Difference between individual racism and institutional racism
Discuss about the Critical Reflection On Concept Of Cultural Safety.
- Personal racism is defined as racist beliefs, assumptions or behaviours of an individual or racial discrimination that stems from personal prejudice or unconscious and conscious. This kind of prejudice is learned from or connected to broader economic processes or histories that are reinforced, supported by institutional or systemic racism. On a contrary, systemic racism comprises of practices and policies entrenched in institutions that result in exclusion of a particular community. From an anti-racist perspective, there is prevalence of prejudice and racism in the society that is depicted by the media (Van Dijk, 2015, 5).
Both types of racism tend to discriminate individuals, however have some differences. In individual racism, a person is abused against his or her race, age, gender or ethnicity. On a contrary, when a certain rule or culture that has been created is racist towards a particular group of people. Individual racism can lead to institutional racism; however, the opposite is not possible. The reason is that institutional racism comes from an individual that formulate into an institution. For example, when an individual tends to treat another one unequally, it is individual racism that is opposed by institutional racism where a policy tends to treat individuals of a certain community unequally. Therefore, racism is an accusation that threatens the diversity in the society through iinstitutional racism (Ahmed, 2012, pp. 146).
- ‘Whiteness in nursing’ refers to those dimensions of racism where it serves for the elevation of white nurses over nurses of colour. Since 1990s, nursing is challenged, exposed to institutionalized systems where whites are dominant and gain privilege. Instead of racist education, the nursing training and course should focus on ’cultural competence’ where it usually disagrees institutionalized structures of white racism and privilege. In context to power dynamics, it can be explained in a way where nursing students are engaged in a class that is focused on social and political power of whiteness in the nursing profession. The strength of whiteness as identity is determined by privilege and historical power given to the white society and numerical minority results in less power and subjected to more discrimination and racially designated (Nielsen, Alice Stuart & Gorman, 2014, 192).
- Cultural awareness training refers to the activities in general practice that is aimed at improving the health of a particular culture by enhancing the cultural awareness of the healthcare professionals, nurses, primary healthcare staffs and medical students. In this training, the professionals are taught about the history and culture of a particular community (example-Aboriginals), they explore how values and attitudes influence assumptions, perceptions and behaviours in the clinical setting and ways in which they can be more culturally aware of the service users. Cultural competency is one of the major disciplines in the nursing curriculum that is required for assessing cultural awareness, skills, knowledge and comfort that strengthens nursing profession (Mareno & Hart, 2014, 83). On a contrary, cultural safety training can be referred to as removal of power indifference through acknowledgement of differences, developing cultural sensitivity, recognition of difference and respecting it, understanding of cultural norms and values of the minority groups, empathetic and collaborative relationships. In addition, self-reflection help the healthcare professionals to gain the capability to understand others’ feelings and emotions which in turn is helpful in establishing a therapeutic relationship with clients that lead to better health outcomes. Cultural safety also incorporates social justice and advocacy on behalf of minority communities. Nursing profession is an art as well as science that have the primary responsibility to provide effective, comprehensive, holistic and culturally appropriate caring towards the patients under their provision of care (Montenery et al. 2013, pp. e52).
During my clinical placement, an Aboriginal patient was admitted to the ward following a suicidal attempt. I was assigned to interact with the patient to know about his problems. At first instance, I was very nervous and unable to initiate the conversation. He was unable to explain his feelings due to limited English proficiency. As I never interacted with any patient from ethnic background, I hesitated to ask him any sort of questions. In this situation, I realized that I should develop cultural awareness and sensitivity towards clients from other ethnic backgrounds.
Three key factors explore concepts of Aboriginals wellbeing in regards to access to healthcare, employment and education. The impact of European colonization, the influence of cultural and geographical dimensions on individuals and their communities and historical barriers are the factors that given clear picture of their physical and mental health status. After the European colonization, the population declined and in 1920s, there were only 60,000 Aboriginals had reaching effects. They were forced to move off their traditional lands and away from active hunter-gatherer lifestyle. Many of them were unable to resist this seizure of lands that resulted in violence. Majority of them died from infectious diseases that were brought by Europeans. After this shift, they moved to lands where they were unable to speak their native language or perform their cultural practices. Later, many laws and policies were enacted that forced them to segregate from the other Australians and they were left with no or little self-determination. The institutional racism forcibly made Aboriginal children to separate from their families and foster families from European background. They suffered from sexual or physical abuse raised by institutional racism as they lived in poverty or servitude as domestic workers or labourers. Therefore, it is evident that Australian history of European colonization is the indicator of health status of the people driven by political, colonial and economic histories (Sherwood, 2013, pp. 28).
The Aboriginals lost their cultural identity and language due to colonization as they were expected to adopt the European culture. They were forced to adopt European language, dress, lifestyle, religion and cultural values. Even the separated children were not allowed to contact or reunite with their families. These historical factors like European colonization, cultural displacement, family disruption and discrimination stemming from institutional racism contributed to high incidence of unemployment, poverty and poor health among the Aboriginals. In the current Australian healthcare scenario, Aboriginals continue to experience discrimination, institutional racism and social disadvantage. In the context to access to healthcare, Aboriginals find it difficult to access healthcare services due to lack of culturally appropriate treatment options, as they consider health not only physical, but also emotional, social and spiritual wellbeing. The European colonization, the colonists invaded the Aboriginal lands and as a result, they got detached from their traditional lands resulted in the loss of their sense of cultural identity (Loos, 2017, pp. xvii).
