Welcome to the third of three interactive modules on "cultural safety."
The purpose of these modules is to reflect on Aboriginal peoples' experiences of colonization and racism as these relate to health and health care. The modules are designed for nurses, nursing students, and nursing instructors, as well as other health and human service workers, to explore the concept of cultural safety as it relates to nursing practice.
Although each module is designed to stand-alone, we recommend you work through the modules in the following order:
- Module 1 introduces the relationships between colonial history and health.
- Module 2 explores power and privilege and the intersections of peoples' experiences in relation to marginalization, oppression, and dominance.
- Module 3 explores the intersections of Aboriginal peoples' experiences in relation to health, health care, and healing.
We, the project authors, acknowledge the influence of the "double-edged sword"1 in the development of these cultural safety modules. One edge of the sword is the danger of our unintended use of stereotyping, labelling, and marginalization while attempting to challenge these very ideas. Many of us speak and use language such as "Aboriginal" and "non-Aboriginal" or "us" and "them" on a daily basis.
The other edge of the sword is the danger of failing to critically discuss the experiences of marginalized individuals and groups. In short, if we ignore the issue of racism, we risk perpetuating oppression.
In the end, we decided that, although speaking more openly about the relationship between oppression and health is important, it is even more important to acknowledge and challenge the "double-edged sword" in this discussion at all times.
Cultural safety involves the recognition that we are all bearers of culture and we need to be aware of and challenge unequal power relations at the individual, family, community, and societal level. There are important differences between cultural safety and the following concepts which are closely aligned with cross-cultural models.
In the following clip, Roger John explains one problem with the cross-cultural approaches.
Cultural safety goes beyond three concepts noted above. Understanding cultural safety can help nurses address inequities in health care, more specifically to:4
- improve health care access for all nations
- acknowledge that we are all bearers of culture
- expose the social, political, and historical context of health care
- interrupt unequal power relations.
Concern with Cross-cultural Model
Ideas about cultural safety originated in Aoteorora/New Zealand and, while thinking about them in the Canadian context is interesting, it is important to remember that the colonial histories of these two countries are different. For that reason, we do not advocate a replication of the cultural safety model in Canada-this would be impossible. However, it has prompted us to think carefully about the inequities in our health care system.
Put simply, in Canada, there is a need for nurses to respond more effectively to the health care needs of Aboriginal peoples. The concept of cultural safety may be viewed as action "that enables safe service to be defined by those who receive the service,"5 which is achieved through relationship building that focuses on increasing the capacities, opportunities, and choices of individuals, groups, and communities accessing health care.
This does not mean, however, that Aboriginal peoples are solely responsible for defining culturally safe health services. As Roger John stated:
Although cultural safety has some merits in its community-up approach, i.e. the community determines what consitutes respectful practices, I think there is also merit in professionals ensuring the safety of community members. The responsibility has always been on us to train professionals when they come to our community. We know what good practice looks like and it's good to know our view is respected, but it would save much time if the responsibility and direction for cultural safety/competence was also found within the profession.6
You are encouraged to take advantage of the activities and reflection opportunities woven throughout the modules. These will help you make meaning of what you see, hear and think in your professional and personal lives.
You may find the information provided in Module 3 disturbing and distressing. If you do, the Suggestions for Self Care may be of help.
We hope that by offering access, through these three modules, to health education that focuses on the need to enact culturally safe practices, we will provide support for capacity building in rural and urban Aboriginal communities throughout Canada.