The aspect of culture impacts the way people view the world, and it is how they perceive the world that influences what they believe in and how they perform things, specifically with regard to practices related to health, dying and death. Patients and family in critical nursing care setting face an environment that is not generally familiar, along with health professionals’ beliefs and practices that may not align with their own.
Therefore, cultural safety and trans-cultural nursing models exist to help in the integration of beliefs and practices of patients and their family in critical care nursing practice. This paper compares and contrasts cultural safety and trans-cultural models of nursing; explains how a nurse’s personal factors may cause nursing care and communication difficulties according to the approach of cultural safety, identifies one systemic factor in Australian health care system that could diminish or demean clients or their families, and evaluates advantages of cultural safety as an approach of addressing the interaction between nursing and the cultures of both individuals and systems..
Definition, Comparison and Contrast of Cultural Safety and Trans-cultural models
Cultural safety and trans-cultural nursing are two main models within nursing which guide nursing care. The trans-cultural nursing model was pioneered by Leininger, which she defined as; “a formal area of study, research and practice, focused on culturally based beliefs, values and practices to assist cultures or subcultures maintain or regain their health and face disabilities or death in culturally congruent and beneficial caring ways” (Leininger, 1978).
Trans-cultural nursing is based on care which is both competent and appropriate in terms of patients’ beliefs, values and world view in order to provide “beneficial and satisfying health care, or to assist them with difficult life situations, disabilities or death (Leininger, 2002). It was developed on the basis of Leininger’s experience of nursing children from diverse ethnic backgrounds in the 1950s. She had realized that staff did not meet the cultural needs of children, and that satisfying their requirements formed an important part of caring for each child.
Cultural safety model, on the other hand, was developed by Ramsden in response to Maori nurses’ concerns related to the hiring and retention of Maori nurses (Nursing Council of New Zealand, 2002). The Nursing Council of New Zealand (2002) defines cultural safety as: “the effective nursing of a person/family from another culture by a nurse who has undertaken a process of reflection on his/her own cultural identity and recognizes the impact of the nurse’s own culture on own nursing practice”.
As a practice, this concept originated from people whose health was negatively affected by the colonization process in New Zealand. It uses the critique of the dominant health care system and its inability to assist people most in need. The concept advocates for the dominant culture to be accountable to the access and provision of appropriate health care to all cultures (Nursing Council of New Zealand, 2002).
Cultural safety model contrasts from trans-cultural model in many ways; one, the cultural safety model was formulated from and indigenous cultural reality, whereas trans-cultural nursing was derived from outsiders cultural perspective; two, cultural safety model advocates for care that considers individual differences. It identifies the patient as someone who may share information if trust is established, trans-cultural nursing, on the other hand, offers care regardless of the differences (Talbot, 2005).
It views patients ostensive as a group member; three, cultural safety model uses culture in the broadest sense compared to trans-cultural model which mainly refers culture to ethnicity; four, the models also differ in terms of cultural knowledge. According to cultural safety, cultural knowledge belongs to the culture, while in trans-cultural model, cultural knowledge can be acquired; fifth, cultural safety model views interactions as bicultural, whereas trans-cultural nursing identifies the nurse as being multi-cultural; sixth, cultural safety model is more concerned with transferring power and cultivating trust with patients, whereas trans-cultural seeks to maintain power (Leininger, 2002).
How Nurse’s Personal Factors may Cause Nursing Care and Communication Difficulties according to Cultural safety Model
Nurses as health care providers strongly view cultural safety as a process concerned primarily with the prevention of injurious ramifications to clients and families of imposing culture (Eckermann, 2005). This section explains how a nurse’s personal factors may cause nursing care and communication difficulties according to cultural safety model. First, the personal characteristics of nurses involve their cultural backgrounds in clinical settings, and may include; class, gender, citizenship, ethnic identity, age, family, and education.
