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Diversity and Health: Introduction to Indigenous and Multicultural Perspectives

Nursing and Cultural Diversity

Name: Amelia Elliott Student Number: n7526016 Due Date: 6th of June 2011 Word Count: 1279 words

Amelia Elliott

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Nursing and Cultural Diversity

The following essay will look at issues regarding diversity and health. It will analyse these issues from the point of view of a nurse and the way they approach nursing care with patients of varied cultures. It will discuss two philosophies of nursing; cultural safety and trans-cultural nursing and outline the similarities and differences between them, personal (cultural background and life experiences) and systemic (cultural characteristics of systems, societies, or organizations) factors that can influence the way a patient is cared for and look at pathways of positive change for the future of nursing. Nursing care can be divided into two models; cultural safety and trans-cultural nursing. Cultural safety is an approach to health care that focuses on putting the cultural needs of the patients at the centre of nursing care. It encourages the health care provider to analyse their own culture and how their values and beliefs can determine the way they treat a patient of another culture (keeping in mind that all interactions between the client and health professional are bi-cultural). The nurse needs to recognise that their own cultural identity impacts the way they practise nursing. Whether a health professional has successfully treated a patient in a culturally safe way is decided by the patient themselves, and whether they feel they have been treated according to their needs (Eckermann et al., 2006). Trans-cultural nursing focuses on learning about another culture in order to understand the people within it. It involves understanding a cultures practices, values and beliefs and using this knowledge to provide health care that is culturally specific (Coup, 1996). Cultural safety and trans-cultural nursing are similar in the fact that the health practitioner has to have some understanding of the patients culture and they both aim to provide more culturally specific care to people. However, they differ on many points. Cultural safety is about self analysis and an understanding of an individuals culture (Eckermann et al., 2006), whereas trans-cultural nursing reduces culture to ethnicity and is about knowledge of other cultures; it stereotypes individuals according to their ethnic group and does not recognise that even though people may belong to the same ethnic group they can have very different individual cultures. Trans-cultural nursing assumes that an individual can be appreciated by learning aspects of their culture as a whole. Cultural safety approaches health care on a more individual level, and does not define a person by their ethnicity but rather by asking them what their cultural

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needs are, instead of assuming them. Due to this, cultural safety gives power to the client as they get to choose the way in which they are to be treated; transcultural nursing keeps the power to choose treatment in the hands of the nurse. In this way, cultural safety looks upon the patient from within and trans-cultural nursing takes an external viewpoint towards the person. An aspect of cultural safety is that the nurses understand that the culture of nursing (environment, language and people) can seem very different to people they encounter who have not been exposed to it. It involves understanding that the way a nurse views health can be very different from the patients view. Trans-cultural nursing tends to ignore this, which can marginalise the patient by not listening to their needs when they are in a different environment to what they are comfortable with. Another major difference between the two philosophies is that cultural safety teaches that individuals are experts on their own culture unlike trans-cultural nursing where people can become experts on anothers culture by studying it (Coup, 1996). Personal factors such as ones cultural background and life experiences can influence the way a nurse cares for culturally diverse patients. Ones culture is made up of a unique set of attributes such as class, gender, age, family, religion, philosophy, ethnic identity and education. All of these can have an effect on someones values, beliefs and attitudes. A personal factor that may cause my own nursing care to be made difficult in the approach of cultural safety would be that I can be narrow-minded. When another person has a belief or attitude about something that is different to mine, sometimes I have difficulty in understanding it and can take the approach that their idea is invalid. I would never tell a client this, but it could still have an impact on the way I care for them. Being narrow-minded could cause me to neglect a patients cultural needs due to not understanding the importance of them or seeing them as trivial. This would be practising in a culturally unsafe way. An example of this could be described by a scenario. If a patient were to refuse treatment that could possibly save their life because their view of what happens after death is different to mine, I would probably try to persuade them to take the treatment anyway because of my doubts about their beliefs. I feel that in this situation I should remember that each persons reality is as valid as my own, and I should respect that (Ramsden, 2002). Due to the dominance of the white Australian culture, racism and discrimination have become embedded into the Australian health care system. Systemic factors

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within the cultures of hospitals, nursing, medicine and politics have greatly disadvantaged the Indigenous population. These factors lead to culturally unsafe practices for clients and their families. The western view of health is very different to that of the Australian Indigenous populations. The culture of the western health system revolves around the biomedical dominance model, whereas the Indigenous populations view of health does not (Willis, Elmer, 2007). The National Aboriginal Health Strategy Working Party (1989) defines health as being able to determine all aspects of ones life, including their dignity and community self-esteem not merely the absence of disease. Unfortunately systems, processes and mentalities in hospitals and other health institutions in Australia do not accommodate this view very well. The reliance on the biomedical dominance model can marginalise Indigenous patients. For instance, the lack of understanding about how Indigenous people view health in our mainstream health care system can cause healthcare practitioners to overlook and ignore the reasons why the patient is not recovering or does not want the recommended treatment; perhaps coming to the conclusion that they have a mental illness or forming the opinion that they are unintelligent and unco-operative. In these circumstances, the culture of the hospital is causing the health professional to practise in a culturally unsafe way.

The above discussion supports cultural safety as a practice that would greatly benefit Indigenous health in Australia. Therefore, individuals should have to partake in a course on cultural safety to increase their cultural awareness, and institutions should seek to reform their systems in order to accommodate varied individuals. Miller, Dunn and Currell (2005) express the view that as early as primary school children should be educated about Indigenous Australians from a non-white Australian perspective in order to create a fair image of Indigenous people in young Australians minds; one free from stereotypes and racism (whether covert or overt). Through the continued education of students and health practitioners about cultural safety the future for Indigenous health could be improved by the dominant culture learning to understand and validate Indigenous culture and the individuals within it. One project that has already included the philosophy of cultural safety into its practice is Positive Images of Mens Health. They promote holistic care, considering an individuals needs in regard to their physical, emotional, social, cultural, environmental, economic, political and spiritual wellbeing (Positive Images of Mens Health, 2003). This is not unlike Indigenous peoples view of health and wellbeing. If institutions today could

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incorporate these aspects into the way they operate it would be a step in the right direction to caring for Indigenous patients in a culturally safe way.

Reference List
1. Coup, Anne. (1996). Cultural safety and culturally congruent care: a comparative analysis of Irihapeti Ramsdens and Madeline Leiningers educational projects for practice. Nursing Praxis in New Zealand, 11 (1), 411. 2. Eckermann, A. Dowd, T. Chong, E, Nixon, L. Gray, R. Johnson, S. (2010). Binan Goonj: Bridging Cultures in Aboriginal Health (3rd Ed.). NSW: Elsevier 3. Miller, Dunn and Currell. (2005). Phillips, Jean and Lampert, Jo (2005). Introductory Indigenous studies in education: the importance of knowing. NSW: Pearson. 4. National Aboriginal Health Strategy Working Party. (1989). A National Aboriginal Health Strategy, Canberra, National Aboriginal Health Strategy Working Party. 5. Positive Images of Mens Health: Pilot project. (2003). Men from Culturally and Linguistically Diverse Backgrounds 6. Ramsden, I. M. (2002). The Appropriateness of Cultural Safety for Nursing and Midwifery. Cultural safety and nursing education in Aotearoa and Waipounamu, Wellington, N.Z: University of Wellington. 7. Willis, K. Elmer, S. (2007). Society, Culture and Heath: An Introduction to Sociology for Nurses. Victoria: Oxford University Press. .

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