Module 1 Cultural Safety
What is culture?
Culture can be thought of in many different ways; this includes personal culture, professional and organisational culture and societal culture. Everyone has culture. Cultures are created by and between people who interact within a particular environment. Culture is both learned and dynamic as it responds to different contexts and needs.
Personal culture
Culture is a dynamic construct, continually constructed and reinforced by those around us. We are not born “with” culture rather we are born into cultures.
Consider how distinct aspects of your being and identity are emphasised depending on the context you are in, who else is there and what is happening. At times ethnicity may be emphasised, at other times gender identity, sexuality, professional identity, class or ability. Culture refers to multiple aspects of our identity including but not limited to age, class, socio-economic status, ability, ethnicity, gender, sexual orientation, and education. Culture refers to our way of life, our social experience of belonging, status and opportunity and is expressed in our beliefs, values, attitudes, and assumptions that we use to make decisions and respond to situations in everyday life including in our professional practice.
Personal culture through the lens of cultural safety
Culturally safe individuals understand that there is as much variation within personal cultures, as between them. For this reason, it is not possible to learn all cultural variations. Culturally safe practice accepts that the individual is the expert on their own cultural needs. Cultural safety supports good practice by power sharing, negotiation and working in partnership as it focuses on the unique needs of the person in front of us as they understand those needs. This practice supports each individual to communicate their needs in a safe, respectful and trusting space and promotes listening rather than assuming.
Example
It is easy to assume that the people with whom we work as colleagues, students, or research participants, share the same values, beliefs, attitudes, assumptions, privileges, social status and social experience. Likewise, an assumption could be that everyone has the same sense of belonging in a tertiary institution and of feeling trusted and respected.
However, not everyone enjoys the privileges associated with a sense of belonging that comes with being part of the majority or dominant cultures.
Culturally safe practitioners reflect on and understand their personal and professional cultures and the impacts these have on other individuals (colleagues, students, others).
Professional and organisational culture
Professional cultures are the beliefs, values, priorities, sensibilities, ways of doing business, protocols, knowledge, jargon/language that exist within a profession.
Professional and organisational culture through the lens of cultural safety
Culturally safe individuals reflect on and understand the cultures of their professions and of the organisations, institutions or settings where they work and the impacts these have on others.
Cultural safety is applicable in all situations. Every interpersonal situation involves several cultures. It involves the culture of the individual, the culture of the profession we are working with, it occurs in the organisational cultures and within the broader societal culture.
Example
As professionals, we can take for granted or overlook the power imbalance that exists between us and service users such as students, research participants and patients. We become insiders to the cultures of our professions and workplaces and thus hold significant power over others. This power exists in terms of knowledge and status.
Cultural safety brings these dynamics to mind enhancing our capacity to focus on the needs of those with whom we work.
Unsafe cultural practices are actions which diminish, demean or disempower the cultural identity and wellbeing of individuals such as a service users.
Societal culture
Our social experience and our personal, community and nations’ histories are part of who we are as cultural beings. People and society co-create each other’s culture. That is to say, the society and communities we live in are the cultures we are socialised into. The people we become influence the culture of society through our actions. The theory that explains this effect is known as ‘social constructionism’ which is a theory underlying cultural safety.
Societal culture through the lens of cultural safety
While there are variations in the cultural ways of our society, there are also dominating aspects of the society. These aspects can be considered as the dominant culture.
Global declarations, national policies and laws aspire to respect and ensure equity in relation to aspects of culture discussed in this module such as age, ability, ethnicity, gender, and gender identity.
Cultural diversity is valued and those from non-dominant cultures should not be disadvantaged.
However, many from non-dominant cultures have poor health and social outcomes and suffer significant disadvantage in Australia. This is not due to any difference inherent in the people but in how society supports these cultures.
Example
While Australia is considered a secular and multi-faith society, the Christian religion dominates cultural norms.
While it is considered multi-cultural, the English language dominates and ways of doing business throughout society are based on European knowledges, philosophical traditions, pedagogical practices, and medical practice.
Critical Reflection Exercise 1
Reflect on the different cultures that impact on you and your practice, by answering the following questions.
Be curious about the thoughts, ideas, feelings, emotions that come up during your reflection. These can be key pieces of information to explore and consider their source.
There are no “correct” ways to feel or think. There will be diverse viewpoints.
On-going self-inquiry takes time, non-judgement, and exploration.
- Write down at least three cultures that you identify with. These may be your religious or spiritual culture, your ethnicities, your professional culture, your generation, your gender.
- Write down as many norms or rules you can think of that are part of the cultures you identified.
- What cultures exist within your university, your faculty, your school or centre, hospital or clinic?
- What are some of the norms or rules that govern your professional interaction with colleagues, students and/or clients or patients?
- What are the rewards and punishments that helped you learn the norms or rules of one your cultures?
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- What do these say about what this culture values?
- Are these the same for everyone?
- Do they change over time?
Having reflected on the diversity of cultures to which you belong, and how these impact on your interactions with others, let us consider principles that allow people to feel safe, respected and valued.
Cultural safety
Cultural safety is a process. It is about power sharing, negotiation, flexibility, and openness to various ways of knowing, ways of producing knowledge and ways of applying knowledge.
It includes:
- Cultural self awareness and corporate awareness. This acknowledges that we all have culture. We have culture as individuals. We are a part of groups that have culture. We are also a part of organisations and societies that have culture.
- Cultural sensitivity. This acknowledges that there are differences between cultures and that these differences are legitimate.
- Cultural safety. This is an outcome of self reflection on aspects of our cultural lives, which allows for power sharing, trust and enables partnerships. It gives power to the service user from the service provider.
