Understanding Personal And Institutional Racism: Impacts On Indigenous Australians And Importance Of Culturally Safe Nursing Practice

Personal and Institutional Racism

Personal racism is a concept that involves experience of discrimination or stereotyping based on racial differences and differences in values and behaviour of a person as per racial and cultural different.  In contrast, institutional or systematic racism is a form of racism expressed by political or social institution resulting in disparities in the area of housing, income, employment, justice, wealth and health care. Hence, personal racism is a type of discrimination linked to values, attitudes, feelings and opinion and institutional racism is linked to discrimination occurring due to policies, procedures, systems and practices (Payne, Vuletich & Lundberg, 2017). One example can also clear define the difference between personal racism and institutional racism. For example, if a person is not allowed to enter a hotel because of his race, it is a type of personal racism situation. In contrast, if a company restricts hiring people from a specific racial group, it is an example of institutional racism.

Many people are discriminated based on their colour. Whiteness is a concept related to those groups of individuals who enjoy certain privileges in society because of their power dynamics. It is a cultural norm where certain groups are positioned at the top of the cultural-racial hierarchy not because of biological category but because of white as a social construction. These groups of people enjoy rights, benefits and advantages beyond those enjoyed by other individuals in the society (Molloy, 2017). Hence, the imbalance of power and inequity is the main factor that defines the white group and the impact of power facilitates domination of the white group in society. The superiority of the whites over non-white ethnic groups informs institutional culture and practices too.

The whiteness concept relate to contemporary nursing practice in Australia too because white group enjoy many privileges within health care service and inequities exists in relation to health access and availability of care for the disadvantaged groups like the indigenous Australians. Durey and Thompson (2012) give the evidence regarding the effect of white Anglo-Australian cultural dominance in health service delivery to indigenous Australian. Many nurse are only involved in discriminating the indigenous people because they have negative attitude towards indigenous people and the indigenous beliefs are subjugated to the dominant western biomedical model in Australian health care system.

Cultural competence is defined as the set of skills, values and behaviours needed to meet social, cultural and linguistic needs of different client group. On the other hand, cultural safety is a list of expected behaviour that ensures respect for culturally and socially diverse client group in health services (Holland, 2017). Hence, cultural safety is a competence that can come under the provision of cultural competence. Cultural safety exemplifies both cultural awareness and cultural sensitivity. However, the difference between the two concepts is that cultural safety is term mainly focussed on the causes of inequality whereas cultural competence is a term that determines the way in which individual skills and behaviour influence service provision and addresses the negative impact of colonial history for disadvantaged group.

Understanding Whiteness in Contemporary Nursing Practice in Australia

Cultural safety is often targeted during cultural competence training as it increases staff’s understanding regarding the need to respect differences and understand the limitations of cultural competence. It helps to identify the power differences that exist in health service delivery and appropriately respond to such inequities through structured education. The lens of cultural safety supports health care staffs to consider impact of racism and prejudice and challenge unusual power relations (Repo et al., 2017).

Report: One of the week 1-5 readings that grabbed my attention includes the 10 year review of the Close the Gap Strategy by Close the Gap Campaign Steering Committee (2018) because it gave me idea regarding the actions that Australian government has taken so far to meet the goals of the Close the Gap strategy.

Respond:  I am overwhelmed by the reading as it developed my understanding that despite great investment by Australian government, they are still not able to meet complex health needs of Aboriginal and Torres Strait Islander peoples.

Relate: My personal understanding was that government investment in different areas of health care would resolve poor outcomes of indigenous people. However, after reading the 10 year review, I developed the idea that critical thinking is needed to ensure that investment is made in the right areas for promotion of indigenous health.

Reasoning: I got to learn that focussing on holistic factors of well-being such as addressing the social determinants of health is vital for indigenous people because proper housing, employment and health infrastructure also influence the engagement of indigenous people with the health care system (Gee et al., 2014).

Reconstructing: With this knowledge, I have gained knowledge regarding the importance of cultural sensitivity to prepare appropriate well-being plan for disadvantaged group. I plan to develop my cultural competence so that I can address disadvantage and promote equality for the indigenous people. 

