Cultural Safe Practice Flashcards
What is culture
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
What is Cultural Competence?
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.
What is cultural awareness
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
What is cultural sensitivity
Alerts people to the legitimacy of difference and begins a process of self-exploration
What is cultural safety
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
What is cultural responsiveness
The lifelong practice of cultural safety, reflection on interactions and action
The Cultural Safety Continuum
Cultural Awareness –> Cultural Sensitivity –> Cultural Safety –> Cultural Responsiveness
Principles of cultural safety
- Self Reflection
- Engage in discourse
- Undertake a process of decolonisation
- Ensure you do not diminish, demean or disempower others through actions
- Seek to minimise power differentials
Cultural Safety - Self Reflection
Being aware of your own cultural identity
Understanding your own assumptions, beliefs, and values about yourself and about the people that you care for
Cultural Safety - Engage in Discourse
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
Cultural Safety - Decolonisation
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
Flow on effect of colonisation
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
Cultural Safety - Disempowerment
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
Cultural Safety - Power Differentials
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
What are some culturally unsafe indigenous experiences of cancer treatment
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
Barriers to aboriginal health
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
Enablers of aboriginal health
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
Cancer beliefs of indigenous peoples
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
Government priorities in improving healthcare
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
First Nations health professionals
Cultural capability officer
Indigenous health liaison officer
Patient journey officer
Aboriginal health worker
Cultural Capability Officer Role
Actively participate in cultural improvement opportunities for the business
Contribute to the development of positive outcomes
Indigenous Health Liaison Officer Role
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
Patient Journey Officer Role
Assist patients and their families who are travelling from rural, remote and regional communities
Communication barriers
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
Communication enablers
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
Trauma informed principles
- Leadership
- Culture
- Learning System
Trauma informed care
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
Social and cultural determinants of health
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
Code of conduct for health professionals
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
Indigenous peoples protected rights
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
Where can you see opportunity
for cultural safety in practice?
- Self reflective practice
- Engaging in discourse
- Minimising power
- Valuing, appreciating or empowering cultural differences
- undergoing a process of decolonisation
What is shame and guilt
Shame = self conscious emotion associated with negative evaluation of self
Guilt = feeling responsible or regretful for a perceived offence, real or imaginary
How to achieve liberation
Removing barriers
What documents detail indigenous rights
United Nations declaration on the rights of indigenous people (UNDRIP)
Australian charter of healthcare rights
SBAR
Situation, background, assessment and recommendation
It is a structured communication framework that can help teams share information about the condition of a patient
