NURS1008 Indigenous Health and Cultural Safety

Cultural Safety

The concept of cultural safety can be explained as the concept of caring which is primarily advocated by mainly Maori nurses, situated at areas of New Zealand in period back in late 1980s.  The cultural safety concerns with the powerful relationship among the nurse along with the other people within the health care. The people receiving the nursing care within the healthcare are also empowered for deciding things which will be culturally safe for them than to comply passively among the authorities of the nurses along with different health professional within the healthcare. The concept of cultural safety has been basically focusing at building one partnership relationship where vulnerable other gets the liberty for negotiating the nursing care, although if that allows the nurses to divert from their usual practice area. The dominant health care system mainly aims at changing the attitudes and behaviours of the healthcare professionals along with the nurses (Mackean et al., 2020). 

The practise of cultural safety also requires different skills like personal, attitudinal as well as cognitive skills which can enhance their communication as well as interactions with the others. Thus, development of cultural safety is a gradual process, not an ending point. The cultural safety also involves practice of personal reflective ideas, which helps in recognising the values that are inherent in cultures of nursing cancer patients, and also in the own culture of one, which may result in the conflict with many others. There are three major steps for the cultural safety, which include creating cultural awareness or consciousness related to the own culture as well as recognising similar and unique qualities of different cultural groups. The second step includes the cultural assessment or appraisal, which helps in identifying different cultural domains having the differences. The third step for reaching cultural safety is the development of the skill for developing appropriate attitudes, behaviours as well as communication strategies which can gradually help in reducing the gaps related to inequalities among different cultural grouped people (Schmidt, Wilhelmy, & Gross, 2020).

According to the Howard definition of culture, “The customary, learned manner in which human groups organise their behaviour and thought in relation to their environment, how people act, and especially interact with one another, how people perceive, classify and interpret their world” (as cited in R. Hampton & M. Toombs, 2013).

Cultural safety is all about a relationship between nurses and their patients who are in their care. To build a power relationship, it is important to close a gap in inequities for Indigenous people to enhance cultural safety skills (EdCaN learning). Nurses and healthcare professionals have a major role to play to close this gap. Cultural safety is about the nurses or health professionals review their own theory of assumption and culture to build an honest partnership with Indigenous people in a respectful way (joint statement, 2018).

A nursing care recipient is authorised to determine what is culturally safe and not just obeying passively to the nurses and other healthcare professionals (EdCaN learning).  Cultural safety allows the patient to comment on care to get a positive experience. It empowers patient to contribute to changes to health services they are getting (H. Nguyen, Indigenous Health, 2008). Cultural safety requires some level of personal skills and attitude to improve interactions with Indigenous people. That can be developed by personal reflective practice (EdCaN learning).

An essential foundation for successful clinical and person-centred care is cultural competence. To provide the highest quality care to their patients, cultural competence is significant for healthcare professionals (H. Nguyen, Indigenous Health, 2008). There are three steps towards cultural safety. One is awareness of one’s own culture and identifies alike nature as other cultural groups. The second is a cultural assessment to meet person-centred care. The third is effective communication strategies. To improve culturally safe practice, nurses should have the capability to make modifications to services that meet the requirements of different cultures (EdCaN learning).

The concept of cultural safety is being drawn in New Zealand from the work of Maori nurses and is defined as An environment that is socially, emotionally, physically and spiritually safe for people where their identity is not being questioned or rejected. It is about mutual respect, sharing information and learning experiences, working and living together with nobility (as cited in Australian Human Rights Commission,2011). Pathways to cultural safety come after understanding cultural awareness and cultural sensitivity.

Principles of Cultural Safety:

Principle 1: To reflect on their own practice is an important aspect of cultural safety practice for health professionals: Self-reflection is described as thinking deeply about their own personality and behaviour. Peer evaluation, feedback from colleagues and clients (as explained by Taylor and Guerin, 2014).

Principle 2: Need to minimize the power differentials between yourself and client: Develop a good relationship between yourself and the client. Language is being considered very powerful in health care (as explained by Taylor and Guerin, 2014).

Principle 3: Engage in a conversation with the client to learn about them: True interaction with the client to consider their needs, values, understanding, and preferred ways of doing things are needed for a culturally safe approach (as explained by Taylor and Guerin, 2014).

Principle 4: Undertake a process of decolonization: Learning and acknowledging the role that colonisation and history has impacted Indigenous people and their lives. Learn the history of the community, people and their families (as explained by Taylor and Guerin, 2014).