Culturally safe practice is a process, which includes all aspects requiring an ongoing reflection by individuals on their personal and organisational cultures and the dimensions of power that inform them. Cultural safety brings to light individuals’ socialisation which can produce unhelpful attitudes and actions towards those considered different to themselves (Ramsden 2002). Culturally safe individuals acknowledge the impact their values, assumptions and biases can have on others’ experiences with both an institution/service, and with them personally. This self-reflective work is essential to gain and maintain trust and forms the basis of working partnerships. Cultural safety provides a way to effectively work within teams to ensure people are not diminished, demeaned, or disempowered.
Cultural Safety in Tertiary Education
Tertiary institutions have evolved from Western knowledge systems which dictate what types of knowledge are considered valid and marginalize the voices and knowledges outside that dominant Western system.
A cultural safety approach encourages an examination of these assumptions and an openness to exploring other knowledge systems within our disciplines. These are early steps in decolonising education and research practice by recognising that these assumptions exist and impact on what knowledge is valued and shared.
We can apply a cultural safety lens to the tertiary education context to think about the social determinants of access to tertiary education and issues of retention.
In Australia, success at school is linked to the individual’s and school’s socio-economic status. Adults of tertiary educated parents are more likely to complete tertiary education than those without tertiary-educated parents (https://www.oecd.org/pisa/Equity-in-Education-country-note-Australia.pdf).
Students from socioeconomically disadvantaged backgrounds may lack support and opportunities for adequate preparation for university study. Geographical location and financial issues can impact on access to university, or the resources such as computers and internet needed to be successful during a student’s time at university. Unfamiliar social or cultural norms of the tertiary classroom setting can serve to exclude students from full participation in learning. Such fundamental structural inequalities can present barriers and foster poor performance or self-exclusion by students. Adjusting to new places, people and practices can cause feelings of being out of place, anxiety, confusion, frustration and doubt, and culturally safe individuals can assist students in overcoming these feelings.
Reflective practice enables awareness of and empathy towards these experiences and feelings. Cultural safety challenges individuals to acknowledge and negotiate power imbalances to address racism, stigma, and discrimination in society, in our professional roles (teaching, research and student support) and in our everyday lives. Cultural safety is an outcome that is defined by those with whom we work, teach or who participate in research projects.
Examples of professional and institutional cultures impacting on practice
- Looking for apology after ‘whitesplaining’ response to Indigenous eye doctor | NITV (sbs.com.au)
- Racism in universities is a systemic problem, not a series of incidents | Kehinde Andrews | The Guardian
- Racism and the Tertiary Student Experience in Australia | Adam Graycar (2010) | Australian Human Rights Commission
- Students face “confronting” levels of racism | ANU
- Researchers say racism is costing the Australian economy billions | ABC News
- #MeTooPhD reveals shocking examples of academic sexism | The Guardian
- At 93, Australia’s oldest university student is busier than ever The Sydney Morning Herald
Critical Reflection Exercise 2
Reflect on a professional interaction you had with a student, research participant, colleague, client or patient where you felt uncomfortable with your reaction to them or with the decisions you made.
- What were your thoughts, feelings, ideas, beliefs, and values going into the interaction, during the interaction and after the interaction?
- What did you learn about yourself?
- How could you approach it differently in the future?
Cultural safety strategies
Reflection is a key strategy of cultural safety. It is an on-going process of reflecting on self, one’s own culture and profession. This includes considering the power and privilege, attitudes, assumptions and beliefs about others that may be inherent in these cultures.
Strategies for culturally safe practice include:
- Being knowledgeable about history and current social issues. Examining the power dimensions represented in these historical events and current issues. Thinking about the impact of these power dimensions on the lives of those who are not privileged by these power dimensions.
- Consider the knowledge that forms the core understanding of your discipline. How has this knowledge been developed? Were there particular voices that were privileged in the development of this knowledge? Read the history of your discipline with a critical lens. Can this understanding have an impact on your teaching and research?
- Applying active listening skills so you are really hearing, and checking your understanding of others views in your interpersonal interactions.
- Actively negotiating knowledge and outcomes through respectful relationships and partnerships with others to develop trust and power sharing.
Critical Reflection Exercise 3
Adopting a flexible and open-minded approach use the following techniques to develop a culturally safe practice.
- Reflect and examine your attitudes towards people who are experiencing poor mental health.
- Has your attitude changed over time, or as your personal experience with mental health has changed ?
- What are the facilitators and barriers of your attitudes and beliefs when working with people who are experiencing poor mental health?
- Consider how power operates between you and a person (student/patient/colleague) who is experiencing poor mental health.
- How does the balance of power look?
- Are you in the more powerful position?
- How can power sharing be negotiated?
References
Further reading
Kurtz D.L.M. et al (2018) Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review. International Journal of Medical Education, 9, 271-285. doi: 10.5116/ijme.5bc7.21e2. PMID: 30368488; PMCID: PMC6387770.
Merritt, F. et al. (2018). The ‘enhancing tertiary tutor’s cultural safety’ study : Aboriginal and Torres Strait Islander cultural training for tutors of medical students. Focus on health professional education, 19 (3), 11–22.
Sanderson, C. D. et al. (2021). Developing a Social Determinants of Learning Framework: A Case Study. Nursing education perspectives, 42 (4), 205–211. DOI: 10.1097/01.NEP.0000000000000810
Wilson L, Wilkinson A, Tikao K. (2022) Health professional perspectives on translation of cultural safety concepts into practice: A scoping study. Frontiers in Rehabilitation Science. 2022 Jul 28;3:891571. doi: 10.3389/fresc.2022.891571
Curriculum Resources
https://indigenouspsyched.org.au/resources/
