Talk of safety conjures its opposites: danger, risk, injury. And this is precisely what the term cultural safety signals: the possibility that some people who seek help from service agencies feel safe and accepted as who they are in terms of their cultural identity and behaviours, while others feel that their cultural identity or behaviours have been disregarded, challenged or harmed as a result of their encounters with health care providers and services. Unlike the linked concepts of cultural sensitivity or cultural competence, which may contribute to a service recipient’s experiences, cultural safety is an outcome. Regardless of how culturally sensitive, attuned or informed we think we have been as a service provider, the concept of cultural safety asks: How safe did the service recipient experience a service encounter in terms of being respected and assisted in having their cultural location, values, and preferences taken into account in the service encounter?
Many Aboriginal people have experienced their cultural identity, beliefs, and lifestyles denigrated by non-Aboriginal service providers including doctors, nurses, teachers, social workers, clergy and others. Another experience of cultural ‘un-safety’ is more subtle and involves being asked to present oneself for a service (e.g., traveling to a hospital in a nearby town) or to participate in a program of care (e.g., entering a long-term care facility). For many people, this entails crossing cultural borders, to the foreign culture of an institution, or to a social group composed of people from cultures other than ones own. The sense of risk in cross-cultural encounters, especially when one is part of a culture that has long been the object of racism, can be mitigated by being accompanied – for example, by an advocate or a case worker. This support can provide cultural orientation and mediation both for the service recipient and for the service providers.
Indicators of Cultural Un-safety
- Low utilization of available services
- Denial’of suggestions that there is a problem
- Non-compliance’ with referrals or prescribed interventions
- Reticence in interactions with practitioners
- Anger
- Low self-worth
- Complaints about lack of ‘cultural appropriateness’ of tools and interventions transported from dominant culture to minority culture
Are there guidelines for practice that will increase the likelihood that people who seek help will experience the service setting, encounter, and outcomes as culturally safe? Research undertaken in the Early Childhood Development Intercultural Partnerships Program at the University of Victoria’s School of Child and Youth Care has helped to shed light on this question. Findings of several projects involving partnerships with First Nations communities have led to the formulation of several principles.
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Five Principles to Engender Cultural Safety
1 |
Protocols |
Find out about cultural forms of engagement and respect these. |
2 |
Personal knowledge |
Become mindful of one’s own cultural identity, socio-historical location in relation to service recipients, pre-commitments to certain beliefs and ways of conceptualizing things like health and wellness. Be prepared to share information about oneself if this will help to create equity and trust. |
3 |
Partnerships |
Promote collaborative practice in which those seeking help are also welcomed into a joint problem solving approach as carriers of important information and know-how. |
4 |
Process |
Engage in mutual learning, frequent checking in to ensure that proposed action plans ‘fit’ with service recipient’s values, preferences, and lifestyles. |
5 |
Positive purpose |
Ensure that there is a good probability that positive steps to achieve a service recipients goals (or resolve problems) can be taken and that these are likely to be beneficial. Make it matter. |
Practicing these principles can increase the likelihood that a person seeking help will feel respected, included, and protected in terms of their cultural identity, cherished values and goals.
Resources and Reports
References
'Cultural safety’ and the analysis of health policy affecting Aboriginal people. V. Smye & A. Browne, Nurse Researcher (2002), 9 (3): 42-56.
Cultural safety in nursing: the New Zealand experience. E. Papps & I. Ramsden. International Journal for Quality in Health Care (1996), 8 (5): 491-497.
Troubling National Discourses in Anti-Racist Curricular Planning. C. Schick & V. St. Denis, Canadian Journal of Education (2005), 28 (3): 295-317.
