Cultural Safety in Clinical Practice

“Health is influenced by culture and beliefs” (NRS-429V, 2011, p. 1). In order for the nurse to properly care for the patient, she must know and understand the patient’s culture. “Cultural care is a comprehensive model that includes the assessment of a client’s cultural needs, beliefs, and health care practices” (NRS-429V, 2011, p. 1). It is not enough to just know where the patient lives or where he came from. The nurse must embrace the concept of cultural competence and cultural awareness. This requires not only the awareness of the cultural beliefs and values of their patients, but also

Health in all cultures is an important aspect of life. A person’s cultural background, religion and/or beliefs, greatly influences a person’s health and their response to medical care (Spector, 2004). These diverse cultures guide decisions made in daily life; what food eaten, living arrangements made, medications taken and medical advice listened to. A nurse must be knowledgeable and respectful of these diverse cultures and understand their importance when providing care. This understanding helps to build a strong nurse/patient relationship, increasing patient compliance, which ensures positive outcomes are met. Patients who are satisfied

Nursing Council New Zealand (2011) defines cultural safety as the effective nursing of a person from another culture by a nurse who has undertaken a process of reflection and recognizes the impact of the nurses culture on own nursing. Irihapeti Ramsden (1946-2003) introduced the term ‘cultural safety’ into the education requirements of New Zealand nursing during the year 1990 (Wepa, 2012). As a result of this, Ramsden produced a document named Kawa Whakaruruhau. The document outlined concerns surrounding Maori health within New Zealand. In response to the publication of Kawa Whakaruruhau the Nursing Council of New Zealand amended, in 1990, the standards of nursing and curriculum assessment processes to include cultural safety (Wepa, 2012). Ramsden and Spoonley (1994) discuss that during the

Cultural competence in nursing is imperative for effective patient care. A nurse must know his or her own values and beliefs as well as knowing about a patient cultural practices in relation to healthcare. Cultural competence is defined by some as: “the learned, shared and transmitted values, beliefs, norms and lifeways of a particular group that guides their thinking, decisions and actions.” Also it is noted that an important change to this definition is “the recognition of the dynamic,

By making sure all your practices as a nurse are culturally safe, you will know that you are treating every patient that comes under your care with the respect and standard of care that they require as an individual with their own beliefs. As a nurse, you need to be open minded and open to accepting cultures that may be different to you own so you do not compromise the care of the health consumer, and therefore affect the therapeutic relationship you need to have with the patient to care for them effectively. This is an essential skill that all nurses need to use in every practice they take part

Practicing cultural safety requires nurses to have undertaken personal reflection of their own cultural identity. This enables them to recognise the impact that their personal culture has on their professional practice (Cox & Taua, 2013). This personal reflection should allow the nurse to provide effective care to an individual or family from a different culture (Cox & Taua, 2013). In this essay I will reflect upon two of my own cultural groupings, discuss the concept of “other”, the relevance of cultural safety to nursing practice and how I might care for someone who is culturally different from myself.

Firstly, a challenge that the nurse may face are the cultural differences in non-verbal communication. For example, “maintaining eye contact during conversation [conveys] respect” in American culture (Potter, 2014, p. 247). However, eye contact is “considered intrusive, threatening, or harmful” in Aboriginal culture (Potter, 2014, p. 247). Whereas patients in Western culture are expressive, Aboriginal patients often control their affect to maintain a calm demeanor (Eliopoulos, 2010, p. 30). Secondly, another challenge that the nurse may face is a language barrier. For instance, the nurse may be unable to communicate with the Aboriginal client in their native language. Alternatively, the Aboriginal client may unable to communicate in a common language with the nurse. Thirdly, a challenge that the nurse may face is the consolidation of traditional Aboriginal and Western healing practices. For instance, Aboriginal culture emphasizes the role of “energy and nature” in the healing process (Potter, 2014, p. 243). However, Western culture has only been recently introduced to this concept (Potter, 2014, p. 243). Whereas Western medicine emphasizes the use of pharmaceutical drugs, traditional Aboriginal medicine “promotes harmony within a community and in the physical and spiritual worlds through sweating and purging,

The main ideas that Lisa Bourque Bearskin is stating in this article is that nurses need to be more sensitive to cultural care. They need to be aware of the issues in healthcare and strive to remove any barriers for certain groups, such as the first nations, and they need to disrupt any unequal relations in the social, political and historical aspect of healthcare. The way this can be done is by shifting their thoughts from cultural competence to cultural safety by way of relational ethics. Cultural competence is explained as the knowledge, skills, and attitudes that nurses need to use to care for cultural differences. Another framework described cultural competence as going through the stages of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural competency works very well when making policies in an agency but this view fosters a view of culture that does not encourage nurses to ask questions. (Bearskin, 2011) Cultural Competence causes different cultures to be put in a box, which cannot be done because cultures are constantly changing and every person’s culture is different. Culture is individual. Lisa Bourque Bearskin goes on to say that cultural safety is what nurses should use for ethical practice. In cultural safety, a nurse must strive to improve health care and its access for all people, while recognizing that there are many different cultures that have a right to be recognized. Bourque

