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Posts tagged ‘cultural safety’

Evidence guiding culturally safe nursing practice

The current ANS featured article titled “Toward Cultural Safety Nurse and Patient Perceptions of Illicit Substance Use in a Hospitalized Setting”  is based on a collaborative project that focuses on cultural safety in health care.  The authors, Bernadette (Bernie) Pauly, PhD, RN; Jane McCall, MSN, RN; Annette J. Browne, PhD, RN; J. Parker, MA and Ashley Mollison, MA shared this background about their work:

Our article describes an ethnographic research project examining the experiences of people who use illicit drugs and nurses who provide care for them in acute care settings. The idea for this research emerged from a recognition that people who are identified as using illicit drugs and facing socio-economic disadvantages often experience stigma when accessing health care services. Nurses working at Insite, Vancouver’s supervised injection site, found that cultural safety helps to mitigate stigma when working with people who use illicit drugs, so this project set out to explore what cultural safety might look like with this population in other settings. Cultural safety was developed in New Zealand to address persistent health inequities experienced by Maori people and has been a strategy to enhance care for people experiencing the negative effects of stigma, racism and other forms of discrimination, and ongoing marginalization.

In exploring the meaning of cultural safety, from the perspectives of people who use illicit drugs and nurses, participants described 3 main conceptualizations of illicit drug use, as 1) individual failings; 2) criminal activity, and 3) a disease of ‘addiction’. They discussed how these intersect to negatively impact access to care, management of pain, and access to of harm reduction supplies.

In relation to illicit drug use, cultural safety can prompt nurses and other healthcare providers about the importance of situating drug use in the history of the criminalization of drug use, and how continued legacies of that criminalization impact the care that people receive, preventing people from accessing health services now and in the future. Creating culturally safe(r) environments involves health care professionals
examining their own values and conceptualizations of drug use, and about people who use drugs, and how that might affect practices and policies in acute care

This project would not have been possible without the leadership and input from a peer advisory committee comprised of members of the Society of Living Illicit Drug Users (SOLID), an organization run by and for people who use(d) illicit drugs. The peer advisory met regularly throughout the project to provide direction on the interview questions, strategies for data collection, and input on research findings. A nurse advisory committee provided parallel leadership and direction to the research process. The advisory groups ensured that the research questions were relevant, that the process of data collection was attentive to needs of participants, and that the research findings were interpreted within an appropriate context of lived experience and practice. Together with the research team, the nurses and peers developed a practical set of recommendations for practice.

The results of the research were presented at two hospital forums where advisory committee members, nurses and managers discussed how research recommendations could be implemented through changes to hospital policy and practice. As a result of the research there have been changes to hospital harm reduction policies and practices. Today, the cultural safety bulletin is being mobilized by SOLID to offer peer-run trainings to front line health and social service providers.

This article is available for download without cost while it is featured on the ANS web site!  Download and read it now!  Then come back here and share your comments – we would be delighted to hear from you!

Critical Cultural Competence

In the current, very timely “Editor’s Pick” article titled “Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care, Dr. Adel F. Almutairi and Dr. Patricia Rodney describe the concept of “critical cultural competence” as essential to peace and health.  In their analysis, they view peace as not only a political responsibility of the state, but also a sociocultural concept that is relevant to all human encounters, animated by the ideal of human dignity.  The basis for this perspective is described in the article as follows:

The theoretical underpinnings of the approach to critical  cultural competence that we articulate in this article is an extension of the findings from Almutairi’s doctoral research project, which was a qualitative exploration of the cultural competence of a multicultural nursing workforce in a tertiary hospital in Saudi Arabia.  The nursing workforce in that Saudi tertiary hospital includes nurses from more than 25 nationalities from different parts of the world who provide care to the indigenous people of Saudi Arabia. The findings in Almutairi’s doctoral research project explicated the complex nature of cultural and linguistic diversity during clinical encounters. He found that this diversity poses threats to the physical, psychological, emotional, spiritual, and cultural safety of nurses, patients, families, and their communities. Such threats are caused by the increased potential for cultural clashes, negative attitude, and misunderstandings related to both communication and behavior. (p. 203)

Using evidence from Dr. Almutairi’s research, they present an analysis of the challenges of working in a multicultural environment, as well globe300as insights that can lead to peace in health care delivery.  They conclude:

 In this article, we have argued that because of its foundations in postcolonial theory and cultural safety—as well as its operationalization through critical awareness, critical knowledge, critical skills, and empowerment—critical cultural competence offers an action orientation from which to enact our shared responsibility and address structural injustices. It is our conviction that as a nursing profession we are well positioned to look toward the future and share responsibility locally, nationally, and globally to foster equitable and peaceful heath care. (p. 209)

I hope that ANS readers will find this message relevant, will share this work broadly, and will join the challenge to foster equitable and peaceful health care.  To download your copy of the article at no cost, visit the ANS web site now!


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