Prerequisite knowledge: Cultural safety and culturally-responsive care Archives

This resource acknowledges and is respectful of the many people who did not grow up with their families and community; who grew up without the influence of their heritage or knowledge of traditional and contemporary cultural ways.

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.

Key points are listed here, with a suggested review activity for each, to support students in enhancing understanding:

Key Point 1: Feeling ‘culturally-safe’ is the experience of the care recipient, and not something defined by the caregiver.
The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 provides the following information: Definition: Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practice is 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. How to: To ensure culturally safe and respectful practice, health practitioners must: ・Acknowledge colonisation and systemic racism, social, cultural, behavioural and economic factors which impact individual and community health ・Acknowledge and address individual racism, their own biases, assumptions, stereotypes and prejudices and provide care that is holistic, free of bias and racism ・Recognise the importance of self-determined decision-making, partnership and collaboration in healthcare which is driven by the individual, family and community ・Foster a safe working environment through leadership to support the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues.² Update Activity: To refresh your understanding of the expectations of registered health practitioners in Australia, review the following key documents: National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025² Cultural Respect Framework (2016-2026) for Aboriginal and Torres Strait Islander health: a national approach to building a culturally respectful health system.³

Key Point 2: Cultural awareness is not cultural safety
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: Dune, T., McLeod, K., Williams, R. (Eds.) (2021) Culture, diversity and health in Australia: towards culturally safe health care. London: Routledge. 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.

**Key Point 3: A culturally-responsive approach to care is the ‘how to’ of cultural safety**
In Australia, there has been increasing recognition that improving cultural safety in healthcare can improve not only access to healthcare for Australian Indigenous peoples, but also the quality of the healthcare they receive.⁴ The Indigenous Allied Health Association (IAHA) Framework provides this definition of cultural-responsiveness: Cultural-responsiveness is innately transformative and must incorporate knowledge (knowing), self-knowledge and behaviour (being) and action (doing). It is about the approaches we take in engaging with people and how we act to embed what we learn in practice. This requires genuine dialogue to improve practice and health outcomes. Cultural responsiveness is the means by which we achieve, maintain and govern cultural safety.⁵ ‘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 Cultural Competence Continuum Read through the descriptions for each of the points on the continuum and consider, how you would rate your most recent practice setting.

Educator Resources:

Cultural Safety Learning Activity: The Deconstruction Exercise

PalliBytes Module: Cultural safety and culturally-responsive care

PalliBytes Module: Inclusive and culturally-responsive palliative care

References

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.