Racism refers to the discriminative behaviour met out to a person in the society based merely on the colour of their skin. It may lead to debarring the person from basic societal benefits like education, employment and healthcare. When a person of colour is subjected to an individual level of discrimination, it is referred to as personal racism. It is firmly guided by prejudices, which when endorsed by one group results in reinforcement of the other group as inferior(Jones, 1997). Institutional/ systemic racism refers to the discrimination in administrative policies and practices being met out to various groups within an institution. A relevant example of this may be found in schools where punitive measures are more stringent for students of colour or within the employment sector where hiring practices are biased towards certain races. The urge for social dominance in this hierarchy has led to both intentional and unintentional expressions of bias (Brigham, 1993).
The concept of whiteness is referred to as the selective availability of benefits like quality healthcare, wages and education for the whites over people of colour. In purview of the contemporary nursing practice in Australia, whiteness has resulted in a massive health gap between the health of the Aboriginal Australians and the white Australian population. Racial discrimination has been a hindrance in provision of adequate healthcare access to the aboriginal population. Delivering culturally appropriate healthcare facilities to this population remains a challenge mainly due to miniscule representation of their population within the medical community. According to a 2011 report, the Australian nursing community had a mere 0.8% representation from the Aboriginal and Torres Strait Islanders(Stuart & Nielsen, 2011). Even this minuscule representation suffers from white dominance in the contemporary nursing field and their indigenous practices are ignored, even when treating their own population (Nielsen et al., 2014). This means less knowledge-flow from their community and consequent widening of the health gap.
The term cultural safety is said to have been originated within the Maori mid-wifery students- community while being trained in an Anglo educational setup. It was devised to describe their fear of safety of the colonial training measures. Today, it has become a framework for navigating the risks and challenges concerning the health of indigenous people. It amalgamates the concepts of sociocultural and historical backgrounds to devise effective health service based on cultural identity of the recipient(Johnstone & Kanitsaki, 2007). While it enables the patient to draw maximum benefits from the healthcare provider, it also results in endorsement of regimes yielding positive results.Cultural competence, on the other hand, focuses on the skill of the healthcare provider to deliver a positive experience for the patient by integration of cultural parameters with clinical concepts. It involves assessment of community-based values and transforming the derived knowledge resource to provide bespoke healthcare for meeting the cultural, linguistic and social needs of the patient (Durie, 2001). Both cultural safety and cultural competence seem to be contrasting with one another with the former being a robust branding for inequality and discrimination of medical policies and practices for indigenous people; nonetheless, practically both complement each other for maintenance of high standards of healthcare (Williamson & Harrison, 2010). (212 words)
In accordance with the 5Rs of Reflection Framework, report on one of the prescribed readings (from Week’s 1-5) that grabbed your attention, and then describe your response to this prescribed reading.
NSB202 has etched the prime areas of concern for healthcare for Aboriginal and Torres Strait Islanders. Out of the various contexts, I was maximally intrigued by the concern about the mental healthcare of these people (Pg.22). I was disturbed by the fact that despite the strong positive values embedded in their community, their mental health suffers because of personal and systemic racism. The enhancement in suicide rates and instances of substance abuse, specifically within their youth population is disheartening. It highlights the need to practice cultural safety and competence in healthcare and also educate the mainstream population to denounce whiteness.
Discuss how institutional racism has been enacted and perpetuated throughout Australia’s history, particularly in regards to Indigenous peoples’ access to adequate health care, education and employment. Describe how these actions relate to the concept of white privilege.
Institutional racism is deeply rooted within the Australian societies and even today ethnic disparity continues to be a constant with regards to the Aboriginals. The long history of colonial rule and constant oppression of the Aboriginals has taken a heavy toll on their healthcare, education and employment. There is ample evidence stating the ill state of these three consequential markers of racism within the Australian Aboriginals. The life expectancy of an indigenous male is 21 years less and that of a female is 19 years less as compared to non-aboriginal males and females. They exhibit a high susceptibility to diabetes, cardiovascular and respiratory disorders and triple the rate of infant mortality as compared to mainstream population8. Despite the adverse health conditions, procurement of healthcare services remains an issue because of poverty. Poor health also became a limitation for attainment of education and employment.
