According to the nursing council of New Zealand, cultural safety can be described as the way of working with people of different backgrounds without showing signs of demeaning them, diminishing them or disempowering them (Wepa, 2015). It focusses on the art of people appreciating the cultures of other people and being in a position to work with them in a way that can be deemed as respectful and acceptable. Diversity is always a major outstanding and prominent feature of the Australian population. In the different interactions that happen, individuals are expected to demonstrate a clear understanding of this concept in the course of discharging their duties. Healthcare provision is one of the areas where this concept is very applicable. Nurses interact with different individual in their practice. Owing to the difference in culture, this concept is of importance in dealing with the Aboriginal Torres strait Islanders (Laverty, McDermott & Calma, 2017). This has been a major area of attention in the healthcare sector in Australia. This paper focusses on principles of cultural safety in the healthcare setting and the nursing guidelines and ethical decision making in relation to cultural safety.
The first principle is on reflection of one’s own practice. This focusses on meditation on one’s own behavior and actions. It involves taking a step back and reviewing one’s own beliefs and practices. It’s a conscious way of making themselves aware of how their beliefs and practices impact on other people (Holland, 2017). In practice this principle will enable the nurses have a critical thought of the way their practices will affect other coworkers and patients. It is an audit of the effects of one’s culture on others. Reflection can be achieved through obtaining a feedback from the peers, colleagues and clients or from a conscious self-initiative process.
The second principle involves minimizing the power differentials between yourself and the clients. It suggests for development of a method of reducing the differences between the two culture in question. it’s a way of reducing the rift and striking an acceptable compromise. In practice, this process will involve the reviewing of the difference and negotiating for an acceptable way of practice that is acceptable to all parties involved (Pauly, McCall, Browne, Parker & Mollison, 2015). It makes all parties feel part of the decision-making process and takes away the feeling of alienation. Caution is always taken to ensure that the consideration does not compromise the benefits of the practice in question.
The third principle requires one to engage in a conversation with the client. Communication is an active process involving talking and listening. It facilitates the passing of information between individuals. This is the way to learn about other peoples’ culture and to share with them about your own (Giger, 2016). Emphasis is made on one having proper communication skills to make the whole process fruitful and beneficial to their practice. A nursing the care plan can be influenced by culture of a client. They are often customized to meet the medical needs of the patient without conflicting with their culture. This makes the involved parties feel acknowledged. It smoothens the interaction of those involved.
The fourth principle involves undertaking a process of decolonization. It’s a fact that colonization had far reaching consequences on the indigenous communities; which has perpetuated among the generations. Putting this into perspective, one should address this by ensuring they do not perpetuate the same negative feelings (Fleming, Creedy & West, 2018). Learning the histories of communities and families puts one in a position to deal with the people’s fears and concerns. Learning about the failure of the system in promoting cultural safety sets a platform for correcting the wrong.
The fifth principle states that one should treat people regardless of their cultural or individual difference. In the course of practice, partiality should not be detected when dealing with people of diverse cultures. High levels of professionalism are demonstrated when one can work comfortable with others without being bothered of the existing differences. All the five principles provide the framework to promote cultural safety.
The first nursing guideline is recognizing that one provides care that is free from discrimination on the basis of race and culture. An Aboriginal person has the right to access healthcare without discrimination on basis of their culture. He/she should feel safe in the healthcare domain. The nurse acts as the advocate for the Aboriginal person and seeks to access a culturally safe environment for the Aboriginal person by understanding and respecting the Aboriginal culture. The Aboriginal people have undergone unfair treatment after colonization which affects their health up to date; the nurse acts as an advocate for better treatment and access to services for the Aboriginal with due consideration of their culture. It should be customized to their culture rather than imposed on them.
According to Australian Nursing and Midwifery Council(2014), the nurse should recognize that promoting a culturally safe environment for the aboriginal person includes allowing the family to be involved in their care. The nurse understands that he/she can’t make solo decisions and there is a need to consult the family of the patient. The nurse should be cultural aware of the Aboriginal person and their culture and differentiate their own beliefs from those of others. The nurse recognizes the need to respect the Aboriginal person’s culture and involves informed consent while performing nursing care. Informed consent involves granting the patient the right to choose or refute before a particular nursing procedure. Their culture is a major consideration in making such decisions. allowing them to make a free decision free of coercion will ensure cultural safety.
The nurse involves open and nonjudgmental communication while interacting with the client (O’hagan et.al 2014). He/she is willing to listen to the concerns of the Aboriginal person. The communication respects the cultural boundaries of the Aboriginal person. When there is a disagreement or prejudice against the Aboriginal person the nursing care is less efficient. The nurse should go a step ahead to find an interpreter when the Aboriginal person is not conversant with English to ensure that their needs are met. Difference in language should not hinder provision of care. Language is an important aspect of any culture and should be respected.
