Cultural Safety in Healthcare for Aboriginal and Torres Strait Islander People

This article discusses the cultural factors that affect healthcare for Aboriginal and Torres Strait Islander people, including issues with time, language, and shame. It also explores the importance of cultural safety and how healthcare professionals can develop effective partnerships with patients. The article includes information on the National Aboriginal and Torres Strait Islander Health Workers Association's cultural safety framework.

Running head: QUESTIONS AND ANSWERS
QUESTIONS AND ANSWERS
Name of the student:
Name of the university:
Author note:

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QUESTIONS AND ANSWERS
Question 1:
1.1.1
Aboriginals and the Torres Islanders follow cultural factors that are quite different from
that of the cultural traditions followed by the non-natives of the nation of Australia. One of the
most important cultural issues is the concept of time. Often it is seen that the Aboriginal’s
observance of time as well as measurement sometimes become a source of conflict when the
healthcare professionals try to provide care to the people (Shepherd et al. 2016). Time is rigid for
the non-natives and they are very particular about the time of appointments with patients. On the
other hand, native people provide more importance to kin and relationships and often may turn
up late, as they do not follow structured time and schedules. They call this koori time and hence
it may become a source of conflict. Another important issue is their concept of maintaining
silence. Often their culture supports them to maintain silence in the midst of the interactions or
discussions. They consider this as a norm to provide respect and values. However, non-natives
may misinterpret it with lack of understanding of the natives and many try to fill up the gaps.
This may result in conflict and disappointment among the natives and non-native people.
Question 2:
One of the biggest issues that may influence relationships development and communication
among the natives and non-natives is the language barriers. The English language that is used by
the Aboriginal and Torres Strait Islander people is quite different from the Standard Australian
English. Therefore, even if they speak in English, there might raise many issues where if the
healthcare professionals follow their real meaning of the words, then they may misunderstand

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what the native people really wanted to mean and express. This can be explained with the help of
examples. When the Aboriginal and Torres Strait Islander people say, “your treatment was
deadly”, they actually mean that the treatment was fantastic as according to them, deadly means
great, awesome or fantastic (Couzos et al. 2016). If they state, “my dubbay is goomi”, what they
actually mean is “my girlfriend is alcoholic. Therefore, professionals need to be knowledgeable
about their language to avoid any issues and misunderstanding. Another issue is that the
Aboriginal and Torres Strait Islander people has a very different concept of shame in comparison
to that of the non-native people. Often, during primary healthcare treatment, it is seen that
healthcare professionals need to be well aware of different personal information and habits in
order to provide proper recommendations. While the non-native patients are quite outspoken
about such facts, the Aboriginal and Torres Strait Islander people suffer from the feeling of
shame while sharing private and personal information, cultural beliefs and others. This may also
create issues as the healthcare professionals may fail to provide a comprehensive care plan to
help them overcome their disorders.
Question 3:
Cultural safety can be defined as the aspect of being acceptable to various differences
along with possessing the ability for analyzing the power imbalances, colonization, institutional
discriminations and different relationships with settlers. Researchers are of the opinion that
cultural safety is mainly about providing of quality healthcare that aligns successfully with the
familiar cultural values as well as norms of the persons who are accessing the service that differ
from the dominant culture or the culture of the providers (Raman et al. 2017). Cultural safety in
the workplace can be developed by planning for cultural safety training which would mainly aim
at the enhancement of the capacity of the health sector for improvement of program policy

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QUESTIONS AND ANSWERS
designs. Moreover, it would be also aimed at the making the employees culturally competent by
helping them to develop knowledge abut cultural traditions, inhibitions and preferences of the
Aboriginal and Torres Strait Islander people and thereby developing skills and cultural
sensitivity and cultural respect to ensure satisfaction for the native people. This will help in
development of strong relationships among the native patients and healthcare professionals that
would ensure better health of the Aboriginal and Torres Strait Islander people.
Question 4:
The healthcare professionals of the present organizations follow a number of interventions to
ensure cultural safety in the workplace. The first important aspect is maintaining of the protocols.
Professionals show respect to the native people, ask for informed consent, ask questions to seek
for cultural knowledge, demonstrate reciprocity and engages in community accompaniment.
However, the organizational culture still needs to provide more effort to make the healthcare
professionals to develop cultural awareness and cultural knowledge on their own terms by going
through evidence based articles, internet websites and many others (Brown et al. 2017). The
organization should try to encourage employees to develop the skills and personal knowledge
and such encouragement will help individuals to be more efficient. The third important aspect
that is well followed in the organization is the culture of effective partnership. The employees
ensure to promote the collaborative practice where Aboriginal and Torres Strait Islander people
seeking for help are welcomed to a joint problem solving approach and treat them as carriers if
important information and are respected entirely making them the centre of the decision making
procedures. The fourth aspect is following of the proper process that engage in mutual learning,
frequent evaluation to check that proposed programs are working well and aligning with the
recipient’s values, preferences, and lifestyles. The last aspect is positive purpose that are built on

