilege to challenge racism and instigate trust in health-care (Brascoupé, & Catherine Waters BA,. 2009). This can be achieved via increment in ATSI workforce through employment of staffs bringing indigenous leadership into play, increasing accessibility and participation of ATSI people. Furthermore, the capacity of non-indigenous workforces must also be addressed in strategies for delivery of culturally safe nursing practices (Walker, et al., 2009).
With 100 enrolled and registered nurses alongside Personal-Care-Assistants (PCA) across Darwin, Golden-Glow-Nursing endeavours to increase the wellbeing and number of ATSI nursing and PCA workforce in delivering culturally-safe care services for improved and better outcomes of the community. Furthermore, the organisation has a developed relationship with Charles-Darwin-University providing students the opportunity to learn from qualified nurses during community placement, to enhance working-relationship and qualified workforce maintenance throughout the Territory (“about us | Golden Glow Nursing”, 2019).
Position
Golden-Glow-Nursing resolves to:
Golden-Glow-Nursing recommends
Rationale
Why is a position statement important in providing Culturally Safe environment in healthcare?
Nursing and healthcare services must be transparent, trustworthy and freed from biases. To provide services enriched with safety and respect to a diversified culture, cultural safety needs utmost implementation. The same can be attained via respecting cultural, socio-economic, political differences amongst the clientele evoking self-reflection means to delve into cultural identity (Brascoupé, & Catherine Waters BA, 2009). The Golden-Glow-Nursing’s position statement, helps the nursing staffs, PCAs’ and health-care providers in delivering culturally adhering health-care services free of racial discrimination, or power imbalances amongst the clientele or amongst themselves (“about us | Golden Glow Nursing”, 2019).
In Darwin and across the Territory cultural diversity is prominent in the demographics, which relates to the viewpoint of maintaining culturally safe community services enhancing the health outcome of its clientele. The community-care services can be enhanced furthermore, by providing individualistic care to all its clientele, respectfully abiding by the unique social, physical, emotional and cultural development of all, including the ATSI people.
What importance does effective communication play in providing a Culturally Safe environment?
Effective communication acts as an important cultural phenomenon affecting nursing care and healthcare service delivery amongst people/patients of diverse cultural groups, the ATSI community in the present scenario (Institute of Medicine, 2011). In healthcare settings, nurses play a holistic key role in recognising an individual’s values, preferences, needs. Thus respect to an individual patients needs is mandatory and a nurse must always enhance a patient-nurse power relationship development, to deliver compassion and culturally based care which is appropriate, safe and effective (Cullen-Drill, & Prendergast, 2011).
Interpersonal communication is effective in timely registering the proper care required by the patient, via communication amongst the family members, other health-care professionals encouraging shared decision making (Peplau, Travelbee, & Orlando, 2015). Both verbal and non-verbal communication involving, written records, speech, language barriers, appearance and cultural artefacts must be given due consideration. The therapeutic goals in a diverse cultural setting, can be achieved by nurses through 3 phases in a nurse-patient relationship development: a) orientation b) working c) resolution (Masters, 2014).
In Orientation, the nurse diagnoses using “Patient-Explanatory-Model” assessing the patients’ condition drawing knowledge from patient’s belief, culture, values. In working phase, implementation and working of a plan is executed relying on open communication with patient regarding plan execution and goal achievement. Patient issues are resolved in the termination phase, with future health plans. It would also be apt if ATSI workers are made to address the ATSI patients, as they will be more culturally apt in caregiving, addressing the cultural diversity of the ATSI patients.
Interrelationship between effective communication and health literacy?
Improvement in communication quality in health-care setting is a must for addressing the challenges that patients face due to limitations in health literacy (Reisi, et al., 2014). Poor health has a direct relationship with limitation in health literacy which may be further addressed to poor quality of communication. The ability of a health-care professional to understand and to act on basis of health information refers to that individual’s health-literacy. Development of plain language, navigation aid, patient-friendly health-education materials, education of nurses about issues of health-literacy, redesign of patient-consent forms, “teach-back” communication techniques, are efforts in overcoming limitation of health literacy (Tamura-Lis, 2013).
System strategies are effective means which also aid in overcoming health-literacy limitations and patient-centred communication practices must be advanced and implemented by nurses in health-care setting to properly address the needs, desires of patients, respecting their individual decision making skills regarding health, empowering the patients and increasing their self-awareness in the process. Clear forms, improved material to education regarding health, staff training, and clarity in communication, reinforcement and teach-back techniques must be used to address the challenges faced in caring for culturally distinct patients specifically the ATSI patients in the present case.
The external influences (historical and contemporary, factors like the media) that may contribute or detract from Culturally Safe practice in the healthcare environment
In Australia there still exist a strong disparity between the indigenous and non-indigenous populace healthcare (Australian Institute of Health, 2012). Behaviour plays a significant role in health based outcomes, with indigenous populace showing increased health-risk behaviours. Certain themes act as external influences and worked against Australia’s socio-ecological model, they influence the cultural safety and health behaviour amongst the indigenous and ATSI populace.
