A critical lens on culture in nursing practice

Abstract

Increasing evidence demonstrates that the Aboriginal population experience greater health disparities and receive a lower quality of health care services. The Canadian Nurses Association (CNA) code of ethics states that nurses are required to incorporate culture into all domains of their nursing practice and ethical care. The aim of this article is to examine the concepts of cultural competency and cultural safety by way of relational ethics. To address these disparities in health care, cultural competency training programs are being widely advised. Recent research into cultural safety has not only recognized the importance of culture in nursing practice and organizational structures, but also extended the concepts to the culture of the client. In recognizing this diversity, nurses must pay close attention to their relationships with their clients. It is argued that the answers lie in relational ethics, which honors indigenous people's connection to self, others, the environment, and the universe.

Applying cultural safety beyond Indigenous contexts: Insights from health research with Amish and Low German Mennonites

“…Attention is then deviated from individual behaviors to recognition that people make choices within particular social, historical, economic, and political contexts. A cultural safety lens also prompts us to reflect on organizational and societal policies and practices that impact the access and delivery of healthcare (Bourque Bearskin, ; Canadian Association of Schools of Nursing, ). Therefore, cultural safety helps to shift health care practices and policies away from dominant neocolonial approaches, which may have unwittingly created inequities in health care service access and delivery, toward those that support the health of groups within society that may be considered marginalized or in the minority.…”

“…Cultural safety assumes that all relationships have a cultural dimension and that this dimension is essential to build a relationship of trust before cultural safety can be considered (Bourque Bearskin, ; Mackay, Harding, Jurlina, Scobie, & Khan, ). This implies for health care providers a critical reflection on their own social locations and the effects that their locations can have on their relationships (Parisa, Reza, Afsaneh, & Sarieh, ).…”

“…Equal partnership involves the creation of a space for mutual respect and dialogue between two parties (Wilson & Neville, ). This relational space is the starting point for developing an awareness of power imbalances in the health care system on a microscopic, mesoscopic, and macroscopic level (Bourque Bearskin, ). Active participation implies a sincere commitment by both parties on a cognitive, affective, and behavioral level throughout each phase of care, education, or research.…”

“…Active participation implies a sincere commitment by both parties on a cognitive, affective, and behavioral level throughout each phase of care, education, or research. On a larger scale, this participation implies this commitment by both parties at every step in an organizational or political decision (Bourque Bearskin, ; Thomas, ). The protection of cultural identity and well‐being aims at minimizing the potential for exploitation or danger as a result of the perpetuation of cultural stereotypes by critically examining the ethical foundations of the relationships, whether at an individual or organizational level (Wilson & Neville, ).…”

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“…[44] For instance, neocolonial health policies and practices correlate negatively to influence Indigenous' clinical and health outcomes. [45] Eurocentrist views of illness, rejection of Indigenous traditions, and racial inequity create the conditions of social, cultural, and economic marginalization affecting Indigenous populations in Canada and New Zealand. [46,47] A social justice lens represents another fundamental knowledge in nursing.…”