Cultural Safety

Cultural Safety (Aboriginal and Torres Strait Islander Peoples’ Well‐Being)

Step 1

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Personal Racism vs. Systemic/Institutional Racism

As the name implies, personal racism is perpetrated at the individual level. It is based on the personal belief that race should take an important place when making decisions affecting individuals or a community. The racism can either be overt or covert, the former suggesting a form, which is carried out openly, while the latter suggests the more hidden forms which are difficult to identify. A good example of personal racism is the microaggressions that are perpetrated by the members of the privileged class against the Aboriginals and Torres Strait Islanders in Australia.

Systemic/institutional racism goes beyond the person to organisations or institutions, which have instituted a system of racism in their decision-making. Where this form of discrimination occurs, there are laws, norms, and regulations which are discriminatory. In this case, the in-group is a part of the institutions, which are racist against the out-groups. In society, it is possible to have systems that are founded on racism (Eckermann et al., 2010). For example, when a health care facility has a history of discriminating against the Aboriginals and Torres Strait Islanders, this is a clear example of systematic racism. There are various other systems, including education and law enforcement, which have been blamed for perpetrating this form of racism.

The Power Dynamics Associated with the Whiteness of Nursing

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Whiteness has historically suggested a form of power against those who are different. In Australia, the concept has played a critical role in how the Aboriginal and Torres Strait Islander peoples are treated within the healthcare system (Best, 2018). Whiteness has been used as a source of power and a tool for discriminating against the people of colour. It has been the basis for denial of effective and quality health care for the target community (Nielsen, Stuart & Gorman, 2014). The problem is intensified when the most important part of the care providers, the nurses, are the perpetrators of racism using the power provided by the colour of their skin.

Cultural Safety vs. Cultural Awareness Training

While the two concepts may have different meanings, they suggest a journey towards the provision of better health care to the conventionally marginalised individuals. The concept of cultural safety is positioned within the same historical background. It includes cultural awareness and its impact on the competence of the provider and safety outcomes of the recipient of care. Cultural awareness training is a process, while cultural safety is an outcome. When receiving the training, the health care provider, such as the nurse, is being equipped with the knowledge of one’s culture and the others, particularly the recipients of health care. The knowledge plays a role in providing care because the cultural differences are no longer barriers to quality outcome (Best, 2018). The culture of the provider and that of the recipient have a critical influence in the continuum of care. However, when the nurse has received the training, it becomes possible to recognise the possible barriers and prevent them before they impact negatively on the care process. Cultural safety emerges when the care provider has the necessary competence to operate in an environment of cultural diversity and still provide quality care. It includes the understanding of how the historical context could impact on the possibility of providing the right care.

Step 2

Report and Response

I have been attending lectures, doing individual and group activities and reading about the concept of racism. One of the things that are different from what I expected was the concept of microaggressions. Before taking the course, I would have assumed that the people who are the target of microaggressions are just exaggerating. I did not understand why an individual would be bothered by comments that seem so harmless. It still does not feel convincing that someone would care about what strangers think of him. However, this is one concept I need to understand more deeply.

Step 3

The Historical Factors that Contributed to Institutional Racism and White Privilege

The history of Australia cannot be complete without revisiting the aspect of colonisation and the impact it had on the lives of the Aboriginal and Torres Strait Islander peoples. Like many other indigenous communities around the world, this group of people have undergone the process of colonisation (Lovett, 2018). The time was marked by a huge power difference between these people and the colonisers who treated them with a high level of inequality (Marmot, 2016). The legacy of colonialism persisted for many decades to-date. Interestingly, even when colonization came to an end, the effect persisted (Best, 2018). It created a form of superiority in the in-group which was used as the basis for discriminating against the out-group. The colonisers sent the message that the white race was superior to others. The power became entrenched in the minds of the whites. The institutions that were created since the time were based on that belief which almost became a norm. Unfortunately, even the most important institution, including healthcare was founded on the same ideology.

Racist policies were also designed, which negatively affected the health and wellbeing of the Aboriginal and Torres Strait Islander peoples. The racist political system has influenced the current reality of these people based on inequality. The effects are from different perspectives. The Aboriginal and Torres Strait Islander peoples experience greater levels of poverty and deprivation compared to the white Australians (Forsyth, 2007). The conditions affect their health negatively and the racist policies have not been effective in providing them any reprieve (Best, 2018). Even where policies are in place, their implementation is affected by the systems, which are also founded on racism. Racism and white privilege has kept these people away from accessing higher levels of education and employment. There is still a considerably lower rate of enrolment in higher learning institutions for these people compared to whites. Without the resources, their potential for accessing quality healthcare is also affected.