Principle 5: Ensure that you do not diminish, demean or disempower others through your actions: Treat peoplewithrespect and dignity. Do not demean, diminish or disempower others through your action (as explained by Taylor and Guerin, 2014)

History and Policies Past and Present  Impact on Health

The history can provide the perspectives for developing as well as understanding the problems related to health issues within the communities. This can also help in coping up with them. The history of the public health can help in searching effective ways for preventing the disease as well as securing the health within the population. The process of preventing any disease involves defining the disease, then measuring the occurrence of the disease, as well as seeking all types of effective interventions. The evolutionary effects related to the public health is continuing process, where pathogen changes, along with the changes of host and the environment. Thus, for facing the challenges in the future, it is very crucial to understand the situations of the past and then deal with the present. Thus, experiencing from the past is regarded as one vital tool for the formulation of the health policies in the present day (Schmidt, Wilhelmy, & Gross, 2020). 

The policies within the healthcare are vital as they set the general planning of the action which is required for guiding the desired outcomes. The policy represents the fundamental guidelines which help in making any decision. Within the environment of the health care, the policies set the foundation required for the delivery of the cost effective and safe quality health care. Thus, the policies of healthcare in Australia have undergone through changes to keep up with the changes in the health problem and guideline schedules in the country (Wilson et al., 2020). 

As a good health professional, it is significant to know a patient’s history. When it comes to Indigenous health then it is very important to know cultural history other than an individual’s health history. That is because, to deal with current health problems, it is vital to know what has contributed to their current issues (Taylor K & Guerin P, 2014). Some estimates about the years of living for Indigenous people in Australia are more than 40,000 years which is a long time in comparison with non-Indigenous Australians (Taylor K & Guerin P, 2014).  The original inhabitants of Australia are Aboriginal and Torres Strait Islander peoples. They still find themselves isolated. Racial discrimination, levels of employment, education, access to other services like health care, loss of traditional language leads the poor health in Indigenous Australians (Hampton Ronald & Toombs Maree, (editors.), 2013). Prior to the invasion, William Dampier an early explorer of this continent described Aboriginal people as the ‘most miserable people in the world’. However, some pictorial evidence described them as fit and healthy (Best O & Fredericks B (editors), 2018). Colonization has been influencing the health and well-being of Indigenous peoples today. Many of the health issues and disease of the Indigenous population today are directly or indirectly connected to colonial history (Taylor K & Guerin P, 2014). Various governments, throughout Australia’s history, attempted various policies to deal with the existence of original inhabitants. One of them is The White Australia policy set in motion in 1901 (Hampton Ronald & Toombs Maree, (editors.), 2013). From the 1890s to the 1950s is the time period that was considered a segregation time. Assimilation policies were instituted from the 1950s to the 1960s. The period from 1967 to 1972 aimed at integration. From 1975 to 1996 self-management policy and from 1996 to 2007 reconciliation policy were implemented (Taylor K & Guerin P, 2014).

The reason, why many Indigenous people cannot get over the past, is because the negative effects of colonization are still having an impact on Indigenous people every day. This can be evident from the increasing suicide rates, mortality gap and discrimination (as cited in Australians Together, 2021)

 The history of Aboriginal and non-aboriginal relations has had the following phases:

1) The 60,000+ years before the arrival of Europeans

2) Initial invasion and colonization (1788 to 1890)

3) Protection and segregation (the 1890s to the 1950s)

4) Assimilation (the 1940s to the 960s)

5) Integration, self-determination and self-management (1967 to mid1990s)

6) Reconciliation (1991 to the end of 2000) (as cited in “Working with Indigenous Australians, 2020”)

Connection between the past and the present: The social and economic effects of Indigenous peoples' colonization and influence have accumulated over centuries. Policies and practices that systematically disadvantage Indigenous people exacerbated the problem. In certain cases, this has resulted in trauma, poverty, and other types of a disadvantage being passed down from generation to generation. As a result, the disadvantages we see today are often the long-term consequences of past generations' lack of resources, such as insufficient nutrition, schooling, and health care (as cited in “Australians Together”, 2021) 

Effects of colonization – It had a tremendously bad impact on Indigenous people, who have lived on this land for thousands of years. A surge of epidemic diseases was the most immediate result. Smallpox had killed half of the Indigenous people in the Sydney area within fourteen months of the arrival of the First Fleet, according to Governor Phillip. Indigenous girls and women were sexually abused and exploited, resulting in an outbreak of venereal disease among Indigenous people (as cited in Australians Together, 2021)

