Outline and mihi

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Outline 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

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Outline (contd)

• 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

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New Zealand context

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

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The 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.

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Treaty of Waitangi (contd)

• 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.

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Cultural 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 safetywhat about cultural safety?

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Definition

• 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.

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Cultural 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.

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The process towards achieving 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.

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Cultural 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.

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Cultural safety

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

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Founding concepts

• The inter-dependence of culture and ethnicity
• The Treaty of Waitangi and Te Tiriti o Waitangi
• Sociological concepts such as power

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Evolving 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

Broad based
Treaty based
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Related 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

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The behaviour debate

• Is it to be assumed that one can perform a value?
  (Cairns, 1992)
• Human action is nothing but behaviour
• Or
• Human action is something that excludes behaviour
• So how do you measure attribute acquisition by
  individuals?

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• 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

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• 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

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Cultural safety Cultural competence or cultural
security

• Achieve certain competencies to become safe
• Or
• Achieve certain safety milestones to become
  competent

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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

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Whakatauki / 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

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