Reflection on definitions
The definitions provided here are only one way of expressing ideas about the concepts discussed in the Cultural Safety modules. Use these definitions as a starting point and as an opportunity to do further reading and reflection on topics that interest you. Once you have learned and thought more about those topics, you may want to develop your own definitions or expand on some that you particularly like.
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The process of absorbing something. This term also refers to the forced integration of Aboriginal peoples into the dominant (European-Canadian) culture. Assimilation was an explicit policy of the Canadian government and is exemplified in a speech by Duncan Campbell Scott, superintendent of Indian affairs, to a parliamentary committee in 1920: "I want to get rid of the Indian problem. .. Our objective is to continue until there is not a single Indian in Canada that has not been absorbed into the body politic, and there is no Indian question, and no Indian Department ..."1
Assimilationist assumptions reflect the male-dominated European culture that embraced Christian ideologies, biomedical practices, and capitalist aspirations, and that supported the introduction of the reserve system.2
The period of European colonization during which colonizing groups assimilated and subjugated Indigenous peoples of North America (and other countries). Intent on appropriating land and resources in the name of their homelands, the colonizers utilized processes including settlement, physical force, and legislation to gain ownership.3
1. a policy of acquiring or maintaining colonies. 2. derog. This policy regarded as the esp. economic exploitation of weak or backward peoples by a larger power.4
Doane and Varcoe (2005) talk about attending "to the ways in which colonization has shaped and continues to influence families around the globe. Through colonial rule, many cultures have had to cope with the imposition of Christian-European family norms and with the values of their colonizers... A postcolonial perspective further directs us to challenge the ways in which colonialism is enacted through theory and question the use of theories based on Eurocentric norms as a basis for our practice with families in multicultural societies."5
Loomba (1998) states that: "Colonialism was not an identical process in different parts of the world but everywhere it locked the original inhabitants and the newcomers into the most complex and traumatic relationships in human history... colonialism can be defined as the conquest and control of other people's land and goods... it has been a recurrent and widespread feature of human history."6
Most often refers to the process of European nations in geographic, economic, social and political expansion beginning in the 15th century.
See Diversity Training
According to the 2004 revision of the concept of context/culture in the CAEN curriculum (formerly Collaborative Nursing Program curriculum), by Colleen Varcoe, PhD:
In the Collaborative Curriculum, culture is not confused with nor confined to ethnicity, race or nation. Culture is not seen as an object; there is no such "thing" as culture and therefore culture is not a "thing" that groups of individuals have (Allen, 1999). Rather, culture is created. Culture is a dynamic lived experience that happens between people, and culture is always in process. As a process that happens between people, culture is a relational process (Stephenson, 1999; Doane & Varcoe, 2004). Culture is a process and set of signifying practices through which meanings are produced and exchanged (Hall, 1997) and inextricably mediated by historical, social economic and political processes (Anderson & Reimer Kirkham, 1999).
Culture is always perspectival (Allen, 1999), meaning that culture is always viewed from a particular perspective no one can stand outside of their own values, beliefs, attitudes (all of which can be thought of as "cultural") to view difference. Thus it is essential to begin understanding culture and context by interrogating our own perspectives." (part 2, p.31)
According to Papps, cultural awareness "is a beginning step toward understanding that there is difference."7 Cultural awareness involves observing people's different activities and how they go about doing them. It does not usually involve looking at the political, social, and economic characteristics of difference or at one's own experiences or relationships to these characteristics.
Example: A health care worker noticing that people with ethnic backgrounds different from the mainstream culture may not eat the hospital meals prepared for them is an example of cultural awareness in practice.
Cultural competence describes "skills, knowledge, and attitudes to safely and satisfactorily deliver CulturalCare."8 CulturalCare refers to "health care that is culturally sensitive, culturally appropriate, and culturally competent. CulturalCare is critical to meet the complex culture-bound health care needs of a given person, family and community."9 In the United States, CulturalCare is informed by the National Standards for Culturally and Linguistically Appropriate Services in Health Care (Office of Minority Health). For the purposes of these modules, cultural competence is considered to be similar to cultural sensitivity in that it does not demand that health care workers critically reflect on their own values or those of the health care system and, thereby, become aware of inequities.
