NSB 102 Professional Practice & Cultural Safety Module 1 PDF

NSB 102 Professional Practice and Cultural Safety Module 1: Week 1 lecture Introduction to cultural safety Dr Audra de Witt Acknowledgement to Dr Leonie Cox for some material content  Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, we acknowledge the...

NSB 102 Professional Practice and Cultural Safety Module 1: Week 1 lecture Introduction to cultural safety Dr Audra de Witt Acknowledgement to Dr Leonie Cox for some material content  Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, we acknowledge the Traditional Owners-the Jagera and the Turrbal peoples of the land where QUT now stands and recognize these places have always been places for teaching and learning. We pay our respects to their Elders past and, present and acknowledge the important role Aboriginal and Torres Strait Islander peoples continue to play within the QUT community. www.reconciliation.qut.edu.au  Module 1 learning outcomes: after completing all learnings and activities for weeks 1 and 2 participants will…  Gain an understanding of the history,  Be able discuss assumptions principles and need for cultural safety underlying cultural safety  Have an understanding of how life  Demonstrate knowledge of worlds, world views, values attitudes cultural safety and its use in the and beliefs influence interactions real word of nursing care including our nursing practice  Start to have an understanding of  Be able to describe steps towards the relationship between cultural cultural safety and the importance of safety, professional practice and the language we use becoming a registered nurse 3 What is cultural safety? Can mean different things in different contexts 1. A philosophy: what is the nature of reality and existence seeks social justice and fairness-wealth, jobs, opportunities, confronts discrimination and racism, raises critical debate, sees issues in terms of power imbalance and social experience. 2. Epistemology: a theory of knowledge: the scope and validity of knowledge knowledge based on critical perspectives aiming for social change, theory of social constructionism i.e. knowledge is constructed by humans and is value and power laden. 3. A model for practice – this is our main focus in this unit What is cultural safety? 3. A model for practice Flexible, responsive and respectful health care - power sharing and negotiation Prioritising clients needs - at the centre/ heart of nursing and health care Recognising that health means different things to different people, is determined by the person & family - especially important when caring for person/family from another culture Culturally safe nurses: Have undertaken a process of reflection on own cultural identity and social position Recognise the impact of own personal culture and social position and its impacts on own professional practice and interactions Are knowledgeable about Australian history and current social practices and have taken a stance on these Consider, reflect and are aware of professional and health organisation cultures, its impacts on client care and takes actions accordingly Where did cultural safety come from? Originated in NZ in the 1980’s - Maori Scholar Dr Irihapeti Ramsden key person in formation of this concept Arose from colonial history of Aotearoa/NZ When Maori midwifery students expressed concerns of feeling unsafe within a predominantly anglo educational setting where they were training in Concept was later further developed to explain poor uptake of health services by Maori people in general Led to implementation of principles of cultural safety as way to address Indigenous health inequities in NZ Cultural safety was intended to reduce alienation of existing health service organisations, for health staff to understand how colonial violence and dispossession produced health inequities and For staff to suspend own ethnocentric views (my way is the correct way & other views are wrong) and respect alternative world views and cultural practices & prioritise needs /preferences of clients Broad definition of culture used in cultural safety …learned yet dynamic ways of being in everyday life, informed by attributes such as age, class, ability, ethnicity, gender and sexual orientation, which influence beliefs, values and attitudes and how humans explain and respond to life’s context and circumstances’ (Cox 2013 in Happell et al. p. 347) 7  Cultural Safety Principles Organisations /professions/staff groups/individuals have cultures Dominant culture accepts the heritage of cultural imperialism and colonisation Our cultural beliefs [and related values assumptions, attitudes] can impose limitations