The nurse is aware of the factors that affect the health of the Aboriginal person including discrimination, poor availability of water, substance abuse and violence during colonization (Wepa,2015). These factors help the nurse in assessing and planning care regarding certain aspects of the Aboriginal person. Some of these include mental health and screening for chronic illnesses. The nurse links the Aboriginal person to a counselor and the nutritionist after assessing and noting some of these challenges that affect the Aboriginal person.
The nurse is the change agent by promoting and supporting the security of the Aboriginal person (Horvat, Horey, Romios & Kis?Rigo, 2014). This includes reporting cases of discrimination and championing for the rights of the Aboriginal person. The nurse is aware of the challenges that the Aboriginal people face such as discrimination and racism and hence ensure that the hospital is a safe haven for the Aboriginal patient.
The nurse empowers the Aboriginal person (Crawford, Roger & Candlin,2017). This involves providing nursing education and health education regarding the various conditions that he/she is likely to be predisposed to. The nurse is a health educator and is aware of culturally sensitive areas that he/she should avoid mentioning. The nurse also networks with various organizations who can provide for the health matters of the Aboriginal patient.
The nurse provides emotional support and listening ear for the Aboriginal person in terms of hearing their plight regarding the challenges that may have contributed to the health problem. This creates trust between the two parties and the nurse is awre of other probable socioeconomic conditions the Aboriginal patient is going through. The nurse may need to liaise with the social workers.
Importance Of Ethical Decisionmaking Within Culturally Safe Nursing Care
Ethical decision making encompasses decisions have least of harm to the patient and those that are in the best interest of the patient. Principles of autonomy, justice, beneficence, and non-maleficence ensure that decisions made in the healthcare are patient-centered(Johnstone,2015). Ethical decision making is important in culturally safe nursing care as it ensures that the care of the patient is prioritized within their cultural beliefs. Any decision that may undermine the culture of a patient is not considered. Ethical decision-making involves helping the client choose what is best by informing of the available choices. The client knows what is regarded right according to their culture and is best able to make the decision that respects his beliefs.
Ethical decisionmaking ensures that what is done in regards to the care of the patient is done in terms of fairness in regards to their culture. A nurse who makes decisions that adhere to the principle of justice ensures that the decision made is fair and culturally safe for the patient. This is especially important in dilemmas which pose uncertainty regarding the care of the patient but with cultural awareness, the nurse makes competent decisions.
Conclusion
This paper has summarized the importance of providing culturally safe nursing in regards to the Aboriginal person. The principles of cultural safety include improving the health outcomes of the Aboriginal people by ensuring access to healthcare. Reducing bias and discrimination in the healthcare provision by learning one own’s culture and differentiating it from that of the Aboriginal people. Another principle is respecting the culture of Aboriginal people. This principle has been linked to the nursing practice where nurses are expected to ensure a culturally safe environment for the Aboriginal person.
Furthermore, the nurses have guidelines they are expected to follow to ensure that the cultural safety while caring for the Aboriginal person. The paper goes into detail to explain the essence of making ethical decisions to promote a culturally safe environment. Finally, it is important for the nurse to ensure they enhance diversity, respect other’s culture and maintain neutrality while providing primary care for the patients.
References
Crawford, T., Roger, P., & Candlin, S. (2017). The interactional consequences of ‘empowering discourse’in intercultural patient education. Patient education and counseling, 100(3), 495-500.
Fleming, T., Creedy, D. K., & West, R. (2018). Evaluating awareness of Cultural Safety in the Australian midwifery workforce: A snapshot. Women and Birth.
Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.
Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text. Routledge.
Horvat, L., Horey, D., Romios, P., & Kis?Rigo, J. (2014). Cultural competence education for health professionals. Cochrane database of systematic reviews, (5).
Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.
Laverty, M., McDermott, D. R., & Calma, T. (2017). Embedding cultural safety in Australia’s main health care standards. The Medical journal of Australia, 207(1), 15-16.
Nursing, A., & Council, M. (2014). Codes of Professional Conduct & Ethics for Nurses & Midwives, 2008. Australian Nursing and Midwifery Council.
O’hagan, S., Manias, E., Elder, C., Pill, J., Woodward?Kron, R., McNamara, T., … & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), 1344-1355.
Pauly, B. B., McCall, J., Browne, A. J., Parker, J., & Mollison, A. (2015). Toward cultural safety. Advances in Nursing Science, 38(2), 121-135.
Wepa, D. (Ed.). (2015). Cultural safety in Aotearoa New Zealand. Cambridge University Press.
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