Cultural Safety: An analysis

Introduction

Cultural safety is relatively new concept in New zealand. Over the last few years it passed the national boundaries and gained international attention to acheieve a social justice. It is an ethno cultural practice which heighlight the need of critical thinking against the inequalities whcich persists in the health care system. In this essay i would like to describe about two vulnerable group in the society such as elderly and disability, their characeristics, how they differ and discriminated against. Followed by the discription regarding the postion of power, personal values and ther positive and negative influences. In addition this essay explains the principle of cultural safety and the Maori health strategy.

Old age

Aging is the normal process of time related changes. It begins in birth and continues throughout life. Design strategies and rendering care for the elderly are challenging to the health professionals. Old age is the period of transition from adulthood to the second childhood when the people undergo the cellular and extra cellular changes. It causes changes in physical appearance and function. This group of people differ from others in many ways. the most apparent change is in the physical appearance, it shows thin and wrinkled skin and loss of elasticity. In addition hair become gray or white. Cognitive impairement is an other characteristic of the elderly. There may be temporary changes in the cognitive ability while admitted to hospital because of the unfamiliar environment (C. Smeltzer & G.Bare, 2004) . The food intake become less during elderly when compare to other age group and the life style become slow paced and relxed. They feel loneliness, frustation, social isolation and difficulty in coping. They possess more interest to become a part in the celebrations and enjoy well. During this period most of the elderly turn to spiritual life and spend more time in prayers and reading spiritual books. This is the time they recall thier past events and stories. Most families give a good position to the elderly and they have the power to make the decisions in thier family as a eder citizen. They have the power to influence the decision of others though this customs erode nowaday. Old people are consideres as the assest of the houses. They can make good decisions from the light of their experiences. They can guide their younger generation in a fruitful way. They can cultivate the moral values to their young ones and they act as a liason to transfer their cultures to the next generation. Whereas some people think that elderly are needy, unhappy,inactive and senile. They cannot learn new things and they are not useful for their youner counterparts. Many seniors do not have adequate drug coverage in the society. They are usually confused with the emerging technologies. Their opinions and ideas are considered as insignificant in the society. Many elderly are put into nursing homes and assisted living because of their frail health. Lack of proper communication make them to suffer from malnutrition and also they face neglect from those who suppose to take care of them. Many elderly are abused by thier children by taking the money from their accounts. Though they are weak the family members take advantage of them and rob their properties (“how the elderly,” 2009). As they require more care family members shows unwillingness to take care of them.

Disability

A disabled person is the one who was limited or unable to carry out his daily activities due to congenital or long term disabilities. Disabilities can be of varoius types including the disabilities in seeing, hearing, speaking, legs, hands, other physical disabilities and mental disability. Disability is a complex phenomenon in which the person have the limiatation or difficulty in carry out the tasks, have impairement in body functions, and have participation restriction while involving in life situations. Disabilities can be physical, emotional, mental, cognitive, sensory or the combination of these (“Disability,” 2012). People with disabilities are facing many barriers to lead a healthy life. Compare to other people they have poorer health, less access to health care, less insurance coverage, they skipp medical care because of higher expense and they engage in unhealthy behaviours including physical inactivity and smoking . The people with disabilities can be discriminated in many ways such as thoughtlessly, deliberately, prejudicially, financially, accidently, architecturally, innocently and hostilely. The disabled have equal rights in the society as same as other people. But in the present scenario people with disabilities are subjected many direct and indirect discrimination. Direct discrimination occurs in the areas such as education, employment, training, access to public premises, provision of facilities and services, accommodation, membership and activities in clubs and buying lands. Indirect discrimination occurs when the people not recognise or respond to the need of the disabilities (“Disability discrimination,” 2012).

