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Connection with curriculum |
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This topic relates to the concepts: cultural safety, cultural competence, Aboriginal and Torres Strait Islander health
Analyse the strengths and limitations of key terms and definitions in the context of culturally safe health practice in Intensive Care Medicine; Propose examples for applying key terms and definitions in Intensive Care Medicine.
Introduction
It is acknowledged that concepts of cultural safety, cultural competence, and related topics are emerging and changing as they are discussed in broader society.
In the current topic, you will engage with the concept of cultural awareness, cultural safety, cultural competence and other related terms in order to develop an understanding of the relationship between awareness and learning about others. This raises the opportunity to start to unpack and locate yourself within a continuous learning approach as a health professional who works with Aboriginal and Torres Strait Islander Peoples.
What we mostly ‘do’ in Australia is Cultural Awareness: teaching the uninitiated learner about Aboriginal and Torres Strait Islander Peoples - othering. On the other hand, cultural safety is about learning about the self and your own values - reflexivity.
The term ‘Cultural Safety’ originally comes from Aotearoa New Zealand, where Māori nurses sought to improve outcomes for Māori People (Ramsden, 2002). They formulated a hierarchy of learning:
- Cultural Awareness – learning about the other
- Cultural Sensitivity – learning to have sensitivity based on knowledge of the other
- Cultural Competence – applying knowledge about the cultural beliefs and practices of both self and others to interactions with people from different cultural backgrounds in ways that are considered appropriate by those people
- Cultural Safety – where the individual and institution change their practices
Only the person and/or their family can determine whether or not care is culturally safe and respectful.
It is not just individuals who matter, but also organisational culture; the environment in which individuals operate, the institution's value and belief system, and those who make the decisions. While the workforce's skills, competencies, attitudes, and responsiveness are critical, focusing only on this aspect of change and reform will miss a broader point – that of institutional change and reform.
Cultural Awareness
Select the heading below to learn more about Cultural Awareness
Cultural awareness means being aware of, and having sensitivity to cultural diversity and differences. It involves demonstrating respect and openness for other people and other cultures (Victorian Public Sector Commission, 2022).
Cultural Safety
Select the headings below to learn more about Cultural Safety.
Cultural safety refers to addressing racism and unconscious bias within healthcare professionals and in the enabling environment delivering policy or services to Indigenous Peoples (for example, systems, policies, funding drivers and measures). As the emerging discussion of Cultural Safety originated in Aotearoa New Zealand, and as a bi-national College, CICM recognises both the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Council of New Zealand’s definitions of cultural safety. Ahpra defines cultural safety as:
Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practise is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism (Australian Health Practitioner Regulation Agency, 2020)
The Medical Council of New Zealand defines cultural safety as:
The need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.
The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.
The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities (Medical Council of New Zealand, 2019).
Ensuring that specialists and systems delivering healthcare are aware of the impact of their own culture and cultural values on the delivery of services and that they have some knowledge of, respect for and sensitivity towards the cultural needs of others is critical. Cultural safety involves health professionals reflecting on their own views and biases and how these could affect their decision-making and the patient’s health outcomes (Curtis, 2019). Cultural safety is not an optional add-on to being a clinically safe specialist; it is instead an intrinsic component of both clinical and patient safety (Phillips, 2015).
Cultural safety is a core component of clinical safety (Phillips, 2015; Australian Health Practitioner Regulation Agency 2020), and as such, is an essential part of closing the gap in health and social outcomes for Indigenous Peoples (Laverty et al., 2017). The health, human and community services sector will not increase life expectancy and improve the quality of Indigenous Peoples’ lives for both patients and employees if there is not an investment in cultural safety (Victorian Government, 2019). Markwick et al. (2019) have shown in Victoria that one-third of the gap in health outcomes for Aboriginal Victorians is due to racism in the public health system. If racism is a public health issue, then cultural safety is one of the solutions. Therefore, Ahpra and the Medical Board of Australia now require cultural safety as a core skill for the practice of medicine in Australia. Cultural safety is a fundamental human right (Victorian Government, 2019) and is a euphemism for racism in an enabling environment. Organisations are required by national and international legislation to provide safety, both physically and psychologically, in workplaces that are free from racism (World Health Organization & Burton, 2010).