on practice Cultural safety principles Health professionals acknowledge our power and privileged position in society Positive attitudes by those in positions of power >>> a major impact on the health and identity of others Those in positions of power have the choice of changing or perpetuating dominating practices Values underlying cultural safety  social justice  respect dignity of everyone  humility  acceptance  freedom and democracy  trust  partnership  power sharing and negotiation  flexibility  relationships and reciprocity  openness Cultural safety ideals  life long learning  Historical literacy  critical reflection  uniqueness of individuals  social justice  wide and varied education of nurses  skilled service  power and resource sharing  limit suffering  community leadership  community skills  Cultural safety in context to Healthcare and First Nations Australians “ Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities.” “Cultural safe practise is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and response healthcare free of racism”. Source: AHPRA and National Boards. The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 P9  Is cultural safety only relevant to nursing First Nation peoples?? Not only relevant to First Nation peoples contexts - but highly relevant due to everyone due to burden of racism and other disadvantages relevant to all nursing practice contexts-hospitals, clinics, community Culturally safe nurses… avoid stereotypes deal with the unique person in front of us who may or may not adhere to cultural ideals recognise that social and not cultural issues may be at play  Health is a Human Right – World Health Organisation … WHO Constitution (1946) envisages “….the highest attainable standard of health as a fundamental right of every human being” Countries have legal obligation to ‘ensure access to timely, acceptable and affordable health care’ Rights-based approach to health = need to prioritise disadvantaged populations and for greater equity in health (via supportive health policies & programs) – echoed in 2030 Agenda for Sustainable Development and Universal Health Coverage “The right to health must be without discrimination on the grounds of race, age, ethnicity or any other factor”. This means countries need to take steps to redress any discriminatory law, practice or policy.  Why is cultural safety needed in colonised nations t improve First Nations peoples health? I wonder if you consider that you had a solid education in Australian history? If so that’s great but consider logging onto learnourtruth OR watch ‘The First Australians’ tv series SBS Culturally safe nurses are historically literate Assumptions re terra nullius and about Indigenous people (that they didn’t care about the land, didn’t fight back) Stolen generations – forced removal of children from their kin, country and culture under govt policy of assimilation Dispossession of land and resources, conflicts, massacres, undermining of cultural identities, discrimination, racism, destructions of traditional ways of life Study your week 2 required reading for a summary of relevant historical events Cox, L. (2007). Fear, Trust and Aborigines: The Historical Experience of State Institutions and Current Encounters in the Health System. Health and History, 9(2), pp. 70-92.  Why do we need a culturally safe and responsive heath system? Improves access to health care - to ALL e.g. First Nations peoples and traditionally less represented populations) Accessible health care = physically accessible/close to home, affordable, appropriate, acceptable Improves quality of health care delivered Culturally safe = respects cultural values, strengths and differences – recognising that practices of dominant culture is not the only &/or best way - acknowledges, accepts others and other successful ways to live a good life It addresses racism and inequity It requires health professionals and health services to be aware, culturally responsive, take action to overcome racism and power imbalances It respects all and aims to deliver care based on individualised needs based on personal values, cultures and beliefs, rather than expected people to ‘fit’ into a ‘one size fits all’ system So cultural safety in the health context –defined with reference to peoples’ experiences of receiving health care (positive? negative?), how health care is delivered (respectful?) and accessibility of services (ease/friendliness) NSB 102 Cultural Safety and Professional Practice Module 1: Part 2: Week 1 What has cultural safety got to do with you? Dr Audra de Witt Acknowledgement to Dr Leonie Cox for some material content  Lifeworlds and worldviews Our Lifeworld the context and experience of everyday life … (experience informed by e.g. identity, social position/status, family, communities, society. Socially constructed notions eg about gender, age, ability, ethnicity, identity, disability, racism, sexuality etc) and it interacts with Our Worldview values, beliefs, assumptions, norms etc. people and organisations are underpinned by these PAUSE: Our worldviews influence how we answer… the BIG questions: When/how did the world begin? How did we get here? Why am I here? What happens after death? What is good/bad? What is the nature of life? Do you have other BIG questions?  