Principles of Cultural Safety for ATSI People
ATSI, or Aboriginal and Torres Strait Islander, is an indigenous group that is further distinguished into two groups by their place of origins. One group that includes people from mainland Australia and Tasmania is hence known as Aboriginal Australians. The other group of people from Torres Strait Island are known as Torres Strait Islanders. ATSI is an Australian population that makes up less than 3% (Government of Australia, 2021). These are the first inhibitors and original settlers of Australia. ATSI population experiences more health inequalities than other Australians (Government of Australia, 2021). Minimising health inequality and achieving equitable healthcare can be done by practising cultural safety and culturally respectful communication. This essay will discuss all the principles of cultural safety and respectful communication practices.
For Aboriginal and Torres Strait Islanders, cultural safety in healthcare is all about creating safe circumstances and delivering accessible and racism-free healthcare services. The Nursing Council of New Zealand shared five principles of cultural safety in the year 2005 that are also applied to the Australian nursing and midwifery context (Best et al., 2018, p-58). The first cultural safety principle is to ‘reflect on your own practice, which is vital to ensuring cultural safety. According to this principle, nurses and midwifery need to reflect their cultural identity, their assumption about health, illness and people, their personal or their patient’s definition of health, and the implication of these definitions for nursing practices. These reflections are important as the biomedical system may provoke indigenous nurses’ beliefs, values and attitudes (Best et al., 2018, p-58). The second cultural safety principle is all about minimizing power differentials in nursing practice with first people or ATSI people. In context to this principle, nurses and midwifery practices must try to minimize power differentials with First people as it is critical to know about your values and how these reflect and impact the Indigenous people. It is important to understand the biomedical dominance in Australia and how it affects indigenous people’s cultural safety and health (Best et al., 2018, p-59).
The third principle is to ‘engage in discourse with the patient or client’, who is all about the practices and obligations required while dealing with the indigenous people. It is about understanding the unique needs, beliefs of first people regarding health care and their preferred way. It was found that these kinds of patient engagements were not successful with the first people in history as the patient could not understand the slang and medical vocabulary used by nurses and healthcare professionals. This principle basically emphasizes using patient-friendly language or first-person language during client engagement (Best et al., 2018, p-59). The four factors given by an aboriginal registered nurse while engaging with the first people or Indigenous patient include nurse’s readiness to practice cultural safety, nurse’s ability to communicate and listen appropriately, nurse’s knowledge of regional aboriginal health system, and the nurse’s level of acceptance by the regional aboriginal community. The fourth principle is to undertake a process of decolonization; it has been found that the colonization experienced by first people or Aboriginal people has a harmful effect on their health worldwide. Various evidence suggests that colonisation created a remarkable hurdle in improving the health of the ATSI population that is also seen in the life expectancy rate of Indigenous people compared to non-Indigenous people (Best et al., 2018, p-60). The Cultural safety approach given by the New Zealand Council of Nursing emphasises decolonisation in the health care system. In context to this book, it has been suggested that decolonisation should be practised within health service delivery in the urban, rural and remote regions of Australia. Another statement in the book suggested that colonisation is a critical issue responsible for the absence of progress in Aboriginal health. It is believed that Australian nurses must undergo a process of decolonisation to hear, identify, accept and understand the pain, and worries of Aboriginal people, so the health care system improve for these people. Non-indigenous nurses must respectfully and receptively hear the voice of the First people; thus, both indigenous and non-indigenous nurses should practice decolonisation (Best et al., 2018, p-60). The final and most difficult principle is to ensure that the nurses do not diminish, demean or disempower other people with their actions. This final principle is based on self-reflection, self-awareness, and understanding of their beliefs and attitude. It is critical in nursing and midwifery to understand how their values beliefs affect the other person to not disrespect the client. While communicating with the client during undertaking admission assessment, it is critical to ask about their community as it is not safe to assume their community based on their appearance, colour, and language. Hence these principles are vital and preferred practices for healthcare professionals like nurses and midwifery while working with the Aboriginal and Torres Strait Islander people (Best et al., 2018, p-61).
Engage in Discourse with Patients
Understanding Aboriginal worldviews and co-designing the working practices can achieve better health outcomes within the first people. Sometimes non-Aboriginal nurses and midwifery struggle to recognise the importance of social relationships to Aboriginal people; thus, these communication practices will help these health professionals to overcome the differences and create a better framework or model to understand first people (Wright, Lin, O’Connell, Bullen & Flavell, 2021). Cultural communication practices involve all the different ways to respectfully communicate with people with different backgrounds. These practices are critical to understanding their perspective, values and promoting a better relationship between Aboriginal and Torres Strait Islander people (SNAICC National voice for our children, 2021). These effective communicating practices are as follow:
Display or demonstrating understanding is one of the first steps or communication practice that is helpful while interacting with the first people. As it is known, the Aboriginal and Torres Strait Islander people have gone through so much racial discrimination that has a negative impact on these people. These people have mistrusted towards the Government system or services. Thus, while interacting with these people as healthcare professionals, nurses should reflect their beliefs, values, and experiences without judging their beliefs and worldviews that might be different from theirs (Aboriginal and Torres Strait Islander Cultural capability, 2015). Respect and sensitivity are another set of communication practices that nurses and healthcare professionals must follow. It is very important to respect the various aspects of Aboriginal culture as these people are very sensitive towards their beliefs and cultural values (NSW Department of Community Services, 2009, pp. 18). Using appropriate language is also an effective communicating practice that should be used by Nurses and midwifery’s while dealing with first people. There are approximately 250 different languages, and even aboriginal English is also slightly different from the Australian English language. However, the words have the same meaning, but the first people pronounce words and letters differently, so a healthcare professional must sensitively use language or non-verbal gestures while communicating (NSW Department of Community Services, 2009, pp. 23). Building a rapport or taking a person before business, using simple language, and being mindful while using non-verbal communication are a few personal communication practices while dealing with the first people. There are other practices that nurses and midwifery must practice while communicating with the Aboriginal and Torres Strait Islander people are like seeking permission to touch and explain a reason for the same.