Personal cultural backgrounds of nurses and their life experiences influence their values and attitudes; as nurses have cultural awareness characteristics for their self examination and exploration of their own cultural background. With these personal factors, nurses are able to recognize their own bias, prejudices and assumptions about patients who are different. Incase a nurse is not aware of his/her own cultural or professional characteristics, there will exist a danger of causing difficulty in nursing care as a nurse may exert culture imposition to a patient (Leininger, 2002).
Secondly, the idea of cultural safety enables a nurse to interact with patients, and work with them, in a manner that takes cognizance to their cultural backgrounds and puts those factors into consideration. This adds to nurse’s personal characteristic of having cultural knowledge. They have sound knowledge about diverse cultural and ethnic groups. With cultural knowledge, a nurse is able to integrate issues, such as, beliefs and cultural values related to health, and treatment. In health care contexts, patients are usually vulnerable to cultural risks. If these patients are not kept safe in health care settings, the capacity of nurses to ensure the cultural safety of clients in those contexts will be eroded (Crisp, 2005).
Third, nurses have personal characteristics of cultural encounters that encourage them to engage directly in cross cultural interactions with patients from varied backgrounds. Direct encounters with patients from diverse communities, modifies the nurses’ beliefs that exist about the cultural community and helps in avoiding stereotyping. A personal characteristic of cultural encounters also puts into consideration an assessment of the patient’s language requirements.
For instance, a nurse may formally enlist the services of an interpreter to interview patients to facilitate communication (Crisp, 2005). Poor cultural encounters may pose a problem as nurses may lack knowledge regarding patients in terms of disease entities. Additionally, for a nurse who does not share same culture and language is placed at a significant danger by patients. For the case of immigrant nurses, they are vulnerable to racial motivated abuse from patients. Racial factors can affect relationships between nurses and patients and the ensuing treatment results (Davidson et al., 2005).
Fourth, the cultural desire characteristic in nurses involves the concept of caring. Campinha-Bacote (1999) stated that, “people don’t care how much you know, until they know first how much you care”. Nurses should show real desire to offer care that is culturally responsive to patients. This personal characteristic involves a sincere urge to be and flexible with patients, to accept differences and strengthen similarities. Lack of cultural desire on the part of nurses definitely places them at risk of relating effectively with patients. Poor relationship leads to ineffective communication which results to undesirable treatment outcomes (Talbot, 2005).
Fifth, cross-cultural communication differences between nurses and patients may prove difficult sometimes. This may be due to due the existence of culturally related differences that result to misunderstandings and reactions that are not understood, for example: some cultures bar anyone to express emotional distress or pain; do not allow a person to disclose detailed information about themselves to others; some patients may not comprehend the medical language used and others (Crisp, 2005).
Important Systemic Cultural Factors in Australian Health Care System
Commonwealth of Australia (1999) acknowledges that Australian society is multicultural. Australia is comprised of a population that is made up of people from 200 different nations, about 116 religions are practiced, and more than 180 languages with 16% more speaking languages other than English at home. Cultural and language diversity of the indigenous people of Australia form the multicultural society of Australia. This section identifies one important systemic cultural factor in Australian health care system that could diminish, or demean, patients and their families, that is, Australian health care system being non-responsive to the communities of minority racial, ethno-cultural and language backgrounds (Talbot, 2005).
Allotey (2002) admits that despite Australian health care system being responsible for offering services to the people and minority racial, ethnic cultural and language backgrounds over the past decade; it is not responsible as it should be to the needs of these communities. Majority of the people from minority groups are alienated in terms of their interactions with highly structured mainstream Australian health care institutions offering health and illness services.
Australian health care system does not display the concept of equity in terms of cultural safety (Allotey, 2002). It is controlled by the medical framework, specifically in acute illness care services that lacks critical systemic factor of cultural awareness. Ramsden (2002) highlights the inappropriate health care services offered to the Maori people. A combination of systemic factors, such as, attitudes of Australian health care professionals, historical, cultural and economical cause vulnerable groups such as Aboriginals not to use existing health care services in Australia (Eckermann et al., 2005).
