outline and mihi l mihi/acknowledgement: irihapeti ramsden, nursing council of nz, eit hawkes bay,...

Outline and mihiOutline and mihi

Mihi/Acknowledgement: Irihapeti Ramsden, Nursing Council of NZ, EIT Hawkes Bay, Pearson Education.

New Zealand context Brief history of cultural safety in New

Zealand Cultural awareness, cultural sensitivity and

cultural safety

Outline (cont’d)Outline (cont’d)

Journey of an indigenous woman to produce ‘Cultural safety in Aotearoa New Zealand’.

Lessons I have learnt in terms of cultural knowledge and the broad based concept adopted by the NCNZ.

Cultural competence, cultural security Behaviourist debate Ways of addressing relevant issues

New Zealand context New Zealand context

With over a thousand years of human settlement it’s history is dominated by the relationship between Maori (indigenous people) and Pakeha (European descendants)

The Treaty of WaitangiThe Treaty of Waitangi

The Treaty of Waitangi was signed in 1840 between the Maori chiefs and representatives of the British Crown.

Contains 3 articles– guaranteed Maori certain

rights and privileges

– including the protection of their customs, land, forests, fisheries and health.

Treaty of Waitangi (cont’d)Treaty of Waitangi (cont’d)

The Treaty has always been the reference point from which Maori people have negotiated with the Crown for self determination over their resources.

The Treaty provides the reference point therefore for cultural safety in New Zealand.

Cultural SafetyCultural Safety

The term “cultural safety” was coined by a Maori nursing student in the late 1980s. She made a plea at a meeting of health educators by saying “You talk of ethical safety, legal safety and physical safety…what about cultural safety?”

DefinitionDefinition

Simply put cultural safety is defined by those who receive the service (1996)

The term Kawa Whakaruruhau is also used which was developed by Irihapeti Ramsden.

Cultural safetyCultural safety

Cultural safety is well beyond cultural awareness and cultural sensitivity.

It gives people the power to comment on care and to be involved in changes in where their experience has been negative.

The process towards The process towards achieving cultural safetyachieving cultural safety

Cultural awareness is a beginning step

toward understanding that there is difference. Many people undergo courses designed to sensitise them to formal ritual and practice rather than to the emotional, social, economic and political context in which people exist.

Cultural sensitivityCultural sensitivity

Alerts students to the legitimacy of difference and begins a process of self-exploration as the powerful bearers of their own life experience and realities and the impact these may have on others.

Cultural safetyCultural safety

is an outcome of nursing and midwifery education that enables safe service to be defined by those who receive the service.

Founding conceptsFounding concepts

The inter-dependence of culture and ethnicity

The Treaty of Waitangi and Te Tiriti o Waitangi

Sociological concepts such as power

Evolving nature of cultural safetyEvolving nature of cultural safety

Collaboration of stories from health professionals, educators and commentators

Always mindful that the pain of the Maori experience of poor health provided the catalyst for cultural safety

Treaty based Broad based

Related conceptsRelated concepts

Cultural security defined as:“a commitment to the principle that the construct and

provision of services offered by the health system will not compromise the legitimate cultural rights, values and expectations of Aboriginal people” (Western Australian Department of Health)

“…shift in emphasis from attitude to behaviour”

Source: Cultural security and related concepts: a brief summary of the literature, Professor Neil Tomson, Health InfoNet, Perth, WA, 2005

The ‘behaviour’ debateThe ‘behaviour’ debate

Is it to be assumed that one can perform a value? (Cairns, 1992)

Human action is nothing but behaviourOr

Human action is something that excludes behaviour

So how do you measure attribute acquisition by individuals?

Attributes such as empathy, patience, creativity, honesty, respect and compassion do not lend themselves to simple measurement

Solution: Devise competency standards that are restricted to describing knowledge & skills

“Empathising with the patient’ – can be assessed holistically in the workplace & above, beside and below

Adaptive learning vs generative learning

Specialised knowledge comes at a price Self regulation vs externally imposed

system Legislation & governing/professional

bodies regulates cultural safety practice in the same manner as ethical, legal and physical safety

Cultural safety & Cultural Cultural safety & Cultural competence or cultural securitycompetence or cultural security

Achieve certain competencies to become safe

Or Achieve certain safety milestones to

become competent

Where to from here?Where to from here?

Beginning step towards stimulating critical thinking about the ‘taken-for-grantedness’ in the health professions

Lessons learnt from the nurse-patient relationship in Aotearoa New Zealand can help inform new learning in countries outside New Zealand

Whakatauki / proverbWhakatauki / proverb

Nahau te rourou

Naku te rourou

Ka ora ai te manuhiri

With your basket of knowledge

and my basket of knowledge

the people will prosper