Health outcomes for Aboriginal and Torres Strait Islander Peoples are negatively impacted by culturally unsafe health workforces, organisations and systems. These negative impacts can change a person’s trajectory on their life course, can lead to significant physical and psychological challenges, and in some cases, death (Wylie & McConkey, 2019). The effects of these negative impacts on the person, the family and the community are immeasurable.
If an intensive care unit is not culturally safe, as well as impacting the person’s care and well-being, this may make the patient less likely to engage with the healthcare system in the future, with significant impact on chronic disease management and disease burden.
Caution:
- Cultural safety focuses on the patient’s or client’s experience and perspective to define and improve the quality of healthcare. It is not based on the perspective of the intensive care specialist providing the care.
- Indigenous Peoples are not homogenous. It is important to understand that there are a range of diverse views and examples of Indigenous experiences of cultural safety between and within Indigenous populations, both in terms of location and historical and cultural experiences.
- There is much written about slightly different but related terms, such as ‘cultural security’, ‘culturally appropriate’, ‘culturally aware’, ‘culturally valid’ and ‘culturally competent’. These concepts are all important, however, the highest standard to attain is cultural safety as this recognises that cultural safety is a core component of clinical safety (Australian Health Practitioner Regulation Agency, 2020) and allows for systems and sectors to effect greater change across individual intensive care specialist’s knowledge, attitude and behaviours.
Cultural Competence
Select the headings below to learn more about Cultural Competence.
Cultural competence is one key element of cultural safety. Focussing on the skills, knowledge and competencies of individual health professionals, cultural competency describes the awareness of one’s own culture, plus knowledge, understanding of, and sensitivity towards other cultural beliefs and practices, combined with the ability to interact with and advocate for people from different cultural backgrounds in ways that are considered appropriate by those people (Indigenous Higher Education Advisory Council, 2011).
Cultural competence ensures health professionals develop the ability to communicate and interact effectively with people across varying cultures who have varying beliefs. Improving cultural competence in the workplace can improve productivity and performance. As specialists and trainees, you will encounter other health professionals with diverse backgrounds. Specialists and trainees who increase their cultural competence will have a greater appreciation for their patients and their fellow healthcare colleagues.
Improving communication by having cultural competence helps keep patients safe. Clear communication allows specialists and trainees to obtain accurate medical information pertaining to the patient and encourages discussion in which the patient can ask questions and build trust and rapport (Bainbridge et al., 2015; Hunt, 2013).
Caution:
- Cultural competence is not a ‘once and done’ exercise. Gaining cultural competency requires continuous development (which may include: being involved in the community, supervision/mentoring, and learning about issues that impact on Indigenous Peoples).
- Cultural competence is not the same as cultural safety. Cultural competence focusses on the non-Indigenous specialists' or trainees’ knowledge of and skill in working with Indigenous Peoples’ cultures. Cultural safety is about the non-Indigenous specialist and trainee focussing on their own cultures (reflexivity), as well as their skill in advocating for Indigenous Peoples.
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Activities to facilitate learning |
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The following activities will enhance your learning on this topic.
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Watch |
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- Watch the video called 'Animating cultural safety' on cultural safety for clinicians. https://research.qut.edu.au/heal/projects/cultural-safety/
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Review |
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- The Australian Government Department of Health 2021-2031 National Aboriginal and Torres Strait Islander Health Plan is a key document that will support cultural safety learning. All topics in this learning resource align with the content of this plan. Review the overview (page 7) of this plan.
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Review |
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- Review the objectives of the AHPRA cultural safety strategy (page 9)
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Additional recommended resources |
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- Explore the
Glossary of Healing Terms
- Find out
about Appropriate Terminology when speaking or writing about Aboriginal and Torres Strait
Islander Peoples.
- View a short video which
includes a description
and discussion about cultural safety from
Professor Gregory Phillips during his time with Griffith University
- Review the Queensland Health Aboriginal and Torres Strait Islander Care guideline
- Read the Indigenous Program of Experience in the Palliative Approach brochure on what people with serious illness need Review the video on understanding non-compliance.
Reflect on your learningSelect the image to answer the reflection question for this topic. |
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