Indigenous Health Statistics Today

Indigenous Australians are reported to experience the disease burden which is almost 2.3 times that of rate of the non-indigenous -Australians. In year of 2018-19, it has been found that 45% of the population which accounts for around 238,600 have reported that the health condition is either ‘excellent’ or even ‘very good’, another 32% % of the population which accounts for around 168,900 people reported their health condition as ‘good’, while 24% % of the population which accounts for around 128,200 people have reported their health condition as either ‘fair’ or even ‘poor’.  The health condition of indigenous Australian has been found to be improved since the year of 2014-2015, where only 40% % of the population are found to report as great health. The chronic diseases are found to cause about 64% of total burden of the diseases among the indigenous Australians. Different chronic diseases include mental disorders, cardiovascular diseases, chronic kidney diseases, cancer, vision diabetes, hearing loss as well as selected respiratory, musculoskeletal, congenital and neurological disorders. Survey report states that males (47%) are rated to have either excellent or great health condition in comparison to females (43%). The leading causal reason for the burden of the total disease that are experienced by the indigenous Australians were respiratory diseases (7.9%), mental as well as substance use disorders (19%), cardiovascular diseases (12%), injuries along with suicide (15%), cancer (9.4%) (Carson et al., 2020).

Indigenous Health Statistics Today

Indigenous health has been an Australian health issue for quite some time. In 2008, the Australian government agreed to targets to 'close the gap', to decrease the distance between Indigenous Australian employment, education, child mortality and life expectancy and that of Non-Indigenous Australians. In 2020, the Australian Government renewed this agreement working with the Indigenous and Torres Strait Islander people to build a framework on 'Closing the Gap' (Australian Institute of Health and Welfare, 2020).

There are multiple aspects of Indigenous Health that have improved since 2007. While there has been some improvement on aspects, there has also been a stagnation, or even decline in other areas. Between 2007 and 2017, the proportion of low birth-weight babies born to indigenous mothers fell from 11.3% to 10.3%, between 2006 and 2018, the rate of avoidable deaths among Indigenous people per 100,000 fell to 303 from 374. Indigenous Australians were dying from avoidable causes at three times the rate of non-indigenous people (Australian Institute of Health and Welfare, 2020). Indigenous Australians are seeing lower rates of daily smoking, as well as an increase in the rate of Indigenous people who never smoked at all.

Whilst there have been improvements in some areas of Indigenous health in Australia, there has also been stagnation or even worsening in some areas. In 2018-2019 31% of Indigenous adults were reported to have high or very high levels of psychological distress. This is not significantly different to the reported 33% from 2014-2015 (Australian Institute of Health and Welfare, 2020). Cancer death rates of Indigenous Australians increased from 205 to 235 per 100,000 between 2006 and 2018, whilst a decrease in cancer death rates was seen in the same period from non-Indigenous Australians. Cancer is the current leading cause of death of Indigenous Australians. Between 2006 and 2019, a 61% increase in the imprisonment rates for Indigenous adults was experienced, compared to a 36% increase for non-Indigenous adults (Australian Institute of Health and Welfare, 2020).

The Australian Government is trying to take steps to correct some inequity that is present between Indigenous and non-Indigenous people, but while they are fixing some things, others are not being sufficiently investigated or resolved and are itself leading to an increase in the gap that is present. Working with the Indigenous people to create and develop these programs, such as the “Close the Gap” agreement is a step in the right direction. It is impossible to fix issues with people without those people being directly involved. A doctor will find it increasingly difficult to diagnose a patient without being able to complete a thorough examination or even asking the patient some questions. When individuals do not understand the cultural, physical, and mental backgrounds of the people they are creating initiatives for, they risk missing integral information that would benefit the initiatives, when it could be simply all that was needed was to ask the question and involve those who at the centre of these initiatives.  Working with the Indigenous people to improve their quality of life is in the best interest of “Closing the Gap”.

When talking more about closing the gap, the 2020 national agreement on closing the gap aims to enhance the health and outcomes of Indigenous people. It is strongly evident, measles, flu and smallpox, such infectious diseases were not present in Aboriginal people before the invasion (Craft J & Gordan C, 2019).

There are statistics that show the substantial gap in health outcomes between non-Indigenous and Indigenous Australians. The life expectancy of indigenous males was 69.1 years and for female was 73.7 years compared with 79.7 years for non-Indigenous males and 83.1 years for females. Infant mortality per 100 births for Indigenous people is 14.3 compared with 4.7 for the non-Indigenous population. In 2015, 2879 Indigenous deaths were registered in Australia. Standardized death rates which are deaths per 1000 for the total Australian population in 2010, it was 5.7 and in 2015 it was 5.5 while it was 11.3 in 2010 and 9.8 in 2015 for the Aboriginal and Torres Strait Islander population (Craft J & Gordan C, 2019).