Ramsden,10 a Maori nurse leader, developed the concept of cultural safety in nursing education to draw attention to colonizing processes in Aotearoa/New Zealand (A/NZ). She was not only concerned with how colonization had affected the health of Maori people, but also with neo-colonial processes that perpetuated inequalities in the present system. The dominant health care culture in A/NZ disregarded the health and illness belief systems of the Maori, and instead, privileged those of the dominant "Euro-white" culture. Nurses in A/NZ are now required to meet standards of both cultural safety and clinical safety. Unlike cultural awareness, cultural competence, or cultural sensitivity, cultural safety "enables safe service to be defined by those who receive the service."11
Example: In practice, looking at diet choices using the lens of cultural safety can result in several courses of action. Advocacy in providing alternate food choices could take place and staff discussions about this could involve critical reflection on how health care access is denied because hospital policy reflects only the values of the dominant culture. These actions could lead to changes in dietary policy, including engaging patients in decision-making about their diet.
The main themes of cultural safety are that we are all bearers of culture and that we need to be aware of and challenge unequal power relations at the level of individual, family, community, and society. Cultural safety draws our attention to the social, economic, and political position of certain groups within society, such as the Maori people in A/NZ or Aboriginal peoples in Canada. Cultural safety reminds us to reflect on the ways in which our health policies, research, education, and practices may recreate the traumas inflicted upon Aboriginal peoples.
Cultural sensitivity involves the recognition that the lived experiences of all people include aspects similar and different to our own and that our actions affect other people. It involves getting to know and understand other cultures and perspectives. Culturally sensitive approaches acknowledge that difference is important and must be respected. However, culturally sensitive approaches in health care tend to focus on "others" as the bearers of culture. For example, although a culturally sensitive approach to nursing promotes respecting difference among patients/clients, people ultimately expected to conform to certain health care standards. Situations involving family visiting, medication, and dietary compliance are common areas of conflict. Cultural sensitivity does not involve challenging the dominance of a health care system that "treats everyone the same" nor does it involve health care providers critically reflecting on their own actions and health care relationships in the context of our wider society.
Example: Continuing with the hospital food example found under (see Cultural Awareness, culturally sensitive health care workers may discuss alternate diet choices that take into account people's background, beliefs, habits, etc., with hospital staff and/or family members and ultimately provide more food choices.
For our purpose of understanding cultural safety, culture is understood as created by people through dynamic interactive processes.12 Culture is not an "object" to be observed or something that one individual or group "has."13 Culture is much more than ethnicity or one's ethnic, family, or national background.14 In order to achieve culturally safe interactions in health care settings, health care providers must pay attention to history, ethnicity, social class, gender, age, ability, sexual orientation, physical size, etc., as well as their assumptions, values, and beliefs about these experiences. The way in which our experiences are informed by these factors simultaneously, that is the intersectionality of our lived experience, is important. Cultural safety is not a checklist of correct behaviours. It is knowing about your own culture, privilege, and social location and being aware of how relationships intersect and how inequities may result from these intersections.
The Supreme Court of Canada decision on the claim to Aboriginal title and self-government made by the Hereditary Chiefs of the Gitksan and Wet'suwet'en Nations of B.C. Decisions were made on a number of important issues surrounding Aboriginal land claims, including the admissibility of oral history as evidence, the nature of Aboriginal title, the test for proving Aboriginal title, and infringement of and extinguishment of Aboriginal title.15
Diversity Training (Cross-cultural Training)
Workshops or other educational sessions provided by an organization to increase the ability of its workers to serve people from different cultural groups. In health care, the goal is to assist health care providers to deliver "culturally sensitive" or "culturally competent" care. Many times, however, diversity training is based on a limited view of culture as a list of behaviours and practices associated with different groups. Such a view does not help providers to see themselves as bearers of "culture," nor does it address the power relations between them and their patients/clients or the effects of racism on the health of many peoples.
A state in which one view prevails over all other views. If unexamined, the dominant view may perpetuate a situation where there is undue influence and power over an individual or group of people. Patterns of dominance can, over time, be internalized as societal norms, values, and behaviours that lead to submission and oppression of people due to differences of culture, age, history, income, class, gender, or occupation.
The process of viewing one's own culture and/or ethic background as superior or the default position as to the way the world should be.16
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Usually seen as the opposite to exclusionary othering, which uses power in relationships for "domination and subordination". Inclusionary othering is a constructive, positive process to connect with people through their differences and uses power in relationships for "transformation and coalition building".17
Persons within the colonized group unconsciously adopt the world view, cultural stereotypes, and cultural practices of the colonizer. As a result, dominant cultural values, beliefs, social structures, and power structures are perpetuated and reinforced, including racism and sexism.
People in the dominant culture come to see the effects of colonization as normal or natural and are unable to see their privilege. They assume that everyone shares their view of the order of things, including stereotypes of colonized peoples and the view of history as written by the colonizers.