Institutional racism has significantly influenced the lives of indigenous people in Australia. Throughout the Australian history, the indigenous group has suffered from disadvantage because of dominance of white and the existence of institutional racism. Government policies and laws also favoured the white groups like Europeans and increased sufferings and disadvantages for the indigenous people. This was the reason for loss of their lands, forced migration and economic distress due to poor employment and education opportunities. One of the historical events that significantly influenced the lives of indigenous people included the European settlement. As English explorer Captain James Cook claimed eastern portion of the Australian continent, this resulted in dispossession of land, death and accelerate sufferings for the indigenous community. As they had to migrate to new land, they failed to get appropriate employment and provide basic education to their children (Snyder & Wilson, 2015). The event of European settlement is linked to white privilege as the European used their power to eliminate the black races. The protection policy further promoted institutional racism for indigenous group and results in discrimination in relation to education and employment. Due to these historical experiences, the children of indigenous Australians are known as stolen generation as they were placed in foster care and did not get basic amenities for good living (Biddle, Khoo & Taylor, 2015). In the area of education, one example of institutional racism includes poor attendance of indigenous children in schools because of lack of recognition of indigenous culture and history in school, poor engagement of parents in education and presence of disadvantage in many areas of life for indigenous Australians (Purdie & Buckley, 2010).

Cultural Competence and Cultural Safety: Importance in Nursing Practice

Institutional racism is a major cause behind poor access to health care and disparities in health outcomes for indigenous Australians too. Health care system has not adapted culturally appropriate policies to ensure that language and cultural support related issues are addressed. Cultural barriers like language gap, poor cultural sensitivity among health care staffs and differences in health beliefs and interpretation about health between indigenous people and health care staffs has resulted in poor access to mainstream health care facilities and lack of motivation to visit health care service (Li, 2017). Durey et al. (2016) gives the evidence that many indigenous Australians lack the motivation to visit health care service and seek treatment because they experience discrimination by health care staffs. Their religious beliefs and courtesy were not respected by staffs and they had different opinions about the utility of treatment for them. This justifies why indigenous Australians have poor health outcome and mortality rate compared to non-indigenous group. The poor experience of indigenous people in health care is also related to the concept of white privilege because health care system in Australia is dominated by the white group and it lacks indigenous health care staffs who understand cultural needs of Aboriginal group in care. Health services lack commitment to develop effective partnership with local aboriginal communities and provide responsive care to the indigenous people. 

Culturally safe nursing practice involves delivery of care that respects cultural needs of indigenous people and reduces risk of non-compliance to treatment because of violation of cultural beliefs of indigenous people. Cultural safe practice can address personal and institutional racism because this form of practice enables nurse to deliver care by considering the cultural values, behaviour and background of people (Richardson, Yarwood & Richardson, 2017). Hence, it reduces poor access to care or poor experience in care because of increase in knowledge regarding cultural preferences of indigenous group. It enables tailoring service delivery according to the needs and preferences of specific communities (Bainbridge et al., 2015). Hence, culturally safe nursing practices involve utilization of the cultural competence skills and cultural safety knowledge while delivering care. This ensures that Indigenous people do not feel disrespected or violated while coming in contact with nurses and they become satisfied with the care received.

There are many evidences regarding achievement of positive health outcomes for indigenous people by means of culturally safe practice. For example, cultural sensitive training has helped nurse to improve participation in health care for Indigenous Australians and increased their satisfaction with care. Butler et al. (2016) reports that culturally safe practice improves outcome and quality of care, makes the care delivery more efficient and effectives, increases patient’s satisfaction with care and reduces cost associated with care.

Impacts of Institutional Racism on Indigenous Australians

Report: During my past week learning activity, I got the opportunity to complete activities on cultural competences and its role in influencing health outcome for indigenous Australians. By engaging in the activity and reviewing several readings related to the task, I have understood that nurse’s cultural competence and knowledge plays a vital role in addressing diverse health needs of Aboriginal and Torres Strait Islander people and reducing disparities in their health outcome.

Respond: By completing the class activity, I got to learn that indigenous people suffer from poor health experience because of personal and institutional racism. The review of cause behind disparities in health outcome of indigenous and non-indigenous population group in Australia revealed that poor experiences in care, poor cultural sensitivity of nursing staffs and lack of respect for their cultural needs is a barrier for them in seeking care (Durey & Thompson, 2012). I am overwhelmed by the manner in which the white privilege and institutional racism has affected health and well-being for the group. However, I also feel delighted to learn that there is scope for nurse to improve the situation of indigenous people by engaging in culturally safe practice. By this activity, I realize the importance of cultural competency skills of nurse in addressing discrimination and barrier to health care access for patient.

