Culture and Safety in Health Care

This article discusses the importance of culture and safety in health care, focusing on ACEM's position statement. It explores how effective communication and health literacy contribute to a culturally safe environment. The article also highlights ACEM's core values and discusses the barriers to implementing the position statement and how to overcome them.

Running Head: CULTURE AND SAFETY IN HEALTH CARE
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Culture and Safety in Health Care
Student’s Name
Institutional Affiliation

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Introduction
A position statement generally alludes to a goal or thesis about culture and safety in
healthcare. Therefore, there is need to provide arguments through literature to support a certain
perspective and certainly take a stand. Culture ideally refers to a shared belief system and values
of a certain person or population (Molloy &Grootjans, 2014). Essentially, it explains how
individuals constituting a certain group interact and live as a result of common experiences and
understanding. The Australian College for Emergency Medicine (ACEM), which is located in
Melbourne, will be utilized for the purpose of this paper. The organization is ideally a training
institution for specialist emergency clinicians from both New Zealand and Australia (AHPRA,
2012). In this paper, ACEM’s is discussed, while also focusing on how effective communication
and health literacy is applied within the organization to deliver culturally safe care.
Part One
Our Position
Located in Melbourne Australia, the Australasian College for Emergency Medicine
(ACEM) is an organization that is ideally concerned with offering training programs to
emergency physicians spread across New Zealand and Australia (Forero&Nugus, 2012).
 ACEM accepts the fact that people living in Australia and New Zealand should
enjoy the right to access healthcare that matches their desires and wants. Situated
in a society that is diverse, both linguistically and culturally, ACEM ensures that
cultural issues are embedded in nearly all levels of the organization.

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 The organization acknowledges that patients come from diverse cultures, and, as
such, this aspect will need to be factored in all emergency departments. Both
Australia and New Zealand are countries which are characterized by a profound
measure of cultural diversity (ACEM, 2019).
 Notwithstanding, there still exists linguistically and culturally diverse patients
who are at risk of being accorded health care services that are unsafe. Moreover,
these patient populations carry a higher risk of contracting various diseases. Such
patients include the Maori, Torres Islander, and the Aboriginal populations, most
of whom have no proper understanding of English.
 The ACEM acknowledges the fact that both Australia and New Zealand have
such kinds of patient populations who are often linguistically and culturally
distinct. Also, there are harmonies of experiences springing from colonization and
its subsequent implications. The profound health disparities synonymous with the
Aboriginal, Maori, and Torres Strait Islander populations are inseparably
connected to socioeconomic disadvantages, not to mention the intergenerational
trauma and the long-standing discrimination.
 The prime objective of cultural safety and competency in emergency rooms is to
guarantee quality health care along with the best results for all patients regardless
of their cultural affiliations.
 ACEM recognizes that a culturally safe organization, which aligns with the
patient’s culture, can enhance communication between patients and practitioners,
enhance the understanding of patients, reduce anxiety and fear among patients,

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ensure patient satisfaction, and improve clinical assessment practices (Chapman,
Martin & Smith, 2014). At the same time, culturally safe care can come in handy
in minimizing unwarranted investigations, improving the timeliness and precision
of diagnoses, improving treatment adherence, and increase attendance during the
follow-up exercise.
 ACEM generally believes that culturally safe and competent care can lessen
hesitancy to seek medical attention and also reduce rates of discharge contrary to
advise from practitioners (Allen, 2009).
 Overall, the organization holds and believes that culturally safe care translates to
enhanced patient wellbeing and improved clinical results. All patients, regardless
of their background or gender, are entitled to being provided with culturally safe
care devoid of racism or any other form of discrimination. As a 2008 endorsement
of the Australian Health Ministers, the Australian Charter of Health Care Rights
guarantees patients dignity, consideration, and respect (Keleher&Parker, 2013),
and the ACEM operates in accordance with this policy.
 ACEM is also dedicated to ensuring its trainees leave the organization equipped
with the ability to deliver culturally safe care.
 On the same line, ACEM advocates for the enactment of culturally safe
environments in both Australia and New Zealand.
ACEM’s Core Values
The organization’s core values are a list of principles that guide its operations, and
generally encompass how the organization operates to achieve its mission and vision of ensuring