PAUSE: Frames of Reference Frames of reference… the way we perceive and react to the world, people and life’s experience based on our beliefs, values, experiences and attitudes Reflect: Has your frame of reference changed over time?  In cultural safety personal culture does not = ethnicity Learned not biologically inherited Influenced by the social class and ethnic group to which family belong Learned from family and Includes power relations (gender, class, ethnicity, gender and sexual identity) Broader society Economic, political, social, historical and physical environments e.g. school, media  Ethnicity Cannot be used interchangeably with culture Socially constructed Group identity [in/out] Common ancestors (kinship), lore/law, history, language, food, dance, ceremony, dress, religion e.g. in broad terms identify as Australian (culture) but are members of the Polish club, the Greek club (ethnicity) Ethnicity doesn’t include gender, class, power relations, organisational cultures Sharing an identity does not mean everyone is the same as many differences within groups as between groups beliefs, morals, values, assumptions differ among individuals in a cultural group Beliefs Beliefs are meanings or I don’t get all this fundamental stuff about beliefs, ideas we hold values, attitudes about the nature and assumptions! of the world..... What’s the difference? What are beliefs? What are some beliefs people hold? Attitudes persistent ways of thinking about the self, others Well what are and the world attitudes? that influence behaviour.... PAUSE: Activity about attitudes…reflect… How do you see yourself? What is your attitude toward study? What is your attitude toward spending money? What is your attitude toward Indigenous Australians? What is your attitude toward refugees? What is your attitude toward white Australians? Values Values are aspects Hmmm.. of life that we and hold in high values? regard  Well what are Assumptions assumptions then? Assumptions are supposing something to be true without proof-related to our automatic responses and established opinions When we assume we take things for granted- closely related to stereotypes- humans tend to make assumptions based on how someone looks-often misleading  stereotyping Assumes all people of a particular background share the same beliefs, values, and behaviours; that they are all the same Can you think of some common stereotypes about nurses? Young people? Men? Women? Stereotypes are related to social constructionism as they are created socially- between people as they interact.  Guess you Norms know what ‘norms’ are Sure....norms are generally too? accepted rules of acceptable and unacceptable behaviour  assumptions stereotypes attitudes behaviour/ACTION All the above can impact directly on health and can result in death! As nurses and health professionals we need to be mindful and reflect on how it may impact the care we provide and take appropriate action to provide culturally safe care based on client needs An example … impact of stereotypes. assumptions, media focusattitudes, on alcoholvalues issue on health Eg stereotype in the nurse’s mind= all Aboriginal people are drunks assumption = this Aboriginal person is “just a drunk”. i.e. suggests not fully human attitude = this person is not sick reflects values = and not worthy of medical attention ACTION = sent home, misdiagnosis, illness ignored OUTCOME = severe illness/death NSB 102 Professional Practice & Cultural Safety Module 1: Part 3 What has cultural safety got to do with you? Dr Audra de Witt Acknowledgement to Dr Leonie Cox for some material content Culture is dynamic beliefs, morals, values change … we negotiate meanings/culture meanings and identity are fluid and related to specific contexts Aussies more Australian when overseas? Crikey, bonza mate CULTURE, SELF AND POWER the limitations of one's knowledge and perspectives To begin cultural safety … principles of collaboration, partnerships, and ownership an exploration of culture identity formation and values social privilege, social