The aborigine people still view the state health care services as part of the white bureaucratic system that lacks cultural awareness. Instead, the community uses their own community controlled health services that offer cheap, accessible and appropriate services; which allows choice based on cultural difference. In general, the minority racial, ethno-cultural, and language groups in Australia are underserved by the health care system. As a result, they experience unequal problems of disease, face cultural and language constraints in terms of accessing appropriate health care. In addition, they get diminished lower level and quality of health care compared with the average Australian population (Allotey, 2002).
Evaluations of Advantages of Cultural Safety as an Approach to Addressing the Interaction
Cultural safety is an important approach which considers society’s structural inequalities and cultural differences in looking at health and health care. As a concept of education and practice, cultural safety is a concept that addresses the indigenous health issues. It was developed b Ramsden, a Maori nurse for the purpose of providing improved health care services to Maori people in Aotearoa in New Zealand (Zamsden, 2002). The health status of the Maori people as with other marginalized native peoples was bad as compared to the majority group, as measured by life expectancy, infant mortality rates, and significantly different rates of certain diseases.
The holistic concept of Maori peoples health included; the spiritual, the family, the mental, and the physical, which recognized the importance of social and material conditions of health. The cultural safety model draws links between Maori health and their positioning within processes of historical and social change that had marginalized their culture and resulted in their social and material suffering (Ramsden, 2002).
The cultural safety concept accommodates the notion that health care workers are safe to work with people from differing cultures. It makes them to be open-minded and flexible in their attitudes to patients and enables them to examine their own cultural realities and the attitudes they carry to their professional practice (Talbot, 2005). Achieving cultural safety requires knowledge of the location of health problems within historical and social processes and exposure to alternative perspectives on health. Therefore, cultural safety concept allows health care providers to tackle personal and structural racism (Davidson et al., 2004)
Another significant advantage of cultural safety approach in addressing interaction between nursing and the cultures of both individual and systems is that it can be adapted to be applied in multi-cultural societies. Although the concept was developed particularly in bicultural context of Aotearoa in New Zealand, its principles respect the varied ways of applying health care and it recognizes the historical and social construction of a minority group’s health status (Ramsden, 2002).
Cultural safety approach also protects the interests of providers of health care, such as, nurses, language interpreters, doctors and others. Cultural safety model encourages significant cultural interaction between health care providers and patients. This minimizes health care risks among health care providers, as their safety could be placed in significant danger by patients and their families whose language and culture they don’t share. Cultural safety approach also encourages “racial respect” and teaches anti-racism (Davidson et al., 2004). It also applies broadly to include diverse communities and to include the needs and interests of minority groups who are vulnerable and risk of being treated in unsafe ways (Talbot, 2005).
Possible Barriers of implementing the Practice of Cultural safety
All nurses and other health care practitioners have the responsibility to offer safe care to patients from diverse socio-cultural backgrounds in cross-cultural settings. Barriers to the implementation of cultural safety practice occur when there is lack of cultural knowledge, cultural skill, cultural encounter, cultural desire and understanding of cultural language. Significant barriers hinder the smooth implementation of cultural safety in the health care setting.
Some possible barriers to implementing the cultural safety practice include; racial stereotypes, ethnicity, language differences, ignorance and illiteracy, and marginalization. Cultural safety does not require nurses to investigate the cultural dimensions of any culture a part from their own. It does not believe that nurses could attain a deep internal knowledge of any culture other than their own; and does not differentiate between generic and professional care. Instead, the emphasis of care in this model is on the patient’s experience as the determinant of effective nursing care (Talbot, 2005).
In sum, the concept of cultural safety is derived the principle of equity. The provision of culturally safe services and care is not a mere facilitation of accessibility to mainstream services through liaison offices, but rather ensures that it relates to the system or service that satisfies the health of an individual and their holistic understanding of health. Eckermann et al., (2005) postulates that, for Aboriginal people, health is a spiritual concept and to maintain health means sustaining links with all forms of cultural expression; through language, family relationships, and links to land.
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