Moreover in First people culture, extended periods of silence during the communication are used to listen, show respect and consensus; thus, nurses and midwifery must be respectful and provide adequate time to the person (Aboriginal and Torres Strait Islander Cultural capability, 2015). One of the most important communication practices is seeking consultation, approval and permission for the proposed action, while working with the first people nurses and midwifery ask for permission or approval at the beginning, middle and end of the treatment (NSW Department of Community Services, 2009). These communication practices also include providing options and ownership to the first people. When the choices or options for care and ownership is given to the Aboriginal and Torres Strait Islander people, they effectively participate in the process and increase medication compliance. Providing clear instruction and explanations to Aboriginal and Torres Strait Islander people is also one of the critical communication practices that healthcare professionals should follow as these people may misunderstand the instruction. Indirect questioning is one of the most preferred communication approaches that should be used while dealing with the Aboriginal and Torres Strait Islander people as direct question sometimes leads to misunderstanding, and indirect questioning, avoiding the compound question, using simple words yield more comprehensive information (Fleming, Creedy & West, 2020). The local indigenous nurses and midwifery also assist with the cultural information, which is also helpful in distributing information among the first people with better communication assistance and cultural support ((Fleming, Creedy & West, 2019).
Conclusion:
The Aboriginal communities are most prominently relying on their traditions and culture; thus, it is essential to develop an understanding of their diverse community and their belief and values. The government suggested five principles of cultural safety that are also applied to the Australian nursing and midwifery context; these principles are the most preferred practices in the healthcare professionals while dealing with the Aboriginal and Torres Strait Islander people. Some cultural communication practices are used to promote shared understanding and trust in healthcare; these practices consist of making rapport, using language that is easily understood by the First people, understanding their silence, asking for approval and content before any treatment will help fill the gap between health care and the Aboriginal community.
Reference
Aboriginal and Torres Strait Islander Cultural capability, 2015, ‘Communicating effectively with Aboriginal and Torres Strait Islander people’ <https://www.health.qld.gov.au/__data/assets/pdf_file/0021/151923/communicating.pdf>
Best, Odette, Fredericks & Bronwyn, 2018, ‘The cultural safety journey: An Australian nursing context’, in Yatdjuligin: aboriginal and Torres Strait Islander nursing and midwifery care (2nd edition), Cambridge, United Kingdom: Cambridge University Press, pp. 46-66
Fleming, T, Creedy, D, K & West, R, 2020, The influence of yarning circles: a cultural safety professional, development program for midwives, Women and Birth, vol. 33, no.2, pp. 175-185, < https://www.sciencedirect.com/science/article/abs/pii/S1871519218304268>
Fleming, T., Creedy, D.K. & West, R., 2019. Cultural safety continuing professional development for midwifery academics: An integrative literature review. Women and Birth, vol. 32, no. 4, pp.318-326, < https://www.sciencedirect.com/science/article/abs/pii/S1871519218301999>
Government of Australia, 2021, Aboriginal and Torres Strait Islander People, <https://www.stylemanual.gov.au/accessible-and-inclusive-content/inclusive-language/aboriginal-and-torres-strait-islander-peoples>
NSW Department of Community Services, 2009, Working with Aboriginal people and communities: A practice resource, pp. 18-28,
<https://www.community.nsw.gov.au/__data/assets/pdf_file/0017/321308/working_with_aboriginal.pdf>
SNAICC National voice for our children, 2021, Cultural protocols, <https://www.supportingcarers.snaicc.org.au/connecting-to-culture/cultural-protocols/>
Wright, M, Lin, A, O’Connell, M, Bullen, J & Flavell, H, 2021, Understanding and working with different worldviews to co-design cultural security in clinical mental health settings to engage with Aboriginal and Torres Strait Islander clients, Cambridge university press, < https://www.cambridge.org/core/journals/primary-health-care-research-and-development/article/understanding-and-working-with-different-worldviews-to-codesign-cultural-security-in-clinical-mental-health-settings-to-engage-with-aboriginal-and-torres-strait-islander-clients/C5AC92C11AF6F2B9417043D2E97743B3>
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