Cultural competency and cultural safety

| January 19, 2016

Migrants, culturally and linguistically diverse groups or the Indigenous population play a significant role in Australia’s history and in shaping the nation we live in at this very moment (ABS, 2014). They play important roles in terms of population, workforce growth and contributing to overall Australia’s unique culture and society in many ways. All Australian’s have equal rights to

The relevance and relationship between culture or ethnicity, socioeconomic status and cultural competency are key factors that affect all Australians in one-way or another. Australia is well known as one of the most culturally and ethnically diverse societies in the world. The Australian Government (2015) stated that one in four Australians were born outside of Australia and that many more are first or second generation Australians. Culture in its broadest form is referred to the accepted behaviour within particular ethnic groups in society. Queensland Health (2015) claimed that ethnicity in Australia is closely associated with low socioeconomic status. The Australian Bureau of Statistics (2015) defined socioeconomic disadvantage as people’s reduced ability to access social resources and their reduced ability to participate in society. Australian migrants who do not speak English well may experience difficulty in accessing education and health services thus determining their socioeconomic status. Aboriginal and Torres Strait Islanders are also greatly affected by low socioeconomics due to inadequate access to education, health services and employment. Factors affecting access to these facilities and low participation rates include social marginalisation, economic disadvantages, health problems, varied community expectations and geographical isolation. Cultural competency is a crucial method for increasing equity in healthcare access to improve quality of life of Indigenous Australians and other ethnical groups (Bainbridge, McCalman, Clifford & Tsey, 2015). Factors affecting socioeconomic status due to ethnicity of individuals can be challenging, thus all health professionals must consider all elements of cultural competency.

The different elements and principles of cultural competency allow health professionals and health consumers to utilise health resources. Essential elements include valuing of cultural diversity, conducting cultural self-assessment, management of dynamic differences to improve interactions between ethnical groups, acquiring and institutionalising cultural knowledge and adapting to diversity and cultural contexts. As an exercise and sports science professional (ESSP), it is imperative to value cultural diversity especially when working with a culturally diverse colleagues and providing health care for culturally diverse communities. The element of cultural self-assessment proposes that health professionals must be self-aware of their own cultures especially working in very ethnically diverse areas such as Western Sydney to decrease cultural barriers. DeLisser (2009) stated that lack of cultural awareness could make it difficult to achieve high quality health care particularly as an ESSP. Managing the dynamics of difference aims to improve interactions between cultures. This can be achieved by ethno-specific training for ESSP’s and pairing cross-cultural health professional and health consumer. Organisations must implement ways to integrate understanding of other cultures in health care delivery and practices. Adapting to diversity and cultural contexts allows organisations to have embedded policies and service delivery types to suit the ever-changing culturally diverse society. As an ESSP, it is likely that the practice or workplace will be situated in a very culturally diverse area such as specific Western Sydney suburbs. It is likely that an ESSP will not always be self-aware when interacting with different ethnic individuals. Hence why elements of cultural competency must be knowledgeable, experienced, enhanced and polished through cross-cultural encounters. The National health and medical research council (NHRMC) dimensions were also constructed to guide the health system in promoting cultural competency.

Governments and health services will be better equipped to deal with Australia’s health issues if they incorporate cultural guidelines into the delivery of health care particularly as an ESSP (NHMRC, 2014). The NHRMC have created cultural guidelines, which include systemic, organisational, professional and individual dimensions. The Australian government acts as the systemic dimension, which sanctions the need for organisations such as Western Sydney University (WSU) to educate students about cultural competency before they begin their career in health. WSU has implemented units such as culture diversity in health to train and educate students on how to become culturally competent prior to entering the workforce. Similarly, Exercise and Sports Science Australia (ESSA) have also put in place codes of professional conducts and ethical practice to support systemic policies and organisational education about cultural competency (ESSA, 2014). For example, ESSA (2014) stated ESSP’s must support equitable and transparent allocation of health care resources within the health care system. They must also understand that their use of resources can directly affect the patient access to health care resources. As an ESSP, reflecting upon and exercising these NHRMC dimensions will have an inevitable affect on the individual’s cultural competence inside and outside of the workplace. The NHRMC dimensions promote self-reflection, self-awareness, cultural competency education and training to deliver quality health care for health consumers.

Cultural competency elements, principles and the NHRMC dimensions all interrelate so that health professionals are able to provide high quality health care and must have the full support and commitment of systemic and organisational institutions (RACMA, 2015). As an ESSP, there is great probability of working in a culturally diverse community. An organisation with culturally diverse employees and cross-cultural client-professional pairing will demonstrate a strong value of cultural diversity from the viewpoint of a health consumer. Embedded systemic, organisational and professional cultural competency knowledge and training will have a vast affect on the quality of health service a health consumer will receive. The health consumer will be more comfortable working with culturally competent professionals and a common respect of each others cultures will be achieved. ESSP’s who graduate from organisational institutions such as WSU will be well prepared for cultural diversity and will be culturally competent. The elements and principles learned from University will not only ensure superior delivery of health care to the health consumer but also help the graduate to be comfortable to work in culturally diverse communities and practices. By utilising and reflecting upon the elements, principles and dimensions of cultural competency, it is possible to achieve and ensure culturally/socially safe professional practice for both the health consumer and health professional.

