The creation
of cultural safety in our communities will be the focus of the case studies in the next part of this Chapter.
In the next Chapter I will extend the human rights - based framework that I have outlined, to provide even more practical responses based on the
creation of cultural safety and security.
In this Chapter I will be taking our strategies to an even more practical level, looking at how we can create
environments of cultural safety and security to address lateral violence.
Such conversations can be confronting, but they are vital to moving forward together, as personal reflection is a core
element of cultural safety in health.
The
goal of cultural safety is for all people to feel respected and safe when they interact with the health care system.
There was even an opportunity to explore the
issues of cultural safety through literature at the first LIME Connection book club.
Many times I have experienced a traumatic
lack of cultural safety in the health system, whether as a client or as the carer of a loved one.
Meanwhile, Associate Professor Julie Leask from the University of Sydney has tweeted on the
importance of cultural safety for improving immunisation rates and the quality of services.
Meanwhile, Dr Ruth DeSouza, a
scholar of cultural safety in nursing, has provided a handy guide below, busting some myths about cultural safety.
The Nursing Council of New Zealand (2005) summarises the
principles of cultural safety as including the need for health professionals to reflect on practice, to minimise power differentials, engage in a discourse with patients, decolonise practice, and in not diminishing, demeaning or disempowering others through your actions.
VACCA conceives
of cultural safety as re-claiming cultural norms and creating environments where Aboriginal people transition; first from victimhood to survivors of oppression, through to seeing themselves and their communities as achievers and contributors.
Likewise, the leadership of organisations such as NACCHO, the Lowitja Institute and the Close the Gap Campaign in developing the
understanding of cultural safety more broadly across the health system is making a real difference.
As part of Croakey's ongoing Acknowledgement series, Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses (CATSINaM), advocated for the nursing profession to follow the lead of psychologists in making an apology to Aboriginal and Torres Strait Islander people as part of moves towards wider
embedding of cultural safety.
This report provides an in - depth look at the state
of cultural safety knowledge in Aboriginal health care, including such things as terminology, core competencies, accreditation standards, undergraduate and graduate level curriculum, professional development and continuing education opportunities, and provincial and national projects engaging with the issue.
It could be a number of things: it could be better recording processes by the jurisdictions, could be them being able to finally ask the question and encourage people to identify, and probably I think the most positive aspect is it could be because of heightened awareness around the issue by
MATSITI of cultural safety — it could be that some of those teachers felt more comfortable in identifying by 2015 than they did in 2012.
Most importantly however, this research advances the need to recognise that any
test of cultural safety in the classroom is best measured by Aboriginal people themselves.
The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and other experts in the
field of cultural safety have welcomed the new standards as long overdue, but there are concerns about a lack of clarity in the terminology used, as they use the language of «cultural awareness» and «cultural competence» rather than «cultural safety», although this latter concept is the focus of supporting documents.
If we were to reflect on this mainstream media coverage from a cultural safety perspective, it could be viewed as a teachable moment and an opportunity to inform the public about the real meaning and
significance of cultural safety in healthcare.
As previously reported at Croakey, the concept
of cultural safety reverses the gaze so that health professionals examine their own beliefs, behaviours and practices as well as issues such as institutional racism, whereas transcultural concepts like cultural awareness can promote the «other - ing» of patients and «cultural voyeurism».
«We're happy about the plans to measure the impact of the new standards but it needs to be remembered that a
foundation of cultural safety is that it is up to the recipient of care — not the institution or the service providers — to decide if care and services are culturally safe.»
A key indicator of the current poor
levels of cultural safety in health care delivery within the hospital setting is the unacceptable rate of discharge against medical advice for Aboriginal and Torres Strait Islander people.
While teaching into a number of subjects, he actively advocates for the accurate
weaving of cultural safety and Indigenous knowledges into the nursing curriculum.
Also watch the video interview below, where Mohamed and West put out a call to journal editors who might like to engage with their plans to develop a «paper trail» to trace the
development of Cultural Safety in an Australian context, led by Aboriginal and Torres Strait Islander scholars and practitioners.
The most transformative
aspect of cultural safety is a patient centered care approach, which emphasises sharing decision - making, information, power and responsibility.
Recently I sought Australian academic journal articles on the
topic of cultural safety and security, and found 26 journal articles: 16 of them cost $ 563 (range from $ 4 to $ 71) and 10 were free open access.
Other strategies that have also been cited as important when considering the needs and preferences of Aboriginal people in a program include developing and using culturally specific tools [22], integrating Aboriginal ways of learning or knowing [22,23,40,49,50] and
consideration of the cultural safety of participants [18].
Despite widespread recognition of the oral health gap between Indigenous and non-Indigenous Australians, progress in addressing the underlying
issues of cultural safety and cultural competence among providers has been slow.
These barriers include inequitable federal funding for health and social services for First Nations children living on reserve, a failure to address jurisdictional gaps in services and fully implement Jordan's Principle, as well as a
lack of cultural safety in services provision.
The
concept of Cultural Safety, originating through the work of Maori midwives in 2000, is slowly gaining traction in health education in universities, and in professional development in health services in Australia.
At the same time, health leaders — including the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and other nursing and midwifery groups, the Australian Indigenous Doctors Association, and other peak health groups have spoken up for the
importance of cultural safety for improving care and outcomes for Aboriginal and Torres Strait Islander people.
As a
scholar of cultural safety, I set up a Google alert service in 2015 to help keep me in touch with related discussions, in the media and more widely.
Under the standards, nurses must be able to apply the
principles of cultural safety and demonstrate that they are practising in a way the patient deems to be culturally safe.
As part of Croakey's ongoing Acknowledgement series, Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses (CATSINaM), suggests the nursing profession should follow the lead of psychologists in making such an apology as part of moves towards wider
embedding of cultural safety.
It said institutionalised racism, lack
of cultural safety and distrust in the health sector was already affecting access and outcomes for Indigenous people, with high rates of discharge against medical advice contributing to chronic ill health including diabetes, kidney disease and cancer.