Another level of the effect is in access to health care. Institutionalised racism continues to impact on the healthcare available to the Aboriginal and Torres Strait Islander peoples (Lovett, 2018). Institutionalised racism and the white privilege continue to affect their possibility of seeking help. Instead, most of these people seek alternative healthcare, including spirituality and other traditional sources, which are not necessarily as effective as the modern medical care. Solution for these people lies in dealing with the legacy of colonization, creating policies and institutions which are directed on providing cultural safety.

Step 4

Culturally Safety Nursing Practice

Understanding how culture affects the healthcare system will be the most effective way of dealing with the barriers to quality. The most effective way of reaching this point is developing cultural safety theory and practice for the nurses and other healthcare providers working with diverse communities. The process begins with an understanding of one’s own culture and how it affects the provision of care. Again, addressing the problem will be possible if the nurses will acknowledge the fact that the problem exists (Best, 2018). There is the reality of a cultural imbalance and inequality, especially between the whites and the indigenous communities. Hence, their training should be adapted to the cultural needs of the marginalised. It is only when the recipients of care perceive the system as addressing their cultural needs that successful cultural safety will have been achieved. The level of cultural competence is what the nurses and other health care providers should seek to achieve (Downing & Kowal, 2011).

Institutions are made up of individuals, the laws, norms, and regulations. It is necessary for all these elements to transform to such a level that people can work within diverse environments without allowing the cultural beliefs to get in the way (Nielsen, Stuart, & Gorman, 2014). By creating cultural awareness among the health care providers, it is possible to transform the systems. The workers hold an important place in society, with the potential to impact on the prevailing policies and systems. When each person changes positively, it becomes possible for the whole system to change. The health care workers can influence the government policies affecting the health and wellbeing of the Aboriginal and Torres Strait Islander peoples. They can also make sure that the current policies, such as the “National Aboriginal and Torres Strait Islander Health Plan 2013‐2023” (Australian Government, 2013, p. 1), are implemented. The solution will begin by making the education of the nurses more culturally sensitive to develop competent nurses who are able to adapt culturally safe care.

Step 5

The 5Rs of Reflection Framework: Aboriginal and Torres Strait Islander health and wellbeing

Reporting. I have attended the lectures, read assigned readings and tutorial materials and watched the video on the Aboriginal and Torres Strait Islander peoples’ well-being. I should say that the content has really challenged my view of the self and the people.

Responding. I have realised that the experience of these people with health and wellbeing is something that I had never thought of. I feel that it is strange there are people in the country that are facing such serious health challenges. In fact, it feels completely unreal.

Relating. I thought that I was supposed to be trained to be culturally competent so that I can provide care to all Australians as a registered nurse. On reading about elements such as cultural safety, I realise that there are some people who need more help than others and that I should be aware of the cultural differences and the way they affect the potential to provide them with proper and quality care.

Reasoning. I had not realised how cultural safety is critical in changing the lives of the Aboriginal and Torres Strait Islander peoples in terms of their access to healthcare (Best, 2018). It has dawned on me that training to be culturally aware is critical if I have to become a good nurse in Australia. I have to learn about my own culture and those of others, particularly the indigenous peoples.

Reconstructing. The theory of cultural safety makes more sense compared to others that we have learned in the course. Culture has the most important role to play in improving the healthcare system in Australia (Best, 2018). Since I want to be part of the change for the better lives for the Aboriginal and Torres Strait Islander peoples, I have to continue learning about my culture and theirs.

Role in ensuring cultural safe nursing care for Aboriginal and Torres Strait Islander peoples

Reporting. Before taking the course, I had not realised that the Aboriginal and Torres Strait Islander people need me to be better equipped culturally to provide them with better care. I have taken a keen interest in the course to understand the reality of this marginalised community in the country.

Responding. I had not realised that cultural safety was something these people needed more than any other part of the Australian community. In fact, the concept appears strange to me because I had not considered its effect on my career. I am still on a journey to understand the cultures of these people in order to become a better nurse and provide cultural safety in their care.

Relating. I am expected to work hard to gain a deeper understanding of different cultures in Australia. I find it challenging, but since I realise its importance I am prepared for it. I desire to help the Aboriginal and Torres Strait Islander peoples in becoming healthier.

Reasoning. It is necessary for the Aboriginal and Torres Strait Islander peoples to perceive the health care system as being sensitive to their unique cultural needs (Best, 2018). Such an environment will be made possible by us who are taking the nursing training.

Reconstructing. I am willing and prepared to go through the cultural awareness training to be equipped to provide culturally safe care to the Aboriginal and Torres Strait Islander people. Understanding the social determinants of health unique to these people is at the core of providing them with quality health care (Cox & Taua, 2016). I believe that their health care situation will improve if there are more of us in Australia.

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