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Culture is a pattern of ideas, customs, and behavior shared by a particular people, community, or society. These patterns identify members as part of a group and distinguish members from other groups. Culture is constantly evolving. One way of thinking about cultures is whether they are primarily ‘collectivist’ or ‘individualist’. Knowing the difference can help health professionals with diagnosis and with tailoring a treatment plan that includes a larger or smaller group. The influence of culture on health is vast. It affects perceptions of health, illness, and death, beliefs about causes of disease, approaches to health promotion, how illness and pain are experienced and expressed, where patients seek help, and the types of treatment patients prefer.
Health is a cultural concept because culture shapes how we perceive the world and our experiences. Along with other determinants of health and disease, culture helps to define how patients and healthcare providers view health and illness and what patients and healthcare providers believe about the causes of disease. For example, some patients are unaware of germ theory and may instead believe in fatalism, a djinn (in rural Afghanistan, an evil spirit that seizes infants and is responsible for tetanus-like illness), the ‘evil eye’, or a demon. Which diseases or conditions are stigmatized and why? In many cultures, depression is a common stigma, and seeing a psychiatrist means a person is ‘crazy’. Culture also influences how illness and pain are experienced and expressed. In some cultures, stoicism is the norm, even in the face of severe pain. In other cultures, people openly express moderately painful feelings. Culture also affects health in other ways, such as:
- Acceptance of a diagnosis, including who should be told, when, and how.
- Acceptance of preventive or health promotion measures (e.g., vaccines, prenatal care, birth control, screening tests, etc.).
- Perception of the amount of control individuals have in preventing and controlling the disease.
- Perceptions of death, dying and who should be involved.
- Willingness to discuss symptoms with a healthcare provider, or with an interpreter present.
- Influence of family dynamics, including traditional gender roles, filial responsibilities, and patterns of support among family members.
- How accessible the health system is, as well as how well it functions.
Healthcare providers are more likely to have positive interactions with patients and provide better care if they understand their patient’s cultural values, beliefs, and practices.
The healthcare system in Australia is now focusing on ‘culturally safe care’. This approach has been taken by NMBA for nurses by setting expectations around culturally safe practice and reflects the current expectations of governments to provide a culturally safe health system. Many health services already provide cultural safety training for their staff. Cultural safety is about the person who is providing care reflecting on their own assumptions and culture in order to work in a genuine partnership with Aboriginal and Torres Strait Islander people. The principle of cultural safety in the new Code of Conduct for Nurses provides simple, common-sense guidance on how to work in partnership with Aboriginal and Torres Strait Islander people. The Code does not require nurses to declare or apologies for white privilege.
The guidance around cultural safety in the Code sets out clearly the behaviors that are expected of nurses, and the standard of conduct that patients and their families can expect. It is vital guidance for improving health outcomes and experiences for Aboriginal and Torres Strait Islander people. The Code was developed through an evidence-based and extensive consultation process conducted over a two-year period. Its development included literature reviews to ensure they were based on the best available international and Australian evidence, as well as an analysis of complaints about the conduct of nurses to ensure they were meeting the public’s needs.
In nursing education, most of the current teaching practices perpetuate an essentialist perspective of culture and make it imperative to refresh the concept of cultural competence in nursing. In Australia, indigenous cultural training has a role in the development and provision of healthcare that contributes to the health of Aboriginal and Torres Strait Islander people. Patient-family-centered care is yet another approach that has been used to support culturally safe healthcare practices.
Critically reflecting on culture in nursing, I believe that nursing has come a long way in terms of recognizing and being diligent in incorporating culture as an inherent component of practice. There is a need for nurses to shift their thought from cultural competence to cultural safety for better ethical nursing practices. The CNA Code of Ethics holds nurses’ commitment to ethical practice in the highest regard. However, it has been suggested that Aboriginal people suffer a great burden of ill health, in addition to being one of the fastest-growing and most diverse populations in Canada. Becoming culturally competent is an individual process for nurses; cultural competence is also a marker of the attitude, knowledge, and skills required to work with other cultural groups. However, the need for cultural safety emphasizes the importance of understanding the influence of culture on relationships in healthcare. There must be a convergence of various fields of healthcare to create an environment that promotes culturally safe nursing care to guide ethical decision-making, as well as to heighten nurses’ awareness and expand their understanding of the moral actions in their relationships with others from different cultural backgrounds. As nurses continue to struggle in meeting the diverse needs of society, one of the most important reminders and teaching is to always be respectful to all human beings. Respectful practice means: R – reflect deeply on your own cultural values and beliefs; E – examine and question assumptions and biases in practice; S – share and recognize the ethical space of the nurse-patient relationship; P – participate and celebrate cultural uniqueness; E – engage in relationship building; C – create open, and trusting environments; and T – treat people with dignity and compassion.
References
- Adelson, N. (2005). ‘The Embodiment of Inequity: Health Disparities in Aboriginal Canada’. Canadian Journal of Public Health. doi: 10.1007/bf03403702.
- Hackett, P. (2005). ‘From Past to Present: Understanding First Nations Health Pattern in a Historical Context’. Canadian Journal of Public Health. Springer, pp.S17–S21. doi: 10.1007/bf03405311.
- How Culture Influences Health| Culture & Health| Caring for Kids New to Canada (no date). Available at: https://www.kidsnewtocanada.ca/culture/influence (Accessed: 2 April 2020).
- Kowal, E. (2014). ‘Putting Indigenous Cultural Training into Nursing Practice’. doi: 10.5172/conu.2011.37.1.010.
- Lisa, R. and Bearskin, B. (2011). ‘A Critical Lens on Culture in Nursing Practice’. doi: 10.1177/0969733011408048.
- Nurses Association, C. (2017). ‘Code of Ethics for Registered Nurses’. 2017 Edition.
- ‘Nursing and Midwifery Board of Australia – Cultural Safety’. (no date). Available at: http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD18%2F25108&dbid=AP&chksum=rUoevBUF2wIJy%2FkYRor4qw%3D%3D (Accessed: 2 April 2020).
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