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QUESTIONS AND ANSWERS
achieving the service recipient’s goals by building on strength, ensuring confidentiality and
causing no harm to patients culturally, mentally and physically.
Question 5:
Cultural biasness can be defined as the phenomenon for interpreting as well as judging different
phenomena by the standards that are inherent to one’s own culture. It is mainly the interpretation
of another phenomenon that remains based on own cultural standards. I am from a non-native
background and I never got the cope to mingle and be friends with any Aboriginal and Torres
Strait Islander people. Therefore, I was not aware whether I had any cultural biasness towards
them. After going through the courses to be culturally competent, I thought that I have developed
the ability to overcome such biasness and provide culturally safe practices to them. It was only
after several interactions with such patients, several complaints were lodged against me (Cox
2016). I realized that I had a feeling that they were illiterate and had not health literacy and
therefore my interaction made them feel humiliated making them feel inferior. I realized that in
order to be extra careful, I have behaved and communicated accordingly with their preferred
cultural norms but somehow my inner thoughts about the, being illiterate was reflected in my
communication with the patient. This is an example of cultural biasness where I thought that
since they are Aboriginal and Torres Strait Islander people, they have no health literacy. I need to
change such aspect of my communication procedure to make them feel respected.
Question 6:
Intercultural communication and being culturally aware of the people coming from different
backgrounds are extremely important to maintain effective teamwork. Collaboration can only be
ensured only when all the people working together are aware of each other’s cultural norms.

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QUESTIONS AND ANSWERS
Preferences and inhibitions and thereby respect the aspects to ensure effective bonding. When
the employees feel that their organization as well as their colleagues is respectful to each other’s,
they will be able to develop better bonds and this will help them to be emotionally dependent on
each other (Mercer et al. 2014). Deep bonds help in development of trust among the people
coming from different cultures and therefore, productivity of the team would be higher. Better
the cultural awareness of different colleagues, better will be their knowledge regarding the
cultural preferences and inhibitions of employees from various backgrounds and hence they will
be able to work collaboratively without creating any conflicts and issues.
Question 7:
In order to provide culturally competent care and ensure cultural respect in the practices
of the healthcare professionals to the Aboriginal and Torres Strait Islander people, several norms
are followed. One of the most important is eye contact. One of the norms is that Aboriginal and
Torres Strait Islander people do not prefer eye contact when they interact with others. It is
customarily considered as a gesture for respect. In the western culture, such gesture can be taken
as being dishonest, rude as well as showing lack of interest. Therefore, healthcare professionals
who maintain eye contact with Aboriginal and Torres Strait Islander people may make them feel
uncomfortable and disrespectful. Therefore, I tend to follow this norm and never communicate
with them with direct eye contact. Another important norm that is also followed is the
questioning procedures (Wain et al. 2016). It is mainly seen that the Aboriginal and Torres Strait
Islander people prefer the indirect questioning. Therefore, if the non-native professionals
maintain direct questioning, it may lead to the creation of misunderstandings thereby
discouraging participations. This may make it difficult for the professional to get important
information mainly in cases when the patients are communication in the non-standards English.

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Still, professionals should utilize indirect and round about approaches to ask questions to the
patients to ensure that they are providing cultural respect while caring for them.
Question 8:
A cultural broker can be defined as the person from the Aboriginal and Torres Strait
Islander people group as well as a professional who has developed an understanding of the
worldviews and cultural values, practices and beliefs of both parties. One of the most important
issues that are faced by the professionals is the language barriers. However, many of the
Aboriginal and Torres Strait Islander people are nowadays been able to understand English and
can also speak in non-standard Australian English which are understandable to a certain extent
by the professionals. This is not the case of the elderly persons of the community. They are not at
all knowledgeable about the English language (Durey et al. 2017). They do not prefer
disrespecting their culture by communication in a language that is not their mother tongue. In
this situation, one can never force the elderly patients of the community to speak in English and
on the other hand, they cannot understand what the native elders say to them. Therefore, in such
situation cultural brokers of native colleagues or interpreters need to be summoned for clearly
understanding the demands and needs of the patients and thereby providing care that aligns with
their cultural norms.
Question 9:
One of the best ways by which healthcare professionals can develop effective partnerships with
the Aboriginal and Torres Strait Islander people is by building rapport. Researchers are of the
opinion in many traditional cultures like that of the Aboriginal and Torres Strait Islander people,
a high sense of value id put on the development and maintenance of relationships. “Taking a

