Cultural Safety Essay Instructions
The vision of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 reads:
“The Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander peoples have access to health services that are effective, high quality, appropriate and affordable” (Australian Government, 2013, p. 7).
Racism is a significant inhibitor to ‘closing the gap’ in health outcomes between Aboriginal and Torres Strait Islander peoples and other Australians (Murrie, 2017). For health professionals to be effective agents in realising the national vision, we are required to be culturally safe practitioners, who are literate in the dynamics of race and racism and importantly their impacts on the well-being of people we care for. Cultural safety must be realised at both the individual practice level and at the institutional level. Health professionals must also be knowledgeable of the historical and political factors that created and continue to maintain poor health outcomes experienced by Aboriginal and Torres Strait Islander peoples. In this assessment you will be required to discuss the application of culturally safety to the Aboriginal and Torres Strait Islander peoples’ health and well-being context. You are also required to utilise the 5Rs Reflection Framework to reflect on your learning experience throughout the initial weeks of this unit.
Application of Culturally Safety to the Aboriginal and Torres Strait Islander Peoples’ Health and Well-being Context
Personal Racism vs. System/Institutional Racism
Individual racism denotes the actions, attitudes, and beliefs of individual, which perpetuate or support racism in unconscious and conscious ways. Individual racism mostly happens during interpersonal interaction where an individual is able to bring personal beliefs, attitudes, assumption and behaviours in personal interaction. Institutional racism is general or specific instances of racial domination, discrimination, exploitation, and inequality in institution or organizational contexts such as the nation-state or labour market (Pearson, 2016).
Institutional racism specifically refers to the manners in which practices and policies of an institution create varying result for various ratio groups intentionally or unintentionally (Kelaher, Ferdinand & Paradies, 2014). The main difference between individual racism and institutional racism is that individual racism displays what is in a person, while institutional racism portrays rules made to govern an institution which end up creating results or benefits disparity among people of different races. The main similarity between the two is that they both result to discrimination of the minority groups in the society.
The Power of Dynamics Associated with the Concept of Whiteness
Australia has been experiencing white supremacy since the colonial time where the indigenous community was massacred and highly reduced in population. The whiteness was then propagated in many ways including development of policies that favoured white people over indigenous communities, especially with regard to access of public services (Walton et al., 2018). White dominance is still deep-rooted in Australian culture, though it has been made extra invisible via its dominant position denial.
However, according to Wills (2012) whiteness as non-normative, subjective racialised class is only generally invisible to those that dwell in this power space. This simply means that indigenous people in the Australia do always feel the white supremacy while trying to go about their normal life routines, especially with relation to access to public services or facilities. There is white dominance in all sectors in the county and limiting chances for the indigenous people and aspects of racism, while interacting with whites in those sectors (Smith, 2015).
Concepts Cultural Safety vs. Cultural Competency
Cultural safety refers to an environment that is safe for individuals despite of who they are. It is an environment with no assault, denial or challenge of people identity, of who people are and what they require. Cultural safety is about shared knowledge, shared meaning, shared respect and experience of listening truly and learning with dignity as a group. Cultural competence is perceived as a set of corresponding policies, attitudes, and behaviours which come together in an agency, system, or amongst professionals and allows them to efficiently work in cross-cultural situations (Freeman et al., 2014).
Cultural competence is regarded as the systems’ ability to offer care to patients with different behaviours, beliefs and values, including modifying delivery to meet the linguistic, cultural and social needs of patients. A cultural competent care system incorporates and acknowledges the cross-cultural relations assessment, the culture importance, and vigilance to the dynamics, which yield from cultural differences, the cultural knowledge expansions and the services adaption to meet unique cultural needs (Kingsley et al., 2013). The level of cultural competence in an organization can be measures by the level of cultural safety experienced in that organization. This means, cultural safety is an outcome of a cultural competency in any organization. The two concepts are said to complete one another (Laverty, McDermott & Calma, 2017).
5Rs of Reflection Framework
The course prescribes two main reading one by Marrie (2017) and the other by Australian Government (2013). The reading that grabs my attention between the two is the Australian Government (2013) which is a health plan for the minority groups in the country. The two Australian indigenous groups; Aboriginal and Torres Strait Islander have been experiencing a high level of discrimination with regard to access to quality and affordable health care services. This has resulted to high level of health disparity between the two groups and the rest of the population in the country. This article acts as a ray of hope for the two groups. The article appeals to me more because it demonstrates the government recognition of its past mistakes and their effects and desire for change.
Enactment and Perpetuation of Institutional Racism throughout Australian’s History
The Australian indigenous groups have experienced a long history of institutional inequality, which includes educational inequality, healthcare inequality and employment inequality (Durey & Thompson, 2012). There is a clear documentation of disparity between Australian indigenous people mortality rates and that of other Australians. Indigenous Australians are disadvantages across a range of health, economic and social indicator (Cronin, 2017). They have been experiencing physical or verbal abuse or discrimination in the housing, education, employment or health sectors resulting to poor general health among the indigenous people (Australian Institute of Health and Welfare, 2015). Institutional racism in Australia was reported to take part in all sectors with indigenous Australians getting less benefit from the countries laws and policies, compared to other Australians (Craven, 2016). They have also been conditional on disparaging comments in both social and health contexts. As a result, Aboriginal people experienced increasing problems accessing mainstream healthcare as a result of racial attitudes of health practitioners, discriminative health practices and policies and high cost of services. This was highly witnessed until recently when health programs are structured targeting indigenous people. Indigenous Australian regions have been experiencing poor distribution of healthcare facilities and professionals, which affects healthcare accessibility. There is also cultural challenge where healthcare professionals are unable or refuse to integrate indigenous people cultural aspects in treatment plan (Freeman et al., 2014).
