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How students understand cultural safety
... Research regarding nursing students' understanding of culture is limited (Maltby, 2008; Vandenberg, 2008; Warren, 2003). The comparative strengths and limitations of an essentialist versus a constructivist perspective of culture remain largely theoretical. ...
In this qualitative study, we explored how students understood "culture." Participants defined culture and wrote narratives regarding specific cultural encounters. The sample comprised both nursing (n=14) and non-nursing (n=8) students to allow for comparison groups. Content analysis of the narratives revealed two broad paradigms of cultural understanding: essentialist and constructivist. Essentialist narratives comprised four themes: determinism (culture defied individual resistance); relativism (the possibility of making value judgments disappeared); Othering (culture was equated to exotica, and emphasized difference); and, reductionism (personhood was eclipsed by culture). In contrast, the constructivist narratives were characterized by influence (non-determinism), dynamism (culture was dynamic and evolutionary); and, relationship-building. The unintended negative consequences of essentialist notions of culture were revealed in the nursing students' narratives. Pedagogy is implicated in nursing students' essentialized understanding of culture.
... The Nursing Council of New Zealand (the Council) also emphasises the educational focus associated with cultural safety, noting that it is "focused on the knowledge and understanding of the individual nurse" and that as a result "the nurse who can understand his or her own culture and the theory of power relationships can be culturally safe in any context" (Nursing Council of New Zealand (NCNZ), 2005, p. 4). This focus is mirrored in the literature which considers the challenges associated with teaching (Hughes 06 Farrow, 2006; Jeffs, 2001; Ramsden 1992; Ramsden, 2000a; Richardson ôs Carryer, 2005; Thompson, 2002) and explores the perspectives of those being taught (Saxon, 1995; Warren, 2003). By comparison, there have been relatively few publications of research seeking to explore the impact of cultural safety in clinical practice (Bunker, 2001; Hughes Ô5 Farrow, 2006). ...
Cultural safety is a concept that emerged within the New Zealand nursing context. The purpose is to ensure that nursing practice is congruent with the aims and objectives of the Treaty of Waitangi (the founding document between Maori and the Crown) and so facilitates the nursing of patients regardful of all that makes them unique and individual. While cultural safety has continued to develop since its inception in the 1980s, there remains relatively little research looking at its application in practice. This is due in part to the core element that recognises that only the recipient of care can determine if cultural safety has occurred. There are inherent difficulties in questioning patients about the quality of their care from a cultural safety perspective. One of these is the uncertainty around the public perception and understanding of cultural safety together with the implications of asking a vulnerable group to comment on this aspect of care. An alternative to asking patients to comment on whether they received culturally safe care is to consider the perceptions of health care professionals regarding this concept. This paper presents the results of a small study aimed at eliciting the beliefs and attitudes of a group of senior nurses with respect to the concept of cultural safety, and their perception of its role in clinical practice. It was undertaken as a preliminary to a wider survey.
Objectives:
To review the research literature on cultural safety education within post-secondary health science programs.
Methods:
We conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings.
Results:
A total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program. Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities.
Conclusions:
This review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people. Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.
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