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QUESTIONS AND ANSWERS
business” approach will help the professionals to make the patients feel satisfied and comfortable
and this will in turn ensure formation of rapport and building of relationships. Thereby
developing rapport with the patients is the best way to make them participative about their own
decision-making in their treatment. Another important procedure is to make them feel respected
showing that their autonomy and dignity is respected through the maintenance of the bioethics of
“justice”. When the Aboriginal and Torres Strait Islander people will see that fairness,
entitlement and equality are maintained, they would feel comfortable and satisfied seeing that the
professionals are genuinely respecting their culture (Freeman et al. 2014). Ensuring fair
distribution of resources, respecting their rights and respecting their morally acceptable laws
would help the professionals to gain trust and this will make them collaborative and participative
in the care processes.
Question 10:
In order to develop effective partnerships with the Aboriginal and Torres Strait Islander people,
it is extremely important for the professionals to develop rapport and strong relationships with
them. These should be based on development of strong bonds and trust. The patients will gain
trust on professionals when they see that the professionals care for their cultural traditions,
norms, preferences and inhbtions and they are included in decision-making. For these, they have
to be culturally competent and develop cultural awareness and cultural knowledge. Therefore, it
becomes extremely important to have resources that provide them with such knowledge.
Effective evidence based journal articles with high level of evidences along with different
interest articles discussing about different aspects of cultural norms of the native people are the
best resources (Hart et al. 2015). Besides, effective training sessions for development of
culturally competent skills and verbal and non-verbal communication is also required. Therefore,

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QUESTIONS AND ANSWERS
when such resources are easily available, the professional can make themselves competent and
hence can successfully encourage Aboriginal and Torres Strait Islander people in effective
collaborative sessions helping them to provide person centered care.
Questions 11:
National Aboriginal and Torres Strait Islander Health Workers Association also called
the NATSIHWA have developed their cultural safety framework in the year 2013. This
framework was developed to increase the capability within the healthcare systems for delivering
effectively the culturally safe as well as the responsive health and well being services for
Aboriginal and Torres Strait Islander people. The PDF document comprises of eight important
domains which when followed sincerely by the healthcare workers, recorded, and documented
accordingly will help to ensure development of a culture of safety within the workplace. The
domains according to increasing orders are country and community, understanding local cultural
contextuality, recognizing & valuing the role of Aboriginal and Torres Strait Islander health
workers, individual domains, systemic reflection, equity and sustainability, collaboration and
cooperation followed by monitoring and evaluation (Laverty et al. 2017). I would be mainly
taking the role of monitoring and evaluation to check whether documentation of the case of
patients, reporting of errors, improper service delivery, poor cultural practice knowledge and
others are conducted effectively or not. Following this, I would be preparing a report from the
documentation that would mainly be containing the needs and requirements of the professionals
to ensure cultural safety in workplace.

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QUESTIONS AND ANSWERS
Question 12:
The term self-determination can be defined as the process and the collective rights that are
exercised by the Aboriginal and Torres Strait Islander people. Researchers are of the opinion that
by the term right to self-determination means right to take decisions and the practical exercise of
self-determination is central to the aboriginal health. Aboriginal self-determination as well as
responsibility is mainly seen to lie at the heart of the Aboriginal and Torres Strait Islander people
community control in the provision of primary healthcare services. Researchers are of the
opinion that meaningful self-determination in the shape and form of the greater individual as
well as communal life control is the contributing factors to improved levels of physical and
mental health of the Aboriginal and Torres Strait Islander people (Hunt et al. 2015). Again,
control and dominations by others in such aspect may lead to ill health and elevated levels of
mortality in the indigenous communities. Therefore, to make them more expressive and allowing
those to reveal their needs, the main resources that are required by healthcare professionals are
community engagement. To develop community engagement, healthcare professionals can
engage in health promotion campaigns that will follow the five priority areas of the Ottawa
charter. The main resources required are allocation of funds for arranging the discussion
sessions, development of primary care services and engaging them effectively through health
literacy sessions. Human resources are also required for proper health promotion program plans.
Besides, pamphlets with pictures, brochures and others would be provided which would help in
developing their knowledge about health issues and help to get access to healthcare services
when required. Proper training would be given to professionals to ensure success of the health
promotion programs and effective discussion sessions.