According to Bodkin and Carlson (2016), the history of educational attitudes, programs and policies targeting indigenous populaces has for most part been very negative in its results and orientation. This history has created a tragic legacy to educational opportunities and outcome of Aboriginal youths. Racist-inspired generational policies resulted to intergenerational alienation and underachievement (Lee, 2017). Actually, educational trends from the historical glance are that the quality and aims of education has drastically differed for non-indigenous and indigenous students (Jeffreys & Dogan, 2012). The entrenched implication of these varying standards was directly associated with the negative insolences of the non-indigenous education providers and the early scientific, social and political attitude directed to the entire indigenous culture. Although people may think that these approaches are not practiced today, indigenous Australians has been experiencing continual resistance to teaching about their traditional cultural identities, learning and values in different indigenous education era in Australia. The historical policies overarching theme in indigenous education were structured with intention of erasing the visibility or/and existence of indigenous Australians (Mansell, 2016). Other than this, there has been education coverage and quality disparity between aboriginal people and the rest (Pearson, 2016). This makes it hard for most Aboriginal youths to secure credible jobs in the government and well established private sectors. White dominance in employment sectors results to high tendency of development of employment policies favouring white Australians than indigenous ones during recruitment (Cronin, 2015; Australian Human Rights Commission, 2015).
How Culturally Safe Nursing Practice Addresses Personal and Institutional Racism
The model of cultural safety was created in the context of an indigenous health care and has been adopted within the wider framework of culturally diverse health care. Cultural safety focuses on directly addressing the impacts of colonialism in the principal health system, by centring on the degree of cultural safety experienced by the person seeking health care (Rowan et al., 2013). Culturally, safe health care setting is an environment that is safe to all patients. In this case, it is environments where Indigenous Australians are served without assault, denial or challenge of their identity, of what they need or who they are. It regards, shared meaning, shared respect, shared experience and knowledge of listening truly and learning collectively with dignity. This means that healthcare institutions adopt operation practices and policies that respect individual culture, that promote high level of equity, that ensure patient needs are prioritized and that ensure high level of accountability in provision of care. Nurses get to be more aware of their own identity and culture and how it influences their practices. This helps in recognition of similar and unique qualities of different cultural groups (Doutrich et al., 2012).
Engagement with indigenous Australian cultural groups is domineering in the process of enhancing cultural consciousness and developing collaborative healthcare programs. Cultural safety thus initiates both individual and systemic change with the objective of assessing processes of formation of identity. It also promotes awareness of personal identity among health workers and effect on care they offer to indigenous Australians (Freeman et al., 2014). Measures like training nurses on cultural safety enhance them in development of cultural of suitable communication strategies, attitudes and behaviours, which lower the inequality gaps in healthcare outcomes. Cultural safety in nursing also ensures culturally suitable care that centres on cultural requirements of the patient, increasing patient satisfaction and outcome (Bainbridge, McCalman, Clifford & Tsey, 2015).
5R of Reflection Framework
Different engagement in this course has improved my understanding of the life of Australian indigenous communities and the challenges that they have been facing over other communities due to discrimination. The recommended readings, videos and lectures have made me learn that Aboriginal and Torres Strait Islander people has been experiencing health disparity compared to other Australians, mostly due to racial discrimination. There has been individual and institutional racism enacted against the aboriginal and Torres Strait Islander people in Australia. This includes discriminative policies and practices that undermine their access to quality care. Individual professional attitudes and behaviours have also added to their misery. In this regard, the indigenous Australians have been experience poor general health for quite a long time, among other social and economic discrimination. I have also learnt that growing level of discrimination and its negative effect on indigenous community health prompted the need for cultural intervention in healthcare provision.
Going through this course I have come to learn that cultural safety is the best intervention measure to improve the health situation of indigenous people in Australia. Cultural safety involve being aware of my own culture and how it influence my nursing practices especially among patients of different culture. This makes me aware of cultural sensitive things. Things that I would have wished my nurse considered while handling my case, despite not being of my culture. Being cultural sensitive is likely to change my attitude and behaviours toward indigenous patients by ensuring that I treat them with respect, love and care. There has been other intervention in the past. However, they were not highly effective simply because they did not pay much attention to cultural safety. I have realized that cultural safety influence individual and institutional behaviour towards indigenous community and hence producing better results.
The reading materials have given me relevant knowledge on how to improve the health situation of Aboriginal and Torres groups in Australia. The video has made me realize how destructive my cultural insensitive and discriminative acts and attitude has been to indigenous group. This make me see the need to learn more about cultural competence and safety in promoting equal treatment to all my patients in the future.
Basically, my behaviour in handling indigenous people was highly influenced by my upbringing. There was white supremacy in my upbringing making it hard to realize where I have applied negative attitude or destructive behaviour. I also lacked knowledge on how my behaviour negatively impacted indigenous people wellbeing.
I have realized the importance of having cultural knowledge in nursing. This is the only way to ensure cultural safety among the aboriginal people. This course has taught me the importance of being cultural sensitive especially while handling indigenous people. I have learnt that the system has been considerably unfair to aboriginals, making them suffer unnecessarily. More need to be done to promote aboriginal and Torres healthcare access.