5 principles of cultural safety

You people talk about legal safety, ethical safety, safety in clinical practice and a safe knowledge base, but what about Cultural Safety?

(Ramsden, 2002, p. 1)

............................................................................................. Learning objectives This chapter will help you to understand and examine: • Your own beliefs, values and attitudes, and the influence these may have on your

work with Aboriginal and Torres Strait Islander Australians • The effects of Australian colonial nursing history on Aboriginal and Torres Strait

Islander people • Nursing practice that respects the differences of clients • The power that nursing practice can have on Aboriginal and Torres Strait Islander

people • The journey from cultural awareness to cultural safety.

............................................................................................. Key words beliefs, values and attitudes colonisation cultural safety decolonisation whiteness of nursing

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cultural safety

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Introduction This chapter explores the framework of cultural safety within nursing and midwifery practice. It discusses cultural safety from the perspectives of both nurses and clients,

with a particular focus on how cultural safety is relevant for Aboriginal and Torres Strait Islander people.

an approach to nursing practice developed in New Zealand that recognises the importance of cultural understanding and seeks to practise

The chapter begins by outlining the development of cultural safety theory by Maori registered nurse Irihapeti Ramsden. Cultural safety is placed within its historical context and is defined as a journey that involves cultural awareness- of your own culture and the culture of others.

in a way that provides a culturally safe service

colonisation

Nursing and midwifery students are encouraged to consider the potential influence of culture on their nursing and midwifery practice, and to ask questions about the 'whiteness' of the nursing profession. This chapter uses an historical approach to explore the 'whiteness' of nursing, the establishment of nursing in Australia, and its effects on Aboriginal and Torres Strait Islander peoples.

Understanding cultural safety involves considering the different ways in which cultures define health. Within Australia, the biomedical model of health dominates; however, this is a relatively new model and is not the only definition available. This chapter provides an Indigenous definition of health, and compares it with the World Health Organization's (WHO) definition.

The cultural safety journey involves moving from cultural awareness to cultural safety. This chapter explores how to cultivate cultural safety and embed it within nursing practice. The chapter concludes with five principles of cultural safety that are fundamental to nursing and midwifery practice with Aboriginal and Torres Strait Islander peoples.

Developing the theory of cultural safety Maori nurse Irihapeti Ramsden developed the nursing framework of cultural safety. In her doctoral thesis she stated 'that the dream of Cultural Safety was about helping people in nursing education, teachers and students, to become aware of their social conditioning and how it has affected them and therefore their practice' (Ramsden, 2002 , p. 2). She argued that the framework for cultural safety is designed to demystify colonial history

and prevent its effect on widespread attitudes and beliefs about indigenous peoples.

the process of taking over land for Ramsden's work in cultural safety emerged from her own journey as a Maori student nurse and nursing graduate, the colonisers' use and establishing control over the indigenous people.

Colonisation typically involves taking political control of a country, occupying it with settlers and exploiting the country's resources.

and her response to the educational process, which 'was so obviously designed for student nurses who did not , and could not share the experience of the colonisation of my land and people and history' (Ramsden, 2002. p. 2).

Chapter 3 The cultural safety journey

For Ramsden, cultural safety starts with an understanding of culture, which she defined as:

The accumulated socially acquired result of shared geography, time, ideas and human experience. Culture may or may not involve kinship, but meanings and understandings are collectively held by group members. Culture is dynamic and mobile and changes according to time, individuals and groups. (Ramsden, 2002, p. lll)

It is important to note that the concept of cultural safety does not anchor culture to ethnicity. Instead, culture is expanded to incorporate many components that can make up an individual's culture. While ethnicity can often be an important aspect of culture, it is not a sufficient definition (and may not always be the most important component).

This definition of culture also accepts that individuals may belong to multiple cultures at any one time. For example, within Australia's Aboriginal and Torres Strait Islander communities, culture can be determined by many markers in addition to physical appearance or ethnicity, such as the link to Country, or by our profession, spirituality or sexuality. ln this sense, Aboriginal and Torres Strait Islander Australians are no different from other Australians.

Ramsden noticed that her experiences as a Maori nurse and the experiences of paheha (white) nurses were in stark contrast. She found that her paheha nursing peers had little understanding of the brutal colonial and racist history of New Zealand.

The omission of the colonial history of New Zealand in the basic state education system had led to a serious deficit in the knowledge of citizens as to the cause and effect outcomes of colonialism. Without a sound knowledge base it seemed to me that those citizens who became nurses and midwives had little information of substance on which to build their practice among this seriously at risk group. (Ramsden, 2002, p. 3)

As a newly graduated nurse, Ramsden was constantly expected to look after only Maori clients and their families . She reported that, at times, she would watch inappropriate care being given to Maori patients and recognise the distress of these clients. She would add to her own client load by helping or explaining things to the client that the paheha nurse had instructed them to do. One outcome of this extra work was that Maori patients would ask to be looked after by Ramsden; the paheha nurses would shrug their shoulders, look at Ramsden and walk away (Ramsden, 2002). She explained that 'this meant dealing with such social mechanisms as personal and institutional racism in the context of a violent colonial history and coming to terms with the inherent power relations, both historical and contemporary' (Ramsden, 2002 , p. 3). The experience described by Ramsden is common among Aboriginal and Torres Strait Islander nurses in Australia (Best & Nielsen, 2005; Nielsen, 2010).

Ramsden questioned the outcomes of inappropriate nursing care for Maori. clients:

Consciously or unconsciously such power reinforced by unsafe , prejudicial demeaning attitudes and wielded inappropriately by health workers, could cause people to distrust and avoid the health services. Nurses need to understand this process and become very

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.,. Yatdjuligin CULTURAL SAFETY is an outcome ,. of nursing and midwifery education that enables safe service to be defined by those who receive the service.

CULTURAL SENSITIVITY alerts students to the legitimacy ,. of difference and begins a process of self-exploration as the powerful bearers of their own life experience and realities and the effect this may have on others.