Occurs when colonized individuals internalize positive messages about the dominant group and negative messages about themselves and their cultural group. This integration of negative stereotypes results in feelings of inferiority, shame, and self-hate, which then underlie the development of patterns of self-destructive behaviour.18
The intersection of ethnicity, race, class, gender, age, ability, sexual/affectional orientation, physical size, etc., in the lived experience of individuals, which is influenced by the simultaneity in time and/or place of these factors. In other words, it is "people's exposure to the multiple, simultaneous and interactive effects of different types of social organization or oppression in which they are located" a person's social location. (Source: Joan Gillie, 2004; quote T. Rennie Warburton, 7 October 2002).
It can also be expressed as: "People with disabilities, like women, people of colour and poor people, have their lives constructed to a large degree by how society values their participation" (HSD 464 Course Manual, Introduction to Disability Studies, School of Social Work, University of Victoria, p.116).
The idea of intersectionality makes more sense if you think about the historical, social, economic, and political context of someone's experiences of health and is integral to a postcolonial framework that is intent on giving voice to marginalized experience in this sense intersectionality refers to the intersection of supposed "oppressions" in the lived experience of individuals and/or groups. Some do not see it as a "layering" of oppressions It is possible to visualize intersectionality more like an oscillating net or web where there are many spaces/shapes for renegotiation and resistance. Also, think about how individual/group differences/similarities are related to the "primary organizing principles of a society [such as family system, legal system, education system, etc.], because those principles locate and position groups within a society's structures of opportunity and power." (Quote from T. Rennie Warburton, 7 October 2002).
Carol McDonald referred to intersectionality as the "distance from centre" (centre being the place of privilege)19, while Colleen Varcoe has referred to it as "multiple difference" that can intensify experiences of discrimination.20 Also, in relation to viewing of intersectionality as "distance from centre," see the definition of marginalization found below.
The process of establishing and maintaining a social division of people where the dominant group is considered the norm, or the "centre," and non-dominant individuals or groups are considered to exist outside the centre, at the "margins." Those who exist at the social, political, and economic edges of society do not have the same access to life opportunities that members of the dominant group have.21
Refers to current processes of colonization that maintain social and political structures, institutions, and practices that differentially privilege members of the dominant group.22
The process of viewing or relating to persons in a way that depersonalizes them. When people are objectified, they cease to be thought of as living, thinking, and experiencing individuals (subjects) and instead, are seen as things that can be studied, measured, manipulated, and acted upon (objects). When things such as culture and health are objectified, they are treated as static and universal phenomena which can be reduced to a list of items to be measured and manipulated.
Individuals have different abilities to exert control and influence in situations or relationships. Many power relations exist within our social, economic, and political structures and institutions. Power and control are often hidden or unwritten and are usually vested in members of the dominant group.
A system of unearned freedoms, rights, benefits, advantages, and access afforded members of the dominant group in a society. This is usually taken for granted by individuals as they are taught not to see it.23
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"... a socially constructed phenomenon based on the erroneous assumption that physical differences such as skin color, hair color, and texture, and facial features are related to intellectual, moral or cultural superiority. The concept of race has no basis in biological reality and as such has no meaning independent of its social definitions."24
"The term racialization has been adopted to emphasize the process whereby populations have been socially constructed as races, usually based on real or imagined cultural, physical and/or genetic attributes. Referring to racialized groups and racialized minorities focuses on the social processes by which people come to be classified as racially different and under what historical circumstances. It also implies that these humanly created practices can be changed." (T. Rennie Warburton, SOCI 335 class notes, 9 September 2002, University of Victoria)
The use of genetic or biological background as a basis for assumptions about individuals or groups. In racism, racialized groups are seen as different from other individuals or groups and are treated differently through daily practices.25
The groups people belong to because of their place or position in history and society. All people have a social location that is defined by their gender, race, social class, age, ability, religion, sexual orientation, and geographic location. Each group membership confers a certain set of social roles and rules, power, and privilege (or lack of), which heavily influence our identity and how we see the world.
Transcultural Nursing Theory
Transcultural nursing theory promotes cultural sensitivity. According to Anderson et al.(p.197), transcultural nursing is concerned with understanding the "health beliefs and practices of different ethnocultural groups."26 Because transcultural nursing neither defines culture beyond ethnicity nor critiques power relations in health care, in terms of our learning in these modules, it does not go far enough to redress inequities. It does, however, provide a foundation from which to explore cultural safety. See Cultural Safety for an explanation of power relations.
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