QUT Faculty of Health Cultural Safety Curriculum Framework

PRINCIPLE 1: broad definition of culture of people and organisations

broad definition of personal culture and identity to include lifeworlds and worldviews

culture is learned and dynamic

all people have culture and ethnicity

ethnicity DOES NOT equal culture which includes gender, sexuality, occupation, age, class

society and humans are co-creating e.g. race is a social not a biological fact

othere are multiple realities and no universally agreed definitions of health

organisations /professions/staff groups all work within and have cultures

PRINCIPLE 2: ongoing critical reflection for institutional and personal cultural awareness for social change

extension of ongoing practice of critical reflection and awareness

acknowledge that our social position and cultures can impose limitations on practice

understand our own beliefs, attitudes and values and their origin

acknowledge power and privilege

organisations support critical reflection on practice and cultural dominance

acknowledge the heritage and ongoing impact of cultural colonial imperialism

commit to decolonise institutional and professional practice

reflect on colonial history and ongoing health impacts

be open to and respect Aboriginal and Torres Strait Islander knowledges, perspectives and experiences

commit to anti- oppressive policy and practice

accept that cultural differences exist and are legitimate

be open to, respect and include all marginalised people

PRINCIPLE 3: biculturalism

all human interactions have cultural dimensions

all interactions between 2 people involve at least 2 personal cultures [+ the culture of the organisation, society]

people are not homogenous; those who share a nationality, ethnicity, a generation or other identifiers may have different values, beliefs, priorities, attitudes, socio-political experience

respects uniqueness of individuals and that people and families are the experts on their cultures

PRINCIPLE 4: social justice through partnerships, power sharing, negotiation

service providers and professions are responsible for eliminating attitudes and improving policy, service design and delivery

commit to human rights including advocacy for equitable distribution of resources

challenge racisms, ageism, sexism, ableism, hetero-dominance, class privilege, ethnocentrisms

actively reducing power differences

acquisition of trust

focus on relationships

open, non-judgemental communication

underpinned by the social determinants of health and awareness of structural inequality to avoid victim blaming

focus on how society treats people differently not on how people differ

challenge negative attitudes by those in positions of power in organisational cultures i.e. do not demean, diminish or disempower any person

flexible, open staff and services to change dominating practices i.e. safety defined by the users of services

Assumptions

Our automatic responses and established opinions.

Attitudes

Our beliefs, feelings and values create states of mind (attitudes) about our self, others, the world, activities and so on. These states of mind determine how we behave toward people and situations. For example if someone highly values paid work and believes that paid work is the foundation of happiness, then their attitude toward paid work will be positive and they will engage happily in paid work. Alternatively if someone values leisure or creativity or community service they might hold the belief that paid work takes them from their true purpose in life and their attitude toward it may be negative and they might not want to engage in paid work.

Beliefs

Beliefs are meanings or fundamental ideas that you have about the nature of the world and that you hold to be true or real but for which there is no generally acceptable evidence. Beliefs usually consider questions of how humans came to be on earth, how the universe came about and how it works. For example someone may believe that aliens are humans’ ancestors but there is no evidence for this proposition. Someone may believe in extra sensory perception but there is no proof of it. Others may believe in creationism but again there is no generally acceptable proof of this.

Critical Theory

Cultural Safety

Critical theory at its most basic seeks to understand and change imbalanced relations of power and domination

“The effective nursing of a person/family from another culture by a nurse who has undertaken a process of reflection on [their] own cultural identity and recognises the impact of the nurse’s culture on nursing practice” (NCoNZ 1996, p. 9)

Culture

Culture occurs at different levels and is a contested concept because there is no universally agree definition but all cultures are learned, dynamic, changing, strategic, negotiated. There is personal culture, professional/institutional/organisational cultures and societal culture.

Personal culture: refers to multiple aspects of our identity (ethnicity, nationality, age, gender, gender identity, sexual

orientation, education, occupation, ability, class and socio-economic status and political persuasion); our way of life;

our social experience of belonging, status and opportunity; the values, beliefs, and attitudes that we use to make

decisions and respond to situations in everyday life including in professional practice. The concept of personal culture as used in cultural safety focuses on the interaction between the lifeworld [aspects of life as it is experienced] and worldviews [beliefs, values, attitudes, assumptions].

Professional /institutional cultures: the beliefs, values, priorities, sensibilities, ways of doing business, dress, knowledge, jargon/language, techniques, social status and influence, and theories of professions.

For example, health care cultures tend to value efficiency, competency, effectiveness, compliance, punctuality, science, intervention and technology and to prioritise completing tasks accurately and quickly.

