Cultural Safety Modules

Question 1

What is epistemology?

Answer 1

The theory of knowledge, especially with regard to its methods, validity, and scope, and the distinction between justified belief and opinion.

Question 2

What is ontology?

Answer 2

The science of “being” in general; we are objects and subjects of the knowledge systems we live, work and grow within (what informs who we are as individuals, as members of a community etc).

Question 3

What is axiology?

Answer 3

The study of the nature of values and value judgements and how these apply to decision-making and behaviour; our epistemologies and ontologies manifest in our axiology.

Question 4

What does “Traditional Knowledge” or “Aboriginal and Torres Strait Islander Knowledge” consist of?

Answer 4

The practices, skills, innovations and know-how of Aboriginal and Torres Strait Islander peoples.

Specifically: language, song, stories, expressions of art, rituals/ceremonies/lore, management of the land including flora and fauna.

Question 5

How is “Traditional Knowledge” or “Aboriginal and Torres Strait Islander Knowledge” shared?

Answer 5

Through oral transmission

Question 6

Why should we be cautious when referring to Aboriginal and Torres Strait Islander peoples as “traditional” owners?

Answer 6

It risks relegating their knowledge and importance to the past. It is important to affirm that Aboriginal and Torres Strait Islander knowledges shape contemporary understandings and continue to be upheld in the present (Griffiths, 2023).

Question 7

What is cultural safety?

Answer 7

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.

Question 8

As outlined by Eckermann (2010), what are some of the underlying assumptions behind cultural safety that apply to all health and community services?

Answer 8

1.Unchallenged, mainstream health services in colonial countries that employ the biomedical model of health care prolong colonisation.
2. Mainstream health services find it difficult to value the differences between people.
3. Each interaction between client and health professional is bicultural.
4. Health practitioners are in a privileged and powerful position in society
5. Negative attitudes held by people in power have a major impact on the identity of others
6. Those in positions of power have a choice of either perpetuating or changing their dominating practices
7. Respect leads to trust, which in turn leads to negotiation.

Question 9

Describe Ramsden’s (2003) model for cultural safety.

Answer 9

1. Cultural awareness - is the beginning step towards understanding that there is a difference
2. Cultural sensitivity - alerts individuals to the legitimacy of difference and begins the process of self-exploration
3. Cultural safety - is an outcome that enables safe service to be defined by those who receive the service

Question 10

Describe Coffin’s (2007) model for cultural safety.

Answer 10

1. Cultural awareness - are individuals that are self-aware of their own culture and are willing to be able to recognise and accept cultural differences.
2. Cultural safety - the application of knowledge, skills and attitudes to empower Aboriginal and Torres Strait Islander peoples.
3. Cultural security - a systematic, organisational approach to ensure individual and community needs are met and sustained.

Question 11

As per Coffin’s (2007) model of cultural safety, is cultural awareness sufficient in creating change?

Answer 11

Cultural awareness alone is inadequate in terms of achieving genuine change in Aboriginal and Torres Strait Islander peoples’ experience of services and outcomes.

“The basic understanding does not lead into action. There is no common or accepted practice and what actions are taken depends upon the individual and their knowledge of Aboriginal culture and cultural security” (Coffin, 2007).

Question 12

How does the Victorian Aboriginal Child Care Agency report the concept of cultural safety?

Answer 12

“It is used in the context of promoting mainstream environments which are culturally competent. But there is also a need to ensure that Aboriginal community environments are also culturally safe and promote the strengthening of culture”

Question 13

What does cultural safety involve according to Eckermann (2010)?

Answer 13

It involves a shift in the power structures of healthcare.

Question 14

What does Saleebey (1996) say is an advantage of a strengths-based approach to health and community services?

Answer 14

It challenges the deficit and pathology-based thinking of the biomedical model and the “destructive emphasis on what is wrong, missing, or abnormal”.

Question 15

What is the strengths-based alternative to the deficit-based thought, “the client has a problem”?

Answer 15

The client has talents and resources.

Question 16

What is the strengths-based alternative to the deficit-based thought, “the goal is to fix the problem”?

Answer 16

The goal is to empower.

Question 17

What is the strengths-based alternative to the deficit-based thought, “therapy is problem focused”?

Answer 17

Therapy is solution focused.

Question 18

What is the strengths-based alternative to the deficit-based thought, “The professional is the expert”?

Answer 18

Both the professional and client are experts.

Question 19

What is the strengths-based alternative to the deficit-based thought, “Actions are driven by the professional”?

Answer 19

Actions are inspired by the client.

Question 20

What is the strengths-based alternative to the deficit-based thought, “Personal accounts assist diagnosis”?

Answer 20

Personal accounts assist in knowing the client.

Question 21

What is the strengths-based alternative to the deficit-based thought, “Resources are knowledge and skills of the professional”?

Answer 21

Resources are the strengths of the individual, family or community.

Question 22

When working with Aboriginal and Torres Strait Islander peoples, strengths-based approaches that focus on health assets (Brough et al., 2004) include what?

Answer 22

1. Community events
2. Neighbourhood networks and commitment to community
3. Extended family
4. Community organisations

Question 23

Name some of the protective factors of Aboriginal and Torres Strait Islander peoples that are supported when following a strengths-based approach.

Answer 23

Personal aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms and cultural connectedness (Henson et al., 2017).

Question 24

What steps should professional individuals use to ensure culturally safe and respectful practice?

Answer 24

1. Acknowledge colonisation and systemic racism, social, cultural, behavioural, and economic factors that impact individual and community health;
2. Acknowledge and address individual racism, their own biases, assumptions, stereotypes and prejudices and provide care that is holistic, and free of bias and racism;
3. Recognise the importance of self-determined decision-making, partnership and collaboration allowing work to be driven by the individual, family and community;
4. Foster a safe working environment through leadership to support the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues.

