Cultural Competence in Nursing: A Review

This assignment reviews the concept of cultural competence in nursing, highlighting its significance in providing high-quality patient care. It examines the benefits of cultural competence, including improved health outcomes, increased patient satisfaction, and enhanced nurse-patient relationships. The challenges of implementing cultural competence in nursing practice are also discussed, including the need for education and training, as well as the importance of addressing systemic inequalities. The assignment concludes by emphasizing the need for nurses to be culturally competent in order to provide safe and effective care for patients from diverse backgrounds.

Running head: CULTURAL SAFETY
Cultural safety
Name of the Student
Name of the University
Author note

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Step 1
a) Personal racism is defined as racist beliefs, assumptions or behaviours of an individual
or racial discrimination that stems from personal prejudice or unconscious and conscious.
This kind of prejudice is learned from or connected to broader economic processes or
histories that are reinforced, supported by institutional or systemic racism. On a contrary,
systemic racism comprises of practices and policies entrenched in institutions that result
in exclusion of a particular community. From an anti-racist perspective, there is
prevalence of prejudice and racism in the society that is depicted by the media (Van Dijk,
2015, pp.5).
Both types of racism tend to discriminate individuals, however have some
differences. In individual racism, a person is abused against his or her race, age, gender
or ethnicity. On a contrary, when a certain rule or culture that has been created is racist
towards a particular group of people. Individual racism can lead to institutional racism;
however, the opposite is not possible. The reason is that institutional racism comes from
an individual that formulate into an institution. For example, when an individual tends to
treat another one unequally, it is individual racism that is opposed by institutional racism
where a policy tends to treat individuals of a certain community unequally. Therefore,
racism is an accusation that threatens the diversity in the society through iinstitutional
racism (Ahmed, 2012, pp. 146).
b) ‘Whiteness in nursing’ refers to those dimensions of racism where it serves for the
elevation of white nurses over nurses of colour. Since 1990s, nursing is challenged,
exposed to institutionalized systems where whites are dominant and gain privilege.

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Instead of racist education, the nursing training and course should focus on ’cultural
competence’ where it usually disagrees institutionalized structures of white racism and
privilege. In context to power dynamics, it can be explained in a way where nursing
students are engaged in a class that is focused on social and political power of whiteness
in the nursing profession. The strength of whiteness as identity is determined by privilege
and historical power given to the white society and numerical minority results in less
power and subjected to more discrimination and racially designated (Nielsen, Alice Stuart
& Gorman, 2014, pp. 192).
c) Cultural awareness training refers to the activities in general practice that is aimed at
improving the health of a particular culture by enhancing the cultural awareness of the
healthcare professionals, nurses, primary healthcare staffs and medical students. In this
training, the professionals are taught about the history and culture of a particular
community (example-Aboriginals), they explore how values and attitudes influence
assumptions, perceptions and behaviours in the clinical setting and ways in which they
can be more culturally aware of the service users. Cultural competency is one of the
major disciplines in the nursing curriculum that is required for assessing cultural
awareness, skills, knowledge and comfort that strengthens nursing profession (Mareno &
Hart, 2014, pp. 83). On a contrary, cultural safety training can be referred to as removal
of power indifference through acknowledgement of differences, developing cultural
sensitivity, recognition of difference and respecting it, understanding of cultural norms
and values of the minority groups, empathetic and collaborative relationships. In addition,
self-reflection help the healthcare professionals to gain the capability to understand
others’ feelings and emotions which in turn is helpful in establishing a therapeutic

