Addressing inequities from an organisational and professional level

Cultural safety is measured by the sense of safety and comfort of kaumātua and whānau using health services. When kaumātua and whānau feel safe and cared for by the service, whether because of its general approach, or because of the individual health professionals delivering care, then cultural safety has been achieved. Although it is important for health and social care professionals to have reflexive practice, and to know, and be comfortable with their own identity, values, beliefs and cultural customs as well as have an understanding and appreciation of Māori cultural values, beliefs and cultural customs, it is also important that they reflect upon their own assumptions, stereotypes and biases concerning Māori.

Curtis et. al. (2019) provide the following definition of cultural safety:

Cultural safety requires healthcare professionals and their associated healthcare organisations to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery. This requires individual healthcare professionals and healthcare organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities, and as measured through progress towards acheiveing [sic] health equity. Cultural safety requires healthcare professionals and their associated healthcare organisations to influence healthcare to reduce bias and achieve equity within the workforce and working environment.

Furthermore, Curtis et.al. (2019) provide recommendations for organisations to implement cultural safety:

  • It is clear from reviewing the current evidence associated with cultural competency and cultural safety that a shift in approach is required. We recommend an approach to cultural safety that encompasses the following core principles:
  • Be clearly focused on achieving health equity, with measurable progress towards this endpoint;
  • Be centred on clarified concepts of cultural safety and critical consciousness rather than narrow based notions of cultural competency;
  • Be focused on the application of cultural safety within a healthcare systemic/organizational context in addition to the individual health provider-patient interface;
  • Focus on cultural safety activities that extend beyond acquiring knowledge about ‘other cultures’ and developing appropriate skills and attitudes and move to interventions that acknowledge and address biases and stereotypes;
  • Promote the framing of cultural safety as requiring a focus on power relationships and inequities within health care interactions that reflect historical and social dynamics.
  • Not be limited to formal training curricula but be aligned across all training/practice environments, systems, structures, and policies.

Cultural safety guidelines can be located in the cultural policy at hospitals, hospices and residential care facilities. There are also Māori health models available that contain information about holistic health care (see below). If you are unsure about what cultural support a family needs from you, ask them. Whānau are normally happy to guide health professionals when they show a sincere willingness to want to get things right. Being humble and saying that you are unfamiliar with cultural protocols but would like to understand what is important for that whānau manaaki shows sincerity and humbleness.

Furthermore, Māori health and social care professionals can be a supportive ally for non-Māori staff who are unfamiliar with some population groups. Ensuring every kaumātua and their whānau feels culturally safe when receiving palliative care may require health and social care professionals to step out of their comfort zones, however having good cultural support (support of Māori colleagues) is essential, especially when trying to support the needs of diverse whānau.

Resource

Curtis, E. Tipene-Leach, D., Walker, C, Loring, B., Paine, S-J and Reid, P. ‘Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition’. International Journal for Equity in Health. (2019) 18:174https://doi.org/10.1186/s12939-019-1082-3

Kui (hospice health care assistant) reflected on an instance where there were gang members visiting someone who was staying at [name of Hospice]. Many of the nurses felt intimidated by their presence, but Kui was able to encourage the nurses and spoke to the visitors to make sure they were respectful of those providing care to their friend:

… we had a patch member in. They didn’t say he was a patch member, but he had a couple of his friends come in [patched up]. Yeah… they weren’t intimidating the nurses, but the way they looked intimidated the nurses… So, it’s like, ‘No, don’t be like that. We’re going in the room. Come on, come on. We’re going in.’ I said [to the gang members], ‘These are the nurses that will look after your friend,’ and I said, ‘and they’re doing a good job so please respect them.’… Yeah and they said, ‘Oh yeah, kia ora whaea. Kia ora whaea.’… I said, ‘Please respect them because I’ll tell you what, you’ll get the best care.’

Kui spoke about how she helped the nurses feel more comfortable around gang members:

So, the nurse that got really scared she said, ‘Kui, I’m scared of that man in there. He’s like, he’s got a patch on.’ I said, ‘Come on, we’ll go in.’ I say, ‘Come on.’ The two nurses said, ‘Kia ora.’ I said, ‘I’m Kui, I’m the HCA. These are two nurses that are looking after your friend.’ I said, ‘Please show them some respect because they’re the best you’re going to get.’ And I said, ‘Please don’t intimidate them.’ ‘Oh, kia ora whaea. Kia ora whaea. No, no we won’t.’ I said ‘Yous going to be ok?’ They said ‘Yes.’ ‘Okay see you later.’ And then we took a body past and I closed the door, right. And they go, ‘Excuse me whaea, why did you close the door?’ I said, ‘Because we had a body being taken out.’ ‘Oh sorry.’ [they said]. I said, ‘Okay then.’

Recommendations

For health and palliative care professionals we recommend:

  • Designing and carrying out end of life care that includes a collaborative, interpersonal teamwork approach; this will involve consulting Māori, and will include the use of te reo Māori (Māori language) and cultural processes
  • Including cultural safety training for all staff.
  • Implementing policies and procedures that support culturally safe practices.
  • Increase their understanding of the older person’s social circumstances and cultural identity, and how this influences the way kaumātua and whānau experience illness and medical interventions (including treatment). This is essential to working effectively with Māori.

Resource

Cultural Safety

Nursing Council Guide

Guidelines for Cultural Safety, the Treaty of Waitangi and Māori Health in Nursing Education and Practice.

http://pro.healthmentoronline.com/assets/Uploads/refract/pdf/Nursing_Council_cultural-safety11.pdf

Royal New Zealand College of General Practitioners

Health Equity and Cultural Safety

https://rnzcgp.org.nz/RNZCGP/Dashboard/Resources/CPD_Resources/Health_equity_and_cultural_safety_?WebsiteKey=4105e6d5-9ad4-4cbf-b3d4-8a1df183be9d

Links and Information for Health Professionals

Māori Health Models

Te Whare Tapa Whā

One popular model for understanding Māori health is the concept of ‘te whare tapa whā’ – the four cornerstones (or sides) of Māori health.

https://www.health.govt.nz/our-work/populations/Māori-health/Māori-health-models/Māori-health-models-te-whare-tapa-wha

Te Wheke

Traditional Māori health acknowledges the link between the mind, the spirit, the human connection with whānau, and the physical world in a way that is seamless and uncontrived. Until the introduction of Western medicine, there was no division between them.

https://www.health.govt.nz/our-work/populations/Māori-health/Māori-health-models/Māori-health-models-te-wheke

Te Pae Mahutonga

Te Pae Mahutonga (Southern Cross Star Constellation) brings together elements of modern health promotion.

https://www.health.govt.nz/our-work/populations/Māori-health/Māori-health-models/Māori-health-models-te-pae-mahutonga

Publications

Ministry publications on Māori health.

https://www.health.govt.nz/our-work/populations/Māori-health/Māori-health-publications

Māori Data Sovereignty

Te Mana Raraunga

https://www.temanararaunga.Māori.nz/

New Zealand History

Te Ara

https://teara.govt.nz/en

Māori History

https://teara.govt.nz/en/search/teara?keys=Māori+history

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