marginalisation and power relationships  Cultural safety in professional practice Includes acknowledging power and privilege and engaging in power sharing and negotiation It’s about being aware of the assumptions, values, practices [cultures] of ourselves, our professions and of the organisations that we work within. E.g. our health care system assumes universal agreement on what constitutes health and assumes that individuals are or even can be responsible for their health and illnesses. Unsafe cultural practice is any action, which diminishes, demeans or disempowers the cultural identity and well-being of people (Nursing Council of NZ 1996: 9 in Taylor and Guerin 2010, p. 12)  Cultural safety: practice and outcomes NO assault on anyone’s cultural Cultural and social differences exist identity and are legitimate RESPECTS uniqueness of individuals>>>challenges racism We all experience life differently- and ethnocentrisms; sexism, there are multiple realities ageism and cultural recipes/stereotypes Culturally safe nursing is based on Respect >>>establishment of nurses undertaking on-going personal partnership and trust>>>power sharing and negotiation –limits cultural self-reflection and awareness imbalances of power awareness by nurses 37 Social constructionism - recognition that knowledge is constructed socially (we will focus and explore this in relation to western medical knowledge) Our cultural identity is socially ‘Social constructionism’: constructed “...knowledge, and in turn our We are born into a culture but we interpretation of meaning is a result of are not born with culture our social interactions with others and our environment...reality is socially We learn and absorb culture from constructed” different aspects of social life (Willis and Elmer 2011, p. 10) Theoretical basis continued: social constructionism We have different bodies and experiences>>>>not just one reality Multiple (many) realities Once we accept that we live in different realities The theory helps us to understand different experience (of health or illness for example) Helps us understand how people explain things to themselves (including health/illness)  Theoretical basis continued: health, wellness, illness and social constructionism One popular / ‘mainstream’ western way of looking at health and illness = based on physical body/biology BUT this perspective is only one way of viewing health …. (NB to remember this as health professionals) For example, Aboriginal and Torres Strait Islander peoples view health as a holistic concept – ie not just the absence of diseases and physical, but also includes social, emotional, cultural, spiritual wellness that extends beyond the individual and includes the community. So definitions and meaning of health, illness, wellness is subjective and can be defined in many ways We always give meaning to experience –including experiences of health, illness and wellness this means experiences are understood through social and cultural processes  Inclusive and Respectful language Guide only. When engaging with culturally diverse communities always seek advice and be guided by relevant stakeholders, community members, Elders on language preferences, protocols Essential component of reconciliation (for First Nation Australians) Language is important – impacts our attitude, understandings and relationships When writing and when engaging with people and communities REFERRING TO ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES Use term ‘Aboriginal and Torres Strait Islander peoples’ ‘Aboriginal’, ‘Aboriginals’, ‘Aborigines’ = not inclusive of diversity of cultures across Australia – that’s why we use ‘peoples’ in the plural (acknowledges diversity) ‘Aboriginal’ = not inclusive of Torres Strait Islander peoples, so reference to both needed when necessary Avoid acronym ATSI = lacks respect and of different identities ‘First Nations’ and ‘First Peoples’ – acceptable language & respects diversity  Inclusive and Respectful language (continued) SHOWING RESPECT Capitalisation Capitalisation demonstrates respect, ‘Aboriginal’ and ‘Torres Strait Islander’ should always be capitalised (same with Traditional Owners, Elders, First Peoples/Nations/Australians). Avoid deficit language Important to acknowledge history – often intergenerational, injustices and inequities experienced Use empowering and strength-based language e.g. acknowledge strengths and resilience of Aboriginal and Torres Strait Islander peoples, cultures and communities despite colonisation/ discrimination etc E.g. difference between a more deficit approach such as “helping disadvantaged Aboriginal and Torres Strait Islander students,” and a more