Question 25

What are the five cross-cultural capabilities as defined by Queensland Health?

Answer 25

1. Self Reflection
2. Cultural Understanding
3. Context
4. Communication
5. Collaboration

Question 26

What are the five components of the Cultural Safety Continuum?

Answer 26

1. Unlearn
2. Learn
3. Apply
4. Reflect
5. Embed

Question 27

In the case study about the QLD Health Inala Community Centre, what were some of the barriers that meant Aboriginal and Torres Strait Islanders were not attending the clinic?

Answer 27

1. No Indigenous person was working there
2. Staff were perceived as unfriendly and uncaring
3. Staff communications suggested they were not wanted at the clinic
4. Long wait times to see a doctor
5. There was “nothing”at the centre that Aboriginal and Torres Strait Islander peoples could identify with.

Question 28

In the case study about the QLD Health Inala Community Centre, what were some of the changes made that saw more Aboriginal and Torres Strait Islander peoples attend the clinic?

Answer 28

1. More Indigenous staff
2. Culturally appropriate waiting room
3. Cultural awareness training for staff
4. Dissemination of information about services in the local community
5. Promote intersectional collaboration with community controlled services and agencies

Question 29

What are the principles of practice applied by Dr Ashim Sinha at the Thursday Island Primary Health Care Centre?

Answer 29

1. Indigenous leadership
2. Cultural safety and equity
3. Person-centred and family-oriented
4. Flexibility and innovation
5. Integration and continuity of care

Question 30

What did McDermott and colleagues (2003) find following a one-year randomised cluster trial in the Torres Strait?

Answer 30

“A one-year randomised cluster trial in the Torres Strait showed reduced hospital admissions and improved care processes when local Indigenous health workers were supported by outreach specialist services to provide basic diabetes care plans and patient recalls. A three-year follow-up clinical audit showed that clinical improvements remained two years after the trial”

Question 31

What are some of the biases that Ray Badger (case study one) had heard of prior to his kidney transplant?

Answer 31

1. A lot of Aboriginal patients end up dying on dialysis before they get a kidney because they don’t look after themselves properly;
2. People who don’t follow the rules, particularly people who miss sessions or turn up with hangovers, get a bad reputation and won’t get a kidney; and
3. They don’t waste kidneys on people who let other health problems develop

Question 32

What was the main barrier that Ray Badger faced in the lead up to his kidney transplant?

Answer 32

The main barrier that was identified was that the wait list for receiving a kidney in Victoria was a lot longer than other states. He relocated to NSW, then to SA to make sure he was more likely to receive a kidney.

Question 33

After re-rupturing her ACL a second time, what were some of the skills Selina Kyle (case study two) used to improve the quality of her rehabilitation?

Answer 33

1. Continuity of care - accessing the same team of healthcare providers from her first injury
2. Integration of family to keep her accountable with rehabilitation (making sure appointments are booked etc)
3. Maintaining communication with her team and coaching staff to remain a part of the team
4. Use of positive affirmation and self-empowerment techniques to avoid relapsing to a dark mental state from her first rupture
5. Attending NRL workshops such as State of Mind
6. Channelling her energy into hobbies to positively impact her personal drive and mental health

Question 34

What adjustments have been made to Mary Jones’ (case study three) home to assist her in activities of daily living?

Answer 34

1. Installation of a ramp at front door, grab-rails in shower and beside toilet, shower chair and over toilet aid
2. Moving furniture so she can walk around the house with her wheelie walker and manual wheelchair and positioning her coffee table so she can use it as a ramp to help herself get back up if she falls
3. Creating room for her exercise program which includes doing laps around her Persian (race track) rug
4. Adjusting kitchen utensils to increase her independence with simple meal preparation including being able to open jars/cans and making herself a cup of coffee

Question 35

How has the ATSICHS (Aboriginal and Torres Strait Islander Community Health Service) assisted Mary with her social and emotional wellbeing?

Answer 35

Mary was frustrated at her new level of dependence, and can find it hard to accept this is now her life. She often felt as though she was a burden to her family, as she could not ask her family to help take her to appointments as it would be difficult to manage with full time work.

The ATSICHS have offered Mary a high level of support, where the staff are accessible by phone and in person if she requires assistance (such as getting to appointments, or if she has had a fall). Mary says they are like an extended family to her.

Question 36

What were some of the negative stereotypes that Katie Smith (case study four) was exposed to throughout her senior schooling?

Answer 36

1. Her broad swimmers shoulders
2. Being Indigenous
3. Alcohol and marijuana consumption

(Essentially negative stereotypes about Aboriginal and Torres Strait Islanders)

Question 37

Did Katie Smith (case study four) feel supported by her school?

Answer 37

No - she sought the help of the school guidance counsellor, yet as they were not Indigenous, Katie often found she did not receive the understanding or level of support she needed. This often left her feeling alone and isolated.

Question 38

What were some of the barriers Katie Smith (case study four) found upon her transition to the Indigenous Coordinator Role?

Answer 38

1. She was expected to maintain this workload onto of her role in Special Education
2. Indigenous knowledges and perspectives were never a priority for the school
3. Ideas were refused and there was tokenistic allocation of resources within her programs
4. The school did not offer adequate space for Aboriginal and Torres Strait Islanders to use whilst other groups got sufficient space

Question 39

What were some of the approaches Katie Smith (case study four) used in her mental health recovery?

Answer 39

1. Attended a psychologist and had a devised mental health care plan
2. Took up walking in the local bushland as means of exercise and connection to country
3. Going out to where her father was born to make connection to traditional country and meet her extended family (allowing her to build and invest in her identity and connection to culture)