All these factors must be addressed in realising the external influences which may detract or contribute to cultural safety in organisations.
How might this contribute to improving the health outcomes of the organisation’s target clients?
The cultural differences, racial and communication differences and differences in cultural obligations must be addressed by Golden-Glow-Nursing, to promote uniform health-and-care services to patients by respecting their individual culture and independence. Choice of service must be provided to all patients’ and impartial means must be barred showcasing respect to individual patient-rights. Patients must be provided accurate information, timely too in an understandable format, considering the language reading and writing barrier amongst ATSI and non-Indigenous patients (WHO, 2015). The right to advocacy must be addressed and supported by the Golden Glow Nursing staffs and registered nurses. Even the non-ATSI staffs must be trained to address and understand the needs of ATSI patients breaking the racial, cultural and language barrier, in healthcare practices, enhancing the patient health-outcomes.
What are the barriers, to implementing this position statement that might exist within the organisation? How might these barriers be overcome?
Cultural support is essential in ensuring healthcare accessibility. Cultural barriers in nursing and healthcare consists of individual obstacles faced by patients like language differences, medical practices, gender conceptions or sexuality conceptions. These barriers cause miscommunications amongst culturally diverse parties leading to unsatisfactory health outcomes in nursing services amongst ATSI people causing health inequalities (Mobula, et al., 2015). Differences in health interpretation, faiths, values, beliefs prevents ATSI people from accessing mainstream health facilities, delaying health-check-up, follow-ups and routine appointments.
Cultural competency in nurses and health-care providers can minimise disparities via incorporation of culture into the service delivery. Nurses need to understand the cultural beliefs and then combine clinical skills, practices, behaviours on ATSI patients (Hunt, et al., 2015). Organisational policies and strategies must be aligned with nurses. Involvement of speech-language professional in pathology, can help conceptualise how systems, and services will be planned and supplied to the indigenous populace. Strategies linked with policies, and practices respecting cultural differences, can help nurses deliver culture-based communication-skills to the patients in Golden-Glow-Nursing, enhancing the wellbeing and healthcare of the ATSI communities through a Culturally Safe Organisational approach.
References
about us | Golden Glow Nursing. (2019). Retrieved 14 October 2019, from https://www.goldenglownursing.com.au/about-us
Australian Institute of Health. (2012). Australia’s Health 2012: The Thirteenth Biennial Health Report of the Australian Institute of Health and Welfare. AIHW. doi: 10.1017/s0266462300008783
Brascoupé, S., & Catherine Waters BA, M. A. (2009). Cultural safety: Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. International Journal of Indigenous Health, 5(2), 6. doi: 10.1093/obo/9780199756797-0192
Cullen-Drill, M., & Prendergast, K. M. (2011). Psychiatric nursing: Back to basics. Journal of psychosocial nursing and mental health services, 49(12), 4-6.doi: 10.3928/02793695-20111108-01
Hunt, L., Ramjan, L., McDonald, G., Koch, J., Baird, D., & Salamonson, Y. (2015). Nursing students’ perspectives of the health and healthcare issues of Australian Indigenous people. Nurse education today, 35(3), 461-467.doi: 10.1016/j.nedt.2014.11.019
Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
Marmot, M., & Bell, R. (2010). Health equity and development: the commission on social determinants of health. European Review, 18(1), 1-7. Doi: 10.1017/s1062798709990081
Masters, K. (2014). Nursing theories: A framework for professional practice. Jones & Bartlett Publishers. doi: 10.5005/jp/books/12786_58
Mobula, L. M., Okoye, M. T., Boulware, L. E., Carson, K. A., Marsteller, J. A., & Cooper, L. A. (2015). Cultural competence and perceptions of community health workers’ effectiveness for reducing health care disparities. Journal of primary care & community health, 6(1), 10-15.doi: doi.org/10.1177/2150131914540917
Peplau, H., Travelbee, J., & Orlando, I. J. (2015). Nurse–Patient Relationship Theories. Nursing Theories and Nursing Practice, 67.
Reisi, M., Javadzade, S. H., Heydarabadi, A. B., Mostafavi, F., Tavassoli, E., & Sharifirad, G. (2014). The relationship between functional health literacy and health promoting behaviors among older adults. Journal of education and health promotion, 3.doi: 10.4103/2277-9531.145925
Tamura-Lis, W. (2013). Teach-Back for quality education and patient safety. Urologic Nursing, 33(6). doi: 10.7257/1053-816x.2013.33.6.267
Walker, R., Cromarty, H., Kelly, L., & Pierre-Hansen, S. (2009). Achieving cultural safety in Aboriginal health services: implementation of a cross-cultural safety model in a hospital setting. Diversity in Health & Care, 6(1).doi: 10.12927/hcq.2013.21617
Waterworth, P., Pescud, M., Braham, R., Dimmock, J., & Rosenberg, M. (2015). Factors influencing the health behaviour of indigenous Australians: Perspectives from support people. PloS one, 10(11), e0142323.doi: 10.1371/journal.pone.0142323
World Health Organization. (2015). World report on ageing and health. World Health Organization.
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