Feb 18, 2020
By Tara Horrill

Cultural safety: Are we on the same page?

Take Away messages:

  • Cultural safety focuses less on the patient and more on the nurse.
  • Cultural safety is distinct from cultural sensitivity and cultural competence.
  • Practicing in culturally safe ways can improve access to and quality of care.

Over the past decade, cultural safety has emerged as an important component of nursing practice, particularly when caring for Indigenous peoples within Canada.

Originally conceptualized by Irihapeti Ramsden, a Maori nurse, cultural safety is a relational approach to nursing care. Its concepts are increasingly being incorporated into nursing curricula and continuing competency training within Canada.

However, there still seems to be confusion about what constitutes cultural safety. I recently attended an Indigenous health conference and was struck by how often the term was used in ways that are inconsistent with its meaning.

Cultural safety: What it is, and what it is not

Cultural safety grew out of the recognition that nurses are often the first health care professionals that patients encounter, and the ways in which they interact with patients play a significant role in the willingness to seek health care. Cultural safety draws attention to unequal power relationships within health care and requires nurses to think about and recognize that power operates in every context.

Cultural safety grew out of the recognition that nurses are often the first health care professionals that patients encounter …

Establishing nurse–patient relationships that are built on trust and collaboration is also an essential component of culturally safe care. Within the context of Indigenous peoples in Canada, which includes a history of colonization and oppression, a culturally safe and relationship-based approach to care can improve access to health care services and patient experiences within the health care system.

However, culture can also be understood more broadly—as any person or group that differs from us as nurses in any way, including socio-economic status, gender, age, ethnic origin, sexual orientation, (dis)ability, or religion. When culture is understood in this way, cultural safety becomes relevant to every nursing interaction.

Practically speaking, cultural safety is about reflexivity. It is about us as nurses examining the beliefs, values, and assumptions held about the “other,” and how these might be influencing our nursing practice. It also includes reflecting on how power has worked to create unequal and unfair life opportunities for some groups of people, including Indigenous peoples in Canada.

Establishing nurse–patient relationships that are built on trust and collaboration is also an essential component of culturally safe care.

Cultural safety is not about becoming competent in specific cultural beliefs, practices, or ways of communicating across cultures, nor is it about sensitivity to different beliefs. While these are all important, and perhaps beneficial, they do not address the role of power within health care relationships and tend to ignore the context of patients’ lives, such as the social and structural determinants that shape life opportunities, health, and health care access.

It starts with me

Why are these differences important? Because as a nurse, I can’t possibly learn all there is to know about another culture. I can’t understand what it is like to experience intergenerational trauma as a result of residential school attendance. I don’t know what it is like to have my health concerns dismissed by a health care provider.

But I can work to understand my own beliefs and assumptions. I can work toward establishing trusting and collaborative relationships with the patients I care for. When I do these things, I help to improve access to health care for Indigenous peoples and other underserved populations, improve the quality of care delivered, and ensure positive health care experiences.

It starts with me.

Additional resources

Fact Sheet: Cultural Safety (National Aboriginal Health Organization)

Cultural Safety training

Book:
Diane Wepa (Ed.), Cultural Safety in Aotearoa New Zealand (2nd ed). 2015.

Tara C. Horrill, BN, PhD(c), RN is a research assistant and doctoral student at the University of Manitoba, Rady Faculty of Health Sciences, College of Nursing in Winnipeg, MB.

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