The most common risk factors of Indigenous deaths were ischemic heart disease which was 13.7%, diabetes 6.7% and lower respiratory diseases 6.1%. suicide and motor vehicle accidents were accounted for 8.2% (Craft J & Gordan C, 2019).

In 2008-09, targets were set in the budget by the Commonwealth Government under ‘Close the Gap’ policy framework and the Council of Australian Governments (COAG) agreed on six concrete targets in 2009 which are mentioned below:

• Withing a generation, close the life expectancy gap
• Within a decade, the difference in mortality rates for aboriginal children under the age of five will be halved
• Ensure that all 4 years old aboriginal children have access to early childhood education in rural communities within 5 years
• Within a decade, close the gap in children's reading, writing, and numeracy skills
• By 2020, the disparity between Indigenous and non-Indigenous students in Year 12 achievement or equivalent achievement rates will be closed.
• Within a decade, the job disparity between Indigenous and non-Indigenous Australians would be cut to half (as cited in “Thackrah & Scott”, 2011)
  
  

For Aboriginal and Torres Strait Islander people, absence of disease or illness does not contribute to being healthy, it is a holistic concept that encompasses both the person and the community’s physical, social, emotional, cultural and spiritual wellbeing (Australian Institute of Health and Welfare, 2021). Indigenous Australians are more likely to be impaired as a result of a higher incidence of low birth weight, chronic illness, infectious disorders, injury, and drug abuse (AIHW,2018).

In 2018–19, among Indigenous Australians, it was estimated that:

• 67% reported at least 1 current long-term health condition, 
• 38% reported eye or sight problems and 
• 24% reported mental health or behavioural condition (Australian Bureau of Statistics, 2019).

 

Success Stories in Indigenous Health

The indigenous eye health (IEH) has been welcoming success story along with personal reflection based on the relevance and interest of the Aboriginal and Torres Strait Islander eye related health care and effort which can close the gap for the vision. The example of the blackout violence is one of the best examples of the success story. For launching the violence preventing programme, the players which are from 85 rugby league team have taken part in the field in 2004 NSW Aboriginal Rugby League Knockout, and were found to wear purple armbands for showing opposition towards the sexual assault and family violence against the women. Almost 2000 of the blackout violence kits were found to be handed to the players as well as spectators. These blackout violence kits were performed for four days of carnival, that involves information for preventing violence and ways for getting help. One training manual is also developed for supporting the violence of the indigenous violence in various forms like community violence, domestic violence as well as different other violence like bullying (Schmidt, Wilhelmy, & Gross, 2020).

After consigned racism and discrimination for more than 200 years, Aboriginal and Torres Strait Islander people have been facing challenges such as poor health, low level of education, poor housing and community conditions and high level of unemployment. According to Oxfam’s strategic plan 2014-2019, a commitment of support Indigenous people too, “Strengthen their voice and achieve self-determination, eliminate injustice, hold governments to account, increase their participation in political and other decision-making processes, build public support to close the gap, and achieve Indigenous equality”(Oxfam Australia, n.d.). Some statistics reflect the impacts on their lives because of the disconnection from the country. It is important for governments and community to work together to overcome the gap. Individuals and community are taking actions across Australia to improve their lives by providing access and opportunities (Oxfam Australia, n.d.).

Oxfam is running programs to make a positive difference in Indigenous peoples lives. They are improvement in health and wellbeing, supporting Aboriginal and Torres Strait Islander people to achieve self-determination, working with youth to make them realise their potential, supporting women’s participation in political and decision-making processes for gender equality, working as a member of the Close the Gap Coalition to end the Indigenous health crisis (Oxfam Australia, n.d.).

Reflection

After studying about the topics cultural safety, Indigenous health statistics situations for today, history as well as policies in past as well as present which can impact the health, along with the success stories related to Indigenous health, I learned about the cultural safety concerns with the powerful relationship among the nurse along with the other people within the health care. It is also found that development of cultural safety is a gradual process, not an ending point. The cultural safety also involves practice of personal reflective ideas, which helps in recognizing the values that are inherent in cultures of nursing patients, and also in the own culture of one, which may result in the conflict with many others. The topics helped in growing me as person and a better nurse, to learn about the cultural differences among the different people. I also gained knowledge about indigenous health statistics situations for Australians of today. The success story of indigenous health is also learned and known about many new stories.

