The concept of cultural safety in healthcare

Introduction

The diverse consumerism of the health care makes it essential to practice cultural safety in health care. Self-realization of own culture, beliefs and values are necessary to understand and accept the culture of others. In this reflective paper I would critically reflect upon my own understanding about the cultural safety. I aim to incorporate the cultural safety in my nursing practice by reflecting on my own culture, beliefs, values, attitudes and behavior and how they impact the health services provided by me. In this paper I will also perform a self-assessment for the self-judging and enhancing my professional practice.

Cultural safety

Cultural safety can be defined as an environment that is physically, socially, mentally and emotionally safe for the people belonging to different cultural background. The concept of cultural safety takes us above cultural awareness and acknowledgement of the differences (Gerlach, 2012). Cultural awareness helps in practicing a care that is devoid of any inequalities or bias. In the light of cultural safety a health care professional can improve care provision for the patients, expose the social, political and the historical contexts of the health care, enable the practitioners to eradicate discrimination, racism and prejudice and finally challenge the biased power relations (Taylor & Guerin, 2010).

Self-perception about values

Over recent years we have been witnessing a downfall of the morale in health care, which is often expressed as feelings of not being values. It is my culture and the upbringing that defines my values. Some of the values that helps in providing a cultural safe care to the patients are kindness, Optimism, caring and compassion, honesty and trust. Apart from the health care provided these are some of the factors that enhance the patient care (Halligan, 2008).

Kindness is the basic element of the profession of nursing. Being kind requires a health professional to remain vulnerable themselves while acknowledging the distress and the vulnerability in the patient (Ellis & Rawson, 2015). Some times when we cannot offer any help to a person’s distress. Especially in case of palliative care patients, it the kindness that allows the patient to be as they are, accepting their feelings and providing companionship to them. Kind and caring gestures like using words of empathy, gentle patting on shoulder, warm hugs for children can sometimes work wonders (Peate, 2012).

Although the origin of the word compassion is firmly linked with religious ideologies of 19th century, however in health care it is the provision of emotional and spiritual care for the patients for making their health care experience more comfortable, especially when the treatment has failed (Peate, 2012). Some of the factors that I follow to provide a compassionate care to the patient is to communicate compassionately with the patient, showing advocacy and respecting the dignity of the patients. I realize that as a nurse I am faced with stress and burnouts but at the same time I also understand that I should keep the priorities of the patient in the frontline and hence their health should not be compromised due to me.

Values, beliefs, and behaviors that contribute to cultural safety

Optimism and positivity is another value that has helped me to handle crisis with resilience, to view difficult times as a challenge (Stagman-Tyrer, 2014). I believe that this value of a person symbolizes the proclivity of the person to achieve his/her goal. A nurse is faced with several adverse situations related to the care of the linguistically or culturally different people, and multiplying responsibilities each day. In order to cope up with this they have to remain optimistic in face of the difficulties (Stagman-Tyrer, 2014).

Honesty and trust are two related terms. It is the honesty of a person helps to build a relationship of trust with the client. Trust helps to build a positive relationship with the client as it creates the scope for openness with the patient and the family members involved in the care (Straughair, 2012). I have realized that with the increased complexities of the consumerism in health care, the patients have become vulnerable and are seeking for answers. Hence I always try to keep a transparency regarding the disclosure of the health care and remain honest and accountable to my practices.  I realize that I need to work more on establishing rapport with the patients so that I can build the credibility that I truly understand the value of the patients.

Beliefs

While I was working with an aboriginal patient I understood how spirituality and mental wellbeing affects the physical health of a patient. Hence one of my beliefs is spirituality. Previously I had a very vague notion regarding the role of the spirituality, which is common in the health care practice of the aboriginals (Connell Meehan, 2012). I have understood that the aboriginal’s connectedness with the land, kingship and spirit contribute to their mental wellbeing. The spiritual dimension of care seeks a meaningful explanation of illness that considers, family, person and the community issue and it is the spirituality that enables a person to perceive his/her life in a different way (Mitchell & Golden, 2012). I have learnt that certain spiritual practices such as meditation can be beneficial for the treatment of chronic pain, depression, hostility, insomnia, anxiety and premenstrual problem, although it should be kept in mind that spiritual beliefs of certain patients or the caregivers can directly contradict medical science.

Another belief that helps me to deliver a patient centered cares, is to keep the interest of the patient at the first place (Salimi & Azimpour, 2013). Being a health care professional I have always believed on going an extra mile for the wellbeing of the patient, for example, while working on a pediatric patient, I often used to gift goodies to children at the time of discharge or often had to work extra time in case of some emergency conditions. As a nurse it is natural to work beyond the comfort zone or time, aiming to abide by the ethical principle of beneficence. This ethical principle requires the health care professionals to provide maximum benefits to the patient.

