Throughout our nursing education; one of the common themes we study is how to become a culturally sensitive nurse. Being culturally sensitive is extremely important no matter where you live or what job you hold. However, taking on the major responsibilities of being a nurse within such a small community where we are neighbors with First Nations communities; it seems to be all that much more vital for us as care takers.
Now; not to knock our school curriculum (and I mean from elementary school and forward) but it seems like we lack major information and teachings that we need to achieve cultural sensitivity—considering growing up among first nations people here in Cape Breton. Having said that, things seem to be changing for the better in that we are taking steps forward to becoming more culturally competent (like this course being available for CBU students for instance). But when we achieve cultural sensitivity, is that enough?
An interesting article titled “Cultural Safety: A Framework for Interactions between Aboriginal Patients and Canadian Family Medicine Practitioners” explains how medicine practitioners base their care with Aboriginal patients on the cultural sensitivity model, which they claim is inadequate. It further explains how health care professionals need to adopt the cultural safety approach as the superior method of training. So how does safety differ from sensitivity? Well, sensitivity is defined as “the recognition/importance of respecting difference”. Whereas safety is going in depth a step further and investigating where these differences stem from. Which leads to self-awareness, elucidation and eliminates assumptions and prejudice.
We argue for the use of cultural safety as a model for interactions between non-Aboriginal practitioners and Aboriginal patients. Cultural safety provides a framework in which these parties may participate in cross cultural health care while acknowledging historical colonial attitudes and worldviews, in an attempt to provide an environment that is safe for each individual receiving care. (Journal of Aboriginal Health, November 2012. Cultural Safety: A Framework for Interactions between Aboriginal Patients and Canadian Family Medicine Practitioners. Page 16.
Throughout our nursing studies were taught that aboriginal peoples have the worst population health stats in Canada. However, this information can be hurtful to the population if we don’t understand the “why” behind the facts because it can lead to blaming the Aboriginal people for their health status. So although the information in this article is directed towards doctors, this information can easily be applied within the nursing field as well. The majority of us graduating will be staying here in Cape Breton, it is about time we understand more about our friends and neighbors.
Medicine programs can integrate cultural safety into their curriculum by teaching residents about the colonial history of Aboriginal people to foster understanding of power imbalances. This knowledge can then be used to help family medicine residents learn to identify their own biases that may affect the care of Aboriginal patients. By advocating for family medicine practitioners to use cultural safety to challenge their own concepts of culture and to address their own worldviews, patient encounters between non-Aboriginal family physicians and Aboriginal patients may be made safer and more productive. (Journal of Aboriginal Health, November 2012. Cultural Safety: A Framework for Interactions between Aboriginal Patients and Canadian Family Medicine Practitioners. Page 20)
They make a very valid point that while the knowledge that Aboriginal Patients generally have poor health status while being very important, that information is not enough. Without making the connection between the health problems and why they came to be; leads to discrimination and prejudice.
“Epidemiological studies risk painting a picture of sick, needy Aboriginal people who are constitutionally less able to sustain good health than non-Aboriginal people.” (Journal of Aboriginal Health, November 2012. Cultural Safety: A Framework for Interactions between Aboriginal Patients and Canadian Family Medicine Practitioners. Page 16.)
The lack of information of “the why” behind the health problems, isn’t directly leading to racism, it is however subconsciously leading to prejudice.
For an unfortunate example of bias, negligence and your listening pleasure, take a listen to CBC’s White Coat Black Art: Second-Class Healthcare for First Nations People?
Cultural sensitivity also carries the risk of perpetuating colonial attitudes toward Aboriginal patients. It implies the non-Aboriginal health care provider is the one with the “correct” culture, interacting with the “other” culture, rather than as a participant in the interaction of two cultures. Cultural sensitivity alone risks focusing on learning the culture of “others,” which firmly establishes a division between Aboriginal patient and non-Aboriginal family medicine practitioner, subtly reinforcing ideas of cultural superiority that persist from the colonial era. (Journal of Aboriginal Health, November 2012. Cultural Safety: A Framework for Interactions between Aboriginal Patients and Canadian Family Medicine Practitioners. Page 18).
I am happy to say that, in taking this course, I can confidently agree that we are congruently learning with what this article is describing as cultural safety. With learning in depth about the surrounding aboriginal communities’ comes the striping away of assumptions and prejudice. I don’t think anybody in the health care system purposely holds these negative beliefs about our neighbors. But it is, however, common for people to avoid a person of a different culture with the worry that we may indirectly or accidentally offend somebody. Avoiding this “uncomfortable” conversation leads to noncompliance within the health care system. The reality is that there was, and still are, situations where people are not getting appropriate health care. The stats alone will not help us become better health care professionals, but rather answering “the why” behind the stats will.
I encourage you to read further into this article here: Journal of Aboriginal Health, November 2012. Cultural Safety: A Framework for Interactions Between Aboriginal Patients and Canadian Family Medicine Practitioners. Page 15-22.
Two-Eyed Seeing for Health 