Cultural Safety

Abstract

First introduced into nursing education and health care in New Zealand in 1992 by Maori scholar Irihapeti Ramsden, the concept of “cultural safety” is situated within a postcolonial discourse and is concerned with social justice through redressing health inequities and improving access to health care. It is understood as providing care in ways that do not leave patients feeling inferior, alienated, disempowered, devalued, or dissuaded from or denied access to health care, but rather maintains their respect and dignity. When applied, the concept challenges health professionals to continually consider the negative effects their beliefs, attitudes, and practices may have on their patients and their care, and critically reflect on and become self-aware of any biases they may have, rooted in their own culture, that may be contributing to power imbalances in patient-provider interactions. Cultural safety responds to the unique needs of minority and marginalized populations by incorporating respect for their cultural traditions and identities. It also takes into account the systemic and structural barriers that may affect access to health care and the quality of care received, including the socioeconomic determinants that affect health and well-being. Cultural safety is defined by the experiences of patients, not caregivers. Originally conceptualized as a decolonizing model of health-care practice and policy for Indigenous peoples to challenge racism and establish trust in health-care encounters through dialogue, power sharing, negotiation, and acknowledging white privilege, cultural safety has evolved to encompass a broader definition of “culture” that includes ethnicity, age, sexual orientation, religious or spiritual beliefs, gender, and (dis)abilities. While cultural safety is increasingly considered a best practice in the care of vulnerable patients, much debate remains about what the concept entails, how it should be taught, and how to apply it in practice, as well as its relevance within various settings and contexts. This review aims to enhance readers’ understanding of cultural safety in health care by providing an overview of literature in this field. This is a relatively small body of literature, focused primarily on the Canadian, New Zealand, Australian, and American contexts, and much of it is relatively recent and not well known, perhaps signaling an increasing urgency to transform health-care systems to address persistent health inequities for vulnerable and marginalized populations in these places. The literature is categorized into three primary themes—Understanding Cultural Safety in Context, Cultural Safety Education and Training, and Application of Cultural Safety in Policy, Practice, and Other Settings—with further sub-themes.