Cultural competence can be defined as using the ability of one’s awareness, attitude, knowledge and skill to effectively interact with a patient’s many cultural differences. Madeline Leininger, a pioneer on transcultural nursing describes it this way; “a formal area of study and practice focused on comparative human-care differences and similarities of the beliefs, values and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people” (Barker, 2009, p. 498). The importance of cultural diversity in healthcare allows for the delivery of appropriate cultural autonomy. Showing respect for others will lead to trust between nurse and

Cultural safety is a concept that is integral to providing best care to patients in nursing practice. The CRNBC defines cultural safety as a process requiring RNs to reflect on their cultural identity, and develop their practice in a way that allows them to affirm the culture of their patients; cultural unsafety can be defined as any actions which demean, diminish, or disempower the cultural identity and well-being of people; this also addresses the dynamics of the power relationship between the Health Care Provider and the patient (p17). Although an environment of cultural safety is a standard that we are held to as nurses, this ideal is not always reached. In this paper I will discuss one such incidence, as well as some of the changes that will assist myself as a nurse, as well as others members of the healthcare team to create an environment of cultural safety.

The outcome of cultural awareness and cultural sensitivity is cultural safety (Berg, 2010). In practicing cultural safety, it is not really expected that health care workers will know all cultures; it is acknowledging and respecting people regardless of their differences and beliefs (Hughes & Farrow, 2006). Moreover, nurses and other health professionals create cultural safe practice when the patients feel safe, respected and understood (Skellet, 2012), as well as if there is a shared understanding and acknowledgement of the unique identity and diversity. Health workers should always consider the cultural and historical background of the Aboriginal and Torres Strait Islander Australians, because practicing cultural safety is significant to

In relation to Aboriginal health, this will require nurses to develop greater awareness of culture and the influences that affect it including racism, colonialism, historical circumstances, and the current political climate in which we live. Nurses working with aboriginal communities need to understand the history, socio-political climate and culture within the specific community (Foster, 2012). Nurses must emphasize the need for solutions that will strengthen cultural identity, identify and promote both existing and traditional sources of strength within First Nations communities, incorporate traditional healing methods, and rely on local control and self-direction by First Nations communities (Mareno & Hart, 2014). In addition to placing a high priority on cultural awareness, nurses should also understand the concept of respect in aboriginal terms and apply respect in all their encounters. Self-awareness of their own beliefs and assumptions are important in order for nurses to have an effective relationship with the community (Foster, 2012). It is important for nurses to reflect on their own cultural knowledge, awareness, skills, and comfort in encounters with a diverse population of

When culturally competent nurses interact with other cultures, they observe how members of the culture communicate, watching for verbal and non-verbal cues. Eye contact is important to identify. For some cultures direct eye contact is not polite. Touch for some cultures is prohibited. If needed, nurses should explain the reason for touching the patient before proceeding. In some cultures males cannot be caregivers of females. Silence doesn’t always mean miscommunication or patient apathy. For some cultures is a positive non-verbal cue or a sign of respect or agreement. Space and distance is very important when providing care. Patients can place themselves close or far from the nurse based on their culture. Healthcare beliefs also vary from cultures. Some cultures are compliant with cares while others may not be very cooperative. Based on these observations, nurses can plan their plan of care based on the patient’s needs (Maier-Lorentz, 2008 Journal Of Cultural Diversity). Nurses also need to observe pain non-verbal cues, food preferences, family arrangements and general norms and interactions.

Culture competence is a quality that any nurse should have. The article that I decided to research refers to the impact that language and different cultures have on a patient’s health. It is the duty of health care professionals to attempt to learn about different cultures and to be sensitive to the way patient’s feel about their beliefs. Once the nurse understands a patient’s

Nursing theory is foundational to nursing practice; however, there exists a reciprocal relationship between practice and theory. Through examining nursing theory, the nurse can make better-informed decisions about the patient’s care. In addition, the theory will influence the care for future patients as well. One theorist that changed the landscape of nursing is Madeleine Leininger. Her culture care theory changed the dialogue of healthcare regarding care. This paper will discuss the importance of theory in nursing theory. Next, a summary of Leininger’s theory will precede a discussion about how the theory will be applied in a nursing context. Finally, the correlation between Leininger’s theory and the practice of a nurse practitioner will ensue. Her culture care theory will inform the practice of a nurse practitioner and how culturally competent care will be given.