Nurses provide care for patient’s drawn from diverse cultures on a daily basis. Further, they have to work with colleagues whose cultural practices are a far cry from their own. Nurses are also tasked with ensuring that they provide individualized, quality, safe and effective care to their patients. In doing this, they must avoid portraying any cultural bias, prejudices or discrimination towards their clients’ failure to which they risk having their nursing care rejected or at worst being sued. Cultural safety is therefore a vital component of nursing care. Cultural safety otherwise called cultural competency is described in academic literature as a multidimensional process purposed to provide health care that is congruent with different cultures (Andrews and Boyle, 2008).
The purpose of this essay is to explore the concept of cultural safety. In addition, it will justify the need for nurses to be culturally competent. Further, it will analyze the concept of cultural competence as it pertains to the nurse-client relationship context. Lastly, it will examine and analyze workplace practices and policies that have been or those that can be implemented to promote cultural competence amongst nursing practitioners.
As far as the origins of cultural safety in Australia are concerned, the concept dates back to the 1980s a period during which New Zealand was under colonization. In specific, cultural safety in Australia grew from the dissatisfaction of Maorians with the nursing care that was being provided to them. The Maorians felt that the nursing care they were receiving was not congruent with their cultural values and beliefs.
Further, they were of the view that it was threatening to the sense of self identity of student nurses from the Maorian group (The Charles Darwin University 1969, p.165). Up to date, nurses still face the challenge of establishing and maintaining therapeutic relationships with clients from very diverse cultures (Murphy, 2011). Murphy’s sentiments are echoed by Jeffreys (2010) and by Anderson (n.d.) who point out that meeting the health care needs of clients is becoming increasingly complex and challenging due to the diversity in their cultures. Cultural competence is therefore relevant to the nursing profession because of the diversity as well as the dynamic nature of clients served. In particular, cultural safety is essential in nursing because it fosters acceptance for the nursing care being provided. More importantly, it preserves the sense of self identity of the clients receiving care and the professionals offering the care.
Concerning the nurse-patient therapeutic relationship, it is a bicultural context because both the nurse and the client bring aspects of their respective cultures into the interaction (Murphy, 2011; Brunner et al, 2009). The nurse-patient relationship is complex in light of the fact that both the nurse and the client begun the process of learning their respective cultures at birth. As such they are already assimilated into their respective cultures and hence express aspects of their culture unconsciously (Jeffreys, 2010). In effect therefore, both parties in the nurse-patient relationship are influenced by their cultures in their interaction (Anderson, n.d.). For instance, different cultures have varying expectations or definitions of the role of a nurse. Purnell (2008) and Leininger (2002) contend that the way a nurse is perceived by a client has a significant impact on the nurse-patient relationship and subsequently on the health outcomes of that particular client.
In regard to culturally defined gender roles and expectations, these have a potential impact on the nurse-patient therapeutic relationship. For instance, in some cultures, it is unacceptable for men to join the nursing profession or to provide care to female clients (Purnell and Paulanka, 2008).The fact that cultural competency potentially influences the quality of patient care delineates the vitality of cultural competency to the nursing profession (Murphy, 2011).
As far as minority groups are concerned, the composition of the nursing fraternity is a far cry from the populations it serves in terms of representativeness. For example, in the US, nurses from the minority groups comprise less than 10% of the nursing workforce (Jeffrey’s, 2010). Closer home, the population of Australia, drawn from very diverse cultures is estimated to be 22 707 341. Of these 22 477 200 are Australian residents while the rest are immigrants (Australian Bureau of Statistics, 2010). Also worth noting is the fact that Australia also has indigenous minority groups like the Aborigines. Majority of the rest of Australians comprise mainly of people from European countries who settled in the country during the colonization period. Therefore Australia is a culturally diverse country because patient cultural diversity is influenced by variables like age, religion, past bias experiences, amongst others.
In regard to cultural changes, provision of health care to clients from diverse cultures in Australia is complicated by cultural evolution and revolution. Cultural Revolution in this case refers to a revolution in thinking among nursing clientele whereby they continually adapt different worldviews (Harper 2008, p.6). Cultural evolution on the other hand refers to the processes of cultural growth and changes occurring within a society (Harper 2008, p.6). These two aspects serve to increase the diversity of nursing clients.
On the ethical and legal front, culturally congruent health care has been described a basic human right (WHO, 2006 cited in Jeffreys, 2008). The findings of an array of empirical studies have in addition attributed this kind of care with better health care outcomes. In addition, recent trends show an increase in the number of lawsuits filed against health care providers on the grounds that culturally competent health care was not provided. The aforementioned factors justify the need for culturally competent nursing care (Leininger and McFarland, 2002).
Concerning workplace practices, Anderson (n.d.) is of the view that cultural sensitivity, awareness and effective verbal and non-verbal communication are the three most critical skills required for a nurse to become culturally competent. Accurate appraisal of a client’s basic knowledge, values, beliefs and expectations as far as nurses, nursing care and health care services are concerned on the other hand is a practice that has also been found to facilitate the provision of culturally competent health care (Purnell and Paulanka, 2008). Such questions should be phrased in a proffessional and considerate manner. Further, nurses must always show their respect for the people supporting their client’s regardless of their characteristics. Moreover, members of the nursing fraternity must seek to understand the different role expectations for both men and women in the client’s society.
As far as other interventions aimed at providing culturally competent nursing care are concerned, nurses should endeavour to communicate with their clients in a language they understand. Other simple measures include asking clients how they would like to be addressed. Most importantly however, nurses must always make an effort to gain the trust of their clients (Anderson, n.d).
Concerning the rationale for the above practices, the aforementioned workplace practices facilitate the provision of culturally competent nursing care. This is so because they foster individualization of nursing care as per the patient’s assessed needs. In other words, details pertaining to the patient’s demographics like age, beliefs amongst others act as a guide on how the nurse approaches the care of a particular patient. For example, knowledge of the patient’s attitudes enables the nurse to plan the best care for their patients (Murphy, 2011). Moreover, information regarding the different cultures challenge or prompt nurses to develop skills in cultural competency. For instance, they might learn to change the words they use when explaining the different aspects of patient care to clients and their families (Seeleman et al., 2009).
Regarding policies that promote cultural safety, enactment of legislation and workplace policies that advocate and recognize culturally competent nursing care as a basic human right is amongst measures that can be employed to promote culturally competent nursing care. Further, policy provision for the integration of training on cultural competency in nursing curriculum also serve the same purpose (Leininger & McFarland 2006, p.78). Further, policies on recruitment and hiring of nurses should provide for the increased recruitment of nurses from minority groups in an effort to ensure that nurses are more representative of the populations they serve. Such legislation engender the aspect of cultural sensitivity and thus preclude individual and group barriers that compromise the achievement of culturally competent care. These barriers include discriminatory practices, stereotyping, prejudices held against certain groups or cultures and racism.
In conclusion therefore, the concept of cultural safety is associated with a myriad of definitions. However, the central idea that resonates within all the definitions is congruency of health care with the cultural beliefs and practices of the recipient of that health care. The nurse-patient relationship is a complex interaction since it is a converging point for two cultures. Fostering acceptance of nursing care, improving the quality and safety of patient care, ethical and legal grounds are some of the reasons that justify the need for nurses to be culturally competent. Showing respect to clients, addressing them by their preferred names as well as establishing trust in therapeutic relationships are some of the workplace practices that promote cultural competency. Lastly, the recognition of culturally safe care as a basic human right and enactment and implementation of policies on the training of culturally competent nurses are some of the policy measures that promote cultural competency.
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