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What is cultural safety?

What does it mean to provide culturally safe care? Hear from Professor Gregory Phillips in this video as he explains what cultural safety means.

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So let’s have a look at what cultural safety actually means. The term comes from New Zealand, where Maori nurses first started saying, let’s have a look at improving Maori people’s health. And they came up with this hierarchy of learning, where they’re saying cultural awareness is the most basic, where you’re just learning about the other. You’re learning about difference. Cultural sensitivity is then having learning to have some sensitivity based on that knowledge of the other. But cultural safety is where the individual actually starts to change their practice and take the lens off and understand their role in the interaction. But it’s also not just about the individual, it’s also about the institution and the environment that they’re working in.

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It’s the values and beliefs that this institution operates on. What are the policies? Who makes the decisions? How do things get done? So you have to do both. A better model is this. Aboriginal health is where Aboriginal leaders do the business. They decide what the priorities are, what the strategies are, how it should be deployed, how it should be evaluated, right? That’s the business of Aboriginal health. Cultural safety really is a euphemism for racism, or for a system that doesn’t know what it doesn’t know. So really, we need the HR department to be responsible for this, not the Aboriginal workers.

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What happened in New Zealand is the Maori nurses said we want to create cultural safety, this term, and we want to make culturally safe hospitals. And that was good, and after about 10 years, cultural safety was written into the National Public Health legislation. So it was very strong. But after a few more years after that, there started to be push-back. And the mainstream system said, why do we have to do Maori health? Why is that special? We’ve got Pacific Islanders here, we’ve got a large Asian immigrant population. We’ve got lots of other people living here. Why are Maori so special? So Maori were forced to explain that Maori health is Maori health.

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And cultural safety, yes, you should be culturally safe for all groups. But it’s no longer a fair division of labour for Maori people to be responsible for both. Let me give you a parallel example. When the AFL first realised it had a problem with sexual violence against women, their response to that was to employ one woman. And that one woman’s job was to not only increase women’s participation in the sport– girls and women playing, women on boards, coaches, referees, et cetera. But for her to do that job well, she actually had to uneducate– or educate all of the blokes out of their blokeyness. Because the blokes didn’t know they had a culture.

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They didn’t know they had a blokey culture, they just thought it was normal. What’s wrong with you women? Why are you so weak? Why can’t you follow our rules? Why aren’t you participating in equal numbers? It’s your fault. Do you see? The locus of responsibility was placed on the minority to not only increase the minority’s participation, but to do that well, educate the majority about what they don’t know they’ve got. So in this case, what we need is Aboriginal health people to be able to freely lead Aboriginal health programmes without the burden of having to educate the 97%. That’s why we burn out. We burn out because we’re trying to do both.

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Those Aboriginal Health Workers in a hospital burn out because they’re lumped with not only delivering good health care for Aboriginal patients and trying to make sure they get through the system well, but to do that job well, they’re lumped with educating the 97% about how not to be inadvertently racist or inadvertently ignorant or unconsciously biased, whichever term you prefer. We can’t think that Aboriginal health is simply fitting us into a normal mainstream system as if nothing about the system has to change. It’s the system, people. It’s not us, all right? It’s the way that we think and conceive of health, the way that we plan health, the way that we measure, the way that we evaluate. That’s the problem.

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Just like those blokes– their culture was the problem in the AFL, not women’s participation or their values or beliefs. So in summary, what we’re doing in Australia is very low level. We’re doing cultural awareness, culturally appropriateness, competence, reflexivity, 20 million terms. They’re all important. But what they’re all doing is dealing with individual competencies, knowledge, skills, and attitudes. And that is important, but that’s only one half of the picture. The other half is what these terms refer to. Safety, respect, security are usually used interchangeably. And it refers to the individual and the institutional capacity.

What does it mean to provide culturally safe care? In this video Professor Gregory Phillips discusses cultural safety in the context of providing health care for Australia’s First Peoples.

In health, we focus on clinical, legal and ethical safety, however cultural safety is just as important and often deeply lacking. Let’s review some of the important terms referred to in the video and explore their definitions.

Cultural Awareness

Cultural awareness allows us to recognise we are each shaped by our individual cultural backgrounds. This influences how we interpret the world around us, perceive ourselves and how we relate to other people (Durey, Thompson & Wood, 2011).

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Cultural Sensitivity

Having cultural sensitivity means we can understand, and therefore be sensitive towards, individual differences, uniqueness and diversity. This begins to develop when we become aware of the influences of our own culture and acknowledge that we have biases. This can be an eye-opening experience, often taking courage and humility. With cultural awareness and sensitivity comes a responsibility to act safely and respectfully around others.

Cultural Safety

This is defined as the way in which respect for culture is established within an organisation, such as your health service. It is about overcoming the cultural power imbalances of places, people and policies to contribute to improvements in Aboriginal and Torres Strait Islander health (AIDA, 2017). The goal of cultural safety is for all people to feel respected and safe when they interact with the health care system.

What most people know about Australia’s First Peoples mostly originates through mass media that perpetuates negative stereotypes. Nairn et al (2014) discuss the implications that these media practices have for cultural safety in nursing practice. Look out for the PDF download at the bottom of this page to learn more.

What does it mean to have ‘cultural respect’?

For First Peoples, cultural respect centres on the ‘recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander people (Australian Government, 2017).’

Developing cultural respect for First Peoples, requires you to:

recognise the impact that colonisation has on the contemporary health status of Aboriginal and Torres Strait Islander people
recognise, affirm and protect Aboriginal and Torres Strait Islander peoples’ ways of knowing, doing and being, through a commitment to ongoing learning in your health care practice
advance the rights, cultures and traditions of Aboriginal and Torres Strait Islander peoples as set out in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP).

Your task

Join the discussion and share your thoughts on the importance of culturally safe healthcare with each other. In what specific ways do you show cultural respect to First Peoples in your clinical practice? You may wish to review AIDA’s website to access practical resources, such as the Factsheet and Cultural Safety Toolkit.

References

AIDA. (2017). Australian Indigenous Doctor’s Association. Cultural Safety Fact Sheet.

Australian Government. (2017). Department of Health. Cultural Respect Framework 2016-2026.

Durey, A., Thompson, S.C. & Wood, M. (2011). Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutionalised racism and misunderstandings in communication. Internal Medicine Journal, vol. 42, no. 1, pp. 17-22.

Nairn, R., DeSouza, R., Moewaka, A., Barnes, Rankine, J., Borell, B., and McCreanor, T. (2014). Nursing in media-saturated societies: implications for cultural safety in nursing practice in Aotearoa New Zealand. Journal of Research in Nursing September 19: 477-487.

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This content is taken from Griffith University online course

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