Cultural Safety Flashcards
equality
sameness, it promotes fairness and justice by giving everyone the same thing, BUT it can only work IF every one starts from the SAME place
equity
fairness, it is about ensuring people get access to the same opportunities. sometimes our differences and/or history can create BARRIERS to participation, so we must FIRST ensure EQUITY before we can enjoy equality
liberation
removing barriers => freedom to enjoy the highest attainable standard of physical and mental health
what is cultural safety
an environment which safe for people, where there is no assault, challenge or denial of their identity, of who they are and what they need. its about shared respect, shared meaning, shared knowledge and experience of learning together with dignity and truly listening
cultural awareness
is a beginning step towards understanding that there is difference. many people undergo courses designed to sensitise them to formal ritual rather than the emotional, social, economic and political context in which people exist
cultural sensitivity
alters people to the legitimacy of difference and begins a process of self-exploration as the powerful bearers of their own life experience and realities and the effect this have on others
cultural safety
is an outcome of education that enables safe service to be defined by those who receive the service
cultural responsiveness
the lifelong practice of cultural safety, reflection on interactions and actions
culturally unsafe Indigenous experiences of cancer treatment
- high cost (travel, accommodation, treatment, medicine - shame associated with lack of affordability)
- hospital environment and processes no recognition of cultural factors, confusing
- lack of flexibility in hospitals for extended family
- communication (use of medical jargon, not recognising holistic approaches to healing and well-being (physical, mental, emotional, spiritual)
barriers
- lack of logistical access to treatment facilities and specialists 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 factors
enablers to healtcare access
- 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
communication barriers
lack of understanding of
- the impact of historical policies and practices on health
- diversity within and across people i.e. differences in cultural connectedness, differences in relationship terms and connections, differences in education levels
- the importance of language use - ‘othering’, creating power imbalances, impact of mixed messaging
- racism in health - impact of stereotypes, unpacking white privilege
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
- preventing re-traumatisation; awareness, understanding and education; safety; control and choice; relationships, connections and collaboration; empowerment, strength and resilience; and cultural competence and diversity
what is trauma informed care
is an approach in healthcare and social services that acknowledges the widespread impact of trauma and understands potential paths for recovery. It emphasizes creating a supportive environment to avoid re-traumatization and promotes healing and empowerment.
trauma-informed principles
- understand trauma and its impact on individuals, families and communal groups
- promotes safety
- ensure cultural competence
- support client’s control
- share power and governance
- integrate care
- support relationship building
- enable recovery
What are the barriers to cancer care access and use for Aboriginal and Torres Strait Islander peoples
- lack of practical and logistical access to treatment
healthcare systems:
- lack of cultural capability (i.e., culturally competent and safe services)
- fear of healthcare systems (i.e., experiencing disempowerment or discrimination/racism)
- distrust of healthcare systems
- unmet needs and preferences (i.e., failure to include family and community, failure to change communication style and non-verbal communication, failure to overcome language barriers leading to miscommunication, inadequate information, explanation and follow up care)
cultural factors:
- lack of knowledge about cancer (benefits of treatment and likelihood of survival)
- cultural perceptions around cancer (feelings of shame)
- nihilism, fatalism and fear
- traditional beliefs around cancer (belief that cancer is a form of punishment, part of their fate, result of a curse, fault of the ‘white man’ after colonisation, or contagious)
- use of traditional medicines
socioeconomic factors:
- poorer education
- higher rates of unemployment
- lower income
What are the enablers to cancer care access and use for Aboriginal and Torres Strait Islander peoples?
- staff communication, education, cultural capability and use of assessment tools
- healthcare systems continuous improvement, First Nations Health Professionals (i.e., cultural capability officer, indigenous health liaison officer, patient journey officer or Aboriginal health worker) and telehealth and outreach services such as cancer education sessions, prevention and screening programs and site visits
- collaboration and linkages with other healthcare providers
What are the barriers to communication for Aboriginal and Torres Strait Islander peoples?
- impact of historical policies and practices (i.e., colonisation)
- diversity within and among people (i.e., socio-cultural factors)
- importance of language (i.e., othering, power imbalances, and mixed messaging)
- impact of discrimination/racism (i.e., systemic racism and person racism, biases, stereotypes, assumptions, prejudices)
What are the enablers to communication for Aboriginal and Torres Strait Islander peoples?
- recognise, understand and respond to trauma (i.e., trauma-informed care)
- understand social and cultural determinants of health
- employ strengths- and rights-based approaches to care to support rights and dignity of patients (i.e., self-determined decision-making, partnership and collaboration through involvement of family and community)
- cultural safety through responsive care (i.e., knowledge, skills, attitudes and competencies to deliver holistic care free from bias and racism)
- prevent re-traumatisation
What is the role of an Indigenous Health Liaison Officer (IHLO)?
- assist multi-disciplinary teams to provide clinical and primary healthcare for patients and their families
- engage with patients and providers and assist in arranging, co-ordination and providing culturally appropriate healthcare
- assist patient’s and their families by providing (1) explanation of hospital system, (2) support and advocacy when speaking to hospital staff, (3) language translation services, (4) explanation of different types of services available at the hospital, (5) accountability to improve treatment adherence and completion and (6) transportation support
discuss some cancer-specific indigenous population statistics
- higher cancer incidence
- higher mortality
- lower 5 year survival
- cancer diagnosis is more advanced, more preventable cancers
- higher comorbidity
- less likely to participate in screening
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?
refers to the ability of individuals and organizations to interact effectively and respectfully with people from diverse cultural backgrounds. It involves understanding, appreciating, and appropriately responding to cultural differences and similarities
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.
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
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
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
Patient Journey Officer Role
Assist patients and their families who are travelling from rural, remote and regional communities
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