Relate: Before completing this activity, my personal understanding was that indigenous people are themselves responsible for poor health outcome. However, by completing the activity, I got the knowledge that several systemic barriers and lack of process for equal access to health and education has increased risk of chronic disease and health related disadvantage for patient. Irrespective of systematic disadvantage and injustice for the group, cultural competence training and engagement of nurse in culturally safe care is a solution to poor health for the group (Butler et al., 2016).

Reason: I regard the role of nurse as vital in promoting health and well-being for indigenous people after reviewing evidence regarding how culturally safe care improved health outcomes for the group. For example, Govere and Govere (2016) revealed cultural competence training is an effective intervention that empowers nurses and other health care providers in providing culturally competent care. Delivery of this form of care was significantly associated with increase in patient satisfaction. Hence, nurse can remove disadvantage and change attitude or beliefs of indigenous group towards health service by being sensitive to the cultural needs, respecting their cultural preferences during care and working to address response while delivery care. Hence, as I aspire to become a nurse, I would use my experience in this activity to take training on cultural competence so that I can reduce discrimination in related to health access for the group.

While reflecting on the key lessons learnt, I can say that cultural difference between service care provider and indigenous Australian is major issue within the health care system. I have learnt that by providing culturally safe nursing practice, nurse can consider power relation, cultural difference, rights of patient and reflect on their own attitude to improve service provision (Alizadeh & Chavan, 2016). I aim to use the framework of cultural competence to efficiently deliver care and respect diversities of the Aboriginal and Torres Strait Islander community. 

References:

Alizadeh, S., & Chavan, M. (2016). Cultural competence dimensions and outcomes: a systematic review of the literature. Health & social care in the community, 24(6), e117-e130.

Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015). Cultural competency in the delivery of health services for Indigenous people. Retrieved from: https://www.aihw.gov.au/getmedia/4f8276f5-e467-442e-a9ef-80b8c010c690/ctgc-ip13.pdf.aspx?inline=true

Biddle, N., Khoo, S. E., & Taylor, J. (2015). Indigenous Australia, white Australia, multicultural Australia: the demography of race and ethnicity in Australia. In The international handbook of the demography of race and ethnicity (pp. 599-622). Springer, Dordrecht.

Butler, M., McCreedy, E., Schwer, N., Burgess, D., Call, K., Przedworski, J., … & Kane, R. L. (2016). Improving cultural competence to reduce health disparities.

Close the Gap Campaign Steering Committee. (2018). A ten-year review: the Closing the Gap Strategy and Recommendations for Reset. Retrieved from: https://www.humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/publications/close-gap-10-year-review

Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians: time to change focus. BMC health services research, 12(1), 151.

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D. (2016). Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC health services research, 16(1), 224.

Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, 2, 55-68.

Govere, L., & Govere, E. M. (2016). How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews on Evidence?Based Nursing, 13(6), 402-410.

Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text. Routledge.

Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210.

Molloy, L. (2017). Nursing care and indigenous Australians: An autoethnography. Collegian, 24(5), 487-490.

Payne, B. K., Vuletich, H. A., & Lundberg, K. B. (2017). The bias of crowds: How implicit bias bridges personal and systemic prejudice. Psychological Inquiry, 28(4), 233-248.

Purdie, N., & Buckley, S. (2010). School attendance and retention of Indigenous Australian students. Retrieved from:  https://research.acer.edu.au/cgi/viewcontent.cgi?article=1045&context=indigenous_education

Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2017). The cultural competence of graduating nursing students. Journal of transcultural nursing, 28(1), 98-107.

Richardson, A., Yarwood, J., & Richardson, S. (2017). Expressions of cultural safety in public health nursing practice. Nursing inquiry, 24(1), e12171.

Snyder, M., & Wilson, K. (2015). “Too much moving… there’s always a reason”: Understanding urban Aboriginal peoples’ experiences of mobility and its impact on holistic health. Health & place, 34, 181-189.