Working with the indigenous

Question 1

What is the purpose of using appropriate terms to describe their groups when relating to indigenous people?

Answer 1

History and attitudes dominate relationships with indigenous groups around the world. This often means that non indigenous colonists and their descendants demonstrate attitudes and use terms that are discriminatory and offensive to the relevant peoples.

It is important then that health professionals avoid causing offence by ensuring they understand and use the current terms that are appropriate when relating to indigenous peoples.

Using appropriate terms is essential for the development of trust, therapeutic relationships and family/community centred goals and practice. Using correct terms also contribute to positive experiences that will ensure Indigenous people continue to seek assistance from health services. (Page 206)

Question 2

Explain why each individual has a unique cultural identity?

Answer 2

Every individual has a particular identity that is unique to that group (Anngela-Cole et al 2010, Hampton & Toombs 2013, Holliday et al 2010) The nationality of the individual provides a particular cultural identity that accompanies values, traditions, beliefs and expectations (of self and others) specific to that nation. Membership of other groups – families, clans (in New Zealand iwi = tribe and hapu = subtribe), communities, sporting groups, religious groups, educational groups, employment groups and political groups – creates additional aspects of cultural identities that relate to and affect the national and/or cultural identity of each person.

If an individual has lived their entire life with their kinship group at a traditional birthplace, their cultural identity will strongly reflect their national group. If the individual was separated from their traditional birthplace early in their life, then their cultural identity might be a mix of other cultures including their original culture.

The complexity of cultural identity indicate it is important that health professionals recognise the factors affecting that identity. It is also essential that health professionals acknowledge there are variations within indigenous peoples that prohibit the stereotypical labelling of any individual because of their ethnicity or nationality.

Question 3

How can I demonstrate cultural safety with indigenous peoples?

Answer 3

Understanding the concept of cultural safety is essential when relating to indigenous peoples from any country. Practice that respects, supports and empowers the cultural identity and wellbeing of an individual produces cultural safety (Nursing Council of New Zealand 2002). Such practice is more than mere awareness or sensitivity; it mandates attitudes of equality and collaboration with the Indigenous community (Lowell 2013). It allows the Indigenous community to have power when receiving health interventions – it is community-centred practice. It also requires action that results from critical reflection about the personal values of the health professional (DiGiacomo et al 2010, Stein-Parbury 2014) and evaluation of personal attitudes and beliefs.

It requires the health professional to acknowledge and accept that their own values and beliefs may be different to those of the in indigenous persons they assist in daily practice (Eckermann et al 2010). This acknowledgment and acceptance should assist the health professional to avoid imposing their own values onto the Indigenous Person/s. Culturally safe practice also requires awareness of and reflection about the culture and values of the particular health service (Alvarez et al 2014, Noe et al 2014, Walker et al 2014). (Page 209)

Question 4

List the five main steps that create culturally safe practice when working with indigenous peoples:

Answer 4

1. Recognise that different cultures have different concepts of spirituality. This can mean that people within that culture prioritise looking after sick family members of factors such as their career.
2. It is important to understand kinship obligations within different cultures. Accommodating this factor may mean providing provisions of a particular area or room for the indigenous peoples to gather.
3. Recognise that indigenous people experience different life circumstances, family histories and community than non indigenous peoples. Many indigenous people experience disease related to poverty and there life expectancy may be shorter when compared to non indigenous people.
4. It Is important to recognise that Indigenous people may react differently to people and the healthcare environment. Some Indigenous peoples may find it difficult operating outside of their community and may show apprehension and reluctance to cooperate.
5. It is important to recognise that the English language may be indigenous peoples second or third language and that in some situations the use of an interpreter is vital to communicate respectfully.

Question 5

Identify eight factors that contribute to the creation of culturally responsive and congruent communication for Indigenous peoples.

Answer 5

1. In some situations it is best to have a soft/informal manner when communicating with indigenous clients.
2. It is important to consider the correct people to approach or include when giving important information.
3. Establish relevant contacts such as local community elders or other relevant organisations.
4. Avoid making assumptions.
5. Open communication that embraces differing communication styles.
6. Ask other health workers with the appropriate cultural background questions such as how to best communicate with members within a specific culture.
7. Listen to what the indigenous people are saying just like any other client.
8. Invest time to establish trust within the therapeutic relationship.

Question 6

List seven barriers to the creation of culturally responsive and congruent communication.

Answer 6

1. Stereotyping
2. Failure to establish a sense of equality and collaboration
3. Failure to explore the actual meaning of words and behaviours
4. Failure to understand that some indigenous people may feel like they have to say the answer which the health professional wants to hear instead of the true answer.
5. Failure to develop trust and overcome any previous negative experience that the indigenous person may have had with the health service.
6. Failure to listen patiently and quietly
7. Failure to clarify understanding

Question 7

Describe how a health professional might overcome at least four of the barriers to culturally responsive and congruent communication.

Answer 7

1. Avoid stereotyping by being self aware of your own personal biases. Actively seek out information whether that be online or people belonging to that specific culture in real life.
2. Establish a sense of equality by accommodating the clients cultural practices during communication. This could mean being aware of eye contact, physical distancing, NVCs and also speech patterns. It may also be best to involve an interpreter in order to carry a your point over correctly. However you must make sure to address the person and not the interpreter.
3. Make sure to actively ask questions in order to gauge your clients comprehension of what you are saying is correct in an effort to avoid misunderstandings.
4. Make sure you don’t lead with questions and always give the client time to process the information provided and clarify any possible questions they may have. Invest appropriate time into the therapeutic relationship so that they know you really do care for them and value their honestly instead of merely trying to tick a box and get the session over with.