Cultural Competency, Cultural Safety and Culture

Cultural Competency, Cultural Safety, and Culture

AHPRA Code of Conduct: Domains 2 and 3

  • Domains 2 & 3 cover Aboriginal and Torres Strait Islander Health and Cultural Safety, and Respectful and Culturally Safe Practice for All.

Domain 2: Aboriginal and Torres Strait Islander Health and Cultural Safety

  • Focus: Practitioners should consider the specific health and cultural needs to foster open, honest, and culturally safe professional relationships.

  • Responsibility: This is the responsibility of all healthcare professionals.

Domain 3: Respectful and Culturally Safe Practice for All

  • Self-reflection: Practitioners need to reflect on their own culture and how it influences behavior and communication.

  • Values, Attitudes, Assumptions, and Beliefs: Reflect on personal values and how they influence interactions with patients, families, the community, and colleagues.

  • Teamwork: Working respectfully and collaboratively within teams is essential.

  • Communication: Communicate respectfully, considering privacy and confidentiality obligations, including online.

  • EBS 3.2: Challenge understanding of effective communication; consider surprising points or potential challenges.

  • Social Media Guidance: Review social media guidance and be cautious about posting work-related content online.

Social Media Example – Jeremy Hunt

  • Incident: UK Health Minister posted a photo on Twitter with patient names visible in the background, breaching patient confidentiality.

End of Life Care

  • Voluntary Assisted Dying (VAD): Legalized in Queensland, but it presents challenges to some people's cultures, beliefs, and attitudes.

Patient Confidentiality

  • Breaches: Any identifying information about a patient can be a breach of confidentiality, not just images or names.

  • Research Ethics: Exercise caution in research to avoid disclosing confidential information.

Cultural Safety

Importance of Cultural Safety

  • Without cultural safety, there is no clinical safety.

  • Pre-workshop activities Importance of reviewing pre-workshop activities related to cultural safety.

  • Assessable Content: All these principles are assessable content.

Key Terminology

Cultural Awareness and Sensitivity

  • Definition: Being aware that different cultures might do things differently.

Cultural Safety

  • Continuum: Cultural safety is a lifelong journey without a peak or end point.

  • Continued Training: Continuing cultural safety training is essential.

Cultural Competency

  • Definition: The ability to participate ethically and effectively in personal and professional intercultural settings.

Cultural Humility

  • Definition: A lifelong commitment to self-evaluation and critique to redressing power imbalances and developing mutual partnerships.

  • Focus: Understanding one's own culture, values, ideas, attitudes, and beliefs, and how they impact healthcare delivery and interactions with others.

Activity 1: Defining Culture

Cultural Tree

  • Examine the cultural tree and consider surface, shallow, and deep cultural elements.

  • Personal Considerations: Think about personal cultural background, prominent aspects, and how to describe culture to someone else.

  • Preconceived Ideas: Recognize and address preconceived ideas; the media often paints certain cultures in particular ways.

Personal Experiences and Thoughts on Culture

Personal Experience - From England.

  • Expat Communities: Understand why expat communities form

  • Reason for communities: sharing surface culture, same interests (music, sport), same humor. Distinct sense of humor.

Personal Experience - Indian

  • Growing up with multiple religions and diverse family

  • Unique Individual Experience: Can fit into both sides.

  • Kinship and Group Identity: Definitions of kinship and group identity can be impactful

  • Cultural and Ethnicity different: Culture can be influenced by religion and ethnicity, but it's unique to everyone.

Cultural Safety

  • Good communication, avoid tunnel vision, and respect diversity.

  • Communicating and being mindful of others.

  • Example: Some cultures might not make eye contact; understand this as a cultural norm, not rudeness.

  • Clinical Safety: Without cultural safety, there is no clinical safety.

Health Equity Video

Health Equity Explained.

  • Access to services and having people in those services that are there for Aboriginal people.

  • Visibility of Aboriginal and Torres Strait Islander staff

  • Model of care recognizes indigenous ways of knowing, doing, and being.

  • Appropriate healthcare: Not biomedical approach; spiritual, cultural, holistic approach is favored

  • Equitable health system provides the same outcomes and lived life expectancy as everyone else.

  • Being able to come to a system, come to a health service that they know that they can get the quality care to ensure that they feel empowered around their health care, ensuring that the services also support them through that journey.

  • Equity is providing people in greatest need with differential approach

  • Provide empowerment and self efficacy to not only the individual but to the community as a whole.