strengths-based alternative such as “providing meaningful opportunities for Aboriginal and Torres Strait Islander students to achieve at their full potential.” Inclusive and Respectful language (continued) No need to be ‘rescued’ or ‘saved’, not ‘in need’- longest living culture in the world Avoid language that divides (Promote mutual respect and genuineness) Use language that connects – promotes mutual respect and genuine relationships NOT divides – eg. us vs them language https://www.reconciliation.org.au/wp-content/uploads/2021/10/inclusive-and-respectful-language.pdf  DIVERSITY Key concepts NORMS CULTURE to learn about and practice cultural ASSUMPTIONS safety ETHNICITY [how we approach nursing practice] we need to understand VALUES attitudes all these concepts, be aware of ourselves and we STEREO- BELIEFS TYPING carry with us  References (part 1-3) AHPRA and National Boards. The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 AIHW. 2021. Cultural safety in health care for Indigenous Australians: monitoring framework, AIHW, Australian Government, accessed 10 January 2023. Cox, L. and Taua, C. (2017). Understanding and applying cultural safety: philosophy and practice of a social determinants approach. In Crisp et al. [eds] Potter and Perry’s Fundamentals of Nursing 5e, pp. 260-287. Sydney: Elsevier. Coalition of Peaks (2020). National Agreement on Closing the Gap. Australian Government, accessed 4 December 2022. Dudgeon P, Wright M and Coffin J (2010) ‘Talking it and walking it: cultural competence’, Journal of Australian Indigenous Issues, 13:29–44. Eckermann, A. K., Dowd. T., Chong, E., Nixon, L., Gray, R., Johnson, S. (2010). Binan Goonj: Bridging Cultures in Aboriginal Health. Australia: Churchill Livingston Elsevier. IAHA (Indigenous Allied Health Australia) 2019. Cultural responsiveness in action: an IAHA Framework, IAHA, accessed 10 January 2023. Nursing Council of New Zealand. (1996). Guidelines for cultural safety in nursing and midwifery. Wellington: Nursing Council of New Zealand. Nursing and Midwifery Board of Australia. (2018). Code Of Conduct For Nurses, NMBA. Ramsden, Irihapeti M. (2002). Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Unpublished PhD Thesis. Massey University. Reconciliation Action Plan (2021). Demonstrating Inclusive and respectful language. https://www.reconciliation.org.au/wp- content/uploads/2021/10/inclusive-and-respectful-language.pdf Taylor, K. and Guerin, P. (2010). Health care and Indigenous Australians: cultural safety in practice. South Yarra, Vic.: Palgrave McMillan. Transforming our World: The 2030 Agenda for Sustainable Development. UN General Assembly. 2015. 21 October. UN Doc. A/RES/70/1. Warren, O.U., Sena, V., Choo, E., and Machan, J. (2012). Emergency Physicians' and Nurses' Attitudes towards Alcohol-Intoxicated Patients. The Journal of Emergency Medicine, Volume 43, Issue 6, December 2012, Pages 1167–1174. Williams, R. (1999).Cultural safety--what does it mean for our work practice? Aust N Z J Public Health. 1999 Apr;23(2):213-4. Willis, K. and Elmer, S. (2011). Society, culture and health: an introduction to sociology for nurses, Melbourne: Oxford University Press. World Health Organisation. (2022). Fact sheet on Human rights. https://www.who.int/news-room/fact-sheets/detail/human-rights-and- health. Accessed on 17 January 2023 NSB 102 Professional Practice & Cultural Safety Module 1: Part 4 Nursing the profession, professionalism and working in teams Dr Audra de Witt Acknowledgement to Dr Leonie Cox for some material content  The nursing profession: taking the best bits from the definitions HENDERSON 1966 Helping the person to do things for their health, recovery or peaceful death that they would perform themselves if they had the strength, health and knowledge to do so ICN 2010 Autonomous and collaborative care of all people in all settings-health promotion, prevention of illness, care of ill, disabled and dying people Advocacy, safe environment, research, policy, health systems change and development, education HENDERSON HAS SOME GREAT ASPECTS THAT WE SHOULD NEVER LOSE SIGHT OFF But no longer just at the bedside-see how much broader and deeper the ICN definition is  Nursing: Science AND Art PROFESSIONAL NURSES ARE ACCOUNTABLE FOR THEIR ACTIONS AND COMMIT TO LIFELONG LEARNING The link between art and science is who you are as a person CARE, COMPASSION, KINDNESS, COLLABORATION AND COMMUNICATION Monitor and mange their conduct in society and at work Reflect on and uphold values, the profession’s values and the values and needs of society Conduct goal orientated careful relationships in safe environments WORK WITHIN A PROFESSIONAL PRACTICE FRAMEWORK