The clash of culture between the whites and aboriginals is the prime reason fuelling this institutional racism. The discriminative practices met out to the aboriginals due to lack of sensitivity to their culture, language and social values has created a strong prejudice among the white population.
Institutional racism is also evident in the early healthcare policies of the country. For example, the allotment of low-cost nursing care for Aboriginal and Torres Strait Islander people born in 1940s while allotment of higher amount for the white population of the same age group. Even the primary health care benefits per capita were 11 times less than that allotted to mainstream Australian population (Henry et al., 2004). Further low representation of the aboriginals within the medical community due to bias in education and employment opportunities has resulted in linguistic barriers between the patient and practitioner. Despite the government efforts for restoration of adverse health conditions of the aboriginals, the extent of impact of racism has been uncurbed. Ad per, the Closing the Gap target report of Australian Institute of Health and Welfare, 47% of the existing health gap may be endowed upon institutional and personal racism. The indigenous population is given least priority for clinical care even in acute health conditions like cancer or coronary heart disease (Bourke et al., 2018).
Discuss how culturally safe nursing practice does address personal and institutional racism that impact on Aboriginal and Torres Strait Islander peoples’ access to health care.
Ensuring cultural safety within the health, educational and employment setup is a major step not only towards better healthcare provision for Aboriginal and Torres Strait Islander peoples but also for addressing personal and institutional racism faced by them. Colonial history of the country has deeply embedded it with the prejudices and stereotypes associated with the aboriginal population and this can only be eradicated by openness of the non-aboriginal population towards bi-culturism. Inclusion of the knowledge resource from the aboriginal communities within the healthcare training modules creates an interface for cross-cultural exchange and helps in eradicating the current indifference and ignorance in the mainstream population (Merritt et al., 2018). It also helps in building an efficient treatment module for the aboriginal patients for enhancing the healthcare standards provided to them. Ensuring better representation of aboriginal population in the nursing workforce would help dissolve linguistic barrier which is currently the major cause for miscommunication and consequent sub-standard healthcare delivery to aboriginals (Brascoupé & Waters, 2009) Its inclusion within the organisational framework makes it obligatory for the provider to tailor the treatment regime as per the cultural needs of the recipient. It ensures the participation of the care recipient in his treatment regimen and thus has a critical impact on the practitioner-recipent relationship. It also calls for administrative policies within the institutions to discourage the co-workers from resorting to racist attitude and empower the nurses in the workplace to challenge and address racist behaviour (Vukic et al., 2012). These policies would also ensure the fairness of the system to promote cultural integrity and social justice. However, cultural safety needs to be accompanied with inculcation of compassion and acceptance within the white Australian population to address the address the negative impacts of racism on aboriginal heath, social and economic status.
In accordance with the 5Rs of Reflection Framework, reflect on the transformation of your understanding regarding the role of nurses in addressing the health needs of Aboriginal and Torres Strait Islander peoples in a culturally safe way. Consider how your knowledge and understanding has developed through your engagement with the learning material and activities (i.e. the required and recommended readings, videos, lectures and tutorial material and activities).
My earlier understanding of the impact of racism on the healthcare needs of the Australian aboriginal population was statistic-based and superficial. Having engaged with the reading material, I have been able to explore and assess the critical role of cultural safety in nursing for the provision of healthcare for Aboriginal and Torres Strait Islander peoples in Australia. Given the history of the country and its impact on the economic, health and social status of the aboriginals, I feel that cultural safety targeted these concerns while also being a robust measure against racism.
Despite the positive agenda associated with cultural safety, I am forced to think about how willing is the mainstream population to adapt to bi-culturism and step down from the superior pedestal in their heads to believing in equality. The shift of power dynamics from the provider to recipient may be enforced during delivering service but does it account for the interpersonal behaviour being met out to the patient or the aboriginal co-workers?
