Cultural Safe Practice

Question 1

What is culture

Answer 1

May include age, gender, sexual orientation, race, socio-economic status, occupation, religion, physical, mental or other health impairments, ethnicity

Implies the integrated pattern of human behaviour that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group

Question 2

What is Cultural Competence?

Answer 2

Defined as a set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals to work effectively in cross-situational situations.

A culturally competent system of care acknowledges and incorporates the importance of culture, the assessment of cross-cultural relations vigilance towards the dynamics that result from cultural differences and the adaptation of services to meet culturally-unique needs.

Question 3

What is cultural awareness

Answer 3

Beginning step towards understanding there is difference

Courses are available to understand this change, however, it fails to address the emotional, social, economic and political context in which people exist

Question 4

What is cultural sensitivity

Answer 4

Alerts people to the legitimacy of difference and begins a process of self-exploration

Question 5

What is cultural safety

Answer 5

An outcome of education that enables safe services to be defined by those who receive the service

Refers to the practitioner-patient encounter in which the patient feels respected and empowered, and that their culture and knowledge has been acknowledged

Question 6

What is cultural responsiveness

Answer 6

The lifelong practice of cultural safety, reflection on interactions and action

Question 7

The Cultural Safety Continuum

Answer 7

Cultural Awareness –> Cultural Sensitivity –> Cultural Safety –> Cultural Responsiveness

Question 8

Principles of cultural safety

Answer 8

1. Self Reflection
2. Engage in discourse
3. Undertake a process of decolonisation
4. Ensure you do not diminish, demean or disempower others through actions
5. Seek to minimise power differentials

Question 9

Cultural Safety - Self Reflection

Answer 9

Being aware of your own cultural identity

Understanding your own assumptions, beliefs, and values about yourself and about the people that you care for

Question 10

Cultural Safety - Engage in Discourse

Answer 10

Listening and respecting

Using Laymans terms (not medical jargon)

Being aware that literacy skills may be lacking

Understanding and engaging in Indigenous knowledges and perspectives

Question 11

Cultural Safety - Decolonisation

Answer 11

Acknowledge the key role of a colonising history in contemporary health outcomes for Indigenous peoples

Learn the history of the community, peoples and families -> urban, rural and remote

Learn about your own personal history and how it has affected your lives

Learn the history of the system that you work in and the impact it has had service users

Question 12

Flow on effect of colonisation

Answer 12

Colonisation –> cultural genocide –> marginalisation from mainstream society and fixed settlements –> poor housing and overcrowding –> unemployment, poverty and poor education –> alcohol and substance abuse –> poor nutrition and healthcare

Question 13

Cultural Safety - Disempowerment

Answer 13

Not challenging peoples identity –> rather asking if people identify as ATSI

Recognising differing practices, communication methods (including silence)

Communicating respectfully and allowing people to feel safe in talking about their own cultural diversity

Question 14

Cultural Safety - Power Differentials

Answer 14

Be aware of language

Consider the patient perspective and needs

Consider the power differential the patient will feel with your professional relationship

Accept alternate ways of doing things

Question 15

What are some culturally unsafe indigenous experiences of cancer treatment

Answer 15

High cost - travel, accomodation, treatment, medicine

Hospital environment and processes - no recognition of cultural factors and confusing

Lack of flexibility in hospitals for extended family

Communication - use of medical jargon, not recognising holistic approach

Question 16

Barriers to aboriginal health

Answer 16

Lack of logistical access to treatment facilities and specialist care

Healthcare systems: lack of cultural capability and trust, unmet needs and distress

Cultural factors: nihilism, fatalistic beliefs and fear, use of traditional medicines

Socioeconomic factos

Question 17

Enablers of aboriginal health

Answer 17

Staff communication, education, cultural capability and use of assessment tools

Healthcare systems, continuous improvement, patient navigators and Telehealth

Collaboration and linkages with other healthcare providers

Question 18

Cancer beliefs of indigenous peoples

Answer 18

Lack of knowledge about cancer exists - poor understanding of its causes, available treatments and likelihood of survival