Kindness, optimism, caring, compassion, honesty, trust, spirituality, shared decision-making

My third belief is to understand the role of the families in providing a culturally safe care. Family plays a crucial role in the decision making process as it is the family that shaped up the personality , behaviors or the health care habits of a person. Hence I have believed that a culturally safe caregiving is not possible, unless I communicate with the families to facilitate a shared decision making.  

The final belief on which I will be reflecting is my belief in god. It is this belief that has led me to believe that every religion, race and ethnicities are equal in the eyes of god, so we don’t have the right to discriminate human beings. It is this belief that has helped me to believe in patient’s autonomy, that every patient has the right to decide or express their opinions.

Behavior

Behavior determines the way, how the care is being conducted to the patient. My culture and my family have helped me to incorporate these behaviors- good communication skills, emotional stability, enthusiastic and caring behavior. Communication skills are a primary skill required in nursing where one needs to communicate with patients, patient’s family and the peers (Manias, 2015). Although I always remain mindful about asking consent before touching the patient before any physical examination but it cannot be expected to obtain a consent before giving a compassionate hug or a friendly pat, but any kind of touching without consent can be considered to be an act of disrespect in many cultures. Apart from verbal communication, non-verbal communication is also important in providing care to geriatric or the pediatric patient (Taylor et al., 2013). I make it sure that my facial expressions are of empathy and the patients feel that they are being cared for, yet I sometimes realize that I can work more in understanding the non-verbal expression of the patients, such as facial grimacing due to pain.  

 In spite of having good communication skills, I believe that I should assimilate more in others culture to communicate to them effectively. I have noticed that individuals with emotional stability are less likely to face stress or burnout or exhibit strong emotional responses in stressful conditions.  I will need to work on my emotional stability to work in stressful conditions. My enthusiastic behavior has helped me lot to reach out and get involved in conversation with people with different cultural background. Being enthusiastic to leaning about a culture has helped me out to accept and assimilate in other culture and I truly enjoy to explore about other cultures. My love for people pushes to me to know about their culture and provide care to them. However I wish to indulge in lifelong learning and thrive to develop my personal and professional skills in nursing.

Conclusion

In conclusion it can be said that cultural safety is the key to provide a safe and comprehensive care to person irrespective of their race, ethnicities and cultures. Each of the beliefs and the values that have been discussed have helped me to polish my concepts about cultural safety and can be possibly used by some to achieve cultural sensitiveness. I believe that, I need to thrive more on my competency skills, which requires a lifelong learning. However I hope to enhance my cultural competency skills and devote myself to the care of people in future practices.   

References

Connell Meehan, T. (2012). Spirituality and spiritual care from a Careful Nursing perspective. Journal of Nursing Management, 20(8), 990-1001.https://doi.org/10.1111/j.1365-2834.2012.01462.x

Ellis, J. M., & Rawson, H. (2015). Nurses’ and personal care assistants’ role in improving the relocation of older people into nursing homes. Journal of Clinical Nursing, 24(13-14), 2005-2013.https://doi.org/10.1111/jocn.12798

Gerlach, A. J. (2012). A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79(3), 151-158.https://doi.org/10.2182/cjot.2012.79.3.4

Halligan, A. (2008). The importance of values in healthcare. Journal of the Royal Society of Medicine, 101(10), 480–481. https://doi.org/10.1258/jrsm.08k019

Manias, E. (2015). Communication relating to family members’ involvement and understandings about patients’ medication management in hospital. Health Expectations, 18(5), 850-866. doi:10.1111/hex.12057

Mitchell, P., & Golden, R. (2012). Core principles & values of effective team-based health care. National Academy of Sciences.https://thuvienso.thanglong.edu.vn/handle/DHTL_123456789/3976

Peate, I. (2012). Kindness, caring and compassion. Australian Nursing and Midwifery Journal, 19(7), 16.

Salimi, S., &Azimpour, A. (2013). Determinants of Nurses’ Caring Behaviors (DNCB): Preliminary Validation of a Scale. Journal of Caring Sciences, 2(4), 269–278. https://doi.org/10.5681/jcs.2013.032

Stagman-Tyrer, D. (2014). Resiliency and the nurse leader: The importance of equanimity, optimism, and perseverance. Nursing management, 45(6), 46-50. doi: 10.1097/01.NUMA.0000449763.99370.7f

Straughair, C. (2012). Exploring compassion: implications for contemporary nursing. Part 1. British Journal of Nursing, 21(3), 160-164.https://doi.org/10.12968/bjon.2012.21.3.160

Taylor, K. A., Lindeman, M. A., Stothers, K., Piper, K., &Kuipers, P. (2012). Intercultural communications in remote Aboriginal Australian communities: What works in dementia education and management?.Health Sociology Review, 21(2), 208-219./doi/abs/10.5172/hesr.2012.21.2.208

Taylor, K., & Guerin, P. (2010). Health care and Indigenous Australians:    Cultural safety in practice(2nd ed., pp. 9-23) South Yarra: Palgrave Macmillan. https://books.google.co.in/books/about/Health_Care_and_Indigenous_Australians.html?id=T9XZpdz2HKQC&redir_esc=y