Societal Culture: Whilst there is tremendous variation in the cultural ways of being amongst the members of a nation or society, there are dominating aspects of the society, which make up the dominant culture. Like personal, professional and organisational cultures, societal culture is about power, history, values, attitudes and priorities expressed in the ways things are done (practices). For example, although Australia is considered a secular and multi- faith society, the Christian religion dominates. 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 biomedical practice.

Ethnicity

Socially constructed group identification/belonging based on common ancestors (kinship) and history and traditions in language, food, dress etc.

Eurocentric

The organisation of society (such as schools, hospitals) according to western (European) values and priorities which are seen as ‘normal’ and ‘right’ by those espousing them. Organising society according to the values and priorities of one cultural tradition is always at the expense of those of other cultural traditions. An example of eurocentrism in health is the assumption that only the biological parents are Mother/Father, while in some Indigenous societies relatives that western society calls Aunt/Uncles are also known as Mother/Father.

Frame of Reference

‘The context, viewpoint, or set of presuppositions or of evaluative criteria within which a person’s perception and thinking seem always to occur…,” Fontana Dictionary of Modern Thought (2nd edn: 1988 at http://www.doceo.co.uk/tools/frame.htm). Our frame of reference is the way we habitually think and the points of view that we hold.

Lifeworld

The lifeworld defined as ‘the sum total of physical surroundings and everyday experiences that make up an individual’s world’ (Merriam-Webster Dictionary online at http://www.merriam-webster.com/dictionary/lifeworld).

Norms

Generally accepted or expected standards of acceptable and unacceptable behaviour that operate in society.

However, norms are trends NOT RULES. For example, an expected norm would be that people hand in someone’s lost property if they find it. Nevertheless, some people do and some people do not! Norms are also standards or occurrences regarded as typical in a society. For example in Australian society, the norm is for many school leavers to go to a coastal area and party, but not ALL school leavers do this. I heard at a colleague’s son’s school the ‘Schoolies’ went to towns in Australia and offer to help with whatever that community needed e.g. cleaning up a park. I wonder if that might become a new norm.

Power            Power is a highly contested concept involving deep and ongoing philosophical debates. Power is not a thing that one either has or does not have. It is an aspect of the social relationships between                              individuals and structures and so we talk of power relationships, and imbalanced power relationships. Those in powerful positions in human relationships have the capacity to influence and control                          the actions of others.

Race

Racialisation

Race is a social construct not a scientific fact as biologically there is only one human race. Some groups however identify with a notion of race since they have always be catergorised according to an assumed race. They reclaim it as a positive social and cultural identifier.

Racialisation is the process of categorising people as being of assumed races.

Racism

Racism is the practice of using the idea of race to claim that some people are inferior to others. Racism discriminates against people based on the social construct of “race‟. Historically, Anglo-Saxons claimed that they were superior to all other people and that this gave them the right to control other people and to take their land for example. This assumed superiority of some societies over others is called “social Darwinism”.

Social

constructionism

Social constructionism refers to a group of social theories that consider the relationship between people and society, often sourced to the work of Peter Berger and Thomas Luckmann ‘s The Social Construction of Reality (1966). It argues that society creates people and that people create society. It considers the way that society creates gender, ‘race’, age for example along with ideas of health. Social constructions affect human beings. Socially created assumptions circulate; influence the way people are treated, and how they act. For example, the social construction of men includes that they are tough, logical, strong resulting in some not seeking health care as readily as women do, probably contributing to the fact that statistically they die earlier.

Socialisation

Socialisation is the process occurring throughout childhood whereby children learn values, beliefs and attitudes and how to act in their context. Families, schools, peers, the mass media and society are socialising agents. When we enter professions, we undergo ‘secondary socialisation’ where we learn the rules, norms, values, beliefs and priorities of the profession.

Stereotyping

Stereotyping is making an assumption, often based on a person’s appearance, that they belong to a particular cultural group and that this group is homogenous. Therefore it is assumed (wrongly) that the members of the group can all be expected to hold the same values, beliefs and attitudes and to behave in the same way. For example stereotypes about Australians are that all easy-going (lazy), dress in shorts, singlets or swim wear all the time and swill large amounts of beer constantly.

Values

Values are guiding principles based on aspects of life that are held in high regard. We draw on our values to help us make decisions in life or to help us to decide how to behave in a given situation. Examples of values are honesty, hard work, fairness/equity and so on. So if we are someone who values honesty for example we wouldn’t decide to cheat in an exam or to keep the wallet we found in a taxi.

Worldview

The idea of the worldview is useful as we all have a worldview. We turn to our personal worldview to answer such questions as: How did the world come about? How did I get here? What am I doing here? What is my purpose in life? What happens when I die? Is there life on other planets? However, there is so much difference within cultural groups that the rigid idea that those who identify with the same culture exactly share a worldviews leads to misguided assumptions and cultural stereotypes.