Textbook of Medical-Surgical Nursing 3e

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Chapter 2   Thoughtful practice

recruitment and retention of Ma¯ori nurses and the health status of Ma¯ori people. Cultural safety involves recognising the 1840 Treaty of Waitangi/Te Tiriti o Waitangi, a bilingual contract that was signed between the governing crown and Ma¯ori the Indigenous people of New Zealand. The Treaty sets out the duties and obligations of the government and its agents, including nurses. Nurses are required to form partner- ships with the Ma¯ori people, be responsive to their needs, involve them in health planning and decision making, and ensure that their beliefs and practices are protected. Crucial to the delivery of culturally safe nursing care to the Ma¯ori people is recognition of their tribal differences and the consequences of European colonisation and contemporary socioeconomic realities. Unsafe cultural practice is an action that ‘diminishes, demeans or disempowers the cultural identity and well-being of an individual’ (NCNZ, 2009, p. 4). In New Zealand, all nurses undertake education in cultural safety in their undergraduate program. This involves exam- ining their own cultural identity and its impact on their professional practice, including interacting with people of different cultural identities. The Nursing Council of New Zealand’s (Te Kaunihera Tapuhi o Aotearoa) scope of practice for Registered Nurses encompasses competencies that specif- ically look at; adherence to the Treaty of Waitangi/Te Tiriti o Waitangi principles of partnership, protection and participa- tion; in addition the application of culturally safe practice as determined by the patient/client and family. In Australia, the content, structure, and format of cross-cultural material are Culturally competent or congruent nursing care refers to the complex integration of attitudes, knowledge, and skills (includ- ing assessment, decision making, judgements, critical thinking, and evaluation) that enables the nurse to provide care in a culturally safe and appropriate manner. Agency and institutional policies are important in support- ing the achievement of culturally competent care, for example, by establishing flexible regulations regarding visitors (includ- ing the number, frequency, and length of visits), providing translation services for non-English-speaking patients, and training staff to provide care for patients with different cultural values (Wilson, 2013). Culturally competent policies also recognise the special dietary needs of patients from selected cultural groups and create an environment in which the tradi- tional healing, spiritual, and religious practices of patients are respected and encouraged. Nurses should be aware that patients’ actions and behaviours are cultural constructions that can vary both within and between ethnic groups. The nurse who assumes that all members of any one cultural group act and behave in the same way may be viewed as stereotyping people. In doing the latter, the nurse may fail to consider important dimensions of a person’s situation and so generate hostility in the patient, which may in turn compromise their relationship. A key component within the application of culturally com- petent care is that the nurse should take into consideration the power that exists within the relationship of client and nurse. The client is the seeker of help who can be considered as vul- nerable, they rely on the expertise of the nurse to guide and support their individual needs towards progress of their goals in healthcare. The nurse’s ability to acknowledge that she or he decided upon by each education provider. Culturally competent nursing care

The nurse should be sensitive to intra- and interracial group applications of cultural competence. In these contexts, cultural elements or attributes may be appropriated and rede- fined in racial terms (Dayer-Berenson, 2011). Alternatively, racial attributes may be redefined as cultural attributes. This may result in tension, adding to the complexity of planning culturally competent care. This tension may be minimised, however, by having a clear understanding that race relates to a major grouping of people with common ancestry and physical characteristics (Caucasian, Asian, Melanesian, Polynesian, and Eurasian); ethnicity refers to subgroups within a partic- ular race that share a common origin, culture, and language (e.g. Ma¯ori are an ethnic group of Polynesians, Chinese are an ethnic group of Asians); and culture relates to the shared values, beliefs, and practices of various groups within an ethnic group that may be similarities and/or differences with each other. In addition, it is crucial that nurses refrain from culturally stereotyping a patient in an attempt to be culturally competent. Some members of one ethnic subculture may, for example, be offended or angered if mistaken for members of another subculture. Similarly, if the attributes of one sub­ culture are mistakenly generalised to a patient belonging to a different subculture, extreme offence could result, as well as inappropriate care planning and implementation. Instead, in person-centred care, the patient or significant others should be consulted regarding personal values, beliefs, preferences, and cultural identification. The term minority is commonly used to refer to a group of people in a society whose physical or cultural characteristics differ from the majority (Giger, Davidhizar & Purnell, 2007a). It is also used to identify social groups that are in a powerless situation relative to other groups in the society. At times, members of a minority group may be singled out or isolated from other members of society, or treated in different or unequal ways. For example, within Australia, Aboriginal and Torres Strait Islander people, immigrants, and refugees may constitute clearly identifiable minority groups. Within New Zealand minority groups include Ma¯oris, Pacific and Asian people, and immigrant groups (NZNC, 2011). Minorities are also context-specific. For example, men may be considered a minority within the nursing profession, but they constitute a majority within the field of medicine. Likewise, people of Middle Eastern background are minorities in the population of the country, but they may make up the majority of some urban communities. As the term ‘minority’ can be used to denote inferiority, members of many cultural and ethnic groups object to being identified as members of a minority group. Culturally safe nursing care Culturally safe nursing care refers to the appropriateness and effectiveness of nursing care as experienced by patients or their families whose cultural beliefs and practices differ from those of the nurse. It extends beyond cultural awareness, cultural sensi- tivity, and the learning of culturally specific beliefs, values, and practices of various ethnic groups (Wilson, 2013). In addition, it recognises the diversity that exists within a cultural group and the need for astute assessment and incorporation of iden- tified traits within the planning and delivery of person-centred care. The concept of cultural safety arose out of the concerns voiced by Ma¯ori nurses in New Zealand regarding the