Implement and uphold National Professional Standards of Practice and Professional Codes of Conduct-discussed in detail in week 4 Adhere to specific services’ governance frameworks USE A UNIQUE BODY OF KNOWLEDGE BASED ON THE CONDUCT OF RESEARCH AND THE EVIDENCE IT GENERATES Nursing: Art & Science >>>produce a positive experience and good outcomes PROFESSIONAL NURSES BEGINNING PRACTITIONERS Study the practice framework Rely on clear, task oriented practical procedures Develop proficiency with technology Study anatomy, physiology, psychology, ethics Develop critical thinking, assessment, communication skills EXPERIENCED NURSES Use advanced assessment and communication skills Understand situations and contexts, use intuition, awareness, experience Manage perceptual limits in practice, interpret information/situations Focus on multiple dimensions at once [e.g., multiple needs in a situation-client, family, novice nurses, the ward/service, the overall system] Social, political and economic influences Nurses respond to need and crisis [war, epidemic, natural disasters] in care of person, their family, friends, community Lobby national and state government about health services for disenfranchised groups [e.g. aged, mental health service users] Work with local government planning to ensure areas/communities have services Nurses stand up and fight for their rights and those of others ANMF Take-action campaigns Aust. Nursing and Midwifery Federation The Conversation, June 2020; image Darren England/AAP also see Geia, L. et al. (2020). A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter, Contemporary Nurse, 56:4, 297-308, DOI: 10.1080/10376178.2020.1809107  Disciplinary (professional) values Superficially we may think that all health care professions have the same values Medical Dr Vinka Barunga Sometimes clashes in values and priorities between professions that can cause issues Paramedics Laura Mannes and William Harrison Psychologist Dr Peta Stapleton Nurse Kate Curtis Nurse Professor Kate Curtis  Reflect: Disciplinary (professional) values The medical profession will focus more on disease processes and interventions aiming to cure or alleviate symptoms We discuss biomedical dominance in another lecture and consider how nursing relates to it -do these professions have the same priorities? What do you think nurses might be more focused on? Successful interdisciplinary teamwork means negotiating and communicating our way through such issues to make sure people have a positive experience of care  Interdisciplinary practice Aim: to give due respect to what colleagues bring to the achievement of patient centred care Knowledge: roles and responsibilities Attitude: respect, values Skills: communication, negotiation of power issues Our focus Introductory: health professional literacy, identifying issues in teamwork and good practice  Teams achieve the work of caring providing a workplace that nurtures Worldwide expectation that nurses work with others in cohesive teams to achieve the goals of the Organisation To provide good quality heath care and a fulfilled workforce who achieve their career aspirations Daly et al. (2013, p. 154) cite work that shows that medical errors, adverse events and patient harm occur when there is poor teamwork and communication What is teamwork? - Teams don’t just happen ‘Xyrichis and Ream (2007, p. 238) define teamwork as a dynamic process involving two or more health professionals with complementary backgrounds and skills, sharing common goals, and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This is accomplished through interdependent collaboration, open communication and shared decision- making’ (Daly et al. 2013, p. 254). People and their ways of being in the world make up teams Particular people and their values create a safe and effective team environment or not If you enter a team that is ineffective you can quickly become socialized into these negative norms Communication and collaboration are the keys to successful teams  Interprofessional communication The interaction between professionals demonstrates: The sharing of relevant client medical history to facilitate rapid and appropriate medical intervention Communication that is relevant to the client’s medical history Active listening to team members (including the client) Communication that ensures a common understanding of care decisions The development of trusting relationships with client and other team members  Role clarification Three important factors that define a specific role: expectations, conception and performance To have a clearly defined leader who understands the skill mix and abilities of each team member Be clear in