Values

Nurses are the one who cares the individual in various stages including birth, death, illness and healing. So if the nurse do not have any knowledge regarding their own as well as their patients, it is impossible for them to provide an expected and efficient nursing care. Till the end of ninteenth century the prevailing values of nursing care were self sacrifice, benevolence, obedience, faithfulness, serious-mindedness, compassion and humanity. But in the present scenario the common person vlaues which possess by a nurse includes aesthetics, altruism, equality, professional competency, justice, sensitivity and truth (Ersoy & Altun, 1998).

Professional competency

Professional competency is the skill and ability to practice safely and effectively without the need of direct supervision ( Rutowski, 2007). The Nursing Council of New Zealand defines nursing competence as the combination of knowledge, skill, values, attitudes and abilities that underpin effective performance as a nurse ( Nursing Council of New Zealand, 2008). A competative nurse can perform the task more skillfully and efficiently and it directly influences to improve the progress of the patient. Though we cannot find any negative impacts peripherally, more competativeness make the nurse to be more concentrate on aquiring knowledge and skills rather than to be flexible with the need of the patient. It can produce a negative patient outcome.

Equality

Equality is the attitude of the nurse to treat the individual against age, gender, disability, marital status, pregnancy, religion, race, belief and sexual orientation (Irwin, 2011) . Equality says as because they are human they are equal. Possessing equality towards the patients help the patients to feel a confidence and dignity towards themselves and it helps in the fast recovery from illness. But in some cases, the people from high social backgrounds may not adjust with the concept. They may feel inferiorty while they treat as same as other low social classess. This may produce disharmony and disputes.

Altruism

Altruism is generally defined as the practice of concern for the welfare of others. Altruism is purely defined as the sacrifice of something for an individual without expecting anything from them (“Altruism,” 2012). Altruism help the nurse to ventilate her empathy and compassion skills and can provide a healing environment to the patient. It certainly produce a positive health outcome. But , at the same time the is more chance for the nurse to be exploited by the patient in the aspect of altruism.

Sensitivity

In nursing sensitivity refers to the ability of the nurses to recognize the needs of the patients and take neccessary measures to satisfy the needs. But the interventions which are taken by the nurse must be within the scope of nursing practice and is an integral part of the nursing process(“Nursing sensitive patient outcomes,” 2004). The nurse who possess sensitivity can identify the reasons behind their behaviour, and their ability to aniticipate these reasons easier definitly help them both. Recieves care from a nurse who is sensitive to the needs of the patient definitly fasten the recovery (Gorman, 2002) . But sometimes, the patient may take advantage from this.

In my personal perspective nursing is the profession in which the personal values possess a great importance. I follow the values like respect, truth, honesty, altruism, humaneness and justice while rendering care. The care which we provide to the patient should be safe and comfortable to them. It will produce a postive outcome.

Power nurses have in their roles when delivering nursing care

In the present scenario charge nurse or registered nurse have the recognisable authority and they are well equipped with management and leadership skills. The registered nurse is the central to the quality, safety and standard of care. Her management and leadership style determines the culture of the ward (“Power to care,” 2012). The nurse who follows evidence based practice and read books improves their knowledge and expertise their skills. It strengthens their practices and help them to influence the actions of others. Hence it improves the patient care. This is the power of a nurse and which is for the good of all (Parker, 2007). For instance, the nurse may have the power to make decision, power to utilize the time effectively, power to advocate, power to breach the code of conducts, code of ethics, and code of rights.

Beneficience

Beneficience is defined as the means of prooting good or doing good. It refers to taking the positive action to help others. Commitment to beneficience help to guide diificult decision. A child immunization may cause discomfort during administartion but when it free from disease it outweigh the temprory discomfort.

Non maleficience

It is an oblligation to never deliberately harm others. It is the avoidance of harm or hurt. In nursing ethics equal emphasis had given to avoid harm and to do good. But to produce the good result can give a little pain to the patient. But for instance, repeated pricking of the patient to get an iv access is the misuses of this power.