The current coursework also made me delve into the readings of Australia culture and history. After going through this, I concluded that nursing education and cultural education need to be imparted in cohesion, especially in context of countries like Australia and New Zealand. The cultural considerations for the aboriginals can only be realised by the white population by learning about the social, political and economic reforms that have landed the community in the dismal state. Inculcation of empathy for the cultural values of aboriginals among non-aboriginals is possible only via taking them through this historical discourse.
The efficacy of cultural safety in healthcare can be majorly attributed to educational initiatives in various healthcare domains including nursing. This has helped in eradication of culturally unsafe clinical principles for treatment of indigenous people. It has encouraged the engagement of patient and nurse and led to enhancement in trust and willingness among aboriginals to opt for professional healthcare. Crampton et al., (2003) suggested a cultural immersion education program for healthcare trainees and highlighted its effect in combatting racism and acceptance of nurses towards culturally safe practices. Conforming and acceptance would also pave way for fair employment and organisational policies and better representation of aboriginals in the nursing workforce. Trained and certified aboriginal nurses are essential for dealing with linguistic barrier which leads to miscommunication between the nurse and patient, especially in busy clinical environment (Kelly et al., 2018).
It was interesting to note the fine line between cultural safety and cultural competence that are complementary in practice despite being contrasting in definition. With respect to nursing, the two parameters create a balance in the power relationships of the care provider and recipient. I have imbibed that as a registered nurse, cultural safety is not just guided by understanding of the indigenous culture but also being aware of one’s own culture. It is instrumental to developing a higher cultural intelligence to read, interpret and respond to different nursing scenarios when dealing with a patient from a different cultural identity.
References
Bourke, C. J., Marrie, H., & Marrie, A. (2018). Transforming institutional racism at an Australian hospital. Australian Health Review
Brascoupé, S., & Waters, C. (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), 6-41.
Brigham, J. C. (1993). College students’ racial attitudes. Journal of Applied Social Psychology, 23, 1933-1967.
Crampton, P., Dowell, A., Parkin, C., & Thompson, C. (2003). Combating effects of racism through a cultural immersion medical education program. Academic Medicine, 78(6), 595-598.
Durie, M. (2001, November). Cultural competence and medical practice in New Zealand. In Australian and New Zealand Boards and Council Conference(Vol. 22).
Henry, B. R., Houston, S., & Mooney, G. H. (2004). Institutional racism in Australian healthcare: a plea for decency. Medical Journal of Australia, 180(10), 517.
Johnstone, M. J., & Kanitsaki, O. (2007). Health care provider and consumer understandings of cultural safety and cultural competency in health care: An Australian study(Doctoral dissertation, RMIT University).
Jones, J. M. (1997). Prejudice and racism. McGraw-Hill Humanities, Social Sciences & World Languages.
Kelly, J., Dowling, A., McBride, K., Keech, W., & Brown, A. (2018). ‘We get so task orientated at times that we forget the people’: staff communication experiences when caring for Aboriginal cardiac patients. Australian Health Review.
Merritt, F., Savard, J., Craig, P., & Smith, A. (2018). The” enhancing tertiary tutor’s cultural safety” study: Aboriginal and Torres Strait Islander cultural training for tutors of medical students. Focus on Health Professional Education (2204-7662), 19(3).
Nielsen, A. M., Alice Stuart, L., & Gorman, D. (2014). Confronting the cultural challenge of the whiteness of nursing: Aboriginal registered nurses’ perspectives. Contemporary nurse, 48(2), 190-196.
Stuart, L., & Nielsen, A. M. (2011). Two Aboriginal registered nurses show us why black nurses caring for black patients is good medicine. Contemporary Nurse, 37(1), 96-101.
Vukic, A., Jesty, C., Mathews, S. V., & Etowa, J. (2012). Understanding race and racism in nursing: insights from aboriginal nurses. ISRN nursing, 2012.
Williamson, M., & Harrison, L. (2010). Providing culturally appropriate care: a literature review. International journal of nursing studies, 47(6), 761-769.
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