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maintenance of quality standards when training emergency clinicians. The organization’s core
values include integrity, respect, equity, ethics, and collaboration, all of which help to foster a
culturally safe environment (Australasian College for Emergency Medicine, 2018).
Part Two
Why having such a statement is important
This position statement is essential in various ways. One of the ways through which this
statement is important is that it acts as a goal or thesis. This particular ACEM organization, for
instance, is committed to training clinicians who will ensure that all patients in the emergency
rooms receive justice in health care regardless of their cultural backgrounds. The rate of
migration is increasing by the day, and this is also the case with Australia. As a consequence,
patient populations are becoming more culturally diverse. Moreover, Australia is characterized
by populations from diverse cultural backgrounds including the Maori, Strait Islanders, and the
Aboriginal populations who do not have the ability to converse in English and have their unique
cultural inclinations. As a result, it follows that the essence of this ACEM, which generally
ensures the provision of culturally safe care, cannot be underestimated. The aspect of cultural
diversity embedded in the ACEM not only links to the nationality of a person, but also to their
social behaviours, belief systems, ideas, languages, and religious affiliation (Best, 2014; Laverty,
McDermott &Calma, 2017). With that in mind, provision of care can be pretty challenging in the
face of cultural diversity. However, with an evaluation of ACEM, clinicians are more cognizant
of the fact that the preferences of a patient are largely dictated by their culture, and thus the need
to offer the best possible care that aligns with the needs and preferences of the patient.
The Importance of Effective Communication in the provision of Culturally Safe Care

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It is widely assumed and believed that practitioners ought to have at least the basic
communication skills to ensure that they communicate in a manner that is culturally sensitive
(Betancourt, Corbett &Bondaryk, 2014). Communicating in a culturally sensitive manner not
only serves to validate respect and understanding for persons, but also ensures that the patient’s
family and the patient are satisfied (Claramita et al., 2016). Practitioners are able to recognize
patient needs at an individual level through both nonverbal and verbal communication methods.
However, it must be noted that conversing in a culturally sensitive fashion requires the clinician
to be well versed with the ideas, traditions, and ways of life of culturally diverse patients and
families (Douglas et al., 2011). Notably, in the presence of culturally insensitive communication
in a health care organization, patients and families will most probably express their
dissatisfaction with the manner in which they experience or perceive care. This is because there
is likely to be miscommunication, which eventually results in reduced adherence to care and
treatment, increased likelihood of adverse occurrences, and generally poorer health outcomes
(Paternotte et al., 2016). One important note is that the aspects that determine whether or not
communication is cultural sensitive varies among patient populations. Among other things, this
means that the patient, who is generally the care recipient, determines culturally sensitive
communication so as to ensure that the mode of communication applied is both holistic and
individualized, and, most importantly, it integrates the considerations and needs of the patient
(CATSINaM, 2016; CDNM, 2017).
The link between Health Literacy and Effective Communication
ACEM aligns with the fact that effective communication and health literacy between
patients and clinicians are essential in enhancing the quality of health care and the eventual

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outcome of the delivered care. While it is true that clinician-patient communication is an
essential embodiment of health care, a series of research studies have indicated that patients still
experience challenges in understanding and acting as per the instructions from the clinicians
(Koh et al., 2013; Schulz &Nakamoto, 2013). Often are the times when clinicians use advanced
medical terminologies in their communication or even deliver a bulk of information or
instructions without making a follow up to ascertain whether the patients understand all the
matters discussed. Eventually, patients end up understanding barely little of the information or
issues discussed. Poor health literacy is associated with communication gaps between the
patients and clinicians (Sørensen et al., 2012). On the same note, medical vocabularies and
concepts are less familiar among patient populations with poor health literacy. At certain
instances, these patients might opt to conceal their poor health care understanding due to
embarrassment, which will eventually translate to low patient outcomes.
External Influences
There are various external influences that may either promote or hinder a culturally safe
environment in a health care organization. First off, the role of the media in health care cannot be
overlooked. Not only can the media serve the worthy role of health education, but it can also
promote health in a multitude of ways (Moorhead et al., 2013). Due to its wide reach, the media
can serve to sensitive the clinicians and the health care organizations on the essence of offering
quality care regardless of the sex, gender, background, or religion of a patient. Ultimately, this
will reshape the behaviours and attitudes of people in a manner that promotes cultural safety in
health care organizations. Additionally, the history of the indigenous people, for instance, can be
viewed as a hindrance to fostering cultural safety primarily due to the fact that the indigenous