what each of the team member’s roles and responsibilities are Have the correct information to carry out the job assigned Know what other members of the team expect from each other Know what responsibility is expected from each role Good teamwork: This film shows effective teamwork and team member behaviours, e.g. every person has a job, knows their role, importance of clear communication, performs it to the best of their ability, working towards the same goal, if you notice something or a job that needs to be done, you jump in and do it  Why do we teach cultural safety? Avoid blame for ill health and Think critically re privileged, white, medical disadvantage and western ways of thinking …social constructionism [White privilege = societal privilege that Social determinants: historical and benefits white people over non-white current social and political impact people is some societies] Self-reflection…..examine own realities Address conscious/unconscious racism and and attitudes others forms of disrespect, bias and prejudice in nursing education and care Open minded and flexible towards those we see as ‘different’ Challenge systemic/institutionalised racism Well educated, self aware workforce Improve the experience of care/education …culturally safe to practice as defined by the people we serve Culturally safe services/organisations increases likelihood of positive experiences Nurses must deliver cultural safety care – which in turn increases accessibility, mandated by Australian Code of Conduct acceptability of health/education services for Nurses & required of the B Nursing curricula by the Australian Nursing and Midwifery Accreditation Council (Ramsden 2002, p. 94)  Practice of cultural safety: nurses’ cultural self awareness Values, attitudes, beliefs Critical self-reflection expressed in everyday life >>>>assumptions moral judgements impact our work focus on self not other conflict often presented as a moral issue on cultural baggage, power, cultural position, “good” people, do well/behave identity well….enjoy good health on habits of mind and frames of reference “bad” people …undeserving , immoral –blamed for ill-health treated badly What have been your experiences?  Key professional attributes Appropriate for working with all people including mainstream, migrants, refugees, Aboriginal people and Torres Strait Islander peoples Respect Non-judgmental attitude Trust Reciprocity Empathy not sympathy Work with the person not on the person the skill for nurses is NOT knowing the customs or even the health related beliefs of specific groups 65 Nursing and Midwifery Board of Australia ‘Cultural safety is a philosophy of practice that is about how a health professional does something, not [just] what they do. It is about how people are treated in society, not about their diversity as such, so its focus is on systemic and structural issues and on the social determinants of health. Cultural safety represents a key philosophical shift from providing care regardless of difference, to care that takes account of peoples’ unique needs. It requires nurses and midwives to undertake an ongoing process of self-reflection and cultural self-awareness, and an acknowledgement of how a nurse’s/midwife’s personal culture impacts on care’ (2018, p. 15) References Cox, L. and Taua, C. (2017). Understanding and applying cultural safety: philosophy and practice of a social determinants approach. In Crisp et al. [eds] Potter and Perry’s Fundamentals of Nursing 5e, pp. 260-287. Sydney: Elsevier. Crisp, J., Taylor C., Douglas, C. and Rebeiro, G. (2013). Potter & Perry's Fundamentals of Nursing 4e, Sydney: Elsevier. Crisp, J., Taylor C., Douglas, C. and Rebeiro, G. (2017). Potter and Perry’s Fundamentals of Nursing 5e, Sydney: Elsevier. Hofmeyer, A. & Cummings, G. C. (2014). Becoming part of a multi-disciplinary healthcare team in J. Daly., S. Speedy., & D. Jackson [Eds.] Contexts of Nursing. (4th Edn). (eBook pp. 253-412). Sydney: Elsevier. Eckermann, A. K., Dowd. T., Chong, E., Nixon, L., Gray, R., Johnson, S. (2010). Binan Goonj: Bridging Cultures in Aboriginal Health. Australia: Churchill Livingston Elsevier. Nursing Council of New Zealand. (1996). Guidelines for cultural safety in nursing and midwifery. Wellington: Nursing Council of New Zealand. Ramsden, Irihapeti M. (2002). Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Unpublished PhD Thesis. Massey University. Taylor, K. and Guerin, P. (2010). Health care and Indigenous Australians: cultural safety in practice. South Yarra, Vic.: Palgrave McMillan. Williams, R. (1999).Cultural safety--what does it mean for our work practice? Aust N Z J Public Health. 1999 Apr;23(2):213-4. 67