Recognising the many factors that were involved – the dispersal, dislocation, isolation, and lack of acceptance of Aboriginal and Torres Strait Islander people over many generations is imperative. Dispossession of land and family, interruption of culture and intergenerational trauma have significantly impacted on the health and wellbeing of Aboriginal and Torres Strait Islander peoples.
The cultural capability of health services is an important additional factor impacting on health, influencing whether care will be accessed, and the quality and effectiveness of the care received. IPEPA Cultural Considerations1
It is important that students undertaking these toolkit activities have a sound understanding of cultural safety as it provides the framework for provision of culturally-responsive palliative care.
Some key points are listed here, with a suggested review activity for each, to support students in enhancing their understanding if needed:
|The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 provides the following information:
Update Activity: To refresh your understanding of the expectations of registered health practitioners in Australia, review the following key documents:
|Cultural awareness helps you understand about different cultures, the focus is outwards (on others). Often people find that learning is ‘interesting’ but not necessarily challenging.
Cultural safety involves an inward focus and examination of your own beliefs, behaviours and practices – ‘cultural self-awareness’. It involves recognising, understanding and responding to biases and racism.
In contrast to cultural awareness training, learning cultural safety is often ‘uncomfortable’ as it challenges personal truths and accepted norms, encouraging critical self-reflection. It explores privilege, power and systems that create disadvantage, and how this shapes the lives of people from various backgrounds.
Update Activity: To refresh your understanding, review a current textbook chapter on cultural safety in health, for example:
Cox, L., Taua, C., Drummond, A., and Kidd, J., (2021). Enabling Cultural Safety. In J. Crisp, C. Taylor, C. Douglas & G. Rebeiro (Eds.) Fundamentals of nursing, 6e. (pp. 49-83). Sydney: Elsevier.
|In Australia, there has been increasing recognition that improving cultural safety in healthcare can improve not only Australian Indigenous peoples’ access to healthcare but improve the quality of the healthcare they receive.4
The Indigenous Allied Health Association (IAHA) Framework provides this definition of cultural-responsiveness:
‘Culturally-responsive’ describes the ways that we need to engage with people to provide culturally-safe care. A culturally-responsive approach to care requires caregivers who are able to comfortably interact and work with people, families and communities who are both similar and markedly different.
Providing culturally-safe and responsive care requires health professionals (and health services) to develop the ability to understand and effectively interact with people across diverse cultural groups. It involves becoming aware of the cultural differences that exist, appreciating and having an understanding of those differences and accepting them. It also means being prepared to guard against viewing or perceiving one’s own behaviours, beliefs and actions as the norm.
Cultural-responsiveness requires a life-long process of self-reflection and self-critique. It does not require mastery of lists of ‘different’ or ‘unique’ beliefs and behaviours, supposedly pertaining to other cultures, rather it encourages development of a respectful and responsive attitude toward diverse points of view.
To provide culturally-responsive care requires health systems and services to structurally embed cultural safety. Individuals cannot practise in a culturally-responsive way unless the barriers to cultural safety in the systems in which they work are addressed.
Update Activity: Cultural Competence Continuum, developed as part of the Aboriginal Cultural Competency Framework provides a helpful reflection tool for organisational cultural competence.6
Read through the descriptions for each of the points on the continuum and consider, how you would rate your most recent practice setting.
- PEPA Project Team, Cultural Considerations: Providing end-of-life care for Aboriginal peoples and Torres Strait Islander peoples. 2020, Program of Experience in the Palliative Approach.
- AHPRA and National Boards, The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025. 2020.
- Australian Health Ministers’ Advisory Council, Cultural Respect Framework (2016-2026) for Aboriginal and Torres Strait Islander health: A national approach to building a culturally respectful health system, Australian Government Department of Health, Editor. 2016.
- Australian Institute of Health and Welfare, Culturally safe health care for Indigenous Australians, in Australia’s Health: Snapshots. 2020, Australian Government: ACT.
- Indigenous Allied Health Australia. Cultural Responsiveness in Action: An IAHA Framework. 2019; Available from: https://iaha.com.au/workforce-support/training-and-development/cultural-responsiveness-in-action-training/.
- Victorian Aboriginal Child Care Agency, Aboriginal Cultural Competency Framework, Victorian Government Department of Human Services, Editor. 2008. p. 24.