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people are associated with higher smoking rates due to colonialism. As most indigenous
populations consider smoking as part of their culture, clinicians might face challenges in offering
care that aligns with such a predisposition. Also, partly due to colonization, the indigenous/non-
indigenous health differential remains stubbornly high in Australia (O’Sullivan, 2012), which
augurs poorly in an organization’s endeavour to ensure cultural safety.
How the position statement improves health outcomes
As mentioned, ACEM significantly improves the health outcomes of patients. To begin
with, this statement particularly serves to empower both the patients and clinicians. This is
because ACEM places the responsibility of ensuring safe care on both the patients and clinicians.
Although ACEM primarily focuses on ensuring that patients receive the best quality of care, it
has seemingly expanded to include a wide range of cultural aspects synonymous with individuals
from diverse cultures. It places great importance on identifying and assessing the beliefs and
ideas of patients, while also acknowledging the implications of the same on other associated
parties (Baba, 2013). Maintaining an environment that is reflective of understanding and justice
towards the patients regardless of their backgrounds is one of the prime components of
competent health care. Most importantly, ACEM puts the safety and quality of care accorded to
patients above everything else.
Barriers to implementing this position statement and how to overcome them
ACEM serves to assist practitioners to make good decisions about health care and also
act in a culturally sensitive manner. Just like other clinical guidelines, ACEM may be ignored by
the clinicians. Also, there are various organizational challenges that may derail the
implementation of goals about culture and safety in ACEM, which includes poor team

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coordination and vagueness in the definition of roles. Research indicates that poor understanding
of one’s professional roles could put patient safety at risk (Doyle, Lennox & Bell, 2013).
Additionally, achieving a culturally safe health care environment requires participation from all
the departments of the organization including the management, staff, and so forth. Ideally, there
exist great challenges in synchronizing these different groups of the organization to work in a
united fashion for the sake of implementing culture and safety in ACEM. These barriers can,
however, be removed through training all the involved parties on the essence of the ACEM and
the importance of ensuring a culturally safe health care environment in general.
Conclusion
In summary, this paper focuses on the position statement of ACEM. It also outlines how
effective communication and health literacy play part in the realization of a culturally safe
organization. Effective communication, along with good health literacy, has over the years been
subject of a series of research studies. It has been established that they both results in better
health outcomes, which is characteristic of a culturally safe environment. The barriers to
implementing such a position statement and the most viable solutions to break these barriers are
also discussed.

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References
ACEM.(2019). Indigenous Health and Cultural Competency Program. Retrieved from
https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Cultural-
competency/Indigenous-Health-and-Cultural-Competency.aspx
AHPRA (2012).Consultation Submission.Consultation paper on International Criminal History
Checks.ACEM. Available at https://www.ahpra.gov.au/search.aspx?
profile=ahpra&query=%27standards+for+specialist+registration+and+endorsement
%27&collection=ahpra-websites-web&f.Content+type
%7Ccontent=consultation+submission
Allen, S. (2009). Developing a safety culture: the unintended consequence of a'one size fits
all'policy (Doctoral dissertation).
Australasian College for Emergency Medicine (2018).Core Values. Draft for Consultation.
Available at https://acem.org.au/getmedia/c9cc02f6-0e94-48f8-9d49-56bd9b9e6eb2/
ACE_Core-values-document_06
Baba, L. (2013).Cultural safety in First Nations, Inuit and Métis public health: Environmental
scan of cultural competency and safety in education, training and health services. Prince
George, British Columbia, Canada: National Collaborating Centre for Aboriginal Health.
Best, O. (2014). The cultural safety journey: an Australian nursing context. Yatdjuligin:
Aboriginal and Torres Strait Islander nursing and midwifery care, 1st edn, Cambridge
University Press, Port Melbourne, VIC, 51-73.