After reading and researching on the topic, I gained knowledge of Aboriginal and Torres Strait Islander people’s health, concept of cultural safety, health issues in Australia today. I had an opportunity to explore personal and professional conceptualizations of health.

After writing the topics, I can explain what cultural safety is and its importance in nursing practice. I have a confident to demonstrate culturally safe practice in nursing. By doing research on history of Indigenous people’s health, it is apparent to say that Indigenous people’s health have been and remains Australia’s greatest health and social challenge. It is evident by looking at the health policies focusing on the Indigenous people’s health and statistics, there are some improvements in Indigenous people’s lives and in their health.

I agree that there has been a gap in health care facility access, education, housing and employment between non-Indigenous and Indigenous Australians. We together with government and community, can overcome the gap contribute to get better outcomes for Indigenous health in Australia by the application of culturally safe practice.

References

Carson, B., Dunbar, T., Chenhall, R. D., & Bailie, R. (Eds.). (2020). Social determinants of Indigenous health. Routledge.

Mackean, T., Fisher, M., Friel, S., & Baum, F. (2020). A framework to assess cultural safety in Australian public policy. Health promotion international, 35(2), 340-351. https://doi.org/10.1093/heapro/daz011

Schmidt, M., Wilhelmy, S., & Gross, D. (2020). Retrospective diagnosis of mental illness: past and present. The Lancet Psychiatry, 7(1), 14-16. Retrieved from: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30287-1/fulltext

Wilson, C., Heinrich, L., Heidari, P., & Adams, K. (2020). Action research to implement an Indigenous health curriculum framework. Nurse Education Today, 91, 104464. https://doi.org/10.1016/j.nedt.2020.104464

Best O & Fredericks B (editors). (2018). Yatdjuligin: Aboriginal and Torres Strait Islander nursing and midwifery care. Port Melbourne, Victoria: Cambridge University Press.

Hampton Ronald & Toombs Maree, (editors.). (2013). Indigenous Australians and health. South Melbourne, Victoria: Oxford University Press.

Tailor K & Guerin P. (2014). Health care and Indigenous Australians. South Yarra, Australia: Palgrave Macmillan.

 EdCaN learning resources for nurses. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/aboriginal-and-torres-strait-islander-peoples/cultural-safety/cultural-safety.

Joint statement (March 23, 2018). Retrieved from: file:///C:/Users/61415/Downloads/Nursing-and-Midwifery-Board---Statement---Nurses-and-midwives-leading-the-way-for-safer-healthcare.PDF.

Hung The Nguyen. (December 2008). Indigenous Health. Retrieved from: https://www.racgp.org.au/afp/200812/200812nguyen1.pdf.

Oxfam Australia. (n.d.). Retrieved from https://www.oxfam.org.au/what-we-do/indigenous-australia/our-aboriginal-and-torres-strait-islander-peoples-program/

Craft J & Gordan C. (2019). Understanding pathophysiology (ANZ 3rd ed.). New South Wales, Australia: Elsevier.

Australian Institute of Health and Welfare. (2020). Aboriginal and Torres Strait Islander Health Performance Framework 2020 summary report. Cat. no. IHPF 2. Canberra: AIHW

Australian Human Rights Commission. (2011). Cultural safety and security: Tools to address lateral violence Social Justice Report 2011. Retrieved from https://humanrights.gov.au/our-work/chapter-4-cultural-safety-and-security-tools-address-lateral-violence-social-justice#Heading48

Australian Institute of Health and Welfare. (2021, February 19). Indigenous health and wellbeing. Retrieved from https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing

Australians Together. (2021, February 12). What about history? Retrieved from https://australianstogether.org.au/discover/australian-history/get-over-it/

Guerin, K. T. (2014). Health Care and Indigenous Australians. Elizabeth Vella.

Thackrah & Scott, R. &. (2011). Indigenous Australian Health and Cultures.

Working with Indigenous Australians. (2020, June). Practice Implications > History. Retrieved from http://www.workingwithindigenousaustralians.info/content/Practice_Implications_1_History.html

Are you stuck with an overly convoluted assignment based on a particular subject matter? Are you looking for a dedicated team of subject matter experts to help you through the hurdle? Take a look here. MyAssignmenthelp.co.uk is right here to back you up with the following services and beyond. 

• Finance assignment help
• Law assignment help
• Accounting assignment help
• Management assignment help
• Biotechnology assignment help 
• Engineering assignment help and more 

So, get in touch with us right away, place your order and have the best SME by your side to provide you with impeccable assignment help online.