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relationship with clients that lead to better health outcomes. Cultural safety also
incorporates social justice and advocacy on behalf of minority communities. Nursing
profession is an art as well as science that have the primary responsibility to provide
effective, comprehensive, holistic and culturally appropriate caring towards the patients
under their provision of care (Montenery et al. 2013, pp. e52).
Step 2
During my clinical placement, an Aboriginal patient was admitted to the ward following
a suicidal attempt. I was assigned to interact with the patient to know about his problems. At first
instance, I was very nervous and unable to initiate the conversation. He was unable to explain his
feelings due to limited English proficiency. As I never interacted with any patient from ethnic
background, I hesitated to ask him any sort of questions. In this situation, I realized that I should
develop cultural awareness and sensitivity towards clients from other ethnic backgrounds.
Step 3
Three key factors explore concepts of Aboriginals wellbeing in regards to access to
healthcare, employment and education. The impact of European colonization, the influence of
cultural and geographical dimensions on individuals and their communities and historical
barriers are the factors that given clear picture of their physical and mental health status. After
the European colonization, the population declined and in 1920s, there were only 60,000
Aboriginals had reaching effects. They were forced to move off their traditional lands and away
from active hunter-gatherer lifestyle. Many of them were unable to resist this seizure of lands
that resulted in violence. Majority of them died from infectious diseases that were brought by
Europeans. After this shift, they moved to lands where they were unable to speak their native

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language or perform their cultural practices. Later, many laws and policies were enacted that
forced them to segregate from the other Australians and they were left with no or little self-
determination. The institutional racism forcibly made Aboriginal children to separate from their
families and foster families from European background. They suffered from sexual or physical
abuse raised by institutional racism as they lived in poverty or servitude as domestic workers or
labourers. Therefore, it is evident that Australian history of European colonization is the
indicator of health status of the people driven by political, colonial and economic histories
(Sherwood, 2013, pp. 28).
The Aboriginals lost their cultural identity and language due to colonization as they were
expected to adopt the European culture. They were forced to adopt European language, dress,
lifestyle, religion and cultural values. Even the separated children were not allowed to contact or
reunite with their families. These historical factors like European colonization, cultural
displacement, family disruption and discrimination stemming from institutional racism
contributed to high incidence of unemployment, poverty and poor health among the Aboriginals.
In the current Australian healthcare scenario, Aboriginals continue to experience discrimination,
institutional racism and social disadvantage. In the context to access to healthcare, Aboriginals
find it difficult to access healthcare services due to lack of culturally appropriate treatment
options, as they consider health not only physical, but also emotional, social and spiritual
wellbeing. The European colonization, the colonists invaded the Aboriginal lands and as a result,
they got detached from their traditional lands resulted in the loss of their sense of cultural
identity (Loos, 2017, pp. xvii).
According to Gidden’s theory of structuration, there is high rate of unemployment among
them between the ages of 15 to 64 years as compared to non-indigenous population due to

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geographic isolation, social structures and power relations (Bourke et al., 2012, pp. 498). There
is low attainment of education among the Aboriginals as compared to the non-indigenous
population. The Australian Cultural Respect Framework for Aboriginal and Torres Strait
Islander Health 2004-2009 work together to provide education to Aboriginals that underpins
cultural respect (Freeman et al., 2014, pp. 356). About 60% of Aboriginals are unable to start
their Year one and stays behind non-Aboriginals. Due to institutional discrimination, Aboriginals
are unable to attend classes and as a result, have low rates of attendance and unable to focus on
their study. According to Department of the Prime Minister and Cabinet, Australian
Government, Aboriginals are the most disadvantaged population that has reduced access to
healthcare services, employment, education and housing contributing to poor physical and
mental health. As a result, they are exposed to risk factors like stress affecting their wellbeing
and primary care services need to recognize this stress and provide culturally sensitive healthcare
services (Durey, Thompson & Wood, 2012, pp. 20).
Step 4
The mainstream healthcare services in Australia are unable to meet the needs of
Aboriginals as they lack cultural appropriateness, despite of the fact that many policies are
developed for promoting positive healthcare service delivery. In the light of this situation, the
nurses need to understand cultural safety and develop awareness that links power imbalance and
equitable social relationships in the Australian healthcare scenario. Through cultural safety
training, nurses can understand the power differentials exiting in the healthcare and redress these
inequalities through safe nursing practice. Through the lens of cultural safety, nurses can address
the inequalities by critical reflection framework (Gerlach, 2012, pp. 153).