Feelings of ‘shame’ around cancer

Perceptions of culturally unsafe health services

Fatalistic attitudes and associated with a lack of survival

Fear of leaving community, family and country to seek treatment

A form of punishment for a past misdeed

Part of their fate or result of a curse

The fault of a ‘white man’ as it was not a concern before colonisation

Contagious

Question 19

Government priorities in improving healthcare

Answer 19

Engagement and involvement of indigenous communities and healthcare providers

Accuracy of identification and data collection

Access to treatment and support services

Cultural capability and responsiveness of services

Identification and development of specialised models of care

Knowledge and understanding of cancer and cancer services

Translation of evidence into action

Question 20

First Nations health professionals

Answer 20

Cultural capability officer
Indigenous health liaison officer
Patient journey officer
Aboriginal health worker

Question 21

Cultural Capability Officer Role

Answer 21

Actively participate in cultural improvement opportunities for the business

Contribute to the development of positive outcomes

Question 22

Indigenous Health Liaison Officer Role

Answer 22

Assist MDT to provide clinical and primary health care

Engage with patients, clients and visitors to hospitals and health clinics

Assist in arranging, co-ordinating and providing culturally appropriate health care

Organise bedside visits to explain the hospital system

Support and advocate your needs when speaking to hospital staff about important matters

Provide language translational services

Question 23

Patient Journey Officer Role

Answer 23

Assist patients and their families who are travelling from rural, remote and regional communities

Question 24

Communication barriers

Answer 24

Lack of understanding of:
- the impact of historical policies and practices on health
- diversity within and across people
- importance of language use - ‘othering’, creating power imbalances, impact of mixed messaging
- racism in health

Question 25

Communication enablers

Answer 25

Recognise, understand and respond appropriately to trauma (trauma-informed care)

Understand social determinants of health

Employ strength based and rights based approaches to health services - Indigenous Allied Health Australia

Cultural Safety through responsive health practice

Preventing re-traumatisation –> awareness, understanding, education

Question 26

Trauma informed principles

Answer 26

1. Leadership
2. Culture
3. Learning System

Question 27

Trauma informed care

Answer 27

Understand trauma and its impact on individuals, families and communal groups

Promote safety

Ensure cultural competence

support clients control

share power and governance

integrate care

support relationship building

enable recovery

Question 28

Social and cultural determinants of health

Answer 28

Social:
- Social support networks
- Income/social status
- employment and education
- occupation
- access to services (support, public transport, health services)
- Government policy

Cultural:
- Age, gender
- Sexual orientation, ethnicity, religion
- physical and mental ability
- organisational culture
- Discrimination / racism

Question 29

Code of conduct for health professionals

Answer 29

Principle 1:
- Practitioners should practice safely, effectively and in partnership with patients and colleagues
- Use patient centred approaches
- Use best available evidence to achieve best possible patient outcomes

Principle 2:
- Practitioners should consider the specific needs of ATSI and their health cultural safety
- Foster open, honest and culturally safe professional relationships

Principle 3:
- Respectful and culturally safe practice required practitioners to have knowledge of how their own cultural, values, attitudes, assumptions and beliefs influence their interactions with people and families

Question 30

Indigenous peoples protected rights

Answer 30

1991 Anti Discrimination Act

Four fundamental rights
1. Self determination
2. Participation in decision making
3. Respect for and protection of culture
4. equality and non-discrimination

Question 31

Where can you see opportunity
for cultural safety in practice?

Answer 31

1. Self reflective practice
2. Engaging in discourse
3. Minimising power
4. Valuing, appreciating or empowering cultural differences
5. undergoing a process of decolonisation

Question 32

What is shame and guilt

Answer 32

Shame = self conscious emotion associated with negative evaluation of self

Guilt = feeling responsible or regretful for a perceived offence, real or imaginary

Question 33

How to achieve liberation

Answer 33

Removing barriers

Question 34

What documents detail indigenous rights

Answer 34

United Nations declaration on the rights of indigenous people (UNDRIP)
Australian charter of healthcare rights

Question 35

SBAR

Answer 35

Situation, background, assessment and recommendation

It is a structured communication framework that can help teams share information about the condition of a patient