To achieve culturally/socially safety for both health professional and health consumer, factors such as self-awareness and holistic views of health must be exercised. It is a responsibility for health care organisations to develop and sustain healthcare services that are free from discrimination and delivered in a way that shows respect for consumers and their unique cultural needs (NACCHO, 2015). Cultural safety is providing health care that is person-centred and respecting their cultural needs and requirements. Respecting and acknowledging a client who refuses particular treatment due to their religious or cultural beliefs is a key example of practicing cultural safety. It may not be the best health outcome for the client but engaging in such practice will result in high quality feedback from those who define care, which are patients or clients. It is critical that the health professional is able to self reflect upon their actions and decisions to ensure cultural safety. Respecting, communicating effectively, understanding and gaining their trust then to engage treatment accordingly can accomplish this.

The ability for health professionals to self reflect will reduce ignorance of other cultures thus improving delivery of health care. In summary, to achieve cultural safety, a health professional must be able to self reflect, value diversity, aware of culture and its sensitivity. As an ESSP there are a range of ways to ensure provision of culturally safe health services.

Cultural safety is not about protecting people and their culture. It is about enabling and removing cultural barriers to maximise the use of health care. There are a number of ways an ESSP can provide culturally safe health services. Sharing the decision making power and broad approach to intervention ideas will demonstrate person/client centred health care (Williams, 1998). This will build trust and rapport between the ESSP and client. To develop a stronger sense of cultural awareness and cultural sensitivity, an ESSP could socialise and be open-minded with the culturally diverse colleagues. This means not creating cultural cliques in the workplace that inhibit cross-cultural awareness and experiences. Cross-cultural socialising may also help eradicate previous cultural ignorance, stereotypes and other factors that contribute to cultural barriers. Having a broad knowledge or awareness of other cultures may assist in future encounters with other ethically diverse health consumers, which may lead to improved delivery of health care. Another method an ESSP could apply to the practice is to regularly update their knowledge about the dynamic culturally diverse community. This may include searching reliable online articles or government articles that have insightful and high currency information about culture, diversity and health. All health professionals should also be informed by systemic, organisations and professional institutions that govern them about any changes in codes of conducts or policies regarding the preservation of cultural safety in health care.

In conclusion, achieving culturally competent health care is everybody’s responsibility. It is not just the province of governments and policy makers, health care providers dealing with ethnicity, or culturally and linguistically diverse societies. It benefits all citizens of Australia and can only be achieved through teamwork and dedication of all sectors across the community.

 

 

 

References

 

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Australian Bureau of Statistics. (2009). National migrant statistics unit. Retrieved from http://www.abs.gov.au/websitedbs/c311215.nsf/web/Migrant+and+Ethnicity

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Australian Government. (2015). Our people. Retrieved from http://www.australia.gov.au/about-australia/our-country/our-people

Bainbridge, R., McCalman, J., Clifford A., & Tsey, K., (2015). Cultural competency in the delivery of health services for indigenous people. Retrieved from http://trove.nla.gov.au/work/195282375?selectedversion=NBD55089594

Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Toward a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: Georgetown University.

DeLisser, H. (2009). Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals. Hoboken, NJ, USA: Wiley-Blackwell. Retrieved from http://www.ebrary.com

Exercise and Sports Science Australia. (2014). Code of professional conducts and ethical practice. Retreieved from https://www.essa.org.au/wp-content/uploads/2014/06/Code-of-Professional-Conduct-and-Ethical-Practice_FINAL2014.pdf

http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4250.0.55.001Main+Features32009

National Aboriginal Community Controlled Health Organisations. (2015). Cultural safety: Promote and support high performance and best practice. Retrieved from http://www.naccho.org.au/promote-health/cultural-safety/

National Health and Medical Research Council. (2014). Cultural competency in health: A guide for policy, partnerships and participation. Retrieved from https://www.nhmrc.gov.au/guidelines-publications/hp19-hp26

Ngo-Metzger, Q., Telfair, J., Sorkin, D. H., Weidmer, B., Weech-Maldonado, R., Hurtado, M., & Hays, R. D. (2006). Cultural competency and quality of care. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2006/Oct/Cultural%20Competency%20and%20Quality%20of%20Care%20%20Obtaining%20the%20Patients%20Perspective/Ngo%20Metzger_cultcompqualitycareobtainpatientperspect_963%20pdf.pdf

Queensland Health. (2015). Social determinants of health. Retrieved from https://www.health.qld.gov.au/ph/Documents/saphs/20397.pdf

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Williams, R. (1998). Cultural safety. What does it mean for our work practice. Faculty of Aboriginal & Torres Strait Islander Studies. Retrieved from http://www.utas.edu.au/__data/assets/pdf_file/0010/246943/RevisedCulturalSafetyPaper-pha.pdf.

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