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The core competencies for culturally safe nursing comprises of post-colonial
understanding, inclusivity, communication, respect, cultural awareness and indigenous
knowledge and promoting cultural safety can be helpful in challenging the institutional racism
against Aboriginals. The nurses need to understand that European colonization affected the lives
of Aboriginals by examining the relationship between historic trauma and poor health outcomes.
Communication is the cornerstone for culturally safe nursing practice because language is the
main barrier to cultural safety. Through effective and safe communication, nurses can help to
make the Aboriginals feel respected and valued in the healthcare institution. The cultural
awareness and insights into culture of Aboriginals can be helpful in promoting culturally
appropriate and safe practices for them as outlined by The National Aboriginal Health
Organization (NAHO) (Baba, 2013, pp. 8).
Respect acts as the main guiding principle for the Aboriginal health, their identity and
uniqueness. The effective communication and collaboration with the Aboriginals can be helpful
in improving their health status. Among all, the nurses need to be aware of the indigenous
knowledge like cultural, emotional and spiritual practices that can be helpful in understanding
the Aboriginal perceptions, values and factors that is related to their health, wellbeing and
healing. In addition, they also need to understand the linguistic strategy of orientation
questioning (Eades, 2013, pp. 73).
Step 5
a) Reporting: During my clinical placement, many indigenous patients were admitted for
chronic illness. When I approached them, they were unable to explain their problems. I
was not able to understand the cause of their grimacing pain and health complications.

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Due to language disparity, I was unable to understand their concerns and failed to
develop proper care plan for them.
Responding: During this situation, I was very nervous and unable to understand their
language so that I can develop proper interventions for them. I was feeling hesitated and
helpless, as I was unable to understand the cause of their pain and question them about
their health status. I was feeling disappointed and disheartened as I failed to interact with
them in understanding their situation.
Relating: After the situation, I felt that there is lack of cultural awareness in me that
aggravated their health condition. Language is the biggest barrier while communicating
with the patients from other cultural backgrounds. One needs to be culturally aware and
competent towards the individuals from other cultural backgrounds so that they feel
respected, valued and included (Herring et al., 2013, pp. 106).
Reasoning: The main issue in this situation was lack of cultural appropriateness and
ability to interact with people having limited English proficiency. The main factor that is
significant to this situation is cultural safety and overcoming significant language barrier.
A culturally safe nursing practice is required towards Aboriginals to promote their health
and wellbeing.
Reconstructing: Considering this situation, I need to develop an action plan if I
encounter such situations in my nursing profession.
Cultural safety, communication and skill development are the vital components that can
ensure cultural safe nursing practice for the Aboriginals. Making cultural connections
with the Aboriginals is important and as a nurse, I need to provide a socially, spiritually
and respectful environment for them so that they feel included. The culturally safe

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practices like meeting their expectations, preferences and rights so that they feel
empowered can be helpful in delivering culturally safe treatment. I need to not only focus
on my culture, but also consider their cultural dimensions by being flexible and open-
minded in order to provide the best conditions for patients as per the Nightingale theorist
(Nettina, Msn & Nettina, 2013, pp. 2). Non-verbal communication can be essential like
touch, body language and silence can be helpful in establishing a therapeutic relationship
with them where English is limited. The skill of active listening, establishing clear and
respectful communication, developing trust, sharing knowledge and feedback with proper
understanding of their culture can be helpful in providing a culturally safe environment
for them. The Purnell Model for Cultural Competence outlines the adaption of cultural
competency by healthcare professionals (Purnell, 2012, pp. 3). Therefore, through
effective and culturally appropriate communication and practices, Aboriginals can
enhance access to healthcare that promotes their health and wellbeing.

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