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QUESTIONS AND ANSWERS
Questions 13:
After implementing of the different interventions for the development of cultural safety, it is
extremely important to evaluate the outcomes. This is important to find out whether the
outcomes that are developed are bringing out positive results and helping to achieve the goals or
not. Therefore, seeking agreement is extremely important from experienced and knowledgeable
stakeholders to find out that the proposed interventions would bring out positive outcomes or
not. Therefore, in order to ensure success of the outcomes, two important people should be
included. This would be the elder head of the community of the Aboriginal and Torres Strait
Islander people who would be mainly examining that the interventions are at par with their
cultural traditions and norms (McKenzie and Brown 2017). This would help to modify
accordingly if any mistakes are made and the outcomes would be successful. Secondly, another
culturally competent stalwart healthcare professional should be consulted. Such professional had
high level of experiences and he will be able to judge the effectiveness of the interventions and at
the same time can detail out the success rate and maintenance of cultural competency.
Question 14:
Aboriginal and Torres Strait Islander people are highly sensitive to their culture and want
that non-native people provide them their right to self-determinations and treat them with justice
and respect. In such situations, in order to involve them in decision-making, evaluation and
negotiations, first rapport should be built with them ensuring that they start trusting the
professionals and develops a bond with them (Townsend et al. 2018). Therefore, my first motive
is to engage them in culturally competent effective communication and then develop a

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therapeutic relationship with them based of values of empathy, compassion and trusts. The elders
and other members of the family would be requested to put forwards their needs and demands
and also clarify the cultural preferences and inhibitions .making them involved in decision
making and putting them in the central part of the care interventions maintaining their
uniqueness and cultural respect would help them to feel that professionals care for them
genuinely. These will make them feel more involved in every step of the care services.
Question 15:
The best way to evaluate the programs and services is to take interviews of the
Aboriginal and Torres Strait Islander people and their communities and trying to know how they
are perceiving the new approaches that are involved in the programs. Both broad question
interviews and short question surveys would be conducted. Broad questions interviews would
ensure that the healthcare professionals become well aware of the quality of the services that are
provided, how satisfied the patients are, the services that need to be altered and modified, the
services that are still required and others (Smith et al. 2015). The questionnaire-based survey
would help to understand the extent of the services, how many people are satisfied, how many
people are dissatisfied, number of people who wants more services, the quality of care provided
by professionals and many others. All these would ensure effective evaluations of the programs
and services.
Question 16:
The statistical data that would be provided from the questionnaire-based interviews
would help me to understand the success rates of the programs and services. Those services that
have high success rtaes would be kept and those who have low success rates should be altered

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and modified with the help of the information of the broad ended interviews. With these
information and suggestions of elders of the Aboriginal and Torres Strait Islander people and
community and stalwarts professionals in healthcare, new evidences would be search and
accordingly new interventions, programs and services would be provided (Phillips 2015).

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References:
Brown, A.E., Middleton, P.F., Fereday, J.A. and Pincombe, J.I., 2016. Cultural safety and
midwifery care for Aboriginal women–A phenomenological study. Women and Birth, 29(2),
pp.196-202.
Couzos, S. and Thiele, D.D., 2016. Aboriginal peoples participation in their health care: A
patient right and an obligation for health care providers. Aboriginal and Islander Health Worker
Journal, 40, p.6.
Cox, L.G., 2016. Social change and social justice: cultural safety as a vehicle for nurse activism,
presented at 2nd International Critical Perspectives in Nursing and Healthcare, Sydney Nursing
School, Sydney Australia. October 31st-November 2nd.
Durey, A., Halkett, G., Berg, M., Lester, L. and Kickett, M., 2017. Does one workshop on
respecting cultural differences increase health professionals’ confidence to improve the care of
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Hunt, L., Ramjan, L., McDonald, G., Koch, J., Baird, D. and Salamonson, Y., 2015. Nursing
students' perspectives of the health and healthcare issues of Australian Indigenous people. Nurse
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