Veracity

It defined as the truthfulness. It requires the nurse to be honest with the patient. It may not be hard to tell the truth, but it is difficult tod decide how to tell the truth. But when truth does greater harm than good, then it is recommended to hide the truth.

Principles of cultural safety

Cultural safety exists beyond cultural awareness and cultural sensitivity. It provides power to the consumers to comment on the practices and contribute their participation in achieving positive outcome of health and experiences. The council defines cultural safety is in terms of effective nursing pratcice and is detrmined by that particular person or family. Council also emphasizes that culture not excludes the age, sex, sexual orientation, occupational status, socio economic background, ethinicity, religion and disability.

Cultural safety follows four principles. The first principle describes that cultural safety mainly aims at improving the health status and relationship among New Zealanders . it given emphasis on health gains and outcomes also emphasises that know the beliefs and pratcices of different group of people. The second principle states that cultural safety enhances the quality of health and disability services. This principle mainly concentartes on four aspects including power of the nurse, safety of the patient, nurse`s ability to understand the diversity of the culture and the application of social science in nursing practice. Third principle emphasizes the broad nature of cultural safety. It concerns about the inequalities in health care interactions, identification of cause and effect relationship, acceptance of diversity in behaviours, acceptance of the practices and attitudes in disability services and also about the quality improvement services. Fourth principle describes its close focus. The council added the cultural safety education in the undergraduate program so that the staff can gain knowledge from the basic level itself and can deliver an effective service which is culturally safe. It mainly focus on the impact on th nurse`s own culture, nurse`s challenge, balancing the reationships and the identification of power imbalanes (Nursing Council Of New Zealand, 2005).

Health strategy

The Maori health strategy produced by the Ministry of health aimed to support the Maori families and to help them to achieve the maximum health and wellbeing. The expected outcomes of this strategy include the physical, mental, spititual and emotional well being, longer and better quality life and active partcipation of Maoris in the New Zealand society. The core priciples of this strategy are Partnership, Participation and Protection. Maori health strategy has one aim, two directions, three key threads and four pathways. The two directions include the Maori and Crown aspirations and contributions. Three key threads are rangatratanga, building on the gains and reducing the inequalities and the four pathways comprised of community development, Maori participation, effective service delivery and work across sectors (Ministry of health & , 2002).

How well the strategy meet the guidelines

Cultural safety is the effective nursing pracice provided by the nurse to a patient or family from differnt culture, but the effctiveness will be determined by the patient or family. Unsafe cultural practices will diminish the cultural identity and wellbeing of the individual. Maori health strategy clearly aims at the support of maori family and the provision of better quality life. In the cultual safety guidelines, they emphasise that the nurse should acknowledge the rituals, practices and beliefs followed by differnt groups includes the minorities and disabilities. Maori is a group of people have their own culture, and traditions. So, cultural safety guidelines demand the nurse should have the knowldge about their practices while rendering care. In addition the cultural safety guidelines emphasizes that the nurse should be conscious about her own cultural reality and its impact on others culture. She should respond to the diverse need of the people and provide services which they feel safe. As in the same way the Maori health strategy point out that the Maori should recieve the same care as like the Non Maori and they should not feel any inequalities. It also suggests the health professional should protect the culture ,value and practices of Maori and participate them in decision making, planning and development.cultural safety guidelines meet this statement by addressing that the nurse should accept the diversities and to be concern about the quality of services provided. It should be safe and to be accepted by the people from an other culture. Altogether the cultural safety guidelines meet the aims of the Maori Health Strategy. Though the guidelines covers different aspects it had given a great importance for the provision of equal and quality care to the people like Maori.

Conclusion

Cultural safety is an important aspect of health care. Inequalities should be eroded from the field of health care. More appropriate and relevant care should be plan for the elderly and the disabled. Power and personal values should be utilize in an effective way to produce the speedy recovery and positive outcome for the patient. The cultutal safety guidelines provide a clear picture to the nurses to carry out an effective and culturally safe nursing practices.