Cultural Safety In Nursing Education
What Is Cultural Safety
Cultural safety refers to awareness
and action aimed at ensuring patients from different backgrounds feel safe in
their clinical encounters. It is a conscious provision of care that takes into
account how power relations influence health care. This conscious provision of
care aims to protect the identities of patients, particularly those from
minorities and dis-empowered groups.
Implementation of Cultural Safety In Nursing Education
Cultural safety is a key component
in educating nurses to deliver humane and effective care. In order to provide
culturally safe cane, nurses and other caregivers need to understand the ways
in which power structures influence health, and to reflect on how personal and
professional power positions influence their encounters with patients (Ramsden,
2002). Cultural safety education is particularly important in diverse societies
with histories or present situations of colonialism, racism, discrimination,
and conflict (Arieli, Mashiach- Eizenberg , Friedman, & Hirschfeld, 2012)
Translating the concept of cultural safety into nursing education practice is complex and challenging. The major goals for educators and students include identifying conscious and subconscious perceptions of others and acknowledging how these perceptions influence the provision of care. Education focuses on transforming negative perceptions and attitudes toward others (Ramsden, 2002) Educational strategies include providing knowledge on historical and sociopolitical contexts in terms of what these contexts mean in working relationships where there is a difference (Richardson & Carryer, 2005).
Other suggestions include focusing on the ways in which power is embedded in nursing practice and is inherent in the relations between nurses and patients (Jeffs, 2001).Cultural safety education might be experienced as unsafe by both students and teachers, from both majority and minority groups, because it involves dealing with. power relations and tensions, which are often threatening and raise powerful emotions of blame and guilt (Arieli, Friedman, & Hirschfeld, 2012).
In order to teach cultural safety, educators have the responsibility to construct a learning environment where all students feel safe to reflect on and give expression to their cultural identities (Jeffs, 2001). Engaging in reflexivity, both as teachers and as learners, is key to cultural safety education.
History of Cultural Safety
The concept of cultural safety was introduced by Ramsden, a Mauri nurse from New Zealand, in the late 1980s (Papps & Ramsden, 1996; Ramsden, 2002). In 1991, the New Zealand Nursing Council ruled that the state examination would include 20% on cultural safety. The concept of cultural safety was further developed by Ramsden and other scholars who suggested a broader meaning where culture referred not only to ethnic differences but also to differences such as gender, age group, sexual preference, religion, profession, and disability (Ramsden, 2002 ).
Cultural safety is a key competency for professional responsibility. It includes demonstrating professional, legal, ethical, and cultural safety. These categories are examined through the application of physiological and psychosocial knowledge, as well as communication and clinical skills (Nursing Council of New Zealand, 2002/2012). Cultural safety in nursing education is focused on educating students to be reflective of their own attitudes toward patients and their power relations with patients, rather than on their cultural customs and perspectives.
While the goal of cultural competence education is to
educate a professional nurse who treats patients in a culturally appropriate
way (Wells & Black, 2000), the educational aim of cultural safety is a
nurse who investigates the strategies which can illuminate the factors that
threaten the patients' sense of safety (Ramsden, 2002). There have been some
attempts to combine the two concepts of cultural safety and cultural competence
and develop a model for an ethic of care based on both concepts (McEldowney
& Connor, 2011). Cultural safety education is also an institutional
responsibility, because structural conditions enable provision and/or teaching
of culturally safe care (Richardson, 2010).
Cultural safety became a key
concept in nursing education in the 21st century. The meanings of the concept
and its application have been explored by scholars in New Zealand and Australia
(Phiri, Dietsch, & Bonner 2011); Canada (Cash et al., 2013); the United
States (Doutrich, Arcus, Dekker, Spuck, & Pollock-Robinson, 2012 and Israel
(Arieli et al, 2012)
Outcomes of Cultural Safety In Nursing Education
Integrating cultural safety in nursing education necessitates educating nursing students to perceive themselves as active social agents who endeavor to promote social justice. Nursing educators should be responsible for designing adequate cultural safety education programs that will take into consideration the specific power relation structures of each society, as well as the backgrounds of students and teachers. Because the idea of cultural safety may encounter resistance, there is a need for institutional, national, and international support for this educational perspective.
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