CULTURE AND SAFETY IN HEALTH CARE
11
Betancourt, J. R., Corbett, J., &Bondaryk, M. R. (2014). Addressing disparities and achieving
equity: cultural competence, ethics, and health-care transformation. Chest, 145(1), 143-
148.
CATSINaM, (2016).Congress of ToressStraight Islander Nurses and Midwives
(CATSINaM).Cultural safety in policy and practice seminar: Summary and implications.
Available at https://www.catsinam.org.au/communications/resources
CDNM, (2017).Council of Deans of Nursing and Midwifery (CDNM).Cultural safety in
education, practice and research.Available at http://www.cdnm.edu.au/assets/cultural-
safety-final-position-paper.pdf
Chapman, R., Martin, C., & Smith, T. (2014).Evaluation of staff cultural awareness before and
after attending cultural awareness training in an Australian emergency
department.International emergency nursing, 22(4), 179-184.
Claramita, M., Tuah, R., Riskione, P., Prabandari, Y. S., & Effendy, C. (2016).Comparison of
communication skills between trained and untrained students using a culturally sensitive
nurse–client communication guideline in Indonesia.Nurse education today, 36, 236-241.
Douglas, M. K., Pierce, J. U., Rosenkoetter, M., Pacquiao, D., Callister, L. C., Hattar-Pollara,
M., ...& Purnell, L. (2011). Standards of practice for culturally competent nursing care:
2011 update. Journal of Transcultural Nursing, 22(4), 317-333.
Doyle, C., Lennox, L., & Bell, D. (2013).A systematic review of evidence on the links between
patient experience and clinical safety and effectiveness.BMJ open, 3(1), e001570.
Forero, R., &Nugus, P. (2012). Australasian College for Emergency Medicine (ACEM) literature
review on the Australasian triage scale (ATS). Institute of Health Innovation.

CULTURE AND SAFETY IN HEALTH CARE
12
Keleher, H., & Parker, R. (2013). Health promotion by primary care nurses in Australian general
practice. Collegian, 20(4), 215-221.
Koh, H. K., Brach, C., Harris, L. M., &Parchman, M. L. (2013). A proposed ‘health literate care
model’would constitute a systems approach to improving patients’ engagement in care.
Health Affairs, 32(2), 357-367.
Laverty, M., McDermott, D. R., &Calma, T. (2017).Embedding cultural safety in Australia’s
main health care standards.The Medical journal of Australia, 207(1), 15-16.
Molloy, L., &Grootjans, J. (2014). The ideas of frantz fanon and culturally safe practices for
aboriginal and torres strait islander people in Australia. Issues in mental health nursing,
35(3), 207-211.
Moorhead, S. A., Hazlett, D. E., Harrison, L., Carroll, J. K., Irwin, A., &Hoving, C. (2013). A
new dimension of health care: systematic review of the uses, benefits, and limitations of
social media for health communication. Journal of medical Internet research, 15(4), e85.
O’Sullivan, D. (2012). Justice, culture and the political determinants of indigenous Australian
health.Ethnicities, 12(6), 687-705.
Paternotte, E., Scheele, F., Seeleman, C. M., Bank, L., Scherpbier, A. J., & van Dulmen, S.
(2016). Intercultural doctor-patient communication in daily outpatient care: relevant
communication skills. Perspectives on medical education, 5(5), 268-275.
Schulz, P. J., &Nakamoto, K. (2013). Health literacy and patient empowerment in health
communication: the importance of separating conjoined twins. Patient education and
counseling, 90(1), 4-11.

CULTURE AND SAFETY IN HEALTH CARE
13
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H.
(2012). Health literacy and public health: a systematic review and integration of
definitions and models. BMC public health, 12(1), 80.