Impact of European colonization on Aboriginals in Australia
According to Gidden’s theory of structuration, there is high rate of unemployment among them between the ages of 15 to 64 years as compared to non-indigenous population due to geographic isolation, social structures and power relations (Bourke et al., 2012, pp. 498). There is low attainment of education among the Aboriginals as compared to the non-indigenous population. The Australian Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2004-2009 work together to provide education to Aboriginals that underpins cultural respect (Freeman et al., 2014, pp. 356). About 60% of Aboriginals are unable to start their Year one and stays behind non-Aboriginals. Due to institutional discrimination, Aboriginals are unable to attend classes and as a result, have low rates of attendance and unable to focus on their study. According to Department of the Prime Minister and Cabinet, Australian Government, Aboriginals are the most disadvantaged population that has reduced access to healthcare services, employment, education and housing contributing to poor physical and mental health. As a result, they are exposed to risk factors like stress affecting their wellbeing and primary care services need to recognize this stress and provide culturally sensitive healthcare services.
The mainstream healthcare services in Australia are unable to meet the needs of Aboriginals as they lack cultural appropriateness, despite of the fact that many policies are developed for promoting positive healthcare service delivery. In the light of this situation, the nurses need to understand cultural safety and develop awareness that links power imbalance and equitable social relationships in the Australian healthcare scenario. Through cultural safety training, nurses can understand the power differentials exiting in the healthcare and redress these inequalities through safe nursing practice. Through the lens of cultural safety, nurses can address the inequalities by critical reflection framework (Gerlach, 2012, pp. 153).
The core competencies for culturally safe nursing comprises of post-colonial understanding, inclusivity, communication, respect, cultural awareness and indigenous knowledge and promoting cultural safety can be helpful in challenging the institutional racism against Aboriginals. The nurses need to understand that European colonization affected the lives of Aboriginals by examining the relationship between historic trauma and poor health outcomes. Communication is the cornerstone for culturally safe nursing practice because language is the main barrier to cultural safety. Through effective and safe communication, nurses can help to make the Aboriginals feel respected and valued in the healthcare institution. The cultural awareness and insights into culture of Aboriginals can be helpful in promoting culturally appropriate and safe practices for them as outlined by The National Aboriginal Health Organization (NAHO) (Baba, 2013, pp. 8).
Respect acts as the main guiding principle for the Aboriginal health, their identity and uniqueness. The effective communication and collaboration with the Aboriginals can be helpful in improving their health status. Among all, the nurses need to be aware of the indigenous knowledge like cultural, emotional and spiritual practices that can be helpful in understanding the Aboriginal perceptions, values and factors that is related to their health, wellbeing and healing. In addition, they also need to understand the linguistic strategy of orientation questioning (Eades, 2013, pp. 73).
- Reporting: During my clinical placement, many indigenous patients were admitted for chronic illness. When I approached them, they were unable to explain their problems. I was not able to understand the cause of their grimacing pain and health complications. Due to language disparity, I was unable to understand their concerns and failed to develop proper care plan for them.
Challenges faced by Aboriginals in accessing healthcare services
Responding: During this situation, I was very nervous and unable to understand their language so that I can develop proper interventions for them. I was feeling hesitated and helpless, as I was unable to understand the cause of their pain and question them about their health status. I was feeling disappointed and disheartened as I failed to interact with them in understanding their situation.
Relating: After the situation, I felt that there is lack of cultural awareness in me that aggravated their health condition. Language is the biggest barrier while communicating with the patients from other cultural backgrounds. One needs to be culturally aware and competent towards the individuals from other cultural backgrounds so that they feel respected, valued and included (Herring et al., 2013, pp. 106).
Reasoning: The main issue in this situation was lack of cultural appropriateness and ability to interact with people having limited English proficiency. The main factor that is significant to this situation is cultural safety and overcoming significant language barrier. A culturally safe nursing practice is required towards Aboriginals to promote their health and wellbeing.
Considering this situation, I need to develop an action plan if I encounter such situations in my nursing profession.
Cultural safety, communication and skill development are the vital components that can ensure cultural safe nursing practice for the Aboriginals. Making cultural connections with the Aboriginals is important and as a nurse, I need to provide a socially, spiritually and respectful environment for them so that they feel included. The culturally safe practices like meeting their expectations, preferences and rights so that they feel empowered can be helpful in delivering culturally safe treatment. I need to not only focus on my culture, but also consider their cultural dimensions by being flexible and open-minded in order to provide the best conditions for patients as per the Nightingale theorist (Nettina, Msn & Nettina, 2013, pp. 2). Non-verbal communication can be essential like touch, body language and silence can be helpful in establishing a therapeutic relationship with them where English is limited. The skill of active listening, establishing clear and respectful communication, developing trust, sharing knowledge and feedback with proper understanding of their culture can be helpful in providing a culturally safe environment for them. The Purnell Model for Cultural Competence outlines the adaption of cultural competency by healthcare professionals (Purnell, 2012, pp. 3). Therefore, through effective and culturally appropriate communication and practices, Aboriginals can enhance access to healthcare that promotes their health and wellbeing.
References
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