Institute for Indigenous Urban Health

  • IUI is a really valuable resource, especially around health equality and other matters like cultural matters like cultural competencies and cultural safety

Important Notes.

  • A hand up, not a hand out.

  • Don’t change the patient to fit the system, but instead change the system to fit the patient.

Activity 2: Aboriginal and Torres Strait Islander Health and Cultural Safety

Website resources

  • Historic, cultural, environmental, socio economical, and health risk factors.

  • Discuss the determinants of health and their potential impact, positive or negative.

Discussing.

  • Determinants that impact Aboriginal and Torres Strait Islander health and cultural safety

  • Racism can turn some indigenous communities away from coming to your typical clinical doctor.

  • Stereotypically, there is poor health literacy around health literacy and certain other things

  • Living Rural and Remote: Connection to land dictates the place of living of First Nations people.

  • Cultural Incompetence: Saying if you want better health care, move closer to the city is a culturally unsafe sentiment.

Historical Factors

  • Unknown information about being from the stolen generation.

Health Risk Factors

  • Significant difference in mortality rates

  • Medical conditions such as cardiovascular disease and diabetes differ significantly.

Trust.

  • A huge mistrust that affects First Nation relationships with Australian society.

Settler Effects.

  • Settlement saw diseases wipe out a lot of the First Nations indigenous peoples.

  • Recent Distrust during COVID Vaccine times: Numbers of people that were getting vaccinated were quite a bit lower.

Terminology and Effective Communication

  • The healthcare provider did in the terms of communication well or what they could do better and also what sections of the communication guidelines were effective. The terminology and effective communication

Personal Experiences.

  • How to address them, how to talk, whether to make eye contact, all of those cultural sensitivities for people.

Video:

Scene summary and analysis summary.

  • The family gave of closed body language and never moved their hands from covering themselves.

  • The lady talking felt like she didn't have confidence behind what she was saying and wanted to reach out for help.

  • The family was closed down, especially the uncle. The son was more engaged as well as the daughter.

  • The health care provider was above them talking down, that's a bad look.

Patient Main Concerns.

  • There were financial concerns especially regarding the equipment to pay for, as well as having to put down a deposit to loan that equipment.

Keen Interests and Facts.

  • Wanted to get home and back to normal life, as well as fishing.

  • Fishing, has a strong connection to country, which may have been brushed over.

The Doctor.

  • The uncle asked a question directed at the doctor, highlighting a lack of engagement with the practitioner because of profession was stated only once.

Family Concerns and Information.

  • Family wanted things back to normal, but were going to have to wait for a year.

  • I think it's also some of those things, everything was like, oh, this is really far away or at some stage, we'll do this. There was a lot of just words being thrown out more than anything to gloss over facts.

Indigenous Care Worker Analysis.

  • The topic was brought up at a third of the video for only the first time, with only the dad asking about it.

  • The patient has not been engaged with an indigenous health care worker at all, should have been engaged already.

  • There was no patient centered care related to making an appointment from a health care worker point of view.

  • Can be a scar resource from 700-800 beds to engage, and might not have enough to engage every time. Key is early engagement.

  • The importance of the unit always made recommendations on who to engage and what to do.

Improving the Quality of the Visit.

  • Make sure effort is made to improve things.

The Health Professionals and Ethics Consideration.

  • They are occupational expert doctors.

Financial and Discharge Implications.

  • There was no mention on what options to consider

  • Culturally and the point of trust, patients won't come back and has negative flow on outcomes regarding their wellbeing.

Improve Points to Address

Permissions and Approvals.

  • There was no discussion on needing to go to the house, nor was there approval to consider doing a health check to confirm the need and plan for next step.

  • There's nothing really about that consultation that leads me to believe that that patient would be really keen to engage with healthcare services again. And the number of chance that a patient will come back if they don't feel accepted.

  • The lack of culturally appropriate care can lead to someone being reluctant to engage in the health care again.

Video: The Importance of Indigenous Health Workers

Culture.

  • If culture is not utilized in a care plan of a treat patient, then there will be complications, and be non compliant.

  • The role is the value and the importance of having cultural balance with the patients.

Translation.

  • I can provide translation is there is a need and provides the platfform for the people to have a chance to be a part of the process and also share what barriers they face.

Engagement Issues and Factors.

  • Point about non engagement is important due to fear and they might not turn up